Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG

Professional

Both

$7,712.00

Service Code	HCPCS 61540
Min. Negotiated Rate	$611.24
Max. Negotiated Rate	$5,398.40
Rate for Payer: Aetna Commercial	$2,815.85
Rate for Payer: BCBS Complete	$1,481.69
Rate for Payer: BCBS Trust/PPO	$611.24
Rate for Payer: Cash Price	$6,169.60
Rate for Payer: Cash Price	$6,169.60
Rate for Payer: Meridian Medicaid	$1,481.69
Rate for Payer: Priority Health Choice Medicaid	$1,411.13
Rate for Payer: Priority Health Cigna Priority Health	$5,398.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,718.95
Rate for Payer: Priority Health Narrow Network	$3,718.95
Rate for Payer: Priority Health SBD	$3,718.95
Rate for Payer: UMR Bronson Commercial	$3,547.52

PR CRANIOTOMY EXCISION CRANIOPHARYNGIOMA

Professional

Both

$6,564.86

Service Code	HCPCS 61545
Min. Negotiated Rate	$2,062.05
Max. Negotiated Rate	$5,437.45
Rate for Payer: Aetna Commercial	$4,116.77
Rate for Payer: BCBS Complete	$2,165.15
Rate for Payer: BCBS Trust/PPO	$2,713.35
Rate for Payer: Cash Price	$5,251.89
Rate for Payer: Cash Price	$5,251.89
Rate for Payer: Meridian Medicaid	$2,165.15
Rate for Payer: Priority Health Choice Medicaid	$2,062.05
Rate for Payer: Priority Health Cigna Priority Health	$4,595.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,437.45
Rate for Payer: Priority Health Narrow Network	$5,437.45
Rate for Payer: Priority Health SBD	$5,437.45
Rate for Payer: UMR Bronson Commercial	$3,019.84

PR CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE

Professional

Both

$5,502.00

Service Code	HCPCS 62121
Min. Negotiated Rate	$1,003.23
Max. Negotiated Rate	$3,851.40
Rate for Payer: Aetna Commercial	$2,019.44
Rate for Payer: BCBS Complete	$1,053.39
Rate for Payer: BCBS Trust/PPO	$1,394.18
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Meridian Medicaid	$1,053.39
Rate for Payer: Priority Health Choice Medicaid	$1,003.23
Rate for Payer: Priority Health Cigna Priority Health	$3,851.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,659.55
Rate for Payer: Priority Health Narrow Network	$2,659.55
Rate for Payer: Priority Health SBD	$2,659.55
Rate for Payer: UMR Bronson Commercial	$2,530.92

PR CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY

Professional

Both

$6,928.00

Service Code	HCPCS 61537
Min. Negotiated Rate	$1,588.98
Max. Negotiated Rate	$4,849.60
Rate for Payer: Aetna Commercial	$3,184.49
Rate for Payer: BCBS Complete	$1,668.43
Rate for Payer: BCBS Trust/PPO	$2,057.20
Rate for Payer: Cash Price	$5,542.40
Rate for Payer: Cash Price	$5,542.40
Rate for Payer: Meridian Medicaid	$1,668.43
Rate for Payer: Priority Health Choice Medicaid	$1,588.98
Rate for Payer: Priority Health Cigna Priority Health	$4,849.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,192.89
Rate for Payer: Priority Health Narrow Network	$4,192.89
Rate for Payer: Priority Health SBD	$4,192.89
Rate for Payer: UMR Bronson Commercial	$3,186.88

PR CRICOPHARYNGEAL MYOTOMY

Professional

Both

$2,239.00

Service Code	HCPCS 43030
Min. Negotiated Rate	$226.11
Max. Negotiated Rate	$1,567.30
Rate for Payer: Aetna Commercial	$688.64
Rate for Payer: BCBS Complete	$354.49
Rate for Payer: BCBS Trust/PPO	$226.11
Rate for Payer: Cash Price	$1,791.20
Rate for Payer: Cash Price	$1,791.20
Rate for Payer: Meridian Medicaid	$354.49
Rate for Payer: Priority Health Choice Medicaid	$337.61
Rate for Payer: Priority Health Cigna Priority Health	$1,567.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$924.89
Rate for Payer: Priority Health Narrow Network	$924.89
Rate for Payer: Priority Health SBD	$924.89
Rate for Payer: UMR Bronson Commercial	$1,029.94

PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN

Professional

Both

$212.00

Service Code	HCPCS 99292
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$1,875.47
Rate for Payer: Aetna Commercial	$109.66
Rate for Payer: BCBS Complete	$71.12
Rate for Payer: BCBS Trust/PPO	$1,875.47
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Meridian Medicaid	$71.12
Rate for Payer: Priority Health Choice Medicaid	$67.73
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.77
Rate for Payer: Priority Health Narrow Network	$135.77
Rate for Payer: Priority Health SBD	$135.77
Rate for Payer: UMR Bronson Commercial	$97.52

PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN

Professional

Both

$467.00

Service Code	HCPCS 99291
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$1,522.56
Rate for Payer: Aetna Commercial	$218.32
Rate for Payer: BCBS Complete	$141.12
Rate for Payer: BCBS Trust/PPO	$1,522.56
Rate for Payer: Cash Price	$373.60
Rate for Payer: Cash Price	$373.60
Rate for Payer: Meridian Medicaid	$141.12
Rate for Payer: Priority Health Choice Medicaid	$134.40
Rate for Payer: Priority Health Cigna Priority Health	$326.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$395.09
Rate for Payer: Priority Health Narrow Network	$395.09
Rate for Payer: Priority Health SBD	$395.09
Rate for Payer: UMR Bronson Commercial	$214.82

PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN

Professional

Both

$571.00

Service Code	HCPCS 99466
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$399.70
Rate for Payer: Aetna Commercial	$234.41
Rate for Payer: BCBS Complete	$228.40
Rate for Payer: BCBS Trust/PPO	$168.10
Rate for Payer: Cash Price	$456.80
Rate for Payer: Cash Price	$456.80
Rate for Payer: Priority Health Cigna Priority Health	$399.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$292.97
Rate for Payer: Priority Health Narrow Network	$292.97
Rate for Payer: Priority Health SBD	$292.97
Rate for Payer: UMR Bronson Commercial	$262.66

PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN

Professional

Both

$238.00

Service Code	HCPCS 99467
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$166.60
Rate for Payer: Aetna Commercial	$117.37
Rate for Payer: BCBS Complete	$95.20
Rate for Payer: BCBS Trust/PPO	$137.11
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Priority Health Cigna Priority Health	$166.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$148.20
Rate for Payer: Priority Health Narrow Network	$148.20
Rate for Payer: Priority Health SBD	$148.20
Rate for Payer: UMR Bronson Commercial	$109.48

PR CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA

Professional

Both

$8,254.00

Service Code	HCPCS 61518
Min. Negotiated Rate	$1,142.71
Max. Negotiated Rate	$5,777.80
Rate for Payer: Aetna Commercial	$3,575.97
Rate for Payer: BCBS Complete	$1,884.70
Rate for Payer: BCBS Trust/PPO	$1,142.71
Rate for Payer: Cash Price	$6,603.20
Rate for Payer: Cash Price	$6,603.20
Rate for Payer: Meridian Medicaid	$1,884.70
Rate for Payer: Priority Health Choice Medicaid	$1,794.95
Rate for Payer: Priority Health Cigna Priority Health	$5,777.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,727.40
Rate for Payer: Priority Health Narrow Network	$4,727.40
Rate for Payer: Priority Health SBD	$4,727.40
Rate for Payer: UMR Bronson Commercial	$3,796.84

PR CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA

Professional

Both

$7,704.00

Service Code	HCPCS 61530
Min. Negotiated Rate	$1,728.07
Max. Negotiated Rate	$5,392.80
Rate for Payer: Aetna Commercial	$3,972.92
Rate for Payer: BCBS Complete	$2,084.42
Rate for Payer: BCBS Trust/PPO	$1,728.07
Rate for Payer: Cash Price	$6,163.20
Rate for Payer: Cash Price	$6,163.20
Rate for Payer: Meridian Medicaid	$2,084.42
Rate for Payer: Priority Health Choice Medicaid	$1,985.16
Rate for Payer: Priority Health Cigna Priority Health	$5,392.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,238.13
Rate for Payer: Priority Health Narrow Network	$5,238.13
Rate for Payer: Priority Health SBD	$5,238.13
Rate for Payer: UMR Bronson Commercial	$3,543.84

PR CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA

Professional

Both

$8,547.00

Service Code	HCPCS 61519
Min. Negotiated Rate	$1,169.66
Max. Negotiated Rate	$5,982.90
Rate for Payer: Aetna Commercial	$3,807.82
Rate for Payer: BCBS Complete	$1,997.42
Rate for Payer: BCBS Trust/PPO	$1,169.66
Rate for Payer: Cash Price	$6,837.60
Rate for Payer: Cash Price	$6,837.60
Rate for Payer: Meridian Medicaid	$1,997.42
Rate for Payer: Priority Health Choice Medicaid	$1,902.30
Rate for Payer: Priority Health Cigna Priority Health	$5,982.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,028.63
Rate for Payer: Priority Health Narrow Network	$5,028.63
Rate for Payer: Priority Health SBD	$5,028.63
Rate for Payer: UMR Bronson Commercial	$3,931.62

PR CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS

Professional

Both

$6,105.00

Service Code	HCPCS 61522
Min. Negotiated Rate	$581.66
Max. Negotiated Rate	$4,273.50
Rate for Payer: Aetna Commercial	$2,828.40
Rate for Payer: BCBS Complete	$1,489.51
Rate for Payer: BCBS Trust/PPO	$581.66
Rate for Payer: Cash Price	$4,884.00
Rate for Payer: Cash Price	$4,884.00
Rate for Payer: Meridian Medicaid	$1,489.51
Rate for Payer: Priority Health Choice Medicaid	$1,418.58
Rate for Payer: Priority Health Cigna Priority Health	$4,273.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,738.20
Rate for Payer: Priority Health Narrow Network	$3,738.20
Rate for Payer: Priority Health SBD	$3,738.20
Rate for Payer: UMR Bronson Commercial	$2,808.30

PR CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST

Professional

Both

$6,970.00

Service Code	HCPCS 61524
Min. Negotiated Rate	$322.26
Max. Negotiated Rate	$4,879.00
Rate for Payer: Aetna Commercial	$2,693.85
Rate for Payer: BCBS Complete	$1,419.73
Rate for Payer: BCBS Trust/PPO	$322.26
Rate for Payer: Cash Price	$5,576.00
Rate for Payer: Cash Price	$5,576.00
Rate for Payer: Meridian Medicaid	$1,419.73
Rate for Payer: Priority Health Choice Medicaid	$1,352.12
Rate for Payer: Priority Health Cigna Priority Health	$4,879.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,563.81
Rate for Payer: Priority Health Narrow Network	$3,563.81
Rate for Payer: Priority Health SBD	$3,563.81
Rate for Payer: UMR Bronson Commercial	$3,206.20

PR CRNEC SOPL EXPL/DCMPRN CRNL NRV

Professional

Both

$7,690.00

Service Code	HCPCS 61458
Min. Negotiated Rate	$861.66
Max. Negotiated Rate	$5,383.00
Rate for Payer: Aetna Commercial	$2,603.51
Rate for Payer: BCBS Complete	$1,369.63
Rate for Payer: BCBS Trust/PPO	$861.66
Rate for Payer: Cash Price	$6,152.00
Rate for Payer: Cash Price	$6,152.00
Rate for Payer: Meridian Medicaid	$1,369.63
Rate for Payer: Priority Health Choice Medicaid	$1,304.41
Rate for Payer: Priority Health Cigna Priority Health	$5,383.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,447.73
Rate for Payer: Priority Health Narrow Network	$3,447.73
Rate for Payer: Priority Health SBD	$3,447.73
Rate for Payer: UMR Bronson Commercial	$3,537.40

PR CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION

Professional

Both

$6,581.00

Service Code	HCPCS 61450
Min. Negotiated Rate	$732.75
Max. Negotiated Rate	$4,606.70
Rate for Payer: Aetna Commercial	$2,481.54
Rate for Payer: BCBS Complete	$1,307.68
Rate for Payer: BCBS Trust/PPO	$732.75
Rate for Payer: Cash Price	$5,264.80
Rate for Payer: Cash Price	$5,264.80
Rate for Payer: Meridian Medicaid	$1,307.68
Rate for Payer: Priority Health Choice Medicaid	$1,245.41
Rate for Payer: Priority Health Cigna Priority Health	$4,606.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,280.69
Rate for Payer: Priority Health Narrow Network	$3,280.69
Rate for Payer: Priority Health SBD	$3,280.69
Rate for Payer: UMR Bronson Commercial	$3,027.26

PR CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD

Professional

Both

$4,519.40

Service Code	HCPCS 61343
Min. Negotiated Rate	$230.87
Max. Negotiated Rate	$3,751.80
Rate for Payer: Aetna Commercial	$2,837.46
Rate for Payer: BCBS Complete	$1,491.52
Rate for Payer: BCBS Trust/PPO	$230.87
Rate for Payer: Cash Price	$3,615.52
Rate for Payer: Cash Price	$3,615.52
Rate for Payer: Meridian Medicaid	$1,491.52
Rate for Payer: Priority Health Choice Medicaid	$1,420.50
Rate for Payer: Priority Health Cigna Priority Health	$3,163.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,751.80
Rate for Payer: Priority Health Narrow Network	$3,751.80
Rate for Payer: Priority Health SBD	$3,751.80
Rate for Payer: UMR Bronson Commercial	$2,078.92

PR CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM

Professional

Both

$7,913.00

Service Code	HCPCS 61526
Min. Negotiated Rate	$811.47
Max. Negotiated Rate	$5,687.72
Rate for Payer: Aetna Commercial	$4,323.75
Rate for Payer: BCBS Complete	$2,250.81
Rate for Payer: BCBS Trust/PPO	$811.47
Rate for Payer: Cash Price	$6,330.40
Rate for Payer: Cash Price	$6,330.40
Rate for Payer: Meridian Medicaid	$2,250.81
Rate for Payer: Priority Health Choice Medicaid	$2,143.63
Rate for Payer: Priority Health Cigna Priority Health	$5,539.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,687.72
Rate for Payer: Priority Health Narrow Network	$5,687.72
Rate for Payer: Priority Health SBD	$5,687.72
Rate for Payer: UMR Bronson Commercial	$3,639.98

PR CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR

Professional

Both

$3,944.12

Service Code	HCPCS 61514
Min. Negotiated Rate	$137.36
Max. Negotiated Rate	$3,279.57
Rate for Payer: Aetna Commercial	$2,471.98
Rate for Payer: BCBS Complete	$1,304.33
Rate for Payer: BCBS Trust/PPO	$137.36
Rate for Payer: Cash Price	$3,155.30
Rate for Payer: Cash Price	$3,155.30
Rate for Payer: Meridian Medicaid	$1,304.33
Rate for Payer: Priority Health Choice Medicaid	$1,242.22
Rate for Payer: Priority Health Cigna Priority Health	$2,760.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,279.57
Rate for Payer: Priority Health Narrow Network	$3,279.57
Rate for Payer: Priority Health SBD	$3,279.57
Rate for Payer: UMR Bronson Commercial	$1,814.30

PR CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR

Professional

Both

$6,977.00

Service Code	HCPCS 61516
Min. Negotiated Rate	$108.83
Max. Negotiated Rate	$4,883.90
Rate for Payer: Aetna Commercial	$2,419.47
Rate for Payer: BCBS Complete	$1,277.93
Rate for Payer: BCBS Trust/PPO	$108.83
Rate for Payer: Cash Price	$5,581.60
Rate for Payer: Cash Price	$5,581.60
Rate for Payer: Meridian Medicaid	$1,277.93
Rate for Payer: Priority Health Choice Medicaid	$1,217.08
Rate for Payer: Priority Health Cigna Priority Health	$4,883.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,200.86
Rate for Payer: Priority Health Narrow Network	$3,200.86
Rate for Payer: Priority Health SBD	$3,200.86
Rate for Payer: UMR Bronson Commercial	$3,209.42

PR CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR

Professional

Both

$5,279.00

Service Code	HCPCS 61512
Min. Negotiated Rate	$223.47
Max. Negotiated Rate	$4,360.48
Rate for Payer: Aetna Commercial	$3,299.75
Rate for Payer: BCBS Complete	$1,735.52
Rate for Payer: BCBS Trust/PPO	$223.47
Rate for Payer: Cash Price	$4,223.20
Rate for Payer: Cash Price	$4,223.20
Rate for Payer: Meridian Medicaid	$1,735.52
Rate for Payer: Priority Health Choice Medicaid	$1,652.88
Rate for Payer: Priority Health Cigna Priority Health	$3,695.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,360.48
Rate for Payer: Priority Health Narrow Network	$4,360.48
Rate for Payer: Priority Health SBD	$4,360.48
Rate for Payer: UMR Bronson Commercial	$2,428.34

PR CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL

Professional

Both

$10,231.00

Service Code	HCPCS 61521
Min. Negotiated Rate	$1,168.07
Max. Negotiated Rate	$7,161.70
Rate for Payer: Aetna Commercial	$4,087.42
Rate for Payer: BCBS Complete	$2,157.55
Rate for Payer: BCBS Trust/PPO	$1,168.07
Rate for Payer: Cash Price	$8,184.80
Rate for Payer: Cash Price	$8,184.80
Rate for Payer: Meridian Medicaid	$2,157.55
Rate for Payer: Priority Health Choice Medicaid	$2,054.81
Rate for Payer: Priority Health Cigna Priority Health	$7,161.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,404.03
Rate for Payer: Priority Health Narrow Network	$5,404.03
Rate for Payer: Priority Health SBD	$5,404.03
Rate for Payer: UMR Bronson Commercial	$4,706.26

PR CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM

Professional

Both

$8,556.00

Service Code	HCPCS 61520
Min. Negotiated Rate	$1,140.60
Max. Negotiated Rate	$6,360.39
Rate for Payer: Aetna Commercial	$4,834.96
Rate for Payer: BCBS Complete	$2,516.06
Rate for Payer: BCBS Trust/PPO	$1,140.60
Rate for Payer: Cash Price	$6,844.80
Rate for Payer: Cash Price	$6,844.80
Rate for Payer: Meridian Medicaid	$2,516.06
Rate for Payer: Priority Health Choice Medicaid	$2,396.25
Rate for Payer: Priority Health Cigna Priority Health	$5,989.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,360.39
Rate for Payer: Priority Health Narrow Network	$6,360.39
Rate for Payer: Priority Health SBD	$6,360.39
Rate for Payer: UMR Bronson Commercial	$3,935.76

PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF

Professional

Both

$2,713.00

Service Code	HCPCS 36825
Min. Negotiated Rate	$496.72
Max. Negotiated Rate	$1,899.10
Rate for Payer: Aetna Commercial	$1,067.63
Rate for Payer: BCBS Complete	$521.56
Rate for Payer: BCBS Trust/PPO	$1,014.86
Rate for Payer: Cash Price	$2,170.40
Rate for Payer: Cash Price	$2,170.40
Rate for Payer: Meridian Medicaid	$521.56
Rate for Payer: Priority Health Choice Medicaid	$496.72
Rate for Payer: Priority Health Cigna Priority Health	$1,899.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,236.27
Rate for Payer: Priority Health Narrow Network	$1,236.27
Rate for Payer: Priority Health SBD	$1,236.27
Rate for Payer: UMR Bronson Commercial	$1,247.98

PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF

Professional

Both

$1,353.00

Service Code	HCPCS 36830
Min. Negotiated Rate	$417.05
Max. Negotiated Rate	$1,037.85
Rate for Payer: Aetna Commercial	$894.72
Rate for Payer: BCBS Complete	$437.90
Rate for Payer: BCBS Trust/PPO	$967.85
Rate for Payer: Cash Price	$1,082.40
Rate for Payer: Cash Price	$1,082.40
Rate for Payer: Meridian Medicaid	$437.90
Rate for Payer: Priority Health Choice Medicaid	$417.05
Rate for Payer: Priority Health Cigna Priority Health	$947.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,037.85
Rate for Payer: Priority Health Narrow Network	$1,037.85
Rate for Payer: Priority Health SBD	$1,037.85
Rate for Payer: UMR Bronson Commercial	$622.38

Know your out-of-pocket cost for care.

All Charges