Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA PX LUMBAR REGION LUMBAR SYMPATHECTOMY

Professional

Both

$7.00

Service Code	HCPCS 00632
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANESTHESIA PX MAJOR LOWER ABDOMINAL VESSELS NOS

Professional

Both

$15.00

Service Code	HCPCS 00880
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANESTHESIA PX MALE GENITALIA NOS

Professional

Both

$3.00

Service Code	HCPCS 00920
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTHESIA PX MALE GENITALIA SEMINAL VESICLES

Professional

Both

$6.00

Service Code	HCPCS 00922
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANESTHESIA PX ON EYE CORNEAL TRANSPLANT

Professional

Both

$6.00

Service Code	HCPCS 00144
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANESTHESIA PX ON EYE IRIDECTOMY

Professional

Both

$4.00

Service Code	HCPCS 00147
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA PX ON EYE LENS SURGERY

Professional

Both

$4.00

Service Code	HCPCS 00142
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA PX ON EYE NOT OTHERWISE SPECIFIED

Professional

Both

$5.00

Service Code	HCPCS 00140
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTHESIA PX ON EYE OPHTHALMOSCOPY

Professional

Both

$4.00

Service Code	HCPCS 00148
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA PX ON EYE VITREORETINAL SURGERY

Professional

Both

$6.00

Service Code	HCPCS 00145
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANESTHESIA PX ON FACIAL BONES OR SKULL NOS

Professional

Both

$5.00

Service Code	HCPCS 00190
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTHESIA PX ON NOSE & ACCESSORY SINUSES NOS

Professional

Both

$5.00

Service Code	HCPCS 00160
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTHESIA PX ON SALIVARY GLANDS WITH BIOPSY

Professional

Both

$5.00

Service Code	HCPCS 00100
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTHESIA PX THORACIC SPINE & CORD NOS

Professional

Both

$10.00

Service Code	HCPCS 00620
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANESTHESIA PX UPPER ANTERIOR ABDOMINAL WALL NOS

Professional

Both

$4.00

Service Code	HCPCS 00700
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA PX UPPER POSTERIOR ABDOMINAL WALL

Professional

Both

$5.00

Service Code	HCPCS 00730
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTHESIA PX VEINS FOREARM WRIST&HAND NOS

Professional

Both

$3.00

Service Code	HCPCS 01850
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTHESIA PX VEINS KNEE & POPLITEAL AREA NOS

Professional

Both

$3.00

Service Code	HCPCS 01430
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTHESIA PX VEINS OF LOWER LEG NOS

Professional

Both

$3.00

Service Code	HCPCS 01520
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTHESIA PX VEINS UPPER ARM&ELBOW NOS

Professional

Both

$3.00

Service Code	HCPCS 01780
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTHESIA PX VEINS UPR ARM&ELBOW PHLEBORRHAPHY

Professional

Both

$4.00

Service Code	HCPCS 01782
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA RADICAL PERINEAL PROCEDURE

Professional

Both

$7.00

Service Code	HCPCS 00904
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANESTHESIA RECONSTRUCTIVE PROCEDURES OF EYELID

Professional

Both

$5.00

Service Code	HCPCS 00103
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTHESIA THER IVNTL RAD INTRATHORACIC/JUGULAR

Professional

Both

$6.00

Service Code	HCPCS 01932
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANESTHESIA THER IVNTL RAD PX ARTERIAL NOS

Professional

Both

$5.00

Service Code	HCPCS 01924
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

Know your out-of-pocket cost for care.

All Charges