Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR TRIAMCINOLONE ACETONIDE INJ

Professional

Both

$10.00

Service Code	HCPCS J3301
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$0.97
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$0.55
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 TRIMETHOBENZAMIDE HCL INJ

Professional

Both

$24.00

Service Code	HCPCS J3250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$49.27
Rate for Payer: Aetna Commercial	$49.27
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: BCBS Trust/PPO	$48.74
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Priority Health Cigna Priority Health	$16.80
Rate for Payer: UMR Bronson Commercial	$11.04

PR TRIMMING NONDYSTROPHIC NAILS ANY NUMBER

Professional

Both

$32.00

Service Code	HCPCS 11719
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$12.00
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.05
Rate for Payer: Priority Health Narrow Network	$9.05
Rate for Payer: Priority Health SBD	$9.05
Rate for Payer: UMR Bronson Commercial	$14.72

PR TRIM NAIL(S)

Professional

Both

$36.00

Service Code	HCPCS G0127
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$1,929.35
Rate for Payer: Aetna Commercial	$7.62
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS Trust/PPO	$1,929.35
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$25.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.05
Rate for Payer: Priority Health Narrow Network	$9.05
Rate for Payer: Priority Health SBD	$9.05
Rate for Payer: UMR Bronson Commercial	$16.56

PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART

Professional

Both

$1,076.00

Service Code	HCPCS 37246
Min. Negotiated Rate	$215.98
Max. Negotiated Rate	$786.64
Rate for Payer: Aetna Commercial	$465.79
Rate for Payer: BCBS Complete	$226.78
Rate for Payer: BCBS Trust/PPO	$786.64
Rate for Payer: Cash Price	$860.80
Rate for Payer: Cash Price	$860.80
Rate for Payer: Meridian Medicaid	$226.78
Rate for Payer: Priority Health Choice Medicaid	$215.98
Rate for Payer: Priority Health Cigna Priority Health	$753.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$538.34
Rate for Payer: Priority Health Narrow Network	$538.34
Rate for Payer: Priority Health SBD	$538.34
Rate for Payer: UMR Bronson Commercial	$494.96

PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART

Professional

Both

$820.00

Service Code	HCPCS 37247
Min. Negotiated Rate	$107.57
Max. Negotiated Rate	$1,142.18
Rate for Payer: Aetna Commercial	$228.48
Rate for Payer: BCBS Complete	$112.95
Rate for Payer: BCBS Trust/PPO	$1,142.18
Rate for Payer: Cash Price	$656.00
Rate for Payer: Cash Price	$656.00
Rate for Payer: Meridian Medicaid	$112.95
Rate for Payer: Priority Health Choice Medicaid	$107.57
Rate for Payer: Priority Health Cigna Priority Health	$574.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$266.50
Rate for Payer: Priority Health Narrow Network	$266.50
Rate for Payer: Priority Health SBD	$266.50
Rate for Payer: UMR Bronson Commercial	$377.20

PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN

Professional

Both

$925.00

Service Code	HCPCS 37248
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$1,245.73
Rate for Payer: Aetna Commercial	$397.26
Rate for Payer: BCBS Complete	$193.46
Rate for Payer: BCBS Trust/PPO	$1,245.73
Rate for Payer: Cash Price	$740.00
Rate for Payer: Cash Price	$740.00
Rate for Payer: Meridian Medicaid	$193.46
Rate for Payer: Priority Health Choice Medicaid	$184.25
Rate for Payer: Priority Health Cigna Priority Health	$647.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$459.08
Rate for Payer: Priority Health Narrow Network	$459.08
Rate for Payer: Priority Health SBD	$459.08
Rate for Payer: UMR Bronson Commercial	$425.50

PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN

Professional

Both

$454.00

Service Code	HCPCS 37249
Min. Negotiated Rate	$90.31
Max. Negotiated Rate	$317.80
Rate for Payer: Aetna Commercial	$194.65
Rate for Payer: BCBS Complete	$94.83
Rate for Payer: BCBS Trust/PPO	$260.45
Rate for Payer: Cash Price	$363.20
Rate for Payer: Cash Price	$363.20
Rate for Payer: Meridian Medicaid	$94.83
Rate for Payer: Priority Health Choice Medicaid	$90.31
Rate for Payer: Priority Health Cigna Priority Health	$317.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$225.01
Rate for Payer: Priority Health Narrow Network	$225.01
Rate for Payer: Priority Health SBD	$225.01
Rate for Payer: UMR Bronson Commercial	$208.84

PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I

Professional

Both

$318.00

Service Code	HCPCS 36907
Min. Negotiated Rate	$90.53
Max. Negotiated Rate	$1,983.24
Rate for Payer: Aetna Commercial	$196.77
Rate for Payer: BCBS Complete	$95.06
Rate for Payer: BCBS Trust/PPO	$1,983.24
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cash Price	$254.40
Rate for Payer: Meridian Medicaid	$95.06
Rate for Payer: Priority Health Choice Medicaid	$90.53
Rate for Payer: Priority Health Cigna Priority Health	$222.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$226.61
Rate for Payer: Priority Health Narrow Network	$226.61
Rate for Payer: Priority Health SBD	$226.61
Rate for Payer: UMR Bronson Commercial	$146.28

PR TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL

Professional

Both

$9,628.00

Service Code	HCPCS 0237T
Min. Negotiated Rate	$100.60
Max. Negotiated Rate	$6,739.60
Rate for Payer: Aetna Commercial	$4,395.81
Rate for Payer: BCBS Complete	$260.96
Rate for Payer: BCBS Trust/PPO	$100.60
Rate for Payer: Cash Price	$7,702.40
Rate for Payer: Cash Price	$7,702.40
Rate for Payer: Meridian Medicaid	$260.96
Rate for Payer: Priority Health Choice Medicaid	$248.53
Rate for Payer: Priority Health Cigna Priority Health	$6,739.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,548.58
Rate for Payer: Priority Health Narrow Network	$1,548.58
Rate for Payer: Priority Health SBD	$1,548.58
Rate for Payer: UMR Bronson Commercial	$4,428.88

PR TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL

Professional

Both

$8,584.00

Service Code	HCPCS 61597
Min. Negotiated Rate	$1,813.13
Max. Negotiated Rate	$6,008.80
Rate for Payer: Aetna Commercial	$3,837.78
Rate for Payer: BCBS Complete	$2,010.61
Rate for Payer: BCBS Trust/PPO	$1,813.13
Rate for Payer: Cash Price	$6,867.20
Rate for Payer: Cash Price	$6,867.20
Rate for Payer: Meridian Medicaid	$2,010.61
Rate for Payer: Priority Health Choice Medicaid	$1,914.87
Rate for Payer: Priority Health Cigna Priority Health	$6,008.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,051.28
Rate for Payer: Priority Health Narrow Network	$5,051.28
Rate for Payer: Priority Health SBD	$5,051.28
Rate for Payer: UMR Bronson Commercial	$3,948.64

PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR

Professional

Both

$450.00

Service Code	HCPCS 38207
Min. Negotiated Rate	$28.33
Max. Negotiated Rate	$1,622.41
Rate for Payer: Aetna Commercial	$54.89
Rate for Payer: BCBS Complete	$29.75
Rate for Payer: BCBS Trust/PPO	$1,622.41
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Meridian Medicaid	$29.75
Rate for Payer: Priority Health Choice Medicaid	$28.33
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$96.34
Rate for Payer: Priority Health Narrow Network	$96.34
Rate for Payer: Priority Health SBD	$96.34
Rate for Payer: UMR Bronson Commercial	$207.00

PR TR PARASPI MUSC HIP FASC/TDN XTN GRF

Professional

Both

$6,193.00

Service Code	HCPCS 27105
Min. Negotiated Rate	$562.75
Max. Negotiated Rate	$4,335.10
Rate for Payer: Aetna Commercial	$1,161.46
Rate for Payer: BCBS Complete	$590.89
Rate for Payer: BCBS Trust/PPO	$1,594.41
Rate for Payer: Cash Price	$4,954.40
Rate for Payer: Cash Price	$4,954.40
Rate for Payer: Meridian Medicaid	$590.89
Rate for Payer: Priority Health Choice Medicaid	$562.75
Rate for Payer: Priority Health Cigna Priority Health	$4,335.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,337.90
Rate for Payer: Priority Health Narrow Network	$1,337.90
Rate for Payer: Priority Health SBD	$1,337.90
Rate for Payer: UMR Bronson Commercial	$2,848.78

PR TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART

Professional

Both

$2,035.00

Service Code	HCPCS 35695
Min. Negotiated Rate	$640.70
Max. Negotiated Rate	$1,593.21
Rate for Payer: Aetna Commercial	$1,378.42
Rate for Payer: BCBS Complete	$672.74
Rate for Payer: BCBS Trust/PPO	$1,523.09
Rate for Payer: Cash Price	$1,628.00
Rate for Payer: Cash Price	$1,628.00
Rate for Payer: Meridian Medicaid	$672.74
Rate for Payer: Priority Health Choice Medicaid	$640.70
Rate for Payer: Priority Health Cigna Priority Health	$1,424.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,593.21
Rate for Payer: Priority Health Narrow Network	$1,593.21
Rate for Payer: Priority Health SBD	$1,593.21
Rate for Payer: UMR Bronson Commercial	$936.10

PR TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART

Professional

Both

$2,100.00

Service Code	HCPCS 35694
Min. Negotiated Rate	$617.49
Max. Negotiated Rate	$1,534.70
Rate for Payer: Aetna Commercial	$1,327.34
Rate for Payer: BCBS Complete	$648.36
Rate for Payer: BCBS Trust/PPO	$1,526.79
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Meridian Medicaid	$648.36
Rate for Payer: Priority Health Choice Medicaid	$617.49
Rate for Payer: Priority Health Cigna Priority Health	$1,470.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,534.70
Rate for Payer: Priority Health Narrow Network	$1,534.70
Rate for Payer: Priority Health SBD	$1,534.70
Rate for Payer: UMR Bronson Commercial	$966.00

PR TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART

Professional

Both

$4,476.00

Service Code	HCPCS 35691
Min. Negotiated Rate	$591.29
Max. Negotiated Rate	$3,133.20
Rate for Payer: Aetna Commercial	$1,271.09
Rate for Payer: BCBS Complete	$620.85
Rate for Payer: BCBS Trust/PPO	$1,610.26
Rate for Payer: Cash Price	$3,580.80
Rate for Payer: Cash Price	$3,580.80
Rate for Payer: Meridian Medicaid	$620.85
Rate for Payer: Priority Health Choice Medicaid	$591.29
Rate for Payer: Priority Health Cigna Priority Health	$3,133.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,470.33
Rate for Payer: Priority Health Narrow Network	$1,470.33
Rate for Payer: Priority Health SBD	$1,470.33
Rate for Payer: UMR Bronson Commercial	$2,058.96

PR TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART

Professional

Both

$1,722.00

Service Code	HCPCS 35693
Min. Negotiated Rate	$524.41
Max. Negotiated Rate	$2,046.11
Rate for Payer: Aetna Commercial	$1,118.77
Rate for Payer: BCBS Complete	$550.63
Rate for Payer: BCBS Trust/PPO	$2,046.11
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Meridian Medicaid	$550.63
Rate for Payer: Priority Health Choice Medicaid	$524.41
Rate for Payer: Priority Health Cigna Priority Health	$1,205.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,299.57
Rate for Payer: Priority Health Narrow Network	$1,299.57
Rate for Payer: Priority Health SBD	$1,299.57
Rate for Payer: UMR Bronson Commercial	$792.12

PR TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR

Professional

Both

$2,721.00

Service Code	HCPCS 26497
Min. Negotiated Rate	$585.75
Max. Negotiated Rate	$2,458.71
Rate for Payer: Aetna Commercial	$1,202.33
Rate for Payer: BCBS Complete	$615.04
Rate for Payer: BCBS Trust/PPO	$2,458.71
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Meridian Medicaid	$615.04
Rate for Payer: Priority Health Choice Medicaid	$585.75
Rate for Payer: Priority Health Cigna Priority Health	$1,904.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,405.32
Rate for Payer: Priority Health Narrow Network	$1,405.32
Rate for Payer: Priority Health SBD	$1,405.32
Rate for Payer: UMR Bronson Commercial	$1,251.66

PR TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND

Professional

Both

$5,505.00

Service Code	HCPCS 26551
Min. Negotiated Rate	$201.28
Max. Negotiated Rate	$5,035.52
Rate for Payer: Aetna Commercial	$4,427.34
Rate for Payer: BCBS Complete	$2,210.33
Rate for Payer: BCBS Trust/PPO	$201.28
Rate for Payer: Cash Price	$4,404.00
Rate for Payer: Cash Price	$4,404.00
Rate for Payer: Meridian Medicaid	$2,210.33
Rate for Payer: Priority Health Choice Medicaid	$2,105.08
Rate for Payer: Priority Health Cigna Priority Health	$3,853.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,035.52
Rate for Payer: Priority Health Narrow Network	$5,035.52
Rate for Payer: Priority Health SBD	$5,035.52
Rate for Payer: UMR Bronson Commercial	$2,532.30

PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP

Professional

Both

$2,764.00

Service Code	HCPCS 27691
Min. Negotiated Rate	$479.68
Max. Negotiated Rate	$2,829.97
Rate for Payer: Aetna Commercial	$991.04
Rate for Payer: BCBS Complete	$503.66
Rate for Payer: BCBS Trust/PPO	$2,829.97
Rate for Payer: Cash Price	$2,211.20
Rate for Payer: Cash Price	$2,211.20
Rate for Payer: Meridian Medicaid	$503.66
Rate for Payer: Priority Health Choice Medicaid	$479.68
Rate for Payer: Priority Health Cigna Priority Health	$1,934.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,139.77
Rate for Payer: Priority Health Narrow Network	$1,139.77
Rate for Payer: Priority Health SBD	$1,139.77
Rate for Payer: UMR Bronson Commercial	$1,271.44

PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN

Professional

Both

$500.00

Service Code	HCPCS 27692
Min. Negotiated Rate	$64.54
Max. Negotiated Rate	$3,094.06
Rate for Payer: Aetna Commercial	$138.03
Rate for Payer: BCBS Complete	$67.77
Rate for Payer: BCBS Trust/PPO	$3,094.06
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Meridian Medicaid	$67.77
Rate for Payer: Priority Health Choice Medicaid	$64.54
Rate for Payer: Priority Health Cigna Priority Health	$350.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$151.66
Rate for Payer: Priority Health Narrow Network	$151.66
Rate for Payer: Priority Health SBD	$151.66
Rate for Payer: UMR Bronson Commercial	$230.00

PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC

Professional

Both

$1,956.00

Service Code	HCPCS 27690
Min. Negotiated Rate	$411.94
Max. Negotiated Rate	$1,369.20
Rate for Payer: Aetna Commercial	$854.26
Rate for Payer: BCBS Complete	$432.54
Rate for Payer: BCBS Trust/PPO	$627.07
Rate for Payer: Cash Price	$1,564.80
Rate for Payer: Cash Price	$1,564.80
Rate for Payer: Meridian Medicaid	$432.54
Rate for Payer: Priority Health Choice Medicaid	$411.94
Rate for Payer: Priority Health Cigna Priority Health	$1,369.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$977.89
Rate for Payer: Priority Health Narrow Network	$977.89
Rate for Payer: Priority Health SBD	$977.89
Rate for Payer: UMR Bronson Commercial	$899.76

PR TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN

Professional

Both

$2,022.00

Service Code	HCPCS 26480
Min. Negotiated Rate	$508.43
Max. Negotiated Rate	$1,415.40
Rate for Payer: Aetna Commercial	$1,042.22
Rate for Payer: BCBS Complete	$533.85
Rate for Payer: BCBS Trust/PPO	$1,024.37
Rate for Payer: Cash Price	$1,617.60
Rate for Payer: Cash Price	$1,617.60
Rate for Payer: Meridian Medicaid	$533.85
Rate for Payer: Priority Health Choice Medicaid	$508.43
Rate for Payer: Priority Health Cigna Priority Health	$1,415.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,221.47
Rate for Payer: Priority Health Narrow Network	$1,221.47
Rate for Payer: Priority Health SBD	$1,221.47
Rate for Payer: UMR Bronson Commercial	$930.12

PR TRURL DRAINAGE PROSTATIC ABSCESS

Professional

Both

$811.00

Service Code	HCPCS 52700
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$707.87
Rate for Payer: Aetna Commercial	$564.73
Rate for Payer: BCBS Complete	$297.23
Rate for Payer: BCBS Trust/PPO	$283.70
Rate for Payer: Cash Price	$648.80
Rate for Payer: Cash Price	$648.80
Rate for Payer: Meridian Medicaid	$297.23
Rate for Payer: Priority Health Choice Medicaid	$283.08
Rate for Payer: Priority Health Cigna Priority Health	$567.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$707.87
Rate for Payer: Priority Health Narrow Network	$707.87
Rate for Payer: Priority Health SBD	$707.87
Rate for Payer: UMR Bronson Commercial	$373.06

PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY

Professional

Both

$3,480.00

Service Code	HCPCS 53854
Min. Negotiated Rate	$244.52
Max. Negotiated Rate	$2,436.00
Rate for Payer: Aetna Commercial	$482.70
Rate for Payer: BCBS Complete	$256.75
Rate for Payer: BCBS Trust/PPO	$1,462.86
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Meridian Medicaid	$256.75
Rate for Payer: Priority Health Choice Medicaid	$244.52
Rate for Payer: Priority Health Cigna Priority Health	$2,436.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$609.53
Rate for Payer: Priority Health Narrow Network	$609.53
Rate for Payer: Priority Health SBD	$609.53
Rate for Payer: UMR Bronson Commercial	$1,600.80

Know your out-of-pocket cost for care.

All Charges