Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR REPLACE AORTIC VALVE OPEN TRANSTHORACIC APPROACH

Professional

Both

$3,109.00

Service Code	HCPCS 0318T
Min. Negotiated Rate	$1,243.60
Max. Negotiated Rate	$2,176.30
Rate for Payer: BCBS Complete	$1,243.60
Rate for Payer: Cash Price	$2,487.20
Rate for Payer: Priority Health Cigna Priority Health	$2,176.30
Rate for Payer: UMR Bronson Commercial	$1,430.14

PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH

Professional

Both

$3,868.00

Service Code	HCPCS 33361
Min. Negotiated Rate	$754.45
Max. Negotiated Rate	$2,707.60
Rate for Payer: Aetna Commercial	$1,626.97
Rate for Payer: BCBS Complete	$792.17
Rate for Payer: BCBS Trust/PPO	$920.83
Rate for Payer: Cash Price	$3,094.40
Rate for Payer: Cash Price	$3,094.40
Rate for Payer: Meridian Medicaid	$792.17
Rate for Payer: Priority Health Choice Medicaid	$754.45
Rate for Payer: Priority Health Cigna Priority Health	$2,707.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,878.35
Rate for Payer: Priority Health Narrow Network	$1,878.35
Rate for Payer: Priority Health SBD	$1,878.35
Rate for Payer: UMR Bronson Commercial	$1,779.28

PR REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH

Professional

Both

$2,176.00

Service Code	HCPCS 33368
Min. Negotiated Rate	$459.23
Max. Negotiated Rate	$1,523.20
Rate for Payer: Aetna Commercial	$1,000.30
Rate for Payer: BCBS Complete	$482.19
Rate for Payer: BCBS Trust/PPO	$506.11
Rate for Payer: Cash Price	$1,740.80
Rate for Payer: Cash Price	$1,740.80
Rate for Payer: Meridian Medicaid	$482.19
Rate for Payer: Priority Health Choice Medicaid	$459.23
Rate for Payer: Priority Health Cigna Priority Health	$1,523.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,147.97
Rate for Payer: Priority Health Narrow Network	$1,147.97
Rate for Payer: Priority Health SBD	$1,147.97
Rate for Payer: UMR Bronson Commercial	$1,000.96

PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

Professional

Both

$1,338.00

Service Code	HCPCS 49451
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$2,113.73
Rate for Payer: Aetna Commercial	$118.55
Rate for Payer: BCBS Complete	$57.70
Rate for Payer: BCBS Trust/PPO	$2,113.73
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Meridian Medicaid	$57.70
Rate for Payer: Priority Health Choice Medicaid	$54.95
Rate for Payer: Priority Health Cigna Priority Health	$936.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$152.29
Rate for Payer: Priority Health Narrow Network	$152.29
Rate for Payer: Priority Health SBD	$152.29
Rate for Payer: UMR Bronson Commercial	$615.48

PR REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS

Professional

Both

$1,185.00

Service Code	HCPCS 49450
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$829.50
Rate for Payer: Aetna Commercial	$88.08
Rate for Payer: BCBS Complete	$42.71
Rate for Payer: BCBS Trust/PPO	$631.32
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cash Price	$948.00
Rate for Payer: Meridian Medicaid	$42.71
Rate for Payer: Priority Health Choice Medicaid	$40.68
Rate for Payer: Priority Health Cigna Priority Health	$829.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$114.65
Rate for Payer: Priority Health Narrow Network	$114.65
Rate for Payer: Priority Health SBD	$114.65
Rate for Payer: UMR Bronson Commercial	$545.10

PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS

Professional

Both

$1,464.00

Service Code	HCPCS 49452
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$2,855.46
Rate for Payer: Aetna Commercial	$183.16
Rate for Payer: BCBS Complete	$88.79
Rate for Payer: BCBS Trust/PPO	$2,855.46
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Meridian Medicaid	$88.79
Rate for Payer: Priority Health Choice Medicaid	$84.56
Rate for Payer: Priority Health Cigna Priority Health	$1,024.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.19
Rate for Payer: Priority Health Narrow Network	$235.19
Rate for Payer: Priority Health SBD	$235.19
Rate for Payer: UMR Bronson Commercial	$673.44

PR REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP

Professional

Both

$5,749.32

Service Code	HCPCS 33430
Min. Negotiated Rate	$545.73
Max. Negotiated Rate	$4,366.31
Rate for Payer: Aetna Commercial	$3,761.38
Rate for Payer: BCBS Complete	$1,842.20
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: Cash Price	$4,599.46
Rate for Payer: Cash Price	$4,599.46
Rate for Payer: Meridian Medicaid	$1,842.20
Rate for Payer: Priority Health Choice Medicaid	$1,754.48
Rate for Payer: Priority Health Cigna Priority Health	$4,024.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,366.31
Rate for Payer: Priority Health Narrow Network	$4,366.31
Rate for Payer: Priority Health SBD	$4,366.31
Rate for Payer: UMR Bronson Commercial	$2,644.69

PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT

Professional

Both

$1,082.00

Service Code	HCPCS 11970
Min. Negotiated Rate	$361.04
Max. Negotiated Rate	$757.40
Rate for Payer: Aetna Commercial	$605.68
Rate for Payer: BCBS Complete	$379.09
Rate for Payer: BCBS Trust/PPO	$381.90
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Meridian Medicaid	$379.09
Rate for Payer: Priority Health Choice Medicaid	$361.04
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$691.78
Rate for Payer: Priority Health Narrow Network	$691.78
Rate for Payer: Priority Health SBD	$691.78
Rate for Payer: UMR Bronson Commercial	$497.72

PR REPLACEMENT TRICUSPID VALVE W/CARD BYPASS

Professional

Both

$8,637.00

Service Code	HCPCS 33465
Min. Negotiated Rate	$447.47
Max. Negotiated Rate	$6,045.90
Rate for Payer: Aetna Commercial	$3,697.17
Rate for Payer: BCBS Complete	$1,809.11
Rate for Payer: BCBS Trust/PPO	$447.47
Rate for Payer: Cash Price	$6,909.60
Rate for Payer: Cash Price	$6,909.60
Rate for Payer: Meridian Medicaid	$1,809.11
Rate for Payer: Priority Health Choice Medicaid	$1,722.96
Rate for Payer: Priority Health Cigna Priority Health	$6,045.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,288.65
Rate for Payer: Priority Health Narrow Network	$4,288.65
Rate for Payer: Priority Health SBD	$4,288.65
Rate for Payer: UMR Bronson Commercial	$3,973.02

PR REPOSITIONING PERQ R/L VAD W/IMG GDN SEP INSJ

Professional

Both

$484.00

Service Code	HCPCS 33993
Min. Negotiated Rate	$103.52
Max. Negotiated Rate	$1,384.15
Rate for Payer: Aetna Commercial	$222.32
Rate for Payer: BCBS Complete	$108.70
Rate for Payer: BCBS Trust/PPO	$1,384.15
Rate for Payer: Cash Price	$387.20
Rate for Payer: Cash Price	$387.20
Rate for Payer: Meridian Medicaid	$108.70
Rate for Payer: Priority Health Choice Medicaid	$103.52
Rate for Payer: Priority Health Cigna Priority Health	$338.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$257.99
Rate for Payer: Priority Health Narrow Network	$257.99
Rate for Payer: Priority Health SBD	$257.99
Rate for Payer: UMR Bronson Commercial	$222.64

PR REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO

Professional

Both

$369.00

Service Code	HCPCS 43761
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna Commercial	$139.84
Rate for Payer: BCBS Complete	$69.11
Rate for Payer: BCBS Trust/PPO	$106.72
Rate for Payer: Cash Price	$295.20
Rate for Payer: Cash Price	$295.20
Rate for Payer: Meridian Medicaid	$69.11
Rate for Payer: Priority Health Choice Medicaid	$65.82
Rate for Payer: Priority Health Cigna Priority Health	$258.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.68
Rate for Payer: Priority Health Narrow Network	$181.68
Rate for Payer: Priority Health SBD	$181.68
Rate for Payer: UMR Bronson Commercial	$169.74

PR REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB

Professional

Both

$825.00

Service Code	HCPCS 33273
Min. Negotiated Rate	$253.26
Max. Negotiated Rate	$1,148.52
Rate for Payer: Aetna Commercial	$534.44
Rate for Payer: BCBS Complete	$265.92
Rate for Payer: BCBS Trust/PPO	$1,148.52
Rate for Payer: Cash Price	$660.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Meridian Medicaid	$265.92
Rate for Payer: Priority Health Choice Medicaid	$253.26
Rate for Payer: Priority Health Cigna Priority Health	$577.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$627.18
Rate for Payer: Priority Health Narrow Network	$627.18
Rate for Payer: Priority Health SBD	$627.18
Rate for Payer: UMR Bronson Commercial	$379.50

PR REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT

Professional

Both

$300.00

Service Code	HCPCS 62252
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$1,964.75
Rate for Payer: Aetna Commercial	$103.38
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Trust/PPO	$1,964.75
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.12
Rate for Payer: Priority Health Narrow Network	$65.12
Rate for Payer: Priority Health SBD	$142.70
Rate for Payer: UMR Bronson Commercial	$138.00

PR RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ

Professional

Both

$4,834.00

Service Code	HCPCS 32504
Min. Negotiated Rate	$839.47
Max. Negotiated Rate	$3,383.80
Rate for Payer: Aetna Commercial	$2,643.29
Rate for Payer: BCBS Complete	$1,349.73
Rate for Payer: BCBS Trust/PPO	$839.47
Rate for Payer: Cash Price	$3,867.20
Rate for Payer: Cash Price	$3,867.20
Rate for Payer: Meridian Medicaid	$1,349.73
Rate for Payer: Priority Health Choice Medicaid	$1,285.46
Rate for Payer: Priority Health Cigna Priority Health	$3,383.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,781.05
Rate for Payer: Priority Health Narrow Network	$2,781.05
Rate for Payer: Priority Health SBD	$2,781.05
Rate for Payer: UMR Bronson Commercial	$2,223.64

PR RESCJ DIAPHRAGM W/COMPLEX REPAIR

Professional

Both

$2,217.00

Service Code	HCPCS 39561
Min. Negotiated Rate	$573.73
Max. Negotiated Rate	$1,978.34
Rate for Payer: Aetna Commercial	$1,273.41
Rate for Payer: BCBS Complete	$839.36
Rate for Payer: BCBS Trust/PPO	$573.73
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Meridian Medicaid	$839.36
Rate for Payer: Priority Health Choice Medicaid	$799.39
Rate for Payer: Priority Health Cigna Priority Health	$1,551.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,978.34
Rate for Payer: Priority Health Narrow Network	$1,978.34
Rate for Payer: Priority Health SBD	$1,978.34
Rate for Payer: UMR Bronson Commercial	$1,019.82

PR RESCJ DIAPHRAGM W/SIMPLE REPAIR

Professional

Both

$3,604.00

Service Code	HCPCS 39560
Min. Negotiated Rate	$479.70
Max. Negotiated Rate	$2,522.80
Rate for Payer: Aetna Commercial	$818.99
Rate for Payer: BCBS Complete	$537.88
Rate for Payer: BCBS Trust/PPO	$479.70
Rate for Payer: Cash Price	$2,883.20
Rate for Payer: Cash Price	$2,883.20
Rate for Payer: Meridian Medicaid	$537.88
Rate for Payer: Priority Health Choice Medicaid	$512.27
Rate for Payer: Priority Health Cigna Priority Health	$2,522.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,269.79
Rate for Payer: Priority Health Narrow Network	$1,269.79
Rate for Payer: Priority Health SBD	$1,269.79
Rate for Payer: UMR Bronson Commercial	$1,657.84

PR RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL

Professional

Both

$5,311.00

Service Code	HCPCS 61600
Min. Negotiated Rate	$410.49
Max. Negotiated Rate	$3,717.70
Rate for Payer: Aetna Commercial	$2,761.75
Rate for Payer: BCBS Complete	$1,429.34
Rate for Payer: BCBS Trust/PPO	$410.49
Rate for Payer: Cash Price	$4,248.80
Rate for Payer: Cash Price	$4,248.80
Rate for Payer: Meridian Medicaid	$1,429.34
Rate for Payer: Priority Health Choice Medicaid	$1,361.28
Rate for Payer: Priority Health Cigna Priority Health	$3,717.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,628.93
Rate for Payer: Priority Health Narrow Network	$3,628.93
Rate for Payer: Priority Health SBD	$3,628.93
Rate for Payer: UMR Bronson Commercial	$2,443.06

PR RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF

Professional

Both

$7,318.00

Service Code	HCPCS 61601
Min. Negotiated Rate	$1,571.73
Max. Negotiated Rate	$5,122.60
Rate for Payer: Aetna Commercial	$3,136.72
Rate for Payer: BCBS Complete	$1,650.32
Rate for Payer: BCBS Trust/PPO	$2,035.01
Rate for Payer: Cash Price	$5,854.40
Rate for Payer: Cash Price	$5,854.40
Rate for Payer: Meridian Medicaid	$1,650.32
Rate for Payer: Priority Health Choice Medicaid	$1,571.73
Rate for Payer: Priority Health Cigna Priority Health	$5,122.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,161.18
Rate for Payer: Priority Health Narrow Network	$4,161.18
Rate for Payer: Priority Health SBD	$4,161.18
Rate for Payer: UMR Bronson Commercial	$3,366.28

PR RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL

Professional

Both

$6,837.40

Service Code	HCPCS 61616
Min. Negotiated Rate	$70.26
Max. Negotiated Rate	$5,699.61
Rate for Payer: Aetna Commercial	$4,330.86
Rate for Payer: BCBS Complete	$2,262.22
Rate for Payer: BCBS Trust/PPO	$70.26
Rate for Payer: Cash Price	$5,469.92
Rate for Payer: Cash Price	$5,469.92
Rate for Payer: Meridian Medicaid	$2,262.22
Rate for Payer: Priority Health Choice Medicaid	$2,154.50
Rate for Payer: Priority Health Cigna Priority Health	$4,786.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,699.61
Rate for Payer: Priority Health Narrow Network	$5,699.61
Rate for Payer: Priority Health SBD	$5,699.61
Rate for Payer: UMR Bronson Commercial	$3,145.20

PR RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL

Professional

Both

$7,083.00

Service Code	HCPCS 61615
Min. Negotiated Rate	$129.96
Max. Negotiated Rate	$4,958.10
Rate for Payer: Aetna Commercial	$3,660.27
Rate for Payer: BCBS Complete	$1,910.19
Rate for Payer: BCBS Trust/PPO	$129.96
Rate for Payer: Cash Price	$5,666.40
Rate for Payer: Cash Price	$5,666.40
Rate for Payer: Meridian Medicaid	$1,910.19
Rate for Payer: Priority Health Choice Medicaid	$1,819.23
Rate for Payer: Priority Health Cigna Priority Health	$4,958.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,821.95
Rate for Payer: Priority Health Narrow Network	$4,821.95
Rate for Payer: Priority Health SBD	$4,821.95
Rate for Payer: UMR Bronson Commercial	$3,258.18

PR RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL

Professional

Both

$4,631.00

Service Code	HCPCS 61605
Min. Negotiated Rate	$1,385.78
Max. Negotiated Rate	$3,694.04
Rate for Payer: Aetna Commercial	$2,793.41
Rate for Payer: BCBS Complete	$1,455.07
Rate for Payer: BCBS Trust/PPO	$1,670.48
Rate for Payer: Cash Price	$3,704.80
Rate for Payer: Cash Price	$3,704.80
Rate for Payer: Meridian Medicaid	$1,455.07
Rate for Payer: Priority Health Choice Medicaid	$1,385.78
Rate for Payer: Priority Health Cigna Priority Health	$3,241.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,694.04
Rate for Payer: Priority Health Narrow Network	$3,694.04
Rate for Payer: Priority Health SBD	$3,694.04
Rate for Payer: UMR Bronson Commercial	$2,130.26

PR RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR

Professional

Both

$10,019.00

Service Code	HCPCS 61606
Min. Negotiated Rate	$202.34
Max. Negotiated Rate	$7,013.30
Rate for Payer: Aetna Commercial	$3,798.94
Rate for Payer: BCBS Complete	$1,964.32
Rate for Payer: BCBS Trust/PPO	$202.34
Rate for Payer: Cash Price	$8,015.20
Rate for Payer: Cash Price	$8,015.20
Rate for Payer: Meridian Medicaid	$1,964.32
Rate for Payer: Priority Health Choice Medicaid	$1,870.78
Rate for Payer: Priority Health Cigna Priority Health	$7,013.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,983.33
Rate for Payer: Priority Health Narrow Network	$4,983.33
Rate for Payer: Priority Health SBD	$4,983.33
Rate for Payer: UMR Bronson Commercial	$4,608.74

PR RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL

Professional

Both

$10,444.00

Service Code	HCPCS 61608
Min. Negotiated Rate	$131.02
Max. Negotiated Rate	$7,310.80
Rate for Payer: Aetna Commercial	$4,229.44
Rate for Payer: BCBS Complete	$2,223.30
Rate for Payer: BCBS Trust/PPO	$131.02
Rate for Payer: Cash Price	$8,355.20
Rate for Payer: Cash Price	$8,355.20
Rate for Payer: Meridian Medicaid	$2,223.30
Rate for Payer: Priority Health Choice Medicaid	$2,117.43
Rate for Payer: Priority Health Cigna Priority Health	$7,310.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,606.18
Rate for Payer: Priority Health Narrow Network	$5,606.18
Rate for Payer: Priority Health SBD	$5,606.18
Rate for Payer: UMR Bronson Commercial	$4,804.24

PR RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL

Professional

Both

$5,903.00

Service Code	HCPCS 61607
Min. Negotiated Rate	$156.91
Max. Negotiated Rate	$4,524.70
Rate for Payer: Aetna Commercial	$3,949.87
Rate for Payer: BCBS Complete	$2,060.49
Rate for Payer: BCBS Trust/PPO	$156.91
Rate for Payer: Cash Price	$4,722.40
Rate for Payer: Cash Price	$4,722.40
Rate for Payer: Meridian Medicaid	$2,060.49
Rate for Payer: Priority Health Choice Medicaid	$1,962.37
Rate for Payer: Priority Health Cigna Priority Health	$4,132.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,524.70
Rate for Payer: Priority Health Narrow Network	$4,524.70
Rate for Payer: Priority Health SBD	$4,524.70
Rate for Payer: UMR Bronson Commercial	$2,715.38

PR RESCJ PALATE/EXTENSIVE RESCJ LESION

Professional

Both

$2,012.00

Service Code	HCPCS 42120
Min. Negotiated Rate	$418.41
Max. Negotiated Rate	$1,773.92
Rate for Payer: Aetna Commercial	$1,336.73
Rate for Payer: BCBS Complete	$672.51
Rate for Payer: BCBS Trust/PPO	$418.41
Rate for Payer: Cash Price	$1,609.60
Rate for Payer: Cash Price	$1,609.60
Rate for Payer: Meridian Medicaid	$672.51
Rate for Payer: Priority Health Choice Medicaid	$640.49
Rate for Payer: Priority Health Cigna Priority Health	$1,408.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,773.92
Rate for Payer: Priority Health Narrow Network	$1,773.92
Rate for Payer: Priority Health SBD	$1,773.92
Rate for Payer: UMR Bronson Commercial	$925.52

Know your out-of-pocket cost for care.

All Charges