Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR GROUP PSYCHOTHERAPY

Professional

Both

$54.00

Service Code	HCPCS 90853
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$1,235.69
Rate for Payer: Aetna Commercial	$46.80
Rate for Payer: BCBS Complete	$16.11
Rate for Payer: BCBS Trust/PPO	$1,235.69
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Meridian Medicaid	$16.11
Rate for Payer: Priority Health Choice Medicaid	$15.34
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$33.48
Rate for Payer: Priority Health Narrow Network	$33.48
Rate for Payer: Priority Health SBD	$33.48
Rate for Payer: UMR Bronson Commercial	$24.84

PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY

Professional

Both

$2,557.00

Service Code	HCPCS 43631
Min. Negotiated Rate	$790.34
Max. Negotiated Rate	$2,538.28
Rate for Payer: Aetna Commercial	$1,960.99
Rate for Payer: BCBS Complete	$972.21
Rate for Payer: BCBS Trust/PPO	$790.34
Rate for Payer: Cash Price	$2,045.60
Rate for Payer: Cash Price	$2,045.60
Rate for Payer: Meridian Medicaid	$972.21
Rate for Payer: Priority Health Choice Medicaid	$925.91
Rate for Payer: Priority Health Cigna Priority Health	$1,789.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,538.28
Rate for Payer: Priority Health Narrow Network	$2,538.28
Rate for Payer: Priority Health SBD	$2,538.28
Rate for Payer: UMR Bronson Commercial	$1,176.22

PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY

Professional

Both

$3,687.00

Service Code	HCPCS 43632
Min. Negotiated Rate	$979.00
Max. Negotiated Rate	$3,565.47
Rate for Payer: Aetna Commercial	$2,747.05
Rate for Payer: BCBS Complete	$1,362.03
Rate for Payer: BCBS Trust/PPO	$979.00
Rate for Payer: Cash Price	$2,949.60
Rate for Payer: Cash Price	$2,949.60
Rate for Payer: Meridian Medicaid	$1,362.03
Rate for Payer: Priority Health Choice Medicaid	$1,297.17
Rate for Payer: Priority Health Cigna Priority Health	$2,580.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,565.47
Rate for Payer: Priority Health Narrow Network	$3,565.47
Rate for Payer: Priority Health SBD	$3,565.47
Rate for Payer: UMR Bronson Commercial	$1,696.02

PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ

Professional

Both

$3,378.00

Service Code	HCPCS 43633
Min. Negotiated Rate	$1,227.31
Max. Negotiated Rate	$3,367.91
Rate for Payer: Aetna Commercial	$2,599.01
Rate for Payer: BCBS Complete	$1,288.68
Rate for Payer: BCBS Trust/PPO	$1,591.24
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Meridian Medicaid	$1,288.68
Rate for Payer: Priority Health Choice Medicaid	$1,227.31
Rate for Payer: Priority Health Cigna Priority Health	$2,364.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,367.91
Rate for Payer: Priority Health Narrow Network	$3,367.91
Rate for Payer: Priority Health SBD	$3,367.91
Rate for Payer: UMR Bronson Commercial	$1,553.88

PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY

Professional

Both

$6,486.00

Service Code	HCPCS 43620
Min. Negotiated Rate	$734.87
Max. Negotiated Rate	$4,540.20
Rate for Payer: Aetna Commercial	$2,685.76
Rate for Payer: BCBS Complete	$1,326.92
Rate for Payer: BCBS Trust/PPO	$734.87
Rate for Payer: Cash Price	$5,188.80
Rate for Payer: Cash Price	$5,188.80
Rate for Payer: Meridian Medicaid	$1,326.92
Rate for Payer: Priority Health Choice Medicaid	$1,263.73
Rate for Payer: Priority Health Cigna Priority Health	$4,540.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,473.75
Rate for Payer: Priority Health Narrow Network	$3,473.75
Rate for Payer: Priority Health SBD	$3,473.75
Rate for Payer: UMR Bronson Commercial	$2,983.56

PR HAIR REDUC 1/2 LEGS

Professional

Both

$200.00

Service Code	HCPCS 00060
Hospital Revenue Code	990
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$140.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: UMR Bronson Commercial	$92.00

PR HAIR REDUC ABD TRAIL

Professional

Both

$50.00

Service Code	HCPCS 00052
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
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 HAIR REDUC BACK

Professional

Both

$300.00

Service Code	HCPCS 00054
Hospital Revenue Code	990
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: UMR Bronson Commercial	$138.00

PR HAIR REDUC BIKINI LN

Professional

Both

$50.00

Service Code	HCPCS 00055
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
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 HAIR REDUC BRAZ

Professional

Both

$125.00

Service Code	HCPCS 00056
Hospital Revenue Code	990
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$87.50
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: UMR Bronson Commercial	$57.50

PR HAIR REDUC BROW/NOSE/EARS/TOE/HND

Professional

Both

$35.00

Service Code	HCPCS 00061
Hospital Revenue Code	990
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR HAIR REDUC CHIN/NECK

Professional

Both

$50.00

Service Code	HCPCS 00057
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
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 HAIR REDUC FL FACE/SCALP/FL ABD

Professional

Both

$90.00

Service Code	HCPCS 00058
Hospital Revenue Code	990
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$63.00
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: UMR Bronson Commercial	$41.40

PR HAIR REDUC FL LEGS

Professional

Both

$400.00

Service Code	HCPCS 00059
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 HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR

Professional

Both

$100.00

Service Code	HCPCS 00053
Hospital Revenue Code	990
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$70.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: UMR Bronson Commercial	$46.00

PR HAIR REDUC LIP

Professional

Both

$35.00

Service Code	HCPCS 00062
Hospital Revenue Code	990
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR HAIR REDUC LIP & CHIN

Professional

Both

$80.00

Service Code	HCPCS 00063
Hospital Revenue Code	990
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$56.00
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: UMR Bronson Commercial	$36.80

PR HAIR REDUC UDR ARMS OR BUTTOCKS

Professional

Both

$50.00

Service Code	HCPCS 00064
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
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 HAIR REDUC UP/LOW LEGS

Professional

Both

$200.00

Service Code	HCPCS 00065
Hospital Revenue Code	990
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$140.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: UMR Bronson Commercial	$92.00

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT

Professional

Both

$1,441.00

Service Code	HCPCS 28291
Min. Negotiated Rate	$309.28
Max. Negotiated Rate	$1,803.62
Rate for Payer: Aetna Commercial	$653.60
Rate for Payer: BCBS Complete	$324.74
Rate for Payer: BCBS Trust/PPO	$1,803.62
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Meridian Medicaid	$324.74
Rate for Payer: Priority Health Choice Medicaid	$309.28
Rate for Payer: Priority Health Cigna Priority Health	$1,008.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$737.38
Rate for Payer: Priority Health Narrow Network	$737.38
Rate for Payer: Priority Health SBD	$737.38
Rate for Payer: UMR Bronson Commercial	$662.86

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT

Professional

Both

$1,212.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$297.77
Max. Negotiated Rate	$2,027.62
Rate for Payer: Aetna Commercial	$605.08
Rate for Payer: BCBS Complete	$312.66
Rate for Payer: BCBS Trust/PPO	$2,027.62
Rate for Payer: Cash Price	$969.60
Rate for Payer: Cash Price	$969.60
Rate for Payer: Meridian Medicaid	$312.66
Rate for Payer: Priority Health Choice Medicaid	$297.77
Rate for Payer: Priority Health Cigna Priority Health	$848.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$702.15
Rate for Payer: Priority Health Narrow Network	$702.15
Rate for Payer: Priority Health SBD	$702.15
Rate for Payer: UMR Bronson Commercial	$557.52

PR HAMMER TOE CREST FELT - LARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00044
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR HAMMER TOE CREST FELT - LARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00045
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR HAMMER TOE CREST FELT - MEDIUM LT

Professional

Both

$7.00

Service Code	HCPCS 00042
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR HAMMER TOE CREST FELT - MEDIUM RT

Professional

Both

$7.00

Service Code	HCPCS 00043
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

Know your out-of-pocket cost for care.

All Charges