Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANES PX FACIAL BONES/SKL RAD SURG W/PROGNATHISM

Professional

Both

$7.00

Service Code	HCPCS 00192
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 PX HRT PRCRD SAC&GREAT VSLS W/O PUMP OXTJ

Professional

Both

$15.00

Service Code	HCPCS 00560
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.25
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25

PR ANES PX HRT PRCRD SAC&GREAT VSLS W/PUMP OXTJ<1YR

Professional

Both

$26.00

Service Code	HCPCS 00561
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 PX HRT PRCRD SAC&GRT VSL PMP OXT CRC ARREST

Professional

Both

$26.00

Service Code	HCPCS 00563
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 PX HRT PRCRD SAC&GRT VSL W/PMP OXT AGE 1YR+

Professional

Both

$20.00

Service Code	HCPCS 00562
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 PX INTEG SYS ELEC CONVERSION ARRHYTHMIAS

Professional

Both

$4.00

Service Code	HCPCS 00410
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 PX INTEG SYS XTR ANT TRUNK & PERINEUM NOS

Professional

Both

$3.00

Service Code	HCPCS 00400
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 PX LOWER ANT ABDOMINAL WALL PANNICULECTOMY

Professional

Both

$5.00

Service Code	HCPCS 00802
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 PX MAJ LOWER ABDOMINAL VESSELS IVC LIGATION

Professional

Both

$10.00

Service Code	HCPCS 00882
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 PX MALE GENITALIA COMPL AMPUTATION PENIS

Professional

Both

$4.00

Service Code	HCPCS 00932
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 PX MALE GENITALIA INSJ PENILE PROSTHESIS

Professional

Both

$4.00

Service Code	HCPCS 00938
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 PX MALE GENITALIA ORCHIOPEXY UNI/BI

Professional

Both

$4.00

Service Code	HCPCS 00930
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 PX MALE GENITALIA RAD ORCHIECTOMY ABDOMINAL

Professional

Both

$6.00

Service Code	HCPCS 00928
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 PX MALE GENITALIA UNDSCND TESTIS UNI/BI

Professional

Both

$4.00

Service Code	HCPCS 00924
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 PX MALE GENITALIA VASECTOMY UNI/BI

Professional

Both

$3.00

Service Code	HCPCS 00921
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 PX MALE GENTIALIA RAD ORCHIECTOMY INGUN

Professional

Both

$4.00

Service Code	HCPCS 00926
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 PX NRV MUSC TDN FSCA&BRS UPR A&E TNOT OPEN

Professional

Both

$5.00

Service Code	HCPCS 01712
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 PX NRV/MUSC/TND/FASC LWR LEG ANKLE&FOOT NOS

Professional

Both

$3.00

Service Code	HCPCS 01470
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 PX ON EXTERNAL MIDDLE & INNER EAR W/BX NOS

Professional

Both

$5.00

Service Code	HCPCS 00120
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 PX ON NOSE&ACCESSORY SINUSES BX SOFT TISSUE

Professional

Both

$4.00

Service Code	HCPCS 00164
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 PX ON NOSE&ACCESSORY SINUSES RADICAL SURG

Professional

Both

$7.00

Service Code	HCPCS 00162
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 PX UPR ANT ABDL WALL PERCUTANEOUS LIVER BX

Professional

Both

$4.00

Service Code	HCPCS 00702
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 PX VEINS FOREARM WRIST&HAND PHLEBORRHAPHY

Professional

Both

$4.00

Service Code	HCPCS 01852
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 PX VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH

Professional

Both

$5.00

Service Code	HCPCS 01522
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 PX VN KNE&POPLITEAL AREA ARTERIOVENOUS FSTL

Professional

Both

$6.00

Service Code	HCPCS 01432
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

Know your out-of-pocket cost for care.

All Charges