Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PROLONG INPT EVAL ADD15 M

Professional

Both

$62.00

Service Code	HCPCS G0316
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$1,295.39
Rate for Payer: Aetna Commercial	$30.15
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCBS Trust/PPO	$1,295.39
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.55
Rate for Payer: Priority Health Narrow Network	$38.55
Rate for Payer: Priority Health SBD	$38.55
Rate for Payer: UMR Bronson Commercial	$28.52

PR PROLONG OUTPT/OFFICE VIS

Professional

Both

$65.00

Service Code	HCPCS G2212
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$1,127.92
Rate for Payer: Aetna Commercial	$31.89
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Trust/PPO	$1,127.92
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Meridian Medicaid	$20.80
Rate for Payer: Priority Health Choice Medicaid	$19.81
Rate for Payer: Priority Health Cigna Priority Health	$45.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32.02
Rate for Payer: Priority Health Narrow Network	$32.02
Rate for Payer: Priority Health SBD	$32.02
Rate for Payer: UMR Bronson Commercial	$29.90

PR PROMETHAZINE HCL INJECTION

Professional

Both

$15.00

Service Code	HCPCS J2550
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS Trust/PPO	$0.30
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: UMR Bronson Commercial	$6.90

PR PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS

Professional

Both

$2,207.00

Service Code	HCPCS 25490
Min. Negotiated Rate	$882.80
Max. Negotiated Rate	$3,253.04
Rate for Payer: Aetna Commercial	$959.31
Rate for Payer: BCBS Complete	$882.80
Rate for Payer: BCBS Trust/PPO	$3,253.04
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Priority Health Cigna Priority Health	$1,544.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,108.62
Rate for Payer: Priority Health Narrow Network	$1,108.62
Rate for Payer: Priority Health SBD	$1,108.62
Rate for Payer: UMR Bronson Commercial	$1,015.22

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR

Professional

Both

$2,727.00

Service Code	HCPCS 27495
Min. Negotiated Rate	$1,090.80
Max. Negotiated Rate	$1,908.90
Rate for Payer: Aetna Commercial	$1,510.18
Rate for Payer: BCBS Complete	$1,090.80
Rate for Payer: BCBS Trust/PPO	$1,264.22
Rate for Payer: Cash Price	$2,181.60
Rate for Payer: Cash Price	$2,181.60
Rate for Payer: Priority Health Cigna Priority Health	$1,908.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,729.57
Rate for Payer: Priority Health Narrow Network	$1,729.57
Rate for Payer: Priority Health SBD	$1,729.57
Rate for Payer: UMR Bronson Commercial	$1,254.42

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA

Professional

Both

$2,106.00

Service Code	HCPCS 27745
Min. Negotiated Rate	$842.40
Max. Negotiated Rate	$2,619.31
Rate for Payer: Aetna Commercial	$1,016.22
Rate for Payer: BCBS Complete	$842.40
Rate for Payer: BCBS Trust/PPO	$2,619.31
Rate for Payer: Cash Price	$1,684.80
Rate for Payer: Cash Price	$1,684.80
Rate for Payer: Priority Health Cigna Priority Health	$1,474.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,160.71
Rate for Payer: Priority Health Narrow Network	$1,160.71
Rate for Payer: Priority Health SBD	$1,160.71
Rate for Payer: UMR Bronson Commercial	$968.76

PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR

Professional

Both

$2,001.18

Service Code	HCPCS 27187
Min. Negotiated Rate	$800.47
Max. Negotiated Rate	$2,727.08
Rate for Payer: Aetna Commercial	$1,329.48
Rate for Payer: BCBS Complete	$800.47
Rate for Payer: BCBS Trust/PPO	$2,727.08
Rate for Payer: Cash Price	$1,600.94
Rate for Payer: Cash Price	$1,600.94
Rate for Payer: Priority Health Cigna Priority Health	$1,400.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,526.85
Rate for Payer: Priority Health Narrow Network	$1,526.85
Rate for Payer: Priority Health SBD	$1,526.85
Rate for Payer: UMR Bronson Commercial	$920.54

PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT

Professional

Both

$2,531.00

Service Code	HCPCS 24498
Min. Negotiated Rate	$557.36
Max. Negotiated Rate	$1,771.70
Rate for Payer: Aetna Commercial	$1,157.39
Rate for Payer: BCBS Complete	$1,012.40
Rate for Payer: BCBS Trust/PPO	$557.36
Rate for Payer: Cash Price	$2,024.80
Rate for Payer: Cash Price	$2,024.80
Rate for Payer: Priority Health Cigna Priority Health	$1,771.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,331.78
Rate for Payer: Priority Health Narrow Network	$1,331.78
Rate for Payer: Priority Health SBD	$1,331.78
Rate for Payer: UMR Bronson Commercial	$1,164.26

PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS

Professional

Both

$2,049.00

Service Code	HCPCS 23491
Min. Negotiated Rate	$185.93
Max. Negotiated Rate	$1,557.48
Rate for Payer: Aetna Commercial	$1,357.22
Rate for Payer: BCBS Complete	$819.60
Rate for Payer: BCBS Trust/PPO	$185.93
Rate for Payer: Cash Price	$1,639.20
Rate for Payer: Cash Price	$1,639.20
Rate for Payer: Priority Health Cigna Priority Health	$1,434.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,557.48
Rate for Payer: Priority Health Narrow Network	$1,557.48
Rate for Payer: Priority Health SBD	$1,557.48
Rate for Payer: UMR Bronson Commercial	$942.54

PR PROSTATE CA SCREENING; DRE

Professional

Both

$34.00

Service Code	HCPCS G0102
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$1,420.07
Rate for Payer: Aetna Commercial	$8.94
Rate for Payer: BCBS Complete	$5.82
Rate for Payer: BCBS Trust/PPO	$1,420.07
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Meridian Medicaid	$5.82
Rate for Payer: Priority Health Choice Medicaid	$5.54
Rate for Payer: Priority Health Cigna Priority Health	$23.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.14
Rate for Payer: Priority Health Narrow Network	$11.14
Rate for Payer: Priority Health SBD	$11.14
Rate for Payer: UMR Bronson Commercial	$15.64

PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC

Professional

Both

$3,585.00

Service Code	HCPCS 55815
Min. Negotiated Rate	$1,112.29
Max. Negotiated Rate	$2,793.65
Rate for Payer: Aetna Commercial	$2,262.59
Rate for Payer: BCBS Complete	$1,167.90
Rate for Payer: BCBS Trust/PPO	$1,908.22
Rate for Payer: Cash Price	$2,868.00
Rate for Payer: Cash Price	$2,868.00
Rate for Payer: Meridian Medicaid	$1,167.90
Rate for Payer: Priority Health Choice Medicaid	$1,112.29
Rate for Payer: Priority Health Cigna Priority Health	$2,509.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,793.65
Rate for Payer: Priority Health Narrow Network	$2,793.65
Rate for Payer: Priority Health SBD	$2,793.65
Rate for Payer: UMR Bronson Commercial	$1,649.10

PR PROSTATECTOMY RETROPUBIC SUBTOTAL

Professional

Both

$3,275.00

Service Code	HCPCS 55831
Min. Negotiated Rate	$546.35
Max. Negotiated Rate	$2,292.50
Rate for Payer: Aetna Commercial	$1,213.98
Rate for Payer: BCBS Complete	$573.67
Rate for Payer: BCBS Trust/PPO	$1,886.03
Rate for Payer: Cash Price	$2,620.00
Rate for Payer: Cash Price	$2,620.00
Rate for Payer: Meridian Medicaid	$573.67
Rate for Payer: Priority Health Choice Medicaid	$546.35
Rate for Payer: Priority Health Cigna Priority Health	$2,292.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,371.43
Rate for Payer: Priority Health Narrow Network	$1,371.43
Rate for Payer: Priority Health SBD	$1,371.43
Rate for Payer: UMR Bronson Commercial	$1,506.50

PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING

Professional

Both

$2,513.00

Service Code	HCPCS 55840
Min. Negotiated Rate	$685.21
Max. Negotiated Rate	$1,858.29
Rate for Payer: Aetna Commercial	$1,501.37
Rate for Payer: BCBS Complete	$778.97
Rate for Payer: BCBS Trust/PPO	$685.21
Rate for Payer: Cash Price	$2,010.40
Rate for Payer: Cash Price	$2,010.40
Rate for Payer: Meridian Medicaid	$778.97
Rate for Payer: Priority Health Choice Medicaid	$741.88
Rate for Payer: Priority Health Cigna Priority Health	$1,759.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,858.29
Rate for Payer: Priority Health Narrow Network	$1,858.29
Rate for Payer: Priority Health SBD	$1,858.29
Rate for Payer: UMR Bronson Commercial	$1,155.98

PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES

Professional

Both

$3,205.00

Service Code	HCPCS 55821
Min. Negotiated Rate	$532.93
Max. Negotiated Rate	$2,243.50
Rate for Payer: Aetna Commercial	$1,121.76
Rate for Payer: BCBS Complete	$559.58
Rate for Payer: BCBS Trust/PPO	$1,959.99
Rate for Payer: Cash Price	$2,564.00
Rate for Payer: Cash Price	$2,564.00
Rate for Payer: Meridian Medicaid	$559.58
Rate for Payer: Priority Health Choice Medicaid	$532.93
Rate for Payer: Priority Health Cigna Priority Health	$2,243.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,335.76
Rate for Payer: Priority Health Narrow Network	$1,335.76
Rate for Payer: Priority Health SBD	$1,335.76
Rate for Payer: UMR Bronson Commercial	$1,474.30

PR PROSTATE NEEDLE BIOPSY ANY APPROACH

Professional

Both

$494.00

Service Code	HCPCS 55700
Min. Negotiated Rate	$82.22
Max. Negotiated Rate	$2,508.90
Rate for Payer: Aetna Commercial	$167.16
Rate for Payer: BCBS Complete	$86.33
Rate for Payer: BCBS Trust/PPO	$2,508.90
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Meridian Medicaid	$86.33
Rate for Payer: Priority Health Choice Medicaid	$82.22
Rate for Payer: Priority Health Cigna Priority Health	$345.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.88
Rate for Payer: Priority Health Narrow Network	$205.88
Rate for Payer: Priority Health SBD	$205.88
Rate for Payer: UMR Bronson Commercial	$227.24

PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED

Professional

Both

$1,049.00

Service Code	HCPCS 55725
Min. Negotiated Rate	$381.06
Max. Negotiated Rate	$1,726.48
Rate for Payer: Aetna Commercial	$761.53
Rate for Payer: BCBS Complete	$400.11
Rate for Payer: BCBS Trust/PPO	$1,726.48
Rate for Payer: Cash Price	$839.20
Rate for Payer: Cash Price	$839.20
Rate for Payer: Meridian Medicaid	$400.11
Rate for Payer: Priority Health Choice Medicaid	$381.06
Rate for Payer: Priority Health Cigna Priority Health	$734.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$952.65
Rate for Payer: Priority Health Narrow Network	$952.65
Rate for Payer: Priority Health SBD	$952.65
Rate for Payer: UMR Bronson Commercial	$482.54

PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX

Professional

Both

$4,130.00

Service Code	HCPCS 55842
Min. Negotiated Rate	$741.45
Max. Negotiated Rate	$2,891.00
Rate for Payer: Aetna Commercial	$1,503.98
Rate for Payer: BCBS Complete	$778.52
Rate for Payer: BCBS Trust/PPO	$2,404.82
Rate for Payer: Cash Price	$3,304.00
Rate for Payer: Cash Price	$3,304.00
Rate for Payer: Meridian Medicaid	$778.52
Rate for Payer: Priority Health Choice Medicaid	$741.45
Rate for Payer: Priority Health Cigna Priority Health	$2,891.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,859.37
Rate for Payer: Priority Health Narrow Network	$1,859.37
Rate for Payer: Priority Health SBD	$1,859.37
Rate for Payer: UMR Bronson Commercial	$1,899.80

PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM

Professional

Both

$2,782.22

Service Code	HCPCS 55845
Min. Negotiated Rate	$862.01
Max. Negotiated Rate	$2,161.43
Rate for Payer: Aetna Commercial	$1,747.88
Rate for Payer: BCBS Complete	$905.11
Rate for Payer: BCBS Trust/PPO	$1,384.15
Rate for Payer: Cash Price	$2,225.78
Rate for Payer: Cash Price	$2,225.78
Rate for Payer: Meridian Medicaid	$905.11
Rate for Payer: Priority Health Choice Medicaid	$862.01
Rate for Payer: Priority Health Cigna Priority Health	$1,947.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,161.43
Rate for Payer: Priority Health Narrow Network	$2,161.43
Rate for Payer: Priority Health SBD	$2,161.43
Rate for Payer: UMR Bronson Commercial	$1,279.82

PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT

Professional

Both

$1,928.00

Service Code	HCPCS 23335
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$1,935.36
Rate for Payer: Aetna Commercial	$1,694.09
Rate for Payer: BCBS Complete	$853.67
Rate for Payer: BCBS Trust/PPO	$47.12
Rate for Payer: Cash Price	$1,542.40
Rate for Payer: Cash Price	$1,542.40
Rate for Payer: Meridian Medicaid	$853.67
Rate for Payer: Priority Health Choice Medicaid	$813.02
Rate for Payer: Priority Health Cigna Priority Health	$1,349.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,935.36
Rate for Payer: Priority Health Narrow Network	$1,935.36
Rate for Payer: Priority Health SBD	$1,935.36
Rate for Payer: UMR Bronson Commercial	$886.88

PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS

Professional

Both

$2,012.00

Service Code	HCPCS 24160
Min. Negotiated Rate	$87.70
Max. Negotiated Rate	$1,920.05
Rate for Payer: Aetna Commercial	$1,679.78
Rate for Payer: BCBS Complete	$847.18
Rate for Payer: BCBS Trust/PPO	$87.70
Rate for Payer: Cash Price	$1,609.60
Rate for Payer: Cash Price	$1,609.60
Rate for Payer: Meridian Medicaid	$847.18
Rate for Payer: Priority Health Choice Medicaid	$806.84
Rate for Payer: Priority Health Cigna Priority Health	$1,408.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,920.05
Rate for Payer: Priority Health Narrow Network	$1,920.05
Rate for Payer: Priority Health SBD	$1,920.05
Rate for Payer: UMR Bronson Commercial	$925.52

PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT

Professional

Both

$2,483.00

Service Code	HCPCS 23334
Min. Negotiated Rate	$89.15
Max. Negotiated Rate	$1,738.10
Rate for Payer: Aetna Commercial	$1,422.34
Rate for Payer: BCBS Complete	$715.01
Rate for Payer: BCBS Trust/PPO	$89.15
Rate for Payer: Cash Price	$1,986.40
Rate for Payer: Cash Price	$1,986.40
Rate for Payer: Meridian Medicaid	$715.01
Rate for Payer: Priority Health Choice Medicaid	$680.96
Rate for Payer: Priority Health Cigna Priority Health	$1,738.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,617.74
Rate for Payer: Priority Health Narrow Network	$1,617.74
Rate for Payer: Priority Health SBD	$1,617.74
Rate for Payer: UMR Bronson Commercial	$1,142.18

PR PROSTHESIS REMOVAL RADIAL HEAD

Professional

Both

$2,242.00

Service Code	HCPCS 24164
Min. Negotiated Rate	$98.26
Max. Negotiated Rate	$1,569.40
Rate for Payer: Aetna Commercial	$961.44
Rate for Payer: BCBS Complete	$493.15
Rate for Payer: BCBS Trust/PPO	$98.26
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Meridian Medicaid	$493.15
Rate for Payer: Priority Health Choice Medicaid	$469.67
Rate for Payer: Priority Health Cigna Priority Health	$1,569.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,115.78
Rate for Payer: Priority Health Narrow Network	$1,115.78
Rate for Payer: Priority Health SBD	$1,115.78
Rate for Payer: UMR Bronson Commercial	$1,031.32

PR PROSTHESIS SERVICE APHAKIA TEMPORARY

Professional

Both

$22.00

Service Code	HCPCS 92358
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$897.05
Rate for Payer: Aetna Commercial	$11.22
Rate for Payer: BCBS Complete	$8.80
Rate for Payer: BCBS Trust/PPO	$897.05
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Priority Health Cigna Priority Health	$15.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.25
Rate for Payer: Priority Health Narrow Network	$13.25
Rate for Payer: Priority Health SBD	$13.25
Rate for Payer: UMR Bronson Commercial	$10.12

PR PROTECTOR HEEL OR ELBOW

Professional

Both

$20.00

Service Code	HCPCS E0191
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.47
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: UMR Bronson Commercial	$9.20

PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS

Professional

Both

$1,371.00

Service Code	HCPCS 62267
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$959.70
Rate for Payer: Aetna Commercial	$199.28
Rate for Payer: BCBS Complete	$101.77
Rate for Payer: BCBS Trust/PPO	$552.60
Rate for Payer: Cash Price	$1,096.80
Rate for Payer: Cash Price	$1,096.80
Rate for Payer: Meridian Medicaid	$101.77
Rate for Payer: Priority Health Choice Medicaid	$96.92
Rate for Payer: Priority Health Cigna Priority Health	$959.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$257.64
Rate for Payer: Priority Health Narrow Network	$257.64
Rate for Payer: Priority Health SBD	$257.64
Rate for Payer: UMR Bronson Commercial	$630.66

Know your out-of-pocket cost for care.

All Charges