Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CLOSURE INTESTINAL CUTANEOUS FISTULA

Professional

Both

$2,496.00

Service Code	HCPCS 44640
Min. Negotiated Rate	$175.40
Max. Negotiated Rate	$2,437.73
Rate for Payer: Aetna Commercial	$1,881.85
Rate for Payer: BCBS Complete	$931.51
Rate for Payer: BCBS Trust/PPO	$175.40
Rate for Payer: Cash Price	$1,996.80
Rate for Payer: Cash Price	$1,996.80
Rate for Payer: Meridian Medicaid	$931.51
Rate for Payer: Priority Health Choice Medicaid	$887.15
Rate for Payer: Priority Health Cigna Priority Health	$1,747.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,437.73
Rate for Payer: Priority Health Narrow Network	$2,437.73
Rate for Payer: Priority Health SBD	$2,437.73
Rate for Payer: UMR Bronson Commercial	$1,148.16

PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<

Professional

Both

$526.00

Service Code	HCPCS 40830
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$805.66
Rate for Payer: Aetna Commercial	$217.18
Rate for Payer: BCBS Complete	$97.73
Rate for Payer: BCBS Trust/PPO	$805.66
Rate for Payer: Cash Price	$420.80
Rate for Payer: Cash Price	$420.80
Rate for Payer: Meridian Medicaid	$97.73
Rate for Payer: Priority Health Choice Medicaid	$93.08
Rate for Payer: Priority Health Cigna Priority Health	$368.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$256.36
Rate for Payer: Priority Health Narrow Network	$256.36
Rate for Payer: Priority Health SBD	$256.36
Rate for Payer: UMR Bronson Commercial	$241.96

PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL

Professional

Both

$677.00

Service Code	HCPCS 40831
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$949.88
Rate for Payer: Aetna Commercial	$299.67
Rate for Payer: BCBS Complete	$134.86
Rate for Payer: BCBS Trust/PPO	$949.88
Rate for Payer: Cash Price	$541.60
Rate for Payer: Cash Price	$541.60
Rate for Payer: Meridian Medicaid	$134.86
Rate for Payer: Priority Health Choice Medicaid	$128.44
Rate for Payer: Priority Health Cigna Priority Health	$473.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$353.96
Rate for Payer: Priority Health Narrow Network	$353.96
Rate for Payer: Priority Health SBD	$353.96
Rate for Payer: UMR Bronson Commercial	$311.42

PR CLOSURE RECTOURETHRAL FISTULA

Professional

Both

$3,219.00

Service Code	HCPCS 45820
Min. Negotiated Rate	$527.24
Max. Negotiated Rate	$2,253.30
Rate for Payer: Aetna Commercial	$1,722.58
Rate for Payer: BCBS Complete	$855.47
Rate for Payer: BCBS Trust/PPO	$527.24
Rate for Payer: Cash Price	$2,575.20
Rate for Payer: Cash Price	$2,575.20
Rate for Payer: Meridian Medicaid	$855.47
Rate for Payer: Priority Health Choice Medicaid	$814.73
Rate for Payer: Priority Health Cigna Priority Health	$2,253.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,240.76
Rate for Payer: Priority Health Narrow Network	$2,240.76
Rate for Payer: Priority Health SBD	$2,240.76
Rate for Payer: UMR Bronson Commercial	$1,480.74

PR CLOSURE RECTOVESICAL FISTULA

Professional

Both

$2,803.00

Service Code	HCPCS 45800
Min. Negotiated Rate	$812.60
Max. Negotiated Rate	$2,234.88
Rate for Payer: Aetna Commercial	$1,718.44
Rate for Payer: BCBS Complete	$853.23
Rate for Payer: BCBS Trust/PPO	$1,277.43
Rate for Payer: Cash Price	$2,242.40
Rate for Payer: Cash Price	$2,242.40
Rate for Payer: Meridian Medicaid	$853.23
Rate for Payer: Priority Health Choice Medicaid	$812.60
Rate for Payer: Priority Health Cigna Priority Health	$1,962.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,234.88
Rate for Payer: Priority Health Narrow Network	$2,234.88
Rate for Payer: Priority Health SBD	$2,234.88
Rate for Payer: UMR Bronson Commercial	$1,289.38

PR CLOSURE SALIVARY FISTULA

Professional

Both

$802.00

Service Code	HCPCS 42600
Min. Negotiated Rate	$230.47
Max. Negotiated Rate	$630.90
Rate for Payer: Aetna Commercial	$464.04
Rate for Payer: BCBS Complete	$241.99
Rate for Payer: BCBS Trust/PPO	$547.85
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cash Price	$641.60
Rate for Payer: Meridian Medicaid	$241.99
Rate for Payer: Priority Health Choice Medicaid	$230.47
Rate for Payer: Priority Health Cigna Priority Health	$561.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$630.90
Rate for Payer: Priority Health Narrow Network	$630.90
Rate for Payer: Priority Health SBD	$630.90
Rate for Payer: UMR Bronson Commercial	$368.92

PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH

Professional

Both

$944.00

Service Code	HCPCS 57320
Min. Negotiated Rate	$364.02
Max. Negotiated Rate	$1,656.75
Rate for Payer: Aetna Commercial	$662.82
Rate for Payer: BCBS Complete	$382.22
Rate for Payer: BCBS Trust/PPO	$1,656.75
Rate for Payer: Cash Price	$755.20
Rate for Payer: Cash Price	$755.20
Rate for Payer: Meridian Medicaid	$382.22
Rate for Payer: Priority Health Choice Medicaid	$364.02
Rate for Payer: Priority Health Cigna Priority Health	$660.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$805.77
Rate for Payer: Priority Health Narrow Network	$805.77
Rate for Payer: Priority Health SBD	$805.77
Rate for Payer: UMR Bronson Commercial	$434.24

PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION

Professional

Both

$586.00

Service Code	HCPCS 23540
Min. Negotiated Rate	$158.26
Max. Negotiated Rate	$410.20
Rate for Payer: Aetna Commercial	$308.76
Rate for Payer: BCBS Complete	$166.17
Rate for Payer: BCBS Trust/PPO	$393.06
Rate for Payer: Cash Price	$468.80
Rate for Payer: Cash Price	$468.80
Rate for Payer: Meridian Medicaid	$166.17
Rate for Payer: Priority Health Choice Medicaid	$158.26
Rate for Payer: Priority Health Cigna Priority Health	$410.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$372.78
Rate for Payer: Priority Health Narrow Network	$372.78
Rate for Payer: Priority Health SBD	$372.78
Rate for Payer: UMR Bronson Commercial	$269.56

PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION

Professional

Both

$506.00

Service Code	HCPCS 23500
Min. Negotiated Rate	$152.93
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$299.45
Rate for Payer: BCBS Complete	$160.58
Rate for Payer: BCBS Trust/PPO	$226.26
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$404.80
Rate for Payer: Meridian Medicaid	$160.58
Rate for Payer: Priority Health Choice Medicaid	$152.93
Rate for Payer: Priority Health Cigna Priority Health	$354.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$360.00
Rate for Payer: Priority Health Narrow Network	$360.00
Rate for Payer: Priority Health SBD	$360.00
Rate for Payer: UMR Bronson Commercial	$232.76

PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$827.00

Service Code	HCPCS 24500
Min. Negotiated Rate	$223.22
Max. Negotiated Rate	$578.90
Rate for Payer: Aetna Commercial	$439.50
Rate for Payer: BCBS Complete	$234.38
Rate for Payer: BCBS Trust/PPO	$266.26
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$661.60
Rate for Payer: Meridian Medicaid	$234.38
Rate for Payer: Priority Health Choice Medicaid	$223.22
Rate for Payer: Priority Health Cigna Priority Health	$578.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$524.95
Rate for Payer: Priority Health Narrow Network	$524.95
Rate for Payer: Priority Health SBD	$524.95
Rate for Payer: UMR Bronson Commercial	$380.42

PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES

Professional

Both

$450.00

Service Code	HCPCS 27198
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$2,080.97
Rate for Payer: Aetna Commercial	$423.91
Rate for Payer: BCBS Complete	$212.47
Rate for Payer: BCBS Trust/PPO	$2,080.97
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Meridian Medicaid	$212.47
Rate for Payer: Priority Health Choice Medicaid	$202.35
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$482.06
Rate for Payer: Priority Health Narrow Network	$482.06
Rate for Payer: Priority Health SBD	$482.06
Rate for Payer: UMR Bronson Commercial	$207.00

PR CLSD TX PELVIC RING FX W/O MANIPULATION

Professional

Both

$231.00

Service Code	HCPCS 27197
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$1,831.62
Rate for Payer: Aetna Commercial	$174.74
Rate for Payer: BCBS Complete	$90.35
Rate for Payer: BCBS Trust/PPO	$1,831.62
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Meridian Medicaid	$90.35
Rate for Payer: Priority Health Choice Medicaid	$86.05
Rate for Payer: Priority Health Cigna Priority Health	$161.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.29
Rate for Payer: Priority Health Narrow Network	$205.29
Rate for Payer: Priority Health SBD	$205.29
Rate for Payer: UMR Bronson Commercial	$106.26

PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES

Professional

Both

$1,011.00

Service Code	HCPCS 23655
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$707.70
Rate for Payer: Aetna Commercial	$542.19
Rate for Payer: BCBS Complete	$281.80
Rate for Payer: BCBS Trust/PPO	$372.98
Rate for Payer: Cash Price	$808.80
Rate for Payer: Cash Price	$808.80
Rate for Payer: Meridian Medicaid	$281.80
Rate for Payer: Priority Health Choice Medicaid	$268.38
Rate for Payer: Priority Health Cigna Priority Health	$707.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$634.74
Rate for Payer: Priority Health Narrow Network	$634.74
Rate for Payer: Priority Health SBD	$634.74
Rate for Payer: UMR Bronson Commercial	$465.06

PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

Professional

Both

$680.00

Service Code	HCPCS 23650
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$476.00
Rate for Payer: Aetna Commercial	$390.39
Rate for Payer: BCBS Complete	$210.23
Rate for Payer: BCBS Trust/PPO	$328.60
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Meridian Medicaid	$210.23
Rate for Payer: Priority Health Choice Medicaid	$200.22
Rate for Payer: Priority Health Cigna Priority Health	$476.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$470.31
Rate for Payer: Priority Health Narrow Network	$470.31
Rate for Payer: Priority Health SBD	$470.31
Rate for Payer: UMR Bronson Commercial	$312.80

PR CLSR ANAL FSTL W/RCT ADVMNT FLAP

Professional

Both

$1,645.00

Service Code	HCPCS 46288
Min. Negotiated Rate	$359.54
Max. Negotiated Rate	$2,458.18
Rate for Payer: Aetna Commercial	$741.11
Rate for Payer: BCBS Complete	$377.52
Rate for Payer: BCBS Trust/PPO	$2,458.18
Rate for Payer: Cash Price	$1,316.00
Rate for Payer: Cash Price	$1,316.00
Rate for Payer: Meridian Medicaid	$377.52
Rate for Payer: Priority Health Choice Medicaid	$359.54
Rate for Payer: Priority Health Cigna Priority Health	$1,151.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$984.85
Rate for Payer: Priority Health Narrow Network	$984.85
Rate for Payer: Priority Health SBD	$984.85
Rate for Payer: UMR Bronson Commercial	$756.70

PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA

Professional

Both

$1,835.00

Service Code	HCPCS 32810
Min. Negotiated Rate	$570.84
Max. Negotiated Rate	$1,284.50
Rate for Payer: Aetna Commercial	$1,159.79
Rate for Payer: BCBS Complete	$599.38
Rate for Payer: BCBS Trust/PPO	$807.77
Rate for Payer: Cash Price	$1,468.00
Rate for Payer: Cash Price	$1,468.00
Rate for Payer: Meridian Medicaid	$599.38
Rate for Payer: Priority Health Choice Medicaid	$570.84
Rate for Payer: Priority Health Cigna Priority Health	$1,284.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,231.70
Rate for Payer: Priority Health Narrow Network	$1,231.70
Rate for Payer: Priority Health SBD	$1,231.70
Rate for Payer: UMR Bronson Commercial	$844.10

PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL

Professional

Both

$2,528.00

Service Code	HCPCS 44650
Min. Negotiated Rate	$245.13
Max. Negotiated Rate	$2,514.18
Rate for Payer: Aetna Commercial	$1,939.64
Rate for Payer: BCBS Complete	$960.35
Rate for Payer: BCBS Trust/PPO	$245.13
Rate for Payer: Cash Price	$2,022.40
Rate for Payer: Cash Price	$2,022.40
Rate for Payer: Meridian Medicaid	$960.35
Rate for Payer: Priority Health Choice Medicaid	$914.62
Rate for Payer: Priority Health Cigna Priority Health	$1,769.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,514.18
Rate for Payer: Priority Health Narrow Network	$2,514.18
Rate for Payer: Priority Health SBD	$2,514.18
Rate for Payer: UMR Bronson Commercial	$1,162.88

PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ

Professional

Both

$3,506.00

Service Code	HCPCS 44661
Min. Negotiated Rate	$246.19
Max. Negotiated Rate	$2,694.09
Rate for Payer: Aetna Commercial	$2,083.58
Rate for Payer: BCBS Complete	$1,027.00
Rate for Payer: BCBS Trust/PPO	$246.19
Rate for Payer: Cash Price	$2,804.80
Rate for Payer: Cash Price	$2,804.80
Rate for Payer: Meridian Medicaid	$1,027.00
Rate for Payer: Priority Health Choice Medicaid	$978.10
Rate for Payer: Priority Health Cigna Priority Health	$2,454.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,694.09
Rate for Payer: Priority Health Narrow Network	$2,694.09
Rate for Payer: Priority Health SBD	$2,694.09
Rate for Payer: UMR Bronson Commercial	$1,612.76

PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ

Professional

Both

$2,610.00

Service Code	HCPCS 44660
Min. Negotiated Rate	$250.41
Max. Negotiated Rate	$2,327.78
Rate for Payer: Aetna Commercial	$1,795.04
Rate for Payer: BCBS Complete	$895.05
Rate for Payer: BCBS Trust/PPO	$250.41
Rate for Payer: Cash Price	$2,088.00
Rate for Payer: Cash Price	$2,088.00
Rate for Payer: Meridian Medicaid	$895.05
Rate for Payer: Priority Health Choice Medicaid	$852.43
Rate for Payer: Priority Health Cigna Priority Health	$1,827.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,327.78
Rate for Payer: Priority Health Narrow Network	$2,327.78
Rate for Payer: Priority Health SBD	$2,327.78
Rate for Payer: UMR Bronson Commercial	$1,200.60

PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR

Professional

Both

$2,640.00

Service Code	HCPCS 43420
Min. Negotiated Rate	$652.21
Max. Negotiated Rate	$1,848.00
Rate for Payer: Aetna Commercial	$1,345.37
Rate for Payer: BCBS Complete	$684.82
Rate for Payer: BCBS Trust/PPO	$1,339.77
Rate for Payer: Cash Price	$2,112.00
Rate for Payer: Cash Price	$2,112.00
Rate for Payer: Meridian Medicaid	$684.82
Rate for Payer: Priority Health Choice Medicaid	$652.21
Rate for Payer: Priority Health Cigna Priority Health	$1,848.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,793.91
Rate for Payer: Priority Health Narrow Network	$1,793.91
Rate for Payer: Priority Health SBD	$1,793.91
Rate for Payer: UMR Bronson Commercial	$1,214.40

PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR

Professional

Both

$4,095.00

Service Code	HCPCS 43425
Min. Negotiated Rate	$911.43
Max. Negotiated Rate	$2,866.50
Rate for Payer: Aetna Commercial	$1,937.74
Rate for Payer: BCBS Complete	$957.00
Rate for Payer: BCBS Trust/PPO	$986.34
Rate for Payer: Cash Price	$3,276.00
Rate for Payer: Cash Price	$3,276.00
Rate for Payer: Meridian Medicaid	$957.00
Rate for Payer: Priority Health Choice Medicaid	$911.43
Rate for Payer: Priority Health Cigna Priority Health	$2,866.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,503.00
Rate for Payer: Priority Health Narrow Network	$2,503.00
Rate for Payer: Priority Health SBD	$2,503.00
Rate for Payer: UMR Bronson Commercial	$1,883.70

PR CLSR LACRIMAL PUNCTUM PLUG EACH

Professional

Both

$299.00

Service Code	HCPCS 68761
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$1,031.77
Rate for Payer: Aetna Commercial	$152.10
Rate for Payer: BCBS Complete	$78.06
Rate for Payer: BCBS Trust/PPO	$1,031.77
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Meridian Medicaid	$78.06
Rate for Payer: Priority Health Choice Medicaid	$74.34
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$202.56
Rate for Payer: Priority Health Narrow Network	$202.56
Rate for Payer: Priority Health SBD	$202.56
Rate for Payer: UMR Bronson Commercial	$137.54

PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT

Professional

Both

$2,856.00

Service Code	HCPCS 44625
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$1,999.20
Rate for Payer: Aetna Commercial	$1,357.27
Rate for Payer: BCBS Complete	$674.97
Rate for Payer: BCBS Trust/PPO	$203.40
Rate for Payer: Cash Price	$2,284.80
Rate for Payer: Cash Price	$2,284.80
Rate for Payer: Meridian Medicaid	$674.97
Rate for Payer: Priority Health Choice Medicaid	$642.83
Rate for Payer: Priority Health Cigna Priority Health	$1,999.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,765.68
Rate for Payer: Priority Health Narrow Network	$1,765.68
Rate for Payer: Priority Health SBD	$1,765.68
Rate for Payer: UMR Bronson Commercial	$1,313.76

PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS

Professional

Both

$2,914.00

Service Code	HCPCS 44626
Min. Negotiated Rate	$205.51
Max. Negotiated Rate	$2,781.10
Rate for Payer: Aetna Commercial	$2,151.52
Rate for Payer: BCBS Complete	$1,060.10
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: Cash Price	$2,331.20
Rate for Payer: Cash Price	$2,331.20
Rate for Payer: Meridian Medicaid	$1,060.10
Rate for Payer: Priority Health Choice Medicaid	$1,009.62
Rate for Payer: Priority Health Cigna Priority Health	$2,039.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,781.10
Rate for Payer: Priority Health Narrow Network	$2,781.10
Rate for Payer: Priority Health SBD	$2,781.10
Rate for Payer: UMR Bronson Commercial	$1,340.44

PR CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ

Professional

Both

$1,442.00

Service Code	HCPCS 57308
Min. Negotiated Rate	$426.21
Max. Negotiated Rate	$1,574.86
Rate for Payer: Aetna Commercial	$782.21
Rate for Payer: BCBS Complete	$447.52
Rate for Payer: BCBS Trust/PPO	$1,574.86
Rate for Payer: Cash Price	$1,153.60
Rate for Payer: Cash Price	$1,153.60
Rate for Payer: Meridian Medicaid	$447.52
Rate for Payer: Priority Health Choice Medicaid	$426.21
Rate for Payer: Priority Health Cigna Priority Health	$1,009.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$940.22
Rate for Payer: Priority Health Narrow Network	$940.22
Rate for Payer: Priority Health SBD	$940.22
Rate for Payer: UMR Bronson Commercial	$663.32

Know your out-of-pocket cost for care.

All Charges