Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PREPARE FECAL MICROBIOTA FOR INSTILLATION

Professional

Both

$200.00

Service Code	HCPCS 44705
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna Commercial	$96.49
Rate for Payer: BCBS Complete	$47.42
Rate for Payer: BCBS Trust/PPO	$252.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Meridian Medicaid	$47.42
Rate for Payer: Priority Health Choice Medicaid	$45.16
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$125.83
Rate for Payer: Priority Health Narrow Network	$125.83
Rate for Payer: Priority Health SBD	$125.83
Rate for Payer: UMR Bronson Commercial	$92.00

PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA

Professional

Both

$924.00

Service Code	HCPCS 49013
Min. Negotiated Rate	$288.83
Max. Negotiated Rate	$794.36
Rate for Payer: Aetna Commercial	$585.87
Rate for Payer: BCBS Complete	$303.27
Rate for Payer: BCBS Trust/PPO	$562.11
Rate for Payer: Cash Price	$739.20
Rate for Payer: Cash Price	$739.20
Rate for Payer: Meridian Medicaid	$303.27
Rate for Payer: Priority Health Choice Medicaid	$288.83
Rate for Payer: Priority Health Cigna Priority Health	$646.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$794.36
Rate for Payer: Priority Health Narrow Network	$794.36
Rate for Payer: Priority Health SBD	$794.36
Rate for Payer: UMR Bronson Commercial	$425.04

PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT

Professional

Both

$657.00

Service Code	HCPCS 15004
Min. Negotiated Rate	$138.90
Max. Negotiated Rate	$459.90
Rate for Payer: Aetna Commercial	$285.16
Rate for Payer: BCBS Complete	$172.43
Rate for Payer: BCBS Trust/PPO	$138.90
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Meridian Medicaid	$172.43
Rate for Payer: Priority Health Choice Medicaid	$164.22
Rate for Payer: Priority Health Cigna Priority Health	$459.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$316.91
Rate for Payer: Priority Health Narrow Network	$316.91
Rate for Payer: Priority Health SBD	$316.91
Rate for Payer: UMR Bronson Commercial	$302.22

PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT

Professional

Both

$200.00

Service Code	HCPCS 15005
Min. Negotiated Rate	$56.66
Max. Negotiated Rate	$206.12
Rate for Payer: Aetna Commercial	$99.66
Rate for Payer: BCBS Complete	$59.49
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Meridian Medicaid	$59.49
Rate for Payer: Priority Health Choice Medicaid	$56.66
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$108.92
Rate for Payer: Priority Health Narrow Network	$108.92
Rate for Payer: Priority Health SBD	$108.92
Rate for Payer: UMR Bronson Commercial	$92.00

PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT

Professional

Both

$551.00

Service Code	HCPCS 15002
Min. Negotiated Rate	$138.90
Max. Negotiated Rate	$385.70
Rate for Payer: Aetna Commercial	$240.02
Rate for Payer: BCBS Complete	$146.04
Rate for Payer: BCBS Trust/PPO	$138.90
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cash Price	$440.80
Rate for Payer: Meridian Medicaid	$146.04
Rate for Payer: Priority Health Choice Medicaid	$139.09
Rate for Payer: Priority Health Cigna Priority Health	$385.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$267.18
Rate for Payer: Priority Health Narrow Network	$267.18
Rate for Payer: Priority Health SBD	$267.18
Rate for Payer: UMR Bronson Commercial	$253.46

PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT

Professional

Both

$125.00

Service Code	HCPCS 15003
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$138.90
Rate for Payer: Aetna Commercial	$49.66
Rate for Payer: BCBS Complete	$29.97
Rate for Payer: BCBS Trust/PPO	$138.90
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Meridian Medicaid	$29.97
Rate for Payer: Priority Health Choice Medicaid	$28.54
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.08
Rate for Payer: Priority Health Narrow Network	$55.08
Rate for Payer: Priority Health SBD	$55.08
Rate for Payer: UMR Bronson Commercial	$57.50

PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT

Professional

Both

$37.00

Service Code	HCPCS 94640
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$255.17
Rate for Payer: Aetna Commercial	$14.62
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: BCBS Trust/PPO	$255.17
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.13
Rate for Payer: Priority Health Narrow Network	$12.13
Rate for Payer: Priority Health SBD	$12.13
Rate for Payer: UMR Bronson Commercial	$17.02

PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN

Professional

Both

$65.00

Service Code	HCPCS 99401
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$1,234.11
Rate for Payer: Aetna Commercial	$25.12
Rate for Payer: BCBS Complete	$15.66
Rate for Payer: BCBS Trust/PPO	$1,234.11
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Meridian Medicaid	$15.66
Rate for Payer: Priority Health Choice Medicaid	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$45.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.41
Rate for Payer: Priority Health Narrow Network	$30.41
Rate for Payer: Priority Health SBD	$30.41
Rate for Payer: UMR Bronson Commercial	$29.90

PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN

Professional

Both

$112.00

Service Code	HCPCS 99402
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$1,381.50
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: BCBS Complete	$31.76
Rate for Payer: BCBS Trust/PPO	$1,381.50
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Meridian Medicaid	$31.76
Rate for Payer: Priority Health Choice Medicaid	$30.25
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.82
Rate for Payer: Priority Health Narrow Network	$60.82
Rate for Payer: Priority Health SBD	$60.82
Rate for Payer: UMR Bronson Commercial	$51.52

PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN

Professional

Both

$144.00

Service Code	HCPCS 99403
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$393.06
Rate for Payer: Aetna Commercial	$76.44
Rate for Payer: BCBS Complete	$47.42
Rate for Payer: BCBS Trust/PPO	$393.06
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Meridian Medicaid	$47.42
Rate for Payer: Priority Health Choice Medicaid	$45.16
Rate for Payer: Priority Health Cigna Priority Health	$100.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.23
Rate for Payer: Priority Health Narrow Network	$91.23
Rate for Payer: Priority Health SBD	$91.23
Rate for Payer: UMR Bronson Commercial	$66.24

PR PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN

Professional

Both

$184.00

Service Code	HCPCS 99404
Min. Negotiated Rate	$60.28
Max. Negotiated Rate	$805.13
Rate for Payer: Aetna Commercial	$101.22
Rate for Payer: BCBS Complete	$63.29
Rate for Payer: BCBS Trust/PPO	$805.13
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Meridian Medicaid	$63.29
Rate for Payer: Priority Health Choice Medicaid	$60.28
Rate for Payer: Priority Health Cigna Priority Health	$128.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$121.21
Rate for Payer: Priority Health Narrow Network	$121.21
Rate for Payer: Priority Health SBD	$121.21
Rate for Payer: UMR Bronson Commercial	$84.64

PR PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M

Professional

Both

$32.00

Service Code	HCPCS 99412
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$1,314.41
Rate for Payer: Aetna Commercial	$13.09
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$1,314.41
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.85
Rate for Payer: Priority Health Narrow Network	$15.85
Rate for Payer: Priority Health SBD	$15.85
Rate for Payer: UMR Bronson Commercial	$14.72

PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP

Professional

Both

$165.00

Service Code	HCPCS 93279
Min. Negotiated Rate	$43.51
Max. Negotiated Rate	$530.41
Rate for Payer: Aetna Commercial	$85.64
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: BCBS Trust/PPO	$530.41
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.51
Rate for Payer: Priority Health Narrow Network	$43.51
Rate for Payer: Priority Health SBD	$95.99
Rate for Payer: UMR Bronson Commercial	$75.90

PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON

Professional

Both

$85.00

Service Code	HCPCS 93285
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$1,404.75
Rate for Payer: Aetna Commercial	$76.52
Rate for Payer: Aetna Commercial	$76.52
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCBS Complete	$48.00
Rate for Payer: BCBS Trust/PPO	$1,404.75
Rate for Payer: BCBS Trust/PPO	$1,404.75
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$84.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.47
Rate for Payer: Priority Health Narrow Network	$35.47
Rate for Payer: Priority Health Narrow Network	$35.47
Rate for Payer: Priority Health SBD	$86.06
Rate for Payer: Priority Health SBD	$86.06
Rate for Payer: UMR Bronson Commercial	$55.20
Rate for Payer: UMR Bronson Commercial	$39.10

PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB

Professional

Both

$167.00

Service Code	HCPCS 93284
Min. Negotiated Rate	$65.72
Max. Negotiated Rate	$1,468.15
Rate for Payer: Aetna Commercial	$137.14
Rate for Payer: BCBS Complete	$66.80
Rate for Payer: BCBS Trust/PPO	$1,468.15
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.72
Rate for Payer: Priority Health Narrow Network	$65.72
Rate for Payer: Priority Health SBD	$150.37
Rate for Payer: UMR Bronson Commercial	$76.82

PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB

Professional

Both

$155.00

Service Code	HCPCS 93283
Min. Negotiated Rate	$61.47
Max. Negotiated Rate	$214.49
Rate for Payer: Aetna Commercial	$126.86
Rate for Payer: BCBS Complete	$62.00
Rate for Payer: BCBS Trust/PPO	$214.49
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Priority Health Cigna Priority Health	$108.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.47
Rate for Payer: Priority Health Narrow Network	$61.47
Rate for Payer: Priority Health SBD	$139.50
Rate for Payer: UMR Bronson Commercial	$71.30

PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB

Professional

Both

$122.00

Service Code	HCPCS 93282
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$1,583.32
Rate for Payer: Aetna Commercial	$103.28
Rate for Payer: BCBS Complete	$48.80
Rate for Payer: BCBS Trust/PPO	$1,583.32
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cash Price	$97.60
Rate for Payer: Priority Health Cigna Priority Health	$85.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.28
Rate for Payer: Priority Health Narrow Network	$56.28
Rate for Payer: Priority Health SBD	$114.44
Rate for Payer: UMR Bronson Commercial	$56.12

PR PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS

Professional

Both

$5,614.00

Service Code	HCPCS 33031
Min. Negotiated Rate	$1,051.32
Max. Negotiated Rate	$3,929.80
Rate for Payer: Aetna Commercial	$3,326.92
Rate for Payer: BCBS Complete	$1,627.06
Rate for Payer: BCBS Trust/PPO	$1,051.32
Rate for Payer: Cash Price	$4,491.20
Rate for Payer: Cash Price	$4,491.20
Rate for Payer: Meridian Medicaid	$1,627.06
Rate for Payer: Priority Health Choice Medicaid	$1,549.58
Rate for Payer: Priority Health Cigna Priority Health	$3,929.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,856.69
Rate for Payer: Priority Health Narrow Network	$3,856.69
Rate for Payer: Priority Health SBD	$3,856.69
Rate for Payer: UMR Bronson Commercial	$2,582.44

PR PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS

Professional

Both

$3,352.00

Service Code	HCPCS 33030
Min. Negotiated Rate	$1,062.94
Max. Negotiated Rate	$3,118.87
Rate for Payer: Aetna Commercial	$2,685.08
Rate for Payer: BCBS Complete	$1,317.75
Rate for Payer: BCBS Trust/PPO	$1,062.94
Rate for Payer: Cash Price	$2,681.60
Rate for Payer: Cash Price	$2,681.60
Rate for Payer: Meridian Medicaid	$1,317.75
Rate for Payer: Priority Health Choice Medicaid	$1,255.00
Rate for Payer: Priority Health Cigna Priority Health	$2,346.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,118.87
Rate for Payer: Priority Health Narrow Network	$3,118.87
Rate for Payer: Priority Health SBD	$3,118.87
Rate for Payer: UMR Bronson Commercial	$1,541.92

PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

Professional

Both

$4,051.74

Service Code	HCPCS 37184
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$2,836.22
Rate for Payer: Aetna Commercial	$578.15
Rate for Payer: BCBS Complete	$280.69
Rate for Payer: BCBS Trust/PPO	$939.85
Rate for Payer: Cash Price	$3,241.39
Rate for Payer: Cash Price	$3,241.39
Rate for Payer: Meridian Medicaid	$280.69
Rate for Payer: Priority Health Choice Medicaid	$267.32
Rate for Payer: Priority Health Cigna Priority Health	$2,836.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$667.60
Rate for Payer: Priority Health Narrow Network	$667.60
Rate for Payer: Priority Health SBD	$667.60
Rate for Payer: UMR Bronson Commercial	$1,863.80

PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

Professional

Both

$3,373.00

Service Code	HCPCS 37185
Min. Negotiated Rate	$100.96
Max. Negotiated Rate	$2,361.10
Rate for Payer: Aetna Commercial	$219.24
Rate for Payer: BCBS Complete	$106.01
Rate for Payer: BCBS Trust/PPO	$728.00
Rate for Payer: Cash Price	$2,698.40
Rate for Payer: Cash Price	$2,698.40
Rate for Payer: Meridian Medicaid	$106.01
Rate for Payer: Priority Health Choice Medicaid	$100.96
Rate for Payer: Priority Health Cigna Priority Health	$2,361.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$252.67
Rate for Payer: Priority Health Narrow Network	$252.67
Rate for Payer: Priority Health SBD	$252.67
Rate for Payer: UMR Bronson Commercial	$1,551.58

PR PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO

Professional

Both

$163.00

Service Code	HCPCS 99424
Min. Negotiated Rate	$47.07
Max. Negotiated Rate	$1,314.94
Rate for Payer: Aetna Commercial	$74.16
Rate for Payer: BCBS Complete	$49.42
Rate for Payer: BCBS Trust/PPO	$1,314.94
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Meridian Medicaid	$49.42
Rate for Payer: Priority Health Choice Medicaid	$47.07
Rate for Payer: Priority Health Cigna Priority Health	$114.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.52
Rate for Payer: Priority Health Narrow Network	$75.52
Rate for Payer: Priority Health SBD	$75.52
Rate for Payer: UMR Bronson Commercial	$74.98

PR PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO

Professional

Both

$124.00

Service Code	HCPCS 99426
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$1,519.92
Rate for Payer: Aetna Commercial	$49.79
Rate for Payer: BCBS Complete	$32.88
Rate for Payer: BCBS Trust/PPO	$1,519.92
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Meridian Medicaid	$32.88
Rate for Payer: Priority Health Choice Medicaid	$31.31
Rate for Payer: Priority Health Cigna Priority Health	$86.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.46
Rate for Payer: Priority Health Narrow Network	$50.46
Rate for Payer: Priority Health SBD	$50.46
Rate for Payer: UMR Bronson Commercial	$57.04

PR PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO

Professional

Both

$95.00

Service Code	HCPCS 99427
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$971.54
Rate for Payer: Aetna Commercial	$35.13
Rate for Payer: BCBS Complete	$23.04
Rate for Payer: BCBS Trust/PPO	$971.54
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Meridian Medicaid	$23.04
Rate for Payer: Priority Health Choice Medicaid	$21.94
Rate for Payer: Priority Health Cigna Priority Health	$66.50
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	$43.70

PR PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO

Professional

Both

$118.00

Service Code	HCPCS 99425
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$1,104.48
Rate for Payer: Aetna Commercial	$51.70
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCBS Trust/PPO	$1,104.48
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Meridian Medicaid	$34.00
Rate for Payer: Priority Health Choice Medicaid	$32.38
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$52.20
Rate for Payer: Priority Health Narrow Network	$52.20
Rate for Payer: Priority Health SBD	$52.20
Rate for Payer: UMR Bronson Commercial	$54.28

Know your out-of-pocket cost for care.

All Charges