Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE

Professional

Both

$4.00

Service Code	HCPCS 00635
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES DIRECT CABG W/O PUMP OXYGENATOR

Professional

Both

$26.00

Service Code	HCPCS 00566
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$19.50
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.50

PR ANES DIRECT CABG W/PUMP OXYGENATOR

Professional

Both

$18.00

Service Code	HCPCS 00567
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$13.50
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50

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	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

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	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ESOPH THYR LARX TRCH&LYMPH NCK NDL BX THYR

Professional

Both

$3.00

Service Code	HCPCS 00322
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS

Professional

Both

$6.00

Service Code	HCPCS 00860
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES FOREARM WRIST/HAND CAST APPL RMVL/REPAIR

Professional

Both

$3.00

Service Code	HCPCS 01860
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES HEART TRANSPLANT/HEART/LUNG TRANSPLANT

Professional

Both

$20.00

Service Code	HCPCS 00580
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.00

PR ANES HERNIA REPAIR LOWER ABDOMEN NOS<1YR AGE

Professional

Both

$5.00

Service Code	HCPCS 00834
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES HERNIA REPAIR LWR ABD VENTRAL&INCISIONAL

Professional

Both

$6.00

Service Code	HCPCS 00832
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE

Professional

Both

$7.00

Service Code	HCPCS 00754
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA

Professional

Both

$7.00

Service Code	HCPCS 00756
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES HRNA RPR LWR ABD NOS INFT<37WK BRTH<50WK

Professional

Both

$6.00

Service Code	HCPCS 00836
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES HRNA RPR UPR ABD LMBR&VNT HERNIA&/DEHSN

Professional

Both

$6.00

Service Code	HCPCS 00752
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES ICR PX CEREBROSPINAL FLUID SHUNTING PX

Professional

Both

$10.00

Service Code	HCPCS 00220
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR ANES ICR PX CRANIOTOMY/CRANIECTOMY HMTMA

Professional

Both

$10.00

Service Code	HCPCS 00211
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR ANES ICR PX CRNOP/ELEVATION DEPRS SKULL FX XDRL

Professional

Both

$9.00

Service Code	HCPCS 00215
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$6.75
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.75

PR ANES INTEG SYS RAD/MODIFIED RAD BRST W/NODE DSJ

Professional

Both

$13.00

Service Code	HCPCS 00406
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75

PR ANES INTRACRANIAL PROCEDURE IN SITTING POSITION

Professional

Both

$13.00

Service Code	HCPCS 00218
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75

PR ANES INTRACRANIAL PX BURR HOLES W/VENTRG

Professional

Both

$9.00

Service Code	HCPCS 00214
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$6.75
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.75

PR ANES INTRACRANIAL PX ELECTROCOAGULATION ICR NRV

Professional

Both

$6.00

Service Code	HCPCS 00222
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES INTRAORAL PX W/BIOPSY REPAIR CLEFT PALATE

Professional

Both

$6.00

Service Code	HCPCS 00172
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES INTRAORAL PX W/BX EXC RETROPHARYNGEAL TUMOR

Professional

Both

$6.00

Service Code	HCPCS 00174
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS

Professional

Both

$7.00

Service Code	HCPCS 00790
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

Know your out-of-pocket cost for care.

All Charges