Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT

Professional

Both

$1,333.00

Service Code	HCPCS 36228
Min. Negotiated Rate	$157.19
Max. Negotiated Rate	$933.10
Rate for Payer: Aetna Commercial	$325.23
Rate for Payer: BCBS Complete	$165.05
Rate for Payer: BCBS Trust/PPO	$761.81
Rate for Payer: Cash Price	$1,066.40
Rate for Payer: Cash Price	$1,066.40
Rate for Payer: Meridian Medicaid	$165.05
Rate for Payer: Priority Health Choice Medicaid	$157.19
Rate for Payer: Priority Health Cigna Priority Health	$933.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$386.20
Rate for Payer: Priority Health Narrow Network	$386.20
Rate for Payer: Priority Health SBD	$386.20
Rate for Payer: UMR Bronson Commercial	$613.18

PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART

Professional

Both

$1,233.00

Service Code	HCPCS 36224
Min. Negotiated Rate	$232.81
Max. Negotiated Rate	$1,419.54
Rate for Payer: Aetna Commercial	$484.13
Rate for Payer: BCBS Complete	$244.45
Rate for Payer: BCBS Trust/PPO	$1,419.54
Rate for Payer: Cash Price	$986.40
Rate for Payer: Cash Price	$986.40
Rate for Payer: Meridian Medicaid	$244.45
Rate for Payer: Priority Health Choice Medicaid	$232.81
Rate for Payer: Priority Health Cigna Priority Health	$863.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$576.11
Rate for Payer: Priority Health Narrow Network	$576.11
Rate for Payer: Priority Health SBD	$576.11
Rate for Payer: UMR Bronson Commercial	$567.18

PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH

Professional

Both

$2,298.00

Service Code	HCPCS 36216
Min. Negotiated Rate	$169.76
Max. Negotiated Rate	$1,608.60
Rate for Payer: Aetna Commercial	$363.29
Rate for Payer: BCBS Complete	$178.25
Rate for Payer: BCBS Trust/PPO	$1,102.56
Rate for Payer: Cash Price	$1,838.40
Rate for Payer: Cash Price	$1,838.40
Rate for Payer: Meridian Medicaid	$178.25
Rate for Payer: Priority Health Choice Medicaid	$169.76
Rate for Payer: Priority Health Cigna Priority Health	$1,608.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$420.25
Rate for Payer: Priority Health Narrow Network	$420.25
Rate for Payer: Priority Health SBD	$420.25
Rate for Payer: UMR Bronson Commercial	$1,057.08

PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH

Professional

Both

$1,022.00

Service Code	HCPCS 36246
Min. Negotiated Rate	$157.19
Max. Negotiated Rate	$1,388.37
Rate for Payer: Aetna Commercial	$340.06
Rate for Payer: BCBS Complete	$165.05
Rate for Payer: BCBS Trust/PPO	$1,388.37
Rate for Payer: Cash Price	$817.60
Rate for Payer: Cash Price	$817.60
Rate for Payer: Meridian Medicaid	$165.05
Rate for Payer: Priority Health Choice Medicaid	$157.19
Rate for Payer: Priority Health Cigna Priority Health	$715.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$389.92
Rate for Payer: Priority Health Narrow Network	$389.92
Rate for Payer: Priority Health SBD	$389.92
Rate for Payer: UMR Bronson Commercial	$470.12

PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH

Professional

Both

$1,278.00

Service Code	HCPCS 36247
Min. Negotiated Rate	$185.10
Max. Negotiated Rate	$1,650.94
Rate for Payer: Aetna Commercial	$402.83
Rate for Payer: BCBS Complete	$194.36
Rate for Payer: BCBS Trust/PPO	$1,650.94
Rate for Payer: Cash Price	$1,022.40
Rate for Payer: Cash Price	$1,022.40
Rate for Payer: Meridian Medicaid	$194.36
Rate for Payer: Priority Health Choice Medicaid	$185.10
Rate for Payer: Priority Health Cigna Priority Health	$894.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$462.81
Rate for Payer: Priority Health Narrow Network	$462.81
Rate for Payer: Priority Health SBD	$462.81
Rate for Payer: UMR Bronson Commercial	$587.88

PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH

Professional

Both

$1,350.00

Service Code	HCPCS 36217
Min. Negotiated Rate	$208.31
Max. Negotiated Rate	$1,410.56
Rate for Payer: Aetna Commercial	$438.91
Rate for Payer: BCBS Complete	$218.73
Rate for Payer: BCBS Trust/PPO	$1,410.56
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Meridian Medicaid	$218.73
Rate for Payer: Priority Health Choice Medicaid	$208.31
Rate for Payer: Priority Health Cigna Priority Health	$945.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$513.87
Rate for Payer: Priority Health Narrow Network	$513.87
Rate for Payer: Priority Health SBD	$513.87
Rate for Payer: UMR Bronson Commercial	$621.00

PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH

Professional

Both

$819.00

Service Code	HCPCS 36245
Min. Negotiated Rate	$146.54
Max. Negotiated Rate	$1,012.22
Rate for Payer: Aetna Commercial	$315.46
Rate for Payer: BCBS Complete	$153.87
Rate for Payer: BCBS Trust/PPO	$1,012.22
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cash Price	$655.20
Rate for Payer: Meridian Medicaid	$153.87
Rate for Payer: Priority Health Choice Medicaid	$146.54
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$365.46
Rate for Payer: Priority Health Narrow Network	$365.46
Rate for Payer: Priority Health SBD	$365.46
Rate for Payer: UMR Bronson Commercial	$376.74

PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH

Professional

Both

$900.00

Service Code	HCPCS 36215
Min. Negotiated Rate	$132.27
Max. Negotiated Rate	$781.36
Rate for Payer: Aetna Commercial	$283.13
Rate for Payer: BCBS Complete	$138.88
Rate for Payer: BCBS Trust/PPO	$781.36
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Meridian Medicaid	$138.88
Rate for Payer: Priority Health Choice Medicaid	$132.27
Rate for Payer: Priority Health Cigna Priority Health	$630.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$329.81
Rate for Payer: Priority Health Narrow Network	$329.81
Rate for Payer: Priority Health SBD	$329.81
Rate for Payer: UMR Bronson Commercial	$414.00

PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH

Professional

Both

$238.00

Service Code	HCPCS 36248
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$1,877.58
Rate for Payer: Aetna Commercial	$65.59
Rate for Payer: BCBS Complete	$31.31
Rate for Payer: BCBS Trust/PPO	$1,877.58
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Meridian Medicaid	$31.31
Rate for Payer: Priority Health Choice Medicaid	$29.82
Rate for Payer: Priority Health Cigna Priority Health	$166.60
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	$109.48

PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH

Professional

Both

$322.00

Service Code	HCPCS 36218
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$489.73
Rate for Payer: Aetna Commercial	$67.37
Rate for Payer: BCBS Complete	$34.44
Rate for Payer: BCBS Trust/PPO	$489.73
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Meridian Medicaid	$34.44
Rate for Payer: Priority Health Choice Medicaid	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.86
Rate for Payer: Priority Health Narrow Network	$80.86
Rate for Payer: Priority Health SBD	$80.86
Rate for Payer: UMR Bronson Commercial	$148.12

PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART

Professional

Both

$937.00

Service Code	HCPCS 36015
Min. Negotiated Rate	$106.29
Max. Negotiated Rate	$1,087.24
Rate for Payer: Aetna Commercial	$228.81
Rate for Payer: BCBS Complete	$111.60
Rate for Payer: BCBS Trust/PPO	$1,087.24
Rate for Payer: Cash Price	$749.60
Rate for Payer: Cash Price	$749.60
Rate for Payer: Meridian Medicaid	$111.60
Rate for Payer: Priority Health Choice Medicaid	$106.29
Rate for Payer: Priority Health Cigna Priority Health	$655.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.92
Rate for Payer: Priority Health Narrow Network	$264.92
Rate for Payer: Priority Health SBD	$264.92
Rate for Payer: UMR Bronson Commercial	$431.02

PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH

Professional

Both

$732.00

Service Code	HCPCS 36011
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$2,329.71
Rate for Payer: Aetna Commercial	$211.77
Rate for Payer: BCBS Complete	$101.77
Rate for Payer: BCBS Trust/PPO	$2,329.71
Rate for Payer: Cash Price	$585.60
Rate for Payer: Cash Price	$585.60
Rate for Payer: Meridian Medicaid	$101.77
Rate for Payer: Priority Health Choice Medicaid	$96.92
Rate for Payer: Priority Health Cigna Priority Health	$512.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$242.58
Rate for Payer: Priority Health Narrow Network	$242.58
Rate for Payer: Priority Health SBD	$242.58
Rate for Payer: UMR Bronson Commercial	$336.72

PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC

Professional

Both

$961.00

Service Code	HCPCS 36012
Min. Negotiated Rate	$107.99
Max. Negotiated Rate	$1,531.54
Rate for Payer: Aetna Commercial	$232.79
Rate for Payer: BCBS Complete	$113.39
Rate for Payer: BCBS Trust/PPO	$1,531.54
Rate for Payer: Cash Price	$768.80
Rate for Payer: Cash Price	$768.80
Rate for Payer: Meridian Medicaid	$113.39
Rate for Payer: Priority Health Choice Medicaid	$107.99
Rate for Payer: Priority Health Cigna Priority Health	$672.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.10
Rate for Payer: Priority Health Narrow Network	$268.10
Rate for Payer: Priority Health SBD	$268.10
Rate for Payer: UMR Bronson Commercial	$442.06

PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY

Professional

Both

$1,753.00

Service Code	HCPCS 36225
Min. Negotiated Rate	$205.55
Max. Negotiated Rate	$1,878.11
Rate for Payer: Aetna Commercial	$427.29
Rate for Payer: BCBS Complete	$215.83
Rate for Payer: BCBS Trust/PPO	$1,878.11
Rate for Payer: Cash Price	$1,402.40
Rate for Payer: Cash Price	$1,402.40
Rate for Payer: Meridian Medicaid	$215.83
Rate for Payer: Priority Health Choice Medicaid	$205.55
Rate for Payer: Priority Health Cigna Priority Health	$1,227.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$506.96
Rate for Payer: Priority Health Narrow Network	$506.96
Rate for Payer: Priority Health SBD	$506.96
Rate for Payer: UMR Bronson Commercial	$806.38

PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY

Professional

Both

$1,235.00

Service Code	HCPCS 36226
Min. Negotiated Rate	$231.32
Max. Negotiated Rate	$864.50
Rate for Payer: Aetna Commercial	$479.28
Rate for Payer: BCBS Complete	$242.89
Rate for Payer: BCBS Trust/PPO	$726.41
Rate for Payer: Cash Price	$988.00
Rate for Payer: Cash Price	$988.00
Rate for Payer: Meridian Medicaid	$242.89
Rate for Payer: Priority Health Choice Medicaid	$231.32
Rate for Payer: Priority Health Cigna Priority Health	$864.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$572.39
Rate for Payer: Priority Health Narrow Network	$572.39
Rate for Payer: Priority Health SBD	$572.39
Rate for Payer: UMR Bronson Commercial	$568.10

PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC

Professional

Both

$390.00

Service Code	HCPCS 36227
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$1,296.45
Rate for Payer: Aetna Commercial	$158.05
Rate for Payer: BCBS Complete	$80.06
Rate for Payer: BCBS Trust/PPO	$1,296.45
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Meridian Medicaid	$80.06
Rate for Payer: Priority Health Choice Medicaid	$76.25
Rate for Payer: Priority Health Cigna Priority Health	$273.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$188.31
Rate for Payer: Priority Health Narrow Network	$188.31
Rate for Payer: Priority Health SBD	$188.31
Rate for Payer: UMR Bronson Commercial	$179.40

PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT

Professional

Both

$146.00

Service Code	HCPCS 95806
Min. Negotiated Rate	$57.93
Max. Negotiated Rate	$410.49
Rate for Payer: Aetna Commercial	$106.13
Rate for Payer: Aetna Commercial	$106.13
Rate for Payer: BCBS Complete	$222.40
Rate for Payer: BCBS Complete	$58.40
Rate for Payer: BCBS Trust/PPO	$410.49
Rate for Payer: BCBS Trust/PPO	$410.49
Rate for Payer: Cash Price	$444.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$444.80
Rate for Payer: Priority Health Cigna Priority Health	$102.20
Rate for Payer: Priority Health Cigna Priority Health	$389.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.93
Rate for Payer: Priority Health Narrow Network	$57.93
Rate for Payer: Priority Health Narrow Network	$57.93
Rate for Payer: Priority Health SBD	$123.06
Rate for Payer: Priority Health SBD	$123.06
Rate for Payer: UMR Bronson Commercial	$67.16
Rate for Payer: UMR Bronson Commercial	$255.76

PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN

Professional

Both

$1,460.00

Service Code	HCPCS 95807
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$1,022.00
Rate for Payer: Aetna Commercial	$412.45
Rate for Payer: Aetna Commercial	$412.45
Rate for Payer: BCBS Complete	$58.00
Rate for Payer: BCBS Complete	$584.00
Rate for Payer: BCBS Trust/PPO	$78.19
Rate for Payer: BCBS Trust/PPO	$78.19
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$1,168.00
Rate for Payer: Cash Price	$1,168.00
Rate for Payer: Priority Health Cigna Priority Health	$1,022.00
Rate for Payer: Priority Health Cigna Priority Health	$101.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.70
Rate for Payer: Priority Health Narrow Network	$77.70
Rate for Payer: Priority Health Narrow Network	$77.70
Rate for Payer: Priority Health SBD	$518.76
Rate for Payer: Priority Health SBD	$518.76
Rate for Payer: UMR Bronson Commercial	$66.70
Rate for Payer: UMR Bronson Commercial	$671.60

PR SLING OPERATION STRESS INCONTINENCE

Professional

Both

$2,235.00

Service Code	HCPCS 57288
Min. Negotiated Rate	$477.55
Max. Negotiated Rate	$2,553.80
Rate for Payer: Aetna Commercial	$881.31
Rate for Payer: BCBS Complete	$501.43
Rate for Payer: BCBS Trust/PPO	$2,553.80
Rate for Payer: Cash Price	$1,788.00
Rate for Payer: Cash Price	$1,788.00
Rate for Payer: Meridian Medicaid	$501.43
Rate for Payer: Priority Health Choice Medicaid	$477.55
Rate for Payer: Priority Health Cigna Priority Health	$1,564.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,053.37
Rate for Payer: Priority Health Narrow Network	$1,053.37
Rate for Payer: Priority Health SBD	$1,053.37
Rate for Payer: UMR Bronson Commercial	$1,028.10

PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE

Professional

Both

$1,644.00

Service Code	HCPCS 53440
Min. Negotiated Rate	$479.25
Max. Negotiated Rate	$2,746.63
Rate for Payer: Aetna Commercial	$966.60
Rate for Payer: BCBS Complete	$503.21
Rate for Payer: BCBS Trust/PPO	$2,746.63
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Meridian Medicaid	$503.21
Rate for Payer: Priority Health Choice Medicaid	$479.25
Rate for Payer: Priority Health Cigna Priority Health	$1,150.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,200.67
Rate for Payer: Priority Health Narrow Network	$1,200.67
Rate for Payer: Priority Health SBD	$1,200.67
Rate for Payer: UMR Bronson Commercial	$756.24

PR SLINGS

Professional

Both

$12.00

Service Code	HCPCS A4565
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$8.40
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: UMR Bronson Commercial	$5.52

PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN

Professional

Both

$328.00

Service Code	HCPCS 54001
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$1,072.45
Rate for Payer: Aetna Commercial	$178.45
Rate for Payer: BCBS Complete	$94.60
Rate for Payer: BCBS Trust/PPO	$1,072.45
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Meridian Medicaid	$94.60
Rate for Payer: Priority Health Choice Medicaid	$90.10
Rate for Payer: Priority Health Cigna Priority Health	$229.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$224.79
Rate for Payer: Priority Health Narrow Network	$224.79
Rate for Payer: Priority Health SBD	$224.79
Rate for Payer: UMR Bronson Commercial	$150.88

PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME

Professional

Both

$300.00

Service Code	HCPCS 95800
Min. Negotiated Rate	$53.45
Max. Negotiated Rate	$545.73
Rate for Payer: Aetna Commercial	$173.67
Rate for Payer: Aetna Commercial	$173.67
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health Cigna Priority Health	$62.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.45
Rate for Payer: Priority Health Narrow Network	$53.45
Rate for Payer: Priority Health Narrow Network	$53.45
Rate for Payer: Priority Health SBD	$199.87
Rate for Payer: Priority Health SBD	$199.87
Rate for Payer: UMR Bronson Commercial	$138.00
Rate for Payer: UMR Bronson Commercial	$40.94

PR SMOKE/TOBACCO COUNSELNG 3-10

Professional

Both

$20.00

Service Code	HCPCS G0375
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: UMR Bronson Commercial	$9.20

PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM

Professional

Both

$300.00

Service Code	HCPCS 12002
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$517.72
Rate for Payer: Aetna Commercial	$64.58
Rate for Payer: BCBS Complete	$39.36
Rate for Payer: BCBS Trust/PPO	$517.72
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Meridian Medicaid	$39.36
Rate for Payer: Priority Health Choice Medicaid	$37.49
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.93
Rate for Payer: Priority Health Narrow Network	$71.93
Rate for Payer: Priority Health SBD	$71.93
Rate for Payer: UMR Bronson Commercial	$138.00

Know your out-of-pocket cost for care.

All Charges