Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR SPONTANEOUS NYSTAGMUS TEST

Professional

Both

$50.00

Service Code	HCPCS 92541
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$1,875.99
Rate for Payer: Aetna Commercial	$27.79
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$1,875.99
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.85
Rate for Payer: Priority Health Narrow Network	$5.85
Rate for Payer: Priority Health SBD	$33.69
Rate for Payer: UMR Bronson Commercial	$23.00

PR SPORTS PHYSICAL

Professional

Both

$50.00

Service Code	HCPCS 00099
Hospital Revenue Code	960
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UMR Bronson Commercial	$23.00

PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS

Professional

Both

$1,190.00

Service Code	HCPCS 37765
Min. Negotiated Rate	$169.97
Max. Negotiated Rate	$833.00
Rate for Payer: Aetna Commercial	$362.87
Rate for Payer: BCBS Complete	$178.47
Rate for Payer: BCBS Trust/PPO	$463.85
Rate for Payer: Cash Price	$952.00
Rate for Payer: Cash Price	$952.00
Rate for Payer: Meridian Medicaid	$178.47
Rate for Payer: Priority Health Choice Medicaid	$169.97
Rate for Payer: Priority Health Cigna Priority Health	$833.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$423.43
Rate for Payer: Priority Health Narrow Network	$423.43
Rate for Payer: Priority Health SBD	$423.43
Rate for Payer: UMR Bronson Commercial	$547.40

PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS

Professional

Both

$1,225.00

Service Code	HCPCS 37766
Min. Negotiated Rate	$208.31
Max. Negotiated Rate	$857.50
Rate for Payer: Aetna Commercial	$444.13
Rate for Payer: BCBS Complete	$218.73
Rate for Payer: BCBS Trust/PPO	$327.02
Rate for Payer: Cash Price	$980.00
Rate for Payer: Cash Price	$980.00
Rate for Payer: Meridian Medicaid	$218.73
Rate for Payer: Priority Health Choice Medicaid	$208.31
Rate for Payer: Priority Health Cigna Priority Health	$857.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$518.12
Rate for Payer: Priority Health Narrow Network	$518.12
Rate for Payer: Priority Health SBD	$518.12
Rate for Payer: UMR Bronson Commercial	$563.50

PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA

Professional

Both

$1,709.00

Service Code	HCPCS 49220
Min. Negotiated Rate	$683.60
Max. Negotiated Rate	$1,196.30
Rate for Payer: BCBS Complete	$683.60
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Priority Health Cigna Priority Health	$1,196.30
Rate for Payer: UMR Bronson Commercial	$786.14

PR STANDARDIZED COGNITIVE PERFORMANCE TESTING

Professional

Both

$183.00

Service Code	HCPCS 96125
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$667.24
Rate for Payer: Aetna Commercial	$115.45
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Priority Health Cigna Priority Health	$128.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$136.99
Rate for Payer: Priority Health Narrow Network	$136.99
Rate for Payer: Priority Health SBD	$136.99
Rate for Payer: UMR Bronson Commercial	$84.18

PR STAPEDECTOMY/STAPEDOTOMY

Professional

Both

$1,668.00

Service Code	HCPCS 69660
Min. Negotiated Rate	$593.84
Max. Negotiated Rate	$1,545.81
Rate for Payer: Aetna Commercial	$1,052.44
Rate for Payer: BCBS Complete	$623.53
Rate for Payer: BCBS Trust/PPO	$1,545.81
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Meridian Medicaid	$623.53
Rate for Payer: Priority Health Choice Medicaid	$593.84
Rate for Payer: Priority Health Cigna Priority Health	$1,167.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,317.73
Rate for Payer: Priority Health Narrow Network	$1,317.73
Rate for Payer: Priority Health SBD	$1,317.73
Rate for Payer: UMR Bronson Commercial	$767.28

PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT

Professional

Both

$2,385.00

Service Code	HCPCS 69661
Min. Negotiated Rate	$773.40
Max. Negotiated Rate	$1,935.16
Rate for Payer: Aetna Commercial	$1,372.29
Rate for Payer: BCBS Complete	$812.07
Rate for Payer: BCBS Trust/PPO	$1,935.16
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Meridian Medicaid	$812.07
Rate for Payer: Priority Health Choice Medicaid	$773.40
Rate for Payer: Priority Health Cigna Priority Health	$1,669.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,716.11
Rate for Payer: Priority Health Narrow Network	$1,716.11
Rate for Payer: Priority Health SBD	$1,716.11
Rate for Payer: UMR Bronson Commercial	$1,097.10

PR STAPES MOBILIZATION

Professional

Both

$1,425.00

Service Code	HCPCS 69650
Min. Negotiated Rate	$516.95
Max. Negotiated Rate	$1,315.47
Rate for Payer: Aetna Commercial	$913.46
Rate for Payer: BCBS Complete	$542.80
Rate for Payer: BCBS Trust/PPO	$1,315.47
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Meridian Medicaid	$542.80
Rate for Payer: Priority Health Choice Medicaid	$516.95
Rate for Payer: Priority Health Cigna Priority Health	$997.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,145.17
Rate for Payer: Priority Health Narrow Network	$1,145.17
Rate for Payer: Priority Health SBD	$1,145.17
Rate for Payer: UMR Bronson Commercial	$655.50

PR STENGER TEST PURE TONE

Professional

Both

$31.00

Service Code	HCPCS 92565
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$1,644.60
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$1,644.60
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.95
Rate for Payer: Priority Health Narrow Network	$26.95
Rate for Payer: Priority Health SBD	$26.95
Rate for Payer: UMR Bronson Commercial	$14.26

PR STENGER TEST SPEECH

Professional

Both

$77.00

Service Code	HCPCS 92577
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$2,026.03
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: BCBS Trust/PPO	$2,026.03
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$53.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.40
Rate for Payer: Priority Health Narrow Network	$27.40
Rate for Payer: Priority Health SBD	$27.40
Rate for Payer: UMR Bronson Commercial	$35.42

PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR

Professional

Both

$565.00

Service Code	HCPCS 36908
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$1,924.07
Rate for Payer: Aetna Commercial	$278.21
Rate for Payer: BCBS Complete	$134.86
Rate for Payer: BCBS Trust/PPO	$1,924.07
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cash Price	$452.00
Rate for Payer: Meridian Medicaid	$134.86
Rate for Payer: Priority Health Choice Medicaid	$128.44
Rate for Payer: Priority Health Cigna Priority Health	$395.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$319.70
Rate for Payer: Priority Health Narrow Network	$319.70
Rate for Payer: Priority Health SBD	$319.70
Rate for Payer: UMR Bronson Commercial	$259.90

PR STEREOSCOPIC X-RAY GUIDANCE

Professional

Both

$49.00

Service Code	HCPCS G6002
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$590.64
Rate for Payer: Aetna Commercial	$85.81
Rate for Payer: Aetna Commercial	$85.81
Rate for Payer: BCBS Complete	$13.64
Rate for Payer: BCBS Complete	$13.64
Rate for Payer: BCBS Trust/PPO	$590.64
Rate for Payer: BCBS Trust/PPO	$590.64
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$113.60
Rate for Payer: Meridian Medicaid	$13.64
Rate for Payer: Meridian Medicaid	$13.64
Rate for Payer: Priority Health Choice Medicaid	$12.99
Rate for Payer: Priority Health Choice Medicaid	$12.99
Rate for Payer: Priority Health Cigna Priority Health	$34.30
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.24
Rate for Payer: Priority Health Narrow Network	$31.24
Rate for Payer: Priority Health Narrow Network	$31.24
Rate for Payer: Priority Health SBD	$114.22
Rate for Payer: Priority Health SBD	$114.22
Rate for Payer: UMR Bronson Commercial	$65.32
Rate for Payer: UMR Bronson Commercial	$22.54

PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES

Professional

Both

$2,917.88

Service Code	HCPCS 61750
Min. Negotiated Rate	$662.49
Max. Negotiated Rate	$2,409.85
Rate for Payer: Aetna Commercial	$1,819.17
Rate for Payer: BCBS Complete	$960.80
Rate for Payer: BCBS Trust/PPO	$662.49
Rate for Payer: Cash Price	$2,334.30
Rate for Payer: Cash Price	$2,334.30
Rate for Payer: Meridian Medicaid	$960.80
Rate for Payer: Priority Health Choice Medicaid	$915.05
Rate for Payer: Priority Health Cigna Priority Health	$2,042.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,409.85
Rate for Payer: Priority Health Narrow Network	$2,409.85
Rate for Payer: Priority Health SBD	$2,409.85
Rate for Payer: UMR Bronson Commercial	$1,342.22

PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL

Professional

Both

$728.00

Service Code	HCPCS 61783
Min. Negotiated Rate	$147.61
Max. Negotiated Rate	$707.92
Rate for Payer: Aetna Commercial	$300.82
Rate for Payer: BCBS Complete	$154.99
Rate for Payer: BCBS Trust/PPO	$707.92
Rate for Payer: Cash Price	$582.40
Rate for Payer: Cash Price	$582.40
Rate for Payer: Meridian Medicaid	$154.99
Rate for Payer: Priority Health Choice Medicaid	$147.61
Rate for Payer: Priority Health Cigna Priority Health	$509.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$391.26
Rate for Payer: Priority Health Narrow Network	$391.26
Rate for Payer: Priority Health SBD	$391.26
Rate for Payer: UMR Bronson Commercial	$334.88

PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES

Professional

Both

$8,153.00

Service Code	HCPCS 61798
Min. Negotiated Rate	$896.73
Max. Negotiated Rate	$5,707.10
Rate for Payer: Aetna Commercial	$1,782.51
Rate for Payer: BCBS Complete	$941.57
Rate for Payer: BCBS Trust/PPO	$1,623.47
Rate for Payer: Cash Price	$6,522.40
Rate for Payer: Cash Price	$6,522.40
Rate for Payer: Meridian Medicaid	$941.57
Rate for Payer: Priority Health Choice Medicaid	$896.73
Rate for Payer: Priority Health Cigna Priority Health	$5,707.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,360.02
Rate for Payer: Priority Health Narrow Network	$2,360.02
Rate for Payer: Priority Health SBD	$2,360.02
Rate for Payer: UMR Bronson Commercial	$3,750.38

PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES

Professional

Both

$8,153.00

Service Code	HCPCS 61796
Min. Negotiated Rate	$663.50
Max. Negotiated Rate	$5,707.10
Rate for Payer: Aetna Commercial	$1,312.22
Rate for Payer: BCBS Complete	$696.68
Rate for Payer: BCBS Trust/PPO	$828.90
Rate for Payer: Cash Price	$6,522.40
Rate for Payer: Cash Price	$6,522.40
Rate for Payer: Meridian Medicaid	$696.68
Rate for Payer: Priority Health Choice Medicaid	$663.50
Rate for Payer: Priority Health Cigna Priority Health	$5,707.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,745.66
Rate for Payer: Priority Health Narrow Network	$1,745.66
Rate for Payer: Priority Health SBD	$1,745.66
Rate for Payer: UMR Bronson Commercial	$3,750.38

PR STEREOTACTIC RADIOSURGERY 1 SPINAL LESION

Professional

Both

$2,290.00

Service Code	HCPCS 63620
Min. Negotiated Rate	$733.15
Max. Negotiated Rate	$1,929.70
Rate for Payer: Aetna Commercial	$1,450.25
Rate for Payer: BCBS Complete	$769.81
Rate for Payer: BCBS Trust/PPO	$1,093.05
Rate for Payer: Cash Price	$1,832.00
Rate for Payer: Cash Price	$1,832.00
Rate for Payer: Meridian Medicaid	$769.81
Rate for Payer: Priority Health Choice Medicaid	$733.15
Rate for Payer: Priority Health Cigna Priority Health	$1,603.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,929.70
Rate for Payer: Priority Health Narrow Network	$1,929.70
Rate for Payer: Priority Health SBD	$1,929.70
Rate for Payer: UMR Bronson Commercial	$1,053.40

PR STERILE SALINE OR WATER

Professional

Both

$2.00

Service Code	HCPCS A4218
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna Commercial	$1.75
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.40
Rate for Payer: UMR Bronson Commercial	$0.92

PR STERNAL DEBRIDEMENT

Professional

Both

$4,067.00

Service Code	HCPCS 21627
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$2,846.90
Rate for Payer: Aetna Commercial	$720.59
Rate for Payer: BCBS Complete	$369.92
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Meridian Medicaid	$369.92
Rate for Payer: Priority Health Choice Medicaid	$352.30
Rate for Payer: Priority Health Cigna Priority Health	$2,846.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$834.41
Rate for Payer: Priority Health Narrow Network	$834.41
Rate for Payer: Priority Health SBD	$834.41
Rate for Payer: UMR Bronson Commercial	$1,870.82

PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY

Professional

Both

$1,120.00

Service Code	HCPCS 59525
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$530.07
Rate for Payer: BCBS Complete	$322.95
Rate for Payer: BCBS Trust/PPO	$106.19
Rate for Payer: Cash Price	$896.00
Rate for Payer: Cash Price	$896.00
Rate for Payer: Meridian Medicaid	$322.95
Rate for Payer: Priority Health Choice Medicaid	$307.57
Rate for Payer: Priority Health Cigna Priority Health	$784.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$678.51
Rate for Payer: Priority Health Narrow Network	$678.51
Rate for Payer: Priority Health SBD	$678.51
Rate for Payer: UMR Bronson Commercial	$515.20

PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC

Professional

Both

$1,417.00

Service Code	HCPCS 67311
Min. Negotiated Rate	$288.62
Max. Negotiated Rate	$991.90
Rate for Payer: Aetna Commercial	$775.15
Rate for Payer: BCBS Complete	$303.05
Rate for Payer: BCBS Trust/PPO	$310.11
Rate for Payer: Cash Price	$1,133.60
Rate for Payer: Cash Price	$1,133.60
Rate for Payer: Meridian Medicaid	$303.05
Rate for Payer: Priority Health Choice Medicaid	$288.62
Rate for Payer: Priority Health Cigna Priority Health	$991.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$783.88
Rate for Payer: Priority Health Narrow Network	$783.88
Rate for Payer: Priority Health SBD	$783.88
Rate for Payer: UMR Bronson Commercial	$651.82

PR STRAIGHT TIP URINE CATHETER

Professional

Both

$10.00

Service Code	HCPCS A4351
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

PR STRAPPING ANKLE &/FOOT

Professional

Both

$69.00

Service Code	HCPCS 29540
Min. Negotiated Rate	$10.86
Max. Negotiated Rate	$984.22
Rate for Payer: Aetna Commercial	$24.08
Rate for Payer: BCBS Complete	$11.40
Rate for Payer: BCBS Trust/PPO	$984.22
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Meridian Medicaid	$11.40
Rate for Payer: Priority Health Choice Medicaid	$10.86
Rate for Payer: Priority Health Cigna Priority Health	$48.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.55
Rate for Payer: Priority Health Narrow Network	$26.55
Rate for Payer: Priority Health SBD	$26.55
Rate for Payer: UMR Bronson Commercial	$31.74

PR STRAPPING ELBOW/WRIST

Professional

Both

$58.00

Service Code	HCPCS 29260
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$1,354.56
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: BCBS Complete	$12.53
Rate for Payer: BCBS Trust/PPO	$1,354.56
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Meridian Medicaid	$12.53
Rate for Payer: Priority Health Choice Medicaid	$11.93
Rate for Payer: Priority Health Cigna Priority Health	$40.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.11
Rate for Payer: Priority Health Narrow Network	$29.11
Rate for Payer: Priority Health SBD	$29.11
Rate for Payer: UMR Bronson Commercial	$26.68

Know your out-of-pocket cost for care.

All Charges