Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT

Professional

Both

$3,387.18

Service Code	HCPCS 27132
Min. Negotiated Rate	$429.51
Max. Negotiated Rate	$2,546.60
Rate for Payer: Aetna Commercial	$2,237.15
Rate for Payer: BCBS Complete	$1,121.83
Rate for Payer: BCBS Trust/PPO	$429.51
Rate for Payer: Cash Price	$2,709.74
Rate for Payer: Cash Price	$2,709.74
Rate for Payer: Meridian Medicaid	$1,121.83
Rate for Payer: Priority Health Choice Medicaid	$1,068.41
Rate for Payer: Priority Health Cigna Priority Health	$2,371.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,546.60
Rate for Payer: Priority Health Narrow Network	$2,546.60
Rate for Payer: Priority Health SBD	$2,546.60
Rate for Payer: UMR Bronson Commercial	$1,558.10

PR CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY

Professional

Both

$1,740.00

Service Code	HCPCS 23415
Min. Negotiated Rate	$94.66
Max. Negotiated Rate	$1,218.00
Rate for Payer: Aetna Commercial	$929.83
Rate for Payer: BCBS Complete	$475.48
Rate for Payer: BCBS Trust/PPO	$94.66
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Meridian Medicaid	$475.48
Rate for Payer: Priority Health Choice Medicaid	$452.84
Rate for Payer: Priority Health Cigna Priority Health	$1,218.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,076.45
Rate for Payer: Priority Health Narrow Network	$1,076.45
Rate for Payer: Priority Health SBD	$1,076.45
Rate for Payer: UMR Bronson Commercial	$800.40

PR CORDOCENTESIS INTRAUTERINE

Professional

Both

$525.00

Service Code	HCPCS 59012
Min. Negotiated Rate	$128.87
Max. Negotiated Rate	$556.83
Rate for Payer: Aetna Commercial	$220.91
Rate for Payer: BCBS Complete	$135.31
Rate for Payer: BCBS Trust/PPO	$556.83
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Meridian Medicaid	$135.31
Rate for Payer: Priority Health Choice Medicaid	$128.87
Rate for Payer: Priority Health Cigna Priority Health	$367.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$283.77
Rate for Payer: Priority Health Narrow Network	$283.77
Rate for Payer: Priority Health SBD	$283.77
Rate for Payer: UMR Bronson Commercial	$241.50

PR CORF RELATED SERV 15 MINS EA

Professional

Both

$31.00

Service Code	HCPCS G0409
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$1,772.97
Rate for Payer: Aetna Commercial	$13.19
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$1,772.97
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70
Rate for Payer: UMR Bronson Commercial	$14.26

PR CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT

Professional

Both

$3,966.72

Service Code	HCPCS 33510
Min. Negotiated Rate	$1,211.54
Max. Negotiated Rate	$3,016.19
Rate for Payer: Aetna Commercial	$2,596.25
Rate for Payer: BCBS Complete	$1,272.12
Rate for Payer: BCBS Trust/PPO	$1,333.43
Rate for Payer: Cash Price	$3,173.38
Rate for Payer: Cash Price	$3,173.38
Rate for Payer: Meridian Medicaid	$1,272.12
Rate for Payer: Priority Health Choice Medicaid	$1,211.54
Rate for Payer: Priority Health Cigna Priority Health	$2,776.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,016.19
Rate for Payer: Priority Health Narrow Network	$3,016.19
Rate for Payer: Priority Health SBD	$3,016.19
Rate for Payer: UMR Bronson Commercial	$1,824.69

PR CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS

Professional

Both

$4,357.00

Service Code	HCPCS 33511
Min. Negotiated Rate	$1,241.51
Max. Negotiated Rate	$3,310.37
Rate for Payer: Aetna Commercial	$2,850.71
Rate for Payer: BCBS Complete	$1,396.92
Rate for Payer: BCBS Trust/PPO	$1,241.51
Rate for Payer: Cash Price	$3,485.60
Rate for Payer: Cash Price	$3,485.60
Rate for Payer: Meridian Medicaid	$1,396.92
Rate for Payer: Priority Health Choice Medicaid	$1,330.40
Rate for Payer: Priority Health Cigna Priority Health	$3,049.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,310.37
Rate for Payer: Priority Health Narrow Network	$3,310.37
Rate for Payer: Priority Health SBD	$3,310.37
Rate for Payer: UMR Bronson Commercial	$2,004.22

PR CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS

Professional

Both

$9,723.00

Service Code	HCPCS 33512
Min. Negotiated Rate	$1,337.66
Max. Negotiated Rate	$6,806.10
Rate for Payer: Aetna Commercial	$3,251.77
Rate for Payer: BCBS Complete	$1,591.28
Rate for Payer: BCBS Trust/PPO	$1,337.66
Rate for Payer: Cash Price	$7,778.40
Rate for Payer: Cash Price	$7,778.40
Rate for Payer: Meridian Medicaid	$1,591.28
Rate for Payer: Priority Health Choice Medicaid	$1,515.50
Rate for Payer: Priority Health Cigna Priority Health	$6,806.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,774.78
Rate for Payer: Priority Health Narrow Network	$3,774.78
Rate for Payer: Priority Health SBD	$3,774.78
Rate for Payer: UMR Bronson Commercial	$4,472.58

PR CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS

Professional

Both

$9,922.00

Service Code	HCPCS 33513
Min. Negotiated Rate	$1,257.88
Max. Negotiated Rate	$6,945.40
Rate for Payer: Aetna Commercial	$3,340.84
Rate for Payer: BCBS Complete	$1,624.82
Rate for Payer: BCBS Trust/PPO	$1,257.88
Rate for Payer: Cash Price	$7,937.60
Rate for Payer: Cash Price	$7,937.60
Rate for Payer: Meridian Medicaid	$1,624.82
Rate for Payer: Priority Health Choice Medicaid	$1,547.45
Rate for Payer: Priority Health Cigna Priority Health	$6,945.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,861.48
Rate for Payer: Priority Health Narrow Network	$3,861.48
Rate for Payer: Priority Health SBD	$3,861.48
Rate for Payer: UMR Bronson Commercial	$4,564.12

PR CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT

Professional

Both

$11,159.00

Service Code	HCPCS 33516
Min. Negotiated Rate	$1,382.03
Max. Negotiated Rate	$7,811.30
Rate for Payer: Aetna Commercial	$3,631.83
Rate for Payer: BCBS Complete	$1,767.96
Rate for Payer: BCBS Trust/PPO	$1,382.03
Rate for Payer: Cash Price	$8,927.20
Rate for Payer: Cash Price	$8,927.20
Rate for Payer: Meridian Medicaid	$1,767.96
Rate for Payer: Priority Health Choice Medicaid	$1,683.77
Rate for Payer: Priority Health Cigna Priority Health	$7,811.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,200.33
Rate for Payer: Priority Health Narrow Network	$4,200.33
Rate for Payer: Priority Health SBD	$4,200.33
Rate for Payer: UMR Bronson Commercial	$5,133.14

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN

Professional

Both

$788.00

Service Code	HCPCS 33517
Min. Negotiated Rate	$116.72
Max. Negotiated Rate	$1,181.81
Rate for Payer: Aetna Commercial	$252.04
Rate for Payer: BCBS Complete	$122.56
Rate for Payer: BCBS Trust/PPO	$1,181.81
Rate for Payer: Cash Price	$630.40
Rate for Payer: Cash Price	$630.40
Rate for Payer: Meridian Medicaid	$122.56
Rate for Payer: Priority Health Choice Medicaid	$116.72
Rate for Payer: Priority Health Cigna Priority Health	$551.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$289.92
Rate for Payer: Priority Health Narrow Network	$289.92
Rate for Payer: Priority Health SBD	$289.92
Rate for Payer: UMR Bronson Commercial	$362.48

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN

Professional

Both

$1,299.00

Service Code	HCPCS 33518
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$1,337.66
Rate for Payer: Aetna Commercial	$554.43
Rate for Payer: BCBS Complete	$268.38
Rate for Payer: BCBS Trust/PPO	$1,337.66
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Meridian Medicaid	$268.38
Rate for Payer: Priority Health Choice Medicaid	$255.60
Rate for Payer: Priority Health Cigna Priority Health	$909.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$638.89
Rate for Payer: Priority Health Narrow Network	$638.89
Rate for Payer: Priority Health SBD	$638.89
Rate for Payer: UMR Bronson Commercial	$597.54

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN

Professional

Both

$1,892.00

Service Code	HCPCS 33519
Min. Negotiated Rate	$338.24
Max. Negotiated Rate	$1,324.40
Rate for Payer: Aetna Commercial	$733.06
Rate for Payer: BCBS Complete	$355.15
Rate for Payer: BCBS Trust/PPO	$987.39
Rate for Payer: Cash Price	$1,513.60
Rate for Payer: Cash Price	$1,513.60
Rate for Payer: Meridian Medicaid	$355.15
Rate for Payer: Priority Health Choice Medicaid	$338.24
Rate for Payer: Priority Health Cigna Priority Health	$1,324.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$844.22
Rate for Payer: Priority Health Narrow Network	$844.22
Rate for Payer: Priority Health SBD	$844.22
Rate for Payer: UMR Bronson Commercial	$870.32

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN

Professional

Both

$2,540.00

Service Code	HCPCS 33521
Min. Negotiated Rate	$158.49
Max. Negotiated Rate	$1,778.00
Rate for Payer: Aetna Commercial	$879.90
Rate for Payer: BCBS Complete	$425.61
Rate for Payer: BCBS Trust/PPO	$158.49
Rate for Payer: Cash Price	$2,032.00
Rate for Payer: Cash Price	$2,032.00
Rate for Payer: Meridian Medicaid	$425.61
Rate for Payer: Priority Health Choice Medicaid	$405.34
Rate for Payer: Priority Health Cigna Priority Health	$1,778.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,011.78
Rate for Payer: Priority Health Narrow Network	$1,011.78
Rate for Payer: Priority Health SBD	$1,011.78
Rate for Payer: UMR Bronson Commercial	$1,168.40

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN

Professional

Both

$3,227.00

Service Code	HCPCS 33522
Min. Negotiated Rate	$455.61
Max. Negotiated Rate	$2,258.90
Rate for Payer: Aetna Commercial	$988.00
Rate for Payer: BCBS Complete	$478.39
Rate for Payer: BCBS Trust/PPO	$1,230.94
Rate for Payer: Cash Price	$2,581.60
Rate for Payer: Cash Price	$2,581.60
Rate for Payer: Meridian Medicaid	$478.39
Rate for Payer: Priority Health Choice Medicaid	$455.61
Rate for Payer: Priority Health Cigna Priority Health	$2,258.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,136.79
Rate for Payer: Priority Health Narrow Network	$1,136.79
Rate for Payer: Priority Health SBD	$1,136.79
Rate for Payer: UMR Bronson Commercial	$1,484.42

PR CORONARY ENDARTERCOMY OPEN ANY METHOD

Professional

Both

$1,270.00

Service Code	HCPCS 33572
Min. Negotiated Rate	$143.78
Max. Negotiated Rate	$889.00
Rate for Payer: Aetna Commercial	$310.69
Rate for Payer: BCBS Complete	$150.97
Rate for Payer: BCBS Trust/PPO	$863.77
Rate for Payer: Cash Price	$1,016.00
Rate for Payer: Cash Price	$1,016.00
Rate for Payer: Meridian Medicaid	$150.97
Rate for Payer: Priority Health Choice Medicaid	$143.78
Rate for Payer: Priority Health Cigna Priority Health	$889.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$358.54
Rate for Payer: Priority Health Narrow Network	$358.54
Rate for Payer: Priority Health SBD	$358.54
Rate for Payer: UMR Bronson Commercial	$584.20

PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI

Professional

Both

$1,837.00

Service Code	HCPCS 54430
Min. Negotiated Rate	$407.68
Max. Negotiated Rate	$3,265.16
Rate for Payer: Aetna Commercial	$819.70
Rate for Payer: BCBS Complete	$428.06
Rate for Payer: BCBS Trust/PPO	$3,265.16
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Meridian Medicaid	$428.06
Rate for Payer: Priority Health Choice Medicaid	$407.68
Rate for Payer: Priority Health Cigna Priority Health	$1,285.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,020.20
Rate for Payer: Priority Health Narrow Network	$1,020.20
Rate for Payer: Priority Health SBD	$1,020.20
Rate for Payer: UMR Bronson Commercial	$845.02

PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM

Professional

Both

$738.00

Service Code	HCPCS 54435
Min. Negotiated Rate	$265.61
Max. Negotiated Rate	$1,738.11
Rate for Payer: Aetna Commercial	$529.89
Rate for Payer: BCBS Complete	$278.89
Rate for Payer: BCBS Trust/PPO	$1,738.11
Rate for Payer: Cash Price	$590.40
Rate for Payer: Cash Price	$590.40
Rate for Payer: Meridian Medicaid	$278.89
Rate for Payer: Priority Health Choice Medicaid	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$516.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$663.55
Rate for Payer: Priority Health Narrow Network	$663.55
Rate for Payer: Priority Health SBD	$663.55
Rate for Payer: UMR Bronson Commercial	$339.48

PR CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI

Professional

Both

$1,322.00

Service Code	HCPCS 54420
Min. Negotiated Rate	$447.73
Max. Negotiated Rate	$2,612.13
Rate for Payer: Aetna Commercial	$903.25
Rate for Payer: BCBS Complete	$470.12
Rate for Payer: BCBS Trust/PPO	$2,612.13
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Meridian Medicaid	$470.12
Rate for Payer: Priority Health Choice Medicaid	$447.73
Rate for Payer: Priority Health Cigna Priority Health	$925.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,121.24
Rate for Payer: Priority Health Narrow Network	$1,121.24
Rate for Payer: Priority Health SBD	$1,121.24
Rate for Payer: UMR Bronson Commercial	$608.12

PR CORRECT BUNION,SIMPLE

Professional

Both

$1,357.00

Service Code	HCPCS 28290
Min. Negotiated Rate	$542.80
Max. Negotiated Rate	$949.90
Rate for Payer: BCBS Complete	$542.80
Rate for Payer: Cash Price	$1,085.60
Rate for Payer: Priority Health Cigna Priority Health	$949.90
Rate for Payer: UMR Bronson Commercial	$624.22

PR CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE

Professional

Both

$920.00

Service Code	HCPCS 28286
Min. Negotiated Rate	$192.13
Max. Negotiated Rate	$2,002.26
Rate for Payer: Aetna Commercial	$390.83
Rate for Payer: BCBS Complete	$201.74
Rate for Payer: BCBS Trust/PPO	$2,002.26
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Meridian Medicaid	$201.74
Rate for Payer: Priority Health Choice Medicaid	$192.13
Rate for Payer: Priority Health Cigna Priority Health	$644.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$449.89
Rate for Payer: Priority Health Narrow Network	$449.89
Rate for Payer: Priority Health SBD	$449.89
Rate for Payer: UMR Bronson Commercial	$423.20

PR CORRECTION HAMMERTOE

Professional

Both

$937.00

Service Code	HCPCS 28285
Min. Negotiated Rate	$249.85
Max. Negotiated Rate	$1,673.65
Rate for Payer: Aetna Commercial	$502.98
Rate for Payer: BCBS Complete	$262.34
Rate for Payer: BCBS Trust/PPO	$1,673.65
Rate for Payer: Cash Price	$749.60
Rate for Payer: Cash Price	$749.60
Rate for Payer: Meridian Medicaid	$262.34
Rate for Payer: Priority Health Choice Medicaid	$249.85
Rate for Payer: Priority Health Cigna Priority Health	$655.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$586.23
Rate for Payer: Priority Health Narrow Network	$586.23
Rate for Payer: Priority Health SBD	$586.23
Rate for Payer: UMR Bronson Commercial	$431.02

PR CORRECTION INVERTED NIPPLES

Professional

Both

$1,623.00

Service Code	HCPCS 19355
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$1,136.10
Rate for Payer: Aetna Commercial	$666.64
Rate for Payer: BCBS Complete	$415.77
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Meridian Medicaid	$415.77
Rate for Payer: Priority Health Choice Medicaid	$395.97
Rate for Payer: Priority Health Cigna Priority Health	$1,136.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$760.42
Rate for Payer: Priority Health Narrow Network	$760.42
Rate for Payer: Priority Health SBD	$760.42
Rate for Payer: UMR Bronson Commercial	$746.58

PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY

Professional

Both

$141.00

Service Code	HCPCS 67820
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$668.83
Rate for Payer: Aetna Commercial	$29.30
Rate for Payer: BCBS Complete	$14.76
Rate for Payer: BCBS Trust/PPO	$668.83
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Meridian Medicaid	$14.76
Rate for Payer: Priority Health Choice Medicaid	$14.06
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.06
Rate for Payer: Priority Health Narrow Network	$38.06
Rate for Payer: Priority Health SBD	$38.06
Rate for Payer: UMR Bronson Commercial	$64.86

PR CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL CNF

Professional

Both

$1,939.00

Service Code	HCPCS 28297
Min. Negotiated Rate	$387.45
Max. Negotiated Rate	$1,357.30
Rate for Payer: Aetna Commercial	$799.03
Rate for Payer: BCBS Complete	$406.82
Rate for Payer: BCBS Trust/PPO	$1,304.37
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Meridian Medicaid	$406.82
Rate for Payer: Priority Health Choice Medicaid	$387.45
Rate for Payer: Priority Health Cigna Priority Health	$1,357.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$918.15
Rate for Payer: Priority Health Narrow Network	$918.15
Rate for Payer: Priority Health SBD	$918.15
Rate for Payer: UMR Bronson Commercial	$891.94

PR CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT

Professional

Both

$2,359.00

Service Code	HCPCS 28299
Min. Negotiated Rate	$383.61
Max. Negotiated Rate	$1,651.30
Rate for Payer: Aetna Commercial	$775.94
Rate for Payer: BCBS Complete	$402.79
Rate for Payer: BCBS Trust/PPO	$1,113.66
Rate for Payer: Cash Price	$1,887.20
Rate for Payer: Cash Price	$1,887.20
Rate for Payer: Meridian Medicaid	$402.79
Rate for Payer: Priority Health Choice Medicaid	$383.61
Rate for Payer: Priority Health Cigna Priority Health	$1,651.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$900.27
Rate for Payer: Priority Health Narrow Network	$900.27
Rate for Payer: Priority Health SBD	$900.27
Rate for Payer: UMR Bronson Commercial	$1,085.14

Know your out-of-pocket cost for care.

All Charges