Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD

Professional

Both

$4,839.00

Service Code	HCPCS 58951
Min. Negotiated Rate	$149.51
Max. Negotiated Rate	$3,387.30
Rate for Payer: Aetna Commercial	$1,713.00
Rate for Payer: BCBS Complete	$972.21
Rate for Payer: BCBS Trust/PPO	$149.51
Rate for Payer: Cash Price	$3,871.20
Rate for Payer: Cash Price	$3,871.20
Rate for Payer: Meridian Medicaid	$972.21
Rate for Payer: Priority Health Choice Medicaid	$925.91
Rate for Payer: Priority Health Cigna Priority Health	$3,387.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,041.41
Rate for Payer: Priority Health Narrow Network	$2,041.41
Rate for Payer: Priority Health SBD	$2,041.41
Rate for Payer: UMR Bronson Commercial	$2,225.94

PR RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS

Professional

Both

$6,506.00

Service Code	HCPCS 48105
Min. Negotiated Rate	$1,791.76
Max. Negotiated Rate	$4,941.91
Rate for Payer: Aetna Commercial	$3,842.31
Rate for Payer: BCBS Complete	$1,881.35
Rate for Payer: BCBS Trust/PPO	$2,408.52
Rate for Payer: Cash Price	$5,204.80
Rate for Payer: Cash Price	$5,204.80
Rate for Payer: Meridian Medicaid	$1,881.35
Rate for Payer: Priority Health Choice Medicaid	$1,791.76
Rate for Payer: Priority Health Cigna Priority Health	$4,554.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,941.91
Rate for Payer: Priority Health Narrow Network	$4,941.91
Rate for Payer: Priority Health SBD	$4,941.91
Rate for Payer: UMR Bronson Commercial	$2,992.76

PR RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY

Professional

Both

$3,260.00

Service Code	HCPCS 58957
Min. Negotiated Rate	$404.15
Max. Negotiated Rate	$2,282.00
Rate for Payer: Aetna Commercial	$1,889.07
Rate for Payer: BCBS Complete	$1,072.41
Rate for Payer: BCBS Trust/PPO	$404.15
Rate for Payer: Cash Price	$2,608.00
Rate for Payer: Cash Price	$2,608.00
Rate for Payer: Meridian Medicaid	$1,072.41
Rate for Payer: Priority Health Choice Medicaid	$1,021.34
Rate for Payer: Priority Health Cigna Priority Health	$2,282.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,247.35
Rate for Payer: Priority Health Narrow Network	$2,247.35
Rate for Payer: Priority Health SBD	$2,247.35
Rate for Payer: UMR Bronson Commercial	$1,499.60

PR RESEC RECURRENT LARYNX NERVE

Professional

Both

$1,350.00

Service Code	HCPCS 31595
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$945.00
Rate for Payer: BCBS Complete	$540.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Priority Health Cigna Priority Health	$945.00
Rate for Payer: UMR Bronson Commercial	$621.00

PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE

Professional

Both

$641.00

Service Code	HCPCS 28153
Min. Negotiated Rate	$170.61
Max. Negotiated Rate	$988.45
Rate for Payer: Aetna Commercial	$347.52
Rate for Payer: BCBS Complete	$179.14
Rate for Payer: BCBS Trust/PPO	$988.45
Rate for Payer: Cash Price	$512.80
Rate for Payer: Cash Price	$512.80
Rate for Payer: Meridian Medicaid	$179.14
Rate for Payer: Priority Health Choice Medicaid	$170.61
Rate for Payer: Priority Health Cigna Priority Health	$448.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$401.37
Rate for Payer: Priority Health Narrow Network	$401.37
Rate for Payer: Priority Health SBD	$401.37
Rate for Payer: UMR Bronson Commercial	$294.86

PR RESECTION EXTERNAL CARDIAC TUMOR

Professional

Both

$4,553.00

Service Code	HCPCS 33130
Min. Negotiated Rate	$855.83
Max. Negotiated Rate	$3,187.10
Rate for Payer: Aetna Commercial	$1,832.84
Rate for Payer: BCBS Complete	$898.62
Rate for Payer: BCBS Trust/PPO	$1,069.28
Rate for Payer: Cash Price	$3,642.40
Rate for Payer: Cash Price	$3,642.40
Rate for Payer: Meridian Medicaid	$898.62
Rate for Payer: Priority Health Choice Medicaid	$855.83
Rate for Payer: Priority Health Cigna Priority Health	$3,187.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,132.09
Rate for Payer: Priority Health Narrow Network	$2,132.09
Rate for Payer: Priority Health SBD	$2,132.09
Rate for Payer: UMR Bronson Commercial	$2,094.38

PR RESECTION HUMERAL HEAD

Professional

Both

$1,613.00

Service Code	HCPCS 23195
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$1,143.34
Rate for Payer: Aetna Commercial	$996.87
Rate for Payer: BCBS Complete	$508.36
Rate for Payer: BCBS Trust/PPO	$20.80
Rate for Payer: Cash Price	$1,290.40
Rate for Payer: Cash Price	$1,290.40
Rate for Payer: Meridian Medicaid	$508.36
Rate for Payer: Priority Health Choice Medicaid	$484.15
Rate for Payer: Priority Health Cigna Priority Health	$1,129.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,143.34
Rate for Payer: Priority Health Narrow Network	$1,143.34
Rate for Payer: Priority Health SBD	$1,143.34
Rate for Payer: UMR Bronson Commercial	$741.98

PR RESECTION/INCISION SUBVALVULAR TISSUE

Professional

Both

$6,098.00

Service Code	HCPCS 33415
Min. Negotiated Rate	$642.41
Max. Negotiated Rate	$4,268.60
Rate for Payer: Aetna Commercial	$2,718.53
Rate for Payer: BCBS Complete	$1,333.41
Rate for Payer: BCBS Trust/PPO	$642.41
Rate for Payer: Cash Price	$4,878.40
Rate for Payer: Cash Price	$4,878.40
Rate for Payer: Meridian Medicaid	$1,333.41
Rate for Payer: Priority Health Choice Medicaid	$1,269.91
Rate for Payer: Priority Health Cigna Priority Health	$4,268.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,159.29
Rate for Payer: Priority Health Narrow Network	$3,159.29
Rate for Payer: Priority Health SBD	$3,159.29
Rate for Payer: UMR Bronson Commercial	$2,805.08

PR RESECTION MEDIASTINAL TUMOR

Professional

Both

$5,669.00

Service Code	HCPCS 39220
Min. Negotiated Rate	$718.02
Max. Negotiated Rate	$3,968.30
Rate for Payer: Aetna Commercial	$1,157.21
Rate for Payer: BCBS Complete	$753.92
Rate for Payer: BCBS Trust/PPO	$735.39
Rate for Payer: Cash Price	$4,535.20
Rate for Payer: Cash Price	$4,535.20
Rate for Payer: Meridian Medicaid	$753.92
Rate for Payer: Priority Health Choice Medicaid	$718.02
Rate for Payer: Priority Health Cigna Priority Health	$3,968.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,784.19
Rate for Payer: Priority Health Narrow Network	$1,784.19
Rate for Payer: Priority Health SBD	$1,784.19
Rate for Payer: UMR Bronson Commercial	$2,607.74

PR RESECTION OF MEDIASTINAL CYST

Professional

Both

$4,942.00

Service Code	HCPCS 39200
Min. Negotiated Rate	$549.54
Max. Negotiated Rate	$3,459.40
Rate for Payer: Aetna Commercial	$891.30
Rate for Payer: BCBS Complete	$577.02
Rate for Payer: BCBS Trust/PPO	$1,134.79
Rate for Payer: Cash Price	$3,953.60
Rate for Payer: Cash Price	$3,953.60
Rate for Payer: Meridian Medicaid	$577.02
Rate for Payer: Priority Health Choice Medicaid	$549.54
Rate for Payer: Priority Health Cigna Priority Health	$3,459.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,365.01
Rate for Payer: Priority Health Narrow Network	$1,365.01
Rate for Payer: Priority Health SBD	$1,365.01
Rate for Payer: UMR Bronson Commercial	$2,273.32

PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH

Professional

Both

$679.00

Service Code	HCPCS 28126
Min. Negotiated Rate	$162.09
Max. Negotiated Rate	$1,055.54
Rate for Payer: Aetna Commercial	$324.47
Rate for Payer: BCBS Complete	$170.19
Rate for Payer: BCBS Trust/PPO	$1,055.54
Rate for Payer: Cash Price	$543.20
Rate for Payer: Cash Price	$543.20
Rate for Payer: Meridian Medicaid	$170.19
Rate for Payer: Priority Health Choice Medicaid	$162.09
Rate for Payer: Priority Health Cigna Priority Health	$475.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$378.39
Rate for Payer: Priority Health Narrow Network	$378.39
Rate for Payer: Priority Health SBD	$378.39
Rate for Payer: UMR Bronson Commercial	$312.34

PR RESECTION PERICARDIAL CYST/TUMOR

Professional

Both

$2,813.00

Service Code	HCPCS 33050
Min. Negotiated Rate	$636.23
Max. Negotiated Rate	$1,969.10
Rate for Payer: Aetna Commercial	$1,346.58
Rate for Payer: BCBS Complete	$668.04
Rate for Payer: BCBS Trust/PPO	$1,037.58
Rate for Payer: Cash Price	$2,250.40
Rate for Payer: Cash Price	$2,250.40
Rate for Payer: Meridian Medicaid	$668.04
Rate for Payer: Priority Health Choice Medicaid	$636.23
Rate for Payer: Priority Health Cigna Priority Health	$1,969.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,577.26
Rate for Payer: Priority Health Narrow Network	$1,577.26
Rate for Payer: Priority Health SBD	$1,577.26
Rate for Payer: UMR Bronson Commercial	$1,293.98

PR RESECTION RIBS EXTRAPLEURAL ALL STAGES

Professional

Both

$3,082.00

Service Code	HCPCS 32900
Min. Negotiated Rate	$857.96
Max. Negotiated Rate	$2,157.40
Rate for Payer: Aetna Commercial	$1,838.39
Rate for Payer: BCBS Complete	$900.86
Rate for Payer: BCBS Trust/PPO	$924.00
Rate for Payer: Cash Price	$2,465.60
Rate for Payer: Cash Price	$2,465.60
Rate for Payer: Meridian Medicaid	$900.86
Rate for Payer: Priority Health Choice Medicaid	$857.96
Rate for Payer: Priority Health Cigna Priority Health	$2,157.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,953.59
Rate for Payer: Priority Health Narrow Network	$1,953.59
Rate for Payer: Priority Health SBD	$1,953.59
Rate for Payer: UMR Bronson Commercial	$1,417.72

PR RESECTION SCROTUM

Professional

Both

$1,555.00

Service Code	HCPCS 55150
Min. Negotiated Rate	$315.88
Max. Negotiated Rate	$2,291.77
Rate for Payer: Aetna Commercial	$631.01
Rate for Payer: BCBS Complete	$331.67
Rate for Payer: BCBS Trust/PPO	$2,291.77
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Meridian Medicaid	$331.67
Rate for Payer: Priority Health Choice Medicaid	$315.88
Rate for Payer: Priority Health Cigna Priority Health	$1,088.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$791.09
Rate for Payer: Priority Health Narrow Network	$791.09
Rate for Payer: Priority Health SBD	$791.09
Rate for Payer: UMR Bronson Commercial	$715.30

PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS

Professional

Both

$1,326.00

Service Code	HCPCS 23440
Min. Negotiated Rate	$134.57
Max. Negotiated Rate	$1,162.75
Rate for Payer: Aetna Commercial	$1,010.45
Rate for Payer: BCBS Complete	$514.62
Rate for Payer: BCBS Trust/PPO	$134.57
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Meridian Medicaid	$514.62
Rate for Payer: Priority Health Choice Medicaid	$490.11
Rate for Payer: Priority Health Cigna Priority Health	$928.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,162.75
Rate for Payer: Priority Health Narrow Network	$1,162.75
Rate for Payer: Priority Health SBD	$1,162.75
Rate for Payer: UMR Bronson Commercial	$609.96

PR RESPIRATORY FLOW VOLUME LOOP

Professional

Both

$110.00

Service Code	HCPCS 94375
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$2,149.65
Rate for Payer: Aetna Commercial	$41.36
Rate for Payer: BCBS Complete	$44.00
Rate for Payer: BCBS Trust/PPO	$2,149.65
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.86
Rate for Payer: Priority Health Narrow Network	$18.86
Rate for Payer: Priority Health SBD	$51.20
Rate for Payer: UMR Bronson Commercial	$50.60

PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E

Professional

Both

$3,618.00

Service Code	HCPCS 90378
Min. Negotiated Rate	$1,447.20
Max. Negotiated Rate	$2,532.60
Rate for Payer: Aetna Commercial	$1,857.07
Rate for Payer: BCBS Complete	$1,447.20
Rate for Payer: BCBS Trust/PPO	$1,700.79
Rate for Payer: Cash Price	$2,894.40
Rate for Payer: Cash Price	$2,894.40
Rate for Payer: Priority Health Cigna Priority Health	$2,532.60
Rate for Payer: UMR Bronson Commercial	$1,664.28

PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL

Professional

Both

$584.00

Service Code	HCPCS 37222
Min. Negotiated Rate	$114.59
Max. Negotiated Rate	$1,131.09
Rate for Payer: Aetna Commercial	$249.11
Rate for Payer: BCBS Complete	$120.32
Rate for Payer: BCBS Trust/PPO	$1,131.09
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Meridian Medicaid	$120.32
Rate for Payer: Priority Health Choice Medicaid	$114.59
Rate for Payer: Priority Health Cigna Priority Health	$408.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.72
Rate for Payer: Priority Health Narrow Network	$286.72
Rate for Payer: Priority Health SBD	$286.72
Rate for Payer: UMR Bronson Commercial	$268.64

PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL

Professional

Both

$950.00

Service Code	HCPCS 37220
Min. Negotiated Rate	$247.93
Max. Negotiated Rate	$665.00
Rate for Payer: Aetna Commercial	$538.63
Rate for Payer: BCBS Complete	$260.33
Rate for Payer: BCBS Trust/PPO	$463.32
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Meridian Medicaid	$260.33
Rate for Payer: Priority Health Choice Medicaid	$247.93
Rate for Payer: Priority Health Cigna Priority Health	$665.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$619.20
Rate for Payer: Priority Health Narrow Network	$619.20
Rate for Payer: Priority Health SBD	$619.20
Rate for Payer: UMR Bronson Commercial	$437.00

PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT

Professional

Both

$4,901.00

Service Code	HCPCS 24371
Min. Negotiated Rate	$413.46
Max. Negotiated Rate	$3,430.70
Rate for Payer: Aetna Commercial	$2,368.46
Rate for Payer: BCBS Complete	$1,186.91
Rate for Payer: BCBS Trust/PPO	$413.46
Rate for Payer: Cash Price	$3,920.80
Rate for Payer: Cash Price	$3,920.80
Rate for Payer: Meridian Medicaid	$1,186.91
Rate for Payer: Priority Health Choice Medicaid	$1,130.39
Rate for Payer: Priority Health Cigna Priority Health	$3,430.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,694.70
Rate for Payer: Priority Health Narrow Network	$2,694.70
Rate for Payer: Priority Health SBD	$2,694.70
Rate for Payer: UMR Bronson Commercial	$2,254.46

PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT

Professional

Both

$3,706.00

Service Code	HCPCS 24370
Min. Negotiated Rate	$355.73
Max. Negotiated Rate	$2,594.20
Rate for Payer: Aetna Commercial	$2,055.18
Rate for Payer: BCBS Complete	$1,033.04
Rate for Payer: BCBS Trust/PPO	$355.73
Rate for Payer: Cash Price	$2,964.80
Rate for Payer: Cash Price	$2,964.80
Rate for Payer: Meridian Medicaid	$1,033.04
Rate for Payer: Priority Health Choice Medicaid	$983.85
Rate for Payer: Priority Health Cigna Priority Health	$2,594.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,347.96
Rate for Payer: Priority Health Narrow Network	$2,347.96
Rate for Payer: Priority Health SBD	$2,347.96
Rate for Payer: UMR Bronson Commercial	$1,704.76

PR REVISION OF LARYNX, UNSPECIFIED

Professional

Both

$2,020.00

Service Code	HCPCS 31588
Min. Negotiated Rate	$808.00
Max. Negotiated Rate	$1,414.00
Rate for Payer: BCBS Complete	$808.00
Rate for Payer: Cash Price	$1,616.00
Rate for Payer: Priority Health Cigna Priority Health	$1,414.00
Rate for Payer: UMR Bronson Commercial	$929.20

PR REVISION OF RECONSTRUCTED BREAST

Professional

Both

$1,194.00

Service Code	HCPCS 19380
Min. Negotiated Rate	$517.80
Max. Negotiated Rate	$3,918.45
Rate for Payer: Aetna Commercial	$872.03
Rate for Payer: BCBS Complete	$543.69
Rate for Payer: BCBS Trust/PPO	$3,918.45
Rate for Payer: Cash Price	$955.20
Rate for Payer: Cash Price	$955.20
Rate for Payer: Meridian Medicaid	$543.69
Rate for Payer: Priority Health Choice Medicaid	$517.80
Rate for Payer: Priority Health Cigna Priority Health	$835.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$994.30
Rate for Payer: Priority Health Narrow Network	$994.30
Rate for Payer: Priority Health SBD	$994.30
Rate for Payer: UMR Bronson Commercial	$549.24

PR REVISION PERI-IMPLANT CAPSULE BREAST

Professional

Both

$1,220.00

Service Code	HCPCS 19370
Min. Negotiated Rate	$431.33
Max. Negotiated Rate	$2,189.70
Rate for Payer: Aetna Commercial	$723.37
Rate for Payer: BCBS Complete	$452.90
Rate for Payer: BCBS Trust/PPO	$2,189.70
Rate for Payer: Cash Price	$976.00
Rate for Payer: Cash Price	$976.00
Rate for Payer: Meridian Medicaid	$452.90
Rate for Payer: Priority Health Choice Medicaid	$431.33
Rate for Payer: Priority Health Cigna Priority Health	$854.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$827.01
Rate for Payer: Priority Health Narrow Network	$827.01
Rate for Payer: Priority Health SBD	$827.01
Rate for Payer: UMR Bronson Commercial	$561.20

PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC

Professional

Both

$1,580.00

Service Code	HCPCS 57426
Min. Negotiated Rate	$560.83
Max. Negotiated Rate	$1,235.64
Rate for Payer: Aetna Commercial	$1,034.70
Rate for Payer: BCBS Complete	$588.87
Rate for Payer: BCBS Trust/PPO	$628.68
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Meridian Medicaid	$588.87
Rate for Payer: Priority Health Choice Medicaid	$560.83
Rate for Payer: Priority Health Cigna Priority Health	$1,106.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,235.64
Rate for Payer: Priority Health Narrow Network	$1,235.64
Rate for Payer: Priority Health SBD	$1,235.64
Rate for Payer: UMR Bronson Commercial	$726.80

Know your out-of-pocket cost for care.

All Charges