Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA EXTERNAL CEPHALIC VERSION

Professional

Both

$5.00

Service Code	HCPCS 01958
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 EXTERNAL MIDDLE & INNER EAR W/BX NOS

Professional

Both

$5.00

Service Code	HCPCS 00120
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 EXTREME AGE PATIENT<1 YR&>70

Professional

Both

$98.00

Service Code	HCPCS 99100
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$617.05
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare	$49.00
Rate for Payer: Aetna New Business (MI Preferred)	$52.00
Rate for Payer: BCBS Complete	$39.20
Rate for Payer: BCBS Trust/PPO	$617.05
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cash Price	$78.40
Rate for Payer: Priority Health Cigna Priority Health	$63.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.00
Rate for Payer: Priority Health Narrow Network	$50.00
Rate for Payer: Priority Health SBD	$50.00
Rate for Payer: UMR Bronson Commercial	$45.08

PR ANESTHESIA EYE CORNEAL TRANSPLANT

Professional

Both

$6.00

Service Code	HCPCS 00144
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 EYE IRIDECTOMY

Professional

Both

$4.00

Service Code	HCPCS 00147
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 EYE LENS SURGERY

Professional

Both

$4.00

Service Code	HCPCS 00142
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 EYELID RECONSTRUCTIVE PROCEDURE

Professional

Both

$5.00

Service Code	HCPCS 00103
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 EYE NOT OTHERWISE SPECIFIED

Professional

Both

$5.00

Service Code	HCPCS 00140
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 EYE OPHTHALMOSCOPY

Professional

Both

$4.00

Service Code	HCPCS 00148
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 EYE VITREORETINAL SURGERY

Professional

Both

$6.00

Service Code	HCPCS 00145
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 FACIAL BONES OR SKULL NOS

Professional

Both

$5.00

Service Code	HCPCS 00190
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 FOR STERNAL DEBRIDEMENT

Professional

Both

$10.00

Service Code	HCPCS 00550
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 GASTROCNEMIUS RECESSION

Professional

Both

$5.00

Service Code	HCPCS 01474
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 HERNIA REPAIR LOWER ABDOMEN NOS

Professional

Both

$4.00

Service Code	HCPCS 00830
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 HERNIA REPAIR UPPER ABDOMEN NOS

Professional

Both

$4.00

Service Code	HCPCS 00750
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 INCOMPLETE/MISSED ABORTION PROCEDURES

Professional

Both

$4.00

Service Code	HCPCS 01965
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 INDUCED ABORTION PROCEDURES

Professional

Both

$4.00

Service Code	HCPCS 01966
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 INTERPELVI ABDOMINAL AMPUTATION

Professional

Both

$15.00

Service Code	HCPCS 01140
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 INTRACRANIAL PROCEDURE NOS

Professional

Both

$11.00

Service Code	HCPCS 00210
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$7.15
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.15
Rate for Payer: UMR Bronson Commercial	$5.06

PR ANESTHESIA INTRACRANIAL PROCEDURE SUBDURAL TAPS

Professional

Both

$5.00

Service Code	HCPCS 00212
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 INTRACRANIAL VASCULAR PROCEDURE

Professional

Both

$15.00

Service Code	HCPCS 00216
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 INTRAHEPATIC/PORTAL THER IVNTL RAD

Professional

Both

$7.00

Service Code	HCPCS 01931
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 ANESTHESIA INTRAORAL W/BIOPSY RADICAL SURGERY

Professional

Both

$7.00

Service Code	HCPCS 00176
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 ANESTHESIA INTRAORAL WITH BIOPSY NOS

Professional

Both

$5.00

Service Code	HCPCS 00170
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 INTRAPERITONEAL LOWER ABD W/LAPS NOS

Professional

Both

$6.00

Service Code	HCPCS 00840
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

Know your out-of-pocket cost for care.

All Charges