Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM THORACIC

Professional

Both

$2,500.74

Service Code	HCPCS 63046
Min. Negotiated Rate	$189.66
Max. Negotiated Rate	$2,096.72
Rate for Payer: Aetna Commercial	$1,585.22
Rate for Payer: BCBS Complete	$836.45
Rate for Payer: BCBS Trust/PPO	$189.66
Rate for Payer: Cash Price	$2,000.59
Rate for Payer: Cash Price	$2,000.59
Rate for Payer: Meridian Medicaid	$836.45
Rate for Payer: Priority Health Choice Medicaid	$796.62
Rate for Payer: Priority Health Cigna Priority Health	$1,750.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,096.72
Rate for Payer: Priority Health Narrow Network	$2,096.72
Rate for Payer: Priority Health SBD	$2,096.72
Rate for Payer: UMR Bronson Commercial	$1,150.34

PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL

Professional

Both

$1,686.18

Service Code	HCPCS 63655
Min. Negotiated Rate	$297.43
Max. Negotiated Rate	$1,433.67
Rate for Payer: Aetna Commercial	$1,075.11
Rate for Payer: BCBS Complete	$572.54
Rate for Payer: BCBS Trust/PPO	$297.43
Rate for Payer: Cash Price	$1,348.94
Rate for Payer: Cash Price	$1,348.94
Rate for Payer: Meridian Medicaid	$572.54
Rate for Payer: Priority Health Choice Medicaid	$545.28
Rate for Payer: Priority Health Cigna Priority Health	$1,180.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,433.67
Rate for Payer: Priority Health Narrow Network	$1,433.67
Rate for Payer: Priority Health SBD	$1,433.67
Rate for Payer: UMR Bronson Commercial	$775.64

PR LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL

Professional

Both

$6,669.00

Service Code	HCPCS 63275
Min. Negotiated Rate	$191.77
Max. Negotiated Rate	$4,668.30
Rate for Payer: Aetna Commercial	$2,334.21
Rate for Payer: BCBS Complete	$1,225.15
Rate for Payer: BCBS Trust/PPO	$191.77
Rate for Payer: Cash Price	$5,335.20
Rate for Payer: Cash Price	$5,335.20
Rate for Payer: Meridian Medicaid	$1,225.15
Rate for Payer: Priority Health Choice Medicaid	$1,166.81
Rate for Payer: Priority Health Cigna Priority Health	$4,668.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,090.44
Rate for Payer: Priority Health Narrow Network	$3,090.44
Rate for Payer: Priority Health SBD	$3,090.44
Rate for Payer: UMR Bronson Commercial	$3,067.74

PR LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR

Professional

Both

$6,090.00

Service Code	HCPCS 63277
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$4,263.00
Rate for Payer: Aetna Commercial	$2,017.05
Rate for Payer: BCBS Complete	$1,061.89
Rate for Payer: BCBS Trust/PPO	$453.81
Rate for Payer: Cash Price	$4,872.00
Rate for Payer: Cash Price	$4,872.00
Rate for Payer: Meridian Medicaid	$1,061.89
Rate for Payer: Priority Health Choice Medicaid	$1,011.32
Rate for Payer: Priority Health Cigna Priority Health	$4,263.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,670.88
Rate for Payer: Priority Health Narrow Network	$2,670.88
Rate for Payer: Priority Health SBD	$2,670.88
Rate for Payer: UMR Bronson Commercial	$2,801.40

PR LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL

Professional

Both

$5,298.00

Service Code	HCPCS 63278
Min. Negotiated Rate	$351.32
Max. Negotiated Rate	$3,708.60
Rate for Payer: Aetna Commercial	$2,058.50
Rate for Payer: BCBS Complete	$1,089.85
Rate for Payer: BCBS Trust/PPO	$351.32
Rate for Payer: Cash Price	$4,238.40
Rate for Payer: Cash Price	$4,238.40
Rate for Payer: Meridian Medicaid	$1,089.85
Rate for Payer: Priority Health Choice Medicaid	$1,037.95
Rate for Payer: Priority Health Cigna Priority Health	$3,708.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,733.17
Rate for Payer: Priority Health Narrow Network	$2,733.17
Rate for Payer: Priority Health SBD	$2,733.17
Rate for Payer: UMR Bronson Commercial	$2,437.08

PR LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC

Professional

Both

$6,788.00

Service Code	HCPCS 63276
Min. Negotiated Rate	$311.70
Max. Negotiated Rate	$4,751.60
Rate for Payer: Aetna Commercial	$2,318.43
Rate for Payer: BCBS Complete	$1,217.55
Rate for Payer: BCBS Trust/PPO	$311.70
Rate for Payer: Cash Price	$5,430.40
Rate for Payer: Cash Price	$5,430.40
Rate for Payer: Meridian Medicaid	$1,217.55
Rate for Payer: Priority Health Choice Medicaid	$1,159.57
Rate for Payer: Priority Health Cigna Priority Health	$4,751.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,054.22
Rate for Payer: Priority Health Narrow Network	$3,054.22
Rate for Payer: Priority Health SBD	$3,054.22
Rate for Payer: UMR Bronson Commercial	$3,122.48

PR LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR

Professional

Both

$5,800.00

Service Code	HCPCS 63200
Min. Negotiated Rate	$291.09
Max. Negotiated Rate	$4,060.00
Rate for Payer: Aetna Commercial	$1,964.99
Rate for Payer: BCBS Complete	$1,046.01
Rate for Payer: BCBS Trust/PPO	$291.09
Rate for Payer: Cash Price	$4,640.00
Rate for Payer: Cash Price	$4,640.00
Rate for Payer: Meridian Medicaid	$1,046.01
Rate for Payer: Priority Health Choice Medicaid	$996.20
Rate for Payer: Priority Health Cigna Priority Health	$4,060.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,609.15
Rate for Payer: Priority Health Narrow Network	$2,609.15
Rate for Payer: Priority Health SBD	$2,609.15
Rate for Payer: UMR Bronson Commercial	$2,668.00

PR LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR

Professional

Both

$4,934.00

Service Code	HCPCS 63005
Min. Negotiated Rate	$233.48
Max. Negotiated Rate	$3,453.80
Rate for Payer: Aetna Commercial	$1,542.52
Rate for Payer: BCBS Complete	$818.56
Rate for Payer: BCBS Trust/PPO	$233.48
Rate for Payer: Cash Price	$3,947.20
Rate for Payer: Cash Price	$3,947.20
Rate for Payer: Meridian Medicaid	$818.56
Rate for Payer: Priority Health Choice Medicaid	$779.58
Rate for Payer: Priority Health Cigna Priority Health	$3,453.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,049.17
Rate for Payer: Priority Health Narrow Network	$2,049.17
Rate for Payer: Priority Health SBD	$2,049.17
Rate for Payer: UMR Bronson Commercial	$2,269.64

PR LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL

Professional

Both

$2,197.00

Service Code	HCPCS 63011
Min. Negotiated Rate	$449.06
Max. Negotiated Rate	$1,861.74
Rate for Payer: Aetna Commercial	$1,416.81
Rate for Payer: BCBS Complete	$738.27
Rate for Payer: BCBS Trust/PPO	$449.06
Rate for Payer: Cash Price	$1,757.60
Rate for Payer: Cash Price	$1,757.60
Rate for Payer: Meridian Medicaid	$738.27
Rate for Payer: Priority Health Choice Medicaid	$703.11
Rate for Payer: Priority Health Cigna Priority Health	$1,537.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,861.74
Rate for Payer: Priority Health Narrow Network	$1,861.74
Rate for Payer: Priority Health SBD	$1,861.74
Rate for Payer: UMR Bronson Commercial	$1,010.62

PR LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC

Professional

Both

$6,062.00

Service Code	HCPCS 63003
Min. Negotiated Rate	$194.94
Max. Negotiated Rate	$4,243.40
Rate for Payer: Aetna Commercial	$1,595.23
Rate for Payer: BCBS Complete	$840.47
Rate for Payer: BCBS Trust/PPO	$194.94
Rate for Payer: Cash Price	$4,849.60
Rate for Payer: Cash Price	$4,849.60
Rate for Payer: Meridian Medicaid	$840.47
Rate for Payer: Priority Health Choice Medicaid	$800.45
Rate for Payer: Priority Health Cigna Priority Health	$4,243.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,107.48
Rate for Payer: Priority Health Narrow Network	$2,107.48
Rate for Payer: Priority Health SBD	$2,107.48
Rate for Payer: UMR Bronson Commercial	$2,788.52

PR LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL

Professional

Both

$6,133.00

Service Code	HCPCS 63015
Min. Negotiated Rate	$422.11
Max. Negotiated Rate	$4,293.10
Rate for Payer: Aetna Commercial	$1,910.12
Rate for Payer: BCBS Complete	$1,009.33
Rate for Payer: BCBS Trust/PPO	$422.11
Rate for Payer: Cash Price	$4,906.40
Rate for Payer: Cash Price	$4,906.40
Rate for Payer: Meridian Medicaid	$1,009.33
Rate for Payer: Priority Health Choice Medicaid	$961.27
Rate for Payer: Priority Health Cigna Priority Health	$4,293.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,529.89
Rate for Payer: Priority Health Narrow Network	$2,529.89
Rate for Payer: Priority Health SBD	$2,529.89
Rate for Payer: UMR Bronson Commercial	$2,821.18

PR LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR

Professional

Both

$6,135.00

Service Code	HCPCS 63017
Min. Negotiated Rate	$263.09
Max. Negotiated Rate	$4,294.50
Rate for Payer: Aetna Commercial	$1,628.24
Rate for Payer: BCBS Complete	$863.07
Rate for Payer: BCBS Trust/PPO	$263.09
Rate for Payer: Cash Price	$4,908.00
Rate for Payer: Cash Price	$4,908.00
Rate for Payer: Meridian Medicaid	$863.07
Rate for Payer: Priority Health Choice Medicaid	$821.97
Rate for Payer: Priority Health Cigna Priority Health	$4,294.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,164.11
Rate for Payer: Priority Health Narrow Network	$2,164.11
Rate for Payer: Priority Health SBD	$2,164.11
Rate for Payer: UMR Bronson Commercial	$2,822.10

PR LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC

Professional

Both

$6,640.00

Service Code	HCPCS 63016
Min. Negotiated Rate	$313.28
Max. Negotiated Rate	$4,648.00
Rate for Payer: Aetna Commercial	$1,969.01
Rate for Payer: BCBS Complete	$1,037.74
Rate for Payer: BCBS Trust/PPO	$313.28
Rate for Payer: Cash Price	$5,312.00
Rate for Payer: Cash Price	$5,312.00
Rate for Payer: Meridian Medicaid	$1,037.74
Rate for Payer: Priority Health Choice Medicaid	$988.32
Rate for Payer: Priority Health Cigna Priority Health	$4,648.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,610.29
Rate for Payer: Priority Health Narrow Network	$2,610.29
Rate for Payer: Priority Health SBD	$2,610.29
Rate for Payer: UMR Bronson Commercial	$3,054.40

PR LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS

Professional

Both

$5,671.00

Service Code	HCPCS 63185
Min. Negotiated Rate	$801.95
Max. Negotiated Rate	$4,716.13
Rate for Payer: Aetna Commercial	$1,466.36
Rate for Payer: BCBS Complete	$842.05
Rate for Payer: BCBS Trust/PPO	$4,716.13
Rate for Payer: Cash Price	$4,536.80
Rate for Payer: Cash Price	$4,536.80
Rate for Payer: Meridian Medicaid	$842.05
Rate for Payer: Priority Health Choice Medicaid	$801.95
Rate for Payer: Priority Health Cigna Priority Health	$3,969.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,946.67
Rate for Payer: Priority Health Narrow Network	$1,946.67
Rate for Payer: Priority Health SBD	$1,946.67
Rate for Payer: UMR Bronson Commercial	$2,608.66

PR LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR

Professional

Both

$6,034.00

Service Code	HCPCS 63012
Min. Negotiated Rate	$479.17
Max. Negotiated Rate	$4,223.80
Rate for Payer: Aetna Commercial	$1,539.11
Rate for Payer: BCBS Complete	$812.07
Rate for Payer: BCBS Trust/PPO	$479.17
Rate for Payer: Cash Price	$4,827.20
Rate for Payer: Cash Price	$4,827.20
Rate for Payer: Meridian Medicaid	$812.07
Rate for Payer: Priority Health Choice Medicaid	$773.40
Rate for Payer: Priority Health Cigna Priority Health	$4,223.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,041.80
Rate for Payer: Priority Health Narrow Network	$2,041.80
Rate for Payer: Priority Health SBD	$2,041.80
Rate for Payer: UMR Bronson Commercial	$2,775.64

PR LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE

Professional

Both

$2,188.00

Service Code	HCPCS 63191
Min. Negotiated Rate	$243.55
Max. Negotiated Rate	$2,369.65
Rate for Payer: Aetna Commercial	$1,782.81
Rate for Payer: BCBS Complete	$945.37
Rate for Payer: BCBS Trust/PPO	$243.55
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Meridian Medicaid	$945.37
Rate for Payer: Priority Health Choice Medicaid	$900.35
Rate for Payer: Priority Health Cigna Priority Health	$1,531.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,369.65
Rate for Payer: Priority Health Narrow Network	$2,369.65
Rate for Payer: Priority Health SBD	$2,369.65
Rate for Payer: UMR Bronson Commercial	$1,006.48

PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC

Professional

Both

$5,633.00

Service Code	HCPCS 63020
Min. Negotiated Rate	$230.34
Max. Negotiated Rate	$3,943.10
Rate for Payer: Aetna Commercial	$1,495.35
Rate for Payer: BCBS Complete	$746.99
Rate for Payer: BCBS Trust/PPO	$230.34
Rate for Payer: Cash Price	$4,506.40
Rate for Payer: Cash Price	$4,506.40
Rate for Payer: Meridian Medicaid	$746.99
Rate for Payer: Priority Health Choice Medicaid	$711.42
Rate for Payer: Priority Health Cigna Priority Health	$3,943.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,871.37
Rate for Payer: Priority Health Narrow Network	$1,871.37
Rate for Payer: Priority Health SBD	$1,871.37
Rate for Payer: UMR Bronson Commercial	$2,591.18

PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR

Professional

Both

$5,455.00

Service Code	HCPCS 63030
Min. Negotiated Rate	$318.04
Max. Negotiated Rate	$3,818.50
Rate for Payer: Aetna Commercial	$1,255.97
Rate for Payer: BCBS Complete	$622.87
Rate for Payer: BCBS Trust/PPO	$318.04
Rate for Payer: Cash Price	$4,364.00
Rate for Payer: Cash Price	$4,364.00
Rate for Payer: Meridian Medicaid	$622.87
Rate for Payer: Priority Health Choice Medicaid	$593.21
Rate for Payer: Priority Health Cigna Priority Health	$3,818.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,558.81
Rate for Payer: Priority Health Narrow Network	$1,558.81
Rate for Payer: Priority Health SBD	$1,558.81
Rate for Payer: UMR Bronson Commercial	$2,509.30

PR LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR

Professional

Both

$1,783.00

Service Code	HCPCS 63035
Min. Negotiated Rate	$148.67
Max. Negotiated Rate	$1,248.10
Rate for Payer: Aetna Commercial	$248.65
Rate for Payer: BCBS Complete	$156.10
Rate for Payer: BCBS Trust/PPO	$1,004.30
Rate for Payer: Cash Price	$1,426.40
Rate for Payer: Cash Price	$1,426.40
Rate for Payer: Meridian Medicaid	$156.10
Rate for Payer: Priority Health Choice Medicaid	$148.67
Rate for Payer: Priority Health Cigna Priority Health	$1,248.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$394.65
Rate for Payer: Priority Health Narrow Network	$394.65
Rate for Payer: Priority Health SBD	$394.65
Rate for Payer: UMR Bronson Commercial	$820.18

PR LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ

Professional

Both

$8,375.00

Service Code	HCPCS 63051
Min. Negotiated Rate	$405.21
Max. Negotiated Rate	$5,862.50
Rate for Payer: Aetna Commercial	$2,195.15
Rate for Payer: BCBS Complete	$1,144.20
Rate for Payer: BCBS Trust/PPO	$405.21
Rate for Payer: Cash Price	$6,700.00
Rate for Payer: Cash Price	$6,700.00
Rate for Payer: Meridian Medicaid	$1,144.20
Rate for Payer: Priority Health Choice Medicaid	$1,089.71
Rate for Payer: Priority Health Cigna Priority Health	$5,862.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,878.69
Rate for Payer: Priority Health Narrow Network	$2,878.69
Rate for Payer: Priority Health SBD	$2,878.69
Rate for Payer: UMR Bronson Commercial	$3,852.50

PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL

Professional

Both

$6,542.00

Service Code	HCPCS 63040
Min. Negotiated Rate	$889.06
Max. Negotiated Rate	$4,579.40
Rate for Payer: Aetna Commercial	$1,795.55
Rate for Payer: BCBS Complete	$933.51
Rate for Payer: BCBS Trust/PPO	$1,073.51
Rate for Payer: Cash Price	$5,233.60
Rate for Payer: Cash Price	$5,233.60
Rate for Payer: Meridian Medicaid	$933.51
Rate for Payer: Priority Health Choice Medicaid	$889.06
Rate for Payer: Priority Health Cigna Priority Health	$4,579.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,351.53
Rate for Payer: Priority Health Narrow Network	$2,351.53
Rate for Payer: Priority Health SBD	$2,351.53
Rate for Payer: UMR Bronson Commercial	$3,009.32

PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV

Professional

Both

$2,139.00

Service Code	HCPCS 63043
Min. Negotiated Rate	$191.17
Max. Negotiated Rate	$1,862.26
Rate for Payer: Aetna Commercial	$780.02
Rate for Payer: BCBS Complete	$200.73
Rate for Payer: BCBS Trust/PPO	$1,862.26
Rate for Payer: Cash Price	$1,711.20
Rate for Payer: Cash Price	$1,711.20
Rate for Payer: Meridian Medicaid	$200.73
Rate for Payer: Priority Health Choice Medicaid	$191.17
Rate for Payer: Priority Health Cigna Priority Health	$1,497.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,024.87
Rate for Payer: Priority Health Narrow Network	$1,024.87
Rate for Payer: Priority Health SBD	$1,024.87
Rate for Payer: UMR Bronson Commercial	$983.94

PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR

Professional

Both

$2,640.46

Service Code	HCPCS 63042
Min. Negotiated Rate	$836.88
Max. Negotiated Rate	$2,204.31
Rate for Payer: Aetna Commercial	$1,671.08
Rate for Payer: BCBS Complete	$878.72
Rate for Payer: BCBS Trust/PPO	$1,376.75
Rate for Payer: Cash Price	$2,112.37
Rate for Payer: Cash Price	$2,112.37
Rate for Payer: Meridian Medicaid	$878.72
Rate for Payer: Priority Health Choice Medicaid	$836.88
Rate for Payer: Priority Health Cigna Priority Health	$1,848.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,204.31
Rate for Payer: Priority Health Narrow Network	$2,204.31
Rate for Payer: Priority Health SBD	$2,204.31
Rate for Payer: UMR Bronson Commercial	$1,214.61

PR LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR

Professional

Both

$2,083.00

Service Code	HCPCS 63044
Min. Negotiated Rate	$179.97
Max. Negotiated Rate	$1,908.75
Rate for Payer: Aetna Commercial	$741.31
Rate for Payer: BCBS Complete	$188.97
Rate for Payer: BCBS Trust/PPO	$1,908.75
Rate for Payer: Cash Price	$1,666.40
Rate for Payer: Cash Price	$1,666.40
Rate for Payer: Meridian Medicaid	$188.97
Rate for Payer: Priority Health Choice Medicaid	$179.97
Rate for Payer: Priority Health Cigna Priority Health	$1,458.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$973.90
Rate for Payer: Priority Health Narrow Network	$973.90
Rate for Payer: Priority Health SBD	$973.90
Rate for Payer: UMR Bronson Commercial	$958.18

PR LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID

Professional

Both

$6,198.00

Service Code	HCPCS 63172
Min. Negotiated Rate	$919.73
Max. Negotiated Rate	$4,338.60
Rate for Payer: Aetna Commercial	$1,825.56
Rate for Payer: BCBS Complete	$965.72
Rate for Payer: BCBS Trust/PPO	$3,470.40
Rate for Payer: Cash Price	$4,958.40
Rate for Payer: Cash Price	$4,958.40
Rate for Payer: Meridian Medicaid	$965.72
Rate for Payer: Priority Health Choice Medicaid	$919.73
Rate for Payer: Priority Health Cigna Priority Health	$4,338.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,421.75
Rate for Payer: Priority Health Narrow Network	$2,421.75
Rate for Payer: Priority Health SBD	$2,421.75
Rate for Payer: UMR Bronson Commercial	$2,851.08

Know your out-of-pocket cost for care.

All Charges