Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

CHG CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ

Professional

Both

$21.00

Service Code	HCPCS 87081
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$2,824.29
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$2,824.29
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.03
Rate for Payer: Priority Health Narrow Network	$7.03
Rate for Payer: Priority Health SBD	$7.03
Rate for Payer: UMR Bronson Commercial	$9.66

CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE

Professional

Both

$19.00

Service Code	HCPCS 87086
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$2,635.16
Rate for Payer: Aetna Commercial	$7.67
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: BCBS Trust/PPO	$2,635.16
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.43
Rate for Payer: Priority Health Narrow Network	$8.43
Rate for Payer: Priority Health SBD	$8.43
Rate for Payer: UMR Bronson Commercial	$8.74

CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I

Professional

Both

$102.00

Service Code	HCPCS 74430
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$1,300.67
Rate for Payer: Aetna Commercial	$46.64
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Trust/PPO	$1,300.67
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$71.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.05
Rate for Payer: Priority Health Narrow Network	$23.05
Rate for Payer: Priority Health SBD	$63.51
Rate for Payer: UMR Bronson Commercial	$46.92

CHG CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN

Professional

Both

$63.00

Service Code	HCPCS 88141
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$19.81
Rate for Payer: BCBS Complete	$16.11
Rate for Payer: BCBS Trust/PPO	$168.00
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Meridian Medicaid	$16.11
Rate for Payer: Priority Health Choice Medicaid	$15.34
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.31
Rate for Payer: Priority Health Narrow Network	$35.31
Rate for Payer: Priority Health SBD	$35.31
Rate for Payer: UMR Bronson Commercial	$28.98

CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN

Professional

Both

$46.00

Service Code	HCPCS 88142
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$129.43
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$129.43
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.16
Rate for Payer: Priority Health Narrow Network	$31.16
Rate for Payer: Priority Health SBD	$31.16
Rate for Payer: UMR Bronson Commercial	$21.16

CHG DEXA,BONE DENSITY,VERTEB FRACT

Professional

Both

$19.00

Service Code	HCPCS 77082
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$13.30
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: Cash Price	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: UMR Bronson Commercial	$8.74

CHG DISKOGRAPY LUMBAR RS&I

Professional

Both

$103.00

Service Code	HCPCS 72295
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$2,771.99
Rate for Payer: Aetna Commercial	$128.76
Rate for Payer: BCBS Complete	$41.20
Rate for Payer: BCBS Trust/PPO	$2,771.99
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Priority Health Cigna Priority Health	$72.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.44
Rate for Payer: Priority Health Narrow Network	$60.44
Rate for Payer: Priority Health SBD	$170.55
Rate for Payer: UMR Bronson Commercial	$47.38

CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT

Professional

Both

$142.00

Service Code	HCPCS 76828
Min. Negotiated Rate	$35.34
Max. Negotiated Rate	$563.70
Rate for Payer: Aetna Commercial	$59.77
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: BCBS Trust/PPO	$563.70
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.34
Rate for Payer: Priority Health Narrow Network	$35.34
Rate for Payer: Priority Health SBD	$75.28
Rate for Payer: UMR Bronson Commercial	$65.32

CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE

Professional

Both

$237.00

Service Code	HCPCS 76827
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$506.11
Rate for Payer: Aetna Commercial	$84.26
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: BCBS Trust/PPO	$506.11
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Priority Health Cigna Priority Health	$165.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.00
Rate for Payer: Priority Health Narrow Network	$42.00
Rate for Payer: Priority Health SBD	$107.04
Rate for Payer: UMR Bronson Commercial	$109.02

CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART

Professional

Both

$141.00

Service Code	HCPCS 76821
Min. Negotiated Rate	$50.71
Max. Negotiated Rate	$192.30
Rate for Payer: Aetna Commercial	$104.92
Rate for Payer: BCBS Complete	$56.40
Rate for Payer: BCBS Trust/PPO	$192.30
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.71
Rate for Payer: Priority Health Narrow Network	$50.71
Rate for Payer: Priority Health SBD	$136.24
Rate for Payer: UMR Bronson Commercial	$64.86

CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY

Professional

Both

$244.00

Service Code	HCPCS 76820
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$536.22
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: BCBS Complete	$97.60
Rate for Payer: BCBS Trust/PPO	$536.22
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Priority Health Cigna Priority Health	$170.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32.78
Rate for Payer: Priority Health Narrow Network	$32.78
Rate for Payer: Priority Health SBD	$68.63
Rate for Payer: UMR Bronson Commercial	$112.24

CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES

Professional

Both

$38.00

Service Code	HCPCS 80300
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: UMR Bronson Commercial	$17.48

CHG DRUG SCREEN MULT CLASSES

Professional

Both

$30.00

Service Code	HCPCS 80100
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: UMR Bronson Commercial	$13.80

CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH

Professional

Both

$38.00

Service Code	HCPCS 80104
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: UMR Bronson Commercial	$17.48

CHG DRUG SCREEN SINGL CLASS

Professional

Both

$30.00

Service Code	HCPCS 80101
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: UMR Bronson Commercial	$13.80

CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE

Professional

Both

$38.00

Service Code	HCPCS 80305
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$2,169.73
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$2,169.73
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.01
Rate for Payer: Priority Health Narrow Network	$13.01
Rate for Payer: Priority Health SBD	$13.01
Rate for Payer: UMR Bronson Commercial	$17.48

CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE

Professional

Both

$80.00

Service Code	HCPCS 80307
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$2,739.76
Rate for Payer: Aetna Commercial	$59.03
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$2,739.76
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.31
Rate for Payer: Priority Health Narrow Network	$64.31
Rate for Payer: Priority Health SBD	$64.31
Rate for Payer: UMR Bronson Commercial	$36.80

CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS

Professional

Both

$26.00

Service Code	HCPCS 80306
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$1,676.30
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$1,676.30
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.92
Rate for Payer: Priority Health Narrow Network	$17.92
Rate for Payer: Priority Health SBD	$17.92
Rate for Payer: UMR Bronson Commercial	$11.96

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$158.00

Service Code	HCPCS 77081
Min. Negotiated Rate	$14.86
Max. Negotiated Rate	$1,182.34
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.86
Rate for Payer: Priority Health Narrow Network	$14.86
Rate for Payer: Priority Health Narrow Network	$14.86
Rate for Payer: Priority Health SBD	$48.14
Rate for Payer: Priority Health SBD	$48.14
Rate for Payer: UMR Bronson Commercial	$72.68
Rate for Payer: UMR Bronson Commercial	$11.96

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$234.00

Service Code	HCPCS 77080
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$6,131.98
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS Trust/PPO	$6,131.98
Rate for Payer: BCBS Trust/PPO	$6,131.98
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$134.40
Rate for Payer: Priority Health Cigna Priority Health	$117.60
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.34
Rate for Payer: Priority Health Narrow Network	$14.34
Rate for Payer: Priority Health Narrow Network	$14.34
Rate for Payer: Priority Health SBD	$58.38
Rate for Payer: Priority Health SBD	$58.38
Rate for Payer: UMR Bronson Commercial	$107.64
Rate for Payer: UMR Bronson Commercial	$77.28

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$314.00

Service Code	HCPCS 76506
Min. Negotiated Rate	$46.10
Max. Negotiated Rate	$1,651.99
Rate for Payer: Aetna Commercial	$133.74
Rate for Payer: BCBS Complete	$125.60
Rate for Payer: BCBS Trust/PPO	$1,651.99
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Priority Health Cigna Priority Health	$219.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46.10
Rate for Payer: Priority Health Narrow Network	$46.10
Rate for Payer: Priority Health SBD	$174.66
Rate for Payer: UMR Bronson Commercial	$144.44

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$273.00

Service Code	HCPCS 76825
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$403.07
Rate for Payer: Aetna Commercial	$314.31
Rate for Payer: BCBS Complete	$109.20
Rate for Payer: BCBS Trust/PPO	$244.94
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$119.85
Rate for Payer: Priority Health Narrow Network	$119.85
Rate for Payer: Priority Health SBD	$403.07
Rate for Payer: UMR Bronson Commercial	$125.58

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$128.00

Service Code	HCPCS 76826
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$273.66
Rate for Payer: Aetna Commercial	$187.89
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$273.66
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	$59.41
Rate for Payer: Priority Health Narrow Network	$59.41
Rate for Payer: Priority Health SBD	$241.23
Rate for Payer: UMR Bronson Commercial	$58.88

CHG ENDOVASC REPAIR AAA

Professional

Both

$502.00

Service Code	HCPCS 75952
Min. Negotiated Rate	$200.80
Max. Negotiated Rate	$351.40
Rate for Payer: BCBS Complete	$200.80
Rate for Payer: Cash Price	$401.60
Rate for Payer: Priority Health Cigna Priority Health	$351.40
Rate for Payer: UMR Bronson Commercial	$230.92

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$581.00

Service Code	HCPCS 75957
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$429.19
Rate for Payer: Aetna Commercial	$345.53
Rate for Payer: BCBS Complete	$232.40
Rate for Payer: BCBS Trust/PPO	$399.39
Rate for Payer: Cash Price	$464.80
Rate for Payer: Cash Price	$464.80
Rate for Payer: Priority Health Cigna Priority Health	$406.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$429.19
Rate for Payer: Priority Health Narrow Network	$429.19
Rate for Payer: Priority Health SBD	$429.19
Rate for Payer: UMR Bronson Commercial	$267.26

Know your out-of-pocket cost for care.

All Charges