Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA VAGINAL PX VAGINAL HYSTERECTOMY

Professional

Both

$6.00

Service Code	HCPCS 00944
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 VASCULAR SHUNT/SHUNT REVISION

Professional

Both

$6.00

Service Code	HCPCS 01844
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 VULVECTOMY

Professional

Both

$4.00

Service Code	HCPCS 00906
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 ANESTH FOR CHEMONUCLEOLYSIS

Professional

Both

$10.00

Service Code	HCPCS 00634
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 ANESTH,INTESTINE,SCOPE,LOW

Professional

Both

$5.00

Service Code	HCPCS 00810
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 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	$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 THORACOTOMY PX NTRATHRC PX TRACHEA&BRONCHI

Professional

Both

$17.00

Service Code	HCPCS 00548
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: Cash Price	$13.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.75

PR ANES THORACOTOMY PX PULMONARY RESCJ W/THORACOP

Professional

Both

$15.00

Service Code	HCPCS 00546
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 ANESTH,PELV NERV REMOVAL EXTRAPELV

Professional

Both

$3.00

Service Code	HCPCS 01180
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 ANESTH,PELV NERV REMOVAL INTRAPELV

Professional

Both

$4.00

Service Code	HCPCS 01190
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 ANESTH,PERC IMAGE GUIDE SPINAL PROC, DIAG

Professional

Both

$5.00

Service Code	HCPCS 01935
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 ANESTH,PERC IMAGE GUIDE SPINAL PROC, THER

Professional

Both

$5.00

Service Code	HCPCS 01936
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 ANESTH,RAD SURG CLAVICLE/SCAPULA

Professional

Both

$6.00

Service Code	HCPCS 00452
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 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	$9.75
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 ANESTH,SHOULDER SPICA

Professional

Both

$4.00

Service Code	HCPCS 01682
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 ANESTH,THORACOLUMBAR SYMPATHECTOMY

Professional

Both

$13.00

Service Code	HCPCS 00622
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 ANESTH,UGI ENDOSCOPY

Professional

Both

$5.00

Service Code	HCPCS 00740
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 TRANSURETHRAL PX RESECTION OF BLADDER TUMOR

Professional

Both

$5.00

Service Code	HCPCS 00912
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 TRANSURETHRAL PX W/URETHROCYSTOSCOPY NOS

Professional

Both

$3.00

Service Code	HCPCS 00910
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 TRANSVENOUS INSJ/REPLACEMENT PACING CVDFB

Professional

Both

$7.00

Service Code	HCPCS 00534
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 TRURL PX FRAGMNTJ MNPJ&/RMVL URTRL CALCULUS

Professional

Both

$5.00

Service Code	HCPCS 00918
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 TRURL PX POST-TRURL RESECTION BLEEDING

Professional

Both

$5.00

Service Code	HCPCS 00916
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 URGENT HYSTERECTOMY FOLLOWING DELIVERY

Professional

Both

$8.00

Service Code	HCPCS 01962
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR ANES VAG PX COLPTMY VAGNC COLPRPHY&OPN URTL PX

Professional

Both

$4.00

Service Code	HCPCS 00942
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 VAG PX HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY

Professional

Both

$4.00

Service Code	HCPCS 00952
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

Know your out-of-pocket cost for care.

All Charges