Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

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: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

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: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75
Rate for Payer: UMR Bronson Commercial	$5.98

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: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

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: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

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: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

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: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

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: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

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: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

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: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00
Rate for Payer: UMR Bronson Commercial	$3.68

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: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

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: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES XTRPRTL PX LWR ABD W/UR TRACT ADRENALECTOMY

Professional

Both

$10.00

Service Code	HCPCS 00866
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RAD PRST8ECT

Professional

Both

$7.00

Service Code	HCPCS 00865
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RENAL PX

Professional

Both

$7.00

Service Code	HCPCS 00862
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RENAL TRANSPL

Professional

Both

$10.00

Service Code	HCPCS 00868
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANES XTRPRTL PX LWR ABD W/UR TRACT TOT CSTC

Professional

Both

$8.00

Service Code	HCPCS 00864
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES XTRPRTL PX LWR ABD W/UR TRC CYSTOLITHOTOMY

Professional

Both

$5.00

Service Code	HCPCS 00870
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANKLE CONTROL ORTHO PRE OTS

Professional

Both

$98.00

Service Code	HCPCS L4350
Min. Negotiated Rate	$38.78
Max. Negotiated Rate	$171.22
Rate for Payer: Aetna Commercial	$159.33
Rate for Payer: Aetna Medicare	$123.66
Rate for Payer: Aetna New Business (MI Preferred)	$171.22
Rate for Payer: Aetna New Business (MI Preferred)	$159.33
Rate for Payer: BCBS MAPPO	$118.90
Rate for Payer: BCN Commercial	$113.84
Rate for Payer: BCN Medicare Advantage	$118.90
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cofinity Commercial	$171.22
Rate for Payer: Cofinity Commercial	$159.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$118.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$124.84
Rate for Payer: Molina Medicare/Medicaid	$130.79
Rate for Payer: Nomi Health Commercial	$142.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.50
Rate for Payer: PACE SWMI	$118.90
Rate for Payer: PHP Commercial	$166.46
Rate for Payer: PHP Medicare Advantage	$118.90
Rate for Payer: Priority Health Medicare	$118.90
Rate for Payer: Railroad Medicare Medicare	$118.90
Rate for Payer: UHC All Payor (Choice/PPO)	$38.78
Rate for Payer: UHC Core	$38.78
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$118.90
Rate for Payer: UHC Exchange	$38.78
Rate for Payer: UMR Bronson Commercial	$45.08

PR ANKLE DISARTICULATION

Professional

Both

$1,376.00

Service Code	HCPCS 27889
Min. Negotiated Rate	$381.06
Max. Negotiated Rate	$1,139.98
Rate for Payer: Aetna Commercial	$794.51
Rate for Payer: Aetna Medicare	$616.64
Rate for Payer: Aetna New Business (MI Preferred)	$794.51
Rate for Payer: Aetna New Business (MI Preferred)	$853.80
Rate for Payer: BCBS Complete	$400.11
Rate for Payer: BCBS MAPPO	$592.92
Rate for Payer: BCN Commercial	$959.11
Rate for Payer: BCN Medicare Advantage	$592.92
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Cofinity Commercial	$794.51
Rate for Payer: Cofinity Commercial	$853.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$592.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$622.57
Rate for Payer: Meridian Medicaid	$400.11
Rate for Payer: Molina Medicare/Medicaid	$652.21
Rate for Payer: Nomi Health Commercial	$711.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,032.00
Rate for Payer: PACE SWMI	$592.92
Rate for Payer: PHP Commercial	$830.09
Rate for Payer: PHP Medicare Advantage	$592.92
Rate for Payer: Priority Health Choice Medicaid	$381.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,025.26
Rate for Payer: Priority Health Medicare	$592.92
Rate for Payer: Priority Health SBD	$1,025.26
Rate for Payer: Priority Health Tiered Network	$1,025.26
Rate for Payer: Railroad Medicare Medicare	$592.92
Rate for Payer: UHC All Payor (Choice/PPO)	$1,139.98
Rate for Payer: UHC Core	$1,139.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$592.92
Rate for Payer: UHC Exchange	$1,139.98
Rate for Payer: UHC Medicaid	$381.06
Rate for Payer: UHCCP Medicaid	$381.06
Rate for Payer: UMR Bronson Commercial	$632.96

PR ANN BREAST EXAM

Professional

Both

$21.00

Service Code	HCPCS S0613
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: Aetna New Business (MI Preferred)	$25.00
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCN Commercial	$19.15
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75
Rate for Payer: UMR Bronson Commercial	$9.66

PR ANNUAL GYNECOLOGICAL EXAMINA

Professional

Both

$83.00

Service Code	HCPCS S0612
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$65.39
Rate for Payer: Aetna Commercial	$55.00
Rate for Payer: Aetna Medicare	$41.50
Rate for Payer: Aetna New Business (MI Preferred)	$55.00
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: BCN Commercial	$65.39
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.25
Rate for Payer: UMR Bronson Commercial	$38.18

PR ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG

Professional

Both

$276.00

Service Code	HCPCS 99170
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare	$74.03
Rate for Payer: Aetna New Business (MI Preferred)	$102.50
Rate for Payer: Aetna New Business (MI Preferred)	$95.38
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCBS MAPPO	$71.18
Rate for Payer: BCN Commercial	$124.99
Rate for Payer: BCN Medicare Advantage	$71.18
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cofinity Commercial	$95.38
Rate for Payer: Cofinity Commercial	$102.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$71.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$74.74
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Molina Medicare/Medicaid	$78.30
Rate for Payer: Nomi Health Commercial	$85.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.00
Rate for Payer: PACE SWMI	$71.18
Rate for Payer: PHP Commercial	$99.65
Rate for Payer: PHP Medicare Advantage	$71.18
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$115.27
Rate for Payer: Priority Health Medicare	$71.18
Rate for Payer: Priority Health SBD	$115.27
Rate for Payer: Priority Health Tiered Network	$115.27
Rate for Payer: Railroad Medicare Medicare	$71.18
Rate for Payer: UHC All Payor (Choice/PPO)	$139.97
Rate for Payer: UHC Core	$139.97
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$71.18
Rate for Payer: UHC Exchange	$139.97
Rate for Payer: UHC Medicaid	$45.80
Rate for Payer: UHCCP Medicaid	$45.80
Rate for Payer: UMR Bronson Commercial	$126.96

PR ANOPLASTY PLASTIC OPERATION STRICTURE ADULT

Professional

Both

$1,389.00

Service Code	HCPCS 46700
Min. Negotiated Rate	$407.90
Max. Negotiated Rate	$1,205.62
Rate for Payer: Aetna Commercial	$835.13
Rate for Payer: Aetna Medicare	$648.16
Rate for Payer: Aetna New Business (MI Preferred)	$835.13
Rate for Payer: Aetna New Business (MI Preferred)	$897.45
Rate for Payer: BCBS Complete	$428.30
Rate for Payer: BCBS MAPPO	$623.23
Rate for Payer: BCN Commercial	$989.49
Rate for Payer: BCN Medicare Advantage	$623.23
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Cofinity Commercial	$835.13
Rate for Payer: Cofinity Commercial	$897.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$623.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$654.39
Rate for Payer: Meridian Medicaid	$428.30
Rate for Payer: Molina Medicare/Medicaid	$685.55
Rate for Payer: Nomi Health Commercial	$747.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,041.75
Rate for Payer: PACE SWMI	$623.23
Rate for Payer: PHP Commercial	$872.52
Rate for Payer: PHP Medicare Advantage	$623.23
Rate for Payer: Priority Health Choice Medicaid	$407.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,205.62
Rate for Payer: Priority Health Medicare	$623.23
Rate for Payer: Priority Health SBD	$1,205.62
Rate for Payer: Priority Health Tiered Network	$1,205.62
Rate for Payer: Railroad Medicare Medicare	$623.23
Rate for Payer: UHC All Payor (Choice/PPO)	$1,150.58
Rate for Payer: UHC Core	$1,150.58
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$623.23
Rate for Payer: UHC Exchange	$1,150.58
Rate for Payer: UHC Medicaid	$407.90
Rate for Payer: UHCCP Medicaid	$407.90
Rate for Payer: UMR Bronson Commercial	$638.94

PR ANOPLASTY PLASTIC OPERATION STRICTURE INFANT

Professional

Both

$1,468.00

Service Code	HCPCS 46705
Min. Negotiated Rate	$367.64
Max. Negotiated Rate	$1,101.00
Rate for Payer: Aetna Commercial	$752.16
Rate for Payer: Aetna Medicare	$583.76
Rate for Payer: Aetna New Business (MI Preferred)	$752.16
Rate for Payer: Aetna New Business (MI Preferred)	$808.29
Rate for Payer: BCBS Complete	$386.02
Rate for Payer: BCBS MAPPO	$561.31
Rate for Payer: BCN Commercial	$870.97
Rate for Payer: BCN Medicare Advantage	$561.31
Rate for Payer: Cash Price	$1,174.40
Rate for Payer: Cash Price	$1,174.40
Rate for Payer: Cofinity Commercial	$752.16
Rate for Payer: Cofinity Commercial	$808.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$561.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$589.38
Rate for Payer: Meridian Medicaid	$386.02
Rate for Payer: Molina Medicare/Medicaid	$617.44
Rate for Payer: Nomi Health Commercial	$673.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,101.00
Rate for Payer: PACE SWMI	$561.31
Rate for Payer: PHP Commercial	$785.83
Rate for Payer: PHP Medicare Advantage	$561.31
Rate for Payer: Priority Health Choice Medicaid	$367.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,061.22
Rate for Payer: Priority Health Medicare	$561.31
Rate for Payer: Priority Health SBD	$1,061.22
Rate for Payer: Priority Health Tiered Network	$1,061.22
Rate for Payer: Railroad Medicare Medicare	$561.31
Rate for Payer: UHC All Payor (Choice/PPO)	$988.02
Rate for Payer: UHC Core	$988.02
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$561.31
Rate for Payer: UHC Exchange	$988.02
Rate for Payer: UHC Medicaid	$367.64
Rate for Payer: UHCCP Medicaid	$367.64
Rate for Payer: UMR Bronson Commercial	$675.28

PR ANORECTAL MANOMETRY

Professional

Both

$405.00

Service Code	HCPCS 91122
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$406.85
Rate for Payer: Aetna Commercial	$290.91
Rate for Payer: Aetna Medicare	$202.50
Rate for Payer: Aetna New Business (MI Preferred)	$290.91
Rate for Payer: BCBS Complete	$162.00
Rate for Payer: BCN Commercial	$406.85
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$303.75
Rate for Payer: UMR Bronson Commercial	$186.30

Know your out-of-pocket cost for care.

All Charges