Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA VEINS SHOULDER & AXILLA

Professional

Both

$4.00

Service Code	HCPCS 01670
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA VEINS UPPER ARM & ELBOW NOS

Professional

Both

$3.00

Service Code	HCPCS 01780
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTHESIA VEINS UPPER ARM & ELBOW PHLEBORRHAPHY

Professional

Both

$4.00

Service Code	HCPCS 01782
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTHESIA VULVECTOMY

Professional

Both

$4.00

Service Code	HCPCS 00906
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTH FOR CHEMONUCLEOLYSIS

Professional

Both

$10.00

Service Code	HCPCS 00634
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANESTH,INTESTINE,SCOPE,LOW

Professional

Both

$5.00

Service Code	HCPCS 00810
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTH OPEN/SURG ARTHRS EXC CYST/TUMOR HUMERUS

Professional

Both

$5.00

Service Code	HCPCS 01758
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTH OPEN/SURG ARTHRS KNEE DISARTICULATION

Professional

Both

$5.00

Service Code	HCPCS 01404
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTH OPEN/SURG ARTHRS TOTAL ELBOW REPLACEMENT

Professional

Both

$7.00

Service Code	HCPCS 01760
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANESTH OPEN/SURG ARTHRS TOTAL KNEE ARTHROPLASTY

Professional

Both

$7.00

Service Code	HCPCS 01402
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES THORACIC SPINE & CORD ANT APPR W/1 LNG VENT

Professional

Both

$15.00

Service Code	HCPCS 00626
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES THORACOTOMY & THORACOSCOPY DECORTICATION

Professional

Both

$15.00

Service Code	HCPCS 00542
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES THORACOTOMY & THORACOSCOPY NOS

Professional

Both

$12.00

Service Code	HCPCS 00540
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$8.40
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: UMR Bronson Commercial	$5.52

PR ANES THORACOTOMY & THORACOSCOPY PULMONARY RESC

Professional

Both

$15.00

Service Code	HCPCS 00546
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES THORACOTOMY & THORACOSCOPY W/1 LUNG VNTJ

Professional

Both

$15.00

Service Code	HCPCS 00541
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES THORACOTOMY &THORACSCOPY TRACHEA & BRONCHI

Professional

Both

$17.00

Service Code	HCPCS 00548
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$11.90
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: Cash Price	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.90
Rate for Payer: UMR Bronson Commercial	$7.82

PR ANESTH,PELV NERV REMOVAL EXTRAPELV

Professional

Both

$3.00

Service Code	HCPCS 01180
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANESTH,PELV NERV REMOVAL INTRAPELV

Professional

Both

$4.00

Service Code	HCPCS 01190
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, DIAG

Professional

Both

$5.00

Service Code	HCPCS 01935
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, THER

Professional

Both

$5.00

Service Code	HCPCS 01936
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANESTH,RAD SURG CLAVICLE/SCAPULA

Professional

Both

$6.00

Service Code	HCPCS 00452
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.20
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$4.20
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANES THRC SPINE & CORD ANT APPR W/O 1 LUNG VENTJ

Professional

Both

$13.00

Service Code	HCPCS 00625
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.10
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: UMR Bronson Commercial	$5.98

PR ANESTH,SHOULDER SPICA

Professional

Both

$4.00

Service Code	HCPCS 01682
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANESTH,THORACOLUMBAR SYMPATHECTOMY

Professional

Both

$13.00

Service Code	HCPCS 00622
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.10
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: UMR Bronson Commercial	$5.98

PR ANESTH,UGI ENDOSCOPY

Professional

Both

$5.00

Service Code	HCPCS 00740
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

Know your out-of-pocket cost for care.

All Charges