Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES

Professional

Both

$635.00

Service Code	HCPCS 31625
Min. Negotiated Rate	$97.55
Max. Negotiated Rate	$463.32
Rate for Payer: Aetna Commercial	$200.97
Rate for Payer: BCBS Complete	$102.43
Rate for Payer: BCBS Trust/PPO	$463.32
Rate for Payer: Cash Price	$508.00
Rate for Payer: Cash Price	$508.00
Rate for Payer: Meridian Medicaid	$102.43
Rate for Payer: Priority Health Choice Medicaid	$97.55
Rate for Payer: Priority Health Cigna Priority Health	$444.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$210.23
Rate for Payer: Priority Health Narrow Network	$210.23
Rate for Payer: Priority Health SBD	$210.23
Rate for Payer: UMR Bronson Commercial	$292.10

PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON

Professional

Both

$1,234.00

Service Code	HCPCS 31629
Min. Negotiated Rate	$116.51
Max. Negotiated Rate	$863.80
Rate for Payer: Aetna Commercial	$240.07
Rate for Payer: BCBS Complete	$122.34
Rate for Payer: BCBS Trust/PPO	$499.77
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cash Price	$987.20
Rate for Payer: Meridian Medicaid	$122.34
Rate for Payer: Priority Health Choice Medicaid	$116.51
Rate for Payer: Priority Health Cigna Priority Health	$863.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$251.44
Rate for Payer: Priority Health Narrow Network	$251.44
Rate for Payer: Priority Health SBD	$251.44
Rate for Payer: UMR Bronson Commercial	$567.64

PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION

Professional

Both

$170.00

Service Code	HCPCS 31627
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$684.15
Rate for Payer: Aetna Commercial	$125.22
Rate for Payer: BCBS Complete	$63.07
Rate for Payer: BCBS Trust/PPO	$684.15
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Meridian Medicaid	$63.07
Rate for Payer: Priority Health Choice Medicaid	$60.07
Rate for Payer: Priority Health Cigna Priority Health	$119.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.65
Rate for Payer: Priority Health Narrow Network	$129.65
Rate for Payer: Priority Health SBD	$129.65
Rate for Payer: UMR Bronson Commercial	$78.20

PR BRONCHOSCOPY W/EXCISION TUMOR

Professional

Both

$511.00

Service Code	HCPCS 31640
Min. Negotiated Rate	$154.21
Max. Negotiated Rate	$852.15
Rate for Payer: Aetna Commercial	$320.57
Rate for Payer: BCBS Complete	$161.92
Rate for Payer: BCBS Trust/PPO	$852.15
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Meridian Medicaid	$161.92
Rate for Payer: Priority Health Choice Medicaid	$154.21
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$335.70
Rate for Payer: Priority Health Narrow Network	$335.70
Rate for Payer: Priority Health SBD	$335.70
Rate for Payer: UMR Bronson Commercial	$235.06

PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY

Professional

Both

$1,115.00

Service Code	HCPCS 31635
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$972.60
Rate for Payer: Aetna Commercial	$225.61
Rate for Payer: BCBS Complete	$115.18
Rate for Payer: BCBS Trust/PPO	$972.60
Rate for Payer: Cash Price	$892.00
Rate for Payer: Cash Price	$892.00
Rate for Payer: Meridian Medicaid	$115.18
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health	$780.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$236.15
Rate for Payer: Priority Health Narrow Network	$236.15
Rate for Payer: Priority Health SBD	$236.15
Rate for Payer: UMR Bronson Commercial	$512.90

PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST

Professional

Both

$675.00

Service Code	HCPCS 31645
Min. Negotiated Rate	$92.02
Max. Negotiated Rate	$667.24
Rate for Payer: Aetna Commercial	$188.88
Rate for Payer: BCBS Complete	$96.62
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Meridian Medicaid	$96.62
Rate for Payer: Priority Health Choice Medicaid	$92.02
Rate for Payer: Priority Health Cigna Priority Health	$472.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$198.19
Rate for Payer: Priority Health Narrow Network	$198.19
Rate for Payer: Priority Health SBD	$198.19
Rate for Payer: UMR Bronson Commercial	$310.50

PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ

Professional

Both

$602.00

Service Code	HCPCS 31646
Min. Negotiated Rate	$88.82
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: BCBS Complete	$93.26
Rate for Payer: BCBS Trust/PPO	$1,008.00
Rate for Payer: Cash Price	$481.60
Rate for Payer: Cash Price	$481.60
Rate for Payer: Meridian Medicaid	$93.26
Rate for Payer: Priority Health Choice Medicaid	$88.82
Rate for Payer: Priority Health Cigna Priority Health	$421.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$191.23
Rate for Payer: Priority Health Narrow Network	$191.23
Rate for Payer: Priority Health SBD	$191.23
Rate for Payer: UMR Bronson Commercial	$276.92

PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE

Professional

Both

$745.00

Service Code	HCPCS 31628
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$915.54
Rate for Payer: Aetna Commercial	$226.30
Rate for Payer: BCBS Complete	$115.18
Rate for Payer: BCBS Trust/PPO	$915.54
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Meridian Medicaid	$115.18
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health	$521.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$237.08
Rate for Payer: Priority Health Narrow Network	$237.08
Rate for Payer: Priority Health SBD	$237.08
Rate for Payer: UMR Bronson Commercial	$342.70

PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE

Professional

Both

$126.00

Service Code	HCPCS 31632
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$996.90
Rate for Payer: Aetna Commercial	$63.94
Rate for Payer: BCBS Complete	$31.98
Rate for Payer: BCBS Trust/PPO	$996.90
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Meridian Medicaid	$31.98
Rate for Payer: Priority Health Choice Medicaid	$30.46
Rate for Payer: Priority Health Cigna Priority Health	$88.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.68
Rate for Payer: Priority Health Narrow Network	$66.68
Rate for Payer: Priority Health SBD	$66.68
Rate for Payer: UMR Bronson Commercial	$57.96

PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE

Professional

Both

$97.00

Service Code	HCPCS 31633
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$724.83
Rate for Payer: Aetna Commercial	$82.12
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health	$67.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.73
Rate for Payer: Priority Health Narrow Network	$84.73
Rate for Payer: Priority Health SBD	$84.73
Rate for Payer: UMR Bronson Commercial	$44.62

PR BROWLIFT

Professional

Both

$2,600.00

Service Code	HCPCS 00532
Hospital Revenue Code	990
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,820.00
Rate for Payer: BCBS Complete	$1,040.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Priority Health Cigna Priority Health	$1,820.00
Rate for Payer: UMR Bronson Commercial	$1,196.00

PR BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY

Professional

Both

$5,875.00

Service Code	HCPCS 58954
Min. Negotiated Rate	$131.02
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$2,579.73
Rate for Payer: BCBS Complete	$1,458.87
Rate for Payer: BCBS Trust/PPO	$131.02
Rate for Payer: Cash Price	$4,700.00
Rate for Payer: Cash Price	$4,700.00
Rate for Payer: Meridian Medicaid	$1,458.87
Rate for Payer: Priority Health Choice Medicaid	$1,389.40
Rate for Payer: Priority Health Cigna Priority Health	$4,112.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,060.22
Rate for Payer: Priority Health Narrow Network	$3,060.22
Rate for Payer: Priority Health SBD	$3,060.22
Rate for Payer: UMR Bronson Commercial	$2,702.50

PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION

Professional

Both

$5,137.00

Service Code	HCPCS 58953
Min. Negotiated Rate	$131.55
Max. Negotiated Rate	$3,595.90
Rate for Payer: Aetna Commercial	$2,383.00
Rate for Payer: BCBS Complete	$1,348.16
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: Cash Price	$4,109.60
Rate for Payer: Cash Price	$4,109.60
Rate for Payer: Meridian Medicaid	$1,348.16
Rate for Payer: Priority Health Choice Medicaid	$1,283.96
Rate for Payer: Priority Health Cigna Priority Health	$3,595.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,830.61
Rate for Payer: Priority Health Narrow Network	$2,830.61
Rate for Payer: Priority Health SBD	$2,830.61
Rate for Payer: UMR Bronson Commercial	$2,363.02

PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC

Professional

Both

$2,382.00

Service Code	HCPCS 58956
Min. Negotiated Rate	$502.94
Max. Negotiated Rate	$1,924.46
Rate for Payer: Aetna Commercial	$1,617.38
Rate for Payer: BCBS Complete	$917.64
Rate for Payer: BCBS Trust/PPO	$502.94
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Meridian Medicaid	$917.64
Rate for Payer: Priority Health Choice Medicaid	$873.94
Rate for Payer: Priority Health Cigna Priority Health	$1,667.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,924.46
Rate for Payer: Priority Health Narrow Network	$1,924.46
Rate for Payer: Priority Health SBD	$1,924.46
Rate for Payer: UMR Bronson Commercial	$1,095.72

PR BUDESONIDE NON-COMP UNIT

Professional

Both

$9.00

Service Code	HCPCS J7626
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna Commercial	$1.04
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$6.30
Rate for Payer: UMR Bronson Commercial	$4.14

PR BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE

Professional

Both

$2,504.00

Service Code	HCPCS 61210
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$1,752.80
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: BCBS Complete	$246.69
Rate for Payer: BCBS Trust/PPO	$324.90
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Meridian Medicaid	$246.69
Rate for Payer: Priority Health Choice Medicaid	$234.94
Rate for Payer: Priority Health Cigna Priority Health	$1,752.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$622.28
Rate for Payer: Priority Health Narrow Network	$622.28
Rate for Payer: Priority Health SBD	$622.28
Rate for Payer: UMR Bronson Commercial	$1,151.84

PR BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG

Professional

Both

$2,672.00

Service Code	HCPCS 61250
Min. Negotiated Rate	$566.58
Max. Negotiated Rate	$1,870.40
Rate for Payer: Aetna Commercial	$1,119.93
Rate for Payer: BCBS Complete	$594.91
Rate for Payer: BCBS Trust/PPO	$918.19
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Meridian Medicaid	$594.91
Rate for Payer: Priority Health Choice Medicaid	$566.58
Rate for Payer: Priority Health Cigna Priority Health	$1,870.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,492.57
Rate for Payer: Priority Health Narrow Network	$1,492.57
Rate for Payer: Priority Health SBD	$1,492.57
Rate for Payer: UMR Bronson Commercial	$1,229.12

PR BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION

Professional

Both

$4,523.00

Service Code	HCPCS 61140
Min. Negotiated Rate	$829.00
Max. Negotiated Rate	$3,166.10
Rate for Payer: Aetna Commercial	$1,640.54
Rate for Payer: BCBS Complete	$870.45
Rate for Payer: BCBS Trust/PPO	$1,274.79
Rate for Payer: Cash Price	$3,618.40
Rate for Payer: Cash Price	$3,618.40
Rate for Payer: Meridian Medicaid	$870.45
Rate for Payer: Priority Health Choice Medicaid	$829.00
Rate for Payer: Priority Health Cigna Priority Health	$3,166.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,175.44
Rate for Payer: Priority Health Narrow Network	$2,175.44
Rate for Payer: Priority Health SBD	$2,175.44
Rate for Payer: UMR Bronson Commercial	$2,080.58

PR BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST

Professional

Both

$4,040.00

Service Code	HCPCS 61150
Min. Negotiated Rate	$614.94
Max. Negotiated Rate	$2,828.00
Rate for Payer: Aetna Commercial	$1,745.51
Rate for Payer: BCBS Complete	$922.11
Rate for Payer: BCBS Trust/PPO	$614.94
Rate for Payer: Cash Price	$3,232.00
Rate for Payer: Cash Price	$3,232.00
Rate for Payer: Meridian Medicaid	$922.11
Rate for Payer: Priority Health Choice Medicaid	$878.20
Rate for Payer: Priority Health Cigna Priority Health	$2,828.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,312.45
Rate for Payer: Priority Health Narrow Network	$2,312.45
Rate for Payer: Priority Health SBD	$2,312.45
Rate for Payer: UMR Bronson Commercial	$1,858.40

PR BURR HOLE VENTRICULAR PUNCTURE

Professional

Both

$1,834.00

Service Code	HCPCS 61120
Min. Negotiated Rate	$490.54
Max. Negotiated Rate	$1,670.48
Rate for Payer: Aetna Commercial	$965.51
Rate for Payer: BCBS Complete	$515.07
Rate for Payer: BCBS Trust/PPO	$1,670.48
Rate for Payer: Cash Price	$1,467.20
Rate for Payer: Cash Price	$1,467.20
Rate for Payer: Meridian Medicaid	$515.07
Rate for Payer: Priority Health Choice Medicaid	$490.54
Rate for Payer: Priority Health Cigna Priority Health	$1,283.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,288.72
Rate for Payer: Priority Health Narrow Network	$1,288.72
Rate for Payer: Priority Health SBD	$1,288.72
Rate for Payer: UMR Bronson Commercial	$843.64

PR BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL

Professional

Both

$3,613.00

Service Code	HCPCS 61156
Min. Negotiated Rate	$284.75
Max. Negotiated Rate	$2,529.10
Rate for Payer: Aetna Commercial	$1,606.58
Rate for Payer: BCBS Complete	$846.52
Rate for Payer: BCBS Trust/PPO	$284.75
Rate for Payer: Cash Price	$2,890.40
Rate for Payer: Cash Price	$2,890.40
Rate for Payer: Meridian Medicaid	$846.52
Rate for Payer: Priority Health Choice Medicaid	$806.21
Rate for Payer: Priority Health Cigna Priority Health	$2,529.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,109.19
Rate for Payer: Priority Health Narrow Network	$2,109.19
Rate for Payer: Priority Health SBD	$2,109.19
Rate for Payer: UMR Bronson Commercial	$1,661.98

PR BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL

Professional

Both

$4,106.00

Service Code	HCPCS 61154
Min. Negotiated Rate	$757.05
Max. Negotiated Rate	$2,874.20
Rate for Payer: Aetna Commercial	$1,645.02
Rate for Payer: BCBS Complete	$874.69
Rate for Payer: BCBS Trust/PPO	$757.05
Rate for Payer: Cash Price	$3,284.80
Rate for Payer: Cash Price	$3,284.80
Rate for Payer: Meridian Medicaid	$874.69
Rate for Payer: Priority Health Choice Medicaid	$833.04
Rate for Payer: Priority Health Cigna Priority Health	$2,874.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,189.59
Rate for Payer: Priority Health Narrow Network	$2,189.59
Rate for Payer: Priority Health SBD	$2,189.59
Rate for Payer: UMR Bronson Commercial	$1,888.76

PR BUTORPHANOL TARTRATE 1 MG

Professional

Both

$7.00

Service Code	HCPCS J0595
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$4.90
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: BCBS Trust/PPO	$0.72
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE

Professional

Both

$333.00

Service Code	HCPCS 49180
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$553.66
Rate for Payer: Aetna Commercial	$112.01
Rate for Payer: BCBS Complete	$54.13
Rate for Payer: BCBS Trust/PPO	$553.66
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Meridian Medicaid	$54.13
Rate for Payer: Priority Health Choice Medicaid	$51.55
Rate for Payer: Priority Health Cigna Priority Health	$233.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.05
Rate for Payer: Priority Health Narrow Network	$144.05
Rate for Payer: Priority Health SBD	$144.05
Rate for Payer: UMR Bronson Commercial	$153.18

PR BX ANORECTAL WALL ANAL APPROACH

Professional

Both

$754.00

Service Code	HCPCS 45100
Min. Negotiated Rate	$195.53
Max. Negotiated Rate	$534.64
Rate for Payer: Aetna Commercial	$399.52
Rate for Payer: BCBS Complete	$205.31
Rate for Payer: BCBS Trust/PPO	$534.64
Rate for Payer: Cash Price	$603.20
Rate for Payer: Cash Price	$603.20
Rate for Payer: Meridian Medicaid	$205.31
Rate for Payer: Priority Health Choice Medicaid	$195.53
Rate for Payer: Priority Health Cigna Priority Health	$527.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$533.89
Rate for Payer: Priority Health Narrow Network	$533.89
Rate for Payer: Priority Health SBD	$533.89
Rate for Payer: UMR Bronson Commercial	$346.84

Know your out-of-pocket cost for care.

All Charges