Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI

Professional

Both

$114.00

Service Code	HCPCS 75962
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$79.80
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Priority Health Cigna Priority Health	$79.80
Rate for Payer: UMR Bronson Commercial	$52.44

PR TRANSMASTOID ANTROTOMY

Professional

Both

$1,745.00

Service Code	HCPCS 69501
Min. Negotiated Rate	$457.10
Max. Negotiated Rate	$3,498.40
Rate for Payer: Aetna Commercial	$813.51
Rate for Payer: BCBS Complete	$479.96
Rate for Payer: BCBS Trust/PPO	$3,498.40
Rate for Payer: Cash Price	$1,396.00
Rate for Payer: Cash Price	$1,396.00
Rate for Payer: Meridian Medicaid	$479.96
Rate for Payer: Priority Health Choice Medicaid	$457.10
Rate for Payer: Priority Health Cigna Priority Health	$1,221.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,012.70
Rate for Payer: Priority Health Narrow Network	$1,012.70
Rate for Payer: Priority Health SBD	$1,012.70
Rate for Payer: UMR Bronson Commercial	$802.70

PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION

Professional

Both

$2,220.00

Service Code	HCPCS 25931
Min. Negotiated Rate	$125.23
Max. Negotiated Rate	$1,554.00
Rate for Payer: Aetna Commercial	$1,057.63
Rate for Payer: BCBS Complete	$542.36
Rate for Payer: BCBS Trust/PPO	$125.23
Rate for Payer: Cash Price	$1,776.00
Rate for Payer: Cash Price	$1,776.00
Rate for Payer: Meridian Medicaid	$542.36
Rate for Payer: Priority Health Choice Medicaid	$516.53
Rate for Payer: Priority Health Cigna Priority Health	$1,554.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,238.83
Rate for Payer: Priority Health Narrow Network	$1,238.83
Rate for Payer: Priority Health SBD	$1,238.83
Rate for Payer: UMR Bronson Commercial	$1,021.20

PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ

Professional

Both

$1,046.00

Service Code	HCPCS 25929
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$925.30
Rate for Payer: Aetna Commercial	$799.06
Rate for Payer: BCBS Complete	$409.50
Rate for Payer: BCBS Trust/PPO	$2.55
Rate for Payer: Cash Price	$836.80
Rate for Payer: Cash Price	$836.80
Rate for Payer: Meridian Medicaid	$409.50
Rate for Payer: Priority Health Choice Medicaid	$390.00
Rate for Payer: Priority Health Cigna Priority Health	$732.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$925.30
Rate for Payer: Priority Health Narrow Network	$925.30
Rate for Payer: Priority Health SBD	$925.30
Rate for Payer: UMR Bronson Commercial	$481.16

PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX

Professional

Both

$570.00

Service Code	HCPCS 33141
Min. Negotiated Rate	$82.22
Max. Negotiated Rate	$1,088.30
Rate for Payer: Aetna Commercial	$178.18
Rate for Payer: BCBS Complete	$86.33
Rate for Payer: BCBS Trust/PPO	$1,088.30
Rate for Payer: Cash Price	$456.00
Rate for Payer: Cash Price	$456.00
Rate for Payer: Meridian Medicaid	$86.33
Rate for Payer: Priority Health Choice Medicaid	$82.22
Rate for Payer: Priority Health Cigna Priority Health	$399.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.81
Rate for Payer: Priority Health Narrow Network	$204.81
Rate for Payer: Priority Health SBD	$204.81
Rate for Payer: UMR Bronson Commercial	$262.20

PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR

Professional

Both

$2,425.00

Service Code	HCPCS 63057
Min. Negotiated Rate	$204.91
Max. Negotiated Rate	$1,697.50
Rate for Payer: Aetna Commercial	$415.78
Rate for Payer: BCBS Complete	$215.16
Rate for Payer: BCBS Trust/PPO	$543.09
Rate for Payer: Cash Price	$1,940.00
Rate for Payer: Cash Price	$1,940.00
Rate for Payer: Meridian Medicaid	$215.16
Rate for Payer: Priority Health Choice Medicaid	$204.91
Rate for Payer: Priority Health Cigna Priority Health	$1,697.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$542.44
Rate for Payer: Priority Health Narrow Network	$542.44
Rate for Payer: Priority Health SBD	$542.44
Rate for Payer: UMR Bronson Commercial	$1,115.50

PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR

Professional

Both

$6,935.00

Service Code	HCPCS 63056
Min. Negotiated Rate	$545.21
Max. Negotiated Rate	$4,854.50
Rate for Payer: Aetna Commercial	$1,927.37
Rate for Payer: BCBS Complete	$1,010.45
Rate for Payer: BCBS Trust/PPO	$545.21
Rate for Payer: Cash Price	$5,548.00
Rate for Payer: Cash Price	$5,548.00
Rate for Payer: Meridian Medicaid	$1,010.45
Rate for Payer: Priority Health Choice Medicaid	$962.33
Rate for Payer: Priority Health Cigna Priority Health	$4,854.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,542.35
Rate for Payer: Priority Health Narrow Network	$2,542.35
Rate for Payer: Priority Health SBD	$2,542.35
Rate for Payer: UMR Bronson Commercial	$3,190.10

PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC

Professional

Both

$7,309.00

Service Code	HCPCS 63055
Min. Negotiated Rate	$470.19
Max. Negotiated Rate	$5,116.30
Rate for Payer: Aetna Commercial	$2,102.90
Rate for Payer: BCBS Complete	$1,104.38
Rate for Payer: BCBS Trust/PPO	$470.19
Rate for Payer: Cash Price	$5,847.20
Rate for Payer: Cash Price	$5,847.20
Rate for Payer: Meridian Medicaid	$1,104.38
Rate for Payer: Priority Health Choice Medicaid	$1,051.79
Rate for Payer: Priority Health Cigna Priority Health	$5,116.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,774.49
Rate for Payer: Priority Health Narrow Network	$2,774.49
Rate for Payer: Priority Health SBD	$2,774.49
Rate for Payer: UMR Bronson Commercial	$3,362.14

PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX

Professional

Both

$6,554.00

Service Code	HCPCS 55874
Min. Negotiated Rate	$103.73
Max. Negotiated Rate	$4,587.80
Rate for Payer: Aetna Commercial	$210.18
Rate for Payer: BCBS Complete	$108.92
Rate for Payer: BCBS Trust/PPO	$1,585.43
Rate for Payer: Cash Price	$5,243.20
Rate for Payer: Cash Price	$5,243.20
Rate for Payer: Meridian Medicaid	$108.92
Rate for Payer: Priority Health Choice Medicaid	$103.73
Rate for Payer: Priority Health Cigna Priority Health	$4,587.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$261.00
Rate for Payer: Priority Health Narrow Network	$261.00
Rate for Payer: Priority Health SBD	$261.00
Rate for Payer: UMR Bronson Commercial	$3,014.84

PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ

Professional

Both

$2,668.00

Service Code	HCPCS 55875
Min. Negotiated Rate	$496.50
Max. Negotiated Rate	$2,345.12
Rate for Payer: Aetna Commercial	$989.72
Rate for Payer: BCBS Complete	$521.32
Rate for Payer: BCBS Trust/PPO	$2,345.12
Rate for Payer: Cash Price	$2,134.40
Rate for Payer: Cash Price	$2,134.40
Rate for Payer: Meridian Medicaid	$521.32
Rate for Payer: Priority Health Choice Medicaid	$496.50
Rate for Payer: Priority Health Cigna Priority Health	$1,867.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,243.90
Rate for Payer: Priority Health Narrow Network	$1,243.90
Rate for Payer: Priority Health SBD	$1,243.90
Rate for Payer: UMR Bronson Commercial	$1,227.28

PR TRANSPLANTATION TESTIS TO THIGH

Professional

Both

$1,392.00

Service Code	HCPCS 54680
Min. Negotiated Rate	$500.98
Max. Negotiated Rate	$2,125.35
Rate for Payer: Aetna Commercial	$1,011.30
Rate for Payer: BCBS Complete	$526.03
Rate for Payer: BCBS Trust/PPO	$2,125.35
Rate for Payer: Cash Price	$1,113.60
Rate for Payer: Cash Price	$1,113.60
Rate for Payer: Meridian Medicaid	$526.03
Rate for Payer: Priority Health Choice Medicaid	$500.98
Rate for Payer: Priority Health Cigna Priority Health	$974.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,255.79
Rate for Payer: Priority Health Narrow Network	$1,255.79
Rate for Payer: Priority Health SBD	$1,255.79
Rate for Payer: UMR Bronson Commercial	$640.32

PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN

Professional

Both

$1,843.00

Service Code	HCPCS 27397
Min. Negotiated Rate	$591.71
Max. Negotiated Rate	$1,404.80
Rate for Payer: Aetna Commercial	$1,220.27
Rate for Payer: BCBS Complete	$621.30
Rate for Payer: BCBS Trust/PPO	$629.21
Rate for Payer: Cash Price	$1,474.40
Rate for Payer: Cash Price	$1,474.40
Rate for Payer: Meridian Medicaid	$621.30
Rate for Payer: Priority Health Choice Medicaid	$591.71
Rate for Payer: Priority Health Cigna Priority Health	$1,290.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,404.80
Rate for Payer: Priority Health Narrow Network	$1,404.80
Rate for Payer: Priority Health SBD	$1,404.80
Rate for Payer: UMR Bronson Commercial	$847.78

PR TRANSPOSITION OVARY

Professional

Both

$1,434.00

Service Code	HCPCS 58825
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$1,009.81
Rate for Payer: Aetna Commercial	$848.39
Rate for Payer: BCBS Complete	$479.06
Rate for Payer: BCBS Trust/PPO	$82.94
Rate for Payer: Cash Price	$1,147.20
Rate for Payer: Cash Price	$1,147.20
Rate for Payer: Meridian Medicaid	$479.06
Rate for Payer: Priority Health Choice Medicaid	$456.25
Rate for Payer: Priority Health Cigna Priority Health	$1,003.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.81
Rate for Payer: Priority Health Narrow Network	$1,009.81
Rate for Payer: Priority Health SBD	$1,009.81
Rate for Payer: UMR Bronson Commercial	$659.64

PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM

Professional

Both

$4,979.00

Service Code	HCPCS 61598
Min. Negotiated Rate	$1,835.31
Max. Negotiated Rate	$4,885.95
Rate for Payer: Aetna Commercial	$3,710.93
Rate for Payer: BCBS Complete	$1,936.14
Rate for Payer: BCBS Trust/PPO	$1,835.31
Rate for Payer: Cash Price	$3,983.20
Rate for Payer: Cash Price	$3,983.20
Rate for Payer: Meridian Medicaid	$1,936.14
Rate for Payer: Priority Health Choice Medicaid	$1,843.94
Rate for Payer: Priority Health Cigna Priority Health	$3,485.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,885.95
Rate for Payer: Priority Health Narrow Network	$4,885.95
Rate for Payer: Priority Health SBD	$4,885.95
Rate for Payer: UMR Bronson Commercial	$2,290.34

PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS

Professional

Both

$802.00

Service Code	HCPCS 45000
Min. Negotiated Rate	$275.84
Max. Negotiated Rate	$2,674.78
Rate for Payer: Aetna Commercial	$567.64
Rate for Payer: BCBS Complete	$289.63
Rate for Payer: BCBS Trust/PPO	$2,674.78
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cash Price	$641.60
Rate for Payer: Meridian Medicaid	$289.63
Rate for Payer: Priority Health Choice Medicaid	$275.84
Rate for Payer: Priority Health Cigna Priority Health	$561.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$754.95
Rate for Payer: Priority Health Narrow Network	$754.95
Rate for Payer: Priority Health SBD	$754.95
Rate for Payer: UMR Bronson Commercial	$368.92

PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL

Professional

Both

$177.00

Service Code	HCPCS 93293
Min. Negotiated Rate	$19.86
Max. Negotiated Rate	$525.66
Rate for Payer: Aetna Commercial	$64.88
Rate for Payer: BCBS Complete	$70.80
Rate for Payer: BCBS Trust/PPO	$525.66
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Priority Health Cigna Priority Health	$123.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.86
Rate for Payer: Priority Health Narrow Network	$19.86
Rate for Payer: Priority Health SBD	$64.31
Rate for Payer: UMR Bronson Commercial	$81.42

PR TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV

Professional

Both

$6,126.00

Service Code	HCPCS 61595
Min. Negotiated Rate	$1,537.01
Max. Negotiated Rate	$4,288.20
Rate for Payer: Aetna Commercial	$3,082.40
Rate for Payer: BCBS Complete	$1,613.86
Rate for Payer: BCBS Trust/PPO	$1,960.52
Rate for Payer: Cash Price	$4,900.80
Rate for Payer: Cash Price	$4,900.80
Rate for Payer: Meridian Medicaid	$1,613.86
Rate for Payer: Priority Health Choice Medicaid	$1,537.01
Rate for Payer: Priority Health Cigna Priority Health	$4,288.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,061.52
Rate for Payer: Priority Health Narrow Network	$4,061.52
Rate for Payer: Priority Health SBD	$4,061.52
Rate for Payer: UMR Bronson Commercial	$2,817.96

PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR

Professional

Both

$2,118.00

Service Code	HCPCS 50770
Min. Negotiated Rate	$730.16
Max. Negotiated Rate	$2,761.42
Rate for Payer: Aetna Commercial	$1,480.02
Rate for Payer: BCBS Complete	$766.67
Rate for Payer: BCBS Trust/PPO	$2,761.42
Rate for Payer: Cash Price	$1,694.40
Rate for Payer: Cash Price	$1,694.40
Rate for Payer: Meridian Medicaid	$766.67
Rate for Payer: Priority Health Choice Medicaid	$730.16
Rate for Payer: Priority Health Cigna Priority Health	$1,482.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,830.74
Rate for Payer: Priority Health Narrow Network	$1,830.74
Rate for Payer: Priority Health SBD	$1,830.74
Rate for Payer: UMR Bronson Commercial	$974.28

PR TRANSURETHRAL INCISION PROSTATE

Professional

Both

$1,436.00

Service Code	HCPCS 52450
Min. Negotiated Rate	$356.60
Max. Negotiated Rate	$1,005.20
Rate for Payer: Aetna Commercial	$604.49
Rate for Payer: BCBS Complete	$574.40
Rate for Payer: BCBS Trust/PPO	$356.60
Rate for Payer: Cash Price	$1,148.80
Rate for Payer: Cash Price	$1,148.80
Rate for Payer: Priority Health Cigna Priority Health	$1,005.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$758.13
Rate for Payer: Priority Health Narrow Network	$758.13
Rate for Payer: Priority Health SBD	$758.13
Rate for Payer: UMR Bronson Commercial	$660.56

PR TRANSURETHRAL RESECTION BLADDER NECK

Professional

Both

$1,654.00

Service Code	HCPCS 52500
Min. Negotiated Rate	$315.67
Max. Negotiated Rate	$1,157.80
Rate for Payer: Aetna Commercial	$627.52
Rate for Payer: BCBS Complete	$331.45
Rate for Payer: BCBS Trust/PPO	$652.45
Rate for Payer: Cash Price	$1,323.20
Rate for Payer: Cash Price	$1,323.20
Rate for Payer: Meridian Medicaid	$331.45
Rate for Payer: Priority Health Choice Medicaid	$315.67
Rate for Payer: Priority Health Cigna Priority Health	$1,157.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$787.31
Rate for Payer: Priority Health Narrow Network	$787.31
Rate for Payer: Priority Health SBD	$787.31
Rate for Payer: UMR Bronson Commercial	$760.84

PR TRANSV AORTIC ARCH GRAFT W BYPASS

Professional

Both

$10,083.00

Service Code	HCPCS 33870
Min. Negotiated Rate	$4,033.20
Max. Negotiated Rate	$7,058.10
Rate for Payer: BCBS Complete	$4,033.20
Rate for Payer: Cash Price	$8,066.40
Rate for Payer: Priority Health Cigna Priority Health	$7,058.10
Rate for Payer: UMR Bronson Commercial	$4,638.18

PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA

Professional

Both

$5,519.00

Service Code	HCPCS 33871
Min. Negotiated Rate	$972.07
Max. Negotiated Rate	$5,064.77
Rate for Payer: Aetna Commercial	$4,382.46
Rate for Payer: BCBS Complete	$2,134.07
Rate for Payer: BCBS Trust/PPO	$972.07
Rate for Payer: Cash Price	$4,415.20
Rate for Payer: Cash Price	$4,415.20
Rate for Payer: Meridian Medicaid	$2,134.07
Rate for Payer: Priority Health Choice Medicaid	$2,032.45
Rate for Payer: Priority Health Cigna Priority Health	$3,863.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,064.77
Rate for Payer: Priority Health Narrow Network	$5,064.77
Rate for Payer: Priority Health SBD	$5,064.77
Rate for Payer: UMR Bronson Commercial	$2,538.74

PR TRAY FEE

Professional

Both

$33.00

Service Code	HCPCS 00521
Hospital Revenue Code	990
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$23.10
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: Cash Price	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$23.10
Rate for Payer: UMR Bronson Commercial	$15.18

PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES

Professional

Both

$1,286.00

Service Code	HCPCS 24605
Min. Negotiated Rate	$213.96
Max. Negotiated Rate	$900.20
Rate for Payer: Aetna Commercial	$635.25
Rate for Payer: BCBS Complete	$329.66
Rate for Payer: BCBS Trust/PPO	$213.96
Rate for Payer: Cash Price	$1,028.80
Rate for Payer: Cash Price	$1,028.80
Rate for Payer: Meridian Medicaid	$329.66
Rate for Payer: Priority Health Choice Medicaid	$313.96
Rate for Payer: Priority Health Cigna Priority Health	$900.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$743.51
Rate for Payer: Priority Health Narrow Network	$743.51
Rate for Payer: Priority Health SBD	$743.51
Rate for Payer: UMR Bronson Commercial	$591.56

PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES

Professional

Both

$735.00

Service Code	HCPCS 24600
Min. Negotiated Rate	$227.06
Max. Negotiated Rate	$536.69
Rate for Payer: Aetna Commercial	$450.64
Rate for Payer: BCBS Complete	$238.41
Rate for Payer: BCBS Trust/PPO	$525.13
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Meridian Medicaid	$238.41
Rate for Payer: Priority Health Choice Medicaid	$227.06
Rate for Payer: Priority Health Cigna Priority Health	$514.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$536.69
Rate for Payer: Priority Health Narrow Network	$536.69
Rate for Payer: Priority Health SBD	$536.69
Rate for Payer: UMR Bronson Commercial	$338.10

Know your out-of-pocket cost for care.

All Charges