Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR LAPS W/REVISION INTRAPERITONEAL CATHETER

Professional

Both

$938.00

Service Code	HCPCS 49325
Min. Negotiated Rate	$264.12
Max. Negotiated Rate	$1,351.92
Rate for Payer: Aetna Commercial	$560.36
Rate for Payer: BCBS Complete	$277.33
Rate for Payer: BCBS Trust/PPO	$1,351.92
Rate for Payer: Cash Price	$750.40
Rate for Payer: Cash Price	$750.40
Rate for Payer: Meridian Medicaid	$277.33
Rate for Payer: Priority Health Choice Medicaid	$264.12
Rate for Payer: Priority Health Cigna Priority Health	$656.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$726.15
Rate for Payer: Priority Health Narrow Network	$726.15
Rate for Payer: Priority Health SBD	$726.15
Rate for Payer: UMR Bronson Commercial	$431.48

PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES

Professional

Both

$2,460.00

Service Code	HCPCS 58552
Min. Negotiated Rate	$549.43
Max. Negotiated Rate	$1,722.00
Rate for Payer: Aetna Commercial	$1,174.13
Rate for Payer: BCBS Complete	$660.66
Rate for Payer: BCBS Trust/PPO	$549.43
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Meridian Medicaid	$660.66
Rate for Payer: Priority Health Choice Medicaid	$629.20
Rate for Payer: Priority Health Cigna Priority Health	$1,722.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,392.81
Rate for Payer: Priority Health Narrow Network	$1,392.81
Rate for Payer: Priority Health SBD	$1,392.81
Rate for Payer: UMR Bronson Commercial	$1,131.60

PR LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS

Professional

Both

$2,957.00

Service Code	HCPCS 58553
Min. Negotiated Rate	$543.62
Max. Negotiated Rate	$2,069.90
Rate for Payer: Aetna Commercial	$1,347.18
Rate for Payer: BCBS Complete	$753.48
Rate for Payer: BCBS Trust/PPO	$543.62
Rate for Payer: Cash Price	$2,365.60
Rate for Payer: Cash Price	$2,365.60
Rate for Payer: Meridian Medicaid	$753.48
Rate for Payer: Priority Health Choice Medicaid	$717.60
Rate for Payer: Priority Health Cigna Priority Health	$2,069.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,588.81
Rate for Payer: Priority Health Narrow Network	$1,588.81
Rate for Payer: Priority Health SBD	$1,588.81
Rate for Payer: UMR Bronson Commercial	$1,360.22

PR LAPT RPR PARAESOPH HIATAL HERNIA W/MESH

Professional

Both

$2,574.00

Service Code	HCPCS 43333
Min. Negotiated Rate	$801.95
Max. Negotiated Rate	$2,198.43
Rate for Payer: Aetna Commercial	$1,704.43
Rate for Payer: BCBS Complete	$842.05
Rate for Payer: BCBS Trust/PPO	$856.37
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Meridian Medicaid	$842.05
Rate for Payer: Priority Health Choice Medicaid	$801.95
Rate for Payer: Priority Health Cigna Priority Health	$1,801.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,198.43
Rate for Payer: Priority Health Narrow Network	$2,198.43
Rate for Payer: Priority Health SBD	$2,198.43
Rate for Payer: UMR Bronson Commercial	$1,184.04

PR LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK

Professional

Both

$2,108.00

Service Code	HCPCS 58960
Min. Negotiated Rate	$603.32
Max. Negotiated Rate	$1,475.60
Rate for Payer: Aetna Commercial	$1,162.17
Rate for Payer: BCBS Complete	$673.64
Rate for Payer: BCBS Trust/PPO	$603.32
Rate for Payer: Cash Price	$1,686.40
Rate for Payer: Cash Price	$1,686.40
Rate for Payer: Meridian Medicaid	$673.64
Rate for Payer: Priority Health Choice Medicaid	$641.56
Rate for Payer: Priority Health Cigna Priority Health	$1,475.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,410.81
Rate for Payer: Priority Health Narrow Network	$1,410.81
Rate for Payer: Priority Health SBD	$1,410.81
Rate for Payer: UMR Bronson Commercial	$969.68

PR LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS

Professional

Both

$2,368.00

Service Code	HCPCS 47015
Min. Negotiated Rate	$241.96
Max. Negotiated Rate	$2,049.09
Rate for Payer: Aetna Commercial	$1,577.30
Rate for Payer: BCBS Complete	$782.55
Rate for Payer: BCBS Trust/PPO	$241.96
Rate for Payer: Cash Price	$1,894.40
Rate for Payer: Cash Price	$1,894.40
Rate for Payer: Meridian Medicaid	$782.55
Rate for Payer: Priority Health Choice Medicaid	$745.29
Rate for Payer: Priority Health Cigna Priority Health	$1,657.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,049.09
Rate for Payer: Priority Health Narrow Network	$2,049.09
Rate for Payer: Priority Health SBD	$2,049.09
Rate for Payer: UMR Bronson Commercial	$1,089.28

PR LAP,W/CHOLANGIOGRAPHY,BIOPSY

Professional

Both

$2,117.00

Service Code	HCPCS 47561
Min. Negotiated Rate	$846.80
Max. Negotiated Rate	$1,481.90
Rate for Payer: BCBS Complete	$846.80
Rate for Payer: Cash Price	$1,693.60
Rate for Payer: Priority Health Cigna Priority Health	$1,481.90
Rate for Payer: UMR Bronson Commercial	$973.82

PR LAP,W/CHOLANGIOGRAPHY,W/O BX

Professional

Both

$477.00

Service Code	HCPCS 47560
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$333.90
Rate for Payer: BCBS Complete	$190.80
Rate for Payer: Cash Price	$381.60
Rate for Payer: Priority Health Cigna Priority Health	$333.90
Rate for Payer: UMR Bronson Commercial	$219.42

PR LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE

Professional

Both

$777.00

Service Code	HCPCS 31561
Min. Negotiated Rate	$216.20
Max. Negotiated Rate	$1,441.20
Rate for Payer: Aetna Commercial	$432.48
Rate for Payer: BCBS Complete	$227.01
Rate for Payer: BCBS Trust/PPO	$1,441.20
Rate for Payer: Cash Price	$621.60
Rate for Payer: Cash Price	$621.60
Rate for Payer: Meridian Medicaid	$227.01
Rate for Payer: Priority Health Choice Medicaid	$216.20
Rate for Payer: Priority Health Cigna Priority Health	$543.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$468.60
Rate for Payer: Priority Health Narrow Network	$468.60
Rate for Payer: Priority Health SBD	$468.60
Rate for Payer: UMR Bronson Commercial	$357.42

PR LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP

Professional

Both

$1,186.00

Service Code	HCPCS 31541
Min. Negotiated Rate	$166.78
Max. Negotiated Rate	$1,146.94
Rate for Payer: Aetna Commercial	$333.84
Rate for Payer: BCBS Complete	$175.12
Rate for Payer: BCBS Trust/PPO	$1,146.94
Rate for Payer: Cash Price	$948.80
Rate for Payer: Cash Price	$948.80
Rate for Payer: Meridian Medicaid	$175.12
Rate for Payer: Priority Health Choice Medicaid	$166.78
Rate for Payer: Priority Health Cigna Priority Health	$830.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$362.10
Rate for Payer: Priority Health Narrow Network	$362.10
Rate for Payer: Priority Health SBD	$362.10
Rate for Payer: UMR Bronson Commercial	$545.56

PR LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP

Professional

Both

$1,305.00

Service Code	HCPCS 31545
Min. Negotiated Rate	$229.19
Max. Negotiated Rate	$1,178.11
Rate for Payer: Aetna Commercial	$459.09
Rate for Payer: BCBS Complete	$240.65
Rate for Payer: BCBS Trust/PPO	$1,178.11
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Meridian Medicaid	$240.65
Rate for Payer: Priority Health Choice Medicaid	$229.19
Rate for Payer: Priority Health Cigna Priority Health	$913.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$496.38
Rate for Payer: Priority Health Narrow Network	$496.38
Rate for Payer: Priority Health SBD	$496.38
Rate for Payer: UMR Bronson Commercial	$600.30

PR LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE

Professional

Both

$1,086.00

Service Code	HCPCS 31571
Min. Negotiated Rate	$157.83
Max. Negotiated Rate	$760.20
Rate for Payer: Aetna Commercial	$315.31
Rate for Payer: BCBS Complete	$165.72
Rate for Payer: BCBS Trust/PPO	$745.43
Rate for Payer: Cash Price	$868.80
Rate for Payer: Cash Price	$868.80
Rate for Payer: Meridian Medicaid	$165.72
Rate for Payer: Priority Health Choice Medicaid	$157.83
Rate for Payer: Priority Health Cigna Priority Health	$760.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$341.27
Rate for Payer: Priority Health Narrow Network	$341.27
Rate for Payer: Priority Health SBD	$341.27
Rate for Payer: UMR Bronson Commercial	$499.56

PR LARYNGOPLASTY MEDIALIZATION UNLIATERAL

Professional

Both

$2,163.00

Service Code	HCPCS 31591
Min. Negotiated Rate	$706.95
Max. Negotiated Rate	$1,536.85
Rate for Payer: Aetna Commercial	$1,386.63
Rate for Payer: BCBS Complete	$742.30
Rate for Payer: BCBS Trust/PPO	$1,000.07
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Meridian Medicaid	$742.30
Rate for Payer: Priority Health Choice Medicaid	$706.95
Rate for Payer: Priority Health Cigna Priority Health	$1,514.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,536.85
Rate for Payer: Priority Health Narrow Network	$1,536.85
Rate for Payer: Priority Health SBD	$1,536.85
Rate for Payer: UMR Bronson Commercial	$994.98

PR LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC

Professional

Both

$580.00

Service Code	HCPCS 31570
Min. Negotiated Rate	$145.48
Max. Negotiated Rate	$419.47
Rate for Payer: Aetna Commercial	$290.94
Rate for Payer: BCBS Complete	$152.75
Rate for Payer: BCBS Trust/PPO	$419.47
Rate for Payer: Cash Price	$464.00
Rate for Payer: Cash Price	$464.00
Rate for Payer: Meridian Medicaid	$152.75
Rate for Payer: Priority Health Choice Medicaid	$145.48
Rate for Payer: Priority Health Cigna Priority Health	$406.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$314.87
Rate for Payer: Priority Health Narrow Network	$314.87
Rate for Payer: Priority Health SBD	$314.87
Rate for Payer: UMR Bronson Commercial	$266.80

PR LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY

Professional

Both

$381.00

Service Code	HCPCS 31535
Min. Negotiated Rate	$120.13
Max. Negotiated Rate	$1,639.31
Rate for Payer: Aetna Commercial	$239.77
Rate for Payer: BCBS Complete	$126.14
Rate for Payer: BCBS Trust/PPO	$1,639.31
Rate for Payer: Cash Price	$304.80
Rate for Payer: Cash Price	$304.80
Rate for Payer: Meridian Medicaid	$126.14
Rate for Payer: Priority Health Choice Medicaid	$120.13
Rate for Payer: Priority Health Cigna Priority Health	$266.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$259.31
Rate for Payer: Priority Health Narrow Network	$259.31
Rate for Payer: Priority Health SBD	$259.31
Rate for Payer: UMR Bronson Commercial	$175.26

PR LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT

Professional

Both

$437.00

Service Code	HCPCS 31540
Min. Negotiated Rate	$152.93
Max. Negotiated Rate	$1,165.96
Rate for Payer: Aetna Commercial	$306.04
Rate for Payer: BCBS Complete	$160.58
Rate for Payer: BCBS Trust/PPO	$1,165.96
Rate for Payer: Cash Price	$349.60
Rate for Payer: Cash Price	$349.60
Rate for Payer: Meridian Medicaid	$160.58
Rate for Payer: Priority Health Choice Medicaid	$152.93
Rate for Payer: Priority Health Cigna Priority Health	$305.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$332.00
Rate for Payer: Priority Health Narrow Network	$332.00
Rate for Payer: Priority Health SBD	$332.00
Rate for Payer: UMR Bronson Commercial	$201.02

PR LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI

Professional

Both

$740.00

Service Code	HCPCS 31572
Min. Negotiated Rate	$114.81
Max. Negotiated Rate	$1,069.81
Rate for Payer: Aetna Commercial	$228.78
Rate for Payer: BCBS Complete	$120.55
Rate for Payer: BCBS Trust/PPO	$1,069.81
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cash Price	$592.00
Rate for Payer: Meridian Medicaid	$120.55
Rate for Payer: Priority Health Choice Medicaid	$114.81
Rate for Payer: Priority Health Cigna Priority Health	$518.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$248.65
Rate for Payer: Priority Health Narrow Network	$248.65
Rate for Payer: Priority Health SBD	$248.65
Rate for Payer: UMR Bronson Commercial	$340.40

PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC

Professional

Both

$289.00

Service Code	HCPCS 31575
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$1,261.05
Rate for Payer: Aetna Commercial	$84.36
Rate for Payer: BCBS Complete	$46.07
Rate for Payer: BCBS Trust/PPO	$1,261.05
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Meridian Medicaid	$46.07
Rate for Payer: Priority Health Choice Medicaid	$43.88
Rate for Payer: Priority Health Cigna Priority Health	$202.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$94.00
Rate for Payer: Priority Health Narrow Network	$94.00
Rate for Payer: Priority Health SBD	$94.00
Rate for Payer: UMR Bronson Commercial	$132.94

PR LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI

Professional

Both

$554.00

Service Code	HCPCS 31573
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$877.51
Rate for Payer: Aetna Commercial	$188.11
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$877.51
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$387.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.13
Rate for Payer: Priority Health Narrow Network	$205.13
Rate for Payer: Priority Health SBD	$205.13
Rate for Payer: UMR Bronson Commercial	$254.84

PR LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES)

Professional

Both

$395.00

Service Code	HCPCS 31576
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$1,520.98
Rate for Payer: Aetna Commercial	$149.73
Rate for Payer: BCBS Complete	$80.06
Rate for Payer: BCBS Trust/PPO	$1,520.98
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cash Price	$316.00
Rate for Payer: Meridian Medicaid	$80.06
Rate for Payer: Priority Health Choice Medicaid	$76.25
Rate for Payer: Priority Health Cigna Priority Health	$276.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$163.92
Rate for Payer: Priority Health Narrow Network	$163.92
Rate for Payer: Priority Health SBD	$163.92
Rate for Payer: UMR Bronson Commercial	$181.70

PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY

Professional

Both

$376.00

Service Code	HCPCS 31579
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$739.09
Rate for Payer: Aetna Commercial	$150.52
Rate for Payer: BCBS Complete	$80.06
Rate for Payer: BCBS Trust/PPO	$739.09
Rate for Payer: Cash Price	$300.80
Rate for Payer: Cash Price	$300.80
Rate for Payer: Meridian Medicaid	$80.06
Rate for Payer: Priority Health Choice Medicaid	$76.25
Rate for Payer: Priority Health Cigna Priority Health	$263.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.85
Rate for Payer: Priority Health Narrow Network	$164.85
Rate for Payer: Priority Health SBD	$164.85
Rate for Payer: UMR Bronson Commercial	$172.96

PR LARYNGOSCOPY FLX RMVL FOREIGN BODY(S)

Professional

Both

$403.00

Service Code	HCPCS 31577
Min. Negotiated Rate	$84.99
Max. Negotiated Rate	$395.70
Rate for Payer: Aetna Commercial	$169.34
Rate for Payer: BCBS Complete	$89.24
Rate for Payer: BCBS Trust/PPO	$395.70
Rate for Payer: Cash Price	$322.40
Rate for Payer: Cash Price	$322.40
Rate for Payer: Meridian Medicaid	$89.24
Rate for Payer: Priority Health Choice Medicaid	$84.99
Rate for Payer: Priority Health Cigna Priority Health	$282.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.76
Rate for Payer: Priority Health Narrow Network	$184.76
Rate for Payer: Priority Health SBD	$184.76
Rate for Payer: UMR Bronson Commercial	$185.38

PR LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE

Professional

Both

$455.00

Service Code	HCPCS 31531
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$1,325.50
Rate for Payer: Aetna Commercial	$266.77
Rate for Payer: BCBS Complete	$140.68
Rate for Payer: BCBS Trust/PPO	$1,325.50
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Meridian Medicaid	$140.68
Rate for Payer: Priority Health Choice Medicaid	$133.98
Rate for Payer: Priority Health Cigna Priority Health	$318.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$291.25
Rate for Payer: Priority Health Narrow Network	$291.25
Rate for Payer: Priority Health SBD	$291.25
Rate for Payer: UMR Bronson Commercial	$209.30

PR LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX

Professional

Both

$207.00

Service Code	HCPCS 31505
Min. Negotiated Rate	$31.74
Max. Negotiated Rate	$1,167.54
Rate for Payer: Aetna Commercial	$61.01
Rate for Payer: BCBS Complete	$33.33
Rate for Payer: BCBS Trust/PPO	$1,167.54
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Meridian Medicaid	$33.33
Rate for Payer: Priority Health Choice Medicaid	$31.74
Rate for Payer: Priority Health Cigna Priority Health	$144.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.06
Rate for Payer: Priority Health Narrow Network	$68.06
Rate for Payer: Priority Health SBD	$68.06
Rate for Payer: UMR Bronson Commercial	$95.22

PR LARYNGOSCOPY INDIRECT W/BIOPSY

Professional

Both

$434.00

Service Code	HCPCS 31510
Min. Negotiated Rate	$152.77
Max. Negotiated Rate	$1,254.71
Rate for Payer: Aetna Commercial	$152.77
Rate for Payer: BCBS Complete	$173.60
Rate for Payer: BCBS Trust/PPO	$1,254.71
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$347.20
Rate for Payer: Priority Health Cigna Priority Health	$303.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$167.16
Rate for Payer: Priority Health Narrow Network	$167.16
Rate for Payer: Priority Health SBD	$167.16
Rate for Payer: UMR Bronson Commercial	$199.64

Know your out-of-pocket cost for care.

All Charges