Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION

Professional

Both

$770.00

Service Code	HCPCS 23600
Min. Negotiated Rate	$203.34
Max. Negotiated Rate	$539.00
Rate for Payer: Aetna Commercial	$415.71
Rate for Payer: BCBS Complete	$221.63
Rate for Payer: BCBS Trust/PPO	$203.34
Rate for Payer: Cash Price	$616.00
Rate for Payer: Cash Price	$616.00
Rate for Payer: Meridian Medicaid	$221.63
Rate for Payer: Priority Health Choice Medicaid	$211.08
Rate for Payer: Priority Health Cigna Priority Health	$539.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$496.86
Rate for Payer: Priority Health Narrow Network	$496.86
Rate for Payer: Priority Health SBD	$496.86
Rate for Payer: UMR Bronson Commercial	$354.20

PR CLTX PROX TIBFIB JT DISLC REQ ANES

Professional

Both

$745.00

Service Code	HCPCS 27831
Min. Negotiated Rate	$133.15
Max. Negotiated Rate	$636.78
Rate for Payer: Aetna Commercial	$541.69
Rate for Payer: BCBS Complete	$282.92
Rate for Payer: BCBS Trust/PPO	$133.15
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Meridian Medicaid	$282.92
Rate for Payer: Priority Health Choice Medicaid	$269.45
Rate for Payer: Priority Health Cigna Priority Health	$521.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$636.78
Rate for Payer: Priority Health Narrow Network	$636.78
Rate for Payer: Priority Health SBD	$636.78
Rate for Payer: UMR Bronson Commercial	$342.70

PR CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ

Professional

Both

$704.00

Service Code	HCPCS 25660
Min. Negotiated Rate	$296.71
Max. Negotiated Rate	$1,828.45
Rate for Payer: Aetna Commercial	$593.54
Rate for Payer: BCBS Complete	$311.55
Rate for Payer: BCBS Trust/PPO	$1,828.45
Rate for Payer: Cash Price	$563.20
Rate for Payer: Cash Price	$563.20
Rate for Payer: Meridian Medicaid	$311.55
Rate for Payer: Priority Health Choice Medicaid	$296.71
Rate for Payer: Priority Health Cigna Priority Health	$492.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$700.61
Rate for Payer: Priority Health Narrow Network	$700.61
Rate for Payer: Priority Health SBD	$700.61
Rate for Payer: UMR Bronson Commercial	$323.84

PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ

Professional

Both

$239.00

Service Code	HCPCS 24640
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$890.19
Rate for Payer: Aetna Commercial	$105.52
Rate for Payer: BCBS Complete	$54.13
Rate for Payer: BCBS Trust/PPO	$890.19
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$191.20
Rate for Payer: Meridian Medicaid	$54.13
Rate for Payer: Priority Health Choice Medicaid	$51.55
Rate for Payer: Priority Health Cigna Priority Health	$167.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$122.04
Rate for Payer: Priority Health Narrow Network	$122.04
Rate for Payer: Priority Health SBD	$122.04
Rate for Payer: UMR Bronson Commercial	$109.94

PR CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT

Professional

Both

$1,474.00

Service Code	HCPCS 25520
Min. Negotiated Rate	$358.69
Max. Negotiated Rate	$1,412.15
Rate for Payer: Aetna Commercial	$724.04
Rate for Payer: BCBS Complete	$376.62
Rate for Payer: BCBS Trust/PPO	$1,412.15
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Meridian Medicaid	$376.62
Rate for Payer: Priority Health Choice Medicaid	$358.69
Rate for Payer: Priority Health Cigna Priority Health	$1,031.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$848.20
Rate for Payer: Priority Health Narrow Network	$848.20
Rate for Payer: Priority Health SBD	$848.20
Rate for Payer: UMR Bronson Commercial	$678.04

PR CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION

Professional

Both

$1,011.00

Service Code	HCPCS 23575
Min. Negotiated Rate	$192.30
Max. Negotiated Rate	$707.70
Rate for Payer: Aetna Commercial	$502.77
Rate for Payer: BCBS Complete	$264.36
Rate for Payer: BCBS Trust/PPO	$192.30
Rate for Payer: Cash Price	$808.80
Rate for Payer: Cash Price	$808.80
Rate for Payer: Meridian Medicaid	$264.36
Rate for Payer: Priority Health Choice Medicaid	$251.77
Rate for Payer: Priority Health Cigna Priority Health	$707.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$593.38
Rate for Payer: Priority Health Narrow Network	$593.38
Rate for Payer: Priority Health SBD	$593.38
Rate for Payer: UMR Bronson Commercial	$465.06

PR CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ

Professional

Both

$1,346.00

Service Code	HCPCS 23665
Min. Negotiated Rate	$159.61
Max. Negotiated Rate	$942.20
Rate for Payer: Aetna Commercial	$529.72
Rate for Payer: BCBS Complete	$278.67
Rate for Payer: BCBS Trust/PPO	$159.61
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Meridian Medicaid	$278.67
Rate for Payer: Priority Health Choice Medicaid	$265.40
Rate for Payer: Priority Health Cigna Priority Health	$942.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$624.01
Rate for Payer: Priority Health Narrow Network	$624.01
Rate for Payer: Priority Health SBD	$624.01
Rate for Payer: UMR Bronson Commercial	$619.16

PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ

Professional

Both

$1,608.00

Service Code	HCPCS 24535
Min. Negotiated Rate	$376.58
Max. Negotiated Rate	$1,125.60
Rate for Payer: Aetna Commercial	$761.70
Rate for Payer: BCBS Complete	$395.41
Rate for Payer: BCBS Trust/PPO	$605.96
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Meridian Medicaid	$395.41
Rate for Payer: Priority Health Choice Medicaid	$376.58
Rate for Payer: Priority Health Cigna Priority Health	$1,125.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$887.00
Rate for Payer: Priority Health Narrow Network	$887.00
Rate for Payer: Priority Health SBD	$887.00
Rate for Payer: UMR Bronson Commercial	$739.68

PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ

Professional

Both

$827.00

Service Code	HCPCS 24530
Min. Negotiated Rate	$234.09
Max. Negotiated Rate	$578.90
Rate for Payer: Aetna Commercial	$463.61
Rate for Payer: BCBS Complete	$245.79
Rate for Payer: BCBS Trust/PPO	$472.30
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$661.60
Rate for Payer: Meridian Medicaid	$245.79
Rate for Payer: Priority Health Choice Medicaid	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$578.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$552.01
Rate for Payer: Priority Health Narrow Network	$552.01
Rate for Payer: Priority Health SBD	$552.01
Rate for Payer: UMR Bronson Commercial	$380.42

PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ

Professional

Both

$2,156.00

Service Code	HCPCS 27503
Min. Negotiated Rate	$516.95
Max. Negotiated Rate	$1,509.20
Rate for Payer: Aetna Commercial	$1,072.39
Rate for Payer: BCBS Complete	$542.80
Rate for Payer: BCBS Trust/PPO	$1,009.58
Rate for Payer: Cash Price	$1,724.80
Rate for Payer: Cash Price	$1,724.80
Rate for Payer: Meridian Medicaid	$542.80
Rate for Payer: Priority Health Choice Medicaid	$516.95
Rate for Payer: Priority Health Cigna Priority Health	$1,509.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,233.23
Rate for Payer: Priority Health Narrow Network	$1,233.23
Rate for Payer: Priority Health SBD	$1,233.23
Rate for Payer: UMR Bronson Commercial	$991.76

PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ

Professional

Both

$1,545.00

Service Code	HCPCS 27501
Min. Negotiated Rate	$324.83
Max. Negotiated Rate	$3,213.12
Rate for Payer: Aetna Commercial	$663.19
Rate for Payer: BCBS Complete	$341.07
Rate for Payer: BCBS Trust/PPO	$3,213.12
Rate for Payer: Cash Price	$1,236.00
Rate for Payer: Cash Price	$1,236.00
Rate for Payer: Meridian Medicaid	$341.07
Rate for Payer: Priority Health Choice Medicaid	$324.83
Rate for Payer: Priority Health Cigna Priority Health	$1,081.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$771.09
Rate for Payer: Priority Health Narrow Network	$771.09
Rate for Payer: Priority Health SBD	$771.09
Rate for Payer: UMR Bronson Commercial	$710.70

PR CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES

Professional

Both

$696.00

Service Code	HCPCS 28545
Min. Negotiated Rate	$179.77
Max. Negotiated Rate	$656.68
Rate for Payer: Aetna Commercial	$354.16
Rate for Payer: BCBS Complete	$188.76
Rate for Payer: BCBS Trust/PPO	$656.68
Rate for Payer: Cash Price	$556.80
Rate for Payer: Cash Price	$556.80
Rate for Payer: Meridian Medicaid	$188.76
Rate for Payer: Priority Health Choice Medicaid	$179.77
Rate for Payer: Priority Health Cigna Priority Health	$487.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$423.32
Rate for Payer: Priority Health Narrow Network	$423.32
Rate for Payer: Priority Health SBD	$423.32
Rate for Payer: UMR Bronson Commercial	$320.16

PR CLTX TIBIAL FX PROXIMAL W/O MANIPULATION

Professional

Both

$826.00

Service Code	HCPCS 27530
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$1,234.64
Rate for Payer: Aetna Commercial	$379.22
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCBS Trust/PPO	$1,234.64
Rate for Payer: Cash Price	$660.80
Rate for Payer: Cash Price	$660.80
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health	$578.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$454.48
Rate for Payer: Priority Health Narrow Network	$454.48
Rate for Payer: Priority Health SBD	$454.48
Rate for Payer: UMR Bronson Commercial	$379.96

PR CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ

Professional

Both

$1,114.00

Service Code	HCPCS 27532
Min. Negotiated Rate	$378.71
Max. Negotiated Rate	$936.15
Rate for Payer: Aetna Commercial	$769.38
Rate for Payer: BCBS Complete	$397.65
Rate for Payer: BCBS Trust/PPO	$936.15
Rate for Payer: Cash Price	$891.20
Rate for Payer: Cash Price	$891.20
Rate for Payer: Meridian Medicaid	$397.65
Rate for Payer: Priority Health Choice Medicaid	$378.71
Rate for Payer: Priority Health Cigna Priority Health	$779.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$896.19
Rate for Payer: Priority Health Narrow Network	$896.19
Rate for Payer: Priority Health SBD	$896.19
Rate for Payer: UMR Bronson Commercial	$512.44

PR CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ

Professional

Both

$1,758.00

Service Code	HCPCS 27752
Min. Negotiated Rate	$321.63
Max. Negotiated Rate	$3,450.64
Rate for Payer: Aetna Commercial	$655.97
Rate for Payer: BCBS Complete	$337.71
Rate for Payer: BCBS Trust/PPO	$3,450.64
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Meridian Medicaid	$337.71
Rate for Payer: Priority Health Choice Medicaid	$321.63
Rate for Payer: Priority Health Cigna Priority Health	$1,230.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$763.42
Rate for Payer: Priority Health Narrow Network	$763.42
Rate for Payer: Priority Health SBD	$763.42
Rate for Payer: UMR Bronson Commercial	$808.68

PR CLTX TIBIAL SHAFT FX W/O MANIPULATION

Professional

Both

$903.00

Service Code	HCPCS 27750
Min. Negotiated Rate	$215.13
Max. Negotiated Rate	$632.10
Rate for Payer: Aetna Commercial	$426.43
Rate for Payer: BCBS Complete	$225.89
Rate for Payer: BCBS Trust/PPO	$565.81
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Meridian Medicaid	$225.89
Rate for Payer: Priority Health Choice Medicaid	$215.13
Rate for Payer: Priority Health Cigna Priority Health	$632.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$506.56
Rate for Payer: Priority Health Narrow Network	$506.56
Rate for Payer: Priority Health SBD	$506.56
Rate for Payer: UMR Bronson Commercial	$415.38

PR CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ

Professional

Both

$876.00

Service Code	HCPCS 25680
Min. Negotiated Rate	$348.68
Max. Negotiated Rate	$1,480.30
Rate for Payer: Aetna Commercial	$702.57
Rate for Payer: BCBS Complete	$366.11
Rate for Payer: BCBS Trust/PPO	$1,480.30
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cash Price	$700.80
Rate for Payer: Meridian Medicaid	$366.11
Rate for Payer: Priority Health Choice Medicaid	$348.68
Rate for Payer: Priority Health Cigna Priority Health	$613.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$825.21
Rate for Payer: Priority Health Narrow Network	$825.21
Rate for Payer: Priority Health SBD	$825.21
Rate for Payer: UMR Bronson Commercial	$402.96

PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION

Professional

Both

$1,663.00

Service Code	HCPCS 27818
Min. Negotiated Rate	$290.32
Max. Negotiated Rate	$3,352.06
Rate for Payer: Aetna Commercial	$582.68
Rate for Payer: BCBS Complete	$304.84
Rate for Payer: BCBS Trust/PPO	$3,352.06
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Meridian Medicaid	$304.84
Rate for Payer: Priority Health Choice Medicaid	$290.32
Rate for Payer: Priority Health Cigna Priority Health	$1,164.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$685.81
Rate for Payer: Priority Health Narrow Network	$685.81
Rate for Payer: Priority Health SBD	$685.81
Rate for Payer: UMR Bronson Commercial	$764.98

PR CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION

Professional

Both

$573.00

Service Code	HCPCS 27816
Min. Negotiated Rate	$196.17
Max. Negotiated Rate	$2,170.78
Rate for Payer: Aetna Commercial	$388.50
Rate for Payer: BCBS Complete	$205.98
Rate for Payer: BCBS Trust/PPO	$2,170.78
Rate for Payer: Cash Price	$458.40
Rate for Payer: Cash Price	$458.40
Rate for Payer: Meridian Medicaid	$205.98
Rate for Payer: Priority Health Choice Medicaid	$196.17
Rate for Payer: Priority Health Cigna Priority Health	$401.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$460.60
Rate for Payer: Priority Health Narrow Network	$460.60
Rate for Payer: Priority Health SBD	$460.60
Rate for Payer: UMR Bronson Commercial	$263.58

PR CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING

Professional

Both

$877.00

Service Code	HCPCS 22310
Min. Negotiated Rate	$193.83
Max. Negotiated Rate	$613.90
Rate for Payer: Aetna Commercial	$391.04
Rate for Payer: BCBS Complete	$203.52
Rate for Payer: BCBS Trust/PPO	$368.43
Rate for Payer: Cash Price	$701.60
Rate for Payer: Cash Price	$701.60
Rate for Payer: Meridian Medicaid	$203.52
Rate for Payer: Priority Health Choice Medicaid	$193.83
Rate for Payer: Priority Health Cigna Priority Health	$613.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$459.08
Rate for Payer: Priority Health Narrow Network	$459.08
Rate for Payer: Priority Health SBD	$459.08
Rate for Payer: UMR Bronson Commercial	$403.42

PR CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ

Professional

Both

$1,276.00

Service Code	HCPCS 22315
Min. Negotiated Rate	$368.43
Max. Negotiated Rate	$1,187.78
Rate for Payer: Aetna Commercial	$1,027.22
Rate for Payer: BCBS Complete	$530.05
Rate for Payer: BCBS Trust/PPO	$368.43
Rate for Payer: Cash Price	$1,020.80
Rate for Payer: Cash Price	$1,020.80
Rate for Payer: Meridian Medicaid	$530.05
Rate for Payer: Priority Health Choice Medicaid	$504.81
Rate for Payer: Priority Health Cigna Priority Health	$893.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,187.78
Rate for Payer: Priority Health Narrow Network	$1,187.78
Rate for Payer: Priority Health SBD	$1,187.78
Rate for Payer: UMR Bronson Commercial	$586.96

PR CMBND ANTERPOST COLPORRAPHY W/CYSTO

Professional

Both

$1,989.00

Service Code	HCPCS 57260
Min. Negotiated Rate	$499.91
Max. Negotiated Rate	$1,612.37
Rate for Payer: Aetna Commercial	$929.36
Rate for Payer: BCBS Complete	$524.91
Rate for Payer: BCBS Trust/PPO	$1,612.37
Rate for Payer: Cash Price	$1,591.20
Rate for Payer: Cash Price	$1,591.20
Rate for Payer: Meridian Medicaid	$524.91
Rate for Payer: Priority Health Choice Medicaid	$499.91
Rate for Payer: Priority Health Cigna Priority Health	$1,392.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,105.91
Rate for Payer: Priority Health Narrow Network	$1,105.91
Rate for Payer: Priority Health SBD	$1,105.91
Rate for Payer: UMR Bronson Commercial	$914.94

PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR

Professional

Both

$2,561.00

Service Code	HCPCS 57265
Min. Negotiated Rate	$558.91
Max. Negotiated Rate	$1,792.70
Rate for Payer: Aetna Commercial	$1,042.83
Rate for Payer: BCBS Complete	$586.86
Rate for Payer: BCBS Trust/PPO	$1,697.43
Rate for Payer: Cash Price	$2,048.80
Rate for Payer: Cash Price	$2,048.80
Rate for Payer: Meridian Medicaid	$586.86
Rate for Payer: Priority Health Choice Medicaid	$558.91
Rate for Payer: Priority Health Cigna Priority Health	$1,792.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,238.00
Rate for Payer: Priority Health Narrow Network	$1,238.00
Rate for Payer: Priority Health SBD	$1,238.00
Rate for Payer: UMR Bronson Commercial	$1,178.06

PR CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT

Professional

Both

$387.00

Service Code	HCPCS 36598
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$669.36
Rate for Payer: Aetna Commercial	$47.92
Rate for Payer: BCBS Complete	$23.26
Rate for Payer: BCBS Trust/PPO	$669.36
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cash Price	$309.60
Rate for Payer: Meridian Medicaid	$23.26
Rate for Payer: Priority Health Choice Medicaid	$22.15
Rate for Payer: Priority Health Cigna Priority Health	$270.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.85
Rate for Payer: Priority Health Narrow Network	$55.85
Rate for Payer: Priority Health SBD	$55.85
Rate for Payer: UMR Bronson Commercial	$178.02

PR COCCYGECTOMY PRIMARY

Professional

Both

$1,913.00

Service Code	HCPCS 27080
Min. Negotiated Rate	$329.72
Max. Negotiated Rate	$1,339.10
Rate for Payer: Aetna Commercial	$681.94
Rate for Payer: BCBS Complete	$346.21
Rate for Payer: BCBS Trust/PPO	$530.94
Rate for Payer: Cash Price	$1,530.40
Rate for Payer: Cash Price	$1,530.40
Rate for Payer: Meridian Medicaid	$346.21
Rate for Payer: Priority Health Choice Medicaid	$329.72
Rate for Payer: Priority Health Cigna Priority Health	$1,339.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$787.93
Rate for Payer: Priority Health Narrow Network	$787.93
Rate for Payer: Priority Health SBD	$787.93
Rate for Payer: UMR Bronson Commercial	$879.98

Know your out-of-pocket cost for care.

All Charges