Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM

Professional

Both

$899.00

Service Code	HCPCS 15050
Min. Negotiated Rate	$206.12
Max. Negotiated Rate	$629.30
Rate for Payer: Aetna Commercial	$494.38
Rate for Payer: BCBS Complete	$308.19
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$719.20
Rate for Payer: Cash Price	$719.20
Rate for Payer: Meridian Medicaid	$308.19
Rate for Payer: Priority Health Choice Medicaid	$293.51
Rate for Payer: Priority Health Cigna Priority Health	$629.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$568.05
Rate for Payer: Priority Health Narrow Network	$568.05
Rate for Payer: Priority Health SBD	$568.05
Rate for Payer: UMR Bronson Commercial	$413.54

PR PLACE CATH BRACHIAL ART

Professional

Both

$746.00

Service Code	HCPCS 36120
Min. Negotiated Rate	$298.40
Max. Negotiated Rate	$522.20
Rate for Payer: BCBS Complete	$298.40
Rate for Payer: Cash Price	$596.80
Rate for Payer: Priority Health Cigna Priority Health	$522.20
Rate for Payer: UMR Bronson Commercial	$343.16

PR PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS

Professional

Both

$3,219.00

Service Code	HCPCS 48000
Min. Negotiated Rate	$1,200.26
Max. Negotiated Rate	$3,300.29
Rate for Payer: Aetna Commercial	$2,551.38
Rate for Payer: BCBS Complete	$1,260.27
Rate for Payer: BCBS Trust/PPO	$3,234.25
Rate for Payer: Cash Price	$2,575.20
Rate for Payer: Cash Price	$2,575.20
Rate for Payer: Meridian Medicaid	$1,260.27
Rate for Payer: Priority Health Choice Medicaid	$1,200.26
Rate for Payer: Priority Health Cigna Priority Health	$2,253.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,300.29
Rate for Payer: Priority Health Narrow Network	$3,300.29
Rate for Payer: Priority Health SBD	$3,300.29
Rate for Payer: UMR Bronson Commercial	$1,480.74

PR PLACEMENT CHOLEDOCHAL STENT

Professional

Both

$2,497.00

Service Code	HCPCS 47801
Min. Negotiated Rate	$714.40
Max. Negotiated Rate	$1,963.83
Rate for Payer: Aetna Commercial	$1,511.06
Rate for Payer: BCBS Complete	$750.12
Rate for Payer: BCBS Trust/PPO	$1,198.18
Rate for Payer: Cash Price	$1,997.60
Rate for Payer: Cash Price	$1,997.60
Rate for Payer: Meridian Medicaid	$750.12
Rate for Payer: Priority Health Choice Medicaid	$714.40
Rate for Payer: Priority Health Cigna Priority Health	$1,747.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,963.83
Rate for Payer: Priority Health Narrow Network	$1,963.83
Rate for Payer: Priority Health SBD	$1,963.83
Rate for Payer: UMR Bronson Commercial	$1,148.62

PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN

Professional

Both

$1,932.00

Service Code	HCPCS 44300
Min. Negotiated Rate	$538.89
Max. Negotiated Rate	$3,186.71
Rate for Payer: Aetna Commercial	$1,135.71
Rate for Payer: BCBS Complete	$565.83
Rate for Payer: BCBS Trust/PPO	$3,186.71
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Meridian Medicaid	$565.83
Rate for Payer: Priority Health Choice Medicaid	$538.89
Rate for Payer: Priority Health Cigna Priority Health	$1,352.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,478.16
Rate for Payer: Priority Health Narrow Network	$1,478.16
Rate for Payer: Priority Health SBD	$1,478.16
Rate for Payer: UMR Bronson Commercial	$888.72

PR PLACEMENT NEEDLE INTRAOSSEOUS INFUSION

Professional

Both

$554.00

Service Code	HCPCS 36680
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$835.77
Rate for Payer: Aetna Commercial	$79.98
Rate for Payer: BCBS Complete	$39.58
Rate for Payer: BCBS Trust/PPO	$835.77
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Meridian Medicaid	$39.58
Rate for Payer: Priority Health Choice Medicaid	$37.70
Rate for Payer: Priority Health Cigna Priority Health	$387.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$93.62
Rate for Payer: Priority Health Narrow Network	$93.62
Rate for Payer: Priority Health SBD	$93.62
Rate for Payer: UMR Bronson Commercial	$254.84

PR PLACEMENT SETON

Professional

Both

$382.00

Service Code	HCPCS 46020
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,247.84
Rate for Payer: Aetna Commercial	$315.96
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: BCBS Trust/PPO	$1,247.84
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cash Price	$305.60
Rate for Payer: Meridian Medicaid	$78.28
Rate for Payer: Priority Health Choice Medicaid	$74.55
Rate for Payer: Priority Health Cigna Priority Health	$267.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.03
Rate for Payer: Priority Health Narrow Network	$204.03
Rate for Payer: Priority Health SBD	$204.03
Rate for Payer: UMR Bronson Commercial	$175.72

PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR

Professional

Both

$668.00

Service Code	HCPCS 34709
Min. Negotiated Rate	$200.01
Max. Negotiated Rate	$2,173.43
Rate for Payer: Aetna Commercial	$435.90
Rate for Payer: BCBS Complete	$210.01
Rate for Payer: BCBS Trust/PPO	$2,173.43
Rate for Payer: Cash Price	$534.40
Rate for Payer: Cash Price	$534.40
Rate for Payer: Meridian Medicaid	$210.01
Rate for Payer: Priority Health Choice Medicaid	$200.01
Rate for Payer: Priority Health Cigna Priority Health	$467.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$499.51
Rate for Payer: Priority Health Narrow Network	$499.51
Rate for Payer: Priority Health SBD	$499.51
Rate for Payer: UMR Bronson Commercial	$307.28

PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/ RAD EVAL

Professional

Both

$1,480.00

Service Code	HCPCS 36147
Min. Negotiated Rate	$592.00
Max. Negotiated Rate	$1,036.00
Rate for Payer: BCBS Complete	$592.00
Rate for Payer: Cash Price	$1,184.00
Rate for Payer: Priority Health Cigna Priority Health	$1,036.00
Rate for Payer: UMR Bronson Commercial	$680.80

PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,ADDL ACCESS FOR THERAPY

Professional

Both

$660.00

Service Code	HCPCS 36148
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$462.00
Rate for Payer: BCBS Complete	$264.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Priority Health Cigna Priority Health	$462.00
Rate for Payer: UMR Bronson Commercial	$303.60

PR PLASTIC OPERATION PENIS INJURY

Professional

Both

$1,944.00

Service Code	HCPCS 54440
Min. Negotiated Rate	$711.74
Max. Negotiated Rate	$1,537.35
Rate for Payer: Aetna Commercial	$711.74
Rate for Payer: BCBS Complete	$777.06
Rate for Payer: BCBS Trust/PPO	$1,537.35
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Meridian Medicaid	$777.06
Rate for Payer: Priority Health Choice Medicaid	$740.06
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$894.29
Rate for Payer: Priority Health Narrow Network	$894.29
Rate for Payer: Priority Health SBD	$894.29
Rate for Payer: UMR Bronson Commercial	$894.24

PR PLASTIC REPAIR INTROITUS

Professional

Both

$881.00

Service Code	HCPCS 56800
Min. Negotiated Rate	$163.16
Max. Negotiated Rate	$1,759.77
Rate for Payer: Aetna Commercial	$298.27
Rate for Payer: BCBS Complete	$171.32
Rate for Payer: BCBS Trust/PPO	$1,759.77
Rate for Payer: Cash Price	$704.80
Rate for Payer: Cash Price	$704.80
Rate for Payer: Meridian Medicaid	$171.32
Rate for Payer: Priority Health Choice Medicaid	$163.16
Rate for Payer: Priority Health Cigna Priority Health	$616.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$360.75
Rate for Payer: Priority Health Narrow Network	$360.75
Rate for Payer: Priority Health SBD	$360.75
Rate for Payer: UMR Bronson Commercial	$405.26

PR PLASTIC REPAIR URETHROCELE

Professional

Both

$793.00

Service Code	HCPCS 57230
Min. Negotiated Rate	$270.51
Max. Negotiated Rate	$598.88
Rate for Payer: Aetna Commercial	$495.89
Rate for Payer: BCBS Complete	$284.04
Rate for Payer: BCBS Trust/PPO	$286.34
Rate for Payer: Cash Price	$634.40
Rate for Payer: Cash Price	$634.40
Rate for Payer: Meridian Medicaid	$284.04
Rate for Payer: Priority Health Choice Medicaid	$270.51
Rate for Payer: Priority Health Cigna Priority Health	$555.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$598.88
Rate for Payer: Priority Health Narrow Network	$598.88
Rate for Payer: Priority Health SBD	$598.88
Rate for Payer: UMR Bronson Commercial	$364.78

PR PLASTIC RPR PENIS CORRECT ANGULATION

Professional

Both

$3,726.00

Service Code	HCPCS 54360
Min. Negotiated Rate	$459.23
Max. Negotiated Rate	$2,608.20
Rate for Payer: Aetna Commercial	$925.58
Rate for Payer: BCBS Complete	$482.19
Rate for Payer: BCBS Trust/PPO	$602.79
Rate for Payer: Cash Price	$2,980.80
Rate for Payer: Cash Price	$2,980.80
Rate for Payer: Meridian Medicaid	$482.19
Rate for Payer: Priority Health Choice Medicaid	$459.23
Rate for Payer: Priority Health Cigna Priority Health	$2,608.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,150.97
Rate for Payer: Priority Health Narrow Network	$1,150.97
Rate for Payer: Priority Health SBD	$1,150.97
Rate for Payer: UMR Bronson Commercial	$1,713.96

PR PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH

Professional

Both

$1,075.00

Service Code	HCPCS 57220
Min. Negotiated Rate	$223.44
Max. Negotiated Rate	$2,103.16
Rate for Payer: Aetna Commercial	$406.21
Rate for Payer: BCBS Complete	$234.61
Rate for Payer: BCBS Trust/PPO	$2,103.16
Rate for Payer: Cash Price	$860.00
Rate for Payer: Cash Price	$860.00
Rate for Payer: Meridian Medicaid	$234.61
Rate for Payer: Priority Health Choice Medicaid	$223.44
Rate for Payer: Priority Health Cigna Priority Health	$752.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$493.30
Rate for Payer: Priority Health Narrow Network	$493.30
Rate for Payer: Priority Health SBD	$493.30
Rate for Payer: UMR Bronson Commercial	$494.50

PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST

Professional

Both

$100.00

Service Code	HCPCS 94726
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$369.28
Rate for Payer: Aetna Commercial	$57.59
Rate for Payer: Aetna Commercial	$57.59
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCBS Trust/PPO	$369.28
Rate for Payer: BCBS Trust/PPO	$369.28
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$21.60
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health Cigna Priority Health	$18.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.72
Rate for Payer: Priority Health Narrow Network	$15.72
Rate for Payer: Priority Health Narrow Network	$15.72
Rate for Payer: Priority Health SBD	$72.76
Rate for Payer: Priority Health SBD	$72.76
Rate for Payer: UMR Bronson Commercial	$12.42
Rate for Payer: UMR Bronson Commercial	$46.00

PR PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX

Professional

Both

$2,134.00

Service Code	HCPCS 32215
Min. Negotiated Rate	$508.86
Max. Negotiated Rate	$1,493.80
Rate for Payer: Aetna Commercial	$1,032.67
Rate for Payer: BCBS Complete	$534.30
Rate for Payer: BCBS Trust/PPO	$509.28
Rate for Payer: Cash Price	$1,707.20
Rate for Payer: Cash Price	$1,707.20
Rate for Payer: Meridian Medicaid	$534.30
Rate for Payer: Priority Health Choice Medicaid	$508.86
Rate for Payer: Priority Health Cigna Priority Health	$1,493.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,098.34
Rate for Payer: Priority Health Narrow Network	$1,098.34
Rate for Payer: Priority Health SBD	$1,098.34
Rate for Payer: UMR Bronson Commercial	$981.64

PR PLEURECTOMY PARIETAL SEPARATE PROCEDURE

Professional

Both

$2,891.00

Service Code	HCPCS 32310
Min. Negotiated Rate	$409.96
Max. Negotiated Rate	$2,023.70
Rate for Payer: Aetna Commercial	$1,182.92
Rate for Payer: BCBS Complete	$610.34
Rate for Payer: BCBS Trust/PPO	$409.96
Rate for Payer: Cash Price	$2,312.80
Rate for Payer: Cash Price	$2,312.80
Rate for Payer: Meridian Medicaid	$610.34
Rate for Payer: Priority Health Choice Medicaid	$581.28
Rate for Payer: Priority Health Cigna Priority Health	$2,023.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,255.78
Rate for Payer: Priority Health Narrow Network	$1,255.78
Rate for Payer: Priority Health SBD	$1,255.78
Rate for Payer: UMR Bronson Commercial	$1,329.86

PR PL GLYCOLIC 35/70

Professional

Both

$60.00

Service Code	HCPCS 00067
Hospital Revenue Code	990
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UMR Bronson Commercial	$27.60

PR PL ILLUMINIZE

Professional

Both

$80.00

Service Code	HCPCS 00069
Hospital Revenue Code	990
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$56.00
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: UMR Bronson Commercial	$36.80

PR PL JESSNERS

Professional

Both

$60.00

Service Code	HCPCS 00068
Hospital Revenue Code	990
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UMR Bronson Commercial	$27.60

PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST

Professional

Both

$9,986.00

Service Code	HCPCS 19296
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$6,990.20
Rate for Payer: Aetna Commercial	$230.34
Rate for Payer: BCBS Complete	$140.45
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$7,988.80
Rate for Payer: Cash Price	$7,988.80
Rate for Payer: Meridian Medicaid	$140.45
Rate for Payer: Priority Health Choice Medicaid	$133.76
Rate for Payer: Priority Health Cigna Priority Health	$6,990.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$256.91
Rate for Payer: Priority Health Narrow Network	$256.91
Rate for Payer: Priority Health SBD	$256.91
Rate for Payer: UMR Bronson Commercial	$4,593.56

PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR

Professional

Both

$1,195.00

Service Code	HCPCS 34813
Min. Negotiated Rate	$145.91
Max. Negotiated Rate	$836.50
Rate for Payer: Aetna Commercial	$319.87
Rate for Payer: BCBS Complete	$153.21
Rate for Payer: BCBS Trust/PPO	$304.83
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cash Price	$956.00
Rate for Payer: Meridian Medicaid	$153.21
Rate for Payer: Priority Health Choice Medicaid	$145.91
Rate for Payer: Priority Health Cigna Priority Health	$836.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$364.93
Rate for Payer: Priority Health Narrow Network	$364.93
Rate for Payer: Priority Health SBD	$364.93
Rate for Payer: UMR Bronson Commercial	$549.70

PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT

Professional

Both

$272.00

Service Code	HCPCS 55876
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$2,499.92
Rate for Payer: Aetna Commercial	$128.17
Rate for Payer: BCBS Complete	$68.22
Rate for Payer: BCBS Trust/PPO	$2,499.92
Rate for Payer: Cash Price	$217.60
Rate for Payer: Cash Price	$217.60
Rate for Payer: Meridian Medicaid	$68.22
Rate for Payer: Priority Health Choice Medicaid	$64.97
Rate for Payer: Priority Health Cigna Priority Health	$190.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.10
Rate for Payer: Priority Health Narrow Network	$162.10
Rate for Payer: Priority Health SBD	$162.10
Rate for Payer: UMR Bronson Commercial	$125.12

PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

Professional

Both

$1,584.00

Service Code	HCPCS 50432
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$2,416.97
Rate for Payer: Aetna Commercial	$261.42
Rate for Payer: BCBS Complete	$133.30
Rate for Payer: BCBS Trust/PPO	$2,416.97
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Meridian Medicaid	$133.30
Rate for Payer: Priority Health Choice Medicaid	$126.95
Rate for Payer: Priority Health Cigna Priority Health	$1,108.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$323.14
Rate for Payer: Priority Health Narrow Network	$323.14
Rate for Payer: Priority Health SBD	$323.14
Rate for Payer: UMR Bronson Commercial	$728.64

Know your out-of-pocket cost for care.

All Charges