Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES

Professional

Both

$147.00

Service Code	HCPCS 99348
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$125.21
Rate for Payer: Aetna Commercial	$82.16
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: BCBS Trust/PPO	$125.21
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Priority Health Cigna Priority Health	$102.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$96.38
Rate for Payer: Priority Health Narrow Network	$96.38
Rate for Payer: Priority Health SBD	$96.38
Rate for Payer: UMR Bronson Commercial	$67.62

PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES

Professional

Both

$216.00

Service Code	HCPCS 99349
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$288.45
Rate for Payer: Aetna Commercial	$126.46
Rate for Payer: BCBS Complete	$86.40
Rate for Payer: BCBS Trust/PPO	$288.45
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Priority Health Cigna Priority Health	$151.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$161.47
Rate for Payer: Priority Health Narrow Network	$161.47
Rate for Payer: Priority Health SBD	$161.47
Rate for Payer: UMR Bronson Commercial	$99.36

PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES

Professional

Both

$99.00

Service Code	HCPCS 99347
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$728.53
Rate for Payer: Aetna Commercial	$53.66
Rate for Payer: BCBS Complete	$39.60
Rate for Payer: BCBS Trust/PPO	$728.53
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Priority Health Cigna Priority Health	$69.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.54
Rate for Payer: Priority Health Narrow Network	$56.54
Rate for Payer: Priority Health SBD	$56.54
Rate for Payer: UMR Bronson Commercial	$45.54

PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES

Professional

Both

$396.00

Service Code	HCPCS 99345
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$321.73
Rate for Payer: Aetna Commercial	$216.48
Rate for Payer: BCBS Complete	$158.40
Rate for Payer: BCBS Trust/PPO	$321.73
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$256.14
Rate for Payer: Priority Health Narrow Network	$256.14
Rate for Payer: Priority Health SBD	$256.14
Rate for Payer: UMR Bronson Commercial	$182.16

PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES

Professional

Both

$159.00

Service Code	HCPCS 99342
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$133.13
Rate for Payer: Aetna Commercial	$75.54
Rate for Payer: BCBS Complete	$63.60
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Priority Health Cigna Priority Health	$111.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.51
Rate for Payer: Priority Health Narrow Network	$98.51
Rate for Payer: Priority Health SBD	$98.51
Rate for Payer: UMR Bronson Commercial	$73.14

PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES

Professional

Both

$309.00

Service Code	HCPCS 99344
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$216.30
Rate for Payer: Aetna Commercial	$177.73
Rate for Payer: BCBS Complete	$123.60
Rate for Payer: BCBS Trust/PPO	$178.57
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Priority Health Cigna Priority Health	$216.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.04
Rate for Payer: Priority Health Narrow Network	$182.04
Rate for Payer: Priority Health SBD	$182.04
Rate for Payer: UMR Bronson Commercial	$142.14

PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES

Professional

Both

$127.00

Service Code	HCPCS 99341
Min. Negotiated Rate	$50.80
Max. Negotiated Rate	$431.62
Rate for Payer: Aetna Commercial	$53.37
Rate for Payer: BCBS Complete	$50.80
Rate for Payer: BCBS Trust/PPO	$431.62
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cash Price	$101.60
Rate for Payer: Priority Health Cigna Priority Health	$88.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.68
Rate for Payer: Priority Health Narrow Network	$61.68
Rate for Payer: Priority Health SBD	$61.68
Rate for Payer: UMR Bronson Commercial	$58.42

PR HOME SLEEP TEST/TYPE 3 PORTA

Professional

Both

$348.00

Service Code	HCPCS G0399
Min. Negotiated Rate	$58.38
Max. Negotiated Rate	$1,157.51
Rate for Payer: Aetna Commercial	$187.42
Rate for Payer: BCBS Complete	$139.20
Rate for Payer: BCBS Trust/PPO	$1,157.51
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Priority Health Cigna Priority Health	$243.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58.38
Rate for Payer: Priority Health Narrow Network	$58.38
Rate for Payer: Priority Health SBD	$136.09
Rate for Payer: UMR Bronson Commercial	$160.08

PR HOME SLEEP TEST/TYPE 4 PORTA

Professional

Both

$205.00

Service Code	HCPCS G0400
Min. Negotiated Rate	$63.78
Max. Negotiated Rate	$1,317.05
Rate for Payer: Aetna Commercial	$162.24
Rate for Payer: Aetna Commercial	$162.24
Rate for Payer: Aetna Commercial	$162.24
Rate for Payer: BCBS Complete	$82.00
Rate for Payer: BCBS Complete	$57.20
Rate for Payer: BCBS Complete	$139.20
Rate for Payer: BCBS Trust/PPO	$1,317.05
Rate for Payer: BCBS Trust/PPO	$1,317.05
Rate for Payer: BCBS Trust/PPO	$1,317.05
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Priority Health Cigna Priority Health	$143.50
Rate for Payer: Priority Health Cigna Priority Health	$243.60
Rate for Payer: Priority Health Cigna Priority Health	$100.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.78
Rate for Payer: Priority Health Narrow Network	$63.78
Rate for Payer: Priority Health Narrow Network	$63.78
Rate for Payer: Priority Health Narrow Network	$63.78
Rate for Payer: Priority Health SBD	$144.63
Rate for Payer: Priority Health SBD	$144.63
Rate for Payer: Priority Health SBD	$144.63
Rate for Payer: UMR Bronson Commercial	$94.30
Rate for Payer: UMR Bronson Commercial	$65.78
Rate for Payer: UMR Bronson Commercial	$160.08

PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES

Professional

Both

$234.00

Service Code	HCPCS 99343
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$163.80
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: Cash Price	$187.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: UMR Bronson Commercial	$107.64

PR HOPD MNTL HLT, 15-29 MIN

Professional

Both

$50.00

Service Code	HCPCS C7900
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 HOPD MNTL HLT, 30-60 MIN

Professional

Both

$50.00

Service Code	HCPCS C7901
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 HOPD MNTL HLT, EA ADDL

Professional

Both

$50.00

Service Code	HCPCS C7902
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 HOSPICE CARE SUPERVISION

Professional

Both

$187.00

Service Code	HCPCS G0182
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$139.23
Rate for Payer: Aetna Commercial	$104.90
Rate for Payer: BCBS Complete	$74.80
Rate for Payer: BCBS Trust/PPO	$19.02
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Priority Health Cigna Priority Health	$130.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$139.23
Rate for Payer: Priority Health Narrow Network	$139.23
Rate for Payer: Priority Health SBD	$139.23
Rate for Payer: UMR Bronson Commercial	$86.02

PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN

Professional

Both

$384.00

Service Code	HCPCS 99236
Min. Negotiated Rate	$131.63
Max. Negotiated Rate	$1,191.84
Rate for Payer: Aetna Commercial	$211.34
Rate for Payer: BCBS Complete	$138.21
Rate for Payer: BCBS Trust/PPO	$1,191.84
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cash Price	$307.20
Rate for Payer: Meridian Medicaid	$138.21
Rate for Payer: Priority Health Choice Medicaid	$131.63
Rate for Payer: Priority Health Cigna Priority Health	$268.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.27
Rate for Payer: Priority Health Narrow Network	$264.27
Rate for Payer: Priority Health SBD	$264.27
Rate for Payer: UMR Bronson Commercial	$176.64

PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN

Professional

Both

$310.00

Service Code	HCPCS 99235
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$218.72
Rate for Payer: Aetna Commercial	$164.50
Rate for Payer: BCBS Complete	$105.79
Rate for Payer: BCBS Trust/PPO	$218.72
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Meridian Medicaid	$105.79
Rate for Payer: Priority Health Choice Medicaid	$100.75
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$201.74
Rate for Payer: Priority Health Narrow Network	$201.74
Rate for Payer: Priority Health SBD	$201.74
Rate for Payer: UMR Bronson Commercial	$142.60

PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN

Professional

Both

$236.00

Service Code	HCPCS 99234
Min. Negotiated Rate	$61.77
Max. Negotiated Rate	$1,631.92
Rate for Payer: Aetna Commercial	$129.57
Rate for Payer: BCBS Complete	$64.86
Rate for Payer: BCBS Trust/PPO	$1,631.92
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Meridian Medicaid	$64.86
Rate for Payer: Priority Health Choice Medicaid	$61.77
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$125.07
Rate for Payer: Priority Health Narrow Network	$125.07
Rate for Payer: Priority Health SBD	$125.07
Rate for Payer: UMR Bronson Commercial	$108.56

PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN

Professional

Both

$250.00

Service Code	HCPCS 99239
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$1,216.15
Rate for Payer: Aetna Commercial	$104.19
Rate for Payer: BCBS Complete	$76.04
Rate for Payer: BCBS Trust/PPO	$1,216.15
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Meridian Medicaid	$76.04
Rate for Payer: Priority Health Choice Medicaid	$72.42
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$145.20
Rate for Payer: Priority Health Narrow Network	$145.20
Rate for Payer: Priority Health SBD	$145.20
Rate for Payer: UMR Bronson Commercial	$115.00

PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<

Professional

Both

$123.00

Service Code	HCPCS 99238
Min. Negotiated Rate	$51.33
Max. Negotiated Rate	$255.17
Rate for Payer: Aetna Commercial	$70.69
Rate for Payer: BCBS Complete	$53.90
Rate for Payer: BCBS Trust/PPO	$255.17
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Meridian Medicaid	$53.90
Rate for Payer: Priority Health Choice Medicaid	$51.33
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.37
Rate for Payer: Priority Health Narrow Network	$102.37
Rate for Payer: Priority Health SBD	$102.37
Rate for Payer: UMR Bronson Commercial	$56.58

PR HO W/O JOINTS CF

Professional

Both

$248.00

Service Code	HCPCS L3919
Min. Negotiated Rate	$99.20
Max. Negotiated Rate	$173.60
Rate for Payer: Aetna Commercial	$148.45
Rate for Payer: BCBS Complete	$99.20
Rate for Payer: Cash Price	$198.40
Rate for Payer: Cash Price	$198.40
Rate for Payer: Priority Health Cigna Priority Health	$173.60
Rate for Payer: UMR Bronson Commercial	$114.08

PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY

Professional

Both

$1,159.00

Service Code	HCPCS 46258
Min. Negotiated Rate	$311.62
Max. Negotiated Rate	$1,432.75
Rate for Payer: Aetna Commercial	$640.84
Rate for Payer: BCBS Complete	$327.20
Rate for Payer: BCBS Trust/PPO	$1,432.75
Rate for Payer: Cash Price	$927.20
Rate for Payer: Cash Price	$927.20
Rate for Payer: Meridian Medicaid	$327.20
Rate for Payer: Priority Health Choice Medicaid	$311.62
Rate for Payer: Priority Health Cigna Priority Health	$811.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$851.39
Rate for Payer: Priority Health Narrow Network	$851.39
Rate for Payer: Priority Health SBD	$851.39
Rate for Payer: UMR Bronson Commercial	$533.14

PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY

Professional

Both

$1,740.00

Service Code	HCPCS 46262
Min. Negotiated Rate	$236.15
Max. Negotiated Rate	$1,218.00
Rate for Payer: Aetna Commercial	$748.16
Rate for Payer: BCBS Complete	$396.53
Rate for Payer: BCBS Trust/PPO	$236.15
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Meridian Medicaid	$396.53
Rate for Payer: Priority Health Choice Medicaid	$377.65
Rate for Payer: Priority Health Cigna Priority Health	$1,218.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,037.77
Rate for Payer: Priority Health Narrow Network	$1,037.77
Rate for Payer: Priority Health SBD	$1,037.77
Rate for Payer: UMR Bronson Commercial	$800.40

PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU

Professional

Both

$1,698.00

Service Code	HCPCS 46261
Min. Negotiated Rate	$131.02
Max. Negotiated Rate	$1,188.60
Rate for Payer: Aetna Commercial	$701.89
Rate for Payer: BCBS Complete	$360.30
Rate for Payer: BCBS Trust/PPO	$131.02
Rate for Payer: Cash Price	$1,358.40
Rate for Payer: Cash Price	$1,358.40
Rate for Payer: Meridian Medicaid	$360.30
Rate for Payer: Priority Health Choice Medicaid	$343.14
Rate for Payer: Priority Health Cigna Priority Health	$1,188.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$934.29
Rate for Payer: Priority Health Narrow Network	$934.29
Rate for Payer: Priority Health SBD	$934.29
Rate for Payer: UMR Bronson Commercial	$781.08

PR HYALGAN SUPARTZ VISCO-3 DOSE

Professional

Both

$297.00

Service Code	HCPCS J7321
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna Commercial	$75.29
Rate for Payer: BCBS Complete	$118.80
Rate for Payer: BCBS Trust/PPO	$64.00
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: UMR Bronson Commercial	$136.62

PR HYDROCORTISONE SODIUM SUCC I

Professional

Both

$10.00

Service Code	HCPCS J1720
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$18.38
Rate for Payer: Aetna Commercial	$18.38
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$16.18
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

Know your out-of-pocket cost for care.

All Charges