Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR HAMMER TOE CREST FELT - SMALL LT

Professional

Both

$7.00

Service Code	HCPCS 00040
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 - SMALL RT

Professional

Both

$7.00

Service Code	HCPCS 00041
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 - XLARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00046
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 - XLARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00047
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 HAND-HELD PEFR METER

Professional

Both

$50.00

Service Code	HCPCS A4614
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$22.15
Rate for Payer: BCBS Complete	$20.00
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 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB

Professional

Both

$16.00

Service Code	HCPCS 99000
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$595.92
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Complete	$15.66
Rate for Payer: BCBS Trust/PPO	$595.92
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Meridian Medicaid	$15.66
Rate for Payer: Priority Health Choice Medicaid	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.18
Rate for Payer: Priority Health Narrow Network	$7.18
Rate for Payer: Priority Health SBD	$7.18
Rate for Payer: UMR Bronson Commercial	$7.36

PR HAND MUSCLE TEST,MANUAL

Professional

Both

$84.00

Service Code	HCPCS 95832
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$58.80
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: UMR Bronson Commercial	$38.64

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,120.00

Service Code	HCPCS 35572
Min. Negotiated Rate	$213.21
Max. Negotiated Rate	$987.92
Rate for Payer: Aetna Commercial	$465.42
Rate for Payer: BCBS Complete	$223.87
Rate for Payer: BCBS Trust/PPO	$987.92
Rate for Payer: Cash Price	$896.00
Rate for Payer: Cash Price	$896.00
Rate for Payer: Meridian Medicaid	$223.87
Rate for Payer: Priority Health Choice Medicaid	$213.21
Rate for Payer: Priority Health Cigna Priority Health	$784.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$531.42
Rate for Payer: Priority Health Narrow Network	$531.42
Rate for Payer: Priority Health SBD	$531.42
Rate for Payer: UMR Bronson Commercial	$515.20

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$544.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$380.80
Rate for Payer: Aetna Commercial	$135.10
Rate for Payer: BCBS Complete	$83.64
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cash Price	$435.20
Rate for Payer: Meridian Medicaid	$83.64
Rate for Payer: Priority Health Choice Medicaid	$79.66
Rate for Payer: Priority Health Cigna Priority Health	$380.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$151.26
Rate for Payer: Priority Health Narrow Network	$151.26
Rate for Payer: Priority Health SBD	$151.26
Rate for Payer: UMR Bronson Commercial	$250.24

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,105.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$197.66
Max. Negotiated Rate	$777.66
Rate for Payer: Aetna Commercial	$429.28
Rate for Payer: BCBS Complete	$207.54
Rate for Payer: BCBS Trust/PPO	$777.66
Rate for Payer: Cash Price	$884.00
Rate for Payer: Cash Price	$884.00
Rate for Payer: Meridian Medicaid	$207.54
Rate for Payer: Priority Health Choice Medicaid	$197.66
Rate for Payer: Priority Health Cigna Priority Health	$773.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$491.53
Rate for Payer: Priority Health Narrow Network	$491.53
Rate for Payer: Priority Health SBD	$491.53
Rate for Payer: UMR Bronson Commercial	$508.30

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$158.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$153.19
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$228.17
Rate for Payer: Priority Health Narrow Network	$228.17
Rate for Payer: Priority Health SBD	$228.17
Rate for Payer: UMR Bronson Commercial	$72.68

PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT

Professional

Both

$41.00

Service Code	HCPCS 96150
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$28.70
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$28.70
Rate for Payer: UMR Bronson Commercial	$18.86

PR HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS

Professional

Both

$40.00

Service Code	HCPCS 96151
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: UMR Bronson Commercial	$18.40

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT

Professional

Both

$38.00

Service Code	HCPCS 96155
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
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 HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT

Professional

Both

$37.00

Service Code	HCPCS 96154
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$25.90
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90
Rate for Payer: UMR Bronson Commercial	$17.02

PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV

Professional

Both

$38.00

Service Code	HCPCS 96152
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
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 HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

Professional

Both

$194.00

Service Code	HCPCS 96156
Min. Negotiated Rate	$56.02
Max. Negotiated Rate	$135.80
Rate for Payer: Aetna Commercial	$95.48
Rate for Payer: BCBS Complete	$58.82
Rate for Payer: BCBS Trust/PPO	$135.77
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Meridian Medicaid	$58.82
Rate for Payer: Priority Health Choice Medicaid	$56.02
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$111.84
Rate for Payer: Priority Health Narrow Network	$111.84
Rate for Payer: Priority Health SBD	$111.84
Rate for Payer: UMR Bronson Commercial	$89.24

PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN

Professional

Both

$125.00

Service Code	HCPCS 96170
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$97.91
Rate for Payer: Aetna Commercial	$84.24
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$66.04
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.91
Rate for Payer: Priority Health Narrow Network	$97.91
Rate for Payer: Priority Health SBD	$97.91
Rate for Payer: UMR Bronson Commercial	$57.50

PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15

Professional

Both

$56.00

Service Code	HCPCS 96171
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$102.49
Rate for Payer: Aetna Commercial	$30.11
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCBS Trust/PPO	$102.49
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Priority Health Cigna Priority Health	$39.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.48
Rate for Payer: Priority Health Narrow Network	$35.48
Rate for Payer: Priority Health SBD	$35.48
Rate for Payer: UMR Bronson Commercial	$25.76

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN

Professional

Both

$142.00

Service Code	HCPCS 96167
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$115.70
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: BCBS Complete	$41.60
Rate for Payer: BCBS Trust/PPO	$115.70
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Meridian Medicaid	$41.60
Rate for Payer: Priority Health Choice Medicaid	$39.62
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.40
Rate for Payer: Priority Health Narrow Network	$80.40
Rate for Payer: Priority Health SBD	$80.40
Rate for Payer: UMR Bronson Commercial	$65.32

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN

Professional

Both

$50.00

Service Code	HCPCS 96168
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$168.53
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: BCBS Complete	$14.76
Rate for Payer: BCBS Trust/PPO	$168.53
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Meridian Medicaid	$14.76
Rate for Payer: Priority Health Choice Medicaid	$14.06
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.30
Rate for Payer: Priority Health Narrow Network	$28.30
Rate for Payer: Priority Health SBD	$28.30
Rate for Payer: UMR Bronson Commercial	$23.00

PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN

Professional

Both

$133.00

Service Code	HCPCS 96158
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$831.54
Rate for Payer: Aetna Commercial	$65.34
Rate for Payer: BCBS Complete	$39.36
Rate for Payer: BCBS Trust/PPO	$831.54
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Meridian Medicaid	$39.36
Rate for Payer: Priority Health Choice Medicaid	$37.49
Rate for Payer: Priority Health Cigna Priority Health	$93.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.91
Rate for Payer: Priority Health Narrow Network	$75.91
Rate for Payer: Priority Health SBD	$75.91
Rate for Payer: UMR Bronson Commercial	$61.18

PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN

Professional

Both

$46.00

Service Code	HCPCS 96159
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$208.15
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCBS Trust/PPO	$208.15
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Meridian Medicaid	$13.20
Rate for Payer: Priority Health Choice Medicaid	$12.57
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.04
Rate for Payer: Priority Health Narrow Network	$26.04
Rate for Payer: Priority Health SBD	$26.04
Rate for Payer: UMR Bronson Commercial	$21.16

PR HEALTH RISK ASSESSMENT TEST

Professional

Both

$50.00

Service Code	HCPCS 99420
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 HEARING AID CHECK BINAURAL

Professional

Both

$60.00

Service Code	HCPCS 92593
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$392.83
Rate for Payer: Aetna Commercial	$39.35
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$392.83
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.41
Rate for Payer: Priority Health Narrow Network	$49.41
Rate for Payer: Priority Health SBD	$49.41
Rate for Payer: UMR Bronson Commercial	$27.60

Know your out-of-pocket cost for care.

All Charges