Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS

Professional

Both

$358.00

Service Code	HCPCS 44100
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$2,539.54
Rate for Payer: Aetna Commercial	$142.56
Rate for Payer: BCBS Complete	$70.46
Rate for Payer: BCBS Trust/PPO	$2,539.54
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cash Price	$286.40
Rate for Payer: Meridian Medicaid	$70.46
Rate for Payer: Priority Health Choice Medicaid	$67.10
Rate for Payer: Priority Health Cigna Priority Health	$250.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.04
Rate for Payer: Priority Health Narrow Network	$184.04
Rate for Payer: Priority Health SBD	$184.04
Rate for Payer: UMR Bronson Commercial	$164.68

PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX

Professional

Both

$224.00

Service Code	HCPCS 47001
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$1,355.62
Rate for Payer: Aetna Commercial	$140.29
Rate for Payer: BCBS Complete	$68.66
Rate for Payer: BCBS Trust/PPO	$1,355.62
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cash Price	$179.20
Rate for Payer: Meridian Medicaid	$68.66
Rate for Payer: Priority Health Choice Medicaid	$65.39
Rate for Payer: Priority Health Cigna Priority Health	$156.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.50
Rate for Payer: Priority Health Narrow Network	$180.50
Rate for Payer: Priority Health SBD	$180.50
Rate for Payer: UMR Bronson Commercial	$103.04

PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION

Professional

Both

$396.00

Service Code	HCPCS 42806
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$314.34
Rate for Payer: Aetna Commercial	$178.76
Rate for Payer: BCBS Complete	$96.17
Rate for Payer: BCBS Trust/PPO	$314.34
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Meridian Medicaid	$96.17
Rate for Payer: Priority Health Choice Medicaid	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$249.89
Rate for Payer: Priority Health Narrow Network	$249.89
Rate for Payer: Priority Health SBD	$249.89
Rate for Payer: UMR Bronson Commercial	$182.16

PR BX OF BREAST, NEEDLE CORE, IMAGE GUIDE

Professional

Both

$406.00

Service Code	HCPCS 19102
Min. Negotiated Rate	$162.40
Max. Negotiated Rate	$284.20
Rate for Payer: BCBS Complete	$162.40
Rate for Payer: Cash Price	$324.80
Rate for Payer: Priority Health Cigna Priority Health	$284.20
Rate for Payer: UMR Bronson Commercial	$186.76

PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID

Professional

Both

$701.00

Service Code	HCPCS 55706
Min. Negotiated Rate	$239.84
Max. Negotiated Rate	$1,743.92
Rate for Payer: Aetna Commercial	$479.18
Rate for Payer: BCBS Complete	$251.83
Rate for Payer: BCBS Trust/PPO	$1,743.92
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Meridian Medicaid	$251.83
Rate for Payer: Priority Health Choice Medicaid	$239.84
Rate for Payer: Priority Health Cigna Priority Health	$490.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$600.88
Rate for Payer: Priority Health Narrow Network	$600.88
Rate for Payer: Priority Health SBD	$600.88
Rate for Payer: UMR Bronson Commercial	$322.46

PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN

Professional

Both

$311.00

Service Code	HCPCS 35681
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$1,298.03
Rate for Payer: Aetna Commercial	$108.37
Rate for Payer: BCBS Complete	$52.11
Rate for Payer: BCBS Trust/PPO	$1,298.03
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Meridian Medicaid	$52.11
Rate for Payer: Priority Health Choice Medicaid	$49.63
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.42
Rate for Payer: Priority Health Narrow Network	$123.42
Rate for Payer: Priority Health SBD	$123.42
Rate for Payer: UMR Bronson Commercial	$143.06

PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC

Professional

Both

$3,240.00

Service Code	HCPCS 35632
Min. Negotiated Rate	$1,126.34
Max. Negotiated Rate	$2,799.69
Rate for Payer: Aetna Commercial	$2,431.56
Rate for Payer: BCBS Complete	$1,182.66
Rate for Payer: BCBS Trust/PPO	$1,188.68
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Meridian Medicaid	$1,182.66
Rate for Payer: Priority Health Choice Medicaid	$1,126.34
Rate for Payer: Priority Health Cigna Priority Health	$2,268.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,799.69
Rate for Payer: Priority Health Narrow Network	$2,799.69
Rate for Payer: Priority Health SBD	$2,799.69
Rate for Payer: UMR Bronson Commercial	$1,490.40

PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC

Professional

Both

$3,629.00

Service Code	HCPCS 35633
Min. Negotiated Rate	$1,181.81
Max. Negotiated Rate	$3,074.18
Rate for Payer: Aetna Commercial	$2,665.69
Rate for Payer: BCBS Complete	$1,297.17
Rate for Payer: BCBS Trust/PPO	$1,181.81
Rate for Payer: Cash Price	$2,903.20
Rate for Payer: Cash Price	$2,903.20
Rate for Payer: Meridian Medicaid	$1,297.17
Rate for Payer: Priority Health Choice Medicaid	$1,235.40
Rate for Payer: Priority Health Cigna Priority Health	$2,540.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,074.18
Rate for Payer: Priority Health Narrow Network	$3,074.18
Rate for Payer: Priority Health SBD	$3,074.18
Rate for Payer: UMR Bronson Commercial	$1,669.34

PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL

Professional

Both

$3,169.00

Service Code	HCPCS 35634
Min. Negotiated Rate	$1,102.28
Max. Negotiated Rate	$2,740.65
Rate for Payer: Aetna Commercial	$2,379.07
Rate for Payer: BCBS Complete	$1,157.39
Rate for Payer: BCBS Trust/PPO	$1,193.43
Rate for Payer: Cash Price	$2,535.20
Rate for Payer: Cash Price	$2,535.20
Rate for Payer: Meridian Medicaid	$1,157.39
Rate for Payer: Priority Health Choice Medicaid	$1,102.28
Rate for Payer: Priority Health Cigna Priority Health	$2,218.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,740.65
Rate for Payer: Priority Health Narrow Network	$2,740.65
Rate for Payer: Priority Health SBD	$2,740.65
Rate for Payer: UMR Bronson Commercial	$1,457.74

PR BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE

Professional

Both

$4,667.00

Service Code	HCPCS 35626
Min. Negotiated Rate	$991.09
Max. Negotiated Rate	$3,266.90
Rate for Payer: Aetna Commercial	$2,142.20
Rate for Payer: BCBS Complete	$1,040.64
Rate for Payer: BCBS Trust/PPO	$1,555.32
Rate for Payer: Cash Price	$3,733.60
Rate for Payer: Cash Price	$3,733.60
Rate for Payer: Meridian Medicaid	$1,040.64
Rate for Payer: Priority Health Choice Medicaid	$991.09
Rate for Payer: Priority Health Cigna Priority Health	$3,266.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,476.26
Rate for Payer: Priority Health Narrow Network	$2,476.26
Rate for Payer: Priority Health SBD	$2,476.26
Rate for Payer: UMR Bronson Commercial	$2,146.82

PR BYPASS W/VEIN AORTOBI-ILIAC

Professional

Both

$6,277.00

Service Code	HCPCS 35538
Min. Negotiated Rate	$971.54
Max. Negotiated Rate	$4,393.90
Rate for Payer: Aetna Commercial	$3,144.83
Rate for Payer: BCBS Complete	$1,527.75
Rate for Payer: BCBS Trust/PPO	$971.54
Rate for Payer: Cash Price	$5,021.60
Rate for Payer: Cash Price	$5,021.60
Rate for Payer: Meridian Medicaid	$1,527.75
Rate for Payer: Priority Health Choice Medicaid	$1,455.00
Rate for Payer: Priority Health Cigna Priority Health	$4,393.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,618.91
Rate for Payer: Priority Health Narrow Network	$3,618.91
Rate for Payer: Priority Health SBD	$3,618.91
Rate for Payer: UMR Bronson Commercial	$2,887.42

PR BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC

Professional

Both

$4,193.00

Service Code	HCPCS 35531
Min. Negotiated Rate	$63.40
Max. Negotiated Rate	$3,022.58
Rate for Payer: Aetna Commercial	$2,623.52
Rate for Payer: BCBS Complete	$1,276.37
Rate for Payer: BCBS Trust/PPO	$63.40
Rate for Payer: Cash Price	$3,354.40
Rate for Payer: Cash Price	$3,354.40
Rate for Payer: Meridian Medicaid	$1,276.37
Rate for Payer: Priority Health Choice Medicaid	$1,215.59
Rate for Payer: Priority Health Cigna Priority Health	$2,935.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,022.58
Rate for Payer: Priority Health Narrow Network	$3,022.58
Rate for Payer: Priority Health SBD	$3,022.58
Rate for Payer: UMR Bronson Commercial	$1,928.78

PR BYPASS W/VEIN AORTOILIAC

Professional

Both

$4,317.00

Service Code	HCPCS 35537
Min. Negotiated Rate	$1,299.30
Max. Negotiated Rate	$3,228.98
Rate for Payer: Aetna Commercial	$2,806.89
Rate for Payer: BCBS Complete	$1,364.26
Rate for Payer: BCBS Trust/PPO	$1,308.07
Rate for Payer: Cash Price	$3,453.60
Rate for Payer: Cash Price	$3,453.60
Rate for Payer: Meridian Medicaid	$1,364.26
Rate for Payer: Priority Health Choice Medicaid	$1,299.30
Rate for Payer: Priority Health Cigna Priority Health	$3,021.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.98
Rate for Payer: Priority Health Narrow Network	$3,228.98
Rate for Payer: Priority Health SBD	$3,228.98
Rate for Payer: UMR Bronson Commercial	$1,985.82

PR BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE

Professional

Both

$3,605.00

Service Code	HCPCS 35526
Min. Negotiated Rate	$1,080.34
Max. Negotiated Rate	$3,230.55
Rate for Payer: Aetna Commercial	$2,325.27
Rate for Payer: BCBS Complete	$1,134.36
Rate for Payer: BCBS Trust/PPO	$3,230.55
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Meridian Medicaid	$1,134.36
Rate for Payer: Priority Health Choice Medicaid	$1,080.34
Rate for Payer: Priority Health Cigna Priority Health	$2,523.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,693.84
Rate for Payer: Priority Health Narrow Network	$2,693.84
Rate for Payer: Priority Health SBD	$2,693.84
Rate for Payer: UMR Bronson Commercial	$1,658.30

PR BYPASS W/VEIN AXILLARY-BRACHIAL

Professional

Both

$2,363.00

Service Code	HCPCS 35522
Min. Negotiated Rate	$430.04
Max. Negotiated Rate	$1,813.97
Rate for Payer: Aetna Commercial	$1,641.02
Rate for Payer: BCBS Complete	$766.23
Rate for Payer: BCBS Trust/PPO	$430.04
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Meridian Medicaid	$766.23
Rate for Payer: Priority Health Choice Medicaid	$729.74
Rate for Payer: Priority Health Cigna Priority Health	$1,654.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,813.97
Rate for Payer: Priority Health Narrow Network	$1,813.97
Rate for Payer: Priority Health SBD	$1,813.97
Rate for Payer: UMR Bronson Commercial	$1,086.98

PR BYPASS W/VEIN BRACHIAL-BRACHIAL

Professional

Both

$4,108.00

Service Code	HCPCS 35525
Min. Negotiated Rate	$706.73
Max. Negotiated Rate	$2,875.60
Rate for Payer: Aetna Commercial	$1,525.84
Rate for Payer: BCBS Complete	$742.07
Rate for Payer: BCBS Trust/PPO	$2,468.75
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Meridian Medicaid	$742.07
Rate for Payer: Priority Health Choice Medicaid	$706.73
Rate for Payer: Priority Health Cigna Priority Health	$2,875.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,759.18
Rate for Payer: Priority Health Narrow Network	$1,759.18
Rate for Payer: Priority Health SBD	$1,759.18
Rate for Payer: UMR Bronson Commercial	$1,889.68

PR BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL

Professional

Both

$2,485.00

Service Code	HCPCS 35523
Min. Negotiated Rate	$767.87
Max. Negotiated Rate	$1,967.18
Rate for Payer: Aetna Commercial	$1,713.84
Rate for Payer: BCBS Complete	$806.26
Rate for Payer: BCBS Trust/PPO	$1,439.62
Rate for Payer: Cash Price	$1,988.00
Rate for Payer: Cash Price	$1,988.00
Rate for Payer: Meridian Medicaid	$806.26
Rate for Payer: Priority Health Choice Medicaid	$767.87
Rate for Payer: Priority Health Cigna Priority Health	$1,739.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,967.18
Rate for Payer: Priority Health Narrow Network	$1,967.18
Rate for Payer: Priority Health SBD	$1,967.18
Rate for Payer: UMR Bronson Commercial	$1,143.10

PR BYPASS W/VEIN CAROTID-BRACHIAL

Professional

Both

$2,546.00

Service Code	HCPCS 35510
Min. Negotiated Rate	$767.23
Max. Negotiated Rate	$1,907.07
Rate for Payer: Aetna Commercial	$1,653.58
Rate for Payer: BCBS Complete	$805.59
Rate for Payer: BCBS Trust/PPO	$971.54
Rate for Payer: Cash Price	$2,036.80
Rate for Payer: Cash Price	$2,036.80
Rate for Payer: Meridian Medicaid	$805.59
Rate for Payer: Priority Health Choice Medicaid	$767.23
Rate for Payer: Priority Health Cigna Priority Health	$1,782.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,907.07
Rate for Payer: Priority Health Narrow Network	$1,907.07
Rate for Payer: Priority Health SBD	$1,907.07
Rate for Payer: UMR Bronson Commercial	$1,171.16

PR BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID

Professional

Both

$2,616.00

Service Code	HCPCS 35506
Min. Negotiated Rate	$794.49
Max. Negotiated Rate	$1,975.69
Rate for Payer: Aetna Commercial	$1,712.70
Rate for Payer: BCBS Complete	$834.21
Rate for Payer: BCBS Trust/PPO	$1,044.98
Rate for Payer: Cash Price	$2,092.80
Rate for Payer: Cash Price	$2,092.80
Rate for Payer: Meridian Medicaid	$834.21
Rate for Payer: Priority Health Choice Medicaid	$794.49
Rate for Payer: Priority Health Cigna Priority Health	$1,831.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,975.69
Rate for Payer: Priority Health Narrow Network	$1,975.69
Rate for Payer: Priority Health SBD	$1,975.69
Rate for Payer: UMR Bronson Commercial	$1,203.36

PR BYPASS W/VEIN COMMON-IPSILATERAL CAROTID

Professional

Both

$3,023.00

Service Code	HCPCS 35501
Min. Negotiated Rate	$844.22
Max. Negotiated Rate	$2,262.41
Rate for Payer: Aetna Commercial	$1,963.57
Rate for Payer: BCBS Complete	$955.44
Rate for Payer: BCBS Trust/PPO	$844.22
Rate for Payer: Cash Price	$2,418.40
Rate for Payer: Cash Price	$2,418.40
Rate for Payer: Meridian Medicaid	$955.44
Rate for Payer: Priority Health Choice Medicaid	$909.94
Rate for Payer: Priority Health Cigna Priority Health	$2,116.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,262.41
Rate for Payer: Priority Health Narrow Network	$2,262.41
Rate for Payer: Priority Health SBD	$2,262.41
Rate for Payer: UMR Bronson Commercial	$1,390.58

PR BYPASS W/VEIN FEMORAL-FEMORAL

Professional

Both

$2,366.00

Service Code	HCPCS 35558
Min. Negotiated Rate	$721.66
Max. Negotiated Rate	$1,915.05
Rate for Payer: Aetna Commercial	$1,647.15
Rate for Payer: BCBS Complete	$811.85
Rate for Payer: BCBS Trust/PPO	$721.66
Rate for Payer: Cash Price	$1,892.80
Rate for Payer: Cash Price	$1,892.80
Rate for Payer: Meridian Medicaid	$811.85
Rate for Payer: Priority Health Choice Medicaid	$773.19
Rate for Payer: Priority Health Cigna Priority Health	$1,656.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,915.05
Rate for Payer: Priority Health Narrow Network	$1,915.05
Rate for Payer: Priority Health SBD	$1,915.05
Rate for Payer: UMR Bronson Commercial	$1,088.36

PR BYPASS W/VEIN FEMORAL-POPLITEAL

Professional

Both

$2,696.00

Service Code	HCPCS 35556
Min. Negotiated Rate	$868.19
Max. Negotiated Rate	$2,162.93
Rate for Payer: Aetna Commercial	$1,881.82
Rate for Payer: BCBS Complete	$911.60
Rate for Payer: BCBS Trust/PPO	$1,363.54
Rate for Payer: Cash Price	$2,156.80
Rate for Payer: Cash Price	$2,156.80
Rate for Payer: Meridian Medicaid	$911.60
Rate for Payer: Priority Health Choice Medicaid	$868.19
Rate for Payer: Priority Health Cigna Priority Health	$1,887.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,162.93
Rate for Payer: Priority Health Narrow Network	$2,162.93
Rate for Payer: Priority Health SBD	$2,162.93
Rate for Payer: UMR Bronson Commercial	$1,240.16

PR BYPASS W/VEIN ILIOFEMORAL

Professional

Both

$2,550.00

Service Code	HCPCS 35565
Min. Negotiated Rate	$818.35
Max. Negotiated Rate	$2,032.61
Rate for Payer: Aetna Commercial	$1,764.26
Rate for Payer: BCBS Complete	$859.27
Rate for Payer: BCBS Trust/PPO	$1,137.43
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Meridian Medicaid	$859.27
Rate for Payer: Priority Health Choice Medicaid	$818.35
Rate for Payer: Priority Health Cigna Priority Health	$1,785.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,032.61
Rate for Payer: Priority Health Narrow Network	$2,032.61
Rate for Payer: Priority Health SBD	$2,032.61
Rate for Payer: UMR Bronson Commercial	$1,173.00

PR BYPASS W/VEIN ILIOILIAC

Professional

Both

$2,760.00

Service Code	HCPCS 35563
Min. Negotiated Rate	$826.44
Max. Negotiated Rate	$2,053.88
Rate for Payer: Aetna Commercial	$1,779.77
Rate for Payer: BCBS Complete	$867.76
Rate for Payer: BCBS Trust/PPO	$927.69
Rate for Payer: Cash Price	$2,208.00
Rate for Payer: Cash Price	$2,208.00
Rate for Payer: Meridian Medicaid	$867.76
Rate for Payer: Priority Health Choice Medicaid	$826.44
Rate for Payer: Priority Health Cigna Priority Health	$1,932.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,053.88
Rate for Payer: Priority Health Narrow Network	$2,053.88
Rate for Payer: Priority Health SBD	$2,053.88
Rate for Payer: UMR Bronson Commercial	$1,269.60

PR BYPASS W/VEIN SPLENORENAL

Professional

Both

$4,809.00

Service Code	HCPCS 35536
Min. Negotiated Rate	$997.96
Max. Negotiated Rate	$3,366.30
Rate for Payer: Aetna Commercial	$2,274.13
Rate for Payer: BCBS Complete	$1,106.40
Rate for Payer: BCBS Trust/PPO	$997.96
Rate for Payer: Cash Price	$3,847.20
Rate for Payer: Cash Price	$3,847.20
Rate for Payer: Meridian Medicaid	$1,106.40
Rate for Payer: Priority Health Choice Medicaid	$1,053.71
Rate for Payer: Priority Health Cigna Priority Health	$3,366.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,621.49
Rate for Payer: Priority Health Narrow Network	$2,621.49
Rate for Payer: Priority Health SBD	$2,621.49
Rate for Payer: UMR Bronson Commercial	$2,212.14

Know your out-of-pocket cost for care.

All Charges