Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$194.00

Service Code	HCPCS 75716
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$248.91
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: BCBS Complete	$77.60
Rate for Payer: BCBS Trust/PPO	$112.00
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$110.12
Rate for Payer: Priority Health Narrow Network	$110.12
Rate for Payer: Priority Health SBD	$248.91
Rate for Payer: UMR Bronson Commercial	$89.24

CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$178.00

Service Code	HCPCS 75710
Min. Negotiated Rate	$71.20
Max. Negotiated Rate	$230.47
Rate for Payer: Aetna Commercial	$184.17
Rate for Payer: Aetna Commercial	$184.17
Rate for Payer: BCBS Complete	$168.80
Rate for Payer: BCBS Complete	$71.20
Rate for Payer: BCBS Trust/PPO	$183.32
Rate for Payer: BCBS Trust/PPO	$183.32
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$142.40
Rate for Payer: Priority Health Cigna Priority Health	$295.40
Rate for Payer: Priority Health Cigna Priority Health	$124.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.02
Rate for Payer: Priority Health Narrow Network	$106.02
Rate for Payer: Priority Health Narrow Network	$106.02
Rate for Payer: Priority Health SBD	$230.47
Rate for Payer: Priority Health SBD	$230.47
Rate for Payer: UMR Bronson Commercial	$81.88
Rate for Payer: UMR Bronson Commercial	$194.12

CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I

Professional

Both

$186.00

Service Code	HCPCS 75756
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$247.88
Rate for Payer: Aetna Commercial	$184.66
Rate for Payer: BCBS Complete	$74.40
Rate for Payer: BCBS Trust/PPO	$177.51
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Priority Health Cigna Priority Health	$130.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.49
Rate for Payer: Priority Health Narrow Network	$83.49
Rate for Payer: Priority Health SBD	$247.88
Rate for Payer: UMR Bronson Commercial	$85.56

CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I

Professional

Both

$313.00

Service Code	HCPCS 75736
Min. Negotiated Rate	$79.39
Max. Negotiated Rate	$219.21
Rate for Payer: Aetna Commercial	$167.44
Rate for Payer: BCBS Complete	$125.20
Rate for Payer: BCBS Trust/PPO	$182.79
Rate for Payer: Cash Price	$250.40
Rate for Payer: Cash Price	$250.40
Rate for Payer: Priority Health Cigna Priority Health	$219.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.39
Rate for Payer: Priority Health Narrow Network	$79.39
Rate for Payer: Priority Health SBD	$219.21
Rate for Payer: UMR Bronson Commercial	$143.98

CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I

Professional

Both

$123.00

Service Code	HCPCS 75741
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$200.77
Rate for Payer: Aetna Commercial	$158.51
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS Trust/PPO	$104.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.68
Rate for Payer: Priority Health Narrow Network	$91.68
Rate for Payer: Priority Health SBD	$200.77
Rate for Payer: UMR Bronson Commercial	$56.58

CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I

Professional

Both

$427.00

Service Code	HCPCS 75705
Min. Negotiated Rate	$162.19
Max. Negotiated Rate	$381.05
Rate for Payer: Aetna Commercial	$287.69
Rate for Payer: BCBS Complete	$170.80
Rate for Payer: BCBS Trust/PPO	$162.19
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Priority Health Cigna Priority Health	$298.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$176.18
Rate for Payer: Priority Health Narrow Network	$176.18
Rate for Payer: Priority Health SBD	$381.05
Rate for Payer: UMR Bronson Commercial	$196.42

CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I

Professional

Both

$268.00

Service Code	HCPCS 75726
Min. Negotiated Rate	$107.20
Max. Negotiated Rate	$262.74
Rate for Payer: Aetna Commercial	$206.42
Rate for Payer: BCBS Complete	$107.20
Rate for Payer: BCBS Trust/PPO	$145.81
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Priority Health Cigna Priority Health	$187.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$119.34
Rate for Payer: Priority Health Narrow Network	$119.34
Rate for Payer: Priority Health SBD	$262.74
Rate for Payer: UMR Bronson Commercial	$123.28

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS

Professional

Both

$159.00

Service Code	HCPCS 75898
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$3,164.58
Rate for Payer: Aetna Commercial	$3,164.58
Rate for Payer: BCBS Complete	$63.60
Rate for Payer: BCBS Trust/PPO	$328.07
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Priority Health Cigna Priority Health	$111.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.60
Rate for Payer: Priority Health Narrow Network	$67.60
Rate for Payer: Priority Health SBD	$204.36
Rate for Payer: UMR Bronson Commercial	$73.14

CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I

Professional

Both

$296.00

Service Code	HCPCS 75774
Min. Negotiated Rate	$70.17
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$120.01
Rate for Payer: BCBS Complete	$118.40
Rate for Payer: BCBS Trust/PPO	$186.49
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cash Price	$236.80
Rate for Payer: Priority Health Cigna Priority Health	$207.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.17
Rate for Payer: Priority Health Narrow Network	$70.17
Rate for Payer: Priority Health SBD	$149.04
Rate for Payer: UMR Bronson Commercial	$136.16

CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I

Professional

Both

$466.00

Service Code	HCPCS 75630
Min. Negotiated Rate	$98.84
Max. Negotiated Rate	$326.20
Rate for Payer: Aetna Commercial	$192.70
Rate for Payer: Aetna Commercial	$192.70
Rate for Payer: BCBS Complete	$186.40
Rate for Payer: BCBS Complete	$114.80
Rate for Payer: BCBS Trust/PPO	$166.41
Rate for Payer: BCBS Trust/PPO	$166.41
Rate for Payer: Cash Price	$372.80
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$372.80
Rate for Payer: Cash Price	$229.60
Rate for Payer: Priority Health Cigna Priority Health	$200.90
Rate for Payer: Priority Health Cigna Priority Health	$326.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.84
Rate for Payer: Priority Health Narrow Network	$98.84
Rate for Payer: Priority Health Narrow Network	$98.84
Rate for Payer: Priority Health SBD	$240.21
Rate for Payer: Priority Health SBD	$240.21
Rate for Payer: UMR Bronson Commercial	$214.36
Rate for Payer: UMR Bronson Commercial	$132.02

CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I

Professional

Both

$113.00

Service Code	HCPCS 75625
Min. Negotiated Rate	$45.20
Max. Negotiated Rate	$193.59
Rate for Payer: Aetna Commercial	$155.85
Rate for Payer: Aetna Commercial	$155.85
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Complete	$45.20
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$90.40
Rate for Payer: Priority Health Cigna Priority Health	$79.10
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.19
Rate for Payer: Priority Health Narrow Network	$92.19
Rate for Payer: Priority Health Narrow Network	$92.19
Rate for Payer: Priority Health SBD	$193.59
Rate for Payer: Priority Health SBD	$193.59
Rate for Payer: UMR Bronson Commercial	$51.52
Rate for Payer: UMR Bronson Commercial	$51.98

CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I

Professional

Both

$260.00

Service Code	HCPCS 75605
Min. Negotiated Rate	$80.41
Max. Negotiated Rate	$184.89
Rate for Payer: Aetna Commercial	$145.70
Rate for Payer: BCBS Complete	$104.00
Rate for Payer: BCBS Trust/PPO	$157.43
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Priority Health Cigna Priority Health	$182.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.41
Rate for Payer: Priority Health Narrow Network	$80.41
Rate for Payer: Priority Health SBD	$184.89
Rate for Payer: UMR Bronson Commercial	$119.60

CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I

Professional

Both

$105.00

Service Code	HCPCS 75600
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$283.75
Rate for Payer: Aetna Commercial	$227.46
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCBS Trust/PPO	$114.11
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Priority Health Cigna Priority Health	$73.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.85
Rate for Payer: Priority Health Narrow Network	$35.85
Rate for Payer: Priority Health SBD	$283.75
Rate for Payer: UMR Bronson Commercial	$48.30

CHG ASSAY OF LEAD

Professional

Both

$20.00

Service Code	HCPCS 83655
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$365.58
Rate for Payer: Aetna Commercial	$11.50
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$365.58
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.65
Rate for Payer: Priority Health Narrow Network	$12.65
Rate for Payer: Priority Health SBD	$12.65
Rate for Payer: UMR Bronson Commercial	$9.20

CHG ASSAY OF PHOSPHATASE ALKALINE

Professional

Both

$12.00

Service Code	HCPCS 84075
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$1,760.30
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$1,760.30
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.27
Rate for Payer: Priority Health Narrow Network	$5.27
Rate for Payer: Priority Health SBD	$5.27
Rate for Payer: UMR Bronson Commercial	$5.52

CHG ASSAY OF PROGESTERONE

Professional

Both

$92.00

Service Code	HCPCS 84144
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$2,469.80
Rate for Payer: Aetna Commercial	$19.82
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: BCBS Trust/PPO	$2,469.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.79
Rate for Payer: Priority Health Narrow Network	$21.79
Rate for Payer: Priority Health SBD	$21.79
Rate for Payer: UMR Bronson Commercial	$42.32

CHG ASSAY OF PYRUVATE KINASE

Professional

Both

$93.00

Service Code	HCPCS 84220
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$2,574.93
Rate for Payer: Aetna Commercial	$8.97
Rate for Payer: BCBS Complete	$37.20
Rate for Payer: BCBS Trust/PPO	$2,574.93
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Priority Health Cigna Priority Health	$65.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.84
Rate for Payer: Priority Health Narrow Network	$9.84
Rate for Payer: Priority Health SBD	$9.84
Rate for Payer: UMR Bronson Commercial	$42.78

CHG ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE

Professional

Both

$78.00

Service Code	HCPCS 84588
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$4,901.57
Rate for Payer: Aetna Commercial	$32.24
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$4,901.57
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.15
Rate for Payer: Priority Health Narrow Network	$35.15
Rate for Payer: Priority Health SBD	$35.15
Rate for Payer: UMR Bronson Commercial	$35.88

CHG BALLOON ANGIOPLASTY VISCERAL

Professional

Both

$157.00

Service Code	HCPCS 75966
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$109.90
Rate for Payer: BCBS Complete	$62.80
Rate for Payer: Cash Price	$125.60
Rate for Payer: Priority Health Cigna Priority Health	$109.90
Rate for Payer: UMR Bronson Commercial	$72.22

CHG BALLOON ANGIO VENOUS

Professional

Both

$389.00

Service Code	HCPCS 75978
Min. Negotiated Rate	$155.60
Max. Negotiated Rate	$272.30
Rate for Payer: BCBS Complete	$155.60
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$311.20
Rate for Payer: Priority Health Cigna Priority Health	$272.30
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UMR Bronson Commercial	$178.94
Rate for Payer: UMR Bronson Commercial	$23.00

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$128.00

Service Code	HCPCS 77300
Min. Negotiated Rate	$50.19
Max. Negotiated Rate	$205.51
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Complete	$29.60
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Priority Health Cigna Priority Health	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$51.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.19
Rate for Payer: Priority Health Narrow Network	$50.19
Rate for Payer: Priority Health Narrow Network	$50.19
Rate for Payer: Priority Health SBD	$100.90
Rate for Payer: Priority Health SBD	$100.90
Rate for Payer: UMR Bronson Commercial	$58.88
Rate for Payer: UMR Bronson Commercial	$34.04

CHG BILIRUBIN TOTAL

Professional

Both

$23.00

Service Code	HCPCS 82247
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$4,644.29
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$4,644.29
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.27
Rate for Payer: Priority Health Narrow Network	$5.27
Rate for Payer: Priority Health SBD	$5.27
Rate for Payer: UMR Bronson Commercial	$10.58

CHG BILIRUBIN TOTAL TRANSCUTANEOUS

Professional

Both

$13.00

Service Code	HCPCS 88720
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$1,883.39
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: BCBS Trust/PPO	$1,883.39
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.79
Rate for Payer: Priority Health Narrow Network	$7.79
Rate for Payer: Priority Health SBD	$7.79
Rate for Payer: UMR Bronson Commercial	$5.98

CHG BLOOD COUNT HEMOGLOBIN

Professional

Both

$14.00

Service Code	HCPCS 85018
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$4,885.72
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$4,885.72
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.46
Rate for Payer: Priority Health Narrow Network	$2.46
Rate for Payer: Priority Health SBD	$2.46
Rate for Payer: UMR Bronson Commercial	$6.44

CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3

Professional

Both

$43.00

Service Code	HCPCS 82274
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$2,456.07
Rate for Payer: Aetna Commercial	$15.12
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCBS Trust/PPO	$2,456.07
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Priority Health Cigna Priority Health	$30.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.52
Rate for Payer: Priority Health Narrow Network	$16.52
Rate for Payer: Priority Health SBD	$16.52
Rate for Payer: UMR Bronson Commercial	$19.78

Know your out-of-pocket cost for care.

All Charges