Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA

Professional

Both

$1,162.00

Service Code	HCPCS 43277
Min. Negotiated Rate	$237.07
Max. Negotiated Rate	$947.77
Rate for Payer: Aetna Commercial	$503.77
Rate for Payer: BCBS Complete	$248.92
Rate for Payer: BCBS Trust/PPO	$947.77
Rate for Payer: Cash Price	$929.60
Rate for Payer: Cash Price	$929.60
Rate for Payer: Meridian Medicaid	$248.92
Rate for Payer: Priority Health Choice Medicaid	$237.07
Rate for Payer: Priority Health Cigna Priority Health	$813.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$650.88
Rate for Payer: Priority Health Narrow Network	$650.88
Rate for Payer: Priority Health SBD	$650.88
Rate for Payer: UMR Bronson Commercial	$534.52

PR ERCP,BALLOON DIL DUCTS

Professional

Both

$1,639.00

Service Code	HCPCS 43271
Min. Negotiated Rate	$655.60
Max. Negotiated Rate	$1,147.30
Rate for Payer: BCBS Complete	$655.60
Rate for Payer: Cash Price	$1,311.20
Rate for Payer: Priority Health Cigna Priority Health	$1,147.30
Rate for Payer: UMR Bronson Commercial	$753.94

PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE

Professional

Both

$1,458.00

Service Code	HCPCS 43276
Min. Negotiated Rate	$301.82
Max. Negotiated Rate	$1,020.60
Rate for Payer: Aetna Commercial	$641.72
Rate for Payer: BCBS Complete	$316.91
Rate for Payer: BCBS Trust/PPO	$841.58
Rate for Payer: Cash Price	$1,166.40
Rate for Payer: Cash Price	$1,166.40
Rate for Payer: Meridian Medicaid	$316.91
Rate for Payer: Priority Health Choice Medicaid	$301.82
Rate for Payer: Priority Health Cigna Priority Health	$1,020.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.45
Rate for Payer: Priority Health Narrow Network	$828.45
Rate for Payer: Priority Health SBD	$828.45
Rate for Payer: UMR Bronson Commercial	$670.68

PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD

Professional

Both

$1,868.00

Service Code	HCPCS 43265
Min. Negotiated Rate	$271.36
Max. Negotiated Rate	$1,693.20
Rate for Payer: Aetna Commercial	$577.10
Rate for Payer: BCBS Complete	$284.93
Rate for Payer: BCBS Trust/PPO	$1,693.20
Rate for Payer: Cash Price	$1,494.40
Rate for Payer: Cash Price	$1,494.40
Rate for Payer: Meridian Medicaid	$284.93
Rate for Payer: Priority Health Choice Medicaid	$271.36
Rate for Payer: Priority Health Cigna Priority Health	$1,307.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$744.37
Rate for Payer: Priority Health Narrow Network	$744.37
Rate for Payer: Priority Health SBD	$744.37
Rate for Payer: UMR Bronson Commercial	$859.28

PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING

Professional

Both

$1,082.00

Service Code	HCPCS 43260
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$949.92
Rate for Payer: Aetna Commercial	$429.07
Rate for Payer: BCBS Complete	$212.47
Rate for Payer: BCBS Trust/PPO	$949.92
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Meridian Medicaid	$212.47
Rate for Payer: Priority Health Choice Medicaid	$202.35
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$554.46
Rate for Payer: Priority Health Narrow Network	$554.46
Rate for Payer: Priority Health SBD	$554.46
Rate for Payer: UMR Bronson Commercial	$497.72

PR ERCP,INSERT STENT,BILIARY/PANC

Professional

Both

$1,672.00

Service Code	HCPCS 43268
Min. Negotiated Rate	$668.80
Max. Negotiated Rate	$1,170.40
Rate for Payer: BCBS Complete	$668.80
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Priority Health Cigna Priority Health	$1,170.40
Rate for Payer: UMR Bronson Commercial	$769.12

PR ERCP,NASOBILIARY DRAIN TUBE

Professional

Both

$1,617.00

Service Code	HCPCS 43267
Min. Negotiated Rate	$646.80
Max. Negotiated Rate	$1,131.90
Rate for Payer: BCBS Complete	$646.80
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Priority Health Cigna Priority Health	$1,131.90
Rate for Payer: UMR Bronson Commercial	$743.82

PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

Professional

Both

$1,803.00

Service Code	HCPCS 43264
Min. Negotiated Rate	$216.92
Max. Negotiated Rate	$1,262.10
Rate for Payer: Aetna Commercial	$484.52
Rate for Payer: BCBS Complete	$239.53
Rate for Payer: BCBS Trust/PPO	$216.92
Rate for Payer: Cash Price	$1,442.40
Rate for Payer: Cash Price	$1,442.40
Rate for Payer: Meridian Medicaid	$239.53
Rate for Payer: Priority Health Choice Medicaid	$228.12
Rate for Payer: Priority Health Cigna Priority Health	$1,262.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$626.19
Rate for Payer: Priority Health Narrow Network	$626.19
Rate for Payer: Priority Health SBD	$626.19
Rate for Payer: UMR Bronson Commercial	$829.38

PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT

Professional

Both

$802.00

Service Code	HCPCS 43275
Min. Negotiated Rate	$235.79
Max. Negotiated Rate	$933.51
Rate for Payer: Aetna Commercial	$501.03
Rate for Payer: BCBS Complete	$247.58
Rate for Payer: BCBS Trust/PPO	$933.51
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cash Price	$641.60
Rate for Payer: Meridian Medicaid	$247.58
Rate for Payer: Priority Health Choice Medicaid	$235.79
Rate for Payer: Priority Health Cigna Priority Health	$561.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$646.77
Rate for Payer: Priority Health Narrow Network	$646.77
Rate for Payer: Priority Health SBD	$646.77
Rate for Payer: UMR Bronson Commercial	$368.92

PR ERCP,RMV F.B./CHANGE STENT

Professional

Both

$1,660.00

Service Code	HCPCS 43269
Min. Negotiated Rate	$664.00
Max. Negotiated Rate	$1,162.00
Rate for Payer: BCBS Complete	$664.00
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Priority Health Cigna Priority Health	$1,162.00
Rate for Payer: UMR Bronson Commercial	$763.60

PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

Professional

Both

$1,401.00

Service Code	HCPCS 43274
Min. Negotiated Rate	$289.89
Max. Negotiated Rate	$980.70
Rate for Payer: Aetna Commercial	$616.54
Rate for Payer: BCBS Complete	$304.38
Rate for Payer: BCBS Trust/PPO	$813.05
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Meridian Medicaid	$304.38
Rate for Payer: Priority Health Choice Medicaid	$289.89
Rate for Payer: Priority Health Cigna Priority Health	$980.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$795.52
Rate for Payer: Priority Health Narrow Network	$795.52
Rate for Payer: Priority Health SBD	$795.52
Rate for Payer: UMR Bronson Commercial	$644.46

PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE

Professional

Both

$1,322.00

Service Code	HCPCS 43278
Min. Negotiated Rate	$271.36
Max. Negotiated Rate	$925.40
Rate for Payer: Aetna Commercial	$575.78
Rate for Payer: BCBS Complete	$284.93
Rate for Payer: BCBS Trust/PPO	$722.19
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Meridian Medicaid	$284.93
Rate for Payer: Priority Health Choice Medicaid	$271.36
Rate for Payer: Priority Health Cigna Priority Health	$925.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$743.78
Rate for Payer: Priority Health Narrow Network	$743.78
Rate for Payer: Priority Health SBD	$743.78
Rate for Payer: UMR Bronson Commercial	$608.12

PR ERCP W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$1,147.00

Service Code	HCPCS 43261
Min. Negotiated Rate	$212.36
Max. Negotiated Rate	$1,040.08
Rate for Payer: Aetna Commercial	$450.13
Rate for Payer: BCBS Complete	$222.98
Rate for Payer: BCBS Trust/PPO	$1,040.08
Rate for Payer: Cash Price	$917.60
Rate for Payer: Cash Price	$917.60
Rate for Payer: Meridian Medicaid	$222.98
Rate for Payer: Priority Health Choice Medicaid	$212.36
Rate for Payer: Priority Health Cigna Priority Health	$802.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$582.68
Rate for Payer: Priority Health Narrow Network	$582.68
Rate for Payer: Priority Health SBD	$582.68
Rate for Payer: UMR Bronson Commercial	$527.62

PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI

Professional

Both

$1,590.00

Service Code	HCPCS 43263
Min. Negotiated Rate	$224.08
Max. Negotiated Rate	$1,113.00
Rate for Payer: Aetna Commercial	$475.49
Rate for Payer: BCBS Complete	$235.28
Rate for Payer: BCBS Trust/PPO	$935.09
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Meridian Medicaid	$235.28
Rate for Payer: Priority Health Choice Medicaid	$224.08
Rate for Payer: Priority Health Cigna Priority Health	$1,113.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$615.02
Rate for Payer: Priority Health Narrow Network	$615.02
Rate for Payer: Priority Health SBD	$615.02
Rate for Payer: UMR Bronson Commercial	$731.40

PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY

Professional

Both

$1,655.00

Service Code	HCPCS 43262
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$1,187.83
Rate for Payer: Aetna Commercial	$475.36
Rate for Payer: BCBS Complete	$234.83
Rate for Payer: BCBS Trust/PPO	$1,187.83
Rate for Payer: Cash Price	$1,324.00
Rate for Payer: Cash Price	$1,324.00
Rate for Payer: Meridian Medicaid	$234.83
Rate for Payer: Priority Health Choice Medicaid	$223.65
Rate for Payer: Priority Health Cigna Priority Health	$1,158.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$614.43
Rate for Payer: Priority Health Narrow Network	$614.43
Rate for Payer: Priority Health SBD	$614.43
Rate for Payer: UMR Bronson Commercial	$761.30

PR ESCHAROTOMY EACH ADDITIONAL INCISION

Professional

Both

$425.00

Service Code	HCPCS 16036
Min. Negotiated Rate	$52.19
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$86.23
Rate for Payer: BCBS Complete	$54.80
Rate for Payer: BCBS Trust/PPO	$119.96
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Meridian Medicaid	$54.80
Rate for Payer: Priority Health Choice Medicaid	$52.19
Rate for Payer: Priority Health Cigna Priority Health	$297.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.70
Rate for Payer: Priority Health Narrow Network	$100.70
Rate for Payer: Priority Health SBD	$100.70
Rate for Payer: UMR Bronson Commercial	$195.50

PR ESCHAROTOMY FIRST INCISION

Professional

Both

$843.00

Service Code	HCPCS 16035
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$590.10
Rate for Payer: Aetna Commercial	$212.15
Rate for Payer: BCBS Complete	$130.39
Rate for Payer: BCBS Trust/PPO	$23.70
Rate for Payer: Cash Price	$674.40
Rate for Payer: Cash Price	$674.40
Rate for Payer: Meridian Medicaid	$130.39
Rate for Payer: Priority Health Choice Medicaid	$124.18
Rate for Payer: Priority Health Cigna Priority Health	$590.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$236.76
Rate for Payer: Priority Health Narrow Network	$236.76
Rate for Payer: Priority Health SBD	$236.76
Rate for Payer: UMR Bronson Commercial	$387.78

PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH

Professional

Both

$3,398.00

Service Code	HCPCS 43325
Min. Negotiated Rate	$868.19
Max. Negotiated Rate	$2,385.99
Rate for Payer: Aetna Commercial	$1,838.43
Rate for Payer: BCBS Complete	$911.60
Rate for Payer: BCBS Trust/PPO	$1,668.90
Rate for Payer: Cash Price	$2,718.40
Rate for Payer: Cash Price	$2,718.40
Rate for Payer: Meridian Medicaid	$911.60
Rate for Payer: Priority Health Choice Medicaid	$868.19
Rate for Payer: Priority Health Cigna Priority Health	$2,378.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,385.99
Rate for Payer: Priority Health Narrow Network	$2,385.99
Rate for Payer: Priority Health SBD	$2,385.99
Rate for Payer: UMR Bronson Commercial	$1,563.08

PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY

Professional

Both

$2,055.00

Service Code	HCPCS 43327
Min. Negotiated Rate	$521.85
Max. Negotiated Rate	$2,023.92
Rate for Payer: Aetna Commercial	$1,105.09
Rate for Payer: BCBS Complete	$547.94
Rate for Payer: BCBS Trust/PPO	$2,023.92
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Meridian Medicaid	$547.94
Rate for Payer: Priority Health Choice Medicaid	$521.85
Rate for Payer: Priority Health Cigna Priority Health	$1,438.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,440.54
Rate for Payer: Priority Health Narrow Network	$1,440.54
Rate for Payer: Priority Health SBD	$1,440.54
Rate for Payer: UMR Bronson Commercial	$945.30

PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE

Professional

Both

$869.00

Service Code	HCPCS 43460
Min. Negotiated Rate	$133.34
Max. Negotiated Rate	$1,198.18
Rate for Payer: Aetna Commercial	$282.44
Rate for Payer: BCBS Complete	$140.01
Rate for Payer: BCBS Trust/PPO	$1,198.18
Rate for Payer: Cash Price	$695.20
Rate for Payer: Cash Price	$695.20
Rate for Payer: Meridian Medicaid	$140.01
Rate for Payer: Priority Health Choice Medicaid	$133.34
Rate for Payer: Priority Health Cigna Priority Health	$608.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$366.31
Rate for Payer: Priority Health Narrow Network	$366.31
Rate for Payer: Priority Health SBD	$366.31
Rate for Payer: UMR Bronson Commercial	$399.74

PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION

Professional

Both

$42.00

Service Code	HCPCS 91013
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$1,265.81
Rate for Payer: Aetna Commercial	$28.42
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$1,265.81
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$29.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.13
Rate for Payer: Priority Health Narrow Network	$12.13
Rate for Payer: Priority Health SBD	$34.58
Rate for Payer: UMR Bronson Commercial	$19.32

PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT

Professional

Both

$121.00

Service Code	HCPCS 91010
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$297.78
Rate for Payer: Aetna Commercial	$236.76
Rate for Payer: Aetna Commercial	$236.76
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Complete	$150.40
Rate for Payer: BCBS Trust/PPO	$47.55
Rate for Payer: BCBS Trust/PPO	$47.55
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$300.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$300.80
Rate for Payer: Priority Health Cigna Priority Health	$263.20
Rate for Payer: Priority Health Cigna Priority Health	$84.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.89
Rate for Payer: Priority Health Narrow Network	$84.89
Rate for Payer: Priority Health Narrow Network	$84.89
Rate for Payer: Priority Health SBD	$297.78
Rate for Payer: Priority Health SBD	$297.78
Rate for Payer: UMR Bronson Commercial	$172.96
Rate for Payer: UMR Bronson Commercial	$55.66

PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ

Professional

Both

$6,395.00

Service Code	HCPCS 43287
Min. Negotiated Rate	$994.79
Max. Negotiated Rate	$6,148.42
Rate for Payer: Aetna Commercial	$4,797.22
Rate for Payer: BCBS Complete	$2,350.56
Rate for Payer: BCBS Trust/PPO	$994.79
Rate for Payer: Cash Price	$5,116.00
Rate for Payer: Cash Price	$5,116.00
Rate for Payer: Meridian Medicaid	$2,350.56
Rate for Payer: Priority Health Choice Medicaid	$2,238.63
Rate for Payer: Priority Health Cigna Priority Health	$4,476.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,148.42
Rate for Payer: Priority Health Narrow Network	$6,148.42
Rate for Payer: Priority Health SBD	$6,148.42
Rate for Payer: UMR Bronson Commercial	$2,941.70

PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ

Professional

Both

$6,475.00

Service Code	HCPCS 43286
Min. Negotiated Rate	$817.81
Max. Negotiated Rate	$5,529.88
Rate for Payer: Aetna Commercial	$4,282.47
Rate for Payer: BCBS Complete	$2,103.43
Rate for Payer: BCBS Trust/PPO	$817.81
Rate for Payer: Cash Price	$5,180.00
Rate for Payer: Cash Price	$5,180.00
Rate for Payer: Meridian Medicaid	$2,103.43
Rate for Payer: Priority Health Choice Medicaid	$2,003.27
Rate for Payer: Priority Health Cigna Priority Health	$4,532.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,529.88
Rate for Payer: Priority Health Narrow Network	$5,529.88
Rate for Payer: Priority Health SBD	$5,529.88
Rate for Payer: UMR Bronson Commercial	$2,978.50

PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ

Professional

Both

$6,360.00

Service Code	HCPCS 43288
Min. Negotiated Rate	$1,474.49
Max. Negotiated Rate	$6,492.98
Rate for Payer: Aetna Commercial	$5,050.41
Rate for Payer: BCBS Complete	$2,478.93
Rate for Payer: BCBS Trust/PPO	$1,474.49
Rate for Payer: Cash Price	$5,088.00
Rate for Payer: Cash Price	$5,088.00
Rate for Payer: Meridian Medicaid	$2,478.93
Rate for Payer: Priority Health Choice Medicaid	$2,360.89
Rate for Payer: Priority Health Cigna Priority Health	$4,452.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,492.98
Rate for Payer: Priority Health Narrow Network	$6,492.98
Rate for Payer: Priority Health SBD	$6,492.98
Rate for Payer: UMR Bronson Commercial	$2,925.60

Know your out-of-pocket cost for care.

All Charges