Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED

Professional

Both

$2,356.00

Service Code	HCPCS 43279
Min. Negotiated Rate	$777.66
Max. Negotiated Rate	$2,245.46
Rate for Payer: Aetna Commercial	$1,737.87
Rate for Payer: BCBS Complete	$858.36
Rate for Payer: BCBS Trust/PPO	$777.66
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Meridian Medicaid	$858.36
Rate for Payer: Priority Health Choice Medicaid	$817.49
Rate for Payer: Priority Health Cigna Priority Health	$1,649.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,245.46
Rate for Payer: Priority Health Narrow Network	$2,245.46
Rate for Payer: Priority Health SBD	$2,245.46
Rate for Payer: UMR Bronson Commercial	$1,083.76

PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE

Professional

Both

$2,184.00

Service Code	HCPCS 58662
Min. Negotiated Rate	$237.21
Max. Negotiated Rate	$1,528.80
Rate for Payer: Aetna Commercial	$851.14
Rate for Payer: BCBS Complete	$481.07
Rate for Payer: BCBS Trust/PPO	$237.21
Rate for Payer: Cash Price	$1,747.20
Rate for Payer: Cash Price	$1,747.20
Rate for Payer: Meridian Medicaid	$481.07
Rate for Payer: Priority Health Choice Medicaid	$458.16
Rate for Payer: Priority Health Cigna Priority Health	$1,528.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,010.76
Rate for Payer: Priority Health Narrow Network	$1,010.76
Rate for Payer: Priority Health SBD	$1,010.76
Rate for Payer: UMR Bronson Commercial	$1,004.64

PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT

Professional

Both

$1,692.00

Service Code	HCPCS 43774
Min. Negotiated Rate	$530.94
Max. Negotiated Rate	$1,690.43
Rate for Payer: Aetna Commercial	$1,298.33
Rate for Payer: BCBS Complete	$646.35
Rate for Payer: BCBS Trust/PPO	$530.94
Rate for Payer: Cash Price	$1,353.60
Rate for Payer: Cash Price	$1,353.60
Rate for Payer: Meridian Medicaid	$646.35
Rate for Payer: Priority Health Choice Medicaid	$615.57
Rate for Payer: Priority Health Cigna Priority Health	$1,184.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,690.43
Rate for Payer: Priority Health Narrow Network	$1,690.43
Rate for Payer: Priority Health SBD	$1,690.43
Rate for Payer: UMR Bronson Commercial	$778.32

PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY

Professional

Both

$4,575.00

Service Code	HCPCS 43775
Min. Negotiated Rate	$703.54
Max. Negotiated Rate	$3,202.50
Rate for Payer: Aetna Commercial	$1,509.61
Rate for Payer: BCBS Complete	$738.72
Rate for Payer: BCBS Trust/PPO	$1,269.50
Rate for Payer: Cash Price	$3,660.00
Rate for Payer: Cash Price	$3,660.00
Rate for Payer: Meridian Medicaid	$738.72
Rate for Payer: Priority Health Choice Medicaid	$703.54
Rate for Payer: Priority Health Cigna Priority Health	$3,202.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,939.13
Rate for Payer: Priority Health Narrow Network	$1,939.13
Rate for Payer: Priority Health SBD	$1,939.13
Rate for Payer: UMR Bronson Commercial	$2,104.50

PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM

Professional

Both

$3,029.00

Service Code	HCPCS 43644
Min. Negotiated Rate	$916.07
Max. Negotiated Rate	$3,047.46
Rate for Payer: Aetna Commercial	$2,348.37
Rate for Payer: BCBS Complete	$1,165.00
Rate for Payer: BCBS Trust/PPO	$916.07
Rate for Payer: Cash Price	$2,423.20
Rate for Payer: Cash Price	$2,423.20
Rate for Payer: Meridian Medicaid	$1,165.00
Rate for Payer: Priority Health Choice Medicaid	$1,109.52
Rate for Payer: Priority Health Cigna Priority Health	$2,120.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,047.46
Rate for Payer: Priority Health Narrow Network	$3,047.46
Rate for Payer: Priority Health SBD	$3,047.46
Rate for Payer: UMR Bronson Commercial	$1,393.34

PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ

Professional

Both

$3,271.00

Service Code	HCPCS 43645
Min. Negotiated Rate	$1,018.03
Max. Negotiated Rate	$3,237.38
Rate for Payer: Aetna Commercial	$2,485.52
Rate for Payer: BCBS Complete	$1,237.68
Rate for Payer: BCBS Trust/PPO	$1,018.03
Rate for Payer: Cash Price	$2,616.80
Rate for Payer: Cash Price	$2,616.80
Rate for Payer: Meridian Medicaid	$1,237.68
Rate for Payer: Priority Health Choice Medicaid	$1,178.74
Rate for Payer: Priority Health Cigna Priority Health	$2,289.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,237.38
Rate for Payer: Priority Health Narrow Network	$3,237.38
Rate for Payer: Priority Health SBD	$3,237.38
Rate for Payer: UMR Bronson Commercial	$1,504.66

PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER

Professional

Both

$727.00

Service Code	HCPCS 49324
Min. Negotiated Rate	$247.72
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna Commercial	$524.84
Rate for Payer: BCBS Complete	$260.11
Rate for Payer: BCBS Trust/PPO	$2,137.50
Rate for Payer: Cash Price	$581.60
Rate for Payer: Cash Price	$581.60
Rate for Payer: Meridian Medicaid	$260.11
Rate for Payer: Priority Health Choice Medicaid	$247.72
Rate for Payer: Priority Health Cigna Priority Health	$508.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$680.87
Rate for Payer: Priority Health Narrow Network	$680.87
Rate for Payer: Priority Health SBD	$680.87
Rate for Payer: UMR Bronson Commercial	$334.42

PR LAPS LIGATION SPERMATIC VEINS VARICOCELE

Professional

Both

$870.00

Service Code	HCPCS 55550
Min. Negotiated Rate	$275.41
Max. Negotiated Rate	$2,149.12
Rate for Payer: Aetna Commercial	$549.39
Rate for Payer: BCBS Complete	$289.18
Rate for Payer: BCBS Trust/PPO	$2,149.12
Rate for Payer: Cash Price	$696.00
Rate for Payer: Cash Price	$696.00
Rate for Payer: Meridian Medicaid	$289.18
Rate for Payer: Priority Health Choice Medicaid	$275.41
Rate for Payer: Priority Health Cigna Priority Health	$609.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$687.87
Rate for Payer: Priority Health Narrow Network	$687.87
Rate for Payer: Priority Health SBD	$687.87
Rate for Payer: UMR Bronson Commercial	$400.20

PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY

Professional

Both

$508.00

Service Code	HCPCS 44213
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$1,274.26
Rate for Payer: Aetna Commercial	$252.05
Rate for Payer: BCBS Complete	$123.23
Rate for Payer: BCBS Trust/PPO	$1,274.26
Rate for Payer: Cash Price	$406.40
Rate for Payer: Cash Price	$406.40
Rate for Payer: Meridian Medicaid	$123.23
Rate for Payer: Priority Health Choice Medicaid	$117.36
Rate for Payer: Priority Health Cigna Priority Health	$355.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$322.80
Rate for Payer: Priority Health Narrow Network	$322.80
Rate for Payer: Priority Health SBD	$322.80
Rate for Payer: UMR Bronson Commercial	$233.68

PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<

Professional

Both

$1,871.00

Service Code	HCPCS 58545
Min. Negotiated Rate	$459.62
Max. Negotiated Rate	$1,309.70
Rate for Payer: Aetna Commercial	$1,078.67
Rate for Payer: BCBS Complete	$608.11
Rate for Payer: BCBS Trust/PPO	$459.62
Rate for Payer: Cash Price	$1,496.80
Rate for Payer: Cash Price	$1,496.80
Rate for Payer: Meridian Medicaid	$608.11
Rate for Payer: Priority Health Choice Medicaid	$579.15
Rate for Payer: Priority Health Cigna Priority Health	$1,309.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,279.19
Rate for Payer: Priority Health Narrow Network	$1,279.19
Rate for Payer: Priority Health SBD	$1,279.19
Rate for Payer: UMR Bronson Commercial	$860.66

PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS

Professional

Both

$2,355.00

Service Code	HCPCS 58546
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$1,648.50
Rate for Payer: Aetna Commercial	$1,338.60
Rate for Payer: BCBS Complete	$749.23
Rate for Payer: BCBS Trust/PPO	$74.49
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Meridian Medicaid	$749.23
Rate for Payer: Priority Health Choice Medicaid	$713.55
Rate for Payer: Priority Health Cigna Priority Health	$1,648.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,580.28
Rate for Payer: Priority Health Narrow Network	$1,580.28
Rate for Payer: Priority Health SBD	$1,580.28
Rate for Payer: UMR Bronson Commercial	$1,083.30

PR LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY

Professional

Both

$5,521.00

Service Code	HCPCS 45395
Min. Negotiated Rate	$75.55
Max. Negotiated Rate	$3,864.70
Rate for Payer: Aetna Commercial	$2,624.03
Rate for Payer: BCBS Complete	$1,301.64
Rate for Payer: BCBS Trust/PPO	$75.55
Rate for Payer: Cash Price	$4,416.80
Rate for Payer: Cash Price	$4,416.80
Rate for Payer: Meridian Medicaid	$1,301.64
Rate for Payer: Priority Health Choice Medicaid	$1,239.66
Rate for Payer: Priority Health Cigna Priority Health	$3,864.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,410.84
Rate for Payer: Priority Health Narrow Network	$3,410.84
Rate for Payer: Priority Health SBD	$3,410.84
Rate for Payer: UMR Bronson Commercial	$2,539.66

PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR

Professional

Both

$5,982.00

Service Code	HCPCS 45397
Min. Negotiated Rate	$121.51
Max. Negotiated Rate	$4,187.40
Rate for Payer: Aetna Commercial	$2,842.98
Rate for Payer: BCBS Complete	$1,408.32
Rate for Payer: BCBS Trust/PPO	$121.51
Rate for Payer: Cash Price	$4,785.60
Rate for Payer: Cash Price	$4,785.60
Rate for Payer: Meridian Medicaid	$1,408.32
Rate for Payer: Priority Health Choice Medicaid	$1,341.26
Rate for Payer: Priority Health Cigna Priority Health	$4,187.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,697.77
Rate for Payer: Priority Health Narrow Network	$3,697.77
Rate for Payer: Priority Health SBD	$3,697.77
Rate for Payer: UMR Bronson Commercial	$2,751.72

PR LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE

Professional

Both

$1,187.00

Service Code	HCPCS 49652
Min. Negotiated Rate	$474.80
Max. Negotiated Rate	$830.90
Rate for Payer: BCBS Complete	$474.80
Rate for Payer: Cash Price	$949.60
Rate for Payer: Priority Health Cigna Priority Health	$830.90
Rate for Payer: UMR Bronson Commercial	$546.02

PR LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED

Professional

Both

$3,376.00

Service Code	HCPCS 49655
Min. Negotiated Rate	$1,350.40
Max. Negotiated Rate	$2,363.20
Rate for Payer: BCBS Complete	$1,350.40
Rate for Payer: Cash Price	$2,700.80
Rate for Payer: Priority Health Cigna Priority Health	$2,363.20
Rate for Payer: UMR Bronson Commercial	$1,552.96

PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH

Professional

Both

$4,873.00

Service Code	HCPCS 43282
Min. Negotiated Rate	$835.24
Max. Negotiated Rate	$3,411.10
Rate for Payer: Aetna Commercial	$2,344.33
Rate for Payer: BCBS Complete	$1,157.16
Rate for Payer: BCBS Trust/PPO	$835.24
Rate for Payer: Cash Price	$3,898.40
Rate for Payer: Cash Price	$3,898.40
Rate for Payer: Meridian Medicaid	$1,157.16
Rate for Payer: Priority Health Choice Medicaid	$1,102.06
Rate for Payer: Priority Health Cigna Priority Health	$3,411.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,028.65
Rate for Payer: Priority Health Narrow Network	$3,028.65
Rate for Payer: Priority Health SBD	$3,028.65
Rate for Payer: UMR Bronson Commercial	$2,241.58

PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH

Professional

Both

$3,104.00

Service Code	HCPCS 43281
Min. Negotiated Rate	$936.15
Max. Negotiated Rate	$2,692.91
Rate for Payer: Aetna Commercial	$2,084.94
Rate for Payer: BCBS Complete	$1,027.45
Rate for Payer: BCBS Trust/PPO	$936.15
Rate for Payer: Cash Price	$2,483.20
Rate for Payer: Cash Price	$2,483.20
Rate for Payer: Meridian Medicaid	$1,027.45
Rate for Payer: Priority Health Choice Medicaid	$978.52
Rate for Payer: Priority Health Cigna Priority Health	$2,172.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,692.91
Rate for Payer: Priority Health Narrow Network	$2,692.91
Rate for Payer: Priority Health SBD	$2,692.91
Rate for Payer: UMR Bronson Commercial	$1,427.84

PR LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED

Professional

Both

$4,002.00

Service Code	HCPCS 49657
Min. Negotiated Rate	$1,600.80
Max. Negotiated Rate	$2,801.40
Rate for Payer: BCBS Complete	$1,600.80
Rate for Payer: Cash Price	$3,201.60
Rate for Payer: Priority Health Cigna Priority Health	$2,801.40
Rate for Payer: UMR Bronson Commercial	$1,840.92

PR LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE

Professional

Both

$1,464.00

Service Code	HCPCS 49656
Min. Negotiated Rate	$585.60
Max. Negotiated Rate	$1,024.80
Rate for Payer: BCBS Complete	$585.60
Rate for Payer: Cash Price	$1,171.20
Rate for Payer: Priority Health Cigna Priority Health	$1,024.80
Rate for Payer: UMR Bronson Commercial	$673.44

PR LAPS SUPRACERVICAL HYSTERECTOMY >250

Professional

Both

$2,212.00

Service Code	HCPCS 58543
Min. Negotiated Rate	$362.94
Max. Negotiated Rate	$1,548.40
Rate for Payer: Aetna Commercial	$1,009.17
Rate for Payer: BCBS Complete	$568.29
Rate for Payer: BCBS Trust/PPO	$362.94
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Meridian Medicaid	$568.29
Rate for Payer: Priority Health Choice Medicaid	$541.23
Rate for Payer: Priority Health Cigna Priority Health	$1,548.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,198.70
Rate for Payer: Priority Health Narrow Network	$1,198.70
Rate for Payer: Priority Health SBD	$1,198.70
Rate for Payer: UMR Bronson Commercial	$1,017.52

PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY

Professional

Both

$2,410.00

Service Code	HCPCS 58544
Min. Negotiated Rate	$387.24
Max. Negotiated Rate	$1,687.00
Rate for Payer: Aetna Commercial	$1,086.55
Rate for Payer: BCBS Complete	$610.56
Rate for Payer: BCBS Trust/PPO	$387.24
Rate for Payer: Cash Price	$1,928.00
Rate for Payer: Cash Price	$1,928.00
Rate for Payer: Meridian Medicaid	$610.56
Rate for Payer: Priority Health Choice Medicaid	$581.49
Rate for Payer: Priority Health Cigna Priority Health	$1,687.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,289.61
Rate for Payer: Priority Health Narrow Network	$1,289.61
Rate for Payer: Priority Health SBD	$1,289.61
Rate for Payer: UMR Bronson Commercial	$1,108.60

PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR

Professional

Both

$2,183.00

Service Code	HCPCS 58542
Min. Negotiated Rate	$383.55
Max. Negotiated Rate	$1,528.10
Rate for Payer: Aetna Commercial	$993.97
Rate for Payer: BCBS Complete	$559.58
Rate for Payer: BCBS Trust/PPO	$383.55
Rate for Payer: Cash Price	$1,746.40
Rate for Payer: Cash Price	$1,746.40
Rate for Payer: Meridian Medicaid	$559.58
Rate for Payer: Priority Health Choice Medicaid	$532.93
Rate for Payer: Priority Health Cigna Priority Health	$1,528.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,180.25
Rate for Payer: Priority Health Narrow Network	$1,180.25
Rate for Payer: Priority Health SBD	$1,180.25
Rate for Payer: UMR Bronson Commercial	$1,004.18

PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY

Professional

Both

$1,524.00

Service Code	HCPCS 38571
Min. Negotiated Rate	$421.10
Max. Negotiated Rate	$1,418.26
Rate for Payer: Aetna Commercial	$820.26
Rate for Payer: BCBS Complete	$442.16
Rate for Payer: BCBS Trust/PPO	$459.62
Rate for Payer: Cash Price	$1,219.20
Rate for Payer: Cash Price	$1,219.20
Rate for Payer: Meridian Medicaid	$442.16
Rate for Payer: Priority Health Choice Medicaid	$421.10
Rate for Payer: Priority Health Cigna Priority Health	$1,066.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,418.26
Rate for Payer: Priority Health Narrow Network	$1,418.26
Rate for Payer: Priority Health SBD	$1,418.26
Rate for Payer: UMR Bronson Commercial	$701.04

PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT

Professional

Both

$3,292.00

Service Code	HCPCS 47564
Min. Negotiated Rate	$716.75
Max. Negotiated Rate	$2,304.40
Rate for Payer: Aetna Commercial	$1,509.43
Rate for Payer: BCBS Complete	$752.59
Rate for Payer: BCBS Trust/PPO	$2,228.90
Rate for Payer: Cash Price	$2,633.60
Rate for Payer: Cash Price	$2,633.60
Rate for Payer: Meridian Medicaid	$752.59
Rate for Payer: Priority Health Choice Medicaid	$716.75
Rate for Payer: Priority Health Cigna Priority Health	$2,304.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,965.59
Rate for Payer: Priority Health Narrow Network	$1,965.59
Rate for Payer: Priority Health SBD	$1,965.59
Rate for Payer: UMR Bronson Commercial	$1,514.32

PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

Professional

Both

$2,737.00

Service Code	HCPCS 47563
Hospital Charge Code	47563
Min. Negotiated Rate	$461.15
Max. Negotiated Rate	$1,915.90
Rate for Payer: Aetna Commercial	$969.23
Rate for Payer: BCBS Complete	$484.21
Rate for Payer: BCBS Trust/PPO	$584.28
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Meridian Medicaid	$484.21
Rate for Payer: Priority Health Choice Medicaid	$461.15
Rate for Payer: Priority Health Cigna Priority Health	$1,915.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,266.49
Rate for Payer: Priority Health Narrow Network	$1,266.49
Rate for Payer: Priority Health SBD	$1,266.49
Rate for Payer: UMR Bronson Commercial	$1,259.02

Know your out-of-pocket cost for care.

All Charges