Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANES SHOULDER CAST APPL REMOVAL/REPAIR NOS

Professional

Both

$3.00

Service Code	HCPCS 01680
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

PR ANESTH,ABORTION PROC

Professional

Both

$4.00

Service Code	HCPCS 01964
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

PR ANESTH DIAGNOSTIC ARTHROSCOPIC PROC KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01382
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

PR ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION

Professional

Both

$4.00

Service Code	HCPCS 00532
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

PR ANESTHESIA ANORECTAL PROCEDURE

Professional

Both

$5.00

Service Code	HCPCS 00902
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

PR ANESTHESIA ARTERIES FOREARM WRIST & HAND NOS

Professional

Both

$6.00

Service Code	HCPCS 01840
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

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	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANESTHESIA ARTERIES SHOULDER & AXILLA NOS

Professional

Both

$6.00

Service Code	HCPCS 01650
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

PR ANESTHESIA ARTERIES UPPER ARM&ELBOW EMBOLECTOM

Professional

Both

$6.00

Service Code	HCPCS 01772
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

PR ANESTHESIA ARTERIES UPPER ARM & ELBOW NOS

Professional

Both

$6.00

Service Code	HCPCS 01770
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

PR ANESTHESIA ARTERIES UPPER LEG INCL BYPASS GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANESTHESIA ARTHROSCOPIC HIP JOINT PROCEDURE

Professional

Both

$4.00

Service Code	HCPCS 01202
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

PR ANESTHESIA ARTHROSCOPIC PROCEDURE ANKLE & FOOT

Professional

Both

$3.00

Service Code	HCPCS 01464
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

PR ANESTHESIA ARTHROSCOPIC SHOULDER DISARTICULATION

Professional

Both

$9.00

Service Code	HCPCS 01634
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$6.30
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$6.30

PR ANESTHESIA ARTHRS/ENDOSCPIC TOTAL WRIST REPLCMT

Professional

Both

$6.00

Service Code	HCPCS 01832
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

PR ANESTHESIA AXILLARY-BRACHIAL ANEURYSM

Professional

Both

$10.00

Service Code	HCPCS 01652
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

PR ANESTHESIA AXILLARY-FEMORAL BYPASS GRAFT

Professional

Both

$10.00

Service Code	HCPCS 01656
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

PR ANESTHESIA BICEPS TENODESIS RUPTURE LONG TENDON

Professional

Both

$5.00

Service Code	HCPCS 01716
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

PR ANESTHESIA BODY CAST APPLICATION OR REVISION

Professional

Both

$3.00

Service Code	HCPCS 01130
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

PR ANESTHESIA CAROTID/CORONARY THER IVNTL RAD

Professional

Both

$7.00

Service Code	HCPCS 01925
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

PR ANESTHESIA CERVICAL CERCLAGE INCLUDING BIOPSY

Professional

Both

$4.00

Service Code	HCPCS 00948
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

PR ANESTHESIA CERVICAL SPINE & CORD NOS

Professional

Both

$10.00

Service Code	HCPCS 00600
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

PR ANESTHESIA CESAREAN DELIVERY ONLY

Professional

Both

$7.00

Service Code	HCPCS 01961
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

PR ANESTHESIA C HYST W/O ANY LABOR ANALG/ANES CARE

Professional

Both

$8.00

Service Code	HCPCS 01963
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANESTHESIA CLAVICLE AND SCAPULA NOS

Professional

Both

$5.00

Service Code	HCPCS 00450
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

Know your out-of-pocket cost for care.

All Charges