Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI

Professional

Both

$1,623.00

Service Code	HCPCS 21330
Min. Negotiated Rate	$344.21
Max. Negotiated Rate	$1,404.22
Rate for Payer: Aetna Commercial	$702.66
Rate for Payer: BCBS Complete	$361.42
Rate for Payer: BCBS Trust/PPO	$1,404.22
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Meridian Medicaid	$361.42
Rate for Payer: Priority Health Choice Medicaid	$344.21
Rate for Payer: Priority Health Cigna Priority Health	$1,136.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$823.68
Rate for Payer: Priority Health Narrow Network	$823.68
Rate for Payer: Priority Health SBD	$823.68
Rate for Payer: UMR Bronson Commercial	$746.58

PR OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION

Professional

Both

$1,447.00

Service Code	HCPCS 21336
Min. Negotiated Rate	$409.60
Max. Negotiated Rate	$10,615.31
Rate for Payer: Aetna Commercial	$851.72
Rate for Payer: BCBS Complete	$430.08
Rate for Payer: BCBS Trust/PPO	$10,615.31
Rate for Payer: Cash Price	$1,157.60
Rate for Payer: Cash Price	$1,157.60
Rate for Payer: Meridian Medicaid	$430.08
Rate for Payer: Priority Health Choice Medicaid	$409.60
Rate for Payer: Priority Health Cigna Priority Health	$1,012.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$978.41
Rate for Payer: Priority Health Narrow Network	$978.41
Rate for Payer: Priority Health SBD	$978.41
Rate for Payer: UMR Bronson Commercial	$665.62

PR OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION

Professional

Both

$1,837.00

Service Code	HCPCS 21338
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$1,285.90
Rate for Payer: Aetna Commercial	$881.10
Rate for Payer: BCBS Complete	$452.67
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Meridian Medicaid	$452.67
Rate for Payer: Priority Health Choice Medicaid	$431.11
Rate for Payer: Priority Health Cigna Priority Health	$1,285.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,034.07
Rate for Payer: Priority Health Narrow Network	$1,034.07
Rate for Payer: Priority Health SBD	$1,034.07
Rate for Payer: UMR Bronson Commercial	$845.02

PR OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL

Professional

Both

$1,173.00

Service Code	HCPCS 21386
Min. Negotiated Rate	$444.11
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$917.96
Rate for Payer: BCBS Complete	$466.32
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$938.40
Rate for Payer: Cash Price	$938.40
Rate for Payer: Meridian Medicaid	$466.32
Rate for Payer: Priority Health Choice Medicaid	$444.11
Rate for Payer: Priority Health Cigna Priority Health	$821.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,059.09
Rate for Payer: Priority Health Narrow Network	$1,059.09
Rate for Payer: Priority Health SBD	$1,059.09
Rate for Payer: UMR Bronson Commercial	$539.58

PR OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL

Professional

Both

$1,515.00

Service Code	HCPCS 21385
Min. Negotiated Rate	$469.88
Max. Negotiated Rate	$22,818.32
Rate for Payer: Aetna Commercial	$985.76
Rate for Payer: BCBS Complete	$493.37
Rate for Payer: BCBS Trust/PPO	$22,818.32
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Meridian Medicaid	$493.37
Rate for Payer: Priority Health Choice Medicaid	$469.88
Rate for Payer: Priority Health Cigna Priority Health	$1,060.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,123.43
Rate for Payer: Priority Health Narrow Network	$1,123.43
Rate for Payer: Priority Health SBD	$1,123.43
Rate for Payer: UMR Bronson Commercial	$696.90

PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR

Professional

Both

$1,548.00

Service Code	HCPCS 21423
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$1,221.98
Rate for Payer: Aetna Commercial	$1,075.12
Rate for Payer: BCBS Complete	$535.65
Rate for Payer: BCBS Trust/PPO	$24.96
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Meridian Medicaid	$535.65
Rate for Payer: Priority Health Choice Medicaid	$510.14
Rate for Payer: Priority Health Cigna Priority Health	$1,083.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,221.98
Rate for Payer: Priority Health Narrow Network	$1,221.98
Rate for Payer: Priority Health SBD	$1,221.98
Rate for Payer: UMR Bronson Commercial	$712.08

PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA

Professional

Both

$1,779.00

Service Code	HCPCS 26735
Min. Negotiated Rate	$388.09
Max. Negotiated Rate	$1,561.28
Rate for Payer: Aetna Commercial	$790.77
Rate for Payer: BCBS Complete	$407.49
Rate for Payer: BCBS Trust/PPO	$1,561.28
Rate for Payer: Cash Price	$1,423.20
Rate for Payer: Cash Price	$1,423.20
Rate for Payer: Meridian Medicaid	$407.49
Rate for Payer: Priority Health Choice Medicaid	$388.09
Rate for Payer: Priority Health Cigna Priority Health	$1,245.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$919.68
Rate for Payer: Priority Health Narrow Network	$919.68
Rate for Payer: Priority Health SBD	$919.68
Rate for Payer: UMR Bronson Commercial	$818.34

PR OPEN TX POST PELVIC FXCTURE

Professional

Both

$2,321.00

Service Code	HCPCS G0415
Min. Negotiated Rate	$446.41
Max. Negotiated Rate	$2,094.17
Rate for Payer: Aetna Commercial	$1,373.54
Rate for Payer: BCBS Complete	$920.99
Rate for Payer: BCBS Trust/PPO	$446.41
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Meridian Medicaid	$920.99
Rate for Payer: Priority Health Choice Medicaid	$877.13
Rate for Payer: Priority Health Cigna Priority Health	$1,624.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,094.17
Rate for Payer: Priority Health Narrow Network	$2,094.17
Rate for Payer: Priority Health SBD	$2,094.17
Rate for Payer: UMR Bronson Commercial	$1,067.66

PR OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB

Professional

Both

$1,807.00

Service Code	HCPCS 27832
Min. Negotiated Rate	$491.60
Max. Negotiated Rate	$1,321.62
Rate for Payer: Aetna Commercial	$1,009.97
Rate for Payer: BCBS Complete	$516.18
Rate for Payer: BCBS Trust/PPO	$1,321.62
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Meridian Medicaid	$516.18
Rate for Payer: Priority Health Choice Medicaid	$491.60
Rate for Payer: Priority Health Cigna Priority Health	$1,264.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,166.32
Rate for Payer: Priority Health Narrow Network	$1,166.32
Rate for Payer: Priority Health SBD	$1,166.32
Rate for Payer: UMR Bronson Commercial	$831.22

PR OPEN TX RADIAL HEAD/NECK FRACTURE

Professional

Both

$2,319.00

Service Code	HCPCS 24665
Min. Negotiated Rate	$427.70
Max. Negotiated Rate	$1,623.30
Rate for Payer: Aetna Commercial	$875.66
Rate for Payer: BCBS Complete	$449.08
Rate for Payer: BCBS Trust/PPO	$1,195.54
Rate for Payer: Cash Price	$1,855.20
Rate for Payer: Cash Price	$1,855.20
Rate for Payer: Meridian Medicaid	$449.08
Rate for Payer: Priority Health Choice Medicaid	$427.70
Rate for Payer: Priority Health Cigna Priority Health	$1,623.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,014.66
Rate for Payer: Priority Health Narrow Network	$1,014.66
Rate for Payer: Priority Health SBD	$1,014.66
Rate for Payer: UMR Bronson Commercial	$1,066.74

PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC

Professional

Both

$2,848.00

Service Code	HCPCS 24666
Min. Negotiated Rate	$474.78
Max. Negotiated Rate	$1,993.60
Rate for Payer: Aetna Commercial	$977.72
Rate for Payer: BCBS Complete	$498.52
Rate for Payer: BCBS Trust/PPO	$1,044.45
Rate for Payer: Cash Price	$2,278.40
Rate for Payer: Cash Price	$2,278.40
Rate for Payer: Meridian Medicaid	$498.52
Rate for Payer: Priority Health Choice Medicaid	$474.78
Rate for Payer: Priority Health Cigna Priority Health	$1,993.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,129.05
Rate for Payer: Priority Health Narrow Network	$1,129.05
Rate for Payer: Priority Health SBD	$1,129.05
Rate for Payer: UMR Bronson Commercial	$1,310.08

PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA

Professional

Both

$2,490.00

Service Code	HCPCS 25575
Min. Negotiated Rate	$585.32
Max. Negotiated Rate	$1,743.00
Rate for Payer: Aetna Commercial	$1,204.50
Rate for Payer: BCBS Complete	$614.59
Rate for Payer: BCBS Trust/PPO	$1,676.82
Rate for Payer: Cash Price	$1,992.00
Rate for Payer: Cash Price	$1,992.00
Rate for Payer: Meridian Medicaid	$614.59
Rate for Payer: Priority Health Choice Medicaid	$585.32
Rate for Payer: Priority Health Cigna Priority Health	$1,743.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,391.01
Rate for Payer: Priority Health Narrow Network	$1,391.01
Rate for Payer: Priority Health SBD	$1,391.01
Rate for Payer: UMR Bronson Commercial	$1,145.40

PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA

Professional

Both

$1,833.00

Service Code	HCPCS 25574
Min. Negotiated Rate	$439.21
Max. Negotiated Rate	$4,249.65
Rate for Payer: Aetna Commercial	$898.86
Rate for Payer: BCBS Complete	$461.17
Rate for Payer: BCBS Trust/PPO	$4,249.65
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Meridian Medicaid	$461.17
Rate for Payer: Priority Health Choice Medicaid	$439.21
Rate for Payer: Priority Health Cigna Priority Health	$1,283.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,043.76
Rate for Payer: Priority Health Narrow Network	$1,043.76
Rate for Payer: Priority Health SBD	$1,043.76
Rate for Payer: UMR Bronson Commercial	$843.18

PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES

Professional

Both

$1,945.00

Service Code	HCPCS 25670
Min. Negotiated Rate	$395.33
Max. Negotiated Rate	$1,426.94
Rate for Payer: Aetna Commercial	$813.10
Rate for Payer: BCBS Complete	$415.10
Rate for Payer: BCBS Trust/PPO	$1,426.94
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Meridian Medicaid	$415.10
Rate for Payer: Priority Health Choice Medicaid	$395.33
Rate for Payer: Priority Health Cigna Priority Health	$1,361.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$940.10
Rate for Payer: Priority Health Narrow Network	$940.10
Rate for Payer: Priority Health SBD	$940.10
Rate for Payer: UMR Bronson Commercial	$894.70

PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS

Professional

Both

$1,238.00

Service Code	HCPCS 21811
Min. Negotiated Rate	$376.16
Max. Negotiated Rate	$6,603.85
Rate for Payer: Aetna Commercial	$802.06
Rate for Payer: BCBS Complete	$394.97
Rate for Payer: BCBS Trust/PPO	$6,603.85
Rate for Payer: Cash Price	$990.40
Rate for Payer: Cash Price	$990.40
Rate for Payer: Meridian Medicaid	$394.97
Rate for Payer: Priority Health Choice Medicaid	$376.16
Rate for Payer: Priority Health Cigna Priority Health	$866.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$897.73
Rate for Payer: Priority Health Narrow Network	$897.73
Rate for Payer: Priority Health SBD	$897.73
Rate for Payer: UMR Bronson Commercial	$569.48

PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS

Professional

Both

$1,728.00

Service Code	HCPCS 21812
Min. Negotiated Rate	$453.90
Max. Negotiated Rate	$3,247.68
Rate for Payer: Aetna Commercial	$970.72
Rate for Payer: BCBS Complete	$476.60
Rate for Payer: BCBS Trust/PPO	$3,247.68
Rate for Payer: Cash Price	$1,382.40
Rate for Payer: Cash Price	$1,382.40
Rate for Payer: Meridian Medicaid	$476.60
Rate for Payer: Priority Health Choice Medicaid	$453.90
Rate for Payer: Priority Health Cigna Priority Health	$1,209.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,088.20
Rate for Payer: Priority Health Narrow Network	$1,088.20
Rate for Payer: Priority Health SBD	$1,088.20
Rate for Payer: UMR Bronson Commercial	$794.88

PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS

Professional

Both

$1,946.00

Service Code	HCPCS 21813
Min. Negotiated Rate	$99.81
Max. Negotiated Rate	$1,487.52
Rate for Payer: Aetna Commercial	$1,332.58
Rate for Payer: BCBS Complete	$653.06
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: Cash Price	$1,556.80
Rate for Payer: Cash Price	$1,556.80
Rate for Payer: Meridian Medicaid	$653.06
Rate for Payer: Priority Health Choice Medicaid	$621.96
Rate for Payer: Priority Health Cigna Priority Health	$1,362.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,487.52
Rate for Payer: Priority Health Narrow Network	$1,487.52
Rate for Payer: Priority Health SBD	$1,487.52
Rate for Payer: UMR Bronson Commercial	$895.16

PR OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD

Professional

Both

$3,129.00

Service Code	HCPCS 23585
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$2,190.30
Rate for Payer: Aetna Commercial	$1,304.27
Rate for Payer: BCBS Complete	$659.77
Rate for Payer: BCBS Trust/PPO	$187.20
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Meridian Medicaid	$659.77
Rate for Payer: Priority Health Choice Medicaid	$628.35
Rate for Payer: Priority Health Cigna Priority Health	$2,190.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,497.22
Rate for Payer: Priority Health Narrow Network	$1,497.22
Rate for Payer: Priority Health SBD	$1,497.22
Rate for Payer: UMR Bronson Commercial	$1,439.34

PR OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION

Professional

Both

$657.00

Service Code	HCPCS 28531
Min. Negotiated Rate	$117.58
Max. Negotiated Rate	$486.56
Rate for Payer: Aetna Commercial	$237.60
Rate for Payer: BCBS Complete	$123.46
Rate for Payer: BCBS Trust/PPO	$486.56
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Meridian Medicaid	$123.46
Rate for Payer: Priority Health Choice Medicaid	$117.58
Rate for Payer: Priority Health Cigna Priority Health	$459.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$275.24
Rate for Payer: Priority Health Narrow Network	$275.24
Rate for Payer: Priority Health SBD	$275.24
Rate for Payer: UMR Bronson Commercial	$302.22

PR OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC

Professional

Both

$2,403.00

Service Code	HCPCS 23530
Min. Negotiated Rate	$374.88
Max. Negotiated Rate	$1,682.10
Rate for Payer: Aetna Commercial	$767.80
Rate for Payer: BCBS Complete	$393.62
Rate for Payer: BCBS Trust/PPO	$414.72
Rate for Payer: Cash Price	$1,922.40
Rate for Payer: Cash Price	$1,922.40
Rate for Payer: Meridian Medicaid	$393.62
Rate for Payer: Priority Health Choice Medicaid	$374.88
Rate for Payer: Priority Health Cigna Priority Health	$1,682.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$891.08
Rate for Payer: Priority Health Narrow Network	$891.08
Rate for Payer: Priority Health SBD	$891.08
Rate for Payer: UMR Bronson Commercial	$1,105.38

PR OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION

Professional

Both

$984.00

Service Code	HCPCS 21825
Min. Negotiated Rate	$355.28
Max. Negotiated Rate	$6,614.63
Rate for Payer: Aetna Commercial	$728.58
Rate for Payer: BCBS Complete	$373.04
Rate for Payer: BCBS Trust/PPO	$6,614.63
Rate for Payer: Cash Price	$787.20
Rate for Payer: Cash Price	$787.20
Rate for Payer: Meridian Medicaid	$373.04
Rate for Payer: Priority Health Choice Medicaid	$355.28
Rate for Payer: Priority Health Cigna Priority Health	$688.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$841.04
Rate for Payer: Priority Health Narrow Network	$841.04
Rate for Payer: Priority Health SBD	$841.04
Rate for Payer: UMR Bronson Commercial	$452.64

PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA

Professional

Both

$1,540.00

Service Code	HCPCS 28465
Min. Negotiated Rate	$414.92
Max. Negotiated Rate	$1,078.00
Rate for Payer: Aetna Commercial	$835.92
Rate for Payer: BCBS Complete	$435.67
Rate for Payer: BCBS Trust/PPO	$524.60
Rate for Payer: Cash Price	$1,232.00
Rate for Payer: Cash Price	$1,232.00
Rate for Payer: Meridian Medicaid	$435.67
Rate for Payer: Priority Health Choice Medicaid	$414.92
Rate for Payer: Priority Health Cigna Priority Health	$1,078.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$973.30
Rate for Payer: Priority Health Narrow Network	$973.30
Rate for Payer: Priority Health SBD	$973.30
Rate for Payer: UMR Bronson Commercial	$708.40

PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR

Professional

Both

$2,731.00

Service Code	HCPCS 27535
Min. Negotiated Rate	$533.05
Max. Negotiated Rate	$1,911.70
Rate for Payer: Aetna Commercial	$1,202.31
Rate for Payer: BCBS Complete	$604.75
Rate for Payer: BCBS Trust/PPO	$533.05
Rate for Payer: Cash Price	$2,184.80
Rate for Payer: Cash Price	$2,184.80
Rate for Payer: Meridian Medicaid	$604.75
Rate for Payer: Priority Health Choice Medicaid	$575.95
Rate for Payer: Priority Health Cigna Priority Health	$1,911.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,372.12
Rate for Payer: Priority Health Narrow Network	$1,372.12
Rate for Payer: Priority Health SBD	$1,372.12
Rate for Payer: UMR Bronson Commercial	$1,256.26

PR OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC

Professional

Both

$2,067.00

Service Code	HCPCS 25685
Min. Negotiated Rate	$476.91
Max. Negotiated Rate	$1,614.48
Rate for Payer: Aetna Commercial	$981.61
Rate for Payer: BCBS Complete	$500.76
Rate for Payer: BCBS Trust/PPO	$1,614.48
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Meridian Medicaid	$500.76
Rate for Payer: Priority Health Choice Medicaid	$476.91
Rate for Payer: Priority Health Cigna Priority Health	$1,446.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,133.14
Rate for Payer: Priority Health Narrow Network	$1,133.14
Rate for Payer: Priority Health SBD	$1,133.14
Rate for Payer: UMR Bronson Commercial	$950.82

PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP

Professional

Both

$4,086.00

Service Code	HCPCS 27823
Min. Negotiated Rate	$634.95
Max. Negotiated Rate	$3,182.48
Rate for Payer: Aetna Commercial	$1,313.54
Rate for Payer: BCBS Complete	$666.70
Rate for Payer: BCBS Trust/PPO	$3,182.48
Rate for Payer: Cash Price	$3,268.80
Rate for Payer: Cash Price	$3,268.80
Rate for Payer: Meridian Medicaid	$666.70
Rate for Payer: Priority Health Choice Medicaid	$634.95
Rate for Payer: Priority Health Cigna Priority Health	$2,860.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,513.06
Rate for Payer: Priority Health Narrow Network	$1,513.06
Rate for Payer: Priority Health SBD	$1,513.06
Rate for Payer: UMR Bronson Commercial	$1,879.56

Know your out-of-pocket cost for care.

All Charges