Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR URETHROLSS TRVG SEC OPN W/CSTO

Professional

Both

$1,336.00

Service Code	HCPCS 53500
Min. Negotiated Rate	$477.55
Max. Negotiated Rate	$1,201.21
Rate for Payer: Aetna Commercial	$964.14
Rate for Payer: BCBS Complete	$501.43
Rate for Payer: BCBS Trust/PPO	$556.83
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Meridian Medicaid	$501.43
Rate for Payer: Priority Health Choice Medicaid	$477.55
Rate for Payer: Priority Health Cigna Priority Health	$935.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,201.21
Rate for Payer: Priority Health Narrow Network	$1,201.21
Rate for Payer: Priority Health SBD	$1,201.21
Rate for Payer: UMR Bronson Commercial	$614.56

PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT

Professional

Both

$759.00

Service Code	HCPCS 53450
Min. Negotiated Rate	$261.99
Max. Negotiated Rate	$1,193.96
Rate for Payer: Aetna Commercial	$523.11
Rate for Payer: BCBS Complete	$275.09
Rate for Payer: BCBS Trust/PPO	$1,193.96
Rate for Payer: Cash Price	$607.20
Rate for Payer: Cash Price	$607.20
Rate for Payer: Meridian Medicaid	$275.09
Rate for Payer: Priority Health Choice Medicaid	$261.99
Rate for Payer: Priority Health Cigna Priority Health	$531.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$654.91
Rate for Payer: Priority Health Narrow Network	$654.91
Rate for Payer: Priority Health SBD	$654.91
Rate for Payer: UMR Bronson Commercial	$349.14

PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM

Professional

Both

$1,544.00

Service Code	HCPCS 53460
Min. Negotiated Rate	$293.09
Max. Negotiated Rate	$1,080.80
Rate for Payer: Aetna Commercial	$586.56
Rate for Payer: BCBS Complete	$307.74
Rate for Payer: BCBS Trust/PPO	$758.64
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Meridian Medicaid	$307.74
Rate for Payer: Priority Health Choice Medicaid	$293.09
Rate for Payer: Priority Health Cigna Priority Health	$1,080.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$731.64
Rate for Payer: Priority Health Narrow Network	$731.64
Rate for Payer: Priority Health SBD	$731.64
Rate for Payer: UMR Bronson Commercial	$710.24

PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA

Professional

Both

$1,993.00

Service Code	HCPCS 53410
Min. Negotiated Rate	$621.96
Max. Negotiated Rate	$1,732.82
Rate for Payer: Aetna Commercial	$1,257.91
Rate for Payer: BCBS Complete	$653.06
Rate for Payer: BCBS Trust/PPO	$1,732.82
Rate for Payer: Cash Price	$1,594.40
Rate for Payer: Cash Price	$1,594.40
Rate for Payer: Meridian Medicaid	$653.06
Rate for Payer: Priority Health Choice Medicaid	$621.96
Rate for Payer: Priority Health Cigna Priority Health	$1,395.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,558.40
Rate for Payer: Priority Health Narrow Network	$1,558.40
Rate for Payer: Priority Health SBD	$1,558.40
Rate for Payer: UMR Bronson Commercial	$916.78

PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX

Professional

Both

$1,494.00

Service Code	HCPCS 53400
Min. Negotiated Rate	$509.07
Max. Negotiated Rate	$2,001.20
Rate for Payer: Aetna Commercial	$1,025.75
Rate for Payer: BCBS Complete	$534.52
Rate for Payer: BCBS Trust/PPO	$2,001.20
Rate for Payer: Cash Price	$1,195.20
Rate for Payer: Cash Price	$1,195.20
Rate for Payer: Meridian Medicaid	$534.52
Rate for Payer: Priority Health Choice Medicaid	$509.07
Rate for Payer: Priority Health Cigna Priority Health	$1,045.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,276.33
Rate for Payer: Priority Health Narrow Network	$1,276.33
Rate for Payer: Priority Health SBD	$1,276.33
Rate for Payer: UMR Bronson Commercial	$687.24

PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION

Professional

Both

$1,778.00

Service Code	HCPCS 53405
Min. Negotiated Rate	$554.87
Max. Negotiated Rate	$2,435.99
Rate for Payer: Aetna Commercial	$1,120.91
Rate for Payer: BCBS Complete	$582.61
Rate for Payer: BCBS Trust/PPO	$2,435.99
Rate for Payer: Cash Price	$1,422.40
Rate for Payer: Cash Price	$1,422.40
Rate for Payer: Meridian Medicaid	$582.61
Rate for Payer: Priority Health Choice Medicaid	$554.87
Rate for Payer: Priority Health Cigna Priority Health	$1,244.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,391.43
Rate for Payer: Priority Health Narrow Network	$1,391.43
Rate for Payer: Priority Health SBD	$1,391.43
Rate for Payer: UMR Bronson Commercial	$817.88

PR URETHROPLASTY RCNSTJ FEMALE URETHRA

Professional

Both

$1,729.00

Service Code	HCPCS 53430
Min. Negotiated Rate	$619.40
Max. Negotiated Rate	$2,049.80
Rate for Payer: Aetna Commercial	$1,252.24
Rate for Payer: BCBS Complete	$650.37
Rate for Payer: BCBS Trust/PPO	$2,049.80
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Meridian Medicaid	$650.37
Rate for Payer: Priority Health Choice Medicaid	$619.40
Rate for Payer: Priority Health Cigna Priority Health	$1,210.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,555.14
Rate for Payer: Priority Health Narrow Network	$1,555.14
Rate for Payer: Priority Health SBD	$1,555.14
Rate for Payer: UMR Bronson Commercial	$795.34

PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE

Professional

Both

$958.00

Service Code	HCPCS 53502
Min. Negotiated Rate	$311.19
Max. Negotiated Rate	$777.04
Rate for Payer: Aetna Commercial	$622.66
Rate for Payer: BCBS Complete	$326.75
Rate for Payer: BCBS Trust/PPO	$701.05
Rate for Payer: Cash Price	$766.40
Rate for Payer: Cash Price	$766.40
Rate for Payer: Meridian Medicaid	$326.75
Rate for Payer: Priority Health Choice Medicaid	$311.19
Rate for Payer: Priority Health Cigna Priority Health	$670.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$777.04
Rate for Payer: Priority Health Narrow Network	$777.04
Rate for Payer: Priority Health SBD	$777.04
Rate for Payer: UMR Bronson Commercial	$440.68

PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE

Professional

Both

$905.00

Service Code	HCPCS 53505
Min. Negotiated Rate	$288.98
Max. Negotiated Rate	$776.50
Rate for Payer: Aetna Commercial	$622.25
Rate for Payer: BCBS Complete	$326.53
Rate for Payer: BCBS Trust/PPO	$288.98
Rate for Payer: Cash Price	$724.00
Rate for Payer: Cash Price	$724.00
Rate for Payer: Meridian Medicaid	$326.53
Rate for Payer: Priority Health Choice Medicaid	$310.98
Rate for Payer: Priority Health Cigna Priority Health	$633.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$776.50
Rate for Payer: Priority Health Narrow Network	$776.50
Rate for Payer: Priority Health SBD	$776.50
Rate for Payer: UMR Bronson Commercial	$416.30

PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA

Professional

Both

$542.00

Service Code	HCPCS 53010
Min. Negotiated Rate	$191.27
Max. Negotiated Rate	$476.06
Rate for Payer: Aetna Commercial	$376.16
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCBS Trust/PPO	$359.24
Rate for Payer: Cash Price	$433.60
Rate for Payer: Cash Price	$433.60
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health	$379.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$476.06
Rate for Payer: Priority Health Narrow Network	$476.06
Rate for Payer: Priority Health SBD	$476.06
Rate for Payer: UMR Bronson Commercial	$249.32

PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE

Professional

Both

$3,284.00

Service Code	HCPCS 50650
Min. Negotiated Rate	$659.24
Max. Negotiated Rate	$2,298.80
Rate for Payer: Aetna Commercial	$1,331.38
Rate for Payer: BCBS Complete	$692.20
Rate for Payer: BCBS Trust/PPO	$809.36
Rate for Payer: Cash Price	$2,627.20
Rate for Payer: Cash Price	$2,627.20
Rate for Payer: Meridian Medicaid	$692.20
Rate for Payer: Priority Health Choice Medicaid	$659.24
Rate for Payer: Priority Health Cigna Priority Health	$2,298.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,649.18
Rate for Payer: Priority Health Narrow Network	$1,649.18
Rate for Payer: Priority Health SBD	$1,649.18
Rate for Payer: UMR Bronson Commercial	$1,510.64

PR URINARY LEG OR ABDOMEN BAG

Professional

Both

$8.00

Service Code	HCPCS A4358
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna Commercial	$5.46
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: UMR Bronson Commercial	$3.68

PR URTP W/TUBULARIZATION POST URT&/LWR BLDR

Professional

Both

$2,163.00

Service Code	HCPCS 53431
Min. Negotiated Rate	$730.16
Max. Negotiated Rate	$2,997.57
Rate for Payer: Aetna Commercial	$1,480.28
Rate for Payer: BCBS Complete	$766.67
Rate for Payer: BCBS Trust/PPO	$2,997.57
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Meridian Medicaid	$766.67
Rate for Payer: Priority Health Choice Medicaid	$730.16
Rate for Payer: Priority Health Cigna Priority Health	$1,514.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,831.28
Rate for Payer: Priority Health Narrow Network	$1,831.28
Rate for Payer: Priority Health SBD	$1,831.28
Rate for Payer: UMR Bronson Commercial	$994.98

PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER

Professional

Both

$1,594.00

Service Code	HCPCS 50620
Min. Negotiated Rate	$572.97
Max. Negotiated Rate	$1,436.81
Rate for Payer: Aetna Commercial	$1,159.84
Rate for Payer: BCBS Complete	$601.62
Rate for Payer: BCBS Trust/PPO	$1,273.73
Rate for Payer: Cash Price	$1,275.20
Rate for Payer: Cash Price	$1,275.20
Rate for Payer: Meridian Medicaid	$601.62
Rate for Payer: Priority Health Choice Medicaid	$572.97
Rate for Payer: Priority Health Cigna Priority Health	$1,115.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,436.81
Rate for Payer: Priority Health Narrow Network	$1,436.81
Rate for Payer: Priority Health SBD	$1,436.81
Rate for Payer: UMR Bronson Commercial	$733.24

PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP

Professional

Both

$4,561.00

Service Code	HCPCS 50785
Min. Negotiated Rate	$768.08
Max. Negotiated Rate	$3,192.70
Rate for Payer: Aetna Commercial	$1,558.20
Rate for Payer: BCBS Complete	$806.48
Rate for Payer: BCBS Trust/PPO	$3,101.12
Rate for Payer: Cash Price	$3,648.80
Rate for Payer: Cash Price	$3,648.80
Rate for Payer: Meridian Medicaid	$806.48
Rate for Payer: Priority Health Choice Medicaid	$768.08
Rate for Payer: Priority Health Cigna Priority Health	$3,192.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,932.33
Rate for Payer: Priority Health Narrow Network	$1,932.33
Rate for Payer: Priority Health SBD	$1,932.33
Rate for Payer: UMR Bronson Commercial	$2,098.06

PR URTT/URTS XTRNL SPX PENDULOUS URETHRA

Professional

Both

$275.00

Service Code	HCPCS 53000
Min. Negotiated Rate	$95.21
Max. Negotiated Rate	$283.70
Rate for Payer: Aetna Commercial	$189.14
Rate for Payer: BCBS Complete	$99.97
Rate for Payer: BCBS Trust/PPO	$283.70
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Meridian Medicaid	$99.97
Rate for Payer: Priority Health Choice Medicaid	$95.21
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$237.21
Rate for Payer: Priority Health Narrow Network	$237.21
Rate for Payer: Priority Health SBD	$237.21
Rate for Payer: UMR Bronson Commercial	$126.50

PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO

Professional

Both

$64.00

Service Code	HCPCS 93352
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$1,312.83
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: BCBS Trust/PPO	$1,312.83
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Priority Health Cigna Priority Health	$44.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.77
Rate for Payer: Priority Health Narrow Network	$47.77
Rate for Payer: Priority Health SBD	$47.77
Rate for Payer: UMR Bronson Commercial	$29.44

PR USE VERTICAL ELECTRODES

Professional

Both

$22.00

Service Code	HCPCS 92547
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$1,085.66
Rate for Payer: Aetna Commercial	$10.32
Rate for Payer: BCBS Complete	$8.80
Rate for Payer: BCBS Trust/PPO	$1,085.66
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Priority Health Cigna Priority Health	$15.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.69
Rate for Payer: Priority Health Narrow Network	$2.69
Rate for Payer: Priority Health SBD	$14.37
Rate for Payer: UMR Bronson Commercial	$10.12

PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE

Professional

Both

$770.00

Service Code	HCPCS 59870
Min. Negotiated Rate	$347.62
Max. Negotiated Rate	$767.29
Rate for Payer: Aetna Commercial	$572.00
Rate for Payer: BCBS Complete	$365.00
Rate for Payer: BCBS Trust/PPO	$547.32
Rate for Payer: Cash Price	$616.00
Rate for Payer: Cash Price	$616.00
Rate for Payer: Meridian Medicaid	$365.00
Rate for Payer: Priority Health Choice Medicaid	$347.62
Rate for Payer: Priority Health Cigna Priority Health	$539.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$767.29
Rate for Payer: Priority Health Narrow Network	$767.29
Rate for Payer: Priority Health SBD	$767.29
Rate for Payer: UMR Bronson Commercial	$354.20

PR UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX

Professional

Both

$847.00

Service Code	HCPCS 58400
Min. Negotiated Rate	$298.84
Max. Negotiated Rate	$659.48
Rate for Payer: Aetna Commercial	$547.93
Rate for Payer: BCBS Complete	$313.78
Rate for Payer: BCBS Trust/PPO	$568.45
Rate for Payer: Cash Price	$677.60
Rate for Payer: Cash Price	$677.60
Rate for Payer: Meridian Medicaid	$313.78
Rate for Payer: Priority Health Choice Medicaid	$298.84
Rate for Payer: Priority Health Cigna Priority Health	$592.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$659.48
Rate for Payer: Priority Health Narrow Network	$659.48
Rate for Payer: Priority Health SBD	$659.48
Rate for Payer: UMR Bronson Commercial	$389.62

PR U-TUBE HEPATICOENTEROSTOMY

Professional

Both

$2,680.00

Service Code	HCPCS 47802
Min. Negotiated Rate	$974.26
Max. Negotiated Rate	$3,097.42
Rate for Payer: Aetna Commercial	$2,068.89
Rate for Payer: BCBS Complete	$1,022.97
Rate for Payer: BCBS Trust/PPO	$3,097.42
Rate for Payer: Cash Price	$2,144.00
Rate for Payer: Cash Price	$2,144.00
Rate for Payer: Meridian Medicaid	$1,022.97
Rate for Payer: Priority Health Choice Medicaid	$974.26
Rate for Payer: Priority Health Cigna Priority Health	$1,876.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,678.80
Rate for Payer: Priority Health Narrow Network	$2,678.80
Rate for Payer: Priority Health SBD	$2,678.80
Rate for Payer: UMR Bronson Commercial	$1,232.80

PR UVULECTOMY EXCISION UVULA

Professional

Both

$562.00

Service Code	HCPCS 42140
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$596.98
Rate for Payer: Aetna Commercial	$205.69
Rate for Payer: BCBS Complete	$110.71
Rate for Payer: BCBS Trust/PPO	$596.98
Rate for Payer: Cash Price	$449.60
Rate for Payer: Cash Price	$449.60
Rate for Payer: Meridian Medicaid	$110.71
Rate for Payer: Priority Health Choice Medicaid	$105.44
Rate for Payer: Priority Health Cigna Priority Health	$393.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.93
Rate for Payer: Priority Health Narrow Network	$286.93
Rate for Payer: Priority Health SBD	$286.93
Rate for Payer: UMR Bronson Commercial	$258.52

PR VAG HYST > 250 GM RMVL TUBE&/OVARY

Professional

Both

$3,063.00

Service Code	HCPCS 58291
Min. Negotiated Rate	$190.19
Max. Negotiated Rate	$2,144.10
Rate for Payer: Aetna Commercial	$1,495.94
Rate for Payer: BCBS Complete	$836.67
Rate for Payer: BCBS Trust/PPO	$190.19
Rate for Payer: Cash Price	$2,450.40
Rate for Payer: Cash Price	$2,450.40
Rate for Payer: Meridian Medicaid	$836.67
Rate for Payer: Priority Health Choice Medicaid	$796.83
Rate for Payer: Priority Health Cigna Priority Health	$2,144.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,766.34
Rate for Payer: Priority Health Narrow Network	$1,766.34
Rate for Payer: Priority Health SBD	$1,766.34
Rate for Payer: UMR Bronson Commercial	$1,408.98

PR VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE

Professional

Both

$3,389.00

Service Code	HCPCS 58292
Min. Negotiated Rate	$213.96
Max. Negotiated Rate	$2,372.30
Rate for Payer: Aetna Commercial	$1,577.26
Rate for Payer: BCBS Complete	$881.63
Rate for Payer: BCBS Trust/PPO	$213.96
Rate for Payer: Cash Price	$2,711.20
Rate for Payer: Cash Price	$2,711.20
Rate for Payer: Meridian Medicaid	$881.63
Rate for Payer: Priority Health Choice Medicaid	$839.65
Rate for Payer: Priority Health Cigna Priority Health	$2,372.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,861.50
Rate for Payer: Priority Health Narrow Network	$1,861.50
Rate for Payer: Priority Health SBD	$1,861.50
Rate for Payer: UMR Bronson Commercial	$1,558.94

PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY

Professional

Both

$2,915.00

Service Code	HCPCS 58262
Min. Negotiated Rate	$266.26
Max. Negotiated Rate	$2,040.50
Rate for Payer: Aetna Commercial	$1,109.35
Rate for Payer: BCBS Complete	$625.33
Rate for Payer: BCBS Trust/PPO	$266.26
Rate for Payer: Cash Price	$2,332.00
Rate for Payer: Cash Price	$2,332.00
Rate for Payer: Meridian Medicaid	$625.33
Rate for Payer: Priority Health Choice Medicaid	$595.55
Rate for Payer: Priority Health Cigna Priority Health	$2,040.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,316.59
Rate for Payer: Priority Health Narrow Network	$1,316.59
Rate for Payer: Priority Health SBD	$1,316.59
Rate for Payer: UMR Bronson Commercial	$1,340.90

Know your out-of-pocket cost for care.

All Charges