Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANES RADIUS ULNA WRIST/HAND BONES CLOSED PX

Professional

Both

$3.00

Service Code	HCPCS 01820
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 RAD ORCHIECTOMY ABDOMINAL INCL OPN URTL

Professional

Both

$6.00

Service Code	HCPCS 00928
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 RAD ORCHIECTOMY INGUN INCL OPEN URTL PX

Professional

Both

$4.00

Service Code	HCPCS 00926
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 RPR RUPTURED ACHILLES TENDON W/WO GRAFT

Professional

Both

$5.00

Service Code	HCPCS 01472
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 SEMINAL VESICLES INCL OPEN URETHRAL PX

Professional

Both

$6.00

Service Code	HCPCS 00922
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 SHOULDER CAST APPL REMOVAL/REPAIR NOS

Professional

Both

$3.00

Service Code	HCPCS 01680
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 ANESTH,ABORTION PROC

Professional

Both

$4.00

Service Code	HCPCS 01964
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 ANESTH DIAGNOSTIC ARTHROSCOPIC PROC KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01382
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 ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION

Professional

Both

$4.00

Service Code	HCPCS 00532
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 ANESTHESIA ALL PX MAJOR ABDOMINAL BLOOD VESSELS

Professional

Both

$15.00

Service Code	HCPCS 00770
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 ANESTHESIA ANORECTAL PROCEDURE

Professional

Both

$5.00

Service Code	HCPCS 00902
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 ANESTHESIA ARTERIES FOREARM WRIST & HAND NOS

Professional

Both

$6.00

Service Code	HCPCS 01840
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 ANESTHESIA ARTERIES LOWER LEG W/BYPASS GRAFT NOS

Professional

Both

$8.00

Service Code	HCPCS 01500
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 ANESTHESIA ARTERIES SHOULDER & AXILLA NOS

Professional

Both

$6.00

Service Code	HCPCS 01650
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 ANESTHESIA ARTERIES UPPER ARM&ELBOW EMBOLECTOM

Professional

Both

$6.00

Service Code	HCPCS 01772
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 ANESTHESIA ARTERIES UPPER ARM & ELBOW NOS

Professional

Both

$6.00

Service Code	HCPCS 01770
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 ANESTHESIA ARTERIES UPPER LEG INCL BYPASS GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01270
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 ANESTHESIA ARTHROSCOPIC HIP JOINT PROCEDURE

Professional

Both

$4.00

Service Code	HCPCS 01202
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 ANESTHESIA ARTHROSCOPIC PROCEDURE ANKLE & FOOT

Professional

Both

$3.00

Service Code	HCPCS 01464
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 ANESTHESIA ARTHROSCOPIC SHOULDER DISARTICULATION

Professional

Both

$9.00

Service Code	HCPCS 01634
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$5.85
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$5.85
Rate for Payer: UMR Bronson Commercial	$4.14

PR ANESTHESIA ARTHRS/ENDOSCPIC TOTAL WRIST REPLCMT

Professional

Both

$6.00

Service Code	HCPCS 01832
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 ANESTHESIA AXILLARY-BRACHIAL ANEURYSM

Professional

Both

$10.00

Service Code	HCPCS 01652
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANESTHESIA AXILLARY-FEMORAL BYPASS GRAFT

Professional

Both

$10.00

Service Code	HCPCS 01656
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANESTHESIA BICEPS TENODESIS RUPTURE LONG TENDON

Professional

Both

$5.00

Service Code	HCPCS 01716
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 ANESTHESIA BODY CAST APPLICATION OR REVISION

Professional

Both

$3.00

Service Code	HCPCS 01130
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