Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH

Professional

Both

$1,937.00

Service Code	HCPCS 57305
Min. Negotiated Rate	$627.50
Max. Negotiated Rate	$2,391.09
Rate for Payer: Aetna Commercial	$1,168.24
Rate for Payer: BCBS Complete	$658.88
Rate for Payer: BCBS Trust/PPO	$2,391.09
Rate for Payer: Cash Price	$1,549.60
Rate for Payer: Cash Price	$1,549.60
Rate for Payer: Meridian Medicaid	$658.88
Rate for Payer: Priority Health Choice Medicaid	$627.50
Rate for Payer: Priority Health Cigna Priority Health	$1,355.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,398.97
Rate for Payer: Priority Health Narrow Network	$1,398.97
Rate for Payer: Priority Health SBD	$1,398.97
Rate for Payer: UMR Bronson Commercial	$891.02

PR CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR

Professional

Both

$1,295.00

Service Code	HCPCS 57300
Min. Negotiated Rate	$395.12
Max. Negotiated Rate	$2,627.76
Rate for Payer: Aetna Commercial	$717.48
Rate for Payer: BCBS Complete	$414.88
Rate for Payer: BCBS Trust/PPO	$2,627.76
Rate for Payer: Cash Price	$1,036.00
Rate for Payer: Cash Price	$1,036.00
Rate for Payer: Meridian Medicaid	$414.88
Rate for Payer: Priority Health Choice Medicaid	$395.12
Rate for Payer: Priority Health Cigna Priority Health	$906.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$870.63
Rate for Payer: Priority Health Narrow Network	$870.63
Rate for Payer: Priority Health SBD	$870.63
Rate for Payer: UMR Bronson Commercial	$595.70

PR CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX

Professional

Both

$1,130.00

Service Code	HCPCS 53520
Min. Negotiated Rate	$256.23
Max. Negotiated Rate	$893.75
Rate for Payer: Aetna Commercial	$715.24
Rate for Payer: BCBS Complete	$375.51
Rate for Payer: BCBS Trust/PPO	$256.23
Rate for Payer: Cash Price	$904.00
Rate for Payer: Cash Price	$904.00
Rate for Payer: Meridian Medicaid	$375.51
Rate for Payer: Priority Health Choice Medicaid	$357.63
Rate for Payer: Priority Health Cigna Priority Health	$791.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$893.75
Rate for Payer: Priority Health Narrow Network	$893.75
Rate for Payer: Priority Health SBD	$893.75
Rate for Payer: UMR Bronson Commercial	$519.80

PR CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL

Professional

Both

$1,081.00

Service Code	HCPCS 57311
Min. Negotiated Rate	$356.78
Max. Negotiated Rate	$2,101.05
Rate for Payer: Aetna Commercial	$653.71
Rate for Payer: BCBS Complete	$374.62
Rate for Payer: BCBS Trust/PPO	$2,101.05
Rate for Payer: Cash Price	$864.80
Rate for Payer: Cash Price	$864.80
Rate for Payer: Meridian Medicaid	$374.62
Rate for Payer: Priority Health Choice Medicaid	$356.78
Rate for Payer: Priority Health Cigna Priority Health	$756.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$783.04
Rate for Payer: Priority Health Narrow Network	$783.04
Rate for Payer: Priority Health SBD	$783.04
Rate for Payer: UMR Bronson Commercial	$497.26

PR CLSR VESICOVAGINAL FISTUL AABDL APPROACH

Professional

Both

$3,839.00

Service Code	HCPCS 51900
Min. Negotiated Rate	$524.19
Max. Negotiated Rate	$2,687.30
Rate for Payer: Aetna Commercial	$1,056.40
Rate for Payer: BCBS Complete	$550.40
Rate for Payer: BCBS Trust/PPO	$1,789.35
Rate for Payer: Cash Price	$3,071.20
Rate for Payer: Cash Price	$3,071.20
Rate for Payer: Meridian Medicaid	$550.40
Rate for Payer: Priority Health Choice Medicaid	$524.19
Rate for Payer: Priority Health Cigna Priority Health	$2,687.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,313.61
Rate for Payer: Priority Health Narrow Network	$1,313.61
Rate for Payer: Priority Health SBD	$1,313.61
Rate for Payer: UMR Bronson Commercial	$1,765.94

PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<

Professional

Both

$1,299.00

Service Code	HCPCS 15155
Min. Negotiated Rate	$206.12
Max. Negotiated Rate	$909.30
Rate for Payer: Aetna Commercial	$787.97
Rate for Payer: BCBS Complete	$488.90
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Meridian Medicaid	$488.90
Rate for Payer: Priority Health Choice Medicaid	$465.62
Rate for Payer: Priority Health Cigna Priority Health	$909.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$896.06
Rate for Payer: Priority Health Narrow Network	$896.06
Rate for Payer: Priority Health SBD	$896.06
Rate for Payer: UMR Bronson Commercial	$597.54

PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM

Professional

Both

$350.00

Service Code	HCPCS 15156
Min. Negotiated Rate	$95.21
Max. Negotiated Rate	$6,614.63
Rate for Payer: Aetna Commercial	$166.77
Rate for Payer: BCBS Complete	$99.97
Rate for Payer: BCBS Trust/PPO	$6,614.63
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Meridian Medicaid	$99.97
Rate for Payer: Priority Health Choice Medicaid	$95.21
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.91
Rate for Payer: Priority Health Narrow Network	$182.91
Rate for Payer: Priority Health SBD	$182.91
Rate for Payer: UMR Bronson Commercial	$161.00

PR CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM

Professional

Both

$225.00

Service Code	HCPCS 15151
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$206.12
Rate for Payer: Aetna Commercial	$120.68
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$133.58
Rate for Payer: Priority Health Narrow Network	$133.58
Rate for Payer: Priority Health SBD	$133.58
Rate for Payer: UMR Bronson Commercial	$103.50

PR CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA

Professional

Both

$300.00

Service Code	HCPCS 15152
Min. Negotiated Rate	$87.97
Max. Negotiated Rate	$6,614.63
Rate for Payer: Aetna Commercial	$151.77
Rate for Payer: BCBS Complete	$92.37
Rate for Payer: BCBS Trust/PPO	$6,614.63
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Meridian Medicaid	$92.37
Rate for Payer: Priority Health Choice Medicaid	$87.97
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$172.23
Rate for Payer: Priority Health Narrow Network	$172.23
Rate for Payer: Priority Health SBD	$172.23
Rate for Payer: UMR Bronson Commercial	$138.00

PR CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<

Professional

Both

$1,181.00

Service Code	HCPCS 15150
Min. Negotiated Rate	$212.16
Max. Negotiated Rate	$826.70
Rate for Payer: Aetna Commercial	$698.22
Rate for Payer: BCBS Complete	$430.53
Rate for Payer: BCBS Trust/PPO	$212.16
Rate for Payer: Cash Price	$944.80
Rate for Payer: Cash Price	$944.80
Rate for Payer: Meridian Medicaid	$430.53
Rate for Payer: Priority Health Choice Medicaid	$410.03
Rate for Payer: Priority Health Cigna Priority Health	$826.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$786.31
Rate for Payer: Priority Health Narrow Network	$786.31
Rate for Payer: Priority Health SBD	$786.31
Rate for Payer: UMR Bronson Commercial	$543.26

PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ

Professional

Both

$2,229.00

Service Code	HCPCS 27222
Min. Negotiated Rate	$631.33
Max. Negotiated Rate	$2,011.24
Rate for Payer: Aetna Commercial	$1,306.47
Rate for Payer: BCBS Complete	$662.90
Rate for Payer: BCBS Trust/PPO	$2,011.24
Rate for Payer: Cash Price	$1,783.20
Rate for Payer: Cash Price	$1,783.20
Rate for Payer: Meridian Medicaid	$662.90
Rate for Payer: Priority Health Choice Medicaid	$631.33
Rate for Payer: Priority Health Cigna Priority Health	$1,560.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,512.03
Rate for Payer: Priority Health Narrow Network	$1,512.03
Rate for Payer: Priority Health SBD	$1,512.03
Rate for Payer: UMR Bronson Commercial	$1,025.34

PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ

Professional

Both

$1,646.00

Service Code	HCPCS 27220
Min. Negotiated Rate	$269.02
Max. Negotiated Rate	$2,011.24
Rate for Payer: Aetna Commercial	$550.55
Rate for Payer: BCBS Complete	$282.47
Rate for Payer: BCBS Trust/PPO	$2,011.24
Rate for Payer: Cash Price	$1,316.80
Rate for Payer: Cash Price	$1,316.80
Rate for Payer: Meridian Medicaid	$282.47
Rate for Payer: Priority Health Choice Medicaid	$269.02
Rate for Payer: Priority Health Cigna Priority Health	$1,152.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$638.31
Rate for Payer: Priority Health Narrow Network	$638.31
Rate for Payer: Priority Health SBD	$638.31
Rate for Payer: UMR Bronson Commercial	$757.16

PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ

Professional

Both

$1,386.00

Service Code	HCPCS 27842
Min. Negotiated Rate	$321.84
Max. Negotiated Rate	$1,704.38
Rate for Payer: Aetna Commercial	$660.07
Rate for Payer: BCBS Complete	$337.93
Rate for Payer: BCBS Trust/PPO	$1,704.38
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Meridian Medicaid	$337.93
Rate for Payer: Priority Health Choice Medicaid	$321.84
Rate for Payer: Priority Health Cigna Priority Health	$970.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$760.36
Rate for Payer: Priority Health Narrow Network	$760.36
Rate for Payer: Priority Health SBD	$760.36
Rate for Payer: UMR Bronson Commercial	$637.56

PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ

Professional

Both

$917.00

Service Code	HCPCS 26742
Min. Negotiated Rate	$183.81
Max. Negotiated Rate	$641.90
Rate for Payer: Aetna Commercial	$448.66
Rate for Payer: BCBS Complete	$233.49
Rate for Payer: BCBS Trust/PPO	$183.81
Rate for Payer: Cash Price	$733.60
Rate for Payer: Cash Price	$733.60
Rate for Payer: Meridian Medicaid	$233.49
Rate for Payer: Priority Health Choice Medicaid	$222.37
Rate for Payer: Priority Health Cigna Priority Health	$641.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$527.49
Rate for Payer: Priority Health Narrow Network	$527.49
Rate for Payer: Priority Health SBD	$527.49
Rate for Payer: UMR Bronson Commercial	$421.82

PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ

Professional

Both

$620.00

Service Code	HCPCS 26740
Min. Negotiated Rate	$147.82
Max. Negotiated Rate	$434.00
Rate for Payer: Aetna Commercial	$289.66
Rate for Payer: BCBS Complete	$155.21
Rate for Payer: BCBS Trust/PPO	$153.74
Rate for Payer: Cash Price	$496.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: Meridian Medicaid	$155.21
Rate for Payer: Priority Health Choice Medicaid	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$434.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$347.24
Rate for Payer: Priority Health Narrow Network	$347.24
Rate for Payer: Priority Health SBD	$347.24
Rate for Payer: UMR Bronson Commercial	$285.20

PR CLTX CARPAL BONE FX W/MANJ EACH BONE

Professional

Both

$1,101.00

Service Code	HCPCS 25635
Min. Negotiated Rate	$280.73
Max. Negotiated Rate	$1,016.45
Rate for Payer: Aetna Commercial	$560.87
Rate for Payer: BCBS Complete	$294.77
Rate for Payer: BCBS Trust/PPO	$1,016.45
Rate for Payer: Cash Price	$880.80
Rate for Payer: Cash Price	$880.80
Rate for Payer: Meridian Medicaid	$294.77
Rate for Payer: Priority Health Choice Medicaid	$280.73
Rate for Payer: Priority Health Cigna Priority Health	$770.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$661.29
Rate for Payer: Priority Health Narrow Network	$661.29
Rate for Payer: Priority Health SBD	$661.29
Rate for Payer: UMR Bronson Commercial	$506.46

PR CLTX CARPAL BONE FX W/O MANJ EACH BONE

Professional

Both

$700.00

Service Code	HCPCS 25630
Min. Negotiated Rate	$189.78
Max. Negotiated Rate	$962.74
Rate for Payer: Aetna Commercial	$376.68
Rate for Payer: BCBS Complete	$199.27
Rate for Payer: BCBS Trust/PPO	$962.74
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Meridian Medicaid	$199.27
Rate for Payer: Priority Health Choice Medicaid	$189.78
Rate for Payer: Priority Health Cigna Priority Health	$490.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$447.84
Rate for Payer: Priority Health Narrow Network	$447.84
Rate for Payer: Priority Health SBD	$447.84
Rate for Payer: UMR Bronson Commercial	$322.00

PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ

Professional

Both

$736.00

Service Code	HCPCS 26641
Min. Negotiated Rate	$253.90
Max. Negotiated Rate	$597.97
Rate for Payer: Aetna Commercial	$505.26
Rate for Payer: BCBS Complete	$266.60
Rate for Payer: BCBS Trust/PPO	$525.66
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Meridian Medicaid	$266.60
Rate for Payer: Priority Health Choice Medicaid	$253.90
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$597.97
Rate for Payer: Priority Health Narrow Network	$597.97
Rate for Payer: Priority Health SBD	$597.97
Rate for Payer: UMR Bronson Commercial	$338.56

PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ

Professional

Both

$998.00

Service Code	HCPCS 26645
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$698.60
Rate for Payer: Aetna Commercial	$526.41
Rate for Payer: BCBS Complete	$274.87
Rate for Payer: BCBS Trust/PPO	$23.25
Rate for Payer: Cash Price	$798.40
Rate for Payer: Cash Price	$798.40
Rate for Payer: Meridian Medicaid	$274.87
Rate for Payer: Priority Health Choice Medicaid	$261.78
Rate for Payer: Priority Health Cigna Priority Health	$698.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$617.89
Rate for Payer: Priority Health Narrow Network	$617.89
Rate for Payer: Priority Health SBD	$617.89
Rate for Payer: UMR Bronson Commercial	$459.08

PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES

Professional

Both

$593.00

Service Code	HCPCS 26670
Min. Negotiated Rate	$57.73
Max. Negotiated Rate	$489.20
Rate for Payer: Aetna Commercial	$415.80
Rate for Payer: BCBS Complete	$219.18
Rate for Payer: BCBS Trust/PPO	$57.73
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Meridian Medicaid	$219.18
Rate for Payer: Priority Health Choice Medicaid	$208.74
Rate for Payer: Priority Health Cigna Priority Health	$415.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$489.20
Rate for Payer: Priority Health Narrow Network	$489.20
Rate for Payer: Priority Health SBD	$489.20
Rate for Payer: UMR Bronson Commercial	$272.78

PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES

Professional

Both

$1,240.00

Service Code	HCPCS 26675
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$868.00
Rate for Payer: Aetna Commercial	$561.06
Rate for Payer: BCBS Complete	$293.65
Rate for Payer: BCBS Trust/PPO	$46.70
Rate for Payer: Cash Price	$992.00
Rate for Payer: Cash Price	$992.00
Rate for Payer: Meridian Medicaid	$293.65
Rate for Payer: Priority Health Choice Medicaid	$279.67
Rate for Payer: Priority Health Cigna Priority Health	$868.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$660.27
Rate for Payer: Priority Health Narrow Network	$660.27
Rate for Payer: Priority Health SBD	$660.27
Rate for Payer: UMR Bronson Commercial	$570.40

PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ

Professional

Both

$1,280.00

Service Code	HCPCS 27516
Min. Negotiated Rate	$319.71
Max. Negotiated Rate	$1,829.50
Rate for Payer: Aetna Commercial	$641.97
Rate for Payer: BCBS Complete	$335.70
Rate for Payer: BCBS Trust/PPO	$1,829.50
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Meridian Medicaid	$335.70
Rate for Payer: Priority Health Choice Medicaid	$319.71
Rate for Payer: Priority Health Cigna Priority Health	$896.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$755.25
Rate for Payer: Priority Health Narrow Network	$755.25
Rate for Payer: Priority Health SBD	$755.25
Rate for Payer: UMR Bronson Commercial	$588.80

PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ

Professional

Both

$1,330.00

Service Code	HCPCS 27788
Min. Negotiated Rate	$254.54
Max. Negotiated Rate	$931.00
Rate for Payer: Aetna Commercial	$512.28
Rate for Payer: BCBS Complete	$267.27
Rate for Payer: BCBS Trust/PPO	$677.10
Rate for Payer: Cash Price	$1,064.00
Rate for Payer: Cash Price	$1,064.00
Rate for Payer: Meridian Medicaid	$267.27
Rate for Payer: Priority Health Choice Medicaid	$254.54
Rate for Payer: Priority Health Cigna Priority Health	$931.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$602.06
Rate for Payer: Priority Health Narrow Network	$602.06
Rate for Payer: Priority Health SBD	$602.06
Rate for Payer: UMR Bronson Commercial	$611.80

PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ

Professional

Both

$760.00

Service Code	HCPCS 27786
Min. Negotiated Rate	$191.06
Max. Negotiated Rate	$2,764.24
Rate for Payer: Aetna Commercial	$381.27
Rate for Payer: BCBS Complete	$200.61
Rate for Payer: BCBS Trust/PPO	$2,764.24
Rate for Payer: Cash Price	$608.00
Rate for Payer: Cash Price	$608.00
Rate for Payer: Meridian Medicaid	$200.61
Rate for Payer: Priority Health Choice Medicaid	$191.06
Rate for Payer: Priority Health Cigna Priority Health	$532.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.90
Rate for Payer: Priority Health Narrow Network	$450.90
Rate for Payer: Priority Health SBD	$450.90
Rate for Payer: UMR Bronson Commercial	$349.60

PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA

Professional

Both

$539.00

Service Code	HCPCS 26755
Min. Negotiated Rate	$182.54
Max. Negotiated Rate	$1,776.67
Rate for Payer: Aetna Commercial	$366.59
Rate for Payer: BCBS Complete	$191.67
Rate for Payer: BCBS Trust/PPO	$1,776.67
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Meridian Medicaid	$191.67
Rate for Payer: Priority Health Choice Medicaid	$182.54
Rate for Payer: Priority Health Cigna Priority Health	$377.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$432.51
Rate for Payer: Priority Health Narrow Network	$432.51
Rate for Payer: Priority Health SBD	$432.51
Rate for Payer: UMR Bronson Commercial	$247.94

Know your out-of-pocket cost for care.

All Charges