Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE

Professional

Both

$922.00

Service Code	HCPCS 44372
Min. Negotiated Rate	$150.38
Max. Negotiated Rate	$645.40
Rate for Payer: Aetna Commercial	$318.37
Rate for Payer: BCBS Complete	$157.90
Rate for Payer: BCBS Trust/PPO	$368.23
Rate for Payer: Cash Price	$737.60
Rate for Payer: Cash Price	$737.60
Rate for Payer: Meridian Medicaid	$157.90
Rate for Payer: Priority Health Choice Medicaid	$150.38
Rate for Payer: Priority Health Cigna Priority Health	$645.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$412.76
Rate for Payer: Priority Health Narrow Network	$412.76
Rate for Payer: Priority Health SBD	$412.76
Rate for Payer: UMR Bronson Commercial	$424.12

PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY

Professional

Both

$955.00

Service Code	HCPCS 44363
Min. Negotiated Rate	$120.35
Max. Negotiated Rate	$668.50
Rate for Payer: Aetna Commercial	$254.46
Rate for Payer: BCBS Complete	$126.37
Rate for Payer: BCBS Trust/PPO	$283.17
Rate for Payer: Cash Price	$764.00
Rate for Payer: Cash Price	$764.00
Rate for Payer: Meridian Medicaid	$126.37
Rate for Payer: Priority Health Choice Medicaid	$120.35
Rate for Payer: Priority Health Cigna Priority Health	$668.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$330.45
Rate for Payer: Priority Health Narrow Network	$330.45
Rate for Payer: Priority Health SBD	$330.45
Rate for Payer: UMR Bronson Commercial	$439.30

PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY

Professional

Both

$1,098.00

Service Code	HCPCS 44365
Min. Negotiated Rate	$114.59
Max. Negotiated Rate	$768.60
Rate for Payer: Aetna Commercial	$241.56
Rate for Payer: BCBS Complete	$120.32
Rate for Payer: BCBS Trust/PPO	$740.68
Rate for Payer: Cash Price	$878.40
Rate for Payer: Cash Price	$878.40
Rate for Payer: Meridian Medicaid	$120.32
Rate for Payer: Priority Health Choice Medicaid	$114.59
Rate for Payer: Priority Health Cigna Priority Health	$768.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$313.39
Rate for Payer: Priority Health Narrow Network	$313.39
Rate for Payer: Priority Health SBD	$313.39
Rate for Payer: UMR Bronson Commercial	$505.08

PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE

Professional

Both

$1,098.00

Service Code	HCPCS 44364
Min. Negotiated Rate	$128.23
Max. Negotiated Rate	$768.60
Rate for Payer: Aetna Commercial	$271.37
Rate for Payer: BCBS Complete	$134.64
Rate for Payer: BCBS Trust/PPO	$700.00
Rate for Payer: Cash Price	$878.40
Rate for Payer: Cash Price	$878.40
Rate for Payer: Meridian Medicaid	$134.64
Rate for Payer: Priority Health Choice Medicaid	$128.23
Rate for Payer: Priority Health Cigna Priority Health	$768.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$352.19
Rate for Payer: Priority Health Narrow Network	$352.19
Rate for Payer: Priority Health SBD	$352.19
Rate for Payer: UMR Bronson Commercial	$505.08

PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN

Professional

Both

$2,710.00

Service Code	HCPCS 44021
Min. Negotiated Rate	$620.26
Max. Negotiated Rate	$1,897.00
Rate for Payer: Aetna Commercial	$1,316.39
Rate for Payer: BCBS Complete	$651.27
Rate for Payer: BCBS Trust/PPO	$1,724.90
Rate for Payer: Cash Price	$2,168.00
Rate for Payer: Cash Price	$2,168.00
Rate for Payer: Meridian Medicaid	$651.27
Rate for Payer: Priority Health Choice Medicaid	$620.26
Rate for Payer: Priority Health Cigna Priority Health	$1,897.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,706.89
Rate for Payer: Priority Health Narrow Network	$1,706.89
Rate for Payer: Priority Health SBD	$1,706.89
Rate for Payer: UMR Bronson Commercial	$1,246.60

PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL

Professional

Both

$2,888.00

Service Code	HCPCS 44020
Min. Negotiated Rate	$621.96
Max. Negotiated Rate	$2,324.52
Rate for Payer: Aetna Commercial	$1,317.49
Rate for Payer: BCBS Complete	$653.06
Rate for Payer: BCBS Trust/PPO	$2,324.52
Rate for Payer: Cash Price	$2,310.40
Rate for Payer: Cash Price	$2,310.40
Rate for Payer: Meridian Medicaid	$653.06
Rate for Payer: Priority Health Choice Medicaid	$621.96
Rate for Payer: Priority Health Cigna Priority Health	$2,021.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,708.65
Rate for Payer: Priority Health Narrow Network	$1,708.65
Rate for Payer: Priority Health SBD	$1,708.65
Rate for Payer: UMR Bronson Commercial	$1,328.48

PR ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS

Professional

Both

$1,953.00

Service Code	HCPCS 44128
Min. Negotiated Rate	$153.79
Max. Negotiated Rate	$1,367.10
Rate for Payer: Aetna Commercial	$330.68
Rate for Payer: BCBS Complete	$161.48
Rate for Payer: BCBS Trust/PPO	$726.94
Rate for Payer: Cash Price	$1,562.40
Rate for Payer: Cash Price	$1,562.40
Rate for Payer: Meridian Medicaid	$161.48
Rate for Payer: Priority Health Choice Medicaid	$153.79
Rate for Payer: Priority Health Cigna Priority Health	$1,367.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$423.34
Rate for Payer: Priority Health Narrow Network	$423.34
Rate for Payer: Priority Health SBD	$423.34
Rate for Payer: UMR Bronson Commercial	$898.38

PR ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING

Professional

Both

$4,928.00

Service Code	HCPCS 44127
Min. Negotiated Rate	$240.38
Max. Negotiated Rate	$4,992.47
Rate for Payer: Aetna Commercial	$3,863.33
Rate for Payer: BCBS Complete	$1,906.62
Rate for Payer: BCBS Trust/PPO	$240.38
Rate for Payer: Cash Price	$3,942.40
Rate for Payer: Cash Price	$3,942.40
Rate for Payer: Meridian Medicaid	$1,906.62
Rate for Payer: Priority Health Choice Medicaid	$1,815.83
Rate for Payer: Priority Health Cigna Priority Health	$3,449.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,992.47
Rate for Payer: Priority Health Narrow Network	$4,992.47
Rate for Payer: Priority Health SBD	$4,992.47
Rate for Payer: UMR Bronson Commercial	$2,266.88

PR ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING

Professional

Both

$4,247.00

Service Code	HCPCS 44126
Min. Negotiated Rate	$1,573.22
Max. Negotiated Rate	$4,324.53
Rate for Payer: Aetna Commercial	$3,342.37
Rate for Payer: BCBS Complete	$1,651.88
Rate for Payer: BCBS Trust/PPO	$1,607.09
Rate for Payer: Cash Price	$3,397.60
Rate for Payer: Cash Price	$3,397.60
Rate for Payer: Meridian Medicaid	$1,651.88
Rate for Payer: Priority Health Choice Medicaid	$1,573.22
Rate for Payer: Priority Health Cigna Priority Health	$2,972.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,324.53
Rate for Payer: Priority Health Narrow Network	$4,324.53
Rate for Payer: Priority Health SBD	$4,324.53
Rate for Payer: UMR Bronson Commercial	$1,953.62

PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST

Professional

Both

$3,251.00

Service Code	HCPCS 44120
Min. Negotiated Rate	$236.68
Max. Negotiated Rate	$2,275.70
Rate for Payer: Aetna Commercial	$1,649.65
Rate for Payer: BCBS Complete	$818.34
Rate for Payer: BCBS Trust/PPO	$236.68
Rate for Payer: Cash Price	$2,600.80
Rate for Payer: Cash Price	$2,600.80
Rate for Payer: Meridian Medicaid	$818.34
Rate for Payer: Priority Health Choice Medicaid	$779.37
Rate for Payer: Priority Health Cigna Priority Health	$2,275.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,139.64
Rate for Payer: Priority Health Narrow Network	$2,139.64
Rate for Payer: Priority Health SBD	$2,139.64
Rate for Payer: UMR Bronson Commercial	$1,495.46

PR EO W/O JOINTS CF

Professional

Both

$265.00

Service Code	HCPCS L3702
Min. Negotiated Rate	$106.00
Max. Negotiated Rate	$185.50
Rate for Payer: Aetna Commercial	$158.29
Rate for Payer: BCBS Complete	$106.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Priority Health Cigna Priority Health	$185.50
Rate for Payer: UMR Bronson Commercial	$121.90

PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN

Professional

Both

$526.00

Service Code	HCPCS 93641
Min. Negotiated Rate	$210.40
Max. Negotiated Rate	$2,001.73
Rate for Payer: Aetna Commercial	$765.30
Rate for Payer: BCBS Complete	$210.40
Rate for Payer: BCBS Trust/PPO	$2,001.73
Rate for Payer: Cash Price	$420.80
Rate for Payer: Cash Price	$420.80
Rate for Payer: Priority Health Cigna Priority Health	$368.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$379.71
Rate for Payer: Priority Health Narrow Network	$379.71
Rate for Payer: Priority Health SBD	$807.65
Rate for Payer: UMR Bronson Commercial	$241.96

PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS

Professional

Both

$1,700.00

Service Code	HCPCS 93642
Min. Negotiated Rate	$116.80
Max. Negotiated Rate	$2,287.54
Rate for Payer: Aetna Commercial	$445.35
Rate for Payer: BCBS Complete	$680.00
Rate for Payer: BCBS Trust/PPO	$2,287.54
Rate for Payer: Cash Price	$1,360.00
Rate for Payer: Cash Price	$1,360.00
Rate for Payer: Priority Health Cigna Priority Health	$1,190.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$116.80
Rate for Payer: Priority Health Narrow Network	$116.80
Rate for Payer: Priority Health SBD	$465.78
Rate for Payer: UMR Bronson Commercial	$782.00

PR EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<

Professional

Both

$1,439.00

Service Code	HCPCS 15115
Min. Negotiated Rate	$138.90
Max. Negotiated Rate	$1,007.30
Rate for Payer: Aetna Commercial	$751.44
Rate for Payer: BCBS Complete	$467.43
Rate for Payer: BCBS Trust/PPO	$138.90
Rate for Payer: Cash Price	$1,151.20
Rate for Payer: Cash Price	$1,151.20
Rate for Payer: Meridian Medicaid	$467.43
Rate for Payer: Priority Health Choice Medicaid	$445.17
Rate for Payer: Priority Health Cigna Priority Health	$1,007.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$844.27
Rate for Payer: Priority Health Narrow Network	$844.27
Rate for Payer: Priority Health SBD	$844.27
Rate for Payer: UMR Bronson Commercial	$661.94

PR EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM

Professional

Both

$327.00

Service Code	HCPCS 15116
Min. Negotiated Rate	$87.54
Max. Negotiated Rate	$281.44
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: BCBS Complete	$91.92
Rate for Payer: BCBS Trust/PPO	$281.44
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Meridian Medicaid	$91.92
Rate for Payer: Priority Health Choice Medicaid	$87.54
Rate for Payer: Priority Health Cigna Priority Health	$228.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$170.17
Rate for Payer: Priority Health Narrow Network	$170.17
Rate for Payer: Priority Health SBD	$170.17
Rate for Payer: UMR Bronson Commercial	$150.42

PR EPIDIDYMECTOMY BILATERAL

Professional

Both

$1,051.00

Service Code	HCPCS 54861
Min. Negotiated Rate	$363.59
Max. Negotiated Rate	$2,782.03
Rate for Payer: Aetna Commercial	$728.21
Rate for Payer: BCBS Complete	$381.77
Rate for Payer: BCBS Trust/PPO	$2,782.03
Rate for Payer: Cash Price	$840.80
Rate for Payer: Cash Price	$840.80
Rate for Payer: Meridian Medicaid	$381.77
Rate for Payer: Priority Health Choice Medicaid	$363.59
Rate for Payer: Priority Health Cigna Priority Health	$735.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$908.34
Rate for Payer: Priority Health Narrow Network	$908.34
Rate for Payer: Priority Health SBD	$908.34
Rate for Payer: UMR Bronson Commercial	$483.46

PR EPIDIDYMECTOMY UNILATERAL

Professional

Both

$741.00

Service Code	HCPCS 54860
Min. Negotiated Rate	$268.59
Max. Negotiated Rate	$1,211.92
Rate for Payer: Aetna Commercial	$536.30
Rate for Payer: BCBS Complete	$282.02
Rate for Payer: BCBS Trust/PPO	$1,211.92
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Meridian Medicaid	$282.02
Rate for Payer: Priority Health Choice Medicaid	$268.59
Rate for Payer: Priority Health Cigna Priority Health	$518.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$671.13
Rate for Payer: Priority Health Narrow Network	$671.13
Rate for Payer: Priority Health SBD	$671.13
Rate for Payer: UMR Bronson Commercial	$340.86

PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI

Professional

Both

$1,688.00

Service Code	HCPCS 54900
Min. Negotiated Rate	$509.28
Max. Negotiated Rate	$2,046.63
Rate for Payer: Aetna Commercial	$1,027.27
Rate for Payer: BCBS Complete	$534.74
Rate for Payer: BCBS Trust/PPO	$2,046.63
Rate for Payer: Cash Price	$1,350.40
Rate for Payer: Cash Price	$1,350.40
Rate for Payer: Meridian Medicaid	$534.74
Rate for Payer: Priority Health Choice Medicaid	$509.28
Rate for Payer: Priority Health Cigna Priority Health	$1,181.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,276.86
Rate for Payer: Priority Health Narrow Network	$1,276.86
Rate for Payer: Priority Health SBD	$1,276.86
Rate for Payer: UMR Bronson Commercial	$776.48

PR EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD

Professional

Both

$1,576.00

Service Code	HCPCS 15110
Min. Negotiated Rate	$206.12
Max. Negotiated Rate	$1,103.20
Rate for Payer: Aetna Commercial	$761.36
Rate for Payer: BCBS Complete	$480.40
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$1,260.80
Rate for Payer: Cash Price	$1,260.80
Rate for Payer: Meridian Medicaid	$480.40
Rate for Payer: Priority Health Choice Medicaid	$457.52
Rate for Payer: Priority Health Cigna Priority Health	$1,103.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$875.10
Rate for Payer: Priority Health Narrow Network	$875.10
Rate for Payer: Priority Health SBD	$875.10
Rate for Payer: UMR Bronson Commercial	$724.96

PR EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD

Professional

Both

$249.00

Service Code	HCPCS 15111
Min. Negotiated Rate	$64.33
Max. Negotiated Rate	$212.16
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: BCBS Complete	$67.55
Rate for Payer: BCBS Trust/PPO	$212.16
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cash Price	$199.20
Rate for Payer: Meridian Medicaid	$67.55
Rate for Payer: Priority Health Choice Medicaid	$64.33
Rate for Payer: Priority Health Cigna Priority Health	$174.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$124.55
Rate for Payer: Priority Health Narrow Network	$124.55
Rate for Payer: Priority Health SBD	$124.55
Rate for Payer: UMR Bronson Commercial	$114.54

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U

Professional

Both

$1,235.00

Service Code	HCPCS 25450
Min. Negotiated Rate	$402.36
Max. Negotiated Rate	$3,253.04
Rate for Payer: Aetna Commercial	$824.26
Rate for Payer: BCBS Complete	$422.48
Rate for Payer: BCBS Trust/PPO	$3,253.04
Rate for Payer: Cash Price	$988.00
Rate for Payer: Cash Price	$988.00
Rate for Payer: Meridian Medicaid	$422.48
Rate for Payer: Priority Health Choice Medicaid	$402.36
Rate for Payer: Priority Health Cigna Priority Health	$864.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$954.91
Rate for Payer: Priority Health Narrow Network	$954.91
Rate for Payer: Priority Health SBD	$954.91
Rate for Payer: UMR Bronson Commercial	$568.10

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR

Professional

Both

$1,152.00

Service Code	HCPCS 27185
Min. Negotiated Rate	$465.83
Max. Negotiated Rate	$1,108.37
Rate for Payer: Aetna Commercial	$958.27
Rate for Payer: BCBS Complete	$489.12
Rate for Payer: BCBS Trust/PPO	$1,108.37
Rate for Payer: Cash Price	$921.60
Rate for Payer: Cash Price	$921.60
Rate for Payer: Meridian Medicaid	$489.12
Rate for Payer: Priority Health Choice Medicaid	$465.83
Rate for Payer: Priority Health Cigna Priority Health	$806.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,107.08
Rate for Payer: Priority Health Narrow Network	$1,107.08
Rate for Payer: Priority Health SBD	$1,107.08
Rate for Payer: UMR Bronson Commercial	$529.92

PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING

Professional

Both

$374.00

Service Code	HCPCS 59300
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$439.02
Rate for Payer: Aetna Commercial	$160.66
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$439.02
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$261.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$208.22
Rate for Payer: Priority Health Narrow Network	$208.22
Rate for Payer: Priority Health SBD	$208.22
Rate for Payer: UMR Bronson Commercial	$172.04

PR EPOETIN ALFA, NON-ESRD

Professional

Both

$38.00

Service Code	HCPCS J0885
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$9.15
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$6.75
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: UMR Bronson Commercial	$17.48

PR ERCP,ABLATION TUMOR

Professional

Both

$1,623.00

Service Code	HCPCS 43272
Min. Negotiated Rate	$649.20
Max. Negotiated Rate	$1,136.10
Rate for Payer: BCBS Complete	$649.20
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Priority Health Cigna Priority Health	$1,136.10
Rate for Payer: UMR Bronson Commercial	$746.58

Know your out-of-pocket cost for care.

All Charges