Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR BYPASS W/VEIN SUBCLAVIAN-BRACHIAL

Professional

Both

$2,494.00

Service Code	HCPCS 35512
Min. Negotiated Rate	$752.32
Max. Negotiated Rate	$1,868.77
Rate for Payer: Aetna Commercial	$1,621.03
Rate for Payer: BCBS Complete	$789.94
Rate for Payer: BCBS Trust/PPO	$1,303.84
Rate for Payer: Cash Price	$1,995.20
Rate for Payer: Cash Price	$1,995.20
Rate for Payer: Meridian Medicaid	$789.94
Rate for Payer: Priority Health Choice Medicaid	$752.32
Rate for Payer: Priority Health Cigna Priority Health	$1,745.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,868.77
Rate for Payer: Priority Health Narrow Network	$1,868.77
Rate for Payer: Priority Health SBD	$1,868.77
Rate for Payer: UMR Bronson Commercial	$1,147.24

PR BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN

Professional

Both

$4,103.00

Service Code	HCPCS 35511
Min. Negotiated Rate	$699.07
Max. Negotiated Rate	$2,872.10
Rate for Payer: Aetna Commercial	$1,507.56
Rate for Payer: BCBS Complete	$734.02
Rate for Payer: BCBS Trust/PPO	$1,179.69
Rate for Payer: Cash Price	$3,282.40
Rate for Payer: Cash Price	$3,282.40
Rate for Payer: Meridian Medicaid	$734.02
Rate for Payer: Priority Health Choice Medicaid	$699.07
Rate for Payer: Priority Health Cigna Priority Health	$2,872.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,737.38
Rate for Payer: Priority Health Narrow Network	$1,737.38
Rate for Payer: Priority Health SBD	$1,737.38
Rate for Payer: UMR Bronson Commercial	$1,887.38

PR BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS

Professional

Both

$692.00

Service Code	HCPCS 35682
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$1,982.71
Rate for Payer: Aetna Commercial	$476.87
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCBS Trust/PPO	$1,982.71
Rate for Payer: Cash Price	$553.60
Rate for Payer: Cash Price	$553.60
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health	$484.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$544.72
Rate for Payer: Priority Health Narrow Network	$544.72
Rate for Payer: Priority Health SBD	$544.72
Rate for Payer: UMR Bronson Commercial	$318.32

PR BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION

Professional

Both

$849.00

Service Code	HCPCS 35683
Min. Negotiated Rate	$253.90
Max. Negotiated Rate	$1,813.65
Rate for Payer: Aetna Commercial	$551.97
Rate for Payer: BCBS Complete	$266.60
Rate for Payer: BCBS Trust/PPO	$1,813.65
Rate for Payer: Cash Price	$679.20
Rate for Payer: Cash Price	$679.20
Rate for Payer: Meridian Medicaid	$266.60
Rate for Payer: Priority Health Choice Medicaid	$253.90
Rate for Payer: Priority Health Cigna Priority Health	$594.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$633.03
Rate for Payer: Priority Health Narrow Network	$633.03
Rate for Payer: Priority Health SBD	$633.03
Rate for Payer: UMR Bronson Commercial	$390.54

PR BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL

Professional

Both

$4,735.00

Service Code	HCPCS 35566
Min. Negotiated Rate	$803.02
Max. Negotiated Rate	$3,314.50
Rate for Payer: Aetna Commercial	$2,244.41
Rate for Payer: BCBS Complete	$1,086.94
Rate for Payer: BCBS Trust/PPO	$803.02
Rate for Payer: Cash Price	$3,788.00
Rate for Payer: Cash Price	$3,788.00
Rate for Payer: Meridian Medicaid	$1,086.94
Rate for Payer: Priority Health Choice Medicaid	$1,035.18
Rate for Payer: Priority Health Cigna Priority Health	$3,314.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,578.39
Rate for Payer: Priority Health Narrow Network	$2,578.39
Rate for Payer: Priority Health SBD	$2,578.39
Rate for Payer: UMR Bronson Commercial	$2,178.10

PR BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC

Professional

Both

$1,925.00

Service Code	HCPCS 33891
Min. Negotiated Rate	$598.10
Max. Negotiated Rate	$1,489.48
Rate for Payer: Aetna Commercial	$1,300.03
Rate for Payer: BCBS Complete	$628.00
Rate for Payer: BCBS Trust/PPO	$745.96
Rate for Payer: Cash Price	$1,540.00
Rate for Payer: Cash Price	$1,540.00
Rate for Payer: Meridian Medicaid	$628.00
Rate for Payer: Priority Health Choice Medicaid	$598.10
Rate for Payer: Priority Health Cigna Priority Health	$1,347.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,489.48
Rate for Payer: Priority Health Narrow Network	$1,489.48
Rate for Payer: Priority Health SBD	$1,489.48
Rate for Payer: UMR Bronson Commercial	$885.50

PR BYP OTH/THN VEIN AORTOBIFEMORAL

Professional

Both

$5,669.00

Service Code	HCPCS 35646
Min. Negotiated Rate	$1,062.44
Max. Negotiated Rate	$3,968.30
Rate for Payer: Aetna Commercial	$2,302.34
Rate for Payer: BCBS Complete	$1,115.56
Rate for Payer: BCBS Trust/PPO	$1,771.92
Rate for Payer: Cash Price	$4,535.20
Rate for Payer: Cash Price	$4,535.20
Rate for Payer: Meridian Medicaid	$1,115.56
Rate for Payer: Priority Health Choice Medicaid	$1,062.44
Rate for Payer: Priority Health Cigna Priority Health	$3,968.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,645.96
Rate for Payer: Priority Health Narrow Network	$2,645.96
Rate for Payer: Priority Health SBD	$2,645.96
Rate for Payer: UMR Bronson Commercial	$2,607.74

PR BYP OTH/THN VEIN AORTOBI-ILIAC

Professional

Both

$4,846.00

Service Code	HCPCS 35638
Min. Negotiated Rate	$1,080.98
Max. Negotiated Rate	$3,392.20
Rate for Payer: Aetna Commercial	$2,341.64
Rate for Payer: BCBS Complete	$1,135.03
Rate for Payer: BCBS Trust/PPO	$1,131.09
Rate for Payer: Cash Price	$3,876.80
Rate for Payer: Cash Price	$3,876.80
Rate for Payer: Meridian Medicaid	$1,135.03
Rate for Payer: Priority Health Choice Medicaid	$1,080.98
Rate for Payer: Priority Health Cigna Priority Health	$3,392.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,692.24
Rate for Payer: Priority Health Narrow Network	$2,692.24
Rate for Payer: Priority Health SBD	$2,692.24
Rate for Payer: UMR Bronson Commercial	$2,229.16

PR BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL

Professional

Both

$4,967.00

Service Code	HCPCS 35631
Min. Negotiated Rate	$1,154.89
Max. Negotiated Rate	$3,476.90
Rate for Payer: Aetna Commercial	$2,492.94
Rate for Payer: BCBS Complete	$1,212.63
Rate for Payer: BCBS Trust/PPO	$1,452.50
Rate for Payer: Cash Price	$3,973.60
Rate for Payer: Cash Price	$3,973.60
Rate for Payer: Meridian Medicaid	$1,212.63
Rate for Payer: Priority Health Choice Medicaid	$1,154.89
Rate for Payer: Priority Health Cigna Priority Health	$3,476.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,866.72
Rate for Payer: Priority Health Narrow Network	$2,866.72
Rate for Payer: Priority Health SBD	$2,866.72
Rate for Payer: UMR Bronson Commercial	$2,284.82

PR BYP OTH/THN VEIN AORTOFEMORAL

Professional

Both

$3,007.00

Service Code	HCPCS 35647
Min. Negotiated Rate	$966.38
Max. Negotiated Rate	$2,407.63
Rate for Payer: Aetna Commercial	$2,084.62
Rate for Payer: BCBS Complete	$1,014.70
Rate for Payer: BCBS Trust/PPO	$1,996.45
Rate for Payer: Cash Price	$2,405.60
Rate for Payer: Cash Price	$2,405.60
Rate for Payer: Meridian Medicaid	$1,014.70
Rate for Payer: Priority Health Choice Medicaid	$966.38
Rate for Payer: Priority Health Cigna Priority Health	$2,104.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,407.63
Rate for Payer: Priority Health Narrow Network	$2,407.63
Rate for Payer: Priority Health SBD	$2,407.63
Rate for Payer: UMR Bronson Commercial	$1,383.22

PR BYP OTH/THN VEIN AORTOILIAC

Professional

Both

$3,564.00

Service Code	HCPCS 35637
Min. Negotiated Rate	$801.58
Max. Negotiated Rate	$2,571.49
Rate for Payer: Aetna Commercial	$2,231.68
Rate for Payer: BCBS Complete	$1,085.83
Rate for Payer: BCBS Trust/PPO	$801.58
Rate for Payer: Cash Price	$2,851.20
Rate for Payer: Cash Price	$2,851.20
Rate for Payer: Meridian Medicaid	$1,085.83
Rate for Payer: Priority Health Choice Medicaid	$1,034.12
Rate for Payer: Priority Health Cigna Priority Health	$2,494.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,571.49
Rate for Payer: Priority Health Narrow Network	$2,571.49
Rate for Payer: Priority Health SBD	$2,571.49
Rate for Payer: UMR Bronson Commercial	$1,639.44

PR BYP OTH/THN VEIN AXILLARY-AXILLARY

Professional

Both

$2,172.00

Service Code	HCPCS 35650
Min. Negotiated Rate	$637.72
Max. Negotiated Rate	$1,585.77
Rate for Payer: Aetna Commercial	$1,374.21
Rate for Payer: BCBS Complete	$669.61
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: Cash Price	$1,737.60
Rate for Payer: Cash Price	$1,737.60
Rate for Payer: Meridian Medicaid	$669.61
Rate for Payer: Priority Health Choice Medicaid	$637.72
Rate for Payer: Priority Health Cigna Priority Health	$1,520.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,585.77
Rate for Payer: Priority Health Narrow Network	$1,585.77
Rate for Payer: Priority Health SBD	$1,585.77
Rate for Payer: UMR Bronson Commercial	$999.12

PR BYP OTH/THN VEIN AXILLARY-FEMORAL

Professional

Both

$4,108.00

Service Code	HCPCS 35621
Min. Negotiated Rate	$683.73
Max. Negotiated Rate	$2,875.60
Rate for Payer: Aetna Commercial	$1,473.74
Rate for Payer: BCBS Complete	$717.92
Rate for Payer: BCBS Trust/PPO	$2,170.78
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Meridian Medicaid	$717.92
Rate for Payer: Priority Health Choice Medicaid	$683.73
Rate for Payer: Priority Health Cigna Priority Health	$2,875.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,703.86
Rate for Payer: Priority Health Narrow Network	$1,703.86
Rate for Payer: Priority Health SBD	$1,703.86
Rate for Payer: UMR Bronson Commercial	$1,889.68

PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL

Professional

Both

$4,825.00

Service Code	HCPCS 35654
Min. Negotiated Rate	$850.08
Max. Negotiated Rate	$3,377.50
Rate for Payer: Aetna Commercial	$1,837.45
Rate for Payer: BCBS Complete	$892.58
Rate for Payer: BCBS Trust/PPO	$1,290.11
Rate for Payer: Cash Price	$3,860.00
Rate for Payer: Cash Price	$3,860.00
Rate for Payer: Meridian Medicaid	$892.58
Rate for Payer: Priority Health Choice Medicaid	$850.08
Rate for Payer: Priority Health Cigna Priority Health	$3,377.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,115.59
Rate for Payer: Priority Health Narrow Network	$2,115.59
Rate for Payer: Priority Health SBD	$2,115.59
Rate for Payer: UMR Bronson Commercial	$2,219.50

PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN

Professional

Both

$2,278.00

Service Code	HCPCS 35606
Min. Negotiated Rate	$733.79
Max. Negotiated Rate	$1,821.96
Rate for Payer: Aetna Commercial	$1,574.58
Rate for Payer: BCBS Complete	$770.48
Rate for Payer: BCBS Trust/PPO	$1,535.77
Rate for Payer: Cash Price	$1,822.40
Rate for Payer: Cash Price	$1,822.40
Rate for Payer: Meridian Medicaid	$770.48
Rate for Payer: Priority Health Choice Medicaid	$733.79
Rate for Payer: Priority Health Cigna Priority Health	$1,594.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,821.96
Rate for Payer: Priority Health Narrow Network	$1,821.96
Rate for Payer: Priority Health SBD	$1,821.96
Rate for Payer: UMR Bronson Commercial	$1,047.88

PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID

Professional

Both

$2,884.00

Service Code	HCPCS 35601
Min. Negotiated Rate	$873.30
Max. Negotiated Rate	$2,177.30
Rate for Payer: Aetna Commercial	$1,879.18
Rate for Payer: BCBS Complete	$916.96
Rate for Payer: BCBS Trust/PPO	$1,268.45
Rate for Payer: Cash Price	$2,307.20
Rate for Payer: Cash Price	$2,307.20
Rate for Payer: Meridian Medicaid	$916.96
Rate for Payer: Priority Health Choice Medicaid	$873.30
Rate for Payer: Priority Health Cigna Priority Health	$2,018.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,177.30
Rate for Payer: Priority Health Narrow Network	$2,177.30
Rate for Payer: Priority Health SBD	$2,177.30
Rate for Payer: UMR Bronson Commercial	$1,326.64

PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL

Professional

Both

$4,125.00

Service Code	HCPCS 35666
Min. Negotiated Rate	$803.22
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$1,724.92
Rate for Payer: BCBS Complete	$843.38
Rate for Payer: BCBS Trust/PPO	$1,310.71
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Meridian Medicaid	$843.38
Rate for Payer: Priority Health Choice Medicaid	$803.22
Rate for Payer: Priority Health Cigna Priority Health	$2,887.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,002.82
Rate for Payer: Priority Health Narrow Network	$2,002.82
Rate for Payer: Priority Health SBD	$2,002.82
Rate for Payer: UMR Bronson Commercial	$1,897.50

PR BYP OTH/THN VEIN FEMORAL-FEMORAL

Professional

Both

$2,209.00

Service Code	HCPCS 35661
Min. Negotiated Rate	$675.42
Max. Negotiated Rate	$1,683.11
Rate for Payer: Aetna Commercial	$1,456.02
Rate for Payer: BCBS Complete	$709.19
Rate for Payer: BCBS Trust/PPO	$1,335.54
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Meridian Medicaid	$709.19
Rate for Payer: Priority Health Choice Medicaid	$675.42
Rate for Payer: Priority Health Cigna Priority Health	$1,546.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,683.11
Rate for Payer: Priority Health Narrow Network	$1,683.11
Rate for Payer: Priority Health SBD	$1,683.11
Rate for Payer: UMR Bronson Commercial	$1,016.14

PR BYP OTH/THN VEIN FEMORAL-POPLITEAL

Professional

Both

$2,233.00

Service Code	HCPCS 35656
Min. Negotiated Rate	$668.82
Max. Negotiated Rate	$1,668.21
Rate for Payer: Aetna Commercial	$1,449.39
Rate for Payer: BCBS Complete	$702.26
Rate for Payer: BCBS Trust/PPO	$1,054.49
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Meridian Medicaid	$702.26
Rate for Payer: Priority Health Choice Medicaid	$668.82
Rate for Payer: Priority Health Cigna Priority Health	$1,563.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,668.21
Rate for Payer: Priority Health Narrow Network	$1,668.21
Rate for Payer: Priority Health SBD	$1,668.21
Rate for Payer: UMR Bronson Commercial	$1,027.18

PR BYP OTH/THN VEIN ILIOFEMORAL

Professional

Both

$4,492.00

Service Code	HCPCS 35665
Min. Negotiated Rate	$732.29
Max. Negotiated Rate	$3,144.40
Rate for Payer: Aetna Commercial	$1,576.23
Rate for Payer: BCBS Complete	$768.90
Rate for Payer: BCBS Trust/PPO	$1,269.50
Rate for Payer: Cash Price	$3,593.60
Rate for Payer: Cash Price	$3,593.60
Rate for Payer: Meridian Medicaid	$768.90
Rate for Payer: Priority Health Choice Medicaid	$732.29
Rate for Payer: Priority Health Cigna Priority Health	$3,144.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,821.43
Rate for Payer: Priority Health Narrow Network	$1,821.43
Rate for Payer: Priority Health SBD	$1,821.43
Rate for Payer: UMR Bronson Commercial	$2,066.32

PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART

Professional

Both

$2,160.00

Service Code	HCPCS 35671
Min. Negotiated Rate	$707.16
Max. Negotiated Rate	$1,765.04
Rate for Payer: Aetna Commercial	$1,517.78
Rate for Payer: BCBS Complete	$742.52
Rate for Payer: BCBS Trust/PPO	$1,384.67
Rate for Payer: Cash Price	$1,728.00
Rate for Payer: Cash Price	$1,728.00
Rate for Payer: Meridian Medicaid	$742.52
Rate for Payer: Priority Health Choice Medicaid	$707.16
Rate for Payer: Priority Health Cigna Priority Health	$1,512.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,765.04
Rate for Payer: Priority Health Narrow Network	$1,765.04
Rate for Payer: Priority Health SBD	$1,765.04
Rate for Payer: UMR Bronson Commercial	$993.60

PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN

Professional

Both

$2,200.00

Service Code	HCPCS 35612
Min. Negotiated Rate	$653.48
Max. Negotiated Rate	$2,601.35
Rate for Payer: Aetna Commercial	$1,403.00
Rate for Payer: BCBS Complete	$686.15
Rate for Payer: BCBS Trust/PPO	$2,601.35
Rate for Payer: Cash Price	$1,760.00
Rate for Payer: Cash Price	$1,760.00
Rate for Payer: Meridian Medicaid	$686.15
Rate for Payer: Priority Health Choice Medicaid	$653.48
Rate for Payer: Priority Health Cigna Priority Health	$1,540.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,623.54
Rate for Payer: Priority Health Narrow Network	$1,623.54
Rate for Payer: Priority Health SBD	$1,623.54
Rate for Payer: UMR Bronson Commercial	$1,012.00

PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL

Professional

Both

$2,743.00

Service Code	HCPCS 35570
Min. Negotiated Rate	$919.73
Max. Negotiated Rate	$2,284.77
Rate for Payer: Aetna Commercial	$1,981.51
Rate for Payer: BCBS Complete	$965.72
Rate for Payer: BCBS Trust/PPO	$1,043.92
Rate for Payer: Cash Price	$2,194.40
Rate for Payer: Cash Price	$2,194.40
Rate for Payer: Meridian Medicaid	$965.72
Rate for Payer: Priority Health Choice Medicaid	$919.73
Rate for Payer: Priority Health Cigna Priority Health	$1,920.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,284.77
Rate for Payer: Priority Health Narrow Network	$2,284.77
Rate for Payer: Priority Health SBD	$2,284.77
Rate for Payer: UMR Bronson Commercial	$1,261.78

PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL

Professional

Both

$5,135.00

Service Code	HCPCS 35571
Min. Negotiated Rate	$824.95
Max. Negotiated Rate	$3,594.50
Rate for Payer: Aetna Commercial	$1,782.25
Rate for Payer: BCBS Complete	$866.20
Rate for Payer: BCBS Trust/PPO	$1,402.64
Rate for Payer: Cash Price	$4,108.00
Rate for Payer: Cash Price	$4,108.00
Rate for Payer: Meridian Medicaid	$866.20
Rate for Payer: Priority Health Choice Medicaid	$824.95
Rate for Payer: Priority Health Cigna Priority Health	$3,594.50
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	$2,362.10

PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS

Professional

Both

$5,394.00

Service Code	HCPCS 33536
Min. Negotiated Rate	$1,086.18
Max. Negotiated Rate	$4,101.39
Rate for Payer: Aetna Commercial	$3,540.72
Rate for Payer: BCBS Complete	$1,731.94
Rate for Payer: BCBS Trust/PPO	$1,086.18
Rate for Payer: Cash Price	$4,315.20
Rate for Payer: Cash Price	$4,315.20
Rate for Payer: Meridian Medicaid	$1,731.94
Rate for Payer: Priority Health Choice Medicaid	$1,649.47
Rate for Payer: Priority Health Cigna Priority Health	$3,775.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,101.39
Rate for Payer: Priority Health Narrow Network	$4,101.39
Rate for Payer: Priority Health SBD	$4,101.39
Rate for Payer: UMR Bronson Commercial	$2,481.24

Know your out-of-pocket cost for care.

All Charges