Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR EXERCISE EQUIPMENT

Professional

Both

$5.00

Service Code	HCPCS A9300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR EXISION OF SUBLINGUAL GLAND

Professional

Both

$752.00

Service Code	HCPCS 42450
Min. Negotiated Rate	$235.37
Max. Negotiated Rate	$646.18
Rate for Payer: Aetna Commercial	$478.95
Rate for Payer: BCBS Complete	$247.14
Rate for Payer: BCBS Trust/PPO	$563.70
Rate for Payer: Cash Price	$601.60
Rate for Payer: Cash Price	$601.60
Rate for Payer: Meridian Medicaid	$247.14
Rate for Payer: Priority Health Choice Medicaid	$235.37
Rate for Payer: Priority Health Cigna Priority Health	$526.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$646.18
Rate for Payer: Priority Health Narrow Network	$646.18
Rate for Payer: Priority Health SBD	$646.18
Rate for Payer: UMR Bronson Commercial	$345.92

PR EXPL CONGENITAL ATRESIA BILE DUCTS

Professional

Both

$2,845.00

Service Code	HCPCS 47700
Min. Negotiated Rate	$678.34
Max. Negotiated Rate	$1,991.50
Rate for Payer: Aetna Commercial	$1,432.99
Rate for Payer: BCBS Complete	$712.99
Rate for Payer: BCBS Trust/PPO	$678.34
Rate for Payer: Cash Price	$2,276.00
Rate for Payer: Cash Price	$2,276.00
Rate for Payer: Meridian Medicaid	$712.99
Rate for Payer: Priority Health Choice Medicaid	$679.04
Rate for Payer: Priority Health Cigna Priority Health	$1,991.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,865.64
Rate for Payer: Priority Health Narrow Network	$1,865.64
Rate for Payer: Priority Health SBD	$1,865.64
Rate for Payer: UMR Bronson Commercial	$1,308.70

PR EXPLORATION EPIDIDYMIS W/WO BIOPSY

Professional

Both

$660.00

Service Code	HCPCS 54865
Min. Negotiated Rate	$231.32
Max. Negotiated Rate	$1,488.22
Rate for Payer: Aetna Commercial	$459.23
Rate for Payer: BCBS Complete	$242.89
Rate for Payer: BCBS Trust/PPO	$1,488.22
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Meridian Medicaid	$242.89
Rate for Payer: Priority Health Choice Medicaid	$231.32
Rate for Payer: Priority Health Cigna Priority Health	$462.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$577.64
Rate for Payer: Priority Health Narrow Network	$577.64
Rate for Payer: Priority Health SBD	$577.64
Rate for Payer: UMR Bronson Commercial	$303.60

PR EXPLORATION, FEMORAL ARTERY

Professional

Both

$1,532.00

Service Code	HCPCS 35721
Min. Negotiated Rate	$612.80
Max. Negotiated Rate	$1,072.40
Rate for Payer: BCBS Complete	$612.80
Rate for Payer: Cash Price	$1,225.60
Rate for Payer: Priority Health Cigna Priority Health	$1,072.40
Rate for Payer: UMR Bronson Commercial	$704.72

PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY

Professional

Both

$854.00

Service Code	HCPCS 35703
Min. Negotiated Rate	$260.71
Max. Negotiated Rate	$2,000.67
Rate for Payer: Aetna Commercial	$562.28
Rate for Payer: BCBS Complete	$273.75
Rate for Payer: BCBS Trust/PPO	$2,000.67
Rate for Payer: Cash Price	$683.20
Rate for Payer: Cash Price	$683.20
Rate for Payer: Meridian Medicaid	$273.75
Rate for Payer: Priority Health Choice Medicaid	$260.71
Rate for Payer: Priority Health Cigna Priority Health	$597.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$651.12
Rate for Payer: Priority Health Narrow Network	$651.12
Rate for Payer: Priority Health SBD	$651.12
Rate for Payer: UMR Bronson Commercial	$392.84

PR EXPLORATION N/FLWD SURG NECK ARTERY

Professional

Both

$890.00

Service Code	HCPCS 35701
Min. Negotiated Rate	$277.11
Max. Negotiated Rate	$2,119.54
Rate for Payer: Aetna Commercial	$586.02
Rate for Payer: BCBS Complete	$290.97
Rate for Payer: BCBS Trust/PPO	$2,119.54
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cash Price	$712.00
Rate for Payer: Meridian Medicaid	$290.97
Rate for Payer: Priority Health Choice Medicaid	$277.11
Rate for Payer: Priority Health Cigna Priority Health	$623.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$694.74
Rate for Payer: Priority Health Narrow Network	$694.74
Rate for Payer: Priority Health SBD	$694.74
Rate for Payer: UMR Bronson Commercial	$409.40

PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY

Professional

Both

$887.00

Service Code	HCPCS 35702
Min. Negotiated Rate	$257.73
Max. Negotiated Rate	$1,869.13
Rate for Payer: Aetna Commercial	$551.92
Rate for Payer: BCBS Complete	$270.62
Rate for Payer: BCBS Trust/PPO	$1,869.13
Rate for Payer: Cash Price	$709.60
Rate for Payer: Cash Price	$709.60
Rate for Payer: Meridian Medicaid	$270.62
Rate for Payer: Priority Health Choice Medicaid	$257.73
Rate for Payer: Priority Health Cigna Priority Health	$620.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$644.73
Rate for Payer: Priority Health Narrow Network	$644.73
Rate for Payer: Priority Health SBD	$644.73
Rate for Payer: UMR Bronson Commercial	$408.02

PR EXPLORATION OF ARTERY/VEIN

Professional

Both

$1,282.00

Service Code	HCPCS 35761
Min. Negotiated Rate	$512.80
Max. Negotiated Rate	$897.40
Rate for Payer: BCBS Complete	$512.80
Rate for Payer: Cash Price	$1,025.60
Rate for Payer: Priority Health Cigna Priority Health	$897.40
Rate for Payer: UMR Bronson Commercial	$589.72

PR EXPLORATION PENETRATING WOUND SPX CHEST

Professional

Both

$1,125.00

Service Code	HCPCS 20101
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$5,215.40
Rate for Payer: Aetna Commercial	$282.53
Rate for Payer: BCBS Complete	$140.90
Rate for Payer: BCBS Trust/PPO	$5,215.40
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Meridian Medicaid	$140.90
Rate for Payer: Priority Health Choice Medicaid	$134.19
Rate for Payer: Priority Health Cigna Priority Health	$787.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$320.17
Rate for Payer: Priority Health Narrow Network	$320.17
Rate for Payer: Priority Health SBD	$320.17
Rate for Payer: UMR Bronson Commercial	$517.50

PR EXPLORATION PENETRATING WOUND SPX EXTREMITY

Professional

Both

$1,781.00

Service Code	HCPCS 20103
Min. Negotiated Rate	$221.09
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$461.03
Rate for Payer: BCBS Complete	$232.14
Rate for Payer: BCBS Trust/PPO	$2,940.00
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Meridian Medicaid	$232.14
Rate for Payer: Priority Health Choice Medicaid	$221.09
Rate for Payer: Priority Health Cigna Priority Health	$1,246.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$525.97
Rate for Payer: Priority Health Narrow Network	$525.97
Rate for Payer: Priority Health SBD	$525.97
Rate for Payer: UMR Bronson Commercial	$819.26

PR EXPLORATION PENETRATING WOUND SPX NECK

Professional

Both

$1,901.00

Service Code	HCPCS 20100
Min. Negotiated Rate	$383.19
Max. Negotiated Rate	$5,215.40
Rate for Payer: Aetna Commercial	$810.47
Rate for Payer: BCBS Complete	$402.35
Rate for Payer: BCBS Trust/PPO	$5,215.40
Rate for Payer: Cash Price	$1,520.80
Rate for Payer: Cash Price	$1,520.80
Rate for Payer: Meridian Medicaid	$402.35
Rate for Payer: Priority Health Choice Medicaid	$383.19
Rate for Payer: Priority Health Cigna Priority Health	$1,330.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$912.03
Rate for Payer: Priority Health Narrow Network	$912.03
Rate for Payer: Priority Health SBD	$912.03
Rate for Payer: UMR Bronson Commercial	$874.46

PR EXPLORATION POPLITEAL ARTERY

Professional

Both

$1,058.00

Service Code	HCPCS 35741
Min. Negotiated Rate	$423.20
Max. Negotiated Rate	$740.60
Rate for Payer: BCBS Complete	$423.20
Rate for Payer: Cash Price	$846.40
Rate for Payer: Priority Health Cigna Priority Health	$740.60
Rate for Payer: UMR Bronson Commercial	$486.68

PR EXPLORATION SPINAL FUSION

Professional

Both

$5,074.00

Service Code	HCPCS 22830
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$3,551.80
Rate for Payer: Aetna Commercial	$1,097.19
Rate for Payer: BCBS Complete	$559.58
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$4,059.20
Rate for Payer: Cash Price	$4,059.20
Rate for Payer: Meridian Medicaid	$559.58
Rate for Payer: Priority Health Choice Medicaid	$532.93
Rate for Payer: Priority Health Cigna Priority Health	$3,551.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,264.37
Rate for Payer: Priority Health Narrow Network	$1,264.37
Rate for Payer: Priority Health SBD	$1,264.37
Rate for Payer: UMR Bronson Commercial	$2,334.04

PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX

Professional

Both

$2,307.00

Service Code	HCPCS 49000
Min. Negotiated Rate	$492.03
Max. Negotiated Rate	$1,614.90
Rate for Payer: Aetna Commercial	$1,035.31
Rate for Payer: BCBS Complete	$516.63
Rate for Payer: BCBS Trust/PPO	$576.90
Rate for Payer: Cash Price	$1,845.60
Rate for Payer: Cash Price	$1,845.60
Rate for Payer: Meridian Medicaid	$516.63
Rate for Payer: Priority Health Choice Medicaid	$492.03
Rate for Payer: Priority Health Cigna Priority Health	$1,614.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,349.99
Rate for Payer: Priority Health Narrow Network	$1,349.99
Rate for Payer: Priority Health SBD	$1,349.99
Rate for Payer: UMR Bronson Commercial	$1,061.22

PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK

Professional

Both

$1,994.00

Service Code	HCPCS 20102
Min. Negotiated Rate	$164.22
Max. Negotiated Rate	$1,395.80
Rate for Payer: Aetna Commercial	$342.28
Rate for Payer: BCBS Complete	$172.43
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$1,595.20
Rate for Payer: Cash Price	$1,595.20
Rate for Payer: Meridian Medicaid	$172.43
Rate for Payer: Priority Health Choice Medicaid	$164.22
Rate for Payer: Priority Health Cigna Priority Health	$1,395.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$387.07
Rate for Payer: Priority Health Narrow Network	$387.07
Rate for Payer: Priority Health SBD	$387.07
Rate for Payer: UMR Bronson Commercial	$917.24

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD

Professional

Both

$2,307.00

Service Code	HCPCS 35840
Min. Negotiated Rate	$771.06
Max. Negotiated Rate	$1,913.45
Rate for Payer: Aetna Commercial	$1,617.90
Rate for Payer: BCBS Complete	$809.61
Rate for Payer: BCBS Trust/PPO	$1,458.11
Rate for Payer: Cash Price	$1,845.60
Rate for Payer: Cash Price	$1,845.60
Rate for Payer: Meridian Medicaid	$809.61
Rate for Payer: Priority Health Choice Medicaid	$771.06
Rate for Payer: Priority Health Cigna Priority Health	$1,614.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,913.45
Rate for Payer: Priority Health Narrow Network	$1,913.45
Rate for Payer: Priority Health SBD	$1,913.45
Rate for Payer: UMR Bronson Commercial	$1,061.22

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH

Professional

Both

$5,481.00

Service Code	HCPCS 35820
Min. Negotiated Rate	$1,168.60
Max. Negotiated Rate	$3,836.70
Rate for Payer: Aetna Commercial	$2,700.88
Rate for Payer: BCBS Complete	$1,324.23
Rate for Payer: BCBS Trust/PPO	$1,168.60
Rate for Payer: Cash Price	$4,384.80
Rate for Payer: Cash Price	$4,384.80
Rate for Payer: Meridian Medicaid	$1,324.23
Rate for Payer: Priority Health Choice Medicaid	$1,261.17
Rate for Payer: Priority Health Cigna Priority Health	$3,836.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,139.08
Rate for Payer: Priority Health Narrow Network	$3,139.08
Rate for Payer: Priority Health SBD	$3,139.08
Rate for Payer: UMR Bronson Commercial	$2,521.26

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK

Professional

Both

$1,483.00

Service Code	HCPCS 35800
Min. Negotiated Rate	$465.62
Max. Negotiated Rate	$1,156.48
Rate for Payer: Aetna Commercial	$965.79
Rate for Payer: BCBS Complete	$488.90
Rate for Payer: BCBS Trust/PPO	$1,058.18
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Meridian Medicaid	$488.90
Rate for Payer: Priority Health Choice Medicaid	$465.62
Rate for Payer: Priority Health Cigna Priority Health	$1,038.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,156.48
Rate for Payer: Priority Health Narrow Network	$1,156.48
Rate for Payer: Priority Health SBD	$1,156.48
Rate for Payer: UMR Bronson Commercial	$682.18

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR

Professional

Both

$1,494.00

Service Code	HCPCS 35860
Min. Negotiated Rate	$528.24
Max. Negotiated Rate	$1,310.74
Rate for Payer: Aetna Commercial	$1,122.58
Rate for Payer: BCBS Complete	$554.65
Rate for Payer: BCBS Trust/PPO	$1,072.45
Rate for Payer: Cash Price	$1,195.20
Rate for Payer: Cash Price	$1,195.20
Rate for Payer: Meridian Medicaid	$554.65
Rate for Payer: Priority Health Choice Medicaid	$528.24
Rate for Payer: Priority Health Cigna Priority Health	$1,045.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,310.74
Rate for Payer: Priority Health Narrow Network	$1,310.74
Rate for Payer: Priority Health SBD	$1,310.74
Rate for Payer: UMR Bronson Commercial	$687.24

PR EXPL RETROPERITONEUM W/WO BX SPX

Professional

Both

$1,992.00

Service Code	HCPCS 49010
Min. Negotiated Rate	$588.09
Max. Negotiated Rate	$1,612.82
Rate for Payer: Aetna Commercial	$1,245.48
Rate for Payer: BCBS Complete	$617.49
Rate for Payer: BCBS Trust/PPO	$588.53
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Meridian Medicaid	$617.49
Rate for Payer: Priority Health Choice Medicaid	$588.09
Rate for Payer: Priority Health Cigna Priority Health	$1,394.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,612.82
Rate for Payer: Priority Health Narrow Network	$1,612.82
Rate for Payer: Priority Health SBD	$1,612.82
Rate for Payer: UMR Bronson Commercial	$916.32

PR EXPL RPR & PRESACRAL DRG RECTAL INJURY

Professional

Both

$3,018.00

Service Code	HCPCS 45562
Min. Negotiated Rate	$748.06
Max. Negotiated Rate	$2,112.60
Rate for Payer: Aetna Commercial	$1,516.85
Rate for Payer: BCBS Complete	$785.46
Rate for Payer: BCBS Trust/PPO	$1,130.03
Rate for Payer: Cash Price	$2,414.40
Rate for Payer: Cash Price	$2,414.40
Rate for Payer: Meridian Medicaid	$785.46
Rate for Payer: Priority Health Choice Medicaid	$748.06
Rate for Payer: Priority Health Cigna Priority Health	$2,112.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,988.53
Rate for Payer: Priority Health Narrow Network	$1,988.53
Rate for Payer: Priority Health SBD	$1,988.53
Rate for Payer: UMR Bronson Commercial	$1,388.28

PR EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL

Professional

Both

$1,274.00

Service Code	HCPCS 54560
Min. Negotiated Rate	$438.14
Max. Negotiated Rate	$3,980.21
Rate for Payer: Aetna Commercial	$882.98
Rate for Payer: BCBS Complete	$460.05
Rate for Payer: BCBS Trust/PPO	$3,980.21
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Meridian Medicaid	$460.05
Rate for Payer: Priority Health Choice Medicaid	$438.14
Rate for Payer: Priority Health Cigna Priority Health	$891.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,098.01
Rate for Payer: Priority Health Narrow Network	$1,098.01
Rate for Payer: Priority Health SBD	$1,098.01
Rate for Payer: UMR Bronson Commercial	$586.04

PR EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA

Professional

Both

$910.00

Service Code	HCPCS 54550
Min. Negotiated Rate	$314.60
Max. Negotiated Rate	$2,742.41
Rate for Payer: Aetna Commercial	$630.77
Rate for Payer: BCBS Complete	$330.33
Rate for Payer: BCBS Trust/PPO	$2,742.41
Rate for Payer: Cash Price	$728.00
Rate for Payer: Cash Price	$728.00
Rate for Payer: Meridian Medicaid	$330.33
Rate for Payer: Priority Health Choice Medicaid	$314.60
Rate for Payer: Priority Health Cigna Priority Health	$637.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$786.22
Rate for Payer: Priority Health Narrow Network	$786.22
Rate for Payer: Priority Health SBD	$786.22
Rate for Payer: UMR Bronson Commercial	$418.60

PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST

Professional

Both

$804.00

Service Code	HCPCS 25248
Min. Negotiated Rate	$277.33
Max. Negotiated Rate	$1,918.26
Rate for Payer: Aetna Commercial	$558.31
Rate for Payer: BCBS Complete	$291.20
Rate for Payer: BCBS Trust/PPO	$1,918.26
Rate for Payer: Cash Price	$643.20
Rate for Payer: Cash Price	$643.20
Rate for Payer: Meridian Medicaid	$291.20
Rate for Payer: Priority Health Choice Medicaid	$277.33
Rate for Payer: Priority Health Cigna Priority Health	$562.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$643.42
Rate for Payer: Priority Health Narrow Network	$643.42
Rate for Payer: Priority Health SBD	$643.42
Rate for Payer: UMR Bronson Commercial	$369.84

Know your out-of-pocket cost for care.

All Charges