Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR RNL EXPL X NECESSITATING OTH SPEC PX

Professional

Both

$2,465.00

Service Code	HCPCS 50010
Min. Negotiated Rate	$449.64
Max. Negotiated Rate	$3,137.57
Rate for Payer: Aetna Commercial	$951.04
Rate for Payer: BCBS Complete	$472.12
Rate for Payer: BCBS Trust/PPO	$3,137.57
Rate for Payer: Cash Price	$1,972.00
Rate for Payer: Cash Price	$1,972.00
Rate for Payer: Meridian Medicaid	$472.12
Rate for Payer: Priority Health Choice Medicaid	$449.64
Rate for Payer: Priority Health Cigna Priority Health	$1,725.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,197.43
Rate for Payer: Priority Health Narrow Network	$1,197.43
Rate for Payer: Priority Health SBD	$1,197.43
Rate for Payer: UMR Bronson Commercial	$1,133.90

PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY

Professional

Both

$1,359.00

Service Code	HCPCS 50575
Min. Negotiated Rate	$446.66
Max. Negotiated Rate	$1,123.94
Rate for Payer: Aetna Commercial	$915.90
Rate for Payer: BCBS Complete	$468.99
Rate for Payer: BCBS Trust/PPO	$838.41
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Meridian Medicaid	$468.99
Rate for Payer: Priority Health Choice Medicaid	$446.66
Rate for Payer: Priority Health Cigna Priority Health	$951.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,123.94
Rate for Payer: Priority Health Narrow Network	$1,123.94
Rate for Payer: Priority Health SBD	$1,123.94
Rate for Payer: UMR Bronson Commercial	$625.14

PR ROBOTIC SURGICAL SYSTEM

Professional

Both

$60.00

Service Code	HCPCS S2900
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$486.56
Rate for Payer: Aetna Commercial	$318.14
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$486.56
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UMR Bronson Commercial	$27.60

PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID

Professional

Both

$78.00

Service Code	HCPCS 95852
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$1,012.22
Rate for Payer: Aetna Commercial	$6.11
Rate for Payer: BCBS Complete	$3.58
Rate for Payer: BCBS Trust/PPO	$1,012.22
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Meridian Medicaid	$3.58
Rate for Payer: Priority Health Choice Medicaid	$3.41
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.18
Rate for Payer: Priority Health Narrow Network	$7.18
Rate for Payer: Priority Health SBD	$7.18
Rate for Payer: UMR Bronson Commercial	$35.88

PR ROPIVACAINE HCL INJECTION

Professional

Both

$4.00

Service Code	HCPCS J2795
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$0.08
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION

Professional

Both

$567.00

Service Code	HCPCS 35700
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$1,875.47
Rate for Payer: Aetna Commercial	$205.39
Rate for Payer: BCBS Complete	$98.86
Rate for Payer: BCBS Trust/PPO	$1,875.47
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Meridian Medicaid	$98.86
Rate for Payer: Priority Health Choice Medicaid	$94.15
Rate for Payer: Priority Health Cigna Priority Health	$396.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$234.59
Rate for Payer: Priority Health Narrow Network	$234.59
Rate for Payer: Priority Health SBD	$234.59
Rate for Payer: UMR Bronson Commercial	$260.82

PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ

Professional

Both

$1,670.00

Service Code	HCPCS 33530
Min. Negotiated Rate	$326.32
Max. Negotiated Rate	$1,169.00
Rate for Payer: Aetna Commercial	$707.24
Rate for Payer: BCBS Complete	$342.64
Rate for Payer: BCBS Trust/PPO	$357.13
Rate for Payer: Cash Price	$1,336.00
Rate for Payer: Cash Price	$1,336.00
Rate for Payer: Meridian Medicaid	$342.64
Rate for Payer: Priority Health Choice Medicaid	$326.32
Rate for Payer: Priority Health Cigna Priority Health	$1,169.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$814.96
Rate for Payer: Priority Health Narrow Network	$814.96
Rate for Payer: Priority Health SBD	$814.96
Rate for Payer: UMR Bronson Commercial	$768.20

PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO

Professional

Both

$310.00

Service Code	HCPCS 35390
Min. Negotiated Rate	$98.62
Max. Negotiated Rate	$601.21
Rate for Payer: Aetna Commercial	$214.00
Rate for Payer: BCBS Complete	$103.55
Rate for Payer: BCBS Trust/PPO	$601.21
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Meridian Medicaid	$103.55
Rate for Payer: Priority Health Choice Medicaid	$98.62
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$245.77
Rate for Payer: Priority Health Narrow Network	$245.77
Rate for Payer: Priority Health SBD	$245.77
Rate for Payer: UMR Bronson Commercial	$142.60

PR ROUT FOOT CARE PER VISIT

Professional

Both

$26.00

Service Code	HCPCS S0390
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$31.70
Rate for Payer: Aetna Commercial	$25.38
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$31.70
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: UMR Bronson Commercial	$11.96

PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB

Professional

Both

$3,949.00

Service Code	HCPCS 59610
Min. Negotiated Rate	$92.98
Max. Negotiated Rate	$3,555.00
Rate for Payer: Aetna Commercial	$2,150.00
Rate for Payer: BCBS Complete	$2,459.93
Rate for Payer: BCBS Trust/PPO	$92.98
Rate for Payer: Cash Price	$3,159.20
Rate for Payer: Cash Price	$3,159.20
Rate for Payer: Meridian Medicaid	$2,459.93
Rate for Payer: Priority Health Choice Medicaid	$2,342.79
Rate for Payer: Priority Health Cigna Priority Health	$2,764.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,555.00
Rate for Payer: Priority Health Narrow Network	$3,555.00
Rate for Payer: Priority Health SBD	$3,555.00
Rate for Payer: UMR Bronson Commercial	$1,816.54

PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC

Professional

Both

$4,238.00

Service Code	HCPCS 59618
Min. Negotiated Rate	$209.74
Max. Negotiated Rate	$3,795.33
Rate for Payer: Aetna Commercial	$2,150.00
Rate for Payer: BCBS Complete	$2,637.40
Rate for Payer: BCBS Trust/PPO	$209.74
Rate for Payer: Cash Price	$3,390.40
Rate for Payer: Cash Price	$3,390.40
Rate for Payer: Meridian Medicaid	$2,637.40
Rate for Payer: Priority Health Choice Medicaid	$2,511.81
Rate for Payer: Priority Health Cigna Priority Health	$2,966.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,795.33
Rate for Payer: Priority Health Narrow Network	$3,795.33
Rate for Payer: Priority Health SBD	$3,795.33
Rate for Payer: UMR Bronson Commercial	$1,949.48

PR RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST

Professional

Both

$2,489.00

Service Code	HCPCS 50840
Min. Negotiated Rate	$780.22
Max. Negotiated Rate	$4,261.27
Rate for Payer: Aetna Commercial	$1,579.43
Rate for Payer: BCBS Complete	$819.23
Rate for Payer: BCBS Trust/PPO	$4,261.27
Rate for Payer: Cash Price	$1,991.20
Rate for Payer: Cash Price	$1,991.20
Rate for Payer: Meridian Medicaid	$819.23
Rate for Payer: Priority Health Choice Medicaid	$780.22
Rate for Payer: Priority Health Cigna Priority Health	$1,742.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,957.17
Rate for Payer: Priority Health Narrow Network	$1,957.17
Rate for Payer: Priority Health SBD	$1,957.17
Rate for Payer: UMR Bronson Commercial	$1,144.94

PR RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS

Professional

Both

$9,500.00

Service Code	HCPCS 33411
Min. Negotiated Rate	$995.85
Max. Negotiated Rate	$6,650.00
Rate for Payer: Aetna Commercial	$4,508.90
Rate for Payer: BCBS Complete	$2,200.72
Rate for Payer: BCBS Trust/PPO	$995.85
Rate for Payer: Cash Price	$7,600.00
Rate for Payer: Cash Price	$7,600.00
Rate for Payer: Meridian Medicaid	$2,200.72
Rate for Payer: Priority Health Choice Medicaid	$2,095.92
Rate for Payer: Priority Health Cigna Priority Health	$6,650.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,219.03
Rate for Payer: Priority Health Narrow Network	$5,219.03
Rate for Payer: Priority Health SBD	$5,219.03
Rate for Payer: UMR Bronson Commercial	$4,370.00

PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND

Professional

Both

$6,713.00

Service Code	HCPCS 33406
Min. Negotiated Rate	$820.45
Max. Negotiated Rate	$4,699.10
Rate for Payer: Aetna Commercial	$3,869.40
Rate for Payer: BCBS Complete	$1,896.77
Rate for Payer: BCBS Trust/PPO	$820.45
Rate for Payer: Cash Price	$5,370.40
Rate for Payer: Cash Price	$5,370.40
Rate for Payer: Meridian Medicaid	$1,896.77
Rate for Payer: Priority Health Choice Medicaid	$1,806.45
Rate for Payer: Priority Health Cigna Priority Health	$4,699.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,493.98
Rate for Payer: Priority Health Narrow Network	$4,493.98
Rate for Payer: Priority Health SBD	$4,493.98
Rate for Payer: UMR Bronson Commercial	$3,087.98

PR RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE

Professional

Both

$7,968.00

Service Code	HCPCS 33410
Min. Negotiated Rate	$920.83
Max. Negotiated Rate	$5,577.60
Rate for Payer: Aetna Commercial	$3,414.07
Rate for Payer: BCBS Complete	$1,670.21
Rate for Payer: BCBS Trust/PPO	$920.83
Rate for Payer: Cash Price	$6,374.40
Rate for Payer: Cash Price	$6,374.40
Rate for Payer: Meridian Medicaid	$1,670.21
Rate for Payer: Priority Health Choice Medicaid	$1,590.68
Rate for Payer: Priority Health Cigna Priority Health	$5,577.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,961.49
Rate for Payer: Priority Health Narrow Network	$3,961.49
Rate for Payer: Priority Health SBD	$3,961.49
Rate for Payer: UMR Bronson Commercial	$3,665.28

PR RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL

Professional

Both

$4,934.00

Service Code	HCPCS 62143
Min. Negotiated Rate	$679.90
Max. Negotiated Rate	$3,453.80
Rate for Payer: Aetna Commercial	$1,349.48
Rate for Payer: BCBS Complete	$713.90
Rate for Payer: BCBS Trust/PPO	$2,064.60
Rate for Payer: Cash Price	$3,947.20
Rate for Payer: Cash Price	$3,947.20
Rate for Payer: Meridian Medicaid	$713.90
Rate for Payer: Priority Health Choice Medicaid	$679.90
Rate for Payer: Priority Health Cigna Priority Health	$3,453.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,793.23
Rate for Payer: Priority Health Narrow Network	$1,793.23
Rate for Payer: Priority Health SBD	$1,793.23
Rate for Payer: UMR Bronson Commercial	$2,269.64

PR RPLCMT CATH CTR VAD SUBQ PORT/PMP

Professional

Both

$1,004.00

Service Code	HCPCS 36578
Min. Negotiated Rate	$128.65
Max. Negotiated Rate	$1,318.11
Rate for Payer: Aetna Commercial	$269.73
Rate for Payer: BCBS Complete	$135.08
Rate for Payer: BCBS Trust/PPO	$1,318.11
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Meridian Medicaid	$135.08
Rate for Payer: Priority Health Choice Medicaid	$128.65
Rate for Payer: Priority Health Cigna Priority Health	$702.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$320.24
Rate for Payer: Priority Health Narrow Network	$320.24
Rate for Payer: Priority Health SBD	$320.24
Rate for Payer: UMR Bronson Commercial	$461.84

PR RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$756.00

Service Code	HCPCS 36580
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$1,034.41
Rate for Payer: Aetna Commercial	$87.94
Rate for Payer: BCBS Complete	$42.71
Rate for Payer: BCBS Trust/PPO	$1,034.41
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cash Price	$604.80
Rate for Payer: Meridian Medicaid	$42.71
Rate for Payer: Priority Health Choice Medicaid	$40.68
Rate for Payer: Priority Health Cigna Priority Health	$529.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.66
Rate for Payer: Priority Health Narrow Network	$102.66
Rate for Payer: Priority Health SBD	$102.66
Rate for Payer: UMR Bronson Commercial	$347.76

PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT

Professional

Both

$2,100.00

Service Code	HCPCS 36585
Min. Negotiated Rate	$175.73
Max. Negotiated Rate	$1,470.00
Rate for Payer: Aetna Commercial	$362.93
Rate for Payer: BCBS Complete	$184.52
Rate for Payer: BCBS Trust/PPO	$1,150.02
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Meridian Medicaid	$184.52
Rate for Payer: Priority Health Choice Medicaid	$175.73
Rate for Payer: Priority Health Cigna Priority Health	$1,470.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$442.05
Rate for Payer: Priority Health Narrow Network	$442.05
Rate for Payer: Priority Health SBD	$442.05
Rate for Payer: UMR Bronson Commercial	$966.00

PR RPLCMT COMPL TUN CTR VAD W/SUBQ PMP

Professional

Both

$1,907.00

Service Code	HCPCS 36583
Min. Negotiated Rate	$209.59
Max. Negotiated Rate	$1,556.37
Rate for Payer: Aetna Commercial	$440.96
Rate for Payer: BCBS Complete	$220.07
Rate for Payer: BCBS Trust/PPO	$1,556.37
Rate for Payer: Cash Price	$1,525.60
Rate for Payer: Cash Price	$1,525.60
Rate for Payer: Meridian Medicaid	$220.07
Rate for Payer: Priority Health Choice Medicaid	$209.59
Rate for Payer: Priority Health Cigna Priority Health	$1,334.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$519.73
Rate for Payer: Priority Health Narrow Network	$519.73
Rate for Payer: Priority Health SBD	$519.73
Rate for Payer: UMR Bronson Commercial	$877.22

PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT

Professional

Both

$553.00

Service Code	HCPCS 36582
Min. Negotiated Rate	$180.62
Max. Negotiated Rate	$2,421.20
Rate for Payer: Aetna Commercial	$384.84
Rate for Payer: BCBS Complete	$189.65
Rate for Payer: BCBS Trust/PPO	$2,421.20
Rate for Payer: Cash Price	$442.40
Rate for Payer: Cash Price	$442.40
Rate for Payer: Meridian Medicaid	$189.65
Rate for Payer: Priority Health Choice Medicaid	$180.62
Rate for Payer: Priority Health Cigna Priority Health	$387.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.56
Rate for Payer: Priority Health Narrow Network	$450.56
Rate for Payer: Priority Health SBD	$450.56
Rate for Payer: UMR Bronson Commercial	$254.38

PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$1,539.00

Service Code	HCPCS 36581
Min. Negotiated Rate	$114.59
Max. Negotiated Rate	$2,785.20
Rate for Payer: Aetna Commercial	$243.95
Rate for Payer: BCBS Complete	$120.32
Rate for Payer: BCBS Trust/PPO	$2,785.20
Rate for Payer: Cash Price	$1,231.20
Rate for Payer: Cash Price	$1,231.20
Rate for Payer: Meridian Medicaid	$120.32
Rate for Payer: Priority Health Choice Medicaid	$114.59
Rate for Payer: Priority Health Cigna Priority Health	$1,077.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.19
Rate for Payer: Priority Health Narrow Network	$286.19
Rate for Payer: Priority Health SBD	$286.19
Rate for Payer: UMR Bronson Commercial	$707.94

PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER

Professional

Both

$1,837.00

Service Code	HCPCS 62194
Min. Negotiated Rate	$323.97
Max. Negotiated Rate	$1,285.90
Rate for Payer: Aetna Commercial	$632.44
Rate for Payer: BCBS Complete	$340.17
Rate for Payer: BCBS Trust/PPO	$624.98
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Meridian Medicaid	$340.17
Rate for Payer: Priority Health Choice Medicaid	$323.97
Rate for Payer: Priority Health Cigna Priority Health	$1,285.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$851.59
Rate for Payer: Priority Health Narrow Network	$851.59
Rate for Payer: Priority Health SBD	$851.59
Rate for Payer: UMR Bronson Commercial	$845.02

PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT

Professional

Both

$2,222.00

Service Code	HCPCS 63744
Min. Negotiated Rate	$446.66
Max. Negotiated Rate	$1,555.40
Rate for Payer: Aetna Commercial	$885.80
Rate for Payer: BCBS Complete	$468.99
Rate for Payer: BCBS Trust/PPO	$672.00
Rate for Payer: Cash Price	$1,777.60
Rate for Payer: Cash Price	$1,777.60
Rate for Payer: Meridian Medicaid	$468.99
Rate for Payer: Priority Health Choice Medicaid	$446.66
Rate for Payer: Priority Health Cigna Priority Health	$1,555.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,168.68
Rate for Payer: Priority Health Narrow Network	$1,168.68
Rate for Payer: Priority Health SBD	$1,168.68
Rate for Payer: UMR Bronson Commercial	$1,022.12

PR RPLCMT/IRRIGATION VENTRICULAR CATHETER

Professional

Both

$2,672.00

Service Code	HCPCS 62225
Min. Negotiated Rate	$351.45
Max. Negotiated Rate	$1,870.40
Rate for Payer: Aetna Commercial	$682.40
Rate for Payer: BCBS Complete	$369.02
Rate for Payer: BCBS Trust/PPO	$1,401.05
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Meridian Medicaid	$369.02
Rate for Payer: Priority Health Choice Medicaid	$351.45
Rate for Payer: Priority Health Cigna Priority Health	$1,870.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$921.24
Rate for Payer: Priority Health Narrow Network	$921.24
Rate for Payer: Priority Health SBD	$921.24
Rate for Payer: UMR Bronson Commercial	$1,229.12

Know your out-of-pocket cost for care.

All Charges