Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT

Professional

Both

$72.00

Service Code	HCPCS 31502
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$1,778.79
Rate for Payer: Aetna Commercial	$45.05
Rate for Payer: BCBS Complete	$23.26
Rate for Payer: BCBS Trust/PPO	$1,778.79
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Meridian Medicaid	$23.26
Rate for Payer: Priority Health Choice Medicaid	$22.15
Rate for Payer: Priority Health Cigna Priority Health	$50.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$48.15
Rate for Payer: Priority Health Narrow Network	$48.15
Rate for Payer: Priority Health SBD	$48.15
Rate for Payer: UMR Bronson Commercial	$33.12

PR TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I

Professional

Both

$1,358.00

Service Code	HCPCS 34712
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$1,464.98
Rate for Payer: Aetna Commercial	$882.07
Rate for Payer: BCBS Complete	$429.41
Rate for Payer: BCBS Trust/PPO	$1,464.98
Rate for Payer: Cash Price	$1,086.40
Rate for Payer: Cash Price	$1,086.40
Rate for Payer: Meridian Medicaid	$429.41
Rate for Payer: Priority Health Choice Medicaid	$408.96
Rate for Payer: Priority Health Cigna Priority Health	$950.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,019.77
Rate for Payer: Priority Health Narrow Network	$1,019.77
Rate for Payer: Priority Health SBD	$1,019.77
Rate for Payer: UMR Bronson Commercial	$624.68

PR TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE

Professional

Both

$5,554.00

Service Code	HCPCS 33366
Min. Negotiated Rate	$978.10
Max. Negotiated Rate	$3,887.80
Rate for Payer: Aetna Commercial	$2,113.97
Rate for Payer: BCBS Complete	$1,027.00
Rate for Payer: BCBS Trust/PPO	$1,001.66
Rate for Payer: Cash Price	$4,443.20
Rate for Payer: Cash Price	$4,443.20
Rate for Payer: Meridian Medicaid	$1,027.00
Rate for Payer: Priority Health Choice Medicaid	$978.10
Rate for Payer: Priority Health Cigna Priority Health	$3,887.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,442.75
Rate for Payer: Priority Health Narrow Network	$2,442.75
Rate for Payer: Priority Health SBD	$2,442.75
Rate for Payer: UMR Bronson Commercial	$2,554.84

PR TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR

Professional

Both

$1,598.00

Service Code	HCPCS 0387T
Min. Negotiated Rate	$639.20
Max. Negotiated Rate	$1,118.60
Rate for Payer: BCBS Complete	$639.20
Rate for Payer: Cash Price	$1,278.40
Rate for Payer: Priority Health Cigna Priority Health	$1,118.60
Rate for Payer: UMR Bronson Commercial	$735.08

PR TRANSCATH INTRO, STENT, EXCL COR, CAROT, VERT

Professional

Both

$117.00

Service Code	HCPCS 75960
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$81.90
Rate for Payer: BCBS Complete	$46.80
Rate for Payer: Cash Price	$93.60
Rate for Payer: Priority Health Cigna Priority Health	$81.90
Rate for Payer: UMR Bronson Commercial	$53.82

PR TRANSCATH OCCLUSION,PERCUT

Professional

Both

$1,820.00

Service Code	HCPCS 37204
Min. Negotiated Rate	$728.00
Max. Negotiated Rate	$1,274.00
Rate for Payer: BCBS Complete	$728.00
Rate for Payer: Cash Price	$1,456.00
Rate for Payer: Priority Health Cigna Priority Health	$1,274.00
Rate for Payer: UMR Bronson Commercial	$837.20

PR TRANSCATH RX INFUSE OTHER

Professional

Both

$1,607.00

Service Code	HCPCS 37202
Min. Negotiated Rate	$642.80
Max. Negotiated Rate	$1,124.90
Rate for Payer: BCBS Complete	$642.80
Rate for Payer: Cash Price	$1,285.60
Rate for Payer: Priority Health Cigna Priority Health	$1,124.90
Rate for Payer: UMR Bronson Commercial	$739.22

PR TRANSCATH STENT EACH ADDN VESSL,PERC

Professional

Both

$910.00

Service Code	HCPCS 37206
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$637.00
Rate for Payer: BCBS Complete	$364.00
Rate for Payer: Cash Price	$728.00
Rate for Payer: Priority Health Cigna Priority Health	$637.00
Rate for Payer: UMR Bronson Commercial	$418.60

PR TRANSCATH STENT INIT VESSEL,PERCUT

Professional

Both

$1,685.00

Service Code	HCPCS 37205
Min. Negotiated Rate	$674.00
Max. Negotiated Rate	$1,179.50
Rate for Payer: BCBS Complete	$674.00
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Priority Health Cigna Priority Health	$1,179.50
Rate for Payer: UMR Bronson Commercial	$775.10

PR TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART

Professional

Both

$4,430.00

Service Code	HCPCS 61596
Min. Negotiated Rate	$757.05
Max. Negotiated Rate	$4,141.36
Rate for Payer: Aetna Commercial	$3,130.65
Rate for Payer: BCBS Complete	$1,634.88
Rate for Payer: BCBS Trust/PPO	$757.05
Rate for Payer: Cash Price	$3,544.00
Rate for Payer: Cash Price	$3,544.00
Rate for Payer: Meridian Medicaid	$1,634.88
Rate for Payer: Priority Health Choice Medicaid	$1,557.03
Rate for Payer: Priority Health Cigna Priority Health	$3,101.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,141.36
Rate for Payer: Priority Health Narrow Network	$4,141.36
Rate for Payer: Priority Health SBD	$4,141.36
Rate for Payer: UMR Bronson Commercial	$2,037.80

PR TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ

Professional

Both

$662.00

Service Code	HCPCS 93893
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$531.34
Rate for Payer: Aetna Commercial	$176.86
Rate for Payer: BCBS Complete	$264.80
Rate for Payer: BCBS Trust/PPO	$346.04
Rate for Payer: Cash Price	$529.60
Rate for Payer: Cash Price	$529.60
Rate for Payer: Priority Health Cigna Priority Health	$463.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.05
Rate for Payer: Priority Health Narrow Network	$79.05
Rate for Payer: Priority Health SBD	$531.34
Rate for Payer: UMR Bronson Commercial	$304.52

PR TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT

Professional

Both

$121.00

Service Code	HCPCS 93892
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$477.58
Rate for Payer: Aetna Commercial	$176.14
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Trust/PPO	$477.58
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$84.70
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 SBD	$428.48
Rate for Payer: UMR Bronson Commercial	$55.66

PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL

Professional

Both

$620.00

Service Code	HCPCS 93886
Min. Negotiated Rate	$60.19
Max. Negotiated Rate	$434.00
Rate for Payer: Aetna Commercial	$293.15
Rate for Payer: Aetna Commercial	$293.15
Rate for Payer: BCBS Complete	$248.00
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: BCBS Trust/PPO	$362.41
Rate for Payer: BCBS Trust/PPO	$362.41
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: Priority Health Cigna Priority Health	$434.00
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.19
Rate for Payer: Priority Health Narrow Network	$60.19
Rate for Payer: Priority Health Narrow Network	$60.19
Rate for Payer: Priority Health SBD	$363.36
Rate for Payer: Priority Health SBD	$363.36
Rate for Payer: UMR Bronson Commercial	$52.90
Rate for Payer: UMR Bronson Commercial	$285.20

PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD

Professional

Both

$361.00

Service Code	HCPCS 93888
Min. Negotiated Rate	$33.24
Max. Negotiated Rate	$252.70
Rate for Payer: Aetna Commercial	$139.30
Rate for Payer: BCBS Complete	$144.40
Rate for Payer: BCBS Trust/PPO	$118.34
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cash Price	$288.80
Rate for Payer: Priority Health Cigna Priority Health	$252.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$33.24
Rate for Payer: Priority Health Narrow Network	$33.24
Rate for Payer: Priority Health SBD	$214.24
Rate for Payer: UMR Bronson Commercial	$166.06

PR TRANSECTION/AVULSION GREATER OCCIPITAL NERVE

Professional

Both

$850.00

Service Code	HCPCS 64744
Min. Negotiated Rate	$331.64
Max. Negotiated Rate	$870.29
Rate for Payer: Aetna Commercial	$643.70
Rate for Payer: BCBS Complete	$348.22
Rate for Payer: BCBS Trust/PPO	$864.83
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Meridian Medicaid	$348.22
Rate for Payer: Priority Health Choice Medicaid	$331.64
Rate for Payer: Priority Health Cigna Priority Health	$595.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$870.29
Rate for Payer: Priority Health Narrow Network	$870.29
Rate for Payer: Priority Health SBD	$870.29
Rate for Payer: UMR Bronson Commercial	$391.00

PR TRANSECTION/AVULSION OTH SPINAL NRV XDRL

Professional

Both

$1,281.00

Service Code	HCPCS 64772
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$954.09
Rate for Payer: Aetna Commercial	$720.45
Rate for Payer: BCBS Complete	$378.64
Rate for Payer: BCBS Trust/PPO	$267.32
Rate for Payer: Cash Price	$1,024.80
Rate for Payer: Cash Price	$1,024.80
Rate for Payer: Meridian Medicaid	$378.64
Rate for Payer: Priority Health Choice Medicaid	$360.61
Rate for Payer: Priority Health Cigna Priority Health	$896.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$954.09
Rate for Payer: Priority Health Narrow Network	$954.09
Rate for Payer: Priority Health SBD	$954.09
Rate for Payer: UMR Bronson Commercial	$589.26

PR TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL

Professional

Both

$1,040.00

Service Code	HCPCS 64760
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$886.70
Rate for Payer: Aetna Commercial	$671.50
Rate for Payer: BCBS Complete	$352.70
Rate for Payer: BCBS Trust/PPO	$244.60
Rate for Payer: Cash Price	$832.00
Rate for Payer: Cash Price	$832.00
Rate for Payer: Meridian Medicaid	$352.70
Rate for Payer: Priority Health Choice Medicaid	$335.90
Rate for Payer: Priority Health Cigna Priority Health	$728.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$886.70
Rate for Payer: Priority Health Narrow Network	$886.70
Rate for Payer: Priority Health SBD	$886.70
Rate for Payer: UMR Bronson Commercial	$478.40

PR TRANSFER ADDUCTOR ISCHIUM

Professional

Both

$2,605.00

Service Code	HCPCS 27098
Min. Negotiated Rate	$451.13
Max. Negotiated Rate	$1,823.50
Rate for Payer: Aetna Commercial	$926.87
Rate for Payer: BCBS Complete	$473.69
Rate for Payer: BCBS Trust/PPO	$1,106.26
Rate for Payer: Cash Price	$2,084.00
Rate for Payer: Cash Price	$2,084.00
Rate for Payer: Meridian Medicaid	$473.69
Rate for Payer: Priority Health Choice Medicaid	$451.13
Rate for Payer: Priority Health Cigna Priority Health	$1,823.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,072.36
Rate for Payer: Priority Health Narrow Network	$1,072.36
Rate for Payer: Priority Health SBD	$1,072.36
Rate for Payer: UMR Bronson Commercial	$1,198.30

PR TRANSFER ANY PEDICLE FLAP ANY LOCATION

Professional

Both

$723.00

Service Code	HCPCS 15650
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$506.10
Rate for Payer: Aetna Commercial	$403.21
Rate for Payer: BCBS Complete	$272.85
Rate for Payer: BCBS Trust/PPO	$75.69
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cash Price	$578.40
Rate for Payer: Meridian Medicaid	$272.85
Rate for Payer: Priority Health Choice Medicaid	$259.86
Rate for Payer: Priority Health Cigna Priority Health	$506.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$496.13
Rate for Payer: Priority Health Narrow Network	$496.13
Rate for Payer: Priority Health SBD	$496.13
Rate for Payer: UMR Bronson Commercial	$332.58

PR TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR

Professional

Both

$6,813.00

Service Code	HCPCS 27110
Min. Negotiated Rate	$626.01
Max. Negotiated Rate	$4,769.10
Rate for Payer: Aetna Commercial	$1,296.83
Rate for Payer: BCBS Complete	$657.31
Rate for Payer: BCBS Trust/PPO	$1,040.22
Rate for Payer: Cash Price	$5,450.40
Rate for Payer: Cash Price	$5,450.40
Rate for Payer: Meridian Medicaid	$657.31
Rate for Payer: Priority Health Choice Medicaid	$626.01
Rate for Payer: Priority Health Cigna Priority Health	$4,769.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,489.57
Rate for Payer: Priority Health Narrow Network	$1,489.57
Rate for Payer: Priority Health SBD	$1,489.57
Rate for Payer: UMR Bronson Commercial	$3,133.98

PR TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH

Professional

Both

$2,614.00

Service Code	HCPCS 26485
Min. Negotiated Rate	$541.02
Max. Negotiated Rate	$1,829.80
Rate for Payer: Aetna Commercial	$1,113.10
Rate for Payer: BCBS Complete	$568.07
Rate for Payer: BCBS Trust/PPO	$1,205.05
Rate for Payer: Cash Price	$2,091.20
Rate for Payer: Cash Price	$2,091.20
Rate for Payer: Meridian Medicaid	$568.07
Rate for Payer: Priority Health Choice Medicaid	$541.02
Rate for Payer: Priority Health Cigna Priority Health	$1,829.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,298.58
Rate for Payer: Priority Health Narrow Network	$1,298.58
Rate for Payer: Priority Health SBD	$1,298.58
Rate for Payer: UMR Bronson Commercial	$1,202.44

PR TRANSFUSION BLOOD/BLOOD COMPONENTS

Professional

Both

$82.00

Service Code	HCPCS 36430
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$795.09
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: BCBS Trust/PPO	$795.09
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$57.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.24
Rate for Payer: Priority Health Narrow Network	$62.24
Rate for Payer: Priority Health SBD	$62.24
Rate for Payer: UMR Bronson Commercial	$37.72

PR TRANSFUSION INTRAUTERINE FETAL

Professional

Both

$1,388.00

Service Code	HCPCS 36460
Min. Negotiated Rate	$218.11
Max. Negotiated Rate	$1,124.75
Rate for Payer: Aetna Commercial	$465.17
Rate for Payer: BCBS Complete	$229.02
Rate for Payer: BCBS Trust/PPO	$1,124.75
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Meridian Medicaid	$229.02
Rate for Payer: Priority Health Choice Medicaid	$218.11
Rate for Payer: Priority Health Cigna Priority Health	$971.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$544.20
Rate for Payer: Priority Health Narrow Network	$544.20
Rate for Payer: Priority Health SBD	$544.20
Rate for Payer: UMR Bronson Commercial	$638.48

PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE

Professional

Both

$347.00

Service Code	HCPCS 99496
Min. Negotiated Rate	$120.35
Max. Negotiated Rate	$242.90
Rate for Payer: Aetna Commercial	$194.16
Rate for Payer: BCBS Complete	$126.37
Rate for Payer: BCBS Trust/PPO	$204.98
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Meridian Medicaid	$126.37
Rate for Payer: Priority Health Choice Medicaid	$120.35
Rate for Payer: Priority Health Cigna Priority Health	$242.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$241.14
Rate for Payer: Priority Health Narrow Network	$241.14
Rate for Payer: Priority Health SBD	$241.14
Rate for Payer: UMR Bronson Commercial	$159.62

PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE

Professional

Both

$246.00

Service Code	HCPCS 99495
Min. Negotiated Rate	$88.61
Max. Negotiated Rate	$935.09
Rate for Payer: Aetna Commercial	$142.69
Rate for Payer: BCBS Complete	$93.04
Rate for Payer: BCBS Trust/PPO	$935.09
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Meridian Medicaid	$93.04
Rate for Payer: Priority Health Choice Medicaid	$88.61
Rate for Payer: Priority Health Cigna Priority Health	$172.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$176.89
Rate for Payer: Priority Health Narrow Network	$176.89
Rate for Payer: Priority Health SBD	$176.89
Rate for Payer: UMR Bronson Commercial	$113.16

Know your out-of-pocket cost for care.

All Charges