Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PESSARY, NON RUBBER,ANY TYPE

Professional

Both

$75.00

Service Code	HCPCS A4562
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$47.42
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: UMR Bronson Commercial	$34.50

PR PESSARY RUBBER, ANY TYPE

Professional

Both

$75.00

Service Code	HCPCS A4561
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$19.09
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: UMR Bronson Commercial	$34.50

PR PHALANGECTOMY TOE EACH TOE

Professional

Both

$832.00

Service Code	HCPCS 28150
Min. Negotiated Rate	$180.41
Max. Negotiated Rate	$1,132.15
Rate for Payer: Aetna Commercial	$367.96
Rate for Payer: BCBS Complete	$189.43
Rate for Payer: BCBS Trust/PPO	$1,132.15
Rate for Payer: Cash Price	$665.60
Rate for Payer: Cash Price	$665.60
Rate for Payer: Meridian Medicaid	$189.43
Rate for Payer: Priority Health Choice Medicaid	$180.41
Rate for Payer: Priority Health Cigna Priority Health	$582.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$423.83
Rate for Payer: Priority Health Narrow Network	$423.83
Rate for Payer: Priority Health SBD	$423.83
Rate for Payer: UMR Bronson Commercial	$382.72

PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY

Professional

Both

$83.00

Service Code	HCPCS 90863
Min. Negotiated Rate	$31.40
Max. Negotiated Rate	$1,062.41
Rate for Payer: Aetna Commercial	$31.40
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: BCBS Trust/PPO	$1,062.41
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.86
Rate for Payer: Priority Health Narrow Network	$41.86
Rate for Payer: Priority Health SBD	$41.86
Rate for Payer: UMR Bronson Commercial	$38.18

PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX

Professional

Both

$1,413.00

Service Code	HCPCS 42950
Min. Negotiated Rate	$510.35
Max. Negotiated Rate	$1,414.67
Rate for Payer: Aetna Commercial	$1,064.01
Rate for Payer: BCBS Complete	$535.87
Rate for Payer: BCBS Trust/PPO	$665.13
Rate for Payer: Cash Price	$1,130.40
Rate for Payer: Cash Price	$1,130.40
Rate for Payer: Meridian Medicaid	$535.87
Rate for Payer: Priority Health Choice Medicaid	$510.35
Rate for Payer: Priority Health Cigna Priority Health	$989.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,414.67
Rate for Payer: Priority Health Narrow Network	$1,414.67
Rate for Payer: Priority Health SBD	$1,414.67
Rate for Payer: UMR Bronson Commercial	$649.98

PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE

Professional

Both

$192.00

Service Code	HCPCS 99195
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$587.47
Rate for Payer: Aetna Commercial	$110.88
Rate for Payer: BCBS Complete	$76.80
Rate for Payer: BCBS Trust/PPO	$587.47
Rate for Payer: Cash Price	$153.60
Rate for Payer: Cash Price	$153.60
Rate for Payer: Priority Health Cigna Priority Health	$134.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.25
Rate for Payer: Priority Health Narrow Network	$130.25
Rate for Payer: Priority Health SBD	$130.25
Rate for Payer: UMR Bronson Commercial	$88.32

PR PHTFAC ARMS

Professional

Both

$250.00

Service Code	HCPCS 00079
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 PHTFAC CHEST/SHLD

Professional

Both

$125.00

Service Code	HCPCS 00077
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 PHTFAC FACE & NECK/ FL ARMS

Professional

Both

$250.00

Service Code	HCPCS 00076
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 PHTFAC FL LEGS

Professional

Both

$350.00

Service Code	HCPCS 00080
Hospital Revenue Code	990
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$245.00
Rate for Payer: BCBS Complete	$140.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: UMR Bronson Commercial	$161.00

PR PHTFAC HANDS

Professional

Both

$50.00

Service Code	HCPCS 00078
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UMR Bronson Commercial	$23.00

PR PHTFAC HEMANGIOMAS/WARTS

Professional

Both

$35.00

Service Code	HCPCS 00083
Hospital Revenue Code	990
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR PHTFAC NASAL VEIN

Professional

Both

$45.00

Service Code	HCPCS 00082
Hospital Revenue Code	990
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$31.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: UMR Bronson Commercial	$20.70

PR PHTFAC SNGL PIGMENT

Professional

Both

$35.00

Service Code	HCPCS 00081
Hospital Revenue Code	990
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN

Professional

Both

$53.00

Service Code	HCPCS 97750
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$708.45
Rate for Payer: Aetna Commercial	$24.69
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCBS Trust/PPO	$708.45
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Priority Health Cigna Priority Health	$37.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$24.38

PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU

Professional

Both

$179.00

Service Code	HCPCS 93464
Min. Negotiated Rate	$71.60
Max. Negotiated Rate	$740.15
Rate for Payer: Aetna Commercial	$307.40
Rate for Payer: BCBS Complete	$71.60
Rate for Payer: BCBS Trust/PPO	$740.15
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Priority Health Cigna Priority Health	$125.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$122.00
Rate for Payer: Priority Health Narrow Network	$122.00
Rate for Payer: Priority Health SBD	$309.25
Rate for Payer: UMR Bronson Commercial	$82.34

PR PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT

Professional

Both

$7.00

Service Code	HCPCS 01990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
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 PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION

Professional

Both

$366.00

Service Code	HCPCS 99183
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$256.20
Rate for Payer: Aetna Commercial	$120.18
Rate for Payer: BCBS Complete	$70.22
Rate for Payer: BCBS Trust/PPO	$201.28
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cash Price	$292.80
Rate for Payer: Meridian Medicaid	$70.22
Rate for Payer: Priority Health Choice Medicaid	$66.88
Rate for Payer: Priority Health Cigna Priority Health	$256.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$141.04
Rate for Payer: Priority Health Narrow Network	$141.04
Rate for Payer: Priority Health SBD	$141.04
Rate for Payer: UMR Bronson Commercial	$168.36

PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS

Professional

Both

$245.00

Service Code	HCPCS 99288
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$1,059.24
Rate for Payer: Aetna Commercial	$48.75
Rate for Payer: BCBS Complete	$98.00
Rate for Payer: BCBS Trust/PPO	$1,059.24
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Priority Health Cigna Priority Health	$171.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.00
Rate for Payer: Priority Health Narrow Network	$72.00
Rate for Payer: Priority Health SBD	$72.00
Rate for Payer: UMR Bronson Commercial	$112.70

PR PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING

Professional

Both

$30.00

Service Code	HCPCS 99078
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$434.79
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$434.79
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.89
Rate for Payer: Priority Health Narrow Network	$31.89
Rate for Payer: Priority Health SBD	$31.89
Rate for Payer: UMR Bronson Commercial	$13.80

PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE

Professional

Both

$49.00

Service Code	HCPCS 99444
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$34.30
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Priority Health Cigna Priority Health	$34.30
Rate for Payer: UMR Bronson Commercial	$22.54

PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN

Professional

Both

$146.00

Service Code	HCPCS 99442
Min. Negotiated Rate	$56.19
Max. Negotiated Rate	$1,711.16
Rate for Payer: Aetna Commercial	$67.27
Rate for Payer: BCBS Complete	$59.00
Rate for Payer: BCBS Trust/PPO	$1,711.16
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Meridian Medicaid	$59.00
Rate for Payer: Priority Health Choice Medicaid	$56.19
Rate for Payer: Priority Health Cigna Priority Health	$102.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.86
Rate for Payer: Priority Health Narrow Network	$67.86
Rate for Payer: Priority Health SBD	$67.86
Rate for Payer: UMR Bronson Commercial	$67.16

PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN

Professional

Both

$212.00

Service Code	HCPCS 99443
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$1,049.20
Rate for Payer: Aetna Commercial	$99.17
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$1,049.20
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.53
Rate for Payer: Priority Health Narrow Network	$99.53
Rate for Payer: Priority Health SBD	$99.53
Rate for Payer: UMR Bronson Commercial	$97.52

PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN

Professional

Both

$88.00

Service Code	HCPCS 99441
Min. Negotiated Rate	$29.97
Max. Negotiated Rate	$1,561.13
Rate for Payer: Aetna Commercial	$35.71
Rate for Payer: BCBS Complete	$31.47
Rate for Payer: BCBS Trust/PPO	$1,561.13
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Meridian Medicaid	$31.47
Rate for Payer: Priority Health Choice Medicaid	$29.97
Rate for Payer: Priority Health Cigna Priority Health	$61.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.84
Rate for Payer: Priority Health Narrow Network	$35.84
Rate for Payer: Priority Health SBD	$35.84
Rate for Payer: UMR Bronson Commercial	$40.48

PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES

Professional

Both

$256.00

Service Code	HCPCS 99360
Min. Negotiated Rate	$60.51
Max. Negotiated Rate	$179.20
Rate for Payer: Aetna Commercial	$60.51
Rate for Payer: BCBS Complete	$102.40
Rate for Payer: BCBS Trust/PPO	$102.49
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cash Price	$204.80
Rate for Payer: Priority Health Cigna Priority Health	$179.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.09
Rate for Payer: Priority Health Narrow Network	$74.09
Rate for Payer: Priority Health SBD	$74.09
Rate for Payer: UMR Bronson Commercial	$117.76

Know your out-of-pocket cost for care.

All Charges