Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ

Professional

Both

$1,263.00

Service Code	HCPCS 24505
Min. Negotiated Rate	$298.84
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: BCBS Complete	$313.78
Rate for Payer: BCBS Trust/PPO	$313.28
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Meridian Medicaid	$313.78
Rate for Payer: Priority Health Choice Medicaid	$298.84
Rate for Payer: Priority Health Cigna Priority Health	$884.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$706.23
Rate for Payer: Priority Health Narrow Network	$706.23
Rate for Payer: Priority Health SBD	$706.23
Rate for Payer: UMR Bronson Commercial	$580.98

PR CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN

Professional

Both

$934.00

Service Code	HCPCS 27538
Min. Negotiated Rate	$296.71
Max. Negotiated Rate	$716.37
Rate for Payer: Aetna Commercial	$595.65
Rate for Payer: BCBS Complete	$311.55
Rate for Payer: BCBS Trust/PPO	$716.37
Rate for Payer: Cash Price	$747.20
Rate for Payer: Cash Price	$747.20
Rate for Payer: Meridian Medicaid	$311.55
Rate for Payer: Priority Health Choice Medicaid	$296.71
Rate for Payer: Priority Health Cigna Priority Health	$653.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$702.15
Rate for Payer: Priority Health Narrow Network	$702.15
Rate for Payer: Priority Health SBD	$702.15
Rate for Payer: UMR Bronson Commercial	$429.64

PR CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ

Professional

Both

$933.00

Service Code	HCPCS 27238
Min. Negotiated Rate	$306.51
Max. Negotiated Rate	$1,049.20
Rate for Payer: Aetna Commercial	$620.82
Rate for Payer: BCBS Complete	$321.84
Rate for Payer: BCBS Trust/PPO	$1,049.20
Rate for Payer: Cash Price	$746.40
Rate for Payer: Cash Price	$746.40
Rate for Payer: Meridian Medicaid	$321.84
Rate for Payer: Priority Health Choice Medicaid	$306.51
Rate for Payer: Priority Health Cigna Priority Health	$653.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$725.13
Rate for Payer: Priority Health Narrow Network	$725.13
Rate for Payer: Priority Health SBD	$725.13
Rate for Payer: UMR Bronson Commercial	$429.18

PR CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES

Professional

Both

$267.00

Service Code	HCPCS 28665
Min. Negotiated Rate	$81.79
Max. Negotiated Rate	$1,135.32
Rate for Payer: Aetna Commercial	$166.79
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: BCBS Trust/PPO	$1,135.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Meridian Medicaid	$85.88
Rate for Payer: Priority Health Choice Medicaid	$81.79
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.96
Rate for Payer: Priority Health Narrow Network	$189.96
Rate for Payer: Priority Health SBD	$189.96
Rate for Payer: UMR Bronson Commercial	$122.82

PR CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES

Professional

Both

$229.00

Service Code	HCPCS 28660
Min. Negotiated Rate	$61.34
Max. Negotiated Rate	$766.04
Rate for Payer: Aetna Commercial	$122.37
Rate for Payer: BCBS Complete	$64.41
Rate for Payer: BCBS Trust/PPO	$766.04
Rate for Payer: Cash Price	$183.20
Rate for Payer: Cash Price	$183.20
Rate for Payer: Meridian Medicaid	$64.41
Rate for Payer: Priority Health Choice Medicaid	$61.34
Rate for Payer: Priority Health Cigna Priority Health	$160.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$142.98
Rate for Payer: Priority Health Narrow Network	$142.98
Rate for Payer: Priority Health SBD	$142.98
Rate for Payer: UMR Bronson Commercial	$105.34

PR CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ

Professional

Both

$1,946.00

Service Code	HCPCS 27240
Min. Negotiated Rate	$613.87
Max. Negotiated Rate	$1,467.10
Rate for Payer: Aetna Commercial	$1,282.41
Rate for Payer: BCBS Complete	$644.56
Rate for Payer: BCBS Trust/PPO	$1,203.47
Rate for Payer: Cash Price	$1,556.80
Rate for Payer: Cash Price	$1,556.80
Rate for Payer: Meridian Medicaid	$644.56
Rate for Payer: Priority Health Choice Medicaid	$613.87
Rate for Payer: Priority Health Cigna Priority Health	$1,362.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,467.10
Rate for Payer: Priority Health Narrow Network	$1,467.10
Rate for Payer: Priority Health SBD	$1,467.10
Rate for Payer: UMR Bronson Commercial	$895.16

PR CLTX IPHAL JT DISLC W/MANJ REQ ANES

Professional

Both

$809.00

Service Code	HCPCS 26775
Min. Negotiated Rate	$236.22
Max. Negotiated Rate	$2,900.37
Rate for Payer: Aetna Commercial	$466.21
Rate for Payer: BCBS Complete	$248.03
Rate for Payer: BCBS Trust/PPO	$2,900.37
Rate for Payer: Cash Price	$647.20
Rate for Payer: Cash Price	$647.20
Rate for Payer: Meridian Medicaid	$248.03
Rate for Payer: Priority Health Choice Medicaid	$236.22
Rate for Payer: Priority Health Cigna Priority Health	$566.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$557.12
Rate for Payer: Priority Health Narrow Network	$557.12
Rate for Payer: Priority Health SBD	$557.12
Rate for Payer: UMR Bronson Commercial	$372.14

PR CLTX IPHAL JT DISLC W/MANJ W/O ANES

Professional

Both

$547.00

Service Code	HCPCS 26770
Min. Negotiated Rate	$175.73
Max. Negotiated Rate	$1,851.16
Rate for Payer: Aetna Commercial	$345.16
Rate for Payer: BCBS Complete	$184.52
Rate for Payer: BCBS Trust/PPO	$1,851.16
Rate for Payer: Cash Price	$437.60
Rate for Payer: Cash Price	$437.60
Rate for Payer: Meridian Medicaid	$184.52
Rate for Payer: Priority Health Choice Medicaid	$175.73
Rate for Payer: Priority Health Cigna Priority Health	$382.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$412.09
Rate for Payer: Priority Health Narrow Network	$412.09
Rate for Payer: Priority Health SBD	$412.09
Rate for Payer: UMR Bronson Commercial	$251.62

PR CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX

Professional

Both

$1,172.00

Service Code	HCPCS 21440
Min. Negotiated Rate	$388.30
Max. Negotiated Rate	$2,978.97
Rate for Payer: Aetna Commercial	$702.55
Rate for Payer: BCBS Complete	$407.72
Rate for Payer: BCBS Trust/PPO	$2,978.97
Rate for Payer: Cash Price	$937.60
Rate for Payer: Cash Price	$937.60
Rate for Payer: Meridian Medicaid	$407.72
Rate for Payer: Priority Health Choice Medicaid	$388.30
Rate for Payer: Priority Health Cigna Priority Health	$820.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$849.20
Rate for Payer: Priority Health Narrow Network	$849.20
Rate for Payer: Priority Health SBD	$849.20
Rate for Payer: UMR Bronson Commercial	$539.12

PR CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION

Professional

Both

$855.00

Service Code	HCPCS 27760
Min. Negotiated Rate	$204.91
Max. Negotiated Rate	$2,919.55
Rate for Payer: Aetna Commercial	$406.19
Rate for Payer: BCBS Complete	$215.16
Rate for Payer: BCBS Trust/PPO	$2,919.55
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Meridian Medicaid	$215.16
Rate for Payer: Priority Health Choice Medicaid	$204.91
Rate for Payer: Priority Health Cigna Priority Health	$598.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$480.52
Rate for Payer: Priority Health Narrow Network	$480.52
Rate for Payer: Priority Health SBD	$480.52
Rate for Payer: UMR Bronson Commercial	$393.30

PR CLTX METACARPAL FX W/MANIPULATION EACH BONE

Professional

Both

$701.00

Service Code	HCPCS 26605
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$490.70
Rate for Payer: Aetna Commercial	$392.63
Rate for Payer: BCBS Complete	$208.22
Rate for Payer: BCBS Trust/PPO	$49.24
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Meridian Medicaid	$208.22
Rate for Payer: Priority Health Choice Medicaid	$198.30
Rate for Payer: Priority Health Cigna Priority Health	$490.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$468.27
Rate for Payer: Priority Health Narrow Network	$468.27
Rate for Payer: Priority Health SBD	$468.27
Rate for Payer: UMR Bronson Commercial	$322.46

PR CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE

Professional

Both

$1,510.00

Service Code	HCPCS 26607
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$1,057.00
Rate for Payer: Aetna Commercial	$668.91
Rate for Payer: BCBS Complete	$348.44
Rate for Payer: BCBS Trust/PPO	$49.24
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Meridian Medicaid	$348.44
Rate for Payer: Priority Health Choice Medicaid	$331.85
Rate for Payer: Priority Health Cigna Priority Health	$1,057.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$791.51
Rate for Payer: Priority Health Narrow Network	$791.51
Rate for Payer: Priority Health SBD	$791.51
Rate for Payer: UMR Bronson Commercial	$694.60

PR CLTX METACARPAL FX W/O MANIPULATION EACH BONE

Professional

Both

$539.00

Service Code	HCPCS 26600
Min. Negotiated Rate	$103.55
Max. Negotiated Rate	$451.41
Rate for Payer: Aetna Commercial	$375.05
Rate for Payer: BCBS Complete	$201.74
Rate for Payer: BCBS Trust/PPO	$103.55
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Meridian Medicaid	$201.74
Rate for Payer: Priority Health Choice Medicaid	$192.13
Rate for Payer: Priority Health Cigna Priority Health	$377.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$451.41
Rate for Payer: Priority Health Narrow Network	$451.41
Rate for Payer: Priority Health SBD	$451.41
Rate for Payer: UMR Bronson Commercial	$247.94

PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES

Professional

Both

$809.00

Service Code	HCPCS 26705
Min. Negotiated Rate	$254.64
Max. Negotiated Rate	$620.95
Rate for Payer: Aetna Commercial	$510.96
Rate for Payer: BCBS Complete	$276.21
Rate for Payer: BCBS Trust/PPO	$254.64
Rate for Payer: Cash Price	$647.20
Rate for Payer: Cash Price	$647.20
Rate for Payer: Meridian Medicaid	$276.21
Rate for Payer: Priority Health Choice Medicaid	$263.06
Rate for Payer: Priority Health Cigna Priority Health	$566.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$620.95
Rate for Payer: Priority Health Narrow Network	$620.95
Rate for Payer: Priority Health SBD	$620.95
Rate for Payer: UMR Bronson Commercial	$372.14

PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES

Professional

Both

$539.00

Service Code	HCPCS 26700
Min. Negotiated Rate	$64.45
Max. Negotiated Rate	$492.26
Rate for Payer: Aetna Commercial	$412.37
Rate for Payer: BCBS Complete	$219.18
Rate for Payer: BCBS Trust/PPO	$64.45
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Meridian Medicaid	$219.18
Rate for Payer: Priority Health Choice Medicaid	$208.74
Rate for Payer: Priority Health Cigna Priority Health	$377.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$492.26
Rate for Payer: Priority Health Narrow Network	$492.26
Rate for Payer: Priority Health SBD	$492.26
Rate for Payer: UMR Bronson Commercial	$247.94

PR CLTX METAR FX W/MANJ

Professional

Both

$726.00

Service Code	HCPCS 28475
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$1,033.88
Rate for Payer: Aetna Commercial	$299.08
Rate for Payer: BCBS Complete	$158.34
Rate for Payer: BCBS Trust/PPO	$1,033.88
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Meridian Medicaid	$158.34
Rate for Payer: Priority Health Choice Medicaid	$150.80
Rate for Payer: Priority Health Cigna Priority Health	$508.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.32
Rate for Payer: Priority Health Narrow Network	$351.32
Rate for Payer: Priority Health SBD	$351.32
Rate for Payer: UMR Bronson Commercial	$333.96

PR CLTX METATARSOPHLNGL JT DISLC REQ ANES

Professional

Both

$310.00

Service Code	HCPCS 28635
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$342.34
Rate for Payer: Aetna Commercial	$178.03
Rate for Payer: BCBS Complete	$88.79
Rate for Payer: BCBS Trust/PPO	$342.34
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Meridian Medicaid	$88.79
Rate for Payer: Priority Health Choice Medicaid	$84.56
Rate for Payer: Priority Health Cigna Priority Health	$217.00
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	$142.60

PR CLTX METATARSOPHLNGL JT DISLC W/O ANES

Professional

Both

$312.00

Service Code	HCPCS 28630
Min. Negotiated Rate	$71.78
Max. Negotiated Rate	$753.88
Rate for Payer: Aetna Commercial	$146.75
Rate for Payer: BCBS Complete	$75.37
Rate for Payer: BCBS Trust/PPO	$753.88
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Meridian Medicaid	$75.37
Rate for Payer: Priority Health Choice Medicaid	$71.78
Rate for Payer: Priority Health Cigna Priority Health	$218.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$169.54
Rate for Payer: Priority Health Narrow Network	$169.54
Rate for Payer: Priority Health SBD	$169.54
Rate for Payer: UMR Bronson Commercial	$143.52

PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA

Professional

Both

$701.00

Service Code	HCPCS 26725
Min. Negotiated Rate	$202.99
Max. Negotiated Rate	$830.49
Rate for Payer: Aetna Commercial	$403.72
Rate for Payer: BCBS Complete	$213.14
Rate for Payer: BCBS Trust/PPO	$830.49
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Meridian Medicaid	$213.14
Rate for Payer: Priority Health Choice Medicaid	$202.99
Rate for Payer: Priority Health Cigna Priority Health	$490.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$478.47
Rate for Payer: Priority Health Narrow Network	$478.47
Rate for Payer: Priority Health SBD	$478.47
Rate for Payer: UMR Bronson Commercial	$322.46

PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA

Professional

Both

$404.00

Service Code	HCPCS 26720
Min. Negotiated Rate	$127.16
Max. Negotiated Rate	$909.78
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: BCBS Complete	$133.52
Rate for Payer: BCBS Trust/PPO	$909.78
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Meridian Medicaid	$133.52
Rate for Payer: Priority Health Choice Medicaid	$127.16
Rate for Payer: Priority Health Cigna Priority Health	$282.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$297.71
Rate for Payer: Priority Health Narrow Network	$297.71
Rate for Payer: Priority Health SBD	$297.71
Rate for Payer: UMR Bronson Commercial	$185.84

PR CLTX POST HIP ARTHRP DISLC REQ ANES

Professional

Both

$1,500.00

Service Code	HCPCS 27266
Min. Negotiated Rate	$378.93
Max. Negotiated Rate	$3,076.82
Rate for Payer: Aetna Commercial	$779.49
Rate for Payer: BCBS Complete	$397.88
Rate for Payer: BCBS Trust/PPO	$3,076.82
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Meridian Medicaid	$397.88
Rate for Payer: Priority Health Choice Medicaid	$378.93
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$902.32
Rate for Payer: Priority Health Narrow Network	$902.32
Rate for Payer: Priority Health SBD	$902.32
Rate for Payer: UMR Bronson Commercial	$690.00

PR CLTX POST HIP ARTHRP DISLC W/O ANES

Professional

Both

$727.00

Service Code	HCPCS 27265
Min. Negotiated Rate	$274.77
Max. Negotiated Rate	$2,859.69
Rate for Payer: Aetna Commercial	$541.09
Rate for Payer: BCBS Complete	$288.51
Rate for Payer: BCBS Trust/PPO	$2,859.69
Rate for Payer: Cash Price	$581.60
Rate for Payer: Cash Price	$581.60
Rate for Payer: Meridian Medicaid	$288.51
Rate for Payer: Priority Health Choice Medicaid	$274.77
Rate for Payer: Priority Health Cigna Priority Health	$508.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$646.99
Rate for Payer: Priority Health Narrow Network	$646.99
Rate for Payer: Priority Health SBD	$646.99
Rate for Payer: UMR Bronson Commercial	$334.42

PR CLTX PROX FIBULA/SHFT FX W/MANJ

Professional

Both

$1,188.00

Service Code	HCPCS 27781
Min. Negotiated Rate	$267.10
Max. Negotiated Rate	$2,284.34
Rate for Payer: Aetna Commercial	$530.55
Rate for Payer: BCBS Complete	$280.46
Rate for Payer: BCBS Trust/PPO	$2,284.34
Rate for Payer: Cash Price	$950.40
Rate for Payer: Cash Price	$950.40
Rate for Payer: Meridian Medicaid	$280.46
Rate for Payer: Priority Health Choice Medicaid	$267.10
Rate for Payer: Priority Health Cigna Priority Health	$831.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$630.66
Rate for Payer: Priority Health Narrow Network	$630.66
Rate for Payer: Priority Health SBD	$630.66
Rate for Payer: UMR Bronson Commercial	$546.48

PR CLTX PROX FIBULA/SHFT FX W/O MANJ

Professional

Both

$653.00

Service Code	HCPCS 27780
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$2,660.11
Rate for Payer: Aetna Commercial	$375.75
Rate for Payer: BCBS Complete	$199.50
Rate for Payer: BCBS Trust/PPO	$2,660.11
Rate for Payer: Cash Price	$522.40
Rate for Payer: Cash Price	$522.40
Rate for Payer: Meridian Medicaid	$199.50
Rate for Payer: Priority Health Choice Medicaid	$190.00
Rate for Payer: Priority Health Cigna Priority Health	$457.10
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	$300.38

PR CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ

Professional

Both

$1,396.00

Service Code	HCPCS 23605
Min. Negotiated Rate	$282.44
Max. Negotiated Rate	$977.20
Rate for Payer: Aetna Commercial	$569.91
Rate for Payer: BCBS Complete	$296.56
Rate for Payer: BCBS Trust/PPO	$303.24
Rate for Payer: Cash Price	$1,116.80
Rate for Payer: Cash Price	$1,116.80
Rate for Payer: Meridian Medicaid	$296.56
Rate for Payer: Priority Health Choice Medicaid	$282.44
Rate for Payer: Priority Health Cigna Priority Health	$977.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$667.43
Rate for Payer: Priority Health Narrow Network	$667.43
Rate for Payer: Priority Health SBD	$667.43
Rate for Payer: UMR Bronson Commercial	$642.16

Know your out-of-pocket cost for care.

All Charges