Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES

Professional

Both

$76.00

Service Code	HCPCS 99231
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$1,703.77
Rate for Payer: Aetna Commercial	$37.82
Rate for Payer: BCBS Complete	$32.88
Rate for Payer: BCBS Trust/PPO	$1,703.77
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Meridian Medicaid	$32.88
Rate for Payer: Priority Health Choice Medicaid	$31.31
Rate for Payer: Priority Health Cigna Priority Health	$53.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.96
Rate for Payer: Priority Health Narrow Network	$62.96
Rate for Payer: Priority Health SBD	$62.96
Rate for Payer: UMR Bronson Commercial	$34.96

PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES

Professional

Both

$200.00

Service Code	HCPCS 99310
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$500.83
Rate for Payer: Aetna Commercial	$131.98
Rate for Payer: BCBS Complete	$138.57
Rate for Payer: BCBS Trust/PPO	$500.83
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Meridian Medicaid	$138.57
Rate for Payer: Priority Health Choice Medicaid	$131.97
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.03
Rate for Payer: Priority Health Narrow Network	$194.03
Rate for Payer: Priority Health SBD	$194.03
Rate for Payer: UMR Bronson Commercial	$92.00

PR SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES

Professional

Both

$101.00

Service Code	HCPCS 99308
Min. Negotiated Rate	$46.46
Max. Negotiated Rate	$2,410.10
Rate for Payer: Aetna Commercial	$67.42
Rate for Payer: BCBS Complete	$67.17
Rate for Payer: BCBS Trust/PPO	$2,410.10
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Meridian Medicaid	$67.17
Rate for Payer: Priority Health Choice Medicaid	$63.97
Rate for Payer: Priority Health Cigna Priority Health	$70.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.05
Rate for Payer: Priority Health Narrow Network	$100.05
Rate for Payer: Priority Health SBD	$100.05
Rate for Payer: UMR Bronson Commercial	$46.46

PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES

Professional

Both

$134.00

Service Code	HCPCS 99309
Min. Negotiated Rate	$61.64
Max. Negotiated Rate	$323.85
Rate for Payer: Aetna Commercial	$88.90
Rate for Payer: BCBS Complete	$97.12
Rate for Payer: BCBS Trust/PPO	$323.85
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cash Price	$107.20
Rate for Payer: Meridian Medicaid	$97.12
Rate for Payer: Priority Health Choice Medicaid	$92.50
Rate for Payer: Priority Health Cigna Priority Health	$93.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$131.88
Rate for Payer: Priority Health Narrow Network	$131.88
Rate for Payer: Priority Health SBD	$131.88
Rate for Payer: UMR Bronson Commercial	$61.64

PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES

Professional

Both

$66.00

Service Code	HCPCS 99307
Min. Negotiated Rate	$30.36
Max. Negotiated Rate	$2,395.31
Rate for Payer: Aetna Commercial	$42.96
Rate for Payer: BCBS Complete	$36.31
Rate for Payer: BCBS Trust/PPO	$2,395.31
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Meridian Medicaid	$36.31
Rate for Payer: Priority Health Choice Medicaid	$34.58
Rate for Payer: Priority Health Cigna Priority Health	$46.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.12
Rate for Payer: Priority Health Narrow Network	$50.12
Rate for Payer: Priority Health SBD	$50.12
Rate for Payer: UMR Bronson Commercial	$30.36

PR SBSQ OBSERVATION CARE/DAY 15 MINUTES

Professional

Both

$83.00

Service Code	HCPCS 99224
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$58.10
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: Cash Price	$66.40
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: UMR Bronson Commercial	$38.18

PR SBSQ OBSERVATION CARE/DAY 25 MINUTES

Professional

Both

$147.00

Service Code	HCPCS 99225
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$102.90
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: Cash Price	$117.60
Rate for Payer: Priority Health Cigna Priority Health	$102.90
Rate for Payer: UMR Bronson Commercial	$67.62

PR SBSQ OBSERVATION CARE/DAY 35 MINUTES

Professional

Both

$220.00

Service Code	HCPCS 99226
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$154.00
Rate for Payer: BCBS Complete	$88.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Priority Health Cigna Priority Health	$154.00
Rate for Payer: UMR Bronson Commercial	$101.20

PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS

Professional

Both

$247.00

Service Code	HCPCS 99493
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$687.85
Rate for Payer: Aetna Commercial	$101.13
Rate for Payer: BCBS Complete	$68.22
Rate for Payer: BCBS Trust/PPO	$687.85
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Meridian Medicaid	$68.22
Rate for Payer: Priority Health Choice Medicaid	$64.97
Rate for Payer: Priority Health Cigna Priority Health	$172.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.29
Rate for Payer: Priority Health Narrow Network	$154.29
Rate for Payer: Priority Health SBD	$154.29
Rate for Payer: UMR Bronson Commercial	$113.62

PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID

Professional

Both

$2,223.00

Service Code	HCPCS 49185
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$1,556.10
Rate for Payer: Aetna Commercial	$158.18
Rate for Payer: BCBS Complete	$78.06
Rate for Payer: BCBS Trust/PPO	$585.36
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Meridian Medicaid	$78.06
Rate for Payer: Priority Health Choice Medicaid	$74.34
Rate for Payer: Priority Health Cigna Priority Health	$1,556.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.62
Rate for Payer: Priority Health Narrow Network	$204.62
Rate for Payer: Priority Health SBD	$204.62
Rate for Payer: UMR Bronson Commercial	$1,022.58

PR SCREENING PAP SMEAR BY PHYS

Professional

Both

$63.00

Service Code	HCPCS P3001
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$2,624.07
Rate for Payer: Aetna Commercial	$19.81
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCBS Trust/PPO	$2,624.07
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: UMR Bronson Commercial	$28.98

PR SCREENING PROCTOSCOPY

Professional

Both

$151.00

Service Code	HCPCS S0601
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$105.70
Rate for Payer: Aetna Commercial	$24.45
Rate for Payer: BCBS Complete	$60.40
Rate for Payer: BCBS Trust/PPO	$45.43
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Priority Health Cigna Priority Health	$105.70
Rate for Payer: UMR Bronson Commercial	$69.46

PR SCREENING TEST PURE TONE AIR ONLY

Professional

Both

$28.00

Service Code	HCPCS 92551
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$1,709.05
Rate for Payer: Aetna Commercial	$12.13
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$1,709.05
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.17
Rate for Payer: Priority Health Narrow Network	$16.17
Rate for Payer: Priority Health SBD	$16.17
Rate for Payer: UMR Bronson Commercial	$12.88

PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT

Professional

Both

$23.00

Service Code	HCPCS 99173
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$1,121.05
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$1,121.05
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.04
Rate for Payer: Priority Health Narrow Network	$4.04
Rate for Payer: Priority Health SBD	$4.04
Rate for Payer: UMR Bronson Commercial	$10.58

PR SCR MAMMO BI INCL CAD

Professional

Both

$203.00

Service Code	HCPCS G0202
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$142.10
Rate for Payer: BCBS Complete	$81.20
Rate for Payer: Cash Price	$162.40
Rate for Payer: Priority Health Cigna Priority Health	$142.10
Rate for Payer: UMR Bronson Commercial	$93.38

PR SCROTAL EXPLORATION

Professional

Both

$688.00

Service Code	HCPCS 55110
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$2,153.88
Rate for Payer: Aetna Commercial	$496.07
Rate for Payer: BCBS Complete	$261.45
Rate for Payer: BCBS Trust/PPO	$2,153.88
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Meridian Medicaid	$261.45
Rate for Payer: Priority Health Choice Medicaid	$249.00
Rate for Payer: Priority Health Cigna Priority Health	$481.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$622.49
Rate for Payer: Priority Health Narrow Network	$622.49
Rate for Payer: Priority Health SBD	$622.49
Rate for Payer: UMR Bronson Commercial	$316.48

PR SCROTOPLASTY COMPLICATED

Professional

Both

$1,386.00

Service Code	HCPCS 55180
Min. Negotiated Rate	$439.63
Max. Negotiated Rate	$1,956.82
Rate for Payer: Aetna Commercial	$887.31
Rate for Payer: BCBS Complete	$461.61
Rate for Payer: BCBS Trust/PPO	$1,956.82
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Meridian Medicaid	$461.61
Rate for Payer: Priority Health Choice Medicaid	$439.63
Rate for Payer: Priority Health Cigna Priority Health	$970.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,101.79
Rate for Payer: Priority Health Narrow Network	$1,101.79
Rate for Payer: Priority Health SBD	$1,101.79
Rate for Payer: UMR Bronson Commercial	$637.56

PR SCROTOPLASTY SIMPLE

Professional

Both

$671.00

Service Code	HCPCS 55175
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$1,287.47
Rate for Payer: Aetna Commercial	$466.37
Rate for Payer: BCBS Complete	$246.02
Rate for Payer: BCBS Trust/PPO	$1,287.47
Rate for Payer: Cash Price	$536.80
Rate for Payer: Cash Price	$536.80
Rate for Payer: Meridian Medicaid	$246.02
Rate for Payer: Priority Health Choice Medicaid	$234.30
Rate for Payer: Priority Health Cigna Priority Health	$469.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$586.29
Rate for Payer: Priority Health Narrow Network	$586.29
Rate for Payer: Priority Health SBD	$586.29
Rate for Payer: UMR Bronson Commercial	$308.66

PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN

Professional

Both

$2,300.00

Service Code	HCPCS 49900
Min. Negotiated Rate	$529.31
Max. Negotiated Rate	$4,854.55
Rate for Payer: Aetna Commercial	$1,096.92
Rate for Payer: BCBS Complete	$555.78
Rate for Payer: BCBS Trust/PPO	$4,854.55
Rate for Payer: Cash Price	$1,840.00
Rate for Payer: Cash Price	$1,840.00
Rate for Payer: Meridian Medicaid	$555.78
Rate for Payer: Priority Health Choice Medicaid	$529.31
Rate for Payer: Priority Health Cigna Priority Health	$1,610.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,444.65
Rate for Payer: Priority Health Narrow Network	$1,444.65
Rate for Payer: Priority Health SBD	$1,444.65
Rate for Payer: UMR Bronson Commercial	$1,058.00

PR SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC

Professional

Both

$1,757.00

Service Code	HCPCS 13160
Min. Negotiated Rate	$349.63
Max. Negotiated Rate	$1,229.90
Rate for Payer: Aetna Commercial	$864.74
Rate for Payer: BCBS Complete	$534.30
Rate for Payer: BCBS Trust/PPO	$349.63
Rate for Payer: Cash Price	$1,405.60
Rate for Payer: Cash Price	$1,405.60
Rate for Payer: Meridian Medicaid	$534.30
Rate for Payer: Priority Health Choice Medicaid	$508.86
Rate for Payer: Priority Health Cigna Priority Health	$1,229.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$976.22
Rate for Payer: Priority Health Narrow Network	$976.22
Rate for Payer: Priority Health SBD	$976.22
Rate for Payer: UMR Bronson Commercial	$808.22

PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ

Professional

Both

$4,480.00

Service Code	HCPCS 21275
Min. Negotiated Rate	$540.38
Max. Negotiated Rate	$3,205.12
Rate for Payer: Aetna Commercial	$1,121.53
Rate for Payer: BCBS Complete	$567.40
Rate for Payer: BCBS Trust/PPO	$3,205.12
Rate for Payer: Cash Price	$3,584.00
Rate for Payer: Cash Price	$3,584.00
Rate for Payer: Meridian Medicaid	$567.40
Rate for Payer: Priority Health Choice Medicaid	$540.38
Rate for Payer: Priority Health Cigna Priority Health	$3,136.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,290.93
Rate for Payer: Priority Health Narrow Network	$1,290.93
Rate for Payer: Priority Health SBD	$1,290.93
Rate for Payer: UMR Bronson Commercial	$2,060.80

PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT

Professional

Both

$6,167.00

Service Code	HCPCS 61618
Min. Negotiated Rate	$44.38
Max. Negotiated Rate	$4,316.90
Rate for Payer: Aetna Commercial	$1,666.10
Rate for Payer: BCBS Complete	$873.80
Rate for Payer: BCBS Trust/PPO	$44.38
Rate for Payer: Cash Price	$4,933.60
Rate for Payer: Cash Price	$4,933.60
Rate for Payer: Meridian Medicaid	$873.80
Rate for Payer: Priority Health Choice Medicaid	$832.19
Rate for Payer: Priority Health Cigna Priority Health	$4,316.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,201.47
Rate for Payer: Priority Health Narrow Network	$2,201.47
Rate for Payer: Priority Health SBD	$2,201.47
Rate for Payer: UMR Bronson Commercial	$2,836.82

PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL

Professional

Both

$2,516.84

Service Code	HCPCS 37186
Min. Negotiated Rate	$151.23
Max. Negotiated Rate	$1,761.79
Rate for Payer: Aetna Commercial	$328.32
Rate for Payer: BCBS Complete	$158.79
Rate for Payer: BCBS Trust/PPO	$1,049.73
Rate for Payer: Cash Price	$2,013.47
Rate for Payer: Cash Price	$2,013.47
Rate for Payer: Meridian Medicaid	$158.79
Rate for Payer: Priority Health Choice Medicaid	$151.23
Rate for Payer: Priority Health Cigna Priority Health	$1,761.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$376.09
Rate for Payer: Priority Health Narrow Network	$376.09
Rate for Payer: Priority Health SBD	$376.09
Rate for Payer: UMR Bronson Commercial	$1,157.75

PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP

Professional

Both

$9,744.00

Service Code	HCPCS 61619
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$6,820.80
Rate for Payer: Aetna Commercial	$1,797.22
Rate for Payer: BCBS Complete	$969.30
Rate for Payer: BCBS Trust/PPO	$18.49
Rate for Payer: Cash Price	$7,795.20
Rate for Payer: Cash Price	$7,795.20
Rate for Payer: Meridian Medicaid	$969.30
Rate for Payer: Priority Health Choice Medicaid	$923.14
Rate for Payer: Priority Health Cigna Priority Health	$6,820.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,435.33
Rate for Payer: Priority Health Narrow Network	$2,435.33
Rate for Payer: Priority Health SBD	$2,435.33
Rate for Payer: UMR Bronson Commercial	$4,482.24

PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES

Professional

Both

$55.00

Service Code	HCPCS 97535
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$88.75
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$88.75
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$25.30

Know your out-of-pocket cost for care.

All Charges