Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT

Professional

Both

$3,834.34

Service Code	HCPCS 33533
Min. Negotiated Rate	$1,173.42
Max. Negotiated Rate	$2,920.45
Rate for Payer: Aetna Commercial	$2,513.12
Rate for Payer: BCBS Complete	$1,232.09
Rate for Payer: BCBS Trust/PPO	$1,225.66
Rate for Payer: Cash Price	$3,067.47
Rate for Payer: Cash Price	$3,067.47
Rate for Payer: Meridian Medicaid	$1,232.09
Rate for Payer: Priority Health Choice Medicaid	$1,173.42
Rate for Payer: Priority Health Cigna Priority Health	$2,684.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,920.45
Rate for Payer: Priority Health Narrow Network	$2,920.45
Rate for Payer: Priority Health SBD	$2,920.45
Rate for Payer: UMR Bronson Commercial	$1,763.80

PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS

Professional

Both

$5,035.48

Service Code	HCPCS 33535
Min. Negotiated Rate	$1,100.98
Max. Negotiated Rate	$3,811.48
Rate for Payer: Aetna Commercial	$3,289.41
Rate for Payer: BCBS Complete	$1,607.37
Rate for Payer: BCBS Trust/PPO	$1,100.98
Rate for Payer: Cash Price	$4,028.38
Rate for Payer: Cash Price	$4,028.38
Rate for Payer: Meridian Medicaid	$1,607.37
Rate for Payer: Priority Health Choice Medicaid	$1,530.83
Rate for Payer: Priority Health Cigna Priority Health	$3,524.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,811.48
Rate for Payer: Priority Health Narrow Network	$3,811.48
Rate for Payer: Priority Health SBD	$3,811.48
Rate for Payer: UMR Bronson Commercial	$2,316.32

PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS

Professional

Both

$4,511.60

Service Code	HCPCS 33534
Min. Negotiated Rate	$1,126.86
Max. Negotiated Rate	$3,427.93
Rate for Payer: Aetna Commercial	$2,950.85
Rate for Payer: BCBS Complete	$1,446.80
Rate for Payer: BCBS Trust/PPO	$1,126.86
Rate for Payer: Cash Price	$3,609.28
Rate for Payer: Cash Price	$3,609.28
Rate for Payer: Meridian Medicaid	$1,446.80
Rate for Payer: Priority Health Choice Medicaid	$1,377.90
Rate for Payer: Priority Health Cigna Priority Health	$3,158.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,427.93
Rate for Payer: Priority Health Narrow Network	$3,427.93
Rate for Payer: Priority Health SBD	$3,427.93
Rate for Payer: UMR Bronson Commercial	$2,075.34

PR CALIBRATED MICROCAP TUBE

Professional

Both

$75.00

Service Code	HCPCS A4651
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: UMR Bronson Commercial	$34.50

PR CALORIC VESTIBULAR TEST, EACH IRRIGATION, WITH RECORDING

Professional

Both

$19.00

Service Code	HCPCS 92543
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$13.30
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: Cash Price	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: UMR Bronson Commercial	$8.74

PR CANALITH REPOSITIONING PROCEDURE

Professional

Both

$128.00

Service Code	HCPCS 95992
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$189.13
Rate for Payer: Aetna Commercial	$40.81
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$189.13
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$89.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$48.06
Rate for Payer: Priority Health Narrow Network	$48.06
Rate for Payer: Priority Health SBD	$48.06
Rate for Payer: UMR Bronson Commercial	$58.88

PR CANTHOPLASTY

Professional

Both

$1,124.00

Service Code	HCPCS 67950
Min. Negotiated Rate	$292.66
Max. Negotiated Rate	$2,419.61
Rate for Payer: Aetna Commercial	$599.67
Rate for Payer: BCBS Complete	$307.29
Rate for Payer: BCBS Trust/PPO	$2,419.61
Rate for Payer: Cash Price	$899.20
Rate for Payer: Cash Price	$899.20
Rate for Payer: Meridian Medicaid	$307.29
Rate for Payer: Priority Health Choice Medicaid	$292.66
Rate for Payer: Priority Health Cigna Priority Health	$786.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$796.75
Rate for Payer: Priority Health Narrow Network	$796.75
Rate for Payer: Priority Health SBD	$796.75
Rate for Payer: UMR Bronson Commercial	$517.04

PR CANTHOTOMY SEPARATE PROCEDURE

Professional

Both

$367.00

Service Code	HCPCS 67715
Min. Negotiated Rate	$68.37
Max. Negotiated Rate	$523.55
Rate for Payer: Aetna Commercial	$139.69
Rate for Payer: BCBS Complete	$71.79
Rate for Payer: BCBS Trust/PPO	$523.55
Rate for Payer: Cash Price	$293.60
Rate for Payer: Cash Price	$293.60
Rate for Payer: Meridian Medicaid	$71.79
Rate for Payer: Priority Health Choice Medicaid	$68.37
Rate for Payer: Priority Health Cigna Priority Health	$256.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$187.92
Rate for Payer: Priority Health Narrow Network	$187.92
Rate for Payer: Priority Health SBD	$187.92
Rate for Payer: UMR Bronson Commercial	$168.82

PR CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC

Professional

Both

$4,705.00

Service Code	HCPCS 27036
Min. Negotiated Rate	$197.75
Max. Negotiated Rate	$3,293.50
Rate for Payer: Aetna Commercial	$1,355.49
Rate for Payer: BCBS Complete	$689.29
Rate for Payer: BCBS Trust/PPO	$197.75
Rate for Payer: Cash Price	$3,764.00
Rate for Payer: Cash Price	$3,764.00
Rate for Payer: Meridian Medicaid	$689.29
Rate for Payer: Priority Health Choice Medicaid	$656.47
Rate for Payer: Priority Health Cigna Priority Health	$3,293.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,559.53
Rate for Payer: Priority Health Narrow Network	$1,559.53
Rate for Payer: Priority Health SBD	$1,559.53
Rate for Payer: UMR Bronson Commercial	$2,164.30

PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS

Professional

Both

$1,721.00

Service Code	HCPCS 25320
Min. Negotiated Rate	$400.98
Max. Negotiated Rate	$1,520.20
Rate for Payer: Aetna Commercial	$1,305.27
Rate for Payer: BCBS Complete	$673.86
Rate for Payer: BCBS Trust/PPO	$400.98
Rate for Payer: Cash Price	$1,376.80
Rate for Payer: Cash Price	$1,376.80
Rate for Payer: Meridian Medicaid	$673.86
Rate for Payer: Priority Health Choice Medicaid	$641.77
Rate for Payer: Priority Health Cigna Priority Health	$1,204.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,520.20
Rate for Payer: Priority Health Narrow Network	$1,520.20
Rate for Payer: Priority Health SBD	$1,520.20
Rate for Payer: UMR Bronson Commercial	$791.66

PR CAPSULAR CONTRACTURE RELEASE

Professional

Both

$1,971.00

Service Code	HCPCS 23020
Min. Negotiated Rate	$282.11
Max. Negotiated Rate	$1,379.70
Rate for Payer: Aetna Commercial	$919.64
Rate for Payer: BCBS Complete	$469.66
Rate for Payer: BCBS Trust/PPO	$282.11
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Meridian Medicaid	$469.66
Rate for Payer: Priority Health Choice Medicaid	$447.30
Rate for Payer: Priority Health Cigna Priority Health	$1,379.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,063.68
Rate for Payer: Priority Health Narrow Network	$1,063.68
Rate for Payer: Priority Health SBD	$1,063.68
Rate for Payer: UMR Bronson Commercial	$906.66

PR CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH

Professional

Both

$1,555.00

Service Code	HCPCS 26525
Min. Negotiated Rate	$444.11
Max. Negotiated Rate	$1,128.45
Rate for Payer: Aetna Commercial	$907.21
Rate for Payer: BCBS Complete	$466.32
Rate for Payer: BCBS Trust/PPO	$1,128.45
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Meridian Medicaid	$466.32
Rate for Payer: Priority Health Choice Medicaid	$444.11
Rate for Payer: Priority Health Cigna Priority Health	$1,088.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,067.77
Rate for Payer: Priority Health Narrow Network	$1,067.77
Rate for Payer: Priority Health SBD	$1,067.77
Rate for Payer: UMR Bronson Commercial	$715.30

PR CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH

Professional

Both

$1,555.00

Service Code	HCPCS 26520
Min. Negotiated Rate	$441.55
Max. Negotiated Rate	$1,088.50
Rate for Payer: Aetna Commercial	$904.90
Rate for Payer: BCBS Complete	$463.63
Rate for Payer: BCBS Trust/PPO	$1,062.94
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Meridian Medicaid	$463.63
Rate for Payer: Priority Health Choice Medicaid	$441.55
Rate for Payer: Priority Health Cigna Priority Health	$1,088.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,063.17
Rate for Payer: Priority Health Narrow Network	$1,063.17
Rate for Payer: Priority Health SBD	$1,063.17
Rate for Payer: UMR Bronson Commercial	$715.30

PR CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX

Professional

Both

$786.00

Service Code	HCPCS 28270
Min. Negotiated Rate	$215.77
Max. Negotiated Rate	$550.20
Rate for Payer: Aetna Commercial	$440.61
Rate for Payer: BCBS Complete	$226.56
Rate for Payer: BCBS Trust/PPO	$265.73
Rate for Payer: Cash Price	$628.80
Rate for Payer: Cash Price	$628.80
Rate for Payer: Meridian Medicaid	$226.56
Rate for Payer: Priority Health Choice Medicaid	$215.77
Rate for Payer: Priority Health Cigna Priority Health	$550.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$508.61
Rate for Payer: Priority Health Narrow Network	$508.61
Rate for Payer: Priority Health SBD	$508.61
Rate for Payer: UMR Bronson Commercial	$361.56

PR CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT

Professional

Both

$1,964.00

Service Code	HCPCS 26516
Min. Negotiated Rate	$481.59
Max. Negotiated Rate	$3,178.25
Rate for Payer: Aetna Commercial	$983.79
Rate for Payer: BCBS Complete	$505.67
Rate for Payer: BCBS Trust/PPO	$3,178.25
Rate for Payer: Cash Price	$1,571.20
Rate for Payer: Cash Price	$1,571.20
Rate for Payer: Meridian Medicaid	$505.67
Rate for Payer: Priority Health Choice Medicaid	$481.59
Rate for Payer: Priority Health Cigna Priority Health	$1,374.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,155.60
Rate for Payer: Priority Health Narrow Network	$1,155.60
Rate for Payer: Priority Health SBD	$1,155.60
Rate for Payer: UMR Bronson Commercial	$903.44

PR CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON

Professional

Both

$2,811.00

Service Code	HCPCS 23450
Min. Negotiated Rate	$146.45
Max. Negotiated Rate	$1,967.70
Rate for Payer: Aetna Commercial	$1,266.50
Rate for Payer: BCBS Complete	$639.86
Rate for Payer: BCBS Trust/PPO	$146.45
Rate for Payer: Cash Price	$2,248.80
Rate for Payer: Cash Price	$2,248.80
Rate for Payer: Meridian Medicaid	$639.86
Rate for Payer: Priority Health Choice Medicaid	$609.39
Rate for Payer: Priority Health Cigna Priority Health	$1,967.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,450.76
Rate for Payer: Priority Health Narrow Network	$1,450.76
Rate for Payer: Priority Health SBD	$1,450.76
Rate for Payer: UMR Bronson Commercial	$1,293.06

PR CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR

Professional

Both

$3,347.00

Service Code	HCPCS 23462
Min. Negotiated Rate	$313.71
Max. Negotiated Rate	$2,342.90
Rate for Payer: Aetna Commercial	$1,427.63
Rate for Payer: BCBS Complete	$721.05
Rate for Payer: BCBS Trust/PPO	$313.71
Rate for Payer: Cash Price	$2,677.60
Rate for Payer: Cash Price	$2,677.60
Rate for Payer: Meridian Medicaid	$721.05
Rate for Payer: Priority Health Choice Medicaid	$686.71
Rate for Payer: Priority Health Cigna Priority Health	$2,342.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,635.10
Rate for Payer: Priority Health Narrow Network	$1,635.10
Rate for Payer: Priority Health SBD	$1,635.10
Rate for Payer: UMR Bronson Commercial	$1,539.62

PR CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK

Professional

Both

$2,738.00

Service Code	HCPCS 23460
Min. Negotiated Rate	$208.43
Max. Negotiated Rate	$1,916.60
Rate for Payer: Aetna Commercial	$1,456.90
Rate for Payer: BCBS Complete	$736.93
Rate for Payer: BCBS Trust/PPO	$208.43
Rate for Payer: Cash Price	$2,190.40
Rate for Payer: Cash Price	$2,190.40
Rate for Payer: Meridian Medicaid	$736.93
Rate for Payer: Priority Health Choice Medicaid	$701.84
Rate for Payer: Priority Health Cigna Priority Health	$1,916.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,670.34
Rate for Payer: Priority Health Narrow Network	$1,670.34
Rate for Payer: Priority Health SBD	$1,670.34
Rate for Payer: UMR Bronson Commercial	$1,259.48

PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR

Professional

Both

$3,140.00

Service Code	HCPCS 23455
Min. Negotiated Rate	$188.90
Max. Negotiated Rate	$2,198.00
Rate for Payer: Aetna Commercial	$1,328.69
Rate for Payer: BCBS Complete	$666.48
Rate for Payer: BCBS Trust/PPO	$188.90
Rate for Payer: Cash Price	$2,512.00
Rate for Payer: Cash Price	$2,512.00
Rate for Payer: Meridian Medicaid	$666.48
Rate for Payer: Priority Health Choice Medicaid	$634.74
Rate for Payer: Priority Health Cigna Priority Health	$2,198.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,514.58
Rate for Payer: Priority Health Narrow Network	$1,514.58
Rate for Payer: Priority Health SBD	$1,514.58
Rate for Payer: UMR Bronson Commercial	$1,444.40

PR CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK

Professional

Both

$3,431.00

Service Code	HCPCS 23465
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$2,401.70
Rate for Payer: Aetna Commercial	$1,495.78
Rate for Payer: BCBS Complete	$755.49
Rate for Payer: BCBS Trust/PPO	$104.00
Rate for Payer: Cash Price	$2,744.80
Rate for Payer: Cash Price	$2,744.80
Rate for Payer: Meridian Medicaid	$755.49
Rate for Payer: Priority Health Choice Medicaid	$719.51
Rate for Payer: Priority Health Cigna Priority Health	$2,401.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,712.73
Rate for Payer: Priority Health Narrow Network	$1,712.73
Rate for Payer: Priority Health SBD	$1,712.73
Rate for Payer: UMR Bronson Commercial	$1,578.26

PR CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS

Professional

Both

$1,969.00

Service Code	HCPCS 23466
Min. Negotiated Rate	$138.81
Max. Negotiated Rate	$1,718.33
Rate for Payer: Aetna Commercial	$1,490.07
Rate for Payer: BCBS Complete	$759.74
Rate for Payer: BCBS Trust/PPO	$138.81
Rate for Payer: Cash Price	$1,575.20
Rate for Payer: Cash Price	$1,575.20
Rate for Payer: Meridian Medicaid	$759.74
Rate for Payer: Priority Health Choice Medicaid	$723.56
Rate for Payer: Priority Health Cigna Priority Health	$1,378.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,718.33
Rate for Payer: Priority Health Narrow Network	$1,718.33
Rate for Payer: Priority Health SBD	$1,718.33
Rate for Payer: UMR Bronson Commercial	$905.74

PR CAPSULOTOMY WRIST

Professional

Both

$1,608.00

Service Code	HCPCS 25085
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$1,125.60
Rate for Payer: Aetna Commercial	$597.69
Rate for Payer: BCBS Complete	$308.19
Rate for Payer: BCBS Trust/PPO	$119.92
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Meridian Medicaid	$308.19
Rate for Payer: Priority Health Choice Medicaid	$293.51
Rate for Payer: Priority Health Cigna Priority Health	$1,125.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$694.49
Rate for Payer: Priority Health Narrow Network	$694.49
Rate for Payer: Priority Health SBD	$694.49
Rate for Payer: UMR Bronson Commercial	$739.68

PR CARDIOPULMONARY EXERCISE TESTING

Professional

Both

$277.00

Service Code	HCPCS 94621
Min. Negotiated Rate	$89.39
Max. Negotiated Rate	$256.23
Rate for Payer: Aetna Commercial	$168.62
Rate for Payer: BCBS Complete	$110.80
Rate for Payer: BCBS Trust/PPO	$256.23
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$89.39
Rate for Payer: Priority Health Narrow Network	$89.39
Rate for Payer: Priority Health SBD	$204.81
Rate for Payer: UMR Bronson Commercial	$127.42

PR CARDIOPULMONARY RESUSCITATION

Professional

Both

$548.00

Service Code	HCPCS 92950
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$2,166.03
Rate for Payer: Aetna Commercial	$248.46
Rate for Payer: BCBS Complete	$120.99
Rate for Payer: BCBS Trust/PPO	$2,166.03
Rate for Payer: Cash Price	$438.40
Rate for Payer: Cash Price	$438.40
Rate for Payer: Meridian Medicaid	$120.99
Rate for Payer: Priority Health Choice Medicaid	$115.23
Rate for Payer: Priority Health Cigna Priority Health	$383.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$254.40
Rate for Payer: Priority Health Narrow Network	$254.40
Rate for Payer: Priority Health SBD	$254.40
Rate for Payer: UMR Bronson Commercial	$252.08

PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP

Professional

Both

$6,712.00

Service Code	HCPCS 33315
Min. Negotiated Rate	$1,201.32
Max. Negotiated Rate	$4,698.40
Rate for Payer: Aetna Commercial	$2,572.47
Rate for Payer: BCBS Complete	$1,261.39
Rate for Payer: BCBS Trust/PPO	$1,311.77
Rate for Payer: Cash Price	$5,369.60
Rate for Payer: Cash Price	$5,369.60
Rate for Payer: Meridian Medicaid	$1,261.39
Rate for Payer: Priority Health Choice Medicaid	$1,201.32
Rate for Payer: Priority Health Cigna Priority Health	$4,698.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,988.53
Rate for Payer: Priority Health Narrow Network	$2,988.53
Rate for Payer: Priority Health SBD	$2,988.53
Rate for Payer: UMR Bronson Commercial	$3,087.52

Know your out-of-pocket cost for care.

All Charges