Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR BCN APNEALINK PLUS

Professional

Both

$738.65

Service Code	HCPCS 00119
Hospital Revenue Code	960
Min. Negotiated Rate	$295.46
Max. Negotiated Rate	$517.06
Rate for Payer: BCBS Complete	$295.46
Rate for Payer: Cash Price	$590.92
Rate for Payer: Priority Health Cigna Priority Health	$517.06
Rate for Payer: UMR Bronson Commercial	$339.78

PR BCN WATCHPAT

Professional

Both

$547.64

Service Code	HCPCS 00120
Hospital Revenue Code	960
Min. Negotiated Rate	$219.06
Max. Negotiated Rate	$383.35
Rate for Payer: BCBS Complete	$219.06
Rate for Payer: Cash Price	$438.11
Rate for Payer: Priority Health Cigna Priority Health	$383.35
Rate for Payer: UMR Bronson Commercial	$251.91

PR BEDSIDE DRAINAGE BAG

Professional

Both

$15.00

Service Code	HCPCS A4357
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: UMR Bronson Commercial	$6.90

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$986.86
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$986.86
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	$8.89
Rate for Payer: Priority Health Narrow Network	$8.89
Rate for Payer: Priority Health SBD	$8.89
Rate for Payer: UMR Bronson Commercial	$5.06

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$539.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$377.30
Rate for Payer: Aetna Commercial	$39.28
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Priority Health Cigna Priority Health	$377.30
Rate for Payer: UMR Bronson Commercial	$247.94

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$176.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$1,450.71
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$1,450.71
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$146.87
Rate for Payer: Priority Health Narrow Network	$146.87
Rate for Payer: Priority Health SBD	$146.87
Rate for Payer: UMR Bronson Commercial	$80.96

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$44.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$1,436.98
Rate for Payer: Aetna Commercial	$23.66
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$1,436.98
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	$27.23
Rate for Payer: Priority Health Narrow Network	$27.23
Rate for Payer: Priority Health SBD	$27.23
Rate for Payer: UMR Bronson Commercial	$20.24

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$61.00

Service Code	HCPCS 97151
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$1,118.41
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$1,118.41
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.41
Rate for Payer: Priority Health Narrow Network	$37.41
Rate for Payer: Priority Health SBD	$37.41
Rate for Payer: UMR Bronson Commercial	$28.06

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$7.02
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$3.84
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: UMR Bronson Commercial	$4.60

PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT

Professional

Both

$165.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$184.91
Rate for Payer: Aetna Commercial	$48.12
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: BCBS Trust/PPO	$184.91
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.04
Rate for Payer: Priority Health Narrow Network	$65.04
Rate for Payer: Priority Health SBD	$65.04
Rate for Payer: UMR Bronson Commercial	$75.90

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$31.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna Commercial	$29.66
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70
Rate for Payer: UMR Bronson Commercial	$14.26

PR BILATERAL GYNECOMASTIA

Professional

Both

$3,200.00

Service Code	HCPCS 00524
Hospital Revenue Code	990
Min. Negotiated Rate	$1,280.00
Max. Negotiated Rate	$2,240.00
Rate for Payer: BCBS Complete	$1,280.00
Rate for Payer: Cash Price	$2,560.00
Rate for Payer: Priority Health Cigna Priority Health	$2,240.00
Rate for Payer: UMR Bronson Commercial	$1,472.00

PR BILATERAL MASTOPEXY

Professional

Both

$3,800.00

Service Code	HCPCS 00525
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00
Rate for Payer: UMR Bronson Commercial	$1,748.00

PR BILATERAL OTOPLASTY

Professional

Both

$3,100.00

Service Code	HCPCS 00533
Hospital Revenue Code	990
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: BCBS Complete	$1,240.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00
Rate for Payer: UMR Bronson Commercial	$1,426.00

PR BILATERAL REDUCTION MAMMOPLASTY

Professional

Both

$3,800.00

Service Code	HCPCS 00526
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00
Rate for Payer: UMR Bronson Commercial	$1,748.00

PR BILATERAL THORACIC ROLL EXCISION

Professional

Both

$2,700.00

Service Code	HCPCS 00543
Hospital Revenue Code	990
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: BCBS Complete	$1,080.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Priority Health Cigna Priority Health	$1,890.00
Rate for Payer: UMR Bronson Commercial	$1,242.00

PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

Professional

Both

$898.00

Service Code	HCPCS 47554
Min. Negotiated Rate	$279.88
Max. Negotiated Rate	$7,499.75
Rate for Payer: Aetna Commercial	$696.48
Rate for Payer: BCBS Complete	$293.87
Rate for Payer: BCBS Trust/PPO	$7,499.75
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Meridian Medicaid	$293.87
Rate for Payer: Priority Health Choice Medicaid	$279.88
Rate for Payer: Priority Health Cigna Priority Health	$628.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$773.19
Rate for Payer: Priority Health Narrow Network	$773.19
Rate for Payer: Priority Health SBD	$773.19
Rate for Payer: UMR Bronson Commercial	$413.08

PR BILIARY NDSC INTRAOPERATIVE

Professional

Both

$520.00

Service Code	HCPCS 47550
Min. Negotiated Rate	$103.31
Max. Negotiated Rate	$5,071.68
Rate for Payer: Aetna Commercial	$223.49
Rate for Payer: BCBS Complete	$108.48
Rate for Payer: BCBS Trust/PPO	$5,071.68
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Meridian Medicaid	$108.48
Rate for Payer: Priority Health Choice Medicaid	$103.31
Rate for Payer: Priority Health Cigna Priority Health	$364.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$285.75
Rate for Payer: Priority Health Narrow Network	$285.75
Rate for Payer: Priority Health SBD	$285.75
Rate for Payer: UMR Bronson Commercial	$239.20

PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE

Professional

Both

$100.00

Service Code	HCPCS 92504
Min. Negotiated Rate	$10.27
Max. Negotiated Rate	$2,190.33
Rate for Payer: Aetna Commercial	$10.27
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Trust/PPO	$2,190.33
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.58
Rate for Payer: Priority Health Narrow Network	$12.58
Rate for Payer: Priority Health SBD	$12.58
Rate for Payer: UMR Bronson Commercial	$46.00

PR BIOFEEDBACK PERI/URO/RECTAL

Professional

Both

$184.00

Service Code	HCPCS 90911
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$128.80
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Priority Health Cigna Priority Health	$128.80
Rate for Payer: UMR Bronson Commercial	$84.64

PR BIOFEEDBACK TRAINING ANY MODALITY

Professional

Both

$125.00

Service Code	HCPCS 90901
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$724.83
Rate for Payer: Aetna Commercial	$87.36
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.18
Rate for Payer: Priority Health Narrow Network	$61.18
Rate for Payer: Priority Health SBD	$61.18
Rate for Payer: UMR Bronson Commercial	$57.50

PR BIOPSY BONE OPEN DEEP

Professional

Both

$1,239.00

Service Code	HCPCS 20245
Min. Negotiated Rate	$106.88
Max. Negotiated Rate	$867.30
Rate for Payer: Aetna Commercial	$465.71
Rate for Payer: BCBS Complete	$229.25
Rate for Payer: BCBS Trust/PPO	$106.88
Rate for Payer: Cash Price	$991.20
Rate for Payer: Cash Price	$991.20
Rate for Payer: Meridian Medicaid	$229.25
Rate for Payer: Priority Health Choice Medicaid	$218.33
Rate for Payer: Priority Health Cigna Priority Health	$867.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$522.40
Rate for Payer: Priority Health Narrow Network	$522.40
Rate for Payer: Priority Health SBD	$522.40
Rate for Payer: UMR Bronson Commercial	$569.94

PR BIOPSY BONE OPEN SUPERFICIAL

Professional

Both

$535.00

Service Code	HCPCS 20240
Min. Negotiated Rate	$89.03
Max. Negotiated Rate	$1,002.07
Rate for Payer: Aetna Commercial	$190.88
Rate for Payer: BCBS Complete	$93.48
Rate for Payer: BCBS Trust/PPO	$1,002.07
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cash Price	$428.00
Rate for Payer: Meridian Medicaid	$93.48
Rate for Payer: Priority Health Choice Medicaid	$89.03
Rate for Payer: Priority Health Cigna Priority Health	$374.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$211.40
Rate for Payer: Priority Health Narrow Network	$211.40
Rate for Payer: Priority Health SBD	$211.40
Rate for Payer: UMR Bronson Commercial	$246.10

PR BIOPSY BONE TROCAR/NEEDLE DEEP

Professional

Both

$1,880.00

Service Code	HCPCS 20225
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$1,316.00
Rate for Payer: Aetna Commercial	$173.19
Rate for Payer: BCBS Complete	$85.21
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$1,504.00
Rate for Payer: Cash Price	$1,504.00
Rate for Payer: Meridian Medicaid	$85.21
Rate for Payer: Priority Health Choice Medicaid	$81.15
Rate for Payer: Priority Health Cigna Priority Health	$1,316.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.56
Rate for Payer: Priority Health Narrow Network	$194.56
Rate for Payer: Priority Health SBD	$194.56
Rate for Payer: UMR Bronson Commercial	$864.80

PR BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL

Professional

Both

$341.00

Service Code	HCPCS 20220
Min. Negotiated Rate	$54.74
Max. Negotiated Rate	$1,002.07
Rate for Payer: Aetna Commercial	$116.83
Rate for Payer: BCBS Complete	$57.48
Rate for Payer: BCBS Trust/PPO	$1,002.07
Rate for Payer: Cash Price	$272.80
Rate for Payer: Cash Price	$272.80
Rate for Payer: Meridian Medicaid	$57.48
Rate for Payer: Priority Health Choice Medicaid	$54.74
Rate for Payer: Priority Health Cigna Priority Health	$238.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$132.26
Rate for Payer: Priority Health Narrow Network	$132.26
Rate for Payer: Priority Health SBD	$132.26
Rate for Payer: UMR Bronson Commercial	$156.86

Know your out-of-pocket cost for care.

All Charges