Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA PX ON NOSE & ACCESSORY SINUSES NOS

Professional

Both

$5.00

Service Code	HCPCS 00160
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 ANESTHESIA PX ON SALIVARY GLANDS WITH BIOPSY

Professional

Both

$5.00

Service Code	HCPCS 00100
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 ANESTHESIA PX THORACIC SPINE & CORD NOS

Professional

Both

$10.00

Service Code	HCPCS 00620
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 ANESTHESIA PX UPPER ANTERIOR ABDOMINAL WALL NOS

Professional

Both

$4.00

Service Code	HCPCS 00700
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 ANESTHESIA PX UPPER POSTERIOR ABDOMINAL WALL

Professional

Both

$5.00

Service Code	HCPCS 00730
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 ANESTHESIA PX VEINS FOREARM WRIST&HAND NOS

Professional

Both

$3.00

Service Code	HCPCS 01850
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 ANESTHESIA PX VEINS KNEE & POPLITEAL AREA NOS

Professional

Both

$3.00

Service Code	HCPCS 01430
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 ANESTHESIA PX VEINS OF LOWER LEG NOS

Professional

Both

$3.00

Service Code	HCPCS 01520
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 ANESTHESIA PX VEINS UPPER ARM&ELBOW NOS

Professional

Both

$3.00

Service Code	HCPCS 01780
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 ANESTHESIA PX VEINS UPR ARM&ELBOW PHLEBORRHAPHY

Professional

Both

$4.00

Service Code	HCPCS 01782
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 ANESTHESIA RADICAL PERINEAL PROCEDURE

Professional

Both

$7.00

Service Code	HCPCS 00904
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 ANESTHESIA RECONSTRUCTIVE PROCEDURES OF EYELID

Professional

Both

$5.00

Service Code	HCPCS 00103
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 ANESTHESIA THER IVNTL RAD INTRATHORACIC/JUGULAR

Professional

Both

$6.00

Service Code	HCPCS 01932
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 ANESTHESIA THER IVNTL RAD PX ARTERIAL NOS

Professional

Both

$5.00

Service Code	HCPCS 01924
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 ANESTHESIA THER IVNTL RAD PX INTRACRANIAL

Professional

Both

$7.00

Service Code	HCPCS 01933
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 ANESTHESIA THORACOTOMY PROCEDURES DECORTICATION

Professional

Both

$15.00

Service Code	HCPCS 00542
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 ANESTHESIA THORACOTOMY PROCEDURES NOS

Professional

Both

$12.00

Service Code	HCPCS 00540
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$9.00
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00

PR ANESTHESIA THORACOTOMY PX W/1 LUNG VNTJ

Professional

Both

$15.00

Service Code	HCPCS 00541
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 ANESTHESIA TRACHEOBRONCHIAL RECONSTRUCTION

Professional

Both

$18.00

Service Code	HCPCS 00539
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 ANESTHESIA TRANSURETHRAL PX RESECTION PROSTATE

Professional

Both

$5.00

Service Code	HCPCS 00914
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 ANESTHESIA UPPER GI ENDOSCOPIC PX NOS

Professional

Both

$1.00

Service Code	HCPCS 00731
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.75
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75

PR ANESTHESIA VAGINAL DELIVERY ONLY

Professional

Both

$5.00

Service Code	HCPCS 01960
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 ANESTHESIA VAGINAL PROCEDURE W/BIOPSY NOS

Professional

Both

$3.00

Service Code	HCPCS 00940
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 ANESTHESIA VAGINAL PX CERVICAL CERCLAGE

Professional

Both

$4.00

Service Code	HCPCS 00948
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 ANESTHESIA VAGINAL PX CULDOSCOPY

Professional

Both

$5.00

Service Code	HCPCS 00950
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

Know your out-of-pocket cost for care.

All Charges