Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO

Professional

Both

$335.00

Service Code	HCPCS 35686
Min. Negotiated Rate	$99.68
Max. Negotiated Rate	$1,316.52
Rate for Payer: Aetna Commercial	$216.51
Rate for Payer: BCBS Complete	$104.66
Rate for Payer: BCBS Trust/PPO	$1,316.52
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$268.00
Rate for Payer: Meridian Medicaid	$104.66
Rate for Payer: Priority Health Choice Medicaid	$99.68
Rate for Payer: Priority Health Cigna Priority Health	$234.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$248.42
Rate for Payer: Priority Health Narrow Network	$248.42
Rate for Payer: Priority Health SBD	$248.42
Rate for Payer: UMR Bronson Commercial	$154.10

PR CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX

Professional

Both

$2,500.00

Service Code	HCPCS 33025
Min. Negotiated Rate	$485.85
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,030.99
Rate for Payer: BCBS Complete	$510.14
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Meridian Medicaid	$510.14
Rate for Payer: Priority Health Choice Medicaid	$485.85
Rate for Payer: Priority Health Cigna Priority Health	$1,750.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,206.48
Rate for Payer: Priority Health Narrow Network	$1,206.48
Rate for Payer: Priority Health SBD	$1,206.48
Rate for Payer: UMR Bronson Commercial	$1,150.00

PR CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM

Professional

Both

$4,279.00

Service Code	HCPCS 63740
Min. Negotiated Rate	$254.64
Max. Negotiated Rate	$2,995.30
Rate for Payer: Aetna Commercial	$1,267.15
Rate for Payer: BCBS Complete	$676.77
Rate for Payer: BCBS Trust/PPO	$254.64
Rate for Payer: Cash Price	$3,423.20
Rate for Payer: Cash Price	$3,423.20
Rate for Payer: Meridian Medicaid	$676.77
Rate for Payer: Priority Health Choice Medicaid	$644.54
Rate for Payer: Priority Health Cigna Priority Health	$2,995.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,695.84
Rate for Payer: Priority Health Narrow Network	$1,695.84
Rate for Payer: Priority Health SBD	$1,695.84
Rate for Payer: UMR Bronson Commercial	$1,968.34

PR CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM

Professional

Both

$2,356.00

Service Code	HCPCS 63741
Min. Negotiated Rate	$248.83
Max. Negotiated Rate	$1,649.20
Rate for Payer: Aetna Commercial	$868.81
Rate for Payer: BCBS Complete	$466.98
Rate for Payer: BCBS Trust/PPO	$248.83
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Meridian Medicaid	$466.98
Rate for Payer: Priority Health Choice Medicaid	$444.74
Rate for Payer: Priority Health Cigna Priority Health	$1,649.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,179.44
Rate for Payer: Priority Health Narrow Network	$1,179.44
Rate for Payer: Priority Health SBD	$1,179.44
Rate for Payer: UMR Bronson Commercial	$1,083.76

PR CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH

Professional

Both

$5,740.00

Service Code	HCPCS 62192
Min. Negotiated Rate	$478.64
Max. Negotiated Rate	$4,018.00
Rate for Payer: Aetna Commercial	$1,267.26
Rate for Payer: BCBS Complete	$681.02
Rate for Payer: BCBS Trust/PPO	$478.64
Rate for Payer: Cash Price	$4,592.00
Rate for Payer: Cash Price	$4,592.00
Rate for Payer: Meridian Medicaid	$681.02
Rate for Payer: Priority Health Choice Medicaid	$648.59
Rate for Payer: Priority Health Cigna Priority Health	$4,018.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,672.63
Rate for Payer: Priority Health Narrow Network	$1,672.63
Rate for Payer: Priority Health SBD	$1,672.63
Rate for Payer: UMR Bronson Commercial	$2,640.40

PR CRTJ SHUNT VENTRICULO-ATR-JUG-AUR

Professional

Both

$4,966.00

Service Code	HCPCS 62220
Min. Negotiated Rate	$633.46
Max. Negotiated Rate	$3,476.20
Rate for Payer: Aetna Commercial	$1,269.68
Rate for Payer: BCBS Complete	$665.13
Rate for Payer: BCBS Trust/PPO	$1,359.32
Rate for Payer: Cash Price	$3,972.80
Rate for Payer: Cash Price	$3,972.80
Rate for Payer: Meridian Medicaid	$665.13
Rate for Payer: Priority Health Choice Medicaid	$633.46
Rate for Payer: Priority Health Cigna Priority Health	$3,476.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,657.34
Rate for Payer: Priority Health Narrow Network	$1,657.34
Rate for Payer: Priority Health SBD	$1,657.34
Rate for Payer: UMR Bronson Commercial	$2,284.36

PR CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS

Professional

Both

$4,952.00

Service Code	HCPCS 62223
Min. Negotiated Rate	$672.23
Max. Negotiated Rate	$3,466.40
Rate for Payer: Aetna Commercial	$1,340.52
Rate for Payer: BCBS Complete	$705.84
Rate for Payer: BCBS Trust/PPO	$1,466.56
Rate for Payer: Cash Price	$3,961.60
Rate for Payer: Cash Price	$3,961.60
Rate for Payer: Meridian Medicaid	$705.84
Rate for Payer: Priority Health Choice Medicaid	$672.23
Rate for Payer: Priority Health Cigna Priority Health	$3,466.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,775.67
Rate for Payer: Priority Health Narrow Network	$1,775.67
Rate for Payer: Priority Health SBD	$1,775.67
Rate for Payer: UMR Bronson Commercial	$2,277.92

PR CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA

Professional

Both

$7,105.00

Service Code	HCPCS 62100
Min. Negotiated Rate	$1,018.35
Max. Negotiated Rate	$4,973.50
Rate for Payer: Aetna Commercial	$2,017.87
Rate for Payer: BCBS Complete	$1,069.27
Rate for Payer: BCBS Trust/PPO	$2,294.41
Rate for Payer: Cash Price	$5,684.00
Rate for Payer: Cash Price	$5,684.00
Rate for Payer: Meridian Medicaid	$1,069.27
Rate for Payer: Priority Health Choice Medicaid	$1,018.35
Rate for Payer: Priority Health Cigna Priority Health	$4,973.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,681.07
Rate for Payer: Priority Health Narrow Network	$2,681.07
Rate for Payer: Priority Health SBD	$2,681.07
Rate for Payer: UMR Bronson Commercial	$3,268.30

PR CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI

Professional

Both

$2,027.00

Service Code	HCPCS 55873
Min. Negotiated Rate	$486.49
Max. Negotiated Rate	$1,980.07
Rate for Payer: Aetna Commercial	$980.44
Rate for Payer: BCBS Complete	$510.81
Rate for Payer: BCBS Trust/PPO	$1,980.07
Rate for Payer: Cash Price	$1,621.60
Rate for Payer: Cash Price	$1,621.60
Rate for Payer: Meridian Medicaid	$510.81
Rate for Payer: Priority Health Choice Medicaid	$486.49
Rate for Payer: Priority Health Cigna Priority Health	$1,418.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,219.05
Rate for Payer: Priority Health Narrow Network	$1,219.05
Rate for Payer: Priority Health SBD	$1,219.05
Rate for Payer: UMR Bronson Commercial	$932.42

PR CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE

Professional

Both

$101.00

Service Code	HCPCS 17340
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$145.43
Rate for Payer: Aetna Commercial	$52.87
Rate for Payer: BCBS Complete	$32.88
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Meridian Medicaid	$32.88
Rate for Payer: Priority Health Choice Medicaid	$31.31
Rate for Payer: Priority Health Cigna Priority Health	$70.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.42
Rate for Payer: Priority Health Narrow Network	$60.42
Rate for Payer: Priority Health SBD	$60.42
Rate for Payer: UMR Bronson Commercial	$46.46

PR CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC

Professional

Both

$4,470.58

Service Code	HCPCS 51595
Min. Negotiated Rate	$1,378.75
Max. Negotiated Rate	$3,462.61
Rate for Payer: Aetna Commercial	$2,809.09
Rate for Payer: BCBS Complete	$1,447.69
Rate for Payer: BCBS Trust/PPO	$2,019.16
Rate for Payer: Cash Price	$3,576.46
Rate for Payer: Cash Price	$3,576.46
Rate for Payer: Meridian Medicaid	$1,447.69
Rate for Payer: Priority Health Choice Medicaid	$1,378.75
Rate for Payer: Priority Health Cigna Priority Health	$3,129.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,462.61
Rate for Payer: Priority Health Narrow Network	$3,462.61
Rate for Payer: Priority Health SBD	$3,462.61
Rate for Payer: UMR Bronson Commercial	$2,056.47

PR CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR

Professional

Both

$4,810.00

Service Code	HCPCS 51596
Min. Negotiated Rate	$1,485.89
Max. Negotiated Rate	$3,738.20
Rate for Payer: Aetna Commercial	$3,025.03
Rate for Payer: BCBS Complete	$1,560.18
Rate for Payer: BCBS Trust/PPO	$2,189.80
Rate for Payer: Cash Price	$3,848.00
Rate for Payer: Cash Price	$3,848.00
Rate for Payer: Meridian Medicaid	$1,560.18
Rate for Payer: Priority Health Choice Medicaid	$1,485.89
Rate for Payer: Priority Health Cigna Priority Health	$3,367.00
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	$2,212.60

PR CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST

Professional

Both

$4,815.00

Service Code	HCPCS 51590
Min. Negotiated Rate	$1,217.93
Max. Negotiated Rate	$3,370.50
Rate for Payer: Aetna Commercial	$2,483.67
Rate for Payer: BCBS Complete	$1,278.83
Rate for Payer: BCBS Trust/PPO	$2,561.73
Rate for Payer: Cash Price	$3,852.00
Rate for Payer: Cash Price	$3,852.00
Rate for Payer: Meridian Medicaid	$1,278.83
Rate for Payer: Priority Health Choice Medicaid	$1,217.93
Rate for Payer: Priority Health Cigna Priority Health	$3,370.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,060.04
Rate for Payer: Priority Health Narrow Network	$3,060.04
Rate for Payer: Priority Health SBD	$3,060.04
Rate for Payer: UMR Bronson Commercial	$2,214.90

PR CSTOPLASTY/CSTOURTP PLSTC ANY

Professional

Both

$1,113.00

Service Code	HCPCS 51800
Min. Negotiated Rate	$511.98
Max. Negotiated Rate	$3,574.48
Rate for Payer: Aetna Commercial	$1,338.27
Rate for Payer: BCBS Complete	$691.08
Rate for Payer: BCBS Trust/PPO	$3,574.48
Rate for Payer: Cash Price	$890.40
Rate for Payer: Cash Price	$890.40
Rate for Payer: Meridian Medicaid	$691.08
Rate for Payer: Priority Health Choice Medicaid	$658.17
Rate for Payer: Priority Health Cigna Priority Health	$779.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,651.33
Rate for Payer: Priority Health Narrow Network	$1,651.33
Rate for Payer: Priority Health SBD	$1,651.33
Rate for Payer: UMR Bronson Commercial	$511.98

PR CSTOURTP W/UNI/BI URTRONEOCSTOST

Professional

Both

$2,370.00

Service Code	HCPCS 51820
Min. Negotiated Rate	$688.20
Max. Negotiated Rate	$4,989.27
Rate for Payer: Aetna Commercial	$1,392.31
Rate for Payer: BCBS Complete	$722.61
Rate for Payer: BCBS Trust/PPO	$4,989.27
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Meridian Medicaid	$722.61
Rate for Payer: Priority Health Choice Medicaid	$688.20
Rate for Payer: Priority Health Cigna Priority Health	$1,659.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,726.45
Rate for Payer: Priority Health Narrow Network	$1,726.45
Rate for Payer: Priority Health SBD	$1,726.45
Rate for Payer: UMR Bronson Commercial	$1,090.20

PR CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Professional

Both

$919.00

Service Code	HCPCS 42972
Min. Negotiated Rate	$252.53
Max. Negotiated Rate	$896.66
Rate for Payer: Aetna Commercial	$670.67
Rate for Payer: BCBS Complete	$343.08
Rate for Payer: BCBS Trust/PPO	$252.53
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cash Price	$735.20
Rate for Payer: Meridian Medicaid	$343.08
Rate for Payer: Priority Health Choice Medicaid	$326.74
Rate for Payer: Priority Health Cigna Priority Health	$643.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$896.66
Rate for Payer: Priority Health Narrow Network	$896.66
Rate for Payer: Priority Health SBD	$896.66
Rate for Payer: UMR Bronson Commercial	$422.74

PR CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS

Professional

Both

$734.00

Service Code	HCPCS 42970
Min. Negotiated Rate	$265.61
Max. Negotiated Rate	$727.90
Rate for Payer: Aetna Commercial	$542.75
Rate for Payer: BCBS Complete	$278.89
Rate for Payer: BCBS Trust/PPO	$313.28
Rate for Payer: Cash Price	$587.20
Rate for Payer: Cash Price	$587.20
Rate for Payer: Meridian Medicaid	$278.89
Rate for Payer: Priority Health Choice Medicaid	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$513.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$727.90
Rate for Payer: Priority Health Narrow Network	$727.90
Rate for Payer: Priority Health SBD	$727.90
Rate for Payer: UMR Bronson Commercial	$337.64

PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST

Professional

Both

$438.00

Service Code	HCPCS 30905
Min. Negotiated Rate	$67.31
Max. Negotiated Rate	$835.24
Rate for Payer: Aetna Commercial	$136.69
Rate for Payer: BCBS Complete	$70.68
Rate for Payer: BCBS Trust/PPO	$835.24
Rate for Payer: Cash Price	$350.40
Rate for Payer: Cash Price	$350.40
Rate for Payer: Meridian Medicaid	$70.68
Rate for Payer: Priority Health Choice Medicaid	$67.31
Rate for Payer: Priority Health Cigna Priority Health	$306.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$146.32
Rate for Payer: Priority Health Narrow Network	$146.32
Rate for Payer: Priority Health SBD	$146.32
Rate for Payer: UMR Bronson Commercial	$201.48

PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ

Professional

Both

$587.00

Service Code	HCPCS 30906
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$907.62
Rate for Payer: Aetna Commercial	$174.23
Rate for Payer: BCBS Complete	$88.57
Rate for Payer: BCBS Trust/PPO	$907.62
Rate for Payer: Cash Price	$469.60
Rate for Payer: Cash Price	$469.60
Rate for Payer: Meridian Medicaid	$88.57
Rate for Payer: Priority Health Choice Medicaid	$84.35
Rate for Payer: Priority Health Cigna Priority Health	$410.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.83
Rate for Payer: Priority Health Narrow Network	$183.83
Rate for Payer: Priority Health SBD	$183.83
Rate for Payer: UMR Bronson Commercial	$270.02

PR CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ

Professional

Both

$765.00

Service Code	HCPCS 42961
Min. Negotiated Rate	$269.96
Max. Negotiated Rate	$742.62
Rate for Payer: Aetna Commercial	$551.09
Rate for Payer: BCBS Complete	$284.49
Rate for Payer: BCBS Trust/PPO	$269.96
Rate for Payer: Cash Price	$612.00
Rate for Payer: Cash Price	$612.00
Rate for Payer: Meridian Medicaid	$284.49
Rate for Payer: Priority Health Choice Medicaid	$270.94
Rate for Payer: Priority Health Cigna Priority Health	$535.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$742.62
Rate for Payer: Priority Health Narrow Network	$742.62
Rate for Payer: Priority Health SBD	$742.62
Rate for Payer: UMR Bronson Commercial	$351.90

PR CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Professional

Both

$1,864.00

Service Code	HCPCS 42962
Min. Negotiated Rate	$333.56
Max. Negotiated Rate	$1,304.80
Rate for Payer: Aetna Commercial	$682.74
Rate for Payer: BCBS Complete	$350.24
Rate for Payer: BCBS Trust/PPO	$346.04
Rate for Payer: Cash Price	$1,491.20
Rate for Payer: Cash Price	$1,491.20
Rate for Payer: Meridian Medicaid	$350.24
Rate for Payer: Priority Health Choice Medicaid	$333.56
Rate for Payer: Priority Health Cigna Priority Health	$1,304.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$918.42
Rate for Payer: Priority Health Narrow Network	$918.42
Rate for Payer: Priority Health SBD	$918.42
Rate for Payer: UMR Bronson Commercial	$857.44

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS

Professional

Both

$528.00

Service Code	HCPCS 95929
Min. Negotiated Rate	$103.30
Max. Negotiated Rate	$369.60
Rate for Payer: Aetna Commercial	$260.29
Rate for Payer: BCBS Complete	$211.20
Rate for Payer: BCBS Trust/PPO	$111.47
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Priority Health Cigna Priority Health	$369.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.30
Rate for Payer: Priority Health Narrow Network	$103.30
Rate for Payer: Priority Health SBD	$321.13
Rate for Payer: UMR Bronson Commercial	$242.88

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS

Professional

Both

$487.00

Service Code	HCPCS 95928
Min. Negotiated Rate	$99.85
Max. Negotiated Rate	$340.90
Rate for Payer: Aetna Commercial	$253.19
Rate for Payer: Aetna Commercial	$253.19
Rate for Payer: BCBS Complete	$133.20
Rate for Payer: BCBS Complete	$194.80
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$266.40
Rate for Payer: Priority Health Cigna Priority Health	$233.10
Rate for Payer: Priority Health Cigna Priority Health	$340.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.75
Rate for Payer: Priority Health Narrow Network	$103.75
Rate for Payer: Priority Health Narrow Network	$103.75
Rate for Payer: Priority Health SBD	$316.20
Rate for Payer: Priority Health SBD	$316.20
Rate for Payer: UMR Bronson Commercial	$224.02
Rate for Payer: UMR Bronson Commercial	$153.18

PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI

Professional

Both

$322.00

Service Code	HCPCS 95939
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$732.55
Rate for Payer: Aetna Commercial	$578.57
Rate for Payer: BCBS Complete	$128.80
Rate for Payer: BCBS Trust/PPO	$596.45
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.95
Rate for Payer: Priority Health Narrow Network	$154.95
Rate for Payer: Priority Health SBD	$732.55
Rate for Payer: UMR Bronson Commercial	$148.12

PR CURETTAGE POSTPARTUM

Professional

Both

$535.00

Service Code	HCPCS 59160
Min. Negotiated Rate	$121.84
Max. Negotiated Rate	$516.15
Rate for Payer: Aetna Commercial	$203.67
Rate for Payer: BCBS Complete	$127.93
Rate for Payer: BCBS Trust/PPO	$516.15
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cash Price	$428.00
Rate for Payer: Meridian Medicaid	$127.93
Rate for Payer: Priority Health Choice Medicaid	$121.84
Rate for Payer: Priority Health Cigna Priority Health	$374.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.14
Rate for Payer: Priority Health Narrow Network	$269.14
Rate for Payer: Priority Health SBD	$269.14
Rate for Payer: UMR Bronson Commercial	$246.10

Know your out-of-pocket cost for care.

All Charges