Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR DECOMPRESSION UNSPECIFIED NERVE

Professional

Both

$1,748.00

Service Code	HCPCS 64722
Min. Negotiated Rate	$240.69
Max. Negotiated Rate	$5,909.56
Rate for Payer: Aetna Commercial	$455.08
Rate for Payer: BCBS Complete	$252.72
Rate for Payer: BCBS Trust/PPO	$5,909.56
Rate for Payer: Cash Price	$1,398.40
Rate for Payer: Cash Price	$1,398.40
Rate for Payer: Meridian Medicaid	$252.72
Rate for Payer: Priority Health Choice Medicaid	$240.69
Rate for Payer: Priority Health Cigna Priority Health	$1,223.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$622.85
Rate for Payer: Priority Health Narrow Network	$622.85
Rate for Payer: Priority Health SBD	$622.85
Rate for Payer: UMR Bronson Commercial	$804.08

PR DECOMPRESSIVE FASCIOTOMY HAND

Professional

Both

$1,336.00

Service Code	HCPCS 26037
Min. Negotiated Rate	$109.10
Max. Negotiated Rate	$935.20
Rate for Payer: Aetna Commercial	$751.25
Rate for Payer: BCBS Complete	$383.11
Rate for Payer: BCBS Trust/PPO	$109.10
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Meridian Medicaid	$383.11
Rate for Payer: Priority Health Choice Medicaid	$364.87
Rate for Payer: Priority Health Cigna Priority Health	$935.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$867.08
Rate for Payer: Priority Health Narrow Network	$867.08
Rate for Payer: Priority Health SBD	$867.08
Rate for Payer: UMR Bronson Commercial	$614.56

PR DECORTICATION & PARIETAL PLEURECTOMY

Professional

Both

$3,934.00

Service Code	HCPCS 32320
Min. Negotiated Rate	$518.79
Max. Negotiated Rate	$2,753.80
Rate for Payer: Aetna Commercial	$2,067.00
Rate for Payer: BCBS Complete	$1,063.68
Rate for Payer: BCBS Trust/PPO	$518.79
Rate for Payer: Cash Price	$3,147.20
Rate for Payer: Cash Price	$3,147.20
Rate for Payer: Meridian Medicaid	$1,063.68
Rate for Payer: Priority Health Choice Medicaid	$1,013.03
Rate for Payer: Priority Health Cigna Priority Health	$2,753.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,192.52
Rate for Payer: Priority Health Narrow Network	$2,192.52
Rate for Payer: Priority Health SBD	$2,192.52
Rate for Payer: UMR Bronson Commercial	$1,809.64

PR DECORTICATION PULMONARY PARTIAL SEPARATE PROC

Professional

Both

$2,022.00

Service Code	HCPCS 32225
Min. Negotiated Rate	$468.07
Max. Negotiated Rate	$1,415.40
Rate for Payer: Aetna Commercial	$1,281.01
Rate for Payer: BCBS Complete	$660.22
Rate for Payer: BCBS Trust/PPO	$468.07
Rate for Payer: Cash Price	$1,617.60
Rate for Payer: Cash Price	$1,617.60
Rate for Payer: Meridian Medicaid	$660.22
Rate for Payer: Priority Health Choice Medicaid	$628.78
Rate for Payer: Priority Health Cigna Priority Health	$1,415.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,362.28
Rate for Payer: Priority Health Narrow Network	$1,362.28
Rate for Payer: Priority Health SBD	$1,362.28
Rate for Payer: UMR Bronson Commercial	$930.12

PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE

Professional

Both

$2,905.00

Service Code	HCPCS 32220
Min. Negotiated Rate	$758.11
Max. Negotiated Rate	$2,181.86
Rate for Payer: Aetna Commercial	$2,051.72
Rate for Payer: BCBS Complete	$1,060.55
Rate for Payer: BCBS Trust/PPO	$758.11
Rate for Payer: Cash Price	$2,324.00
Rate for Payer: Cash Price	$2,324.00
Rate for Payer: Meridian Medicaid	$1,060.55
Rate for Payer: Priority Health Choice Medicaid	$1,010.05
Rate for Payer: Priority Health Cigna Priority Health	$2,033.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,181.86
Rate for Payer: Priority Health Narrow Network	$2,181.86
Rate for Payer: Priority Health SBD	$2,181.86
Rate for Payer: UMR Bronson Commercial	$1,336.30

PR DEGARELIX INJECTION

Professional

Both

$6.00

Service Code	HCPCS J9155
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.31
Rate for Payer: Aetna Commercial	$4.31
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: BCBS Trust/PPO	$4.18
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$4.20
Rate for Payer: UMR Bronson Commercial	$2.76

PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER

Professional

Both

$1,265.00

Service Code	HCPCS 49436
Min. Negotiated Rate	$119.49
Max. Negotiated Rate	$2,493.58
Rate for Payer: Aetna Commercial	$252.08
Rate for Payer: BCBS Complete	$125.46
Rate for Payer: BCBS Trust/PPO	$2,493.58
Rate for Payer: Cash Price	$1,012.00
Rate for Payer: Cash Price	$1,012.00
Rate for Payer: Meridian Medicaid	$125.46
Rate for Payer: Priority Health Choice Medicaid	$119.49
Rate for Payer: Priority Health Cigna Priority Health	$885.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$326.91
Rate for Payer: Priority Health Narrow Network	$326.91
Rate for Payer: Priority Health SBD	$326.91
Rate for Payer: UMR Bronson Commercial	$581.90

PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS

Professional

Both

$888.00

Service Code	HCPCS 15630
Min. Negotiated Rate	$221.09
Max. Negotiated Rate	$3,918.45
Rate for Payer: Aetna Commercial	$362.89
Rate for Payer: BCBS Complete	$232.14
Rate for Payer: BCBS Trust/PPO	$3,918.45
Rate for Payer: Cash Price	$710.40
Rate for Payer: Cash Price	$710.40
Rate for Payer: Meridian Medicaid	$232.14
Rate for Payer: Priority Health Choice Medicaid	$221.09
Rate for Payer: Priority Health Cigna Priority Health	$621.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$421.72
Rate for Payer: Priority Health Narrow Network	$421.72
Rate for Payer: Priority Health SBD	$421.72
Rate for Payer: UMR Bronson Commercial	$408.48

PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F

Professional

Both

$710.00

Service Code	HCPCS 15620
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$497.00
Rate for Payer: Aetna Commercial	$345.81
Rate for Payer: BCBS Complete	$220.74
Rate for Payer: BCBS Trust/PPO	$75.69
Rate for Payer: Cash Price	$568.00
Rate for Payer: Cash Price	$568.00
Rate for Payer: Meridian Medicaid	$220.74
Rate for Payer: Priority Health Choice Medicaid	$210.23
Rate for Payer: Priority Health Cigna Priority Health	$497.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$401.59
Rate for Payer: Priority Health Narrow Network	$401.59
Rate for Payer: Priority Health SBD	$401.59
Rate for Payer: UMR Bronson Commercial	$326.60

PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS

Professional

Both

$600.00

Service Code	HCPCS 15610
Min. Negotiated Rate	$157.62
Max. Negotiated Rate	$2,032.46
Rate for Payer: Aetna Commercial	$257.64
Rate for Payer: BCBS Complete	$165.50
Rate for Payer: BCBS Trust/PPO	$2,032.46
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Meridian Medicaid	$165.50
Rate for Payer: Priority Health Choice Medicaid	$157.62
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$300.88
Rate for Payer: Priority Health Narrow Network	$300.88
Rate for Payer: Priority Health SBD	$300.88
Rate for Payer: UMR Bronson Commercial	$276.00

PR DELAY FLAP/SECTIONING FLAP TRUNK

Professional

Both

$519.00

Service Code	HCPCS 15600
Min. Negotiated Rate	$136.96
Max. Negotiated Rate	$852.18
Rate for Payer: Aetna Commercial	$222.85
Rate for Payer: BCBS Complete	$143.81
Rate for Payer: BCBS Trust/PPO	$852.18
Rate for Payer: Cash Price	$415.20
Rate for Payer: Cash Price	$415.20
Rate for Payer: Meridian Medicaid	$143.81
Rate for Payer: Priority Health Choice Medicaid	$136.96
Rate for Payer: Priority Health Cigna Priority Health	$363.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$260.59
Rate for Payer: Priority Health Narrow Network	$260.59
Rate for Payer: Priority Health SBD	$260.59
Rate for Payer: UMR Bronson Commercial	$238.74

PR DELIVERY/BIRTHING ROOM RESUSCITATION

Professional

Both

$456.00

Service Code	HCPCS 99465
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$319.20
Rate for Payer: Aetna Commercial	$143.87
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: BCBS Trust/PPO	$115.04
Rate for Payer: Cash Price	$364.80
Rate for Payer: Cash Price	$364.80
Rate for Payer: Meridian Medicaid	$94.15
Rate for Payer: Priority Health Choice Medicaid	$89.67
Rate for Payer: Priority Health Cigna Priority Health	$319.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$179.04
Rate for Payer: Priority Health Narrow Network	$179.04
Rate for Payer: Priority Health SBD	$179.04
Rate for Payer: UMR Bronson Commercial	$209.76

PR DELIVERY PLACENTA SEPARATE PROCEDURE

Professional

Both

$254.00

Service Code	HCPCS 59414
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$177.80
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: BCBS Complete	$88.49
Rate for Payer: BCBS Trust/PPO	$68.68
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cash Price	$203.20
Rate for Payer: Meridian Medicaid	$88.49
Rate for Payer: Priority Health Choice Medicaid	$84.28
Rate for Payer: Priority Health Cigna Priority Health	$177.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.95
Rate for Payer: Priority Health Narrow Network	$127.95
Rate for Payer: Priority Health SBD	$127.95
Rate for Payer: UMR Bronson Commercial	$116.84

PR DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP

Professional

Both

$55.00

Service Code	HCPCS 94664
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$379.32
Rate for Payer: Aetna Commercial	$17.47
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$379.32
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.90
Rate for Payer: Priority Health Narrow Network	$22.90
Rate for Payer: Priority Health SBD	$22.90
Rate for Payer: UMR Bronson Commercial	$25.30

PR DENOSUMAB INJECTION

Professional

Both

$25.00

Service Code	HCPCS J0897
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$25.95
Rate for Payer: Aetna Commercial	$25.95
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$24.59
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: UMR Bronson Commercial	$11.50

PR DEPO-ESTRADIOL CYPIONATE INJ

Professional

Both

$17.00

Service Code	HCPCS J1000
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$36.83
Rate for Payer: Aetna Commercial	$36.83
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: BCBS Trust/PPO	$36.42
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cash Price	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.90
Rate for Payer: UMR Bronson Commercial	$7.82

PR DEPRESSION SCREEN ANNUAL

Professional

Both

$31.00

Service Code	HCPCS G0444
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$1,280.07
Rate for Payer: Aetna Commercial	$9.26
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$1,280.07
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: Priority Health HMO/PPO/Tiered Network	$10.80
Rate for Payer: Priority Health Narrow Network	$10.80
Rate for Payer: Priority Health SBD	$10.80
Rate for Payer: UMR Bronson Commercial	$14.26

PR DERMAGRAFT

Professional

Both

$50.00

Service Code	HCPCS Q4106
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$281.06
Rate for Payer: Aetna Commercial	$46.29
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$281.06
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UMR Bronson Commercial	$23.00

PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100

Professional

Both

$1,555.00

Service Code	HCPCS 15135
Min. Negotiated Rate	$116.11
Max. Negotiated Rate	$1,088.50
Rate for Payer: Aetna Commercial	$810.88
Rate for Payer: BCBS Complete	$508.36
Rate for Payer: BCBS Trust/PPO	$116.11
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Meridian Medicaid	$508.36
Rate for Payer: Priority Health Choice Medicaid	$484.15
Rate for Payer: Priority Health Cigna Priority Health	$1,088.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$931.41
Rate for Payer: Priority Health Narrow Network	$931.41
Rate for Payer: Priority Health SBD	$931.41
Rate for Payer: UMR Bronson Commercial	$715.30

PR DERMAL FILLER JUVEDERM ULTRA

Professional

Both

$675.00

Service Code	HCPCS 00087
Hospital Revenue Code	990
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$270.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50
Rate for Payer: UMR Bronson Commercial	$310.50

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS

Professional

Both

$400.00

Service Code	HCPCS 00089
Hospital Revenue Code	990
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: UMR Bronson Commercial	$184.00

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS >1

Professional

Both

$675.00

Service Code	HCPCS 00090
Hospital Revenue Code	990
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$270.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50
Rate for Payer: UMR Bronson Commercial	$310.50

PR DERMAL FILLER JUVEDERM VOLLURE

Professional

Both

$700.00

Service Code	HCPCS 00118
Hospital Revenue Code	990
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$490.00
Rate for Payer: BCBS Complete	$280.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Priority Health Cigna Priority Health	$490.00
Rate for Payer: UMR Bronson Commercial	$322.00

PR DERMAL FILLER JUVEDERM VOLUMA

Professional

Both

$800.00

Service Code	HCPCS 00091
Hospital Revenue Code	990
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$560.00
Rate for Payer: BCBS Complete	$320.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Priority Health Cigna Priority Health	$560.00
Rate for Payer: UMR Bronson Commercial	$368.00

PR DERMAL FILLER RESTYLANE 1/2 UNIT

Professional

Both

$400.00

Service Code	HCPCS 00252
Hospital Revenue Code	990
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: UMR Bronson Commercial	$184.00

Know your out-of-pocket cost for care.

All Charges