Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR BREAST AUGMENTATION WITH IMPLANT

Professional

Both

$2,000.00

Service Code	HCPCS 19325
Min. Negotiated Rate	$395.33
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$661.62
Rate for Payer: BCBS Complete	$415.10
Rate for Payer: BCBS Trust/PPO	$630.49
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Meridian Medicaid	$415.10
Rate for Payer: Priority Health Choice Medicaid	$395.33
Rate for Payer: Priority Health Cigna Priority Health	$1,400.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$757.96
Rate for Payer: Priority Health Narrow Network	$757.96
Rate for Payer: Priority Health SBD	$757.96
Rate for Payer: UMR Bronson Commercial	$920.00

PR BREAST AUGMENT W MASTOPEXY-GEL 2.5

Professional

Both

$6,540.00

Service Code	HCPCS 00258
Hospital Revenue Code	990
Min. Negotiated Rate	$2,616.00
Max. Negotiated Rate	$4,578.00
Rate for Payer: BCBS Complete	$2,616.00
Rate for Payer: Cash Price	$5,232.00
Rate for Payer: Priority Health Cigna Priority Health	$4,578.00
Rate for Payer: UMR Bronson Commercial	$3,008.40

PR BREAST AUGMENT W MASTOPEXY-GEL 3.5

Professional

Both

$7,440.00

Service Code	HCPCS 00260
Hospital Revenue Code	990
Min. Negotiated Rate	$2,976.00
Max. Negotiated Rate	$5,208.00
Rate for Payer: BCBS Complete	$2,976.00
Rate for Payer: Cash Price	$5,952.00
Rate for Payer: Priority Health Cigna Priority Health	$5,208.00
Rate for Payer: UMR Bronson Commercial	$3,422.40

PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5

Professional

Both

$5,500.00

Service Code	HCPCS 00257
Hospital Revenue Code	990
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: BCBS Complete	$2,200.00
Rate for Payer: Cash Price	$4,400.00
Rate for Payer: Priority Health Cigna Priority Health	$3,850.00
Rate for Payer: UMR Bronson Commercial	$2,530.00

PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5

Professional

Both

$6,400.00

Service Code	HCPCS 00259
Hospital Revenue Code	990
Min. Negotiated Rate	$2,560.00
Max. Negotiated Rate	$4,480.00
Rate for Payer: BCBS Complete	$2,560.00
Rate for Payer: Cash Price	$5,120.00
Rate for Payer: Priority Health Cigna Priority Health	$4,480.00
Rate for Payer: UMR Bronson Commercial	$2,944.00

PR BREAST IMPLANT WARRANTY

Professional

Both

$350.00

Service Code	HCPCS 00523
Hospital Revenue Code	990
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$245.00
Rate for Payer: BCBS Complete	$140.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: UMR Bronson Commercial	$161.00

PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST

Professional

Both

$4,715.00

Service Code	HCPCS 19368
Min. Negotiated Rate	$1,327.27
Max. Negotiated Rate	$3,300.50
Rate for Payer: Aetna Commercial	$2,367.91
Rate for Payer: BCBS Complete	$1,449.47
Rate for Payer: BCBS Trust/PPO	$1,327.27
Rate for Payer: Cash Price	$3,772.00
Rate for Payer: Cash Price	$3,772.00
Rate for Payer: Meridian Medicaid	$1,449.47
Rate for Payer: Priority Health Choice Medicaid	$1,380.45
Rate for Payer: Priority Health Cigna Priority Health	$3,300.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,661.07
Rate for Payer: Priority Health Narrow Network	$2,661.07
Rate for Payer: Priority Health SBD	$2,661.07
Rate for Payer: UMR Bronson Commercial	$2,168.90

PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP

Professional

Both

$4,130.00

Service Code	HCPCS 19369
Min. Negotiated Rate	$199.98
Max. Negotiated Rate	$2,891.00
Rate for Payer: Aetna Commercial	$2,199.14
Rate for Payer: BCBS Complete	$1,347.04
Rate for Payer: BCBS Trust/PPO	$199.98
Rate for Payer: Cash Price	$3,304.00
Rate for Payer: Cash Price	$3,304.00
Rate for Payer: Meridian Medicaid	$1,347.04
Rate for Payer: Priority Health Choice Medicaid	$1,282.90
Rate for Payer: Priority Health Cigna Priority Health	$2,891.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,472.80
Rate for Payer: Priority Health Narrow Network	$2,472.80
Rate for Payer: Priority Health SBD	$2,472.80
Rate for Payer: UMR Bronson Commercial	$1,899.80

PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP

Professional

Both

$2,973.00

Service Code	HCPCS 19367
Min. Negotiated Rate	$1,128.69
Max. Negotiated Rate	$2,172.75
Rate for Payer: Aetna Commercial	$1,924.16
Rate for Payer: BCBS Complete	$1,185.12
Rate for Payer: BCBS Trust/PPO	$1,327.27
Rate for Payer: Cash Price	$2,378.40
Rate for Payer: Cash Price	$2,378.40
Rate for Payer: Meridian Medicaid	$1,185.12
Rate for Payer: Priority Health Choice Medicaid	$1,128.69
Rate for Payer: Priority Health Cigna Priority Health	$2,081.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,172.75
Rate for Payer: Priority Health Narrow Network	$2,172.75
Rate for Payer: Priority Health SBD	$2,172.75
Rate for Payer: UMR Bronson Commercial	$1,367.58

PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP

Professional

Both

$2,863.00

Service Code	HCPCS 19361
Min. Negotiated Rate	$312.59
Max. Negotiated Rate	$2,004.10
Rate for Payer: Aetna Commercial	$1,693.89
Rate for Payer: BCBS Complete	$1,043.99
Rate for Payer: BCBS Trust/PPO	$312.59
Rate for Payer: Cash Price	$2,290.40
Rate for Payer: Cash Price	$2,290.40
Rate for Payer: Meridian Medicaid	$1,043.99
Rate for Payer: Priority Health Choice Medicaid	$994.28
Rate for Payer: Priority Health Cigna Priority Health	$2,004.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,912.97
Rate for Payer: Priority Health Narrow Network	$1,912.97
Rate for Payer: Priority Health SBD	$1,912.97
Rate for Payer: UMR Bronson Commercial	$1,316.98

PR BREAST RECONSTRUC W OTHR TECHNIQ

Professional

Both

$2,846.00

Service Code	HCPCS 19366
Min. Negotiated Rate	$1,138.40
Max. Negotiated Rate	$1,992.20
Rate for Payer: BCBS Complete	$1,138.40
Rate for Payer: Cash Price	$2,276.80
Rate for Payer: Priority Health Cigna Priority Health	$1,992.20
Rate for Payer: UMR Bronson Commercial	$1,309.16

PR BREAST REDUCTION

Professional

Both

$1,900.00

Service Code	HCPCS 19318
Min. Negotiated Rate	$293.06
Max. Negotiated Rate	$1,344.10
Rate for Payer: Aetna Commercial	$1,186.12
Rate for Payer: BCBS Complete	$734.24
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Meridian Medicaid	$734.24
Rate for Payer: Priority Health Choice Medicaid	$699.28
Rate for Payer: Priority Health Cigna Priority Health	$1,330.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,344.10
Rate for Payer: Priority Health Narrow Network	$1,344.10
Rate for Payer: Priority Health SBD	$1,344.10
Rate for Payer: UMR Bronson Commercial	$874.00

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$164.00

Service Code	HCPCS 91065
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$1,135.85
Rate for Payer: Aetna Commercial	$96.87
Rate for Payer: BCBS Complete	$65.60
Rate for Payer: BCBS Trust/PPO	$1,135.85
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Priority Health Cigna Priority Health	$114.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.03
Rate for Payer: Priority Health Narrow Network	$13.03
Rate for Payer: Priority Health SBD	$113.19
Rate for Payer: UMR Bronson Commercial	$75.44

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$176.00

Service Code	HCPCS 94450
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$1,113.66
Rate for Payer: Aetna Commercial	$65.23
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$1,113.66
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	$26.04
Rate for Payer: Priority Health Narrow Network	$26.04
Rate for Payer: Priority Health SBD	$110.04
Rate for Payer: UMR Bronson Commercial	$80.96

PR BRIEF CHECK IN BY MD/QHP

Professional

Both

$29.00

Service Code	HCPCS G2012
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$403.09
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: BCBS Trust/PPO	$403.09
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Meridian Medicaid	$8.49
Rate for Payer: Priority Health Choice Medicaid	$8.09
Rate for Payer: Priority Health Cigna Priority Health	$20.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.85
Rate for Payer: Priority Health Narrow Network	$15.85
Rate for Payer: Priority Health SBD	$15.85
Rate for Payer: UMR Bronson Commercial	$13.34

PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN

Professional

Both

$27.00

Service Code	HCPCS 94060
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$1,399.47
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$84.70
Rate for Payer: Priority Health Cigna Priority Health	$18.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.98
Rate for Payer: Priority Health Narrow Network	$18.98
Rate for Payer: Priority Health Narrow Network	$18.98
Rate for Payer: Priority Health SBD	$85.70
Rate for Payer: Priority Health SBD	$85.70
Rate for Payer: UMR Bronson Commercial	$55.66
Rate for Payer: UMR Bronson Commercial	$12.42

PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS

Professional

Both

$636.00

Service Code	HCPCS 31623
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$720.60
Rate for Payer: Aetna Commercial	$170.36
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$720.60
Rate for Payer: Cash Price	$508.80
Rate for Payer: Cash Price	$508.80
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$445.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$177.81
Rate for Payer: Priority Health Narrow Network	$177.81
Rate for Payer: Priority Health SBD	$177.81
Rate for Payer: UMR Bronson Commercial	$292.56

PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX

Professional

Both

$473.00

Service Code	HCPCS 31652
Min. Negotiated Rate	$137.39
Max. Negotiated Rate	$853.73
Rate for Payer: Aetna Commercial	$286.67
Rate for Payer: BCBS Complete	$144.26
Rate for Payer: BCBS Trust/PPO	$853.73
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cash Price	$378.40
Rate for Payer: Meridian Medicaid	$144.26
Rate for Payer: Priority Health Choice Medicaid	$137.39
Rate for Payer: Priority Health Cigna Priority Health	$331.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$297.73
Rate for Payer: Priority Health Narrow Network	$297.73
Rate for Payer: Priority Health SBD	$297.73
Rate for Payer: UMR Bronson Commercial	$217.58

PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX

Professional

Both

$522.00

Service Code	HCPCS 31653
Min. Negotiated Rate	$152.30
Max. Negotiated Rate	$1,172.30
Rate for Payer: Aetna Commercial	$316.88
Rate for Payer: BCBS Complete	$159.92
Rate for Payer: BCBS Trust/PPO	$1,172.30
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Meridian Medicaid	$159.92
Rate for Payer: Priority Health Choice Medicaid	$152.30
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$330.16
Rate for Payer: Priority Health Narrow Network	$330.16
Rate for Payer: Priority Health SBD	$330.16
Rate for Payer: UMR Bronson Commercial	$240.12

PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

Professional

Both

$584.00

Service Code	HCPCS 31622
Min. Negotiated Rate	$83.07
Max. Negotiated Rate	$408.80
Rate for Payer: Aetna Commercial	$169.32
Rate for Payer: BCBS Complete	$87.22
Rate for Payer: BCBS Trust/PPO	$372.29
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Meridian Medicaid	$87.22
Rate for Payer: Priority Health Choice Medicaid	$83.07
Rate for Payer: Priority Health Cigna Priority Health	$408.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.28
Rate for Payer: Priority Health Narrow Network	$178.28
Rate for Payer: Priority Health SBD	$178.28
Rate for Payer: UMR Bronson Commercial	$268.64

PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE

Professional

Both

$593.00

Service Code	HCPCS 31624
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$1,147.47
Rate for Payer: Aetna Commercial	$172.05
Rate for Payer: BCBS Complete	$87.68
Rate for Payer: BCBS Trust/PPO	$1,147.47
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Meridian Medicaid	$87.68
Rate for Payer: Priority Health Choice Medicaid	$83.50
Rate for Payer: Priority Health Cigna Priority Health	$415.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.05
Rate for Payer: Priority Health Narrow Network	$181.05
Rate for Payer: Priority Health SBD	$181.05
Rate for Payer: UMR Bronson Commercial	$272.78

PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX

Professional

Both

$370.00

Service Code	HCPCS 31630
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$786.64
Rate for Payer: Aetna Commercial	$255.59
Rate for Payer: BCBS Complete	$130.17
Rate for Payer: BCBS Trust/PPO	$786.64
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Meridian Medicaid	$130.17
Rate for Payer: Priority Health Choice Medicaid	$123.97
Rate for Payer: Priority Health Cigna Priority Health	$259.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.57
Rate for Payer: Priority Health Narrow Network	$268.57
Rate for Payer: Priority Health SBD	$268.57
Rate for Payer: UMR Bronson Commercial	$170.20

PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT

Professional

Both

$52.00

Service Code	HCPCS 94070
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$1,284.30
Rate for Payer: Aetna Commercial	$66.61
Rate for Payer: Aetna Commercial	$66.61
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Trust/PPO	$1,284.30
Rate for Payer: BCBS Trust/PPO	$1,284.30
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.38
Rate for Payer: Priority Health Narrow Network	$36.38
Rate for Payer: Priority Health Narrow Network	$36.38
Rate for Payer: Priority Health SBD	$81.74
Rate for Payer: Priority Health SBD	$81.74
Rate for Payer: UMR Bronson Commercial	$23.92
Rate for Payer: UMR Bronson Commercial	$62.10

PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES

Professional

Both

$212.00

Service Code	HCPCS 31654
Min. Negotiated Rate	$41.75
Max. Negotiated Rate	$791.92
Rate for Payer: Aetna Commercial	$86.57
Rate for Payer: BCBS Complete	$43.84
Rate for Payer: BCBS Trust/PPO	$791.92
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Meridian Medicaid	$43.84
Rate for Payer: Priority Health Choice Medicaid	$41.75
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$89.83
Rate for Payer: Priority Health Narrow Network	$89.83
Rate for Payer: Priority Health SBD	$89.83
Rate for Payer: UMR Bronson Commercial	$97.52

PR BRONCHOPLASTY GRAFT REPAIR

Professional

Both

$2,895.00

Service Code	HCPCS 31770
Min. Negotiated Rate	$835.81
Max. Negotiated Rate	$2,026.50
Rate for Payer: Aetna Commercial	$1,717.54
Rate for Payer: BCBS Complete	$877.60
Rate for Payer: BCBS Trust/PPO	$1,379.92
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Meridian Medicaid	$877.60
Rate for Payer: Priority Health Choice Medicaid	$835.81
Rate for Payer: Priority Health Cigna Priority Health	$2,026.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,809.58
Rate for Payer: Priority Health Narrow Network	$1,809.58
Rate for Payer: Priority Health SBD	$1,809.58
Rate for Payer: UMR Bronson Commercial	$1,331.70

Know your out-of-pocket cost for care.

All Charges