Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT

Professional

Both

$1,145.00

Service Code	HCPCS 53855
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$2,298.11
Rate for Payer: Aetna Commercial	$105.97
Rate for Payer: BCBS Complete	$54.13
Rate for Payer: BCBS Trust/PPO	$2,298.11
Rate for Payer: Cash Price	$916.00
Rate for Payer: Cash Price	$916.00
Rate for Payer: Meridian Medicaid	$54.13
Rate for Payer: Priority Health Choice Medicaid	$51.55
Rate for Payer: Priority Health Cigna Priority Health	$801.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.69
Rate for Payer: Priority Health Narrow Network	$129.69
Rate for Payer: Priority Health SBD	$129.69
Rate for Payer: UMR Bronson Commercial	$526.70

PR INSERT TRAY W/O BAG/CATH

Professional

Both

$10.00

Service Code	HCPCS A4310
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.19
Rate for Payer: Aetna Commercial	$7.19
Rate for Payer: BCBS Complete	$4.00
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

PR INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR

Professional

Both

$2,105.00

Service Code	HCPCS 36557
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$1,473.50
Rate for Payer: Aetna Commercial	$429.02
Rate for Payer: BCBS Complete	$214.70
Rate for Payer: BCBS Trust/PPO	$660.90
Rate for Payer: Cash Price	$1,684.00
Rate for Payer: Cash Price	$1,684.00
Rate for Payer: Meridian Medicaid	$214.70
Rate for Payer: Priority Health Choice Medicaid	$204.48
Rate for Payer: Priority Health Cigna Priority Health	$1,473.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$506.43
Rate for Payer: Priority Health Narrow Network	$506.43
Rate for Payer: Priority Health SBD	$506.43
Rate for Payer: UMR Bronson Commercial	$968.30

PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I

Professional

Both

$2,720.00

Service Code	HCPCS 37191
Min. Negotiated Rate	$136.75
Max. Negotiated Rate	$1,904.00
Rate for Payer: Aetna Commercial	$297.44
Rate for Payer: BCBS Complete	$143.59
Rate for Payer: BCBS Trust/PPO	$1,200.83
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Meridian Medicaid	$143.59
Rate for Payer: Priority Health Choice Medicaid	$136.75
Rate for Payer: Priority Health Cigna Priority Health	$1,904.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.64
Rate for Payer: Priority Health Narrow Network	$343.64
Rate for Payer: Priority Health SBD	$343.64
Rate for Payer: UMR Bronson Commercial	$1,251.20

PR IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART

Professional

Both

$3,244.00

Service Code	HCPCS 35585
Min. Negotiated Rate	$1,040.29
Max. Negotiated Rate	$2,589.04
Rate for Payer: Aetna Commercial	$2,251.28
Rate for Payer: BCBS Complete	$1,092.30
Rate for Payer: BCBS Trust/PPO	$1,109.96
Rate for Payer: Cash Price	$2,595.20
Rate for Payer: Cash Price	$2,595.20
Rate for Payer: Meridian Medicaid	$1,092.30
Rate for Payer: Priority Health Choice Medicaid	$1,040.29
Rate for Payer: Priority Health Cigna Priority Health	$2,270.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,589.04
Rate for Payer: Priority Health Narrow Network	$2,589.04
Rate for Payer: Priority Health SBD	$2,589.04
Rate for Payer: UMR Bronson Commercial	$1,492.24

PR IN-SITU VEIN BYPASS FEMORAL-POPLITEAL

Professional

Both

$4,573.00

Service Code	HCPCS 35583
Min. Negotiated Rate	$898.43
Max. Negotiated Rate	$3,201.10
Rate for Payer: Aetna Commercial	$1,939.24
Rate for Payer: BCBS Complete	$943.35
Rate for Payer: BCBS Trust/PPO	$1,453.35
Rate for Payer: Cash Price	$3,658.40
Rate for Payer: Cash Price	$3,658.40
Rate for Payer: Meridian Medicaid	$943.35
Rate for Payer: Priority Health Choice Medicaid	$898.43
Rate for Payer: Priority Health Cigna Priority Health	$3,201.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,239.54
Rate for Payer: Priority Health Narrow Network	$2,239.54
Rate for Payer: Priority Health SBD	$2,239.54
Rate for Payer: UMR Bronson Commercial	$2,103.58

PR IN-SITU VEIN BYP POP-TIBL PRONEAL

Professional

Both

$2,795.00

Service Code	HCPCS 35587
Min. Negotiated Rate	$831.77
Max. Negotiated Rate	$2,117.72
Rate for Payer: Aetna Commercial	$1,824.84
Rate for Payer: BCBS Complete	$873.36
Rate for Payer: BCBS Trust/PPO	$1,028.60
Rate for Payer: Cash Price	$2,236.00
Rate for Payer: Cash Price	$2,236.00
Rate for Payer: Meridian Medicaid	$873.36
Rate for Payer: Priority Health Choice Medicaid	$831.77
Rate for Payer: Priority Health Cigna Priority Health	$1,956.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,117.72
Rate for Payer: Priority Health Narrow Network	$2,117.72
Rate for Payer: Priority Health SBD	$2,117.72
Rate for Payer: UMR Bronson Commercial	$1,285.70

PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

Professional

Both

$1,217.00

Service Code	HCPCS 33216
Min. Negotiated Rate	$233.87
Max. Negotiated Rate	$1,885.50
Rate for Payer: Aetna Commercial	$497.89
Rate for Payer: BCBS Complete	$245.56
Rate for Payer: BCBS Trust/PPO	$1,885.50
Rate for Payer: Cash Price	$973.60
Rate for Payer: Cash Price	$973.60
Rate for Payer: Meridian Medicaid	$245.56
Rate for Payer: Priority Health Choice Medicaid	$233.87
Rate for Payer: Priority Health Cigna Priority Health	$851.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$586.76
Rate for Payer: Priority Health Narrow Network	$586.76
Rate for Payer: Priority Health SBD	$586.76
Rate for Payer: UMR Bronson Commercial	$559.82

PR INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

Professional

Both

$1,217.00

Service Code	HCPCS 33217
Min. Negotiated Rate	$232.17
Max. Negotiated Rate	$1,400.52
Rate for Payer: Aetna Commercial	$493.05
Rate for Payer: BCBS Complete	$243.78
Rate for Payer: BCBS Trust/PPO	$1,400.52
Rate for Payer: Cash Price	$973.60
Rate for Payer: Cash Price	$973.60
Rate for Payer: Meridian Medicaid	$243.78
Rate for Payer: Priority Health Choice Medicaid	$232.17
Rate for Payer: Priority Health Cigna Priority Health	$851.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$580.90
Rate for Payer: Priority Health Narrow Network	$580.90
Rate for Payer: Priority Health SBD	$580.90
Rate for Payer: UMR Bronson Commercial	$559.82

PR INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD

Professional

Both

$535.00

Service Code	HCPCS 22853
Min. Negotiated Rate	$89.99
Max. Negotiated Rate	$392.17
Rate for Payer: Aetna Commercial	$347.96
Rate for Payer: BCBS Complete	$172.21
Rate for Payer: BCBS Trust/PPO	$89.99
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cash Price	$428.00
Rate for Payer: Meridian Medicaid	$172.21
Rate for Payer: Priority Health Choice Medicaid	$164.01
Rate for Payer: Priority Health Cigna Priority Health	$374.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$392.17
Rate for Payer: Priority Health Narrow Network	$392.17
Rate for Payer: Priority Health SBD	$392.17
Rate for Payer: UMR Bronson Commercial	$246.10

PR INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD

Professional

Both

$2,242.00

Service Code	HCPCS 22859
Min. Negotiated Rate	$133.29
Max. Negotiated Rate	$1,569.40
Rate for Payer: Aetna Commercial	$449.13
Rate for Payer: BCBS Complete	$222.76
Rate for Payer: BCBS Trust/PPO	$133.29
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Meridian Medicaid	$222.76
Rate for Payer: Priority Health Choice Medicaid	$212.15
Rate for Payer: Priority Health Cigna Priority Health	$1,569.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$506.05
Rate for Payer: Priority Health Narrow Network	$506.05
Rate for Payer: Priority Health SBD	$506.05
Rate for Payer: UMR Bronson Commercial	$1,031.32

PR INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD

Professional

Both

$866.00

Service Code	HCPCS 22854
Min. Negotiated Rate	$69.19
Max. Negotiated Rate	$606.20
Rate for Payer: Aetna Commercial	$450.55
Rate for Payer: BCBS Complete	$224.32
Rate for Payer: BCBS Trust/PPO	$69.19
Rate for Payer: Cash Price	$692.80
Rate for Payer: Cash Price	$692.80
Rate for Payer: Meridian Medicaid	$224.32
Rate for Payer: Priority Health Choice Medicaid	$213.64
Rate for Payer: Priority Health Cigna Priority Health	$606.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$510.13
Rate for Payer: Priority Health Narrow Network	$510.13
Rate for Payer: Priority Health SBD	$510.13
Rate for Payer: UMR Bronson Commercial	$398.36

PR INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL

Professional

Both

$1,454.00

Service Code	HCPCS 36810
Min. Negotiated Rate	$131.85
Max. Negotiated Rate	$1,017.80
Rate for Payer: Aetna Commercial	$285.92
Rate for Payer: BCBS Complete	$138.44
Rate for Payer: BCBS Trust/PPO	$1,011.69
Rate for Payer: Cash Price	$1,163.20
Rate for Payer: Cash Price	$1,163.20
Rate for Payer: Meridian Medicaid	$138.44
Rate for Payer: Priority Health Choice Medicaid	$131.85
Rate for Payer: Priority Health Cigna Priority Health	$1,017.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$328.21
Rate for Payer: Priority Health Narrow Network	$328.21
Rate for Payer: Priority Health SBD	$328.21
Rate for Payer: UMR Bronson Commercial	$668.84

PR INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN

Professional

Both

$652.00

Service Code	HCPCS 36800
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$720.07
Rate for Payer: Aetna Commercial	$164.38
Rate for Payer: BCBS Complete	$79.62
Rate for Payer: BCBS Trust/PPO	$720.07
Rate for Payer: Cash Price	$521.60
Rate for Payer: Cash Price	$521.60
Rate for Payer: Meridian Medicaid	$79.62
Rate for Payer: Priority Health Choice Medicaid	$75.83
Rate for Payer: Priority Health Cigna Priority Health	$456.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$188.85
Rate for Payer: Priority Health Narrow Network	$188.85
Rate for Payer: Priority Health SBD	$188.85
Rate for Payer: UMR Bronson Commercial	$299.92

PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN

Professional

Both

$1,587.00

Service Code	HCPCS 33224
Min. Negotiated Rate	$319.29
Max. Negotiated Rate	$1,392.07
Rate for Payer: Aetna Commercial	$692.69
Rate for Payer: BCBS Complete	$335.25
Rate for Payer: BCBS Trust/PPO	$1,392.07
Rate for Payer: Cash Price	$1,269.60
Rate for Payer: Cash Price	$1,269.60
Rate for Payer: Meridian Medicaid	$335.25
Rate for Payer: Priority Health Choice Medicaid	$319.29
Rate for Payer: Priority Health Cigna Priority Health	$1,110.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$803.79
Rate for Payer: Priority Health Narrow Network	$803.79
Rate for Payer: Priority Health SBD	$803.79
Rate for Payer: UMR Bronson Commercial	$730.02

PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN

Professional

Both

$967.00

Service Code	HCPCS 33225
Min. Negotiated Rate	$287.76
Max. Negotiated Rate	$1,409.50
Rate for Payer: Aetna Commercial	$629.62
Rate for Payer: BCBS Complete	$302.15
Rate for Payer: BCBS Trust/PPO	$1,409.50
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Meridian Medicaid	$302.15
Rate for Payer: Priority Health Choice Medicaid	$287.76
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$726.66
Rate for Payer: Priority Health Narrow Network	$726.66
Rate for Payer: Priority Health SBD	$726.66
Rate for Payer: UMR Bronson Commercial	$444.82

PR INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS

Professional

Both

$8,044.00

Service Code	HCPCS 33335
Min. Negotiated Rate	$818.87
Max. Negotiated Rate	$5,630.80
Rate for Payer: Aetna Commercial	$2,508.48
Rate for Payer: BCBS Complete	$1,224.93
Rate for Payer: BCBS Trust/PPO	$818.87
Rate for Payer: Cash Price	$6,435.20
Rate for Payer: Cash Price	$6,435.20
Rate for Payer: Meridian Medicaid	$1,224.93
Rate for Payer: Priority Health Choice Medicaid	$1,166.60
Rate for Payer: Priority Health Cigna Priority Health	$5,630.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,909.81
Rate for Payer: Priority Health Narrow Network	$2,909.81
Rate for Payer: Priority Health SBD	$2,909.81
Rate for Payer: UMR Bronson Commercial	$3,700.24

PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$3,056.00

Service Code	HCPCS 53445
Min. Negotiated Rate	$482.66
Max. Negotiated Rate	$3,567.61
Rate for Payer: Aetna Commercial	$968.30
Rate for Payer: BCBS Complete	$506.79
Rate for Payer: BCBS Trust/PPO	$3,567.61
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Meridian Medicaid	$506.79
Rate for Payer: Priority Health Choice Medicaid	$482.66
Rate for Payer: Priority Health Cigna Priority Health	$2,139.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,208.24
Rate for Payer: Priority Health Narrow Network	$1,208.24
Rate for Payer: Priority Health SBD	$1,208.24
Rate for Payer: UMR Bronson Commercial	$1,405.76

PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN

Professional

Both

$1,331.00

Service Code	HCPCS 33970
Min. Negotiated Rate	$219.82
Max. Negotiated Rate	$979.47
Rate for Payer: Aetna Commercial	$474.61
Rate for Payer: BCBS Complete	$230.81
Rate for Payer: BCBS Trust/PPO	$979.47
Rate for Payer: Cash Price	$1,064.80
Rate for Payer: Cash Price	$1,064.80
Rate for Payer: Meridian Medicaid	$230.81
Rate for Payer: Priority Health Choice Medicaid	$219.82
Rate for Payer: Priority Health Cigna Priority Health	$931.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$550.04
Rate for Payer: Priority Health Narrow Network	$550.04
Rate for Payer: Priority Health SBD	$550.04
Rate for Payer: UMR Bronson Commercial	$612.26

PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE

Professional

Both

$803.00

Service Code	HCPCS 57267
Min. Negotiated Rate	$158.90
Max. Negotiated Rate	$1,692.14
Rate for Payer: Aetna Commercial	$302.10
Rate for Payer: BCBS Complete	$166.84
Rate for Payer: BCBS Trust/PPO	$1,692.14
Rate for Payer: Cash Price	$642.40
Rate for Payer: Cash Price	$642.40
Rate for Payer: Meridian Medicaid	$166.84
Rate for Payer: Priority Health Choice Medicaid	$158.90
Rate for Payer: Priority Health Cigna Priority Health	$562.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$352.23
Rate for Payer: Priority Health Narrow Network	$352.23
Rate for Payer: Priority Health SBD	$352.23
Rate for Payer: UMR Bronson Commercial	$369.38

PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH

Professional

Both

$1,437.00

Service Code	HCPCS 54405
Min. Negotiated Rate	$156.83
Max. Negotiated Rate	$1,288.75
Rate for Payer: Aetna Commercial	$1,038.16
Rate for Payer: BCBS Complete	$539.45
Rate for Payer: BCBS Trust/PPO	$156.83
Rate for Payer: Cash Price	$1,149.60
Rate for Payer: Cash Price	$1,149.60
Rate for Payer: Meridian Medicaid	$539.45
Rate for Payer: Priority Health Choice Medicaid	$513.76
Rate for Payer: Priority Health Cigna Priority Health	$1,005.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,288.75
Rate for Payer: Priority Health Narrow Network	$1,288.75
Rate for Payer: Priority Health SBD	$1,288.75
Rate for Payer: UMR Bronson Commercial	$661.02

PR INSJ NON-NDWELLG BLADDER CATHETER

Professional

Both

$159.00

Service Code	HCPCS 51701
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$661.43
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: BCBS Complete	$17.00
Rate for Payer: BCBS Trust/PPO	$661.43
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Meridian Medicaid	$17.00
Rate for Payer: Priority Health Choice Medicaid	$16.19
Rate for Payer: Priority Health Cigna Priority Health	$111.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.53
Rate for Payer: Priority Health Narrow Network	$40.53
Rate for Payer: Priority Health SBD	$40.53
Rate for Payer: UMR Bronson Commercial	$73.14

PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y

Professional

Both

$983.00

Service Code	HCPCS 36555
Min. Negotiated Rate	$52.82
Max. Negotiated Rate	$898.64
Rate for Payer: Aetna Commercial	$113.71
Rate for Payer: BCBS Complete	$55.46
Rate for Payer: BCBS Trust/PPO	$898.64
Rate for Payer: Cash Price	$786.40
Rate for Payer: Cash Price	$786.40
Rate for Payer: Meridian Medicaid	$55.46
Rate for Payer: Priority Health Choice Medicaid	$52.82
Rate for Payer: Priority Health Cigna Priority Health	$688.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$132.46
Rate for Payer: Priority Health Narrow Network	$132.46
Rate for Payer: Priority Health SBD	$132.46
Rate for Payer: UMR Bronson Commercial	$452.18

PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>

Professional

Both

$842.00

Service Code	HCPCS 36556
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$589.40
Rate for Payer: Aetna Commercial	$113.58
Rate for Payer: BCBS Complete	$55.69
Rate for Payer: BCBS Trust/PPO	$253.58
Rate for Payer: Cash Price	$673.60
Rate for Payer: Cash Price	$673.60
Rate for Payer: Meridian Medicaid	$55.69
Rate for Payer: Priority Health Choice Medicaid	$53.04
Rate for Payer: Priority Health Cigna Priority Health	$589.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$131.93
Rate for Payer: Priority Health Narrow Network	$131.93
Rate for Payer: Priority Health SBD	$131.93
Rate for Payer: UMR Bronson Commercial	$387.32

PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID

Professional

Both

$1,565.00

Service Code	HCPCS 54400
Min. Negotiated Rate	$199.17
Max. Negotiated Rate	$1,095.50
Rate for Payer: Aetna Commercial	$681.16
Rate for Payer: BCBS Complete	$356.95
Rate for Payer: BCBS Trust/PPO	$199.17
Rate for Payer: Cash Price	$1,252.00
Rate for Payer: Cash Price	$1,252.00
Rate for Payer: Meridian Medicaid	$356.95
Rate for Payer: Priority Health Choice Medicaid	$339.95
Rate for Payer: Priority Health Cigna Priority Health	$1,095.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$850.52
Rate for Payer: Priority Health Narrow Network	$850.52
Rate for Payer: Priority Health SBD	$850.52
Rate for Payer: UMR Bronson Commercial	$719.90

Know your out-of-pocket cost for care.

All Charges