Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD

Professional

Both

$815.00

Service Code	HCPCS 28111
Min. Negotiated Rate	$205.33
Max. Negotiated Rate	$667.24
Rate for Payer: Aetna Commercial	$427.63
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$652.00
Rate for Payer: Cash Price	$652.00
Rate for Payer: Meridian Medicaid	$215.60
Rate for Payer: Priority Health Choice Medicaid	$205.33
Rate for Payer: Priority Health Cigna Priority Health	$570.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$486.66
Rate for Payer: Priority Health Narrow Network	$486.66
Rate for Payer: Priority Health SBD	$486.66
Rate for Payer: UMR Bronson Commercial	$374.90

PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD

Professional

Both

$1,014.00

Service Code	HCPCS 28113
Min. Negotiated Rate	$275.41
Max. Negotiated Rate	$709.80
Rate for Payer: Aetna Commercial	$559.27
Rate for Payer: BCBS Complete	$289.18
Rate for Payer: BCBS Trust/PPO	$522.49
Rate for Payer: Cash Price	$811.20
Rate for Payer: Cash Price	$811.20
Rate for Payer: Meridian Medicaid	$289.18
Rate for Payer: Priority Health Choice Medicaid	$275.41
Rate for Payer: Priority Health Cigna Priority Health	$709.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$649.04
Rate for Payer: Priority Health Narrow Network	$649.04
Rate for Payer: Priority Health SBD	$649.04
Rate for Payer: UMR Bronson Commercial	$466.44

PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4

Professional

Both

$952.00

Service Code	HCPCS 28112
Min. Negotiated Rate	$202.14
Max. Negotiated Rate	$1,106.26
Rate for Payer: Aetna Commercial	$411.03
Rate for Payer: BCBS Complete	$212.25
Rate for Payer: BCBS Trust/PPO	$1,106.26
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$761.60
Rate for Payer: Meridian Medicaid	$212.25
Rate for Payer: Priority Health Choice Medicaid	$202.14
Rate for Payer: Priority Health Cigna Priority Health	$666.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$477.96
Rate for Payer: Priority Health Narrow Network	$477.96
Rate for Payer: Priority Health SBD	$477.96
Rate for Payer: UMR Bronson Commercial	$437.92

PR OSTECTOMY PRTL 5TH METAR HEAD SPX

Professional

Both

$896.00

Service Code	HCPCS 28110
Min. Negotiated Rate	$189.78
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Commercial	$382.12
Rate for Payer: BCBS Complete	$199.27
Rate for Payer: BCBS Trust/PPO	$583.24
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cash Price	$716.80
Rate for Payer: Meridian Medicaid	$199.27
Rate for Payer: Priority Health Choice Medicaid	$189.78
Rate for Payer: Priority Health Cigna Priority Health	$627.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$444.27
Rate for Payer: Priority Health Narrow Network	$444.27
Rate for Payer: Priority Health SBD	$444.27
Rate for Payer: UMR Bronson Commercial	$412.16

PR OSTECTOMY STERNUM PARTIAL

Professional

Both

$3,875.00

Service Code	HCPCS 21620
Min. Negotiated Rate	$322.91
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$678.09
Rate for Payer: BCBS Complete	$339.06
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$3,100.00
Rate for Payer: Cash Price	$3,100.00
Rate for Payer: Meridian Medicaid	$339.06
Rate for Payer: Priority Health Choice Medicaid	$322.91
Rate for Payer: Priority Health Cigna Priority Health	$2,712.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$771.09
Rate for Payer: Priority Health Narrow Network	$771.09
Rate for Payer: Priority Health SBD	$771.09
Rate for Payer: UMR Bronson Commercial	$1,782.50

PR OSTECTOMY TARSAL COALITION

Professional

Both

$1,411.00

Service Code	HCPCS 28116
Min. Negotiated Rate	$374.88
Max. Negotiated Rate	$1,784.07
Rate for Payer: Aetna Commercial	$769.13
Rate for Payer: BCBS Complete	$393.62
Rate for Payer: BCBS Trust/PPO	$1,784.07
Rate for Payer: Cash Price	$1,128.80
Rate for Payer: Cash Price	$1,128.80
Rate for Payer: Meridian Medicaid	$393.62
Rate for Payer: Priority Health Choice Medicaid	$374.88
Rate for Payer: Priority Health Cigna Priority Health	$987.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$900.27
Rate for Payer: Priority Health Narrow Network	$900.27
Rate for Payer: Priority Health SBD	$900.27
Rate for Payer: UMR Bronson Commercial	$649.06

PR OSTEOCHONDRAL ALLOGRAFT KNEE OPEN

Professional

Both

$4,485.00

Service Code	HCPCS 27415
Min. Negotiated Rate	$709.51
Max. Negotiated Rate	$3,139.50
Rate for Payer: Aetna Commercial	$1,833.39
Rate for Payer: BCBS Complete	$925.91
Rate for Payer: BCBS Trust/PPO	$709.51
Rate for Payer: Cash Price	$3,588.00
Rate for Payer: Cash Price	$3,588.00
Rate for Payer: Meridian Medicaid	$925.91
Rate for Payer: Priority Health Choice Medicaid	$881.82
Rate for Payer: Priority Health Cigna Priority Health	$3,139.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,098.27
Rate for Payer: Priority Health Narrow Network	$2,098.27
Rate for Payer: Priority Health SBD	$2,098.27
Rate for Payer: UMR Bronson Commercial	$2,063.10

PR OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY

Professional

Both

$3,036.00

Service Code	HCPCS 27416
Min. Negotiated Rate	$631.55
Max. Negotiated Rate	$2,125.20
Rate for Payer: Aetna Commercial	$1,308.99
Rate for Payer: BCBS Complete	$663.13
Rate for Payer: BCBS Trust/PPO	$852.15
Rate for Payer: Cash Price	$2,428.80
Rate for Payer: Cash Price	$2,428.80
Rate for Payer: Meridian Medicaid	$663.13
Rate for Payer: Priority Health Choice Medicaid	$631.55
Rate for Payer: Priority Health Cigna Priority Health	$2,125.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,503.35
Rate for Payer: Priority Health Narrow Network	$1,503.35
Rate for Payer: Priority Health SBD	$1,503.35
Rate for Payer: UMR Bronson Commercial	$1,396.56

PR OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS

Professional

Both

$53.00

Service Code	HCPCS 98925
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$1,227.77
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$1,227.77
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Meridian Medicaid	$15.20
Rate for Payer: Priority Health Choice Medicaid	$14.48
Rate for Payer: Priority Health Cigna Priority Health	$37.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.99
Rate for Payer: Priority Health Narrow Network	$30.99
Rate for Payer: Priority Health SBD	$30.99
Rate for Payer: UMR Bronson Commercial	$24.38

PR OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS

Professional

Both

$76.00

Service Code	HCPCS 98926
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$1,021.73
Rate for Payer: Aetna Commercial	$28.73
Rate for Payer: BCBS Complete	$23.04
Rate for Payer: BCBS Trust/PPO	$1,021.73
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Meridian Medicaid	$23.04
Rate for Payer: Priority Health Choice Medicaid	$21.94
Rate for Payer: Priority Health Cigna Priority Health	$53.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46.26
Rate for Payer: Priority Health Narrow Network	$46.26
Rate for Payer: Priority Health SBD	$46.26
Rate for Payer: UMR Bronson Commercial	$34.96

PR OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS

Professional

Both

$100.00

Service Code	HCPCS 98927
Min. Negotiated Rate	$29.18
Max. Negotiated Rate	$1,177.05
Rate for Payer: Aetna Commercial	$37.99
Rate for Payer: BCBS Complete	$30.64
Rate for Payer: BCBS Trust/PPO	$1,177.05
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Meridian Medicaid	$30.64
Rate for Payer: Priority Health Choice Medicaid	$29.18
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.64
Rate for Payer: Priority Health Narrow Network	$60.64
Rate for Payer: Priority Health SBD	$60.64
Rate for Payer: UMR Bronson Commercial	$46.00

PR OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS

Professional

Both

$123.00

Service Code	HCPCS 98928
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$332.83
Rate for Payer: Aetna Commercial	$47.49
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCBS Trust/PPO	$332.83
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.26
Rate for Payer: Priority Health Narrow Network	$77.26
Rate for Payer: Priority Health SBD	$77.26
Rate for Payer: UMR Bronson Commercial	$56.58

PR OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS

Professional

Both

$147.00

Service Code	HCPCS 98929
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$193.36
Rate for Payer: Aetna Commercial	$58.11
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCBS Trust/PPO	$193.36
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health	$102.90
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	$92.53
Rate for Payer: UMR Bronson Commercial	$67.62

PR OSTEOPLASTY CARPAL BONE SHORTENING

Professional

Both

$1,900.00

Service Code	HCPCS 25394
Min. Negotiated Rate	$508.22
Max. Negotiated Rate	$1,330.00
Rate for Payer: Aetna Commercial	$1,047.57
Rate for Payer: BCBS Complete	$533.63
Rate for Payer: BCBS Trust/PPO	$556.83
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Meridian Medicaid	$533.63
Rate for Payer: Priority Health Choice Medicaid	$508.22
Rate for Payer: Priority Health Cigna Priority Health	$1,330.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,206.66
Rate for Payer: Priority Health Narrow Network	$1,206.66
Rate for Payer: Priority Health SBD	$1,206.66
Rate for Payer: UMR Bronson Commercial	$874.00

PR OSTEOPLASTY FEMUR LENGTHENING

Professional

Both

$3,903.00

Service Code	HCPCS 27466
Min. Negotiated Rate	$761.69
Max. Negotiated Rate	$2,732.10
Rate for Payer: Aetna Commercial	$1,582.85
Rate for Payer: BCBS Complete	$799.77
Rate for Payer: BCBS Trust/PPO	$1,594.94
Rate for Payer: Cash Price	$3,122.40
Rate for Payer: Cash Price	$3,122.40
Rate for Payer: Meridian Medicaid	$799.77
Rate for Payer: Priority Health Choice Medicaid	$761.69
Rate for Payer: Priority Health Cigna Priority Health	$2,732.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,812.81
Rate for Payer: Priority Health Narrow Network	$1,812.81
Rate for Payer: Priority Health SBD	$1,812.81
Rate for Payer: UMR Bronson Commercial	$1,795.38

PR OSTEOPLASTY HUMERUS

Professional

Both

$3,270.00

Service Code	HCPCS 24420
Min. Negotiated Rate	$306.41
Max. Negotiated Rate	$2,289.00
Rate for Payer: Aetna Commercial	$1,403.52
Rate for Payer: BCBS Complete	$720.37
Rate for Payer: BCBS Trust/PPO	$306.41
Rate for Payer: Cash Price	$2,616.00
Rate for Payer: Cash Price	$2,616.00
Rate for Payer: Meridian Medicaid	$720.37
Rate for Payer: Priority Health Choice Medicaid	$686.07
Rate for Payer: Priority Health Cigna Priority Health	$2,289.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,638.16
Rate for Payer: Priority Health Narrow Network	$1,638.16
Rate for Payer: Priority Health SBD	$1,638.16
Rate for Payer: UMR Bronson Commercial	$1,504.20

PR OSTEOPLASTY RADIUS/ULNA SHORTENING

Professional

Both

$2,636.00

Service Code	HCPCS 25390
Min. Negotiated Rate	$497.57
Max. Negotiated Rate	$1,845.20
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: BCBS Complete	$522.45
Rate for Payer: BCBS Trust/PPO	$580.07
Rate for Payer: Cash Price	$2,108.80
Rate for Payer: Cash Price	$2,108.80
Rate for Payer: Meridian Medicaid	$522.45
Rate for Payer: Priority Health Choice Medicaid	$497.57
Rate for Payer: Priority Health Cigna Priority Health	$1,845.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,184.19
Rate for Payer: Priority Health Narrow Network	$1,184.19
Rate for Payer: Priority Health SBD	$1,184.19
Rate for Payer: UMR Bronson Commercial	$1,212.56

PR OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN

Professional

Both

$4,677.00

Service Code	HCPCS 27715
Min. Negotiated Rate	$226.28
Max. Negotiated Rate	$3,273.90
Rate for Payer: Aetna Commercial	$1,433.12
Rate for Payer: BCBS Complete	$724.63
Rate for Payer: BCBS Trust/PPO	$226.28
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Meridian Medicaid	$724.63
Rate for Payer: Priority Health Choice Medicaid	$690.12
Rate for Payer: Priority Health Cigna Priority Health	$3,273.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,642.25
Rate for Payer: Priority Health Narrow Network	$1,642.25
Rate for Payer: Priority Health SBD	$1,642.25
Rate for Payer: UMR Bronson Commercial	$2,151.42

PR OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL

Professional

Both

$7,717.00

Service Code	HCPCS 27165
Min. Negotiated Rate	$880.12
Max. Negotiated Rate	$5,401.90
Rate for Payer: Aetna Commercial	$1,842.03
Rate for Payer: BCBS Complete	$924.13
Rate for Payer: BCBS Trust/PPO	$1,570.11
Rate for Payer: Cash Price	$6,173.60
Rate for Payer: Cash Price	$6,173.60
Rate for Payer: Meridian Medicaid	$924.13
Rate for Payer: Priority Health Choice Medicaid	$880.12
Rate for Payer: Priority Health Cigna Priority Health	$5,401.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,100.81
Rate for Payer: Priority Health Narrow Network	$2,100.81
Rate for Payer: Priority Health SBD	$2,100.81
Rate for Payer: UMR Bronson Commercial	$3,549.82

PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION

Professional

Both

$1,712.00

Service Code	HCPCS 28300
Min. Negotiated Rate	$419.61
Max. Negotiated Rate	$1,703.80
Rate for Payer: Aetna Commercial	$866.13
Rate for Payer: BCBS Complete	$440.59
Rate for Payer: BCBS Trust/PPO	$1,703.80
Rate for Payer: Cash Price	$1,369.60
Rate for Payer: Cash Price	$1,369.60
Rate for Payer: Meridian Medicaid	$440.59
Rate for Payer: Priority Health Choice Medicaid	$419.61
Rate for Payer: Priority Health Cigna Priority Health	$1,198.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$996.28
Rate for Payer: Priority Health Narrow Network	$996.28
Rate for Payer: Priority Health SBD	$996.28
Rate for Payer: UMR Bronson Commercial	$787.52

PR OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION

Professional

Both

$1,695.00

Service Code	HCPCS 23480
Min. Negotiated Rate	$134.57
Max. Negotiated Rate	$1,261.30
Rate for Payer: Aetna Commercial	$1,096.36
Rate for Payer: BCBS Complete	$556.67
Rate for Payer: BCBS Trust/PPO	$134.57
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Meridian Medicaid	$556.67
Rate for Payer: Priority Health Choice Medicaid	$530.16
Rate for Payer: Priority Health Cigna Priority Health	$1,186.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,261.30
Rate for Payer: Priority Health Narrow Network	$1,261.30
Rate for Payer: Priority Health SBD	$1,261.30
Rate for Payer: UMR Bronson Commercial	$779.70

PR OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL

Professional

Both

$2,379.00

Service Code	HCPCS 23485
Min. Negotiated Rate	$168.53
Max. Negotiated Rate	$1,665.30
Rate for Payer: Aetna Commercial	$1,269.43
Rate for Payer: BCBS Complete	$645.24
Rate for Payer: BCBS Trust/PPO	$168.53
Rate for Payer: Cash Price	$1,903.20
Rate for Payer: Cash Price	$1,903.20
Rate for Payer: Meridian Medicaid	$645.24
Rate for Payer: Priority Health Choice Medicaid	$614.51
Rate for Payer: Priority Health Cigna Priority Health	$1,665.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,462.50
Rate for Payer: Priority Health Narrow Network	$1,462.50
Rate for Payer: Priority Health SBD	$1,462.50
Rate for Payer: UMR Bronson Commercial	$1,094.34

PR OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION

Professional

Both

$2,857.00

Service Code	HCPCS 27450
Min. Negotiated Rate	$649.86
Max. Negotiated Rate	$1,999.90
Rate for Payer: Aetna Commercial	$1,357.97
Rate for Payer: BCBS Complete	$682.35
Rate for Payer: BCBS Trust/PPO	$1,095.69
Rate for Payer: Cash Price	$2,285.60
Rate for Payer: Cash Price	$2,285.60
Rate for Payer: Meridian Medicaid	$682.35
Rate for Payer: Priority Health Choice Medicaid	$649.86
Rate for Payer: Priority Health Cigna Priority Health	$1,999.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,556.46
Rate for Payer: Priority Health Narrow Network	$1,556.46
Rate for Payer: Priority Health SBD	$1,556.46
Rate for Payer: UMR Bronson Commercial	$1,314.22

PR OSTEOTOMY FIBULA

Professional

Both

$1,275.00

Service Code	HCPCS 27707
Min. Negotiated Rate	$264.12
Max. Negotiated Rate	$2,447.61
Rate for Payer: Aetna Commercial	$528.68
Rate for Payer: BCBS Complete	$277.33
Rate for Payer: BCBS Trust/PPO	$2,447.61
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Meridian Medicaid	$277.33
Rate for Payer: Priority Health Choice Medicaid	$264.12
Rate for Payer: Priority Health Cigna Priority Health	$892.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$625.55
Rate for Payer: Priority Health Narrow Network	$625.55
Rate for Payer: Priority Health SBD	$625.55
Rate for Payer: UMR Bronson Commercial	$586.50

PR OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION

Professional

Both

$1,437.00

Service Code	HCPCS 24400
Min. Negotiated Rate	$227.70
Max. Negotiated Rate	$1,273.57
Rate for Payer: Aetna Commercial	$1,101.27
Rate for Payer: BCBS Complete	$562.03
Rate for Payer: BCBS Trust/PPO	$227.70
Rate for Payer: Cash Price	$1,149.60
Rate for Payer: Cash Price	$1,149.60
Rate for Payer: Meridian Medicaid	$562.03
Rate for Payer: Priority Health Choice Medicaid	$535.27
Rate for Payer: Priority Health Cigna Priority Health	$1,005.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,273.57
Rate for Payer: Priority Health Narrow Network	$1,273.57
Rate for Payer: Priority Health SBD	$1,273.57
Rate for Payer: UMR Bronson Commercial	$661.02

Know your out-of-pocket cost for care.

All Charges