Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC

Professional

Both

$10.00

Service Code	HCPCS 82272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$5,089.64
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$5,089.64
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: Priority Health HMO/PPO/Tiered Network	$4.22
Rate for Payer: Priority Health Narrow Network	$4.22
Rate for Payer: Priority Health SBD	$4.22
Rate for Payer: UMR Bronson Commercial	$4.60

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER

Professional

Both

$14.00

Service Code	HCPCS 82270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$3,891.99
Rate for Payer: Aetna Commercial	$4.16
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$3,891.99
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	$4.57
Rate for Payer: Priority Health Narrow Network	$4.57
Rate for Payer: Priority Health SBD	$4.57
Rate for Payer: UMR Bronson Commercial	$6.44

CHG BONE AGE STUDIES

Professional

Both

$35.00

Service Code	HCPCS 77072
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$3,140.74
Rate for Payer: Aetna Commercial	$29.76
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$3,140.74
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.83
Rate for Payer: Priority Health Narrow Network	$13.83
Rate for Payer: Priority Health SBD	$39.95
Rate for Payer: UMR Bronson Commercial	$16.10

CHG BONE LENGTH STUDIES

Professional

Both

$131.00

Service Code	HCPCS 77073
Min. Negotiated Rate	$19.98
Max. Negotiated Rate	$3,610.40
Rate for Payer: Aetna Commercial	$51.41
Rate for Payer: Aetna Commercial	$51.41
Rate for Payer: BCBS Complete	$52.40
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: BCBS Trust/PPO	$3,610.40
Rate for Payer: BCBS Trust/PPO	$3,610.40
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health Cigna Priority Health	$91.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.98
Rate for Payer: Priority Health Narrow Network	$19.98
Rate for Payer: Priority Health Narrow Network	$19.98
Rate for Payer: Priority Health SBD	$69.15
Rate for Payer: Priority Health SBD	$69.15
Rate for Payer: UMR Bronson Commercial	$60.26
Rate for Payer: UMR Bronson Commercial	$26.22

CHG BRACHYTHER DOSE PLAN COMPLX

Professional

Both

$303.00

Service Code	HCPCS 77328
Min. Negotiated Rate	$121.20
Max. Negotiated Rate	$212.10
Rate for Payer: BCBS Complete	$121.20
Rate for Payer: BCBS Complete	$206.40
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$242.40
Rate for Payer: Priority Health Cigna Priority Health	$212.10
Rate for Payer: Priority Health Cigna Priority Health	$361.20
Rate for Payer: UMR Bronson Commercial	$139.38
Rate for Payer: UMR Bronson Commercial	$237.36

CHG BRACHYTHER DOSE PLAN SIMPLE

Professional

Both

$274.00

Service Code	HCPCS 77326
Min. Negotiated Rate	$109.60
Max. Negotiated Rate	$191.80
Rate for Payer: BCBS Complete	$109.60
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$144.00
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health Cigna Priority Health	$191.80
Rate for Payer: UMR Bronson Commercial	$126.04
Rate for Payer: UMR Bronson Commercial	$82.80

CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL

Professional

Both

$630.00

Service Code	HCPCS 77318
Min. Negotiated Rate	$231.50
Max. Negotiated Rate	$1,342.41
Rate for Payer: Aetna Commercial	$494.97
Rate for Payer: Aetna Commercial	$494.97
Rate for Payer: BCBS Complete	$278.00
Rate for Payer: BCBS Complete	$252.00
Rate for Payer: BCBS Trust/PPO	$1,342.41
Rate for Payer: BCBS Trust/PPO	$1,342.41
Rate for Payer: Cash Price	$556.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$556.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Priority Health Cigna Priority Health	$486.50
Rate for Payer: Priority Health Cigna Priority Health	$441.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$231.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$231.50
Rate for Payer: Priority Health Narrow Network	$231.50
Rate for Payer: Priority Health Narrow Network	$231.50
Rate for Payer: Priority Health SBD	$698.08
Rate for Payer: Priority Health SBD	$698.08
Rate for Payer: UMR Bronson Commercial	$319.70
Rate for Payer: UMR Bronson Commercial	$289.80

CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS

Professional

Both

$250.00

Service Code	HCPCS 78472
Min. Negotiated Rate	$69.15
Max. Negotiated Rate	$429.51
Rate for Payer: Aetna Commercial	$259.45
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCBS Trust/PPO	$429.51
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.15
Rate for Payer: Priority Health Narrow Network	$69.15
Rate for Payer: Priority Health SBD	$326.25
Rate for Payer: UMR Bronson Commercial	$115.00

CHG CELL COUNT MISCELLANEOUS BODY FLUIDS

Professional

Both

$11.00

Service Code	HCPCS 89050
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$2,396.37
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$2,396.37
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.26
Rate for Payer: Priority Health Narrow Network	$7.26
Rate for Payer: Priority Health SBD	$7.26
Rate for Payer: UMR Bronson Commercial	$5.06

CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY

Professional

Both

$645.00

Service Code	HCPCS 78630
Min. Negotiated Rate	$48.65
Max. Negotiated Rate	$694.71
Rate for Payer: Aetna Commercial	$381.57
Rate for Payer: BCBS Complete	$258.00
Rate for Payer: BCBS Trust/PPO	$694.71
Rate for Payer: Cash Price	$516.00
Rate for Payer: Cash Price	$516.00
Rate for Payer: Priority Health Cigna Priority Health	$451.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$48.65
Rate for Payer: Priority Health Narrow Network	$48.65
Rate for Payer: Priority Health SBD	$481.44
Rate for Payer: UMR Bronson Commercial	$296.70

CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I

Professional

Both

$157.00

Service Code	HCPCS 75984
Min. Negotiated Rate	$56.84
Max. Negotiated Rate	$389.89
Rate for Payer: Aetna Commercial	$119.58
Rate for Payer: Aetna Commercial	$119.58
Rate for Payer: BCBS Complete	$62.80
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Trust/PPO	$389.89
Rate for Payer: BCBS Trust/PPO	$389.89
Rate for Payer: Cash Price	$125.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$125.60
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health Cigna Priority Health	$109.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.84
Rate for Payer: Priority Health Narrow Network	$56.84
Rate for Payer: Priority Health Narrow Network	$56.84
Rate for Payer: Priority Health SBD	$147.51
Rate for Payer: Priority Health SBD	$147.51
Rate for Payer: UMR Bronson Commercial	$72.22
Rate for Payer: UMR Bronson Commercial	$62.10

CHG CHEST X-RAY 1 VW

Professional

Both

$28.00

Service Code	HCPCS 71010
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$19.60
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Complete	$28.80
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$50.40
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: UMR Bronson Commercial	$12.88
Rate for Payer: UMR Bronson Commercial	$33.12

CHG CHEST X-RAY 2 VW

Professional

Both

$43.00

Service Code	HCPCS 71020
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$30.10
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: Priority Health Cigna Priority Health	$30.10
Rate for Payer: UMR Bronson Commercial	$19.78
Rate for Payer: UMR Bronson Commercial	$17.48

CHG CHOLESTEROL SERUM/WHOLE BLOOD TOTAL

Professional

Both

$14.00

Service Code	HCPCS 82465
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$1,764.52
Rate for Payer: Aetna Commercial	$4.13
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$1,764.52
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	$4.57
Rate for Payer: Priority Health Narrow Network	$4.57
Rate for Payer: Priority Health SBD	$4.57
Rate for Payer: UMR Bronson Commercial	$6.44

CHG CONTINUING MEDICAL PHYSICS CONSLTJ PR WK

Professional

Both

$151.00

Service Code	HCPCS 77336
Min. Negotiated Rate	$60.40
Max. Negotiated Rate	$2,156.52
Rate for Payer: Aetna Commercial	$90.57
Rate for Payer: BCBS Complete	$60.40
Rate for Payer: BCBS Trust/PPO	$2,156.52
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	$132.14
Rate for Payer: Priority Health Narrow Network	$132.14
Rate for Payer: Priority Health SBD	$132.14
Rate for Payer: UMR Bronson Commercial	$69.46

CHG CREATININE OTHER SOURCE

Professional

Both

$11.00

Service Code	HCPCS 82570
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$2,406.93
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$2,406.93
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.70
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	$5.06

CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID

Professional

Both

$55.00

Service Code	HCPCS 89060
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$2,750.86
Rate for Payer: Aetna Commercial	$6.96
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$2,750.86
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.01
Rate for Payer: Priority Health Narrow Network	$27.01
Rate for Payer: Priority Health SBD	$38.44
Rate for Payer: UMR Bronson Commercial	$25.30

CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP

Professional

Both

$300.00

Service Code	HCPCS 75635
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$651.98
Rate for Payer: Aetna Commercial	$351.85
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Trust/PPO	$164.30
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$170.55
Rate for Payer: Priority Health Narrow Network	$170.55
Rate for Payer: Priority Health SBD	$651.98
Rate for Payer: UMR Bronson Commercial	$138.00

CHG CT ABDOMEN W/CONTRAST MATERIAL

Professional

Both

$128.00

Service Code	HCPCS 74160
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$2,524.22
Rate for Payer: Aetna Commercial	$283.74
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$2,524.22
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$89.60
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 SBD	$374.90
Rate for Payer: UMR Bronson Commercial	$58.88

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST

Professional

Both

$900.00

Service Code	HCPCS 74261
Min. Negotiated Rate	$173.63
Max. Negotiated Rate	$4,266.02
Rate for Payer: Aetna Commercial	$272.64
Rate for Payer: BCBS Complete	$360.00
Rate for Payer: BCBS Trust/PPO	$4,266.02
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Priority Health Cigna Priority Health	$630.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.63
Rate for Payer: Priority Health Narrow Network	$173.63
Rate for Payer: Priority Health SBD	$668.38
Rate for Payer: UMR Bronson Commercial	$414.00

CHG CT GUIDANCE NEEDLE PLACEMENT

Professional

Both

$214.00

Service Code	HCPCS 77012
Min. Negotiated Rate	$85.60
Max. Negotiated Rate	$801.43
Rate for Payer: Aetna Commercial	$181.02
Rate for Payer: BCBS Complete	$85.60
Rate for Payer: BCBS Trust/PPO	$801.43
Rate for Payer: Cash Price	$171.20
Rate for Payer: Cash Price	$171.20
Rate for Payer: Priority Health Cigna Priority Health	$149.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.54
Rate for Payer: Priority Health Narrow Network	$106.54
Rate for Payer: Priority Health SBD	$217.16
Rate for Payer: UMR Bronson Commercial	$98.44

CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT

Professional

Both

$238.00

Service Code	HCPCS 77014
Min. Negotiated Rate	$68.12
Max. Negotiated Rate	$1,757.13
Rate for Payer: Aetna Commercial	$149.64
Rate for Payer: Aetna Commercial	$149.64
Rate for Payer: BCBS Complete	$126.40
Rate for Payer: BCBS Complete	$95.20
Rate for Payer: BCBS Trust/PPO	$1,757.13
Rate for Payer: BCBS Trust/PPO	$1,757.13
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$252.80
Rate for Payer: Priority Health Cigna Priority Health	$166.60
Rate for Payer: Priority Health Cigna Priority Health	$221.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.12
Rate for Payer: Priority Health Narrow Network	$68.12
Rate for Payer: Priority Health Narrow Network	$68.12
Rate for Payer: Priority Health SBD	$184.89
Rate for Payer: Priority Health SBD	$184.89
Rate for Payer: UMR Bronson Commercial	$109.48
Rate for Payer: UMR Bronson Commercial	$145.36

CHG CT GUIDANCE STEREOTACTIC LOCALIZATION

Professional

Both

$457.00

Service Code	HCPCS 77011
Min. Negotiated Rate	$93.72
Max. Negotiated Rate	$344.17
Rate for Payer: Aetna Commercial	$283.63
Rate for Payer: BCBS Complete	$182.80
Rate for Payer: BCBS Trust/PPO	$284.23
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$365.60
Rate for Payer: Priority Health Cigna Priority Health	$319.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$93.72
Rate for Payer: Priority Health Narrow Network	$93.72
Rate for Payer: Priority Health SBD	$344.17
Rate for Payer: UMR Bronson Commercial	$210.22

CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY

Professional

Both

$150.00

Service Code	HCPCS 76380
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$954.11
Rate for Payer: Aetna Commercial	$152.20
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$954.11
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.15
Rate for Payer: Priority Health Narrow Network	$69.15
Rate for Payer: Priority Health SBD	$208.96
Rate for Payer: UMR Bronson Commercial	$69.00

CHG CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL

Professional

Both

$36.00

Service Code	HCPCS 87070
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$2,125.88
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS Trust/PPO	$2,125.88
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	$8.78
Rate for Payer: Priority Health Narrow Network	$8.78
Rate for Payer: Priority Health SBD	$8.78
Rate for Payer: UMR Bronson Commercial	$16.56

Know your out-of-pocket cost for care.

All Charges