Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY

Professional

Both

$728.00

Service Code	HCPCS 31254
Min. Negotiated Rate	$154.43
Max. Negotiated Rate	$1,345.05
Rate for Payer: Aetna Commercial	$310.39
Rate for Payer: BCBS Complete	$162.15
Rate for Payer: BCBS Trust/PPO	$1,345.05
Rate for Payer: Cash Price	$582.40
Rate for Payer: Cash Price	$582.40
Rate for Payer: Meridian Medicaid	$162.15
Rate for Payer: Priority Health Choice Medicaid	$154.43
Rate for Payer: Priority Health Cigna Priority Health	$509.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$334.78
Rate for Payer: Priority Health Narrow Network	$334.78
Rate for Payer: Priority Health SBD	$334.78
Rate for Payer: UMR Bronson Commercial	$334.88

PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS

Professional

Both

$1,333.00

Service Code	HCPCS 31276
Min. Negotiated Rate	$240.05
Max. Negotiated Rate	$1,458.11
Rate for Payer: Aetna Commercial	$482.62
Rate for Payer: BCBS Complete	$252.05
Rate for Payer: BCBS Trust/PPO	$1,458.11
Rate for Payer: Cash Price	$1,066.40
Rate for Payer: Cash Price	$1,066.40
Rate for Payer: Meridian Medicaid	$252.05
Rate for Payer: Priority Health Choice Medicaid	$240.05
Rate for Payer: Priority Health Cigna Priority Health	$933.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$520.00
Rate for Payer: Priority Health Narrow Network	$520.00
Rate for Payer: Priority Health SBD	$520.00
Rate for Payer: UMR Bronson Commercial	$613.18

PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY

Professional

Both

$926.00

Service Code	HCPCS 31255
Min. Negotiated Rate	$205.12
Max. Negotiated Rate	$1,500.90
Rate for Payer: Aetna Commercial	$412.82
Rate for Payer: BCBS Complete	$215.38
Rate for Payer: BCBS Trust/PPO	$1,500.90
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cash Price	$740.80
Rate for Payer: Meridian Medicaid	$215.38
Rate for Payer: Priority Health Choice Medicaid	$205.12
Rate for Payer: Priority Health Cigna Priority Health	$648.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$445.44
Rate for Payer: Priority Health Narrow Network	$445.44
Rate for Payer: Priority Health SBD	$445.44
Rate for Payer: UMR Bronson Commercial	$425.96

PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE

Professional

Both

$117.00

Service Code	HCPCS 43752
Min. Negotiated Rate	$25.13
Max. Negotiated Rate	$1,612.37
Rate for Payer: Aetna Commercial	$54.32
Rate for Payer: BCBS Complete	$26.39
Rate for Payer: BCBS Trust/PPO	$1,612.37
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Meridian Medicaid	$26.39
Rate for Payer: Priority Health Choice Medicaid	$25.13
Rate for Payer: Priority Health Cigna Priority Health	$81.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.98
Rate for Payer: Priority Health Narrow Network	$69.98
Rate for Payer: Priority Health SBD	$69.98
Rate for Payer: UMR Bronson Commercial	$53.82

PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX

Professional

Both

$226.00

Service Code	HCPCS 92511
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$552.07
Rate for Payer: Aetna Commercial	$40.68
Rate for Payer: BCBS Complete	$25.27
Rate for Payer: BCBS Trust/PPO	$552.07
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Meridian Medicaid	$25.27
Rate for Payer: Priority Health Choice Medicaid	$24.07
Rate for Payer: Priority Health Cigna Priority Health	$158.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health SBD	$50.30
Rate for Payer: UMR Bronson Commercial	$103.96

PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$211.00

Service Code	HCPCS 95860
Min. Negotiated Rate	$66.47
Max. Negotiated Rate	$1,210.86
Rate for Payer: Aetna Commercial	$127.72
Rate for Payer: BCBS Complete	$84.40
Rate for Payer: BCBS Trust/PPO	$1,210.86
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Priority Health Cigna Priority Health	$147.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.47
Rate for Payer: Priority Health Narrow Network	$66.47
Rate for Payer: Priority Health SBD	$150.46
Rate for Payer: UMR Bronson Commercial	$97.06

PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$290.00

Service Code	HCPCS 95861
Min. Negotiated Rate	$106.44
Max. Negotiated Rate	$1,443.84
Rate for Payer: Aetna Commercial	$184.98
Rate for Payer: BCBS Complete	$116.00
Rate for Payer: BCBS Trust/PPO	$1,443.84
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Priority Health Cigna Priority Health	$203.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.44
Rate for Payer: Priority Health Narrow Network	$106.44
Rate for Payer: Priority Health SBD	$215.14
Rate for Payer: UMR Bronson Commercial	$133.40

PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$354.00

Service Code	HCPCS 95863
Min. Negotiated Rate	$129.80
Max. Negotiated Rate	$706.87
Rate for Payer: Aetna Commercial	$240.60
Rate for Payer: BCBS Complete	$141.60
Rate for Payer: BCBS Trust/PPO	$706.87
Rate for Payer: Cash Price	$283.20
Rate for Payer: Cash Price	$283.20
Rate for Payer: Priority Health Cigna Priority Health	$247.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.80
Rate for Payer: Priority Health Narrow Network	$129.80
Rate for Payer: Priority Health SBD	$279.37
Rate for Payer: UMR Bronson Commercial	$162.84

PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$405.00

Service Code	HCPCS 95864
Min. Negotiated Rate	$138.33
Max. Negotiated Rate	$953.58
Rate for Payer: Aetna Commercial	$268.89
Rate for Payer: BCBS Complete	$162.00
Rate for Payer: BCBS Trust/PPO	$953.58
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Priority Health Cigna Priority Health	$283.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.33
Rate for Payer: Priority Health Narrow Network	$138.33
Rate for Payer: Priority Health SBD	$313.05
Rate for Payer: UMR Bronson Commercial	$186.30

PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX

Professional

Both

$856.00

Service Code	HCPCS 44385
Min. Negotiated Rate	$46.22
Max. Negotiated Rate	$1,990.63
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: BCBS Complete	$48.53
Rate for Payer: BCBS Trust/PPO	$1,990.63
Rate for Payer: Cash Price	$684.80
Rate for Payer: Cash Price	$684.80
Rate for Payer: Meridian Medicaid	$48.53
Rate for Payer: Priority Health Choice Medicaid	$46.22
Rate for Payer: Priority Health Cigna Priority Health	$599.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.01
Rate for Payer: Priority Health Narrow Network	$127.01
Rate for Payer: Priority Health SBD	$127.01
Rate for Payer: UMR Bronson Commercial	$393.76

PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE

Professional

Both

$1,018.00

Service Code	HCPCS 44386
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$3,257.50
Rate for Payer: Aetna Commercial	$117.55
Rate for Payer: BCBS Complete	$59.27
Rate for Payer: BCBS Trust/PPO	$3,257.50
Rate for Payer: Cash Price	$814.40
Rate for Payer: Cash Price	$814.40
Rate for Payer: Meridian Medicaid	$59.27
Rate for Payer: Priority Health Choice Medicaid	$56.45
Rate for Payer: Priority Health Cigna Priority Health	$712.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.63
Rate for Payer: Priority Health Narrow Network	$154.63
Rate for Payer: Priority Health SBD	$154.63
Rate for Payer: UMR Bronson Commercial	$468.28

PR NDSC NJX IMPLT MATRL URT&/BLDR NCK

Professional

Both

$1,715.00

Service Code	HCPCS 51715
Min. Negotiated Rate	$126.10
Max. Negotiated Rate	$2,071.46
Rate for Payer: Aetna Commercial	$257.04
Rate for Payer: BCBS Complete	$132.40
Rate for Payer: BCBS Trust/PPO	$2,071.46
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Meridian Medicaid	$132.40
Rate for Payer: Priority Health Choice Medicaid	$126.10
Rate for Payer: Priority Health Cigna Priority Health	$1,200.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$317.74
Rate for Payer: Priority Health Narrow Network	$317.74
Rate for Payer: Priority Health SBD	$317.74
Rate for Payer: UMR Bronson Commercial	$788.90

PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG

Professional

Both

$335.00

Service Code	HCPCS 33508
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$878.56
Rate for Payer: Aetna Commercial	$21.23
Rate for Payer: BCBS Complete	$10.51
Rate for Payer: BCBS Trust/PPO	$878.56
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$268.00
Rate for Payer: Meridian Medicaid	$10.51
Rate for Payer: Priority Health Choice Medicaid	$10.01
Rate for Payer: Priority Health Cigna Priority Health	$234.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.01
Rate for Payer: Priority Health Narrow Network	$25.01
Rate for Payer: Priority Health SBD	$25.01
Rate for Payer: UMR Bronson Commercial	$154.10

PR NDSC URETEROTOMY RMVL FB/CALCULUS

Professional

Both

$677.00

Service Code	HCPCS 50980
Min. Negotiated Rate	$223.22
Max. Negotiated Rate	$2,962.71
Rate for Payer: Aetna Commercial	$455.66
Rate for Payer: BCBS Complete	$234.38
Rate for Payer: BCBS Trust/PPO	$2,962.71
Rate for Payer: Cash Price	$541.60
Rate for Payer: Cash Price	$541.60
Rate for Payer: Meridian Medicaid	$234.38
Rate for Payer: Priority Health Choice Medicaid	$223.22
Rate for Payer: Priority Health Cigna Priority Health	$473.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$561.44
Rate for Payer: Priority Health Narrow Network	$561.44
Rate for Payer: Priority Health SBD	$561.44
Rate for Payer: UMR Bronson Commercial	$311.42

PR NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER

Professional

Both

$679.00

Service Code	HCPCS 50972
Min. Negotiated Rate	$224.29
Max. Negotiated Rate	$2,720.22
Rate for Payer: Aetna Commercial	$457.88
Rate for Payer: BCBS Complete	$235.50
Rate for Payer: BCBS Trust/PPO	$2,720.22
Rate for Payer: Cash Price	$543.20
Rate for Payer: Cash Price	$543.20
Rate for Payer: Meridian Medicaid	$235.50
Rate for Payer: Priority Health Choice Medicaid	$224.29
Rate for Payer: Priority Health Cigna Priority Health	$475.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$564.67
Rate for Payer: Priority Health Narrow Network	$564.67
Rate for Payer: Priority Health SBD	$564.67
Rate for Payer: UMR Bronson Commercial	$312.34

PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM

Professional

Both

$1,840.00

Service Code	HCPCS 29848
Min. Negotiated Rate	$333.98
Max. Negotiated Rate	$1,288.00
Rate for Payer: Aetna Commercial	$677.64
Rate for Payer: BCBS Complete	$350.68
Rate for Payer: BCBS Trust/PPO	$571.09
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Meridian Medicaid	$350.68
Rate for Payer: Priority Health Choice Medicaid	$333.98
Rate for Payer: Priority Health Cigna Priority Health	$1,288.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$790.48
Rate for Payer: Priority Health Narrow Network	$790.48
Rate for Payer: Priority Health SBD	$790.48
Rate for Payer: UMR Bronson Commercial	$846.40

PR NECK LIFT

Professional

Both

$2,000.00

Service Code	HCPCS 00541
Hospital Revenue Code	990
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,400.00
Rate for Payer: BCBS Complete	$800.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Priority Health Cigna Priority Health	$1,400.00
Rate for Payer: UMR Bronson Commercial	$920.00

PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI

Professional

Both

$264.00

Service Code	HCPCS 95868
Min. Negotiated Rate	$81.30
Max. Negotiated Rate	$284.75
Rate for Payer: Aetna Commercial	$157.00
Rate for Payer: BCBS Complete	$105.60
Rate for Payer: BCBS Trust/PPO	$284.75
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cash Price	$211.20
Rate for Payer: Priority Health Cigna Priority Health	$184.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$81.30
Rate for Payer: Priority Health Narrow Network	$81.30
Rate for Payer: Priority Health SBD	$186.84
Rate for Payer: UMR Bronson Commercial	$121.44

PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI

Professional

Both

$191.00

Service Code	HCPCS 95867
Min. Negotiated Rate	$54.79
Max. Negotiated Rate	$620.75
Rate for Payer: Aetna Commercial	$120.01
Rate for Payer: BCBS Complete	$76.40
Rate for Payer: BCBS Trust/PPO	$620.75
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Priority Health Cigna Priority Health	$133.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$54.79
Rate for Payer: Priority Health Narrow Network	$54.79
Rate for Payer: Priority Health SBD	$143.73
Rate for Payer: UMR Bronson Commercial	$87.86

PR NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM

Professional

Both

$232.00

Service Code	HCPCS 95866
Min. Negotiated Rate	$83.99
Max. Negotiated Rate	$665.13
Rate for Payer: Aetna Commercial	$146.53
Rate for Payer: BCBS Complete	$92.80
Rate for Payer: BCBS Trust/PPO	$665.13
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cash Price	$185.60
Rate for Payer: Priority Health Cigna Priority Health	$162.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.99
Rate for Payer: Priority Health Narrow Network	$83.99
Rate for Payer: Priority Health SBD	$169.77
Rate for Payer: UMR Bronson Commercial	$106.72

PR NEEDLE ELECTROMYOGRAPHY LARYNX

Professional

Both

$365.00

Service Code	HCPCS 95865
Min. Negotiated Rate	$92.53
Max. Negotiated Rate	$990.03
Rate for Payer: Aetna Commercial	$168.68
Rate for Payer: BCBS Complete	$146.00
Rate for Payer: BCBS Trust/PPO	$990.03
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Priority Health Cigna Priority Health	$255.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.53
Rate for Payer: Priority Health Narrow Network	$92.53
Rate for Payer: Priority Health SBD	$200.32
Rate for Payer: UMR Bronson Commercial	$167.90

PR NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED

Professional

Both

$151.00

Service Code	HCPCS 95885
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$1,360.37
Rate for Payer: Aetna Commercial	$70.67
Rate for Payer: Aetna Commercial	$70.67
Rate for Payer: BCBS Complete	$60.40
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCBS Trust/PPO	$1,360.37
Rate for Payer: BCBS Trust/PPO	$1,360.37
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$120.80
Rate for Payer: Priority Health Cigna Priority Health	$105.70
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.80
Rate for Payer: Priority Health Narrow Network	$23.80
Rate for Payer: Priority Health Narrow Network	$23.80
Rate for Payer: Priority Health SBD	$83.09
Rate for Payer: Priority Health SBD	$83.09
Rate for Payer: UMR Bronson Commercial	$69.46
Rate for Payer: UMR Bronson Commercial	$28.98

PR NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE

Professional

Both

$167.00

Service Code	HCPCS 95886
Min. Negotiated Rate	$66.80
Max. Negotiated Rate	$1,755.54
Rate for Payer: Aetna Commercial	$109.55
Rate for Payer: Aetna Commercial	$109.55
Rate for Payer: BCBS Complete	$66.80
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: BCBS Trust/PPO	$1,755.54
Rate for Payer: BCBS Trust/PPO	$1,755.54
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health Cigna Priority Health	$165.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.22
Rate for Payer: Priority Health Narrow Network	$67.22
Rate for Payer: Priority Health Narrow Network	$67.22
Rate for Payer: Priority Health SBD	$141.11
Rate for Payer: Priority Health SBD	$141.11
Rate for Payer: UMR Bronson Commercial	$109.02
Rate for Payer: UMR Bronson Commercial	$76.82

PR NEEDLE EMG GUID W/CHEMODENERVATION

Professional

Both

$124.00

Service Code	HCPCS 95874
Min. Negotiated Rate	$25.61
Max. Negotiated Rate	$1,247.84
Rate for Payer: Aetna Commercial	$87.83
Rate for Payer: BCBS Complete	$49.60
Rate for Payer: BCBS Trust/PPO	$1,247.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Priority Health Cigna Priority Health	$86.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.61
Rate for Payer: Priority Health Narrow Network	$25.61
Rate for Payer: Priority Health SBD	$103.75
Rate for Payer: UMR Bronson Commercial	$57.04

PR NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI

Professional

Both

$150.00

Service Code	HCPCS 95870
Min. Negotiated Rate	$25.61
Max. Negotiated Rate	$288.98
Rate for Payer: Aetna Commercial	$96.78
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$288.98
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.61
Rate for Payer: Priority Health Narrow Network	$25.61
Rate for Payer: Priority Health SBD	$111.84
Rate for Payer: UMR Bronson Commercial	$69.00

Know your out-of-pocket cost for care.

All Charges