Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS

Professional

Both

$5.00

Service Code	HCPCS 01630
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION

Professional

Both

$15.00

Service Code	HCPCS 01636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES ART KNEE POPLITEAL EXC&GRF/RPR OCCLS/ARYS

Professional

Both

$8.00

Service Code	HCPCS 01444
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES ART KNEE POPLITEAL TEAEC W/WO PATCH GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01442
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES ART LOWER LEG W/BYP GRAFT EMBLC DIR/W/CATH

Professional

Both

$6.00

Service Code	HCPCS 01502
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANES ART UPPER LEG W/BYPASS GRAFT FEM ART LIG

Professional

Both

$4.00

Service Code	HCPCS 01272
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST

Professional

Both

$5.00

Service Code	HCPCS 01112
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES CARDIAC ELECTROPHYSIOL STDY W/RF ABLATION

Professional

Both

$7.00

Service Code	HCPCS 00537
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES CAST APPLICATION REMOVAL/REPAIR KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01420
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY

Professional

Both

$7.00

Service Code	HCPCS 01920
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES C DLVR FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$2.00

Service Code	HCPCS 01968
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: UMR Bronson Commercial	$0.92

PR ANES CERVICAL SPINE & CORD W/PATIENT SITTING

Professional

Both

$13.00

Service Code	HCPCS 00604
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45
Rate for Payer: UMR Bronson Commercial	$5.98

PR ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$5.00

Service Code	HCPCS 01969
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES CLOSED HUMRL H/N STRNCLAV JOINT& SHO JOINT

Professional

Both

$4.00

Service Code	HCPCS 01620
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES CLOSED PROC UPPER END TIBIA FIBULA/PATELLA

Professional

Both

$3.00

Service Code	HCPCS 01390
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES CLOSED SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$4.00

Service Code	HCPCS 01160
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES COLPTMY VAGNC COLPRPHY INCL BX W/OPN URTL

Professional

Both

$4.00

Service Code	HCPCS 00942
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES COMPLETE AMPUTATION PENIS INCL OPEN URTL

Professional

Both

$4.00

Service Code	HCPCS 00932
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES DIAG ARTHROSCOPIC SHOULDER JOINT PROC NOS

Professional

Both

$4.00

Service Code	HCPCS 01622
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE

Professional

Both

$4.00

Service Code	HCPCS 00635
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES DIRECT CABG W/O PUMP OXYGENATOR

Professional

Both

$26.00

Service Code	HCPCS 00566
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90
Rate for Payer: UMR Bronson Commercial	$11.96

PR ANES DIRECT CABG W/PUMP OXYGENATOR

Professional

Both

$18.00

Service Code	HCPCS 00567
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$11.70
Rate for Payer: UMR Bronson Commercial	$8.28

PR ANES DX/THER NERVE BLOCK/INJECTION PRONE POS

Professional

Both

$5.00

Service Code	HCPCS 01992
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS

Professional

Both

$3.00

Service Code	HCPCS 01991
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES ESOPH THYRD LARX TRACH & LYMPH NCK BX THYRD

Professional

Both

$3.00

Service Code	HCPCS 00322
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

Know your out-of-pocket cost for care.

All Charges