Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE

Professional

Both

$693.00

Service Code	HCPCS 41008
Min. Negotiated Rate	$165.50
Max. Negotiated Rate	$1,030.71
Rate for Payer: Aetna Commercial	$338.86
Rate for Payer: BCBS Complete	$173.78
Rate for Payer: BCBS Trust/PPO	$1,030.71
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Meridian Medicaid	$173.78
Rate for Payer: Priority Health Choice Medicaid	$165.50
Rate for Payer: Priority Health Cigna Priority Health	$485.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.97
Rate for Payer: Priority Health Narrow Network	$450.97
Rate for Payer: Priority Health SBD	$450.97
Rate for Payer: UMR Bronson Commercial	$318.78

PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP

Professional

Both

$110.00

Service Code	HCPCS 94610
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$1,160.68
Rate for Payer: Aetna Commercial	$61.24
Rate for Payer: BCBS Complete	$37.35
Rate for Payer: BCBS Trust/PPO	$1,160.68
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Meridian Medicaid	$37.35
Rate for Payer: Priority Health Choice Medicaid	$35.57
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.55
Rate for Payer: Priority Health Narrow Network	$74.55
Rate for Payer: Priority Health SBD	$74.55
Rate for Payer: UMR Bronson Commercial	$50.60

PR INTRAUT COPPER CONTRACEPTIVE

Professional

Both

$1,326.00

Service Code	HCPCS J7300
Min. Negotiated Rate	$609.96
Max. Negotiated Rate	$1,139.25
Rate for Payer: Aetna Commercial	$1,085.00
Rate for Payer: BCBS Complete	$1,139.25
Rate for Payer: BCBS Trust/PPO	$1,100.19
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Meridian Medicaid	$1,139.25
Rate for Payer: Priority Health Choice Medicaid	$1,085.00
Rate for Payer: Priority Health Cigna Priority Health	$928.20
Rate for Payer: UMR Bronson Commercial	$609.96

PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL

Professional

Both

$416.00

Service Code	HCPCS 37253
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$1,099.39
Rate for Payer: Aetna Commercial	$95.73
Rate for Payer: BCBS Complete	$46.07
Rate for Payer: BCBS Trust/PPO	$1,099.39
Rate for Payer: Cash Price	$332.80
Rate for Payer: Cash Price	$332.80
Rate for Payer: Meridian Medicaid	$46.07
Rate for Payer: Priority Health Choice Medicaid	$43.88
Rate for Payer: Priority Health Cigna Priority Health	$291.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$109.59
Rate for Payer: Priority Health Narrow Network	$109.59
Rate for Payer: Priority Health SBD	$109.59
Rate for Payer: UMR Bronson Commercial	$191.36

PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL

Professional

Both

$189.00

Service Code	HCPCS 37252
Min. Negotiated Rate	$55.17
Max. Negotiated Rate	$1,597.58
Rate for Payer: Aetna Commercial	$120.70
Rate for Payer: BCBS Complete	$57.93
Rate for Payer: BCBS Trust/PPO	$1,597.58
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Meridian Medicaid	$57.93
Rate for Payer: Priority Health Choice Medicaid	$55.17
Rate for Payer: Priority Health Cigna Priority Health	$132.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.31
Rate for Payer: Priority Health Narrow Network	$138.31
Rate for Payer: Priority Health SBD	$138.31
Rate for Payer: UMR Bronson Commercial	$86.94

PR INTRAVASC US DURING DX EVAL/ INTERVENTION,EA ADDN VESSEL

Professional

Both

$400.00

Service Code	HCPCS 37251
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 INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA

Professional

Both

$573.00

Service Code	HCPCS 93609
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$995.32
Rate for Payer: Aetna Commercial	$507.22
Rate for Payer: BCBS Complete	$229.20
Rate for Payer: BCBS Trust/PPO	$995.32
Rate for Payer: Cash Price	$458.40
Rate for Payer: Cash Price	$458.40
Rate for Payer: Priority Health Cigna Priority Health	$401.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.54
Rate for Payer: Priority Health Narrow Network	$147.54
Rate for Payer: Priority Health SBD	$527.24
Rate for Payer: UMR Bronson Commercial	$263.58

PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX

Professional

Both

$217.00

Service Code	HCPCS 57180
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$527.77
Rate for Payer: Aetna Commercial	$141.44
Rate for Payer: BCBS Complete	$81.86
Rate for Payer: BCBS Trust/PPO	$527.77
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Meridian Medicaid	$81.86
Rate for Payer: Priority Health Choice Medicaid	$77.96
Rate for Payer: Priority Health Cigna Priority Health	$151.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.28
Rate for Payer: Priority Health Narrow Network	$173.28
Rate for Payer: Priority Health SBD	$173.28
Rate for Payer: UMR Bronson Commercial	$99.82

PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I

Professional

Both

$371.00

Service Code	HCPCS 36901
Min. Negotiated Rate	$104.37
Max. Negotiated Rate	$647.17
Rate for Payer: Aetna Commercial	$225.47
Rate for Payer: BCBS Complete	$109.59
Rate for Payer: BCBS Trust/PPO	$647.17
Rate for Payer: Cash Price	$296.80
Rate for Payer: Cash Price	$296.80
Rate for Payer: Meridian Medicaid	$109.59
Rate for Payer: Priority Health Choice Medicaid	$104.37
Rate for Payer: Priority Health Cigna Priority Health	$259.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$261.20
Rate for Payer: Priority Health Narrow Network	$261.20
Rate for Payer: Priority Health SBD	$261.20
Rate for Payer: UMR Bronson Commercial	$170.66

PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT

Professional

Both

$756.00

Service Code	HCPCS 36903
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$1,744.97
Rate for Payer: Aetna Commercial	$423.38
Rate for Payer: BCBS Complete	$205.54
Rate for Payer: BCBS Trust/PPO	$1,744.97
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cash Price	$604.80
Rate for Payer: Meridian Medicaid	$205.54
Rate for Payer: Priority Health Choice Medicaid	$195.75
Rate for Payer: Priority Health Cigna Priority Health	$529.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$487.81
Rate for Payer: Priority Health Narrow Network	$487.81
Rate for Payer: Priority Health SBD	$487.81
Rate for Payer: UMR Bronson Commercial	$347.76

PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP

Professional

Both

$552.00

Service Code	HCPCS 36902
Min. Negotiated Rate	$148.89
Max. Negotiated Rate	$1,793.58
Rate for Payer: Aetna Commercial	$321.04
Rate for Payer: BCBS Complete	$156.33
Rate for Payer: BCBS Trust/PPO	$1,793.58
Rate for Payer: Cash Price	$441.60
Rate for Payer: Cash Price	$441.60
Rate for Payer: Meridian Medicaid	$156.33
Rate for Payer: Priority Health Choice Medicaid	$148.89
Rate for Payer: Priority Health Cigna Priority Health	$386.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$371.30
Rate for Payer: Priority Health Narrow Network	$371.30
Rate for Payer: Priority Health SBD	$371.30
Rate for Payer: UMR Bronson Commercial	$253.92

PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY

Professional

Both

$732.00

Service Code	HCPCS 36013
Min. Negotiated Rate	$78.17
Max. Negotiated Rate	$800.37
Rate for Payer: Aetna Commercial	$165.19
Rate for Payer: BCBS Complete	$82.08
Rate for Payer: BCBS Trust/PPO	$800.37
Rate for Payer: Cash Price	$585.60
Rate for Payer: Cash Price	$585.60
Rate for Payer: Meridian Medicaid	$82.08
Rate for Payer: Priority Health Choice Medicaid	$78.17
Rate for Payer: Priority Health Cigna Priority Health	$512.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.17
Rate for Payer: Priority Health Narrow Network	$194.17
Rate for Payer: Priority Health SBD	$194.17
Rate for Payer: UMR Bronson Commercial	$336.72

PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA

Professional

Both

$955.00

Service Code	HCPCS 36010
Min. Negotiated Rate	$67.52
Max. Negotiated Rate	$1,275.84
Rate for Payer: Aetna Commercial	$147.28
Rate for Payer: BCBS Complete	$70.90
Rate for Payer: BCBS Trust/PPO	$1,275.84
Rate for Payer: Cash Price	$764.00
Rate for Payer: Cash Price	$764.00
Rate for Payer: Meridian Medicaid	$70.90
Rate for Payer: Priority Health Choice Medicaid	$67.52
Rate for Payer: Priority Health Cigna Priority Health	$668.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$168.09
Rate for Payer: Priority Health Narrow Network	$168.09
Rate for Payer: Priority Health SBD	$168.09
Rate for Payer: UMR Bronson Commercial	$439.30

PR INTRODUCTION CATHETER AORTA

Professional

Both

$565.00

Service Code	HCPCS 36200
Min. Negotiated Rate	$86.69
Max. Negotiated Rate	$1,527.32
Rate for Payer: Aetna Commercial	$187.30
Rate for Payer: BCBS Complete	$91.02
Rate for Payer: BCBS Trust/PPO	$1,527.32
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cash Price	$452.00
Rate for Payer: Meridian Medicaid	$91.02
Rate for Payer: Priority Health Choice Medicaid	$86.69
Rate for Payer: Priority Health Cigna Priority Health	$395.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$215.44
Rate for Payer: Priority Health Narrow Network	$215.44
Rate for Payer: Priority Health SBD	$215.44
Rate for Payer: UMR Bronson Commercial	$259.90

PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE

Professional

Both

$136.00

Service Code	HCPCS 44500
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$1,612.90
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: BCBS Complete	$12.53
Rate for Payer: BCBS Trust/PPO	$1,612.90
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Meridian Medicaid	$12.53
Rate for Payer: Priority Health Choice Medicaid	$11.93
Rate for Payer: Priority Health Cigna Priority Health	$95.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$33.52
Rate for Payer: Priority Health Narrow Network	$33.52
Rate for Payer: Priority Health SBD	$33.52
Rate for Payer: UMR Bronson Commercial	$62.56

PR INTRODUCTION NEEDLE/INTRACATHETER VEIN

Professional

Both

$176.00

Service Code	HCPCS 36000
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$772.37
Rate for Payer: Aetna Commercial	$11.94
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$772.37
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.36
Rate for Payer: Priority Health Narrow Network	$14.36
Rate for Payer: Priority Health SBD	$14.36
Rate for Payer: UMR Bronson Commercial	$80.96

PR INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY

Professional

Both

$721.00

Service Code	HCPCS 36100
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$1,575.39
Rate for Payer: Aetna Commercial	$211.05
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$1,575.39
Rate for Payer: Cash Price	$576.80
Rate for Payer: Cash Price	$576.80
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$504.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$239.38
Rate for Payer: Priority Health Narrow Network	$239.38
Rate for Payer: Priority Health SBD	$239.38
Rate for Payer: UMR Bronson Commercial	$331.66

PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY

Professional

Both

$924.00

Service Code	HCPCS 36140
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$1,951.54
Rate for Payer: Aetna Commercial	$120.54
Rate for Payer: BCBS Complete	$58.15
Rate for Payer: BCBS Trust/PPO	$1,951.54
Rate for Payer: Cash Price	$739.20
Rate for Payer: Cash Price	$739.20
Rate for Payer: Meridian Medicaid	$58.15
Rate for Payer: Priority Health Choice Medicaid	$55.38
Rate for Payer: Priority Health Cigna Priority Health	$646.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.31
Rate for Payer: Priority Health Narrow Network	$138.31
Rate for Payer: Priority Health SBD	$138.31
Rate for Payer: UMR Bronson Commercial	$425.04

PR INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ

Professional

Both

$2,909.00

Service Code	HCPCS 44615
Min. Negotiated Rate	$190.72
Max. Negotiated Rate	$2,036.30
Rate for Payer: Aetna Commercial	$1,443.69
Rate for Payer: BCBS Complete	$714.34
Rate for Payer: BCBS Trust/PPO	$190.72
Rate for Payer: Cash Price	$2,327.20
Rate for Payer: Cash Price	$2,327.20
Rate for Payer: Meridian Medicaid	$714.34
Rate for Payer: Priority Health Choice Medicaid	$680.32
Rate for Payer: Priority Health Cigna Priority Health	$2,036.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,865.64
Rate for Payer: Priority Health Narrow Network	$1,865.64
Rate for Payer: Priority Health SBD	$1,865.64
Rate for Payer: UMR Bronson Commercial	$1,338.14

PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE

Professional

Both

$357.00

Service Code	HCPCS 31500
Min. Negotiated Rate	$88.82
Max. Negotiated Rate	$1,530.49
Rate for Payer: Aetna Commercial	$184.93
Rate for Payer: BCBS Complete	$93.26
Rate for Payer: BCBS Trust/PPO	$1,530.49
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Meridian Medicaid	$93.26
Rate for Payer: Priority Health Choice Medicaid	$88.82
Rate for Payer: Priority Health Cigna Priority Health	$249.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$193.09
Rate for Payer: Priority Health Narrow Network	$193.09
Rate for Payer: Priority Health SBD	$193.09
Rate for Payer: UMR Bronson Commercial	$164.22

PR IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES

Professional

Both

$55.00

Service Code	HCPCS 95940
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$595.92
Rate for Payer: Aetna Commercial	$36.02
Rate for Payer: BCBS Complete	$21.25
Rate for Payer: BCBS Trust/PPO	$595.92
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Meridian Medicaid	$21.25
Rate for Payer: Priority Health Choice Medicaid	$20.24
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.66
Rate for Payer: Priority Health Narrow Network	$42.66
Rate for Payer: Priority Health SBD	$42.66
Rate for Payer: UMR Bronson Commercial	$25.30

PR IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR

Professional

Both

$125.00

Service Code	HCPCS 95941
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$299.74
Rate for Payer: Aetna Commercial	$299.74
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$126.79
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: UMR Bronson Commercial	$57.50

PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES

Professional

Both

$341.00

Service Code	HCPCS 99255
Min. Negotiated Rate	$75.02
Max. Negotiated Rate	$238.70
Rate for Payer: Aetna Commercial	$208.05
Rate for Payer: BCBS Complete	$123.68
Rate for Payer: BCBS Trust/PPO	$75.02
Rate for Payer: Cash Price	$272.80
Rate for Payer: Cash Price	$272.80
Rate for Payer: Meridian Medicaid	$123.68
Rate for Payer: Priority Health Choice Medicaid	$117.79
Rate for Payer: Priority Health Cigna Priority Health	$238.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$236.44
Rate for Payer: Priority Health Narrow Network	$236.44
Rate for Payer: Priority Health SBD	$236.44
Rate for Payer: UMR Bronson Commercial	$156.86

PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES

Professional

Both

$205.00

Service Code	HCPCS 99253
Min. Negotiated Rate	$63.05
Max. Negotiated Rate	$286.87
Rate for Payer: Aetna Commercial	$119.14
Rate for Payer: BCBS Complete	$66.20
Rate for Payer: BCBS Trust/PPO	$286.87
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Meridian Medicaid	$66.20
Rate for Payer: Priority Health Choice Medicaid	$63.05
Rate for Payer: Priority Health Cigna Priority Health	$143.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$126.79
Rate for Payer: Priority Health Narrow Network	$126.79
Rate for Payer: Priority Health SBD	$126.79
Rate for Payer: UMR Bronson Commercial	$94.30

PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES

Professional

Both

$261.00

Service Code	HCPCS 99254
Min. Negotiated Rate	$87.54
Max. Negotiated Rate	$245.66
Rate for Payer: Aetna Commercial	$172.55
Rate for Payer: BCBS Complete	$91.92
Rate for Payer: BCBS Trust/PPO	$245.66
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Meridian Medicaid	$91.92
Rate for Payer: Priority Health Choice Medicaid	$87.54
Rate for Payer: Priority Health Cigna Priority Health	$182.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$176.47
Rate for Payer: Priority Health Narrow Network	$176.47
Rate for Payer: Priority Health SBD	$176.47
Rate for Payer: UMR Bronson Commercial	$120.06

Know your out-of-pocket cost for care.

All Charges