Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR TRURL DSTRJ PRSTATE TISS RF THERMOTH

Professional

Both

$2,877.00

Service Code	HCPCS 53852
Min. Negotiated Rate	$244.52
Max. Negotiated Rate	$2,013.90
Rate for Payer: Aetna Commercial	$482.28
Rate for Payer: BCBS Complete	$256.75
Rate for Payer: BCBS Trust/PPO	$1,575.92
Rate for Payer: Cash Price	$2,301.60
Rate for Payer: Cash Price	$2,301.60
Rate for Payer: Meridian Medicaid	$256.75
Rate for Payer: Priority Health Choice Medicaid	$244.52
Rate for Payer: Priority Health Cigna Priority Health	$2,013.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$610.07
Rate for Payer: Priority Health Narrow Network	$610.07
Rate for Payer: Priority Health SBD	$610.07
Rate for Payer: UMR Bronson Commercial	$1,323.42

PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE

Professional

Both

$1,559.00

Service Code	HCPCS 52601
Min. Negotiated Rate	$462.85
Max. Negotiated Rate	$1,159.61
Rate for Payer: Aetna Commercial	$935.09
Rate for Payer: BCBS Complete	$485.99
Rate for Payer: BCBS Trust/PPO	$659.32
Rate for Payer: Cash Price	$1,247.20
Rate for Payer: Cash Price	$1,247.20
Rate for Payer: Meridian Medicaid	$485.99
Rate for Payer: Priority Health Choice Medicaid	$462.85
Rate for Payer: Priority Health Cigna Priority Health	$1,091.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,159.61
Rate for Payer: Priority Health Narrow Network	$1,159.61
Rate for Payer: Priority Health SBD	$1,159.61
Rate for Payer: UMR Bronson Commercial	$717.14

PR TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE

Professional

Both

$710.00

Service Code	HCPCS 52640
Min. Negotiated Rate	$207.46
Max. Negotiated Rate	$733.28
Rate for Payer: Aetna Commercial	$405.73
Rate for Payer: BCBS Complete	$217.83
Rate for Payer: BCBS Trust/PPO	$733.28
Rate for Payer: Cash Price	$568.00
Rate for Payer: Cash Price	$568.00
Rate for Payer: Meridian Medicaid	$217.83
Rate for Payer: Priority Health Choice Medicaid	$207.46
Rate for Payer: Priority Health Cigna Priority Health	$497.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$516.58
Rate for Payer: Priority Health Narrow Network	$516.58
Rate for Payer: Priority Health SBD	$516.58
Rate for Payer: UMR Bronson Commercial	$326.60

PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS

Professional

Both

$774.00

Service Code	HCPCS 52630
Min. Negotiated Rate	$259.86
Max. Negotiated Rate	$727.47
Rate for Payer: Aetna Commercial	$515.11
Rate for Payer: BCBS Complete	$272.85
Rate for Payer: BCBS Trust/PPO	$727.47
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Meridian Medicaid	$272.85
Rate for Payer: Priority Health Choice Medicaid	$259.86
Rate for Payer: Priority Health Cigna Priority Health	$541.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$648.98
Rate for Payer: Priority Health Narrow Network	$648.98
Rate for Payer: Priority Health SBD	$648.98
Rate for Payer: UMR Bronson Commercial	$356.04

PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP

Professional

Both

$151.00

Service Code	HCPCS 95921
Min. Negotiated Rate	$58.38
Max. Negotiated Rate	$1,174.41
Rate for Payer: Aetna Commercial	$96.18
Rate for Payer: BCBS Complete	$60.40
Rate for Payer: BCBS Trust/PPO	$1,174.41
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Priority Health Cigna Priority Health	$105.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58.38
Rate for Payer: Priority Health Narrow Network	$58.38
Rate for Payer: Priority Health SBD	$117.23
Rate for Payer: UMR Bronson Commercial	$69.46

PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT

Professional

Both

$177.00

Service Code	HCPCS 95924
Min. Negotiated Rate	$70.80
Max. Negotiated Rate	$987.92
Rate for Payer: Aetna Commercial	$163.67
Rate for Payer: BCBS Complete	$70.80
Rate for Payer: BCBS Trust/PPO	$987.92
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	$88.48
Rate for Payer: Priority Health Narrow Network	$88.48
Rate for Payer: Priority Health SBD	$203.46
Rate for Payer: UMR Bronson Commercial	$81.42

PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ

Professional

Both

$181.00

Service Code	HCPCS 95922
Min. Negotiated Rate	$60.64
Max. Negotiated Rate	$759.70
Rate for Payer: Aetna Commercial	$113.87
Rate for Payer: BCBS Complete	$72.40
Rate for Payer: BCBS Trust/PPO	$759.70
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Priority Health Cigna Priority Health	$126.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.64
Rate for Payer: Priority Health Narrow Network	$60.64
Rate for Payer: Priority Health SBD	$129.80
Rate for Payer: UMR Bronson Commercial	$83.26

PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER

Professional

Both

$299.00

Service Code	HCPCS 31730
Min. Negotiated Rate	$119.60
Max. Negotiated Rate	$1,167.54
Rate for Payer: Aetna Commercial	$194.23
Rate for Payer: BCBS Complete	$119.60
Rate for Payer: BCBS Trust/PPO	$1,167.54
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$203.73
Rate for Payer: Priority Health Narrow Network	$203.73
Rate for Payer: Priority Health SBD	$203.73
Rate for Payer: UMR Bronson Commercial	$137.54

PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD

Professional

Both

$1,219.00

Service Code	HCPCS 44015
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$2,262.71
Rate for Payer: Aetna Commercial	$192.38
Rate for Payer: BCBS Complete	$93.71
Rate for Payer: BCBS Trust/PPO	$2,262.71
Rate for Payer: Cash Price	$975.20
Rate for Payer: Cash Price	$975.20
Rate for Payer: Meridian Medicaid	$93.71
Rate for Payer: Priority Health Choice Medicaid	$89.25
Rate for Payer: Priority Health Cigna Priority Health	$853.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$247.55
Rate for Payer: Priority Health Narrow Network	$247.55
Rate for Payer: Priority Health SBD	$247.55
Rate for Payer: UMR Bronson Commercial	$560.74

PR TUBE THORACOSTOMY INCLUDES WATER SEAL

Professional

Both

$590.00

Service Code	HCPCS 32551
Min. Negotiated Rate	$97.77
Max. Negotiated Rate	$753.36
Rate for Payer: Aetna Commercial	$202.73
Rate for Payer: BCBS Complete	$102.66
Rate for Payer: BCBS Trust/PPO	$753.36
Rate for Payer: Cash Price	$472.00
Rate for Payer: Cash Price	$472.00
Rate for Payer: Meridian Medicaid	$102.66
Rate for Payer: Priority Health Choice Medicaid	$97.77
Rate for Payer: Priority Health Cigna Priority Health	$413.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.07
Rate for Payer: Priority Health Narrow Network	$212.07
Rate for Payer: Priority Health SBD	$212.07
Rate for Payer: UMR Bronson Commercial	$271.40

PR TUBOTUBAL ANASTATOMOSIS

Professional

Both

$1,621.00

Service Code	HCPCS 58750
Min. Negotiated Rate	$428.98
Max. Negotiated Rate	$1,292.45
Rate for Payer: Aetna Commercial	$1,090.66
Rate for Payer: BCBS Complete	$648.40
Rate for Payer: BCBS Trust/PPO	$428.98
Rate for Payer: Cash Price	$1,296.80
Rate for Payer: Cash Price	$1,296.80
Rate for Payer: Priority Health Cigna Priority Health	$1,134.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,292.45
Rate for Payer: Priority Health Narrow Network	$1,292.45
Rate for Payer: Priority Health SBD	$1,292.45
Rate for Payer: UMR Bronson Commercial	$745.66

PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA

Professional

Both

$3,833.00

Service Code	HCPCS 61108
Min. Negotiated Rate	$590.86
Max. Negotiated Rate	$2,683.10
Rate for Payer: Aetna Commercial	$1,160.13
Rate for Payer: BCBS Complete	$620.40
Rate for Payer: BCBS Trust/PPO	$1,532.07
Rate for Payer: Cash Price	$3,066.40
Rate for Payer: Cash Price	$3,066.40
Rate for Payer: Meridian Medicaid	$620.40
Rate for Payer: Priority Health Choice Medicaid	$590.86
Rate for Payer: Priority Health Cigna Priority Health	$2,683.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,555.41
Rate for Payer: Priority Health Narrow Network	$1,555.41
Rate for Payer: Priority Health SBD	$1,555.41
Rate for Payer: UMR Bronson Commercial	$1,763.18

PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE

Professional

Both

$2,430.00

Service Code	HCPCS 61107
Min. Negotiated Rate	$200.43
Max. Negotiated Rate	$1,701.00
Rate for Payer: Aetna Commercial	$405.53
Rate for Payer: BCBS Complete	$210.45
Rate for Payer: BCBS Trust/PPO	$1,532.60
Rate for Payer: Cash Price	$1,944.00
Rate for Payer: Cash Price	$1,944.00
Rate for Payer: Meridian Medicaid	$210.45
Rate for Payer: Priority Health Choice Medicaid	$200.43
Rate for Payer: Priority Health Cigna Priority Health	$1,701.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$529.43
Rate for Payer: Priority Health Narrow Network	$529.43
Rate for Payer: Priority Health SBD	$529.43
Rate for Payer: UMR Bronson Commercial	$1,117.80

PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE

Professional

Both

$2,107.00

Service Code	HCPCS 61105
Min. Negotiated Rate	$188.07
Max. Negotiated Rate	$1,474.90
Rate for Payer: Aetna Commercial	$593.07
Rate for Payer: BCBS Complete	$319.60
Rate for Payer: BCBS Trust/PPO	$188.07
Rate for Payer: Cash Price	$1,685.60
Rate for Payer: Cash Price	$1,685.60
Rate for Payer: Meridian Medicaid	$319.60
Rate for Payer: Priority Health Choice Medicaid	$304.38
Rate for Payer: Priority Health Cigna Priority Health	$1,474.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$799.51
Rate for Payer: Priority Health Narrow Network	$799.51
Rate for Payer: Priority Health SBD	$799.51
Rate for Payer: UMR Bronson Commercial	$969.22

PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR

Professional

Both

$2,700.00

Service Code	HCPCS 00528
Hospital Revenue Code	990
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: BCBS Complete	$1,080.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Priority Health Cigna Priority Health	$1,890.00
Rate for Payer: UMR Bronson Commercial	$1,242.00

PR TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON

Professional

Both

$1,436.00

Service Code	HCPCS 46280
Min. Negotiated Rate	$309.49
Max. Negotiated Rate	$5,471.60
Rate for Payer: Aetna Commercial	$637.07
Rate for Payer: BCBS Complete	$324.96
Rate for Payer: BCBS Trust/PPO	$5,471.60
Rate for Payer: Cash Price	$1,148.80
Rate for Payer: Cash Price	$1,148.80
Rate for Payer: Meridian Medicaid	$324.96
Rate for Payer: Priority Health Choice Medicaid	$309.49
Rate for Payer: Priority Health Cigna Priority Health	$1,005.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$849.62
Rate for Payer: Priority Health Narrow Network	$849.62
Rate for Payer: Priority Health SBD	$849.62
Rate for Payer: UMR Bronson Commercial	$660.56

PR TX ECTOPIC PREGNANCY ABDL PREGNANCY

Professional

Both

$1,475.00

Service Code	HCPCS 59130
Min. Negotiated Rate	$318.04
Max. Negotiated Rate	$1,349.95
Rate for Payer: Aetna Commercial	$1,039.81
Rate for Payer: BCBS Complete	$642.55
Rate for Payer: BCBS Trust/PPO	$318.04
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Meridian Medicaid	$642.55
Rate for Payer: Priority Health Choice Medicaid	$611.95
Rate for Payer: Priority Health Cigna Priority Health	$1,032.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,349.95
Rate for Payer: Priority Health Narrow Network	$1,349.95
Rate for Payer: Priority Health SBD	$1,349.95
Rate for Payer: UMR Bronson Commercial	$678.50

PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR

Professional

Both

$1,695.00

Service Code	HCPCS 59120
Min. Negotiated Rate	$51.77
Max. Negotiated Rate	$1,186.50
Rate for Payer: Aetna Commercial	$892.36
Rate for Payer: BCBS Complete	$553.76
Rate for Payer: BCBS Trust/PPO	$51.77
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Meridian Medicaid	$553.76
Rate for Payer: Priority Health Choice Medicaid	$527.39
Rate for Payer: Priority Health Cigna Priority Health	$1,186.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,162.49
Rate for Payer: Priority Health Narrow Network	$1,162.49
Rate for Payer: Priority Health SBD	$1,162.49
Rate for Payer: UMR Bronson Commercial	$779.70

PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER

Professional

Both

$1,781.00

Service Code	HCPCS 59136
Min. Negotiated Rate	$101.96
Max. Negotiated Rate	$1,280.06
Rate for Payer: Aetna Commercial	$986.02
Rate for Payer: BCBS Complete	$609.67
Rate for Payer: BCBS Trust/PPO	$101.96
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Meridian Medicaid	$609.67
Rate for Payer: Priority Health Choice Medicaid	$580.64
Rate for Payer: Priority Health Cigna Priority Health	$1,246.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,280.06
Rate for Payer: Priority Health Narrow Network	$1,280.06
Rate for Payer: Priority Health SBD	$1,280.06
Rate for Payer: UMR Bronson Commercial	$819.26

PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY

Professional

Both

$1,438.00

Service Code	HCPCS 59121
Min. Negotiated Rate	$286.34
Max. Negotiated Rate	$1,162.49
Rate for Payer: Aetna Commercial	$893.35
Rate for Payer: BCBS Complete	$553.98
Rate for Payer: BCBS Trust/PPO	$286.34
Rate for Payer: Cash Price	$1,150.40
Rate for Payer: Cash Price	$1,150.40
Rate for Payer: Meridian Medicaid	$553.98
Rate for Payer: Priority Health Choice Medicaid	$527.60
Rate for Payer: Priority Health Cigna Priority Health	$1,006.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,162.49
Rate for Payer: Priority Health Narrow Network	$1,162.49
Rate for Payer: Priority Health SBD	$1,162.49
Rate for Payer: UMR Bronson Commercial	$661.48

PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE

Professional

Both

$3,445.00

Service Code	HCPCS 24516
Min. Negotiated Rate	$345.51
Max. Negotiated Rate	$2,411.50
Rate for Payer: Aetna Commercial	$1,148.79
Rate for Payer: BCBS Complete	$582.16
Rate for Payer: BCBS Trust/PPO	$345.51
Rate for Payer: Cash Price	$2,756.00
Rate for Payer: Cash Price	$2,756.00
Rate for Payer: Meridian Medicaid	$582.16
Rate for Payer: Priority Health Choice Medicaid	$554.44
Rate for Payer: Priority Health Cigna Priority Health	$2,411.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,320.02
Rate for Payer: Priority Health Narrow Network	$1,320.02
Rate for Payer: Priority Health SBD	$1,320.02
Rate for Payer: UMR Bronson Commercial	$1,584.70

PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL

Professional

Both

$750.00

Service Code	HCPCS 59812
Min. Negotiated Rate	$199.16
Max. Negotiated Rate	$1,118.94
Rate for Payer: Aetna Commercial	$335.23
Rate for Payer: BCBS Complete	$209.12
Rate for Payer: BCBS Trust/PPO	$1,118.94
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Meridian Medicaid	$209.12
Rate for Payer: Priority Health Choice Medicaid	$199.16
Rate for Payer: Priority Health Cigna Priority Health	$525.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$437.70
Rate for Payer: Priority Health Narrow Network	$437.70
Rate for Payer: Priority Health SBD	$437.70
Rate for Payer: UMR Bronson Commercial	$345.00

PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW

Professional

Both

$4,025.00

Service Code	HCPCS 27245
Min. Negotiated Rate	$787.04
Max. Negotiated Rate	$2,817.50
Rate for Payer: Aetna Commercial	$1,639.86
Rate for Payer: BCBS Complete	$826.39
Rate for Payer: BCBS Trust/PPO	$1,447.01
Rate for Payer: Cash Price	$3,220.00
Rate for Payer: Cash Price	$3,220.00
Rate for Payer: Meridian Medicaid	$826.39
Rate for Payer: Priority Health Choice Medicaid	$787.04
Rate for Payer: Priority Health Cigna Priority Health	$2,817.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,873.57
Rate for Payer: Priority Health Narrow Network	$1,873.57
Rate for Payer: Priority Health SBD	$1,873.57
Rate for Payer: UMR Bronson Commercial	$1,851.50

PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT

Professional

Both

$3,403.00

Service Code	HCPCS 27244
Min. Negotiated Rate	$788.10
Max. Negotiated Rate	$2,382.10
Rate for Payer: Aetna Commercial	$1,641.64
Rate for Payer: BCBS Complete	$827.50
Rate for Payer: BCBS Trust/PPO	$1,189.73
Rate for Payer: Cash Price	$2,722.40
Rate for Payer: Cash Price	$2,722.40
Rate for Payer: Meridian Medicaid	$827.50
Rate for Payer: Priority Health Choice Medicaid	$788.10
Rate for Payer: Priority Health Cigna Priority Health	$2,382.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,875.62
Rate for Payer: Priority Health Narrow Network	$1,875.62
Rate for Payer: Priority Health SBD	$1,875.62
Rate for Payer: UMR Bronson Commercial	$1,565.38

PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL

Professional

Both

$800.00

Service Code	HCPCS 59820
Min. Negotiated Rate	$250.70
Max. Negotiated Rate	$1,022.79
Rate for Payer: Aetna Commercial	$413.43
Rate for Payer: BCBS Complete	$263.24
Rate for Payer: BCBS Trust/PPO	$1,022.79
Rate for Payer: Cash Price	$640.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Meridian Medicaid	$263.24
Rate for Payer: Priority Health Choice Medicaid	$250.70
Rate for Payer: Priority Health Cigna Priority Health	$560.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$551.02
Rate for Payer: Priority Health Narrow Network	$551.02
Rate for Payer: Priority Health SBD	$551.02
Rate for Payer: UMR Bronson Commercial	$368.00

Know your out-of-pocket cost for care.

All Charges