Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I

Professional

Both

$571.00

Service Code	HCPCS 93455
Min. Negotiated Rate	$228.40
Max. Negotiated Rate	$1,428.06
Rate for Payer: Aetna Commercial	$1,384.11
Rate for Payer: BCBS Complete	$228.40
Rate for Payer: BCBS Trust/PPO	$472.30
Rate for Payer: Cash Price	$456.80
Rate for Payer: Cash Price	$456.80
Rate for Payer: Priority Health Cigna Priority Health	$399.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$382.08
Rate for Payer: Priority Health Narrow Network	$382.08
Rate for Payer: Priority Health SBD	$1,428.06
Rate for Payer: UMR Bronson Commercial	$262.66

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

Professional

Both

$2,379.00

Service Code	HCPCS 93457
Min. Negotiated Rate	$479.49
Max. Negotiated Rate	$1,737.78
Rate for Payer: Aetna Commercial	$1,695.32
Rate for Payer: BCBS Complete	$951.60
Rate for Payer: BCBS Trust/PPO	$542.56
Rate for Payer: Cash Price	$1,903.20
Rate for Payer: Cash Price	$1,903.20
Rate for Payer: Priority Health Cigna Priority Health	$1,665.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$479.49
Rate for Payer: Priority Health Narrow Network	$479.49
Rate for Payer: Priority Health SBD	$1,737.78
Rate for Payer: UMR Bronson Commercial	$1,094.34

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

Professional

Both

$2,128.00

Service Code	HCPCS 93456
Min. Negotiated Rate	$427.00
Max. Negotiated Rate	$1,594.99
Rate for Payer: Aetna Commercial	$1,544.51
Rate for Payer: BCBS Complete	$851.20
Rate for Payer: BCBS Trust/PPO	$503.47
Rate for Payer: Cash Price	$1,702.40
Rate for Payer: Cash Price	$1,702.40
Rate for Payer: Priority Health Cigna Priority Health	$1,489.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$427.00
Rate for Payer: Priority Health Narrow Network	$427.00
Rate for Payer: Priority Health SBD	$1,594.99
Rate for Payer: UMR Bronson Commercial	$978.88

PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI

Professional

Both

$631.00

Service Code	HCPCS 58340
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$441.70
Rate for Payer: Aetna Commercial	$67.35
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCBS Trust/PPO	$441.13
Rate for Payer: Cash Price	$504.80
Rate for Payer: Cash Price	$504.80
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health	$441.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.96
Rate for Payer: Priority Health Narrow Network	$80.96
Rate for Payer: Priority Health SBD	$80.96
Rate for Payer: UMR Bronson Commercial	$290.26

PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT

Professional

Both

$451.00

Service Code	HCPCS 57511
Min. Negotiated Rate	$95.21
Max. Negotiated Rate	$640.30
Rate for Payer: Aetna Commercial	$171.03
Rate for Payer: BCBS Complete	$99.97
Rate for Payer: BCBS Trust/PPO	$640.30
Rate for Payer: Cash Price	$360.80
Rate for Payer: Cash Price	$360.80
Rate for Payer: Meridian Medicaid	$99.97
Rate for Payer: Priority Health Choice Medicaid	$95.21
Rate for Payer: Priority Health Cigna Priority Health	$315.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$209.73
Rate for Payer: Priority Health Narrow Network	$209.73
Rate for Payer: Priority Health SBD	$209.73
Rate for Payer: UMR Bronson Commercial	$207.46

PR CAUTERY CERVIX ELECTRO/THERMAL

Professional

Both

$471.00

Service Code	HCPCS 57510
Min. Negotiated Rate	$72.63
Max. Negotiated Rate	$689.96
Rate for Payer: Aetna Commercial	$134.58
Rate for Payer: BCBS Complete	$76.26
Rate for Payer: BCBS Trust/PPO	$689.96
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Meridian Medicaid	$76.26
Rate for Payer: Priority Health Choice Medicaid	$72.63
Rate for Payer: Priority Health Cigna Priority Health	$329.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$159.07
Rate for Payer: Priority Health Narrow Network	$159.07
Rate for Payer: Priority Health SBD	$159.07
Rate for Payer: UMR Bronson Commercial	$216.66

PR CAUTERY CERVIX LASER ABLATION

Professional

Both

$543.00

Service Code	HCPCS 57513
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$646.64
Rate for Payer: Aetna Commercial	$170.65
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$646.64
Rate for Payer: Cash Price	$434.40
Rate for Payer: Cash Price	$434.40
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$380.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$209.25
Rate for Payer: Priority Health Narrow Network	$209.25
Rate for Payer: Priority Health SBD	$209.25
Rate for Payer: UMR Bronson Commercial	$249.78

PR CBHC CONSULT FEE

Professional

Both

$300.00

Service Code	HCPCS 00585
Hospital Revenue Code	990
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: UMR Bronson Commercial	$138.00

PR CBHC IN HOUSE REPAIR

Professional

Both

$26.00

Service Code	HCPCS 00580
Hospital Revenue Code	990
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$18.20
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: UMR Bronson Commercial	$11.96

PR CBHC IN-HOUSE REPAIR

Professional

Both

$26.00

Service Code	HCPCS 00590
Hospital Revenue Code	990
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$18.20
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: UMR Bronson Commercial	$11.96

PR CBHC LOSS AND DAMAGE FEE

Professional

Both

$275.00

Service Code	HCPCS 00581
Hospital Revenue Code	990
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$192.50
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: UMR Bronson Commercial	$126.50

PR CBHC MAILING CHARGE

Professional

Both

$12.00

Service Code	HCPCS 00584
Hospital Revenue Code	990
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$8.40
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: UMR Bronson Commercial	$5.52

PR CBHC RECASE BTE

Professional

Both

$60.00

Service Code	HCPCS 00582
Hospital Revenue Code	990
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: BCBS Complete	$24.00
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 CBHC RECASE ITE

Professional

Both

$175.00

Service Code	HCPCS 00583
Hospital Revenue Code	990
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$122.50
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Priority Health Cigna Priority Health	$122.50
Rate for Payer: UMR Bronson Commercial	$80.50

PR CBHC REPAIR 5 YRS AND OLDER

Professional

Both

$425.00

Service Code	HCPCS 00589
Hospital Revenue Code	990
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$297.50
Rate for Payer: BCBS Complete	$170.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Priority Health Cigna Priority Health	$297.50
Rate for Payer: UMR Bronson Commercial	$195.50

PR CBHC REPAIR DIGITAL/CIC

Professional

Both

$300.00

Service Code	HCPCS 00588
Hospital Revenue Code	990
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: UMR Bronson Commercial	$138.00

PR CBHC REPAIR RECEIVER

Professional

Both

$100.00

Service Code	HCPCS 00587
Hospital Revenue Code	990
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 CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE

Professional

Both

$66.69

Service Code	HCPCS 90756
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$46.68
Rate for Payer: Aetna Commercial	$32.37
Rate for Payer: BCBS Complete	$26.68
Rate for Payer: BCBS Trust/PPO	$33.00
Rate for Payer: Cash Price	$53.35
Rate for Payer: Cash Price	$53.35
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: UMR Bronson Commercial	$30.68

PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE

Professional

Both

$71.40

Service Code	HCPCS 90674
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Commercial	$34.17
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$33.98
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cash Price	$57.12
Rate for Payer: Priority Health Cigna Priority Health	$49.98
Rate for Payer: UMR Bronson Commercial	$32.84

PR Ccm/bhi by rhc/fqhc 20min mo

Professional

Both

$246.00

Service Code	HCPCS G0511
Min. Negotiated Rate	$56.54
Max. Negotiated Rate	$589.58
Rate for Payer: Aetna Commercial	$63.19
Rate for Payer: BCBS Complete	$98.40
Rate for Payer: BCBS Trust/PPO	$589.58
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Priority Health Cigna Priority Health	$172.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.54
Rate for Payer: Priority Health Narrow Network	$56.54
Rate for Payer: Priority Health SBD	$56.54
Rate for Payer: UMR Bronson Commercial	$113.16

PR CEFTRIAXONE SODIUM INJECTION

Professional

Both

$20.00

Service Code	HCPCS J0696
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$0.51
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$0.03
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 CERCLAGE CERVIX PREGNANCY VAGINAL

Professional

Both

$720.00

Service Code	HCPCS 59320
Min. Negotiated Rate	$97.13
Max. Negotiated Rate	$504.00
Rate for Payer: Aetna Commercial	$165.15
Rate for Payer: BCBS Complete	$101.99
Rate for Payer: BCBS Trust/PPO	$213.43
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Meridian Medicaid	$101.99
Rate for Payer: Priority Health Choice Medicaid	$97.13
Rate for Payer: Priority Health Cigna Priority Health	$504.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.42
Rate for Payer: Priority Health Narrow Network	$213.42
Rate for Payer: Priority Health SBD	$213.42
Rate for Payer: UMR Bronson Commercial	$331.20

PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL

Professional

Both

$811.00

Service Code	HCPCS 57700
Min. Negotiated Rate	$230.89
Max. Negotiated Rate	$915.54
Rate for Payer: Aetna Commercial	$412.98
Rate for Payer: BCBS Complete	$242.43
Rate for Payer: BCBS Trust/PPO	$915.54
Rate for Payer: Cash Price	$648.80
Rate for Payer: Cash Price	$648.80
Rate for Payer: Meridian Medicaid	$242.43
Rate for Payer: Priority Health Choice Medicaid	$230.89
Rate for Payer: Priority Health Cigna Priority Health	$567.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$510.35
Rate for Payer: Priority Health Narrow Network	$510.35
Rate for Payer: Priority Health SBD	$510.35
Rate for Payer: UMR Bronson Commercial	$373.06

PR CERTOLIZUMAB PEGOL INJ 1MG

Professional

Both

$10.00

Service Code	HCPCS J0717
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$4.90
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

PR CERV FLEX N/ADJ FOAM PRE OTS

Professional

Both

$26.00

Service Code	HCPCS L0120
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$18.20
Rate for Payer: Aetna Commercial	$15.93
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: UMR Bronson Commercial	$11.96

Know your out-of-pocket cost for care.

All Charges