Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC

Professional

Both

$3,865.00

Service Code	HCPCS 38562
Min. Negotiated Rate	$453.26
Max. Negotiated Rate	$2,705.50
Rate for Payer: Aetna Commercial	$873.15
Rate for Payer: BCBS Complete	$475.92
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Meridian Medicaid	$475.92
Rate for Payer: Priority Health Choice Medicaid	$453.26
Rate for Payer: Priority Health Cigna Priority Health	$2,705.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,525.45
Rate for Payer: Priority Health Narrow Network	$1,525.45
Rate for Payer: Priority Health SBD	$1,525.45
Rate for Payer: UMR Bronson Commercial	$1,777.90

PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC

Professional

Both

$2,775.00

Service Code	HCPCS 38564
Min. Negotiated Rate	$448.58
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$878.57
Rate for Payer: BCBS Complete	$471.01
Rate for Payer: BCBS Trust/PPO	$543.62
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Meridian Medicaid	$471.01
Rate for Payer: Priority Health Choice Medicaid	$448.58
Rate for Payer: Priority Health Cigna Priority Health	$1,942.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,518.23
Rate for Payer: Priority Health Narrow Network	$1,518.23
Rate for Payer: Priority Health SBD	$1,518.23
Rate for Payer: UMR Bronson Commercial	$1,276.50

PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN

Professional

Both

$1,588.00

Service Code	HCPCS 25280
Min. Negotiated Rate	$368.92
Max. Negotiated Rate	$1,111.60
Rate for Payer: Aetna Commercial	$754.53
Rate for Payer: BCBS Complete	$387.37
Rate for Payer: BCBS Trust/PPO	$760.22
Rate for Payer: Cash Price	$1,270.40
Rate for Payer: Cash Price	$1,270.40
Rate for Payer: Meridian Medicaid	$387.37
Rate for Payer: Priority Health Choice Medicaid	$368.92
Rate for Payer: Priority Health Cigna Priority Health	$1,111.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$874.75
Rate for Payer: Priority Health Narrow Network	$874.75
Rate for Payer: Priority Health SBD	$874.75
Rate for Payer: UMR Bronson Commercial	$730.48

PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA

Professional

Both

$1,335.00

Service Code	HCPCS 27686
Min. Negotiated Rate	$344.21
Max. Negotiated Rate	$2,402.18
Rate for Payer: Aetna Commercial	$714.76
Rate for Payer: BCBS Complete	$361.42
Rate for Payer: BCBS Trust/PPO	$2,402.18
Rate for Payer: Cash Price	$1,068.00
Rate for Payer: Cash Price	$1,068.00
Rate for Payer: Meridian Medicaid	$361.42
Rate for Payer: Priority Health Choice Medicaid	$344.21
Rate for Payer: Priority Health Cigna Priority Health	$934.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$807.86
Rate for Payer: Priority Health Narrow Network	$807.86
Rate for Payer: Priority Health SBD	$807.86
Rate for Payer: UMR Bronson Commercial	$614.10

PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX

Professional

Both

$1,785.00

Service Code	HCPCS 27685
Min. Negotiated Rate	$301.82
Max. Negotiated Rate	$3,119.66
Rate for Payer: Aetna Commercial	$616.27
Rate for Payer: BCBS Complete	$316.91
Rate for Payer: BCBS Trust/PPO	$3,119.66
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Meridian Medicaid	$316.91
Rate for Payer: Priority Health Choice Medicaid	$301.82
Rate for Payer: Priority Health Cigna Priority Health	$1,249.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$713.88
Rate for Payer: Priority Health Narrow Network	$713.88
Rate for Payer: Priority Health SBD	$713.88
Rate for Payer: UMR Bronson Commercial	$821.10

PR LOCM 250-299MG/ML IODINE,1ML

Professional

Both

$5.00

Service Code	HCPCS Q9948
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR LORAZEPAM INJECTION

Professional

Both

$7.00

Service Code	HCPCS J2060
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$4.90
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: BCBS Trust/PPO	$0.45
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR LOWER LID BLEPHAROPLASTY

Professional

Both

$1,800.00

Service Code	HCPCS 00531
Hospital Revenue Code	990
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,260.00
Rate for Payer: BCBS Complete	$720.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Priority Health Cigna Priority Health	$1,260.00
Rate for Payer: UMR Bronson Commercial	$828.00

PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE

Professional

Both

$102.00

Service Code	HCPCS 20979
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$3,247.68
Rate for Payer: Aetna Commercial	$42.80
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Trust/PPO	$3,247.68
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$71.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.02
Rate for Payer: Priority Health Narrow Network	$49.02
Rate for Payer: Priority Health SBD	$49.02
Rate for Payer: UMR Bronson Commercial	$46.92

PR LT COMPRES BAND >=3 <5/YD

Professional

Both

$3.00

Service Code	HCPCS A6449
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: UMR Bronson Commercial	$1.38

PR LT COMPRES BAND <3/YD

Professional

Both

$3.00

Service Code	HCPCS A6448
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.07
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: UMR Bronson Commercial	$1.38

PR LT COMPRES BAND >=5/YD

Professional

Both

$5.00

Service Code	HCPCS A6450
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR LUX IR ABD/BACK

Professional

Both

$250.00

Service Code	HCPCS 00097
Hospital Revenue Code	990
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: UMR Bronson Commercial	$115.00

PR LUX IR ARMS

Professional

Both

$125.00

Service Code	HCPCS 00095
Hospital Revenue Code	990
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$87.50
Rate for Payer: BCBS Complete	$50.00
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 LUX IR BUTTOCKS

Professional

Both

$150.00

Service Code	HCPCS 00098
Hospital Revenue Code	990
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$105.00
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: UMR Bronson Commercial	$69.00

PR LUX IR CHEST

Professional

Both

$150.00

Service Code	HCPCS 00094
Hospital Revenue Code	990
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$105.00
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: UMR Bronson Commercial	$69.00

PR LUX IR FACE & NECK

Professional

Both

$250.00

Service Code	HCPCS 00093
Hospital Revenue Code	990
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: UMR Bronson Commercial	$115.00

PR LUX IR UP LEGS

Professional

Both

$250.00

Service Code	HCPCS 00096
Hospital Revenue Code	990
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: UMR Bronson Commercial	$115.00

PR LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS

Professional

Both

$912.00

Service Code	HCPCS 38308
Min. Negotiated Rate	$302.46
Max. Negotiated Rate	$1,010.46
Rate for Payer: Aetna Commercial	$570.91
Rate for Payer: BCBS Complete	$317.58
Rate for Payer: BCBS Trust/PPO	$635.54
Rate for Payer: Cash Price	$729.60
Rate for Payer: Cash Price	$729.60
Rate for Payer: Meridian Medicaid	$317.58
Rate for Payer: Priority Health Choice Medicaid	$302.46
Rate for Payer: Priority Health Cigna Priority Health	$638.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,010.46
Rate for Payer: Priority Health Narrow Network	$1,010.46
Rate for Payer: Priority Health SBD	$1,010.46
Rate for Payer: UMR Bronson Commercial	$419.52

PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS

Professional

Both

$511.00

Service Code	HCPCS 54162
Min. Negotiated Rate	$128.23
Max. Negotiated Rate	$1,225.13
Rate for Payer: Aetna Commercial	$255.52
Rate for Payer: BCBS Complete	$134.64
Rate for Payer: BCBS Trust/PPO	$1,225.13
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Meridian Medicaid	$134.64
Rate for Payer: Priority Health Choice Medicaid	$128.23
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$320.97
Rate for Payer: Priority Health Narrow Network	$320.97
Rate for Payer: Priority Health SBD	$320.97
Rate for Payer: UMR Bronson Commercial	$235.06

PR LYSIS INTRANASAL SYNECHIA

Professional

Both

$506.00

Service Code	HCPCS 30560
Min. Negotiated Rate	$97.55
Max. Negotiated Rate	$805.66
Rate for Payer: Aetna Commercial	$184.81
Rate for Payer: BCBS Complete	$102.43
Rate for Payer: BCBS Trust/PPO	$805.66
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$404.80
Rate for Payer: Meridian Medicaid	$102.43
Rate for Payer: Priority Health Choice Medicaid	$97.55
Rate for Payer: Priority Health Cigna Priority Health	$354.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$210.69
Rate for Payer: Priority Health Narrow Network	$210.69
Rate for Payer: Priority Health SBD	$210.69
Rate for Payer: UMR Bronson Commercial	$232.76

PR LYSIS LABIAL ADHESIONS

Professional

Both

$482.00

Service Code	HCPCS 56441
Min. Negotiated Rate	$100.32
Max. Negotiated Rate	$488.15
Rate for Payer: Aetna Commercial	$179.27
Rate for Payer: BCBS Complete	$105.34
Rate for Payer: BCBS Trust/PPO	$488.15
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Meridian Medicaid	$105.34
Rate for Payer: Priority Health Choice Medicaid	$100.32
Rate for Payer: Priority Health Cigna Priority Health	$337.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$220.15
Rate for Payer: Priority Health Narrow Network	$220.15
Rate for Payer: Priority Health SBD	$220.15
Rate for Payer: UMR Bronson Commercial	$221.72

PR LYSIS OF ADHESIONS SALPINX/OVARY

Professional

Both

$2,380.00

Service Code	HCPCS 58740
Min. Negotiated Rate	$207.09
Max. Negotiated Rate	$1,666.00
Rate for Payer: Aetna Commercial	$1,075.71
Rate for Payer: BCBS Complete	$608.33
Rate for Payer: BCBS Trust/PPO	$207.09
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Meridian Medicaid	$608.33
Rate for Payer: Priority Health Choice Medicaid	$579.36
Rate for Payer: Priority Health Cigna Priority Health	$1,666.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,282.04
Rate for Payer: Priority Health Narrow Network	$1,282.04
Rate for Payer: Priority Health SBD	$1,282.04
Rate for Payer: UMR Bronson Commercial	$1,094.80

PR MA/EC CONTRACEPTIVEINJECTION

Professional

Both

$33.00

Service Code	HCPCS J1056
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$23.10
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: Cash Price	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$23.10
Rate for Payer: UMR Bronson Commercial	$15.18

PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC

Professional

Both

$3,282.00

Service Code	HCPCS 32820
Min. Negotiated Rate	$841.78
Max. Negotiated Rate	$2,297.40
Rate for Payer: Aetna Commercial	$1,715.98
Rate for Payer: BCBS Complete	$883.87
Rate for Payer: BCBS Trust/PPO	$878.56
Rate for Payer: Cash Price	$2,625.60
Rate for Payer: Cash Price	$2,625.60
Rate for Payer: Meridian Medicaid	$883.87
Rate for Payer: Priority Health Choice Medicaid	$841.78
Rate for Payer: Priority Health Cigna Priority Health	$2,297.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,818.84
Rate for Payer: Priority Health Narrow Network	$1,818.84
Rate for Payer: Priority Health SBD	$1,818.84
Rate for Payer: UMR Bronson Commercial	$1,509.72

Know your out-of-pocket cost for care.

All Charges