Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL

Professional

Both

$1,484.00

Service Code	HCPCS 33206
Min. Negotiated Rate	$285.63
Max. Negotiated Rate	$1,398.41
Rate for Payer: Aetna Commercial	$610.49
Rate for Payer: BCBS Complete	$299.91
Rate for Payer: BCBS Trust/PPO	$1,398.41
Rate for Payer: Cash Price	$1,187.20
Rate for Payer: Cash Price	$1,187.20
Rate for Payer: Meridian Medicaid	$299.91
Rate for Payer: Priority Health Choice Medicaid	$285.63
Rate for Payer: Priority Health Cigna Priority Health	$1,038.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$716.55
Rate for Payer: Priority Health Narrow Network	$716.55
Rate for Payer: Priority Health SBD	$716.55
Rate for Payer: UMR Bronson Commercial	$682.64

PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT

Professional

Both

$1,632.00

Service Code	HCPCS 33208
Min. Negotiated Rate	$324.83
Max. Negotiated Rate	$1,548.45
Rate for Payer: Aetna Commercial	$698.84
Rate for Payer: BCBS Complete	$341.07
Rate for Payer: BCBS Trust/PPO	$1,548.45
Rate for Payer: Cash Price	$1,305.60
Rate for Payer: Cash Price	$1,305.60
Rate for Payer: Meridian Medicaid	$341.07
Rate for Payer: Priority Health Choice Medicaid	$324.83
Rate for Payer: Priority Health Cigna Priority Health	$1,142.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$814.96
Rate for Payer: Priority Health Narrow Network	$814.96
Rate for Payer: Priority Health SBD	$814.96
Rate for Payer: UMR Bronson Commercial	$750.72

PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR

Professional

Both

$1,780.00

Service Code	HCPCS 33207
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$1,343.47
Rate for Payer: Aetna Commercial	$643.35
Rate for Payer: BCBS Complete	$315.13
Rate for Payer: BCBS Trust/PPO	$1,343.47
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Meridian Medicaid	$315.13
Rate for Payer: Priority Health Choice Medicaid	$300.12
Rate for Payer: Priority Health Cigna Priority Health	$1,246.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$752.20
Rate for Payer: Priority Health Narrow Network	$752.20
Rate for Payer: Priority Health SBD	$752.20
Rate for Payer: UMR Bronson Commercial	$818.80

PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS

Professional

Both

$1,246.00

Service Code	HCPCS 33213
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$1,352.98
Rate for Payer: Aetna Commercial	$450.33
Rate for Payer: BCBS Complete	$223.65
Rate for Payer: BCBS Trust/PPO	$1,352.98
Rate for Payer: Cash Price	$996.80
Rate for Payer: Cash Price	$996.80
Rate for Payer: Meridian Medicaid	$223.65
Rate for Payer: Priority Health Choice Medicaid	$213.00
Rate for Payer: Priority Health Cigna Priority Health	$872.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$529.30
Rate for Payer: Priority Health Narrow Network	$529.30
Rate for Payer: Priority Health SBD	$529.30
Rate for Payer: UMR Bronson Commercial	$573.16

PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS

Professional

Both

$729.00

Service Code	HCPCS 33221
Min. Negotiated Rate	$224.93
Max. Negotiated Rate	$1,089.35
Rate for Payer: Aetna Commercial	$484.70
Rate for Payer: BCBS Complete	$236.18
Rate for Payer: BCBS Trust/PPO	$1,089.35
Rate for Payer: Cash Price	$583.20
Rate for Payer: Cash Price	$583.20
Rate for Payer: Meridian Medicaid	$236.18
Rate for Payer: Priority Health Choice Medicaid	$224.93
Rate for Payer: Priority Health Cigna Priority Health	$510.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$566.00
Rate for Payer: Priority Health Narrow Network	$566.00
Rate for Payer: Priority Health SBD	$566.00
Rate for Payer: UMR Bronson Commercial	$335.34

PR INS PM PLS GEN W/EXIST SINGLE LEAD

Professional

Both

$1,098.00

Service Code	HCPCS 33212
Min. Negotiated Rate	$203.42
Max. Negotiated Rate	$1,488.75
Rate for Payer: Aetna Commercial	$432.27
Rate for Payer: BCBS Complete	$213.59
Rate for Payer: BCBS Trust/PPO	$1,488.75
Rate for Payer: Cash Price	$878.40
Rate for Payer: Cash Price	$878.40
Rate for Payer: Meridian Medicaid	$213.59
Rate for Payer: Priority Health Choice Medicaid	$203.42
Rate for Payer: Priority Health Cigna Priority Health	$768.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$505.90
Rate for Payer: Priority Health Narrow Network	$505.90
Rate for Payer: Priority Health SBD	$505.90
Rate for Payer: UMR Bronson Commercial	$505.08

PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD

Professional

Both

$1,153.00

Service Code	HCPCS 33270
Min. Negotiated Rate	$351.45
Max. Negotiated Rate	$1,575.39
Rate for Payer: Aetna Commercial	$756.49
Rate for Payer: BCBS Complete	$369.02
Rate for Payer: BCBS Trust/PPO	$1,575.39
Rate for Payer: Cash Price	$922.40
Rate for Payer: Cash Price	$922.40
Rate for Payer: Meridian Medicaid	$369.02
Rate for Payer: Priority Health Choice Medicaid	$351.45
Rate for Payer: Priority Health Cigna Priority Health	$807.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$884.12
Rate for Payer: Priority Health Narrow Network	$884.12
Rate for Payer: Priority Health SBD	$884.12
Rate for Payer: UMR Bronson Commercial	$530.38

PR INSRT CH WALL RESPIR ELTRD/RA & CONJ PULSE GEN

Professional

Both

$475.00

Service Code	HCPCS 0466T
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$332.50
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Priority Health Cigna Priority Health	$332.50
Rate for Payer: UMR Bronson Commercial	$218.50

PR INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY

Professional

Both

$209.00

Service Code	HCPCS 32562
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$724.30
Rate for Payer: Aetna Commercial	$78.58
Rate for Payer: BCBS Complete	$39.58
Rate for Payer: BCBS Trust/PPO	$724.30
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$167.20
Rate for Payer: Meridian Medicaid	$39.58
Rate for Payer: Priority Health Choice Medicaid	$37.70
Rate for Payer: Priority Health Cigna Priority Health	$146.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$81.96
Rate for Payer: Priority Health Narrow Network	$81.96
Rate for Payer: Priority Health SBD	$81.96
Rate for Payer: UMR Bronson Commercial	$96.14

PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS

Professional

Both

$446.00

Service Code	HCPCS 32560
Min. Negotiated Rate	$47.71
Max. Negotiated Rate	$722.19
Rate for Payer: Aetna Commercial	$99.91
Rate for Payer: BCBS Complete	$50.10
Rate for Payer: BCBS Trust/PPO	$722.19
Rate for Payer: Cash Price	$356.80
Rate for Payer: Cash Price	$356.80
Rate for Payer: Meridian Medicaid	$50.10
Rate for Payer: Priority Health Choice Medicaid	$47.71
Rate for Payer: Priority Health Cigna Priority Health	$312.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.26
Rate for Payer: Priority Health Narrow Network	$103.26
Rate for Payer: Priority Health SBD	$103.26
Rate for Payer: UMR Bronson Commercial	$205.16

PR INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY

Professional

Both

$225.00

Service Code	HCPCS 32561
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$892.83
Rate for Payer: Aetna Commercial	$87.90
Rate for Payer: BCBS Complete	$44.28
Rate for Payer: BCBS Trust/PPO	$892.83
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Meridian Medicaid	$44.28
Rate for Payer: Priority Health Choice Medicaid	$42.17
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.15
Rate for Payer: Priority Health Narrow Network	$92.15
Rate for Payer: Priority Health SBD	$92.15
Rate for Payer: UMR Bronson Commercial	$103.50

PR INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT

Professional

Both

$50.00

Service Code	HCPCS 99174
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$544.15
Rate for Payer: Aetna Commercial	$5.72
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$544.15
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: Priority Health HMO/PPO/Tiered Network	$8.08
Rate for Payer: Priority Health Narrow Network	$8.08
Rate for Payer: Priority Health SBD	$8.08
Rate for Payer: UMR Bronson Commercial	$23.00

PR INSULIN INJECTION

Professional

Both

$30.00

Service Code	HCPCS J1815
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$0.05
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: UMR Bronson Commercial	$13.80

PR INT ANAST PANCREATIC CYST GI TRACT DIRECT

Professional

Both

$1,927.00

Service Code	HCPCS 48520
Min. Negotiated Rate	$260.45
Max. Negotiated Rate	$1,935.02
Rate for Payer: Aetna Commercial	$1,491.40
Rate for Payer: BCBS Complete	$738.72
Rate for Payer: BCBS Trust/PPO	$260.45
Rate for Payer: Cash Price	$1,541.60
Rate for Payer: Cash Price	$1,541.60
Rate for Payer: Meridian Medicaid	$738.72
Rate for Payer: Priority Health Choice Medicaid	$703.54
Rate for Payer: Priority Health Cigna Priority Health	$1,348.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,935.02
Rate for Payer: Priority Health Narrow Network	$1,935.02
Rate for Payer: Priority Health SBD	$1,935.02
Rate for Payer: UMR Bronson Commercial	$886.42

PR INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y

Professional

Both

$2,830.00

Service Code	HCPCS 48540
Min. Negotiated Rate	$502.41
Max. Negotiated Rate	$2,296.04
Rate for Payer: Aetna Commercial	$1,774.25
Rate for Payer: BCBS Complete	$876.71
Rate for Payer: BCBS Trust/PPO	$502.41
Rate for Payer: Cash Price	$2,264.00
Rate for Payer: Cash Price	$2,264.00
Rate for Payer: Meridian Medicaid	$876.71
Rate for Payer: Priority Health Choice Medicaid	$834.96
Rate for Payer: Priority Health Cigna Priority Health	$1,981.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,296.04
Rate for Payer: Priority Health Narrow Network	$2,296.04
Rate for Payer: Priority Health SBD	$2,296.04
Rate for Payer: UMR Bronson Commercial	$1,301.80

PR INTENSIVE OUTPATIENT PSYCHIA

Professional

Both

$127.00

Service Code	HCPCS S9480
Min. Negotiated Rate	$50.80
Max. Negotiated Rate	$820.98
Rate for Payer: Aetna Commercial	$63.28
Rate for Payer: BCBS Complete	$50.80
Rate for Payer: BCBS Trust/PPO	$820.98
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: UMR Bronson Commercial	$58.42

PR INTER DEVC REMOTE 30D

Professional

Both

$41.00

Service Code	HCPCS G2066
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$1,033.35
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$1,033.35
Rate for Payer: Cash Price	$32.80
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 INTERMITTENT URINARY CATH

Professional

Both

$11.00

Service Code	HCPCS A4353
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.70
Rate for Payer: UMR Bronson Commercial	$5.06

PR INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE

Professional

Both

$735.00

Service Code	HCPCS 64727
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$2,288.07
Rate for Payer: Aetna Commercial	$232.94
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCBS Trust/PPO	$2,288.07
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health	$514.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$301.23
Rate for Payer: Priority Health Narrow Network	$301.23
Rate for Payer: Priority Health SBD	$301.23
Rate for Payer: UMR Bronson Commercial	$338.10

PR INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS

Professional

Both

$1,194.00

Service Code	HCPCS 22841
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$835.80
Rate for Payer: Aetna Commercial	$519.10
Rate for Payer: BCBS Complete	$477.60
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$955.20
Rate for Payer: Cash Price	$955.20
Rate for Payer: Priority Health Cigna Priority Health	$835.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$596.44
Rate for Payer: Priority Health Narrow Network	$596.44
Rate for Payer: Priority Health SBD	$596.44
Rate for Payer: UMR Bronson Commercial	$549.24

PR INTERPELVIABDOMINAL AMPUTATION

Professional

Both

$5,225.00

Service Code	HCPCS 27290
Min. Negotiated Rate	$1,039.87
Max. Negotiated Rate	$3,657.50
Rate for Payer: Aetna Commercial	$2,173.74
Rate for Payer: BCBS Complete	$1,091.86
Rate for Payer: BCBS Trust/PPO	$1,174.41
Rate for Payer: Cash Price	$4,180.00
Rate for Payer: Cash Price	$4,180.00
Rate for Payer: Meridian Medicaid	$1,091.86
Rate for Payer: Priority Health Choice Medicaid	$1,039.87
Rate for Payer: Priority Health Cigna Priority Health	$3,657.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,478.19
Rate for Payer: Priority Health Narrow Network	$2,478.19
Rate for Payer: Priority Health SBD	$2,478.19
Rate for Payer: UMR Bronson Commercial	$2,403.50

PR INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY

Professional

Both

$149.00

Service Code	HCPCS 90887
Min. Negotiated Rate	$45.58
Max. Negotiated Rate	$104.30
Rate for Payer: Aetna Commercial	$83.11
Rate for Payer: BCBS Complete	$47.86
Rate for Payer: BCBS Trust/PPO	$60.75
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Meridian Medicaid	$47.86
Rate for Payer: Priority Health Choice Medicaid	$45.58
Rate for Payer: Priority Health Cigna Priority Health	$104.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.40
Rate for Payer: Priority Health Narrow Network	$98.40
Rate for Payer: Priority Health SBD	$98.40
Rate for Payer: UMR Bronson Commercial	$68.54

PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB

Professional

Both

$133.00

Service Code	HCPCS 93261
Min. Negotiated Rate	$49.17
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$89.88
Rate for Payer: BCBS Complete	$53.20
Rate for Payer: BCBS Trust/PPO	$756.00
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Priority Health Cigna Priority Health	$93.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.17
Rate for Payer: Priority Health Narrow Network	$49.17
Rate for Payer: Priority Health SBD	$99.30
Rate for Payer: UMR Bronson Commercial	$61.18

PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR

Professional

Both

$63.00

Service Code	HCPCS 93292
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$410.49
Rate for Payer: Aetna Commercial	$63.69
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCBS Trust/PPO	$410.49
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.84
Rate for Payer: Priority Health Narrow Network	$28.84
Rate for Payer: Priority Health SBD	$72.35
Rate for Payer: UMR Bronson Commercial	$28.98

PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB

Professional

Both

$197.00

Service Code	HCPCS 93295
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$274.19
Rate for Payer: Aetna Commercial	$50.04
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: BCBS Trust/PPO	$274.19
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Meridian Medicaid	$24.15
Rate for Payer: Priority Health Choice Medicaid	$23.00
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.07
Rate for Payer: Priority Health Narrow Network	$51.07
Rate for Payer: Priority Health SBD	$51.07
Rate for Payer: UMR Bronson Commercial	$90.62

Know your out-of-pocket cost for care.

All Charges