Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

CHG IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS

Professional

Both

$40.00

Service Code	HCPCS 87426
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$1,641.96
Rate for Payer: Aetna Commercial	$45.23
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$1,641.96
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.55
Rate for Payer: Priority Health Narrow Network	$36.55
Rate for Payer: Priority Health SBD	$36.55
Rate for Payer: UMR Bronson Commercial	$18.40

CHG IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS

Professional

Both

$43.00

Service Code	HCPCS 87265
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$1,212.98
Rate for Payer: Aetna Commercial	$11.38
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCBS Trust/PPO	$1,212.98
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	$12.30
Rate for Payer: Priority Health Narrow Network	$12.30
Rate for Payer: Priority Health SBD	$12.30
Rate for Payer: UMR Bronson Commercial	$19.78

CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ

Professional

Both

$75.00

Service Code	HCPCS 87491
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$1,449.13
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Trust/PPO	$1,449.13
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.55
Rate for Payer: Priority Health Narrow Network	$36.55
Rate for Payer: Priority Health SBD	$36.55
Rate for Payer: UMR Bronson Commercial	$34.50

CHG IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ

Professional

Both

$81.00

Service Code	HCPCS 87800
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$1,724.37
Rate for Payer: Aetna Commercial	$41.49
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCBS Trust/PPO	$1,724.37
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$56.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.33
Rate for Payer: Priority Health Narrow Network	$45.33
Rate for Payer: Priority Health SBD	$45.33
Rate for Payer: UMR Bronson Commercial	$37.26

CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ

Professional

Both

$75.00

Service Code	HCPCS 87591
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$593.81
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Trust/PPO	$593.81
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.55
Rate for Payer: Priority Health Narrow Network	$36.55
Rate for Payer: Priority Health SBD	$36.55
Rate for Payer: UMR Bronson Commercial	$34.50

CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ

Professional

Both

$145.00

Service Code	HCPCS 87635
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$2,508.37
Rate for Payer: Aetna Commercial	$51.31
Rate for Payer: BCBS Complete	$58.00
Rate for Payer: BCBS Trust/PPO	$2,508.37
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Priority Health Cigna Priority Health	$101.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.07
Rate for Payer: Priority Health Narrow Network	$53.07
Rate for Payer: Priority Health SBD	$53.07
Rate for Payer: UMR Bronson Commercial	$66.70

CHG IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH

Professional

Both

$46.00

Service Code	HCPCS 86318
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$1,735.47
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$1,735.47
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	$18.63
Rate for Payer: Priority Health Narrow Network	$18.63
Rate for Payer: Priority Health SBD	$18.63
Rate for Payer: UMR Bronson Commercial	$21.16

CHG IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE

Professional

Both

$39.00

Service Code	HCPCS 86294
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$167.47
Rate for Payer: Aetna Commercial	$24.29
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS Trust/PPO	$167.47
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.36
Rate for Payer: Priority Health Narrow Network	$26.36
Rate for Payer: Priority Health SBD	$26.36
Rate for Payer: UMR Bronson Commercial	$17.94

CHG INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES

Professional

Both

$144.00

Service Code	HCPCS 87502
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$713.73
Rate for Payer: Aetna Commercial	$91.01
Rate for Payer: BCBS Complete	$57.60
Rate for Payer: BCBS Trust/PPO	$713.73
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Priority Health Cigna Priority Health	$100.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.46
Rate for Payer: Priority Health Narrow Network	$99.46
Rate for Payer: Priority Health SBD	$99.46
Rate for Payer: UMR Bronson Commercial	$66.24

CHG INTEN MOD RADIOTHER PLAN, SIN/MULT FIELD

Professional

Both

$922.00

Service Code	HCPCS 77418
Min. Negotiated Rate	$368.80
Max. Negotiated Rate	$645.40
Rate for Payer: BCBS Complete	$368.80
Rate for Payer: Cash Price	$737.60
Rate for Payer: Priority Health Cigna Priority Health	$645.40
Rate for Payer: UMR Bronson Commercial	$424.12

CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$1,675.00

Service Code	HCPCS 77778
Min. Negotiated Rate	$301.66
Max. Negotiated Rate	$1,395.66
Rate for Payer: Aetna Commercial	$1,018.17
Rate for Payer: Aetna Commercial	$1,018.17
Rate for Payer: BCBS Complete	$208.80
Rate for Payer: BCBS Complete	$670.00
Rate for Payer: BCBS Trust/PPO	$301.66
Rate for Payer: BCBS Trust/PPO	$301.66
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cash Price	$417.60
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health Cigna Priority Health	$1,172.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$695.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$695.01
Rate for Payer: Priority Health Narrow Network	$695.01
Rate for Payer: Priority Health Narrow Network	$695.01
Rate for Payer: Priority Health SBD	$1,395.66
Rate for Payer: Priority Health SBD	$1,395.66
Rate for Payer: UMR Bronson Commercial	$770.50
Rate for Payer: UMR Bronson Commercial	$240.12

CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE

Professional

Both

$456.00

Service Code	HCPCS 77761
Min. Negotiated Rate	$182.40
Max. Negotiated Rate	$639.70
Rate for Payer: Aetna Commercial	$469.99
Rate for Payer: BCBS Complete	$182.40
Rate for Payer: BCBS Trust/PPO	$324.38
Rate for Payer: Cash Price	$364.80
Rate for Payer: Cash Price	$364.80
Rate for Payer: Priority Health Cigna Priority Health	$319.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$308.84
Rate for Payer: Priority Health Narrow Network	$308.84
Rate for Payer: Priority Health SBD	$639.70
Rate for Payer: UMR Bronson Commercial	$209.76

CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I

Professional

Both

$89.00

Service Code	HCPCS 74360
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$2,791.54
Rate for Payer: Aetna Commercial	$128.38
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: BCBS Trust/PPO	$2,791.54
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$62.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.46
Rate for Payer: Priority Health Narrow Network	$40.46
Rate for Payer: Priority Health SBD	$169.02
Rate for Payer: UMR Bronson Commercial	$40.94

CHG INTRAVASC ULTRASOUND,1ST VESSEL

Professional

Both

$220.00

Service Code	HCPCS 75945
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$154.00
Rate for Payer: BCBS Complete	$88.00
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$176.00
Rate for Payer: Priority Health Cigna Priority Health	$154.00
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: UMR Bronson Commercial	$101.20
Rate for Payer: UMR Bronson Commercial	$38.18

CHG INTRAVASC US, RAD SUPERISE/ INTERP, EA ADDN VESSEL

Professional

Both

$153.00

Service Code	HCPCS 75946
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$107.10
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$122.40
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: UMR Bronson Commercial	$20.70
Rate for Payer: UMR Bronson Commercial	$70.38

CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

Professional

Both

$206.00

Service Code	HCPCS 74340
Min. Negotiated Rate	$39.43
Max. Negotiated Rate	$2,030.79
Rate for Payer: Aetna Commercial	$119.95
Rate for Payer: BCBS Complete	$82.40
Rate for Payer: BCBS Trust/PPO	$2,030.79
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.43
Rate for Payer: Priority Health Narrow Network	$39.43
Rate for Payer: Priority Health SBD	$157.74
Rate for Payer: UMR Bronson Commercial	$94.76

CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS

Professional

Both

$60.00

Service Code	HCPCS 77077
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$3,952.74
Rate for Payer: Aetna Commercial	$53.57
Rate for Payer: Aetna Commercial	$53.57
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$3,952.74
Rate for Payer: BCBS Trust/PPO	$3,952.74
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.09
Rate for Payer: Priority Health Narrow Network	$25.09
Rate for Payer: Priority Health Narrow Network	$25.09
Rate for Payer: Priority Health SBD	$72.21
Rate for Payer: Priority Health SBD	$72.21
Rate for Payer: UMR Bronson Commercial	$27.60
Rate for Payer: UMR Bronson Commercial	$62.10

CHG LIPID PANEL

Professional

Both

$44.00

Service Code	HCPCS 80061
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$2,009.65
Rate for Payer: Aetna Commercial	$12.72
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$2,009.65
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.05
Rate for Payer: Priority Health Narrow Network	$14.05
Rate for Payer: Priority Health SBD	$14.05
Rate for Payer: UMR Bronson Commercial	$20.24

CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS

Professional

Both

$92.00

Service Code	HCPCS 77071
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$882.79
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCBS Trust/PPO	$882.79
Rate for Payer: BCBS Trust/PPO	$882.79
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Cigna Priority Health	$60.90
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.00
Rate for Payer: Priority Health Narrow Network	$84.00
Rate for Payer: Priority Health Narrow Network	$84.00
Rate for Payer: Priority Health SBD	$84.00
Rate for Payer: Priority Health SBD	$84.00
Rate for Payer: UMR Bronson Commercial	$40.02
Rate for Payer: UMR Bronson Commercial	$42.32

CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I

Professional

Both

$37.00

Service Code	HCPCS 75902
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$449.58
Rate for Payer: Aetna Commercial	$104.59
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: BCBS Trust/PPO	$449.58
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.17
Rate for Payer: Priority Health Narrow Network	$28.17
Rate for Payer: Priority Health SBD	$139.30
Rate for Payer: UMR Bronson Commercial	$17.02

CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I

Professional

Both

$332.00

Service Code	HCPCS 75901
Min. Negotiated Rate	$34.31
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial	$267.87
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: BCBS Trust/PPO	$420.00
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$265.60
Rate for Payer: Priority Health Cigna Priority Health	$232.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.31
Rate for Payer: Priority Health Narrow Network	$34.31
Rate for Payer: Priority Health SBD	$355.45
Rate for Payer: UMR Bronson Commercial	$152.72

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

Professional

Both

$515.00

Service Code	HCPCS 77338
Min. Negotiated Rate	$206.00
Max. Negotiated Rate	$2,953.73
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: BCBS Complete	$380.80
Rate for Payer: BCBS Complete	$373.60
Rate for Payer: BCBS Complete	$206.00
Rate for Payer: BCBS Trust/PPO	$2,953.73
Rate for Payer: BCBS Trust/PPO	$2,953.73
Rate for Payer: BCBS Trust/PPO	$2,953.73
Rate for Payer: Cash Price	$747.20
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$747.20
Rate for Payer: Cash Price	$761.60
Rate for Payer: Priority Health Cigna Priority Health	$360.50
Rate for Payer: Priority Health Cigna Priority Health	$666.40
Rate for Payer: Priority Health Cigna Priority Health	$653.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.15
Rate for Payer: Priority Health Narrow Network	$343.15
Rate for Payer: Priority Health Narrow Network	$343.15
Rate for Payer: Priority Health Narrow Network	$343.15
Rate for Payer: Priority Health SBD	$709.87
Rate for Payer: Priority Health SBD	$709.87
Rate for Payer: Priority Health SBD	$709.87
Rate for Payer: UMR Bronson Commercial	$236.90
Rate for Payer: UMR Bronson Commercial	$429.64
Rate for Payer: UMR Bronson Commercial	$437.92

CHG MRA HEAD W/O CONTRST MATERIAL

Professional

Both

$234.00

Service Code	HCPCS 70544
Min. Negotiated Rate	$87.07
Max. Negotiated Rate	$1,742.33
Rate for Payer: Aetna Commercial	$349.94
Rate for Payer: Aetna Commercial	$349.94
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS Complete	$269.20
Rate for Payer: BCBS Trust/PPO	$1,742.33
Rate for Payer: BCBS Trust/PPO	$1,742.33
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$187.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health Cigna Priority Health	$471.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$87.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$87.07
Rate for Payer: Priority Health Narrow Network	$87.07
Rate for Payer: Priority Health Narrow Network	$87.07
Rate for Payer: Priority Health SBD	$344.17
Rate for Payer: Priority Health SBD	$344.17
Rate for Payer: UMR Bronson Commercial	$107.64
Rate for Payer: UMR Bronson Commercial	$309.58

CHG MRA NECK W/O CONTRST MATERIAL

Professional

Both

$231.00

Service Code	HCPCS 70547
Min. Negotiated Rate	$87.07
Max. Negotiated Rate	$1,605.50
Rate for Payer: Aetna Commercial	$351.42
Rate for Payer: BCBS Complete	$92.40
Rate for Payer: BCBS Trust/PPO	$1,605.50
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Priority Health Cigna Priority Health	$161.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$87.07
Rate for Payer: Priority Health Narrow Network	$87.07
Rate for Payer: Priority Health SBD	$344.69
Rate for Payer: UMR Bronson Commercial	$106.26

CHG MRA NECK W/O &W/CONTRAST MATERIAL

Professional

Both

$275.00

Service Code	HCPCS 70549
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$2,120.07
Rate for Payer: Aetna Commercial	$560.98
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: BCBS Trust/PPO	$2,120.07
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.60
Rate for Payer: Priority Health Narrow Network	$130.60
Rate for Payer: Priority Health SBD	$552.62
Rate for Payer: UMR Bronson Commercial	$126.50

Know your out-of-pocket cost for care.

All Charges