Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CAST SUP LNGLEG CYLNDR PED F

Professional

Both

$50.00

Service Code	HCPCS Q4036
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$28.11
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UMR Bronson Commercial	$23.00

PR CAST SUP LNG LEG PED FBRGLS

Professional

Both

$52.00

Service Code	HCPCS Q4032
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$36.40
Rate for Payer: Aetna Commercial	$31.89
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: UMR Bronson Commercial	$23.92

PR CAST SUP LNG LEG SPLNT FBRGL

Professional

Both

$75.00

Service Code	HCPCS Q4042
Min. Negotiated Rate	$28.62
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$28.62
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 CAST SUP LNG LEG SPLNT PED F

Professional

Both

$38.00

Service Code	HCPCS Q4044
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$14.32
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: UMR Bronson Commercial	$17.48

PR CAST SUP LONG ARM ADULT FBRG

Professional

Both

$55.00

Service Code	HCPCS Q4006
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$38.50
Rate for Payer: Aetna Commercial	$24.48
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: UMR Bronson Commercial	$25.30

PR CAST SUP LONG ARM PED FBRGLS

Professional

Both

$25.00

Service Code	HCPCS Q4008
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$12.24
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: UMR Bronson Commercial	$11.50

PR CAST SUP LONG LEG FIBERGLASS

Professional

Both

$114.00

Service Code	HCPCS Q4030
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$79.80
Rate for Payer: Aetna Commercial	$63.77
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Priority Health Cigna Priority Health	$79.80
Rate for Payer: UMR Bronson Commercial	$52.44

PR CAST SUPPLIES UNLISTED

Professional

Both

$100.00

Service Code	HCPCS Q4050
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$70.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: UMR Bronson Commercial	$46.00

PR CAST SUP SHOULDER CAST FBRGL

Professional

Both

$151.00

Service Code	HCPCS Q4004
Min. Negotiated Rate	$60.40
Max. Negotiated Rate	$105.70
Rate for Payer: Aetna Commercial	$102.02
Rate for Payer: BCBS Complete	$60.40
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Priority Health Cigna Priority Health	$105.70
Rate for Payer: UMR Bronson Commercial	$69.46

PR CAST SUP SHRT LEG FIBERGLASS

Professional

Both

$60.00

Service Code	HCPCS Q4038
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$34.52
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UMR Bronson Commercial	$27.60

PR CAST SUP SHRT LEG PED FBRGLS

Professional

Both

$21.00

Service Code	HCPCS Q4040
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$17.26
Rate for Payer: Aetna Commercial	$17.26
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: UMR Bronson Commercial	$9.66

PR CAST SUP SHT ARM ADULT FBRGL

Professional

Both

$42.00

Service Code	HCPCS Q4010
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$29.40
Rate for Payer: Aetna Commercial	$16.32
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$29.40
Rate for Payer: UMR Bronson Commercial	$19.32

PR CAST SUP SHT ARM PED FBRGLAS

Professional

Both

$20.00

Service Code	HCPCS Q4012
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: UMR Bronson Commercial	$9.20

PR CAST SUP SHT ARM SPLINT FBRG

Professional

Both

$25.00

Service Code	HCPCS Q4022
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: UMR Bronson Commercial	$11.50

PR CAST SUP SHT ARM SPLNT PED F

Professional

Both

$27.00

Service Code	HCPCS Q4024
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Priority Health Cigna Priority Health	$18.90
Rate for Payer: UMR Bronson Commercial	$12.42

PR CAST SUP SHT LEG SPLNT FBRGL

Professional

Both

$30.00

Service Code	HCPCS Q4046
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.64
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: UMR Bronson Commercial	$13.80

PR CAST SUP SHT LEG SPLNT PED F

Professional

Both

$25.00

Service Code	HCPCS Q4048
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: UMR Bronson Commercial	$11.50

PR CAST SUP SHT LEG SPLNT PED P

Professional

Both

$20.00

Service Code	HCPCS Q4047
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$4.84
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: UMR Bronson Commercial	$9.20

PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY

Professional

Both

$138.00

Service Code	HCPCS 36660
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$738.56
Rate for Payer: Aetna Commercial	$91.56
Rate for Payer: BCBS Complete	$44.95
Rate for Payer: BCBS Trust/PPO	$738.56
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Meridian Medicaid	$44.95
Rate for Payer: Priority Health Choice Medicaid	$42.81
Rate for Payer: Priority Health Cigna Priority Health	$96.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.92
Rate for Payer: Priority Health Narrow Network	$106.92
Rate for Payer: Priority Health SBD	$106.92
Rate for Payer: UMR Bronson Commercial	$63.48

PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY

Professional

Both

$520.00

Service Code	HCPCS 31717
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$1,013.81
Rate for Payer: Aetna Commercial	$136.71
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS Trust/PPO	$1,013.81
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$364.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.01
Rate for Payer: Priority Health Narrow Network	$144.01
Rate for Payer: Priority Health SBD	$144.01
Rate for Payer: UMR Bronson Commercial	$239.20

PR CATHETERIZE FOR URINE SPEC

Professional

Both

$29.00

Service Code	HCPCS P9612
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$1,574.33
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCBS Trust/PPO	$1,574.33
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$20.30
Rate for Payer: UMR Bronson Commercial	$13.34

PR CATHJ UMBILICAL VEIN DX/THER NB

Professional

Both

$283.00

Service Code	HCPCS 36510
Min. Negotiated Rate	$33.44
Max. Negotiated Rate	$947.77
Rate for Payer: Aetna Commercial	$70.85
Rate for Payer: BCBS Complete	$35.11
Rate for Payer: BCBS Trust/PPO	$947.77
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cash Price	$226.40
Rate for Payer: Meridian Medicaid	$35.11
Rate for Payer: Priority Health Choice Medicaid	$33.44
Rate for Payer: Priority Health Cigna Priority Health	$198.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.51
Rate for Payer: Priority Health Narrow Network	$83.51
Rate for Payer: Priority Health SBD	$83.51
Rate for Payer: UMR Bronson Commercial	$130.18

PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I

Professional

Both

$1,679.00

Service Code	HCPCS 93454
Min. Negotiated Rate	$327.70
Max. Negotiated Rate	$2,147.01
Rate for Payer: Aetna Commercial	$1,231.58
Rate for Payer: Aetna Commercial	$1,231.58
Rate for Payer: BCBS Complete	$306.80
Rate for Payer: BCBS Complete	$671.60
Rate for Payer: BCBS Trust/PPO	$2,147.01
Rate for Payer: BCBS Trust/PPO	$2,147.01
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Cash Price	$613.60
Rate for Payer: Priority Health Cigna Priority Health	$536.90
Rate for Payer: Priority Health Cigna Priority Health	$1,175.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.70
Rate for Payer: Priority Health Narrow Network	$327.70
Rate for Payer: Priority Health Narrow Network	$327.70
Rate for Payer: Priority Health SBD	$1,281.94
Rate for Payer: Priority Health SBD	$1,281.94
Rate for Payer: UMR Bronson Commercial	$772.34
Rate for Payer: UMR Bronson Commercial	$352.82

PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

Professional

Both

$2,157.00

Service Code	HCPCS 93459
Min. Negotiated Rate	$458.69
Max. Negotiated Rate	$1,584.58
Rate for Payer: Aetna Commercial	$1,542.00
Rate for Payer: Aetna Commercial	$1,542.00
Rate for Payer: BCBS Complete	$862.80
Rate for Payer: BCBS Complete	$435.60
Rate for Payer: BCBS Trust/PPO	$570.56
Rate for Payer: BCBS Trust/PPO	$570.56
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Cash Price	$871.20
Rate for Payer: Cash Price	$871.20
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Priority Health Cigna Priority Health	$762.30
Rate for Payer: Priority Health Cigna Priority Health	$1,509.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$458.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$458.69
Rate for Payer: Priority Health Narrow Network	$458.69
Rate for Payer: Priority Health Narrow Network	$458.69
Rate for Payer: Priority Health SBD	$1,584.58
Rate for Payer: Priority Health SBD	$1,584.58
Rate for Payer: UMR Bronson Commercial	$500.94
Rate for Payer: UMR Bronson Commercial	$992.22

PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I

Professional

Both

$1,945.00

Service Code	HCPCS 93458
Min. Negotiated Rate	$404.31
Max. Negotiated Rate	$1,472.99
Rate for Payer: Aetna Commercial	$1,424.59
Rate for Payer: Aetna Commercial	$1,424.59
Rate for Payer: BCBS Complete	$778.00
Rate for Payer: BCBS Complete	$380.40
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$760.80
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$760.80
Rate for Payer: Priority Health Cigna Priority Health	$1,361.50
Rate for Payer: Priority Health Cigna Priority Health	$665.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$404.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$404.31
Rate for Payer: Priority Health Narrow Network	$404.31
Rate for Payer: Priority Health Narrow Network	$404.31
Rate for Payer: Priority Health SBD	$1,472.99
Rate for Payer: Priority Health SBD	$1,472.99
Rate for Payer: UMR Bronson Commercial	$894.70
Rate for Payer: UMR Bronson Commercial	$437.46

Know your out-of-pocket cost for care.

All Charges