Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE

Professional

Both

$2,627.00

Service Code	HCPCS 92986
Min. Negotiated Rate	$384.07
Max. Negotiated Rate	$1,838.90
Rate for Payer: Aetna Commercial	$1,761.54
Rate for Payer: BCBS Complete	$871.78
Rate for Payer: BCBS Trust/PPO	$384.07
Rate for Payer: Cash Price	$2,101.60
Rate for Payer: Cash Price	$2,101.60
Rate for Payer: Meridian Medicaid	$871.78
Rate for Payer: Priority Health Choice Medicaid	$830.27
Rate for Payer: Priority Health Cigna Priority Health	$1,838.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,828.11
Rate for Payer: Priority Health Narrow Network	$1,828.11
Rate for Payer: Priority Health SBD	$1,828.11
Rate for Payer: UMR Bronson Commercial	$1,208.42

PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING

Professional

Both

$1,950.00

Service Code	HCPCS 64561
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$1,365.00
Rate for Payer: Aetna Commercial	$390.63
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCBS Trust/PPO	$449.58
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health	$1,365.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$508.47
Rate for Payer: Priority Health Narrow Network	$508.47
Rate for Payer: Priority Health SBD	$508.47
Rate for Payer: UMR Bronson Commercial	$897.00

PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE

Professional

Both

$445.00

Service Code	HCPCS 64553
Min. Negotiated Rate	$178.00
Max. Negotiated Rate	$661.34
Rate for Payer: Aetna Commercial	$465.57
Rate for Payer: BCBS Complete	$178.00
Rate for Payer: BCBS Trust/PPO	$264.15
Rate for Payer: Cash Price	$356.00
Rate for Payer: Cash Price	$356.00
Rate for Payer: Priority Health Cigna Priority Health	$311.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$661.34
Rate for Payer: Priority Health Narrow Network	$661.34
Rate for Payer: Priority Health SBD	$661.34
Rate for Payer: UMR Bronson Commercial	$204.70

PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV

Professional

Both

$488.00

Service Code	HCPCS 64555
Min. Negotiated Rate	$200.23
Max. Negotiated Rate	$546.40
Rate for Payer: Aetna Commercial	$436.80
Rate for Payer: BCBS Complete	$216.49
Rate for Payer: BCBS Trust/PPO	$200.23
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Meridian Medicaid	$216.49
Rate for Payer: Priority Health Choice Medicaid	$206.18
Rate for Payer: Priority Health Cigna Priority Health	$341.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$546.40
Rate for Payer: Priority Health Narrow Network	$546.40
Rate for Payer: Priority Health SBD	$546.40
Rate for Payer: UMR Bronson Commercial	$224.48

PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL

Professional

Both

$5,241.00

Service Code	HCPCS 63650
Min. Negotiated Rate	$227.17
Max. Negotiated Rate	$3,668.70
Rate for Payer: Aetna Commercial	$533.30
Rate for Payer: BCBS Complete	$277.78
Rate for Payer: BCBS Trust/PPO	$227.17
Rate for Payer: Cash Price	$4,192.80
Rate for Payer: Cash Price	$4,192.80
Rate for Payer: Meridian Medicaid	$277.78
Rate for Payer: Priority Health Choice Medicaid	$264.55
Rate for Payer: Priority Health Cigna Priority Health	$3,668.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$694.76
Rate for Payer: Priority Health Narrow Network	$694.76
Rate for Payer: Priority Health SBD	$694.76
Rate for Payer: UMR Bronson Commercial	$2,410.86

PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL

Professional

Both

$2,422.00

Service Code	HCPCS 47533
Min. Negotiated Rate	$162.73
Max. Negotiated Rate	$2,075.16
Rate for Payer: Aetna Commercial	$352.38
Rate for Payer: BCBS Complete	$170.87
Rate for Payer: BCBS Trust/PPO	$2,075.16
Rate for Payer: Cash Price	$1,937.60
Rate for Payer: Cash Price	$1,937.60
Rate for Payer: Meridian Medicaid	$170.87
Rate for Payer: Priority Health Choice Medicaid	$162.73
Rate for Payer: Priority Health Cigna Priority Health	$1,695.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$452.74
Rate for Payer: Priority Health Narrow Network	$452.74
Rate for Payer: Priority Health SBD	$452.74
Rate for Payer: UMR Bronson Commercial	$1,114.12

PR PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ

Professional

Both

$1,120.00

Service Code	HCPCS 28436
Min. Negotiated Rate	$324.61
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$643.78
Rate for Payer: BCBS Complete	$340.84
Rate for Payer: BCBS Trust/PPO	$387.77
Rate for Payer: Cash Price	$896.00
Rate for Payer: Cash Price	$896.00
Rate for Payer: Meridian Medicaid	$340.84
Rate for Payer: Priority Health Choice Medicaid	$324.61
Rate for Payer: Priority Health Cigna Priority Health	$784.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$770.06
Rate for Payer: Priority Health Narrow Network	$770.06
Rate for Payer: Priority Health SBD	$770.06
Rate for Payer: UMR Bronson Commercial	$515.20

PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE

Professional

Both

$1,626.00

Service Code	HCPCS 27756
Min. Negotiated Rate	$375.95
Max. Negotiated Rate	$2,701.20
Rate for Payer: Aetna Commercial	$767.95
Rate for Payer: BCBS Complete	$394.75
Rate for Payer: BCBS Trust/PPO	$2,701.20
Rate for Payer: Cash Price	$1,300.80
Rate for Payer: Cash Price	$1,300.80
Rate for Payer: Meridian Medicaid	$394.75
Rate for Payer: Priority Health Choice Medicaid	$375.95
Rate for Payer: Priority Health Cigna Priority Health	$1,138.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$891.59
Rate for Payer: Priority Health Narrow Network	$891.59
Rate for Payer: Priority Health SBD	$891.59
Rate for Payer: UMR Bronson Commercial	$747.96

PR PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE

Professional

Both

$850.00

Service Code	HCPCS 25651
Min. Negotiated Rate	$321.84
Max. Negotiated Rate	$1,380.45
Rate for Payer: Aetna Commercial	$650.17
Rate for Payer: BCBS Complete	$337.93
Rate for Payer: BCBS Trust/PPO	$1,380.45
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Meridian Medicaid	$337.93
Rate for Payer: Priority Health Choice Medicaid	$321.84
Rate for Payer: Priority Health Cigna Priority Health	$595.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$760.36
Rate for Payer: Priority Health Narrow Network	$760.36
Rate for Payer: Priority Health SBD	$760.36
Rate for Payer: UMR Bronson Commercial	$391.00

PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB

Professional

Both

$1,510.00

Service Code	HCPCS 26650
Min. Negotiated Rate	$34.87
Max. Negotiated Rate	$1,057.00
Rate for Payer: Aetna Commercial	$639.26
Rate for Payer: BCBS Complete	$331.67
Rate for Payer: BCBS Trust/PPO	$34.87
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Meridian Medicaid	$331.67
Rate for Payer: Priority Health Choice Medicaid	$315.88
Rate for Payer: Priority Health Cigna Priority Health	$1,057.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$749.63
Rate for Payer: Priority Health Narrow Network	$749.63
Rate for Payer: Priority Health SBD	$749.63
Rate for Payer: UMR Bronson Commercial	$694.60

PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ

Professional

Both

$1,540.00

Service Code	HCPCS 28406
Min. Negotiated Rate	$384.89
Max. Negotiated Rate	$1,368.30
Rate for Payer: Aetna Commercial	$736.35
Rate for Payer: BCBS Complete	$404.13
Rate for Payer: BCBS Trust/PPO	$1,368.30
Rate for Payer: Cash Price	$1,232.00
Rate for Payer: Cash Price	$1,232.00
Rate for Payer: Meridian Medicaid	$404.13
Rate for Payer: Priority Health Choice Medicaid	$384.89
Rate for Payer: Priority Health Cigna Priority Health	$1,078.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$871.18
Rate for Payer: Priority Health Narrow Network	$871.18
Rate for Payer: Priority Health SBD	$871.18
Rate for Payer: UMR Bronson Commercial	$708.40

PR PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION

Professional

Both

$1,400.00

Service Code	HCPCS 25671
Min. Negotiated Rate	$350.60
Max. Negotiated Rate	$1,651.47
Rate for Payer: Aetna Commercial	$708.23
Rate for Payer: BCBS Complete	$368.13
Rate for Payer: BCBS Trust/PPO	$1,651.47
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Meridian Medicaid	$368.13
Rate for Payer: Priority Health Choice Medicaid	$350.60
Rate for Payer: Priority Health Cigna Priority Health	$980.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$823.68
Rate for Payer: Priority Health Narrow Network	$823.68
Rate for Payer: Priority Health SBD	$823.68
Rate for Payer: UMR Bronson Commercial	$644.00

PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END

Professional

Both

$2,192.00

Service Code	HCPCS 27509
Min. Negotiated Rate	$438.14
Max. Negotiated Rate	$1,534.40
Rate for Payer: Aetna Commercial	$894.48
Rate for Payer: BCBS Complete	$460.05
Rate for Payer: BCBS Trust/PPO	$1,481.35
Rate for Payer: Cash Price	$1,753.60
Rate for Payer: Cash Price	$1,753.60
Rate for Payer: Meridian Medicaid	$460.05
Rate for Payer: Priority Health Choice Medicaid	$438.14
Rate for Payer: Priority Health Cigna Priority Health	$1,534.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,045.30
Rate for Payer: Priority Health Narrow Network	$1,045.30
Rate for Payer: Priority Health SBD	$1,045.30
Rate for Payer: UMR Bronson Commercial	$1,008.32

PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE

Professional

Both

$1,510.00

Service Code	HCPCS 26608
Min. Negotiated Rate	$58.11
Max. Negotiated Rate	$1,057.00
Rate for Payer: Aetna Commercial	$640.23
Rate for Payer: BCBS Complete	$331.89
Rate for Payer: BCBS Trust/PPO	$58.11
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Meridian Medicaid	$331.89
Rate for Payer: Priority Health Choice Medicaid	$316.09
Rate for Payer: Priority Health Cigna Priority Health	$1,057.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$749.13
Rate for Payer: Priority Health Narrow Network	$749.13
Rate for Payer: Priority Health SBD	$749.13
Rate for Payer: UMR Bronson Commercial	$694.60

PR PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT

Professional

Both

$1,618.00

Service Code	HCPCS 26676
Min. Negotiated Rate	$65.37
Max. Negotiated Rate	$1,132.60
Rate for Payer: Aetna Commercial	$675.35
Rate for Payer: BCBS Complete	$351.35
Rate for Payer: BCBS Trust/PPO	$65.37
Rate for Payer: Cash Price	$1,294.40
Rate for Payer: Cash Price	$1,294.40
Rate for Payer: Meridian Medicaid	$351.35
Rate for Payer: Priority Health Choice Medicaid	$334.62
Rate for Payer: Priority Health Cigna Priority Health	$1,132.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$793.04
Rate for Payer: Priority Health Narrow Network	$793.04
Rate for Payer: Priority Health SBD	$793.04
Rate for Payer: UMR Bronson Commercial	$744.28

PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA

Professional

Both

$1,078.00

Service Code	HCPCS 26756
Min. Negotiated Rate	$279.03
Max. Negotiated Rate	$754.60
Rate for Payer: Aetna Commercial	$560.82
Rate for Payer: BCBS Complete	$292.98
Rate for Payer: BCBS Trust/PPO	$702.64
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Meridian Medicaid	$292.98
Rate for Payer: Priority Health Choice Medicaid	$279.03
Rate for Payer: Priority Health Cigna Priority Health	$754.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$661.81
Rate for Payer: Priority Health Narrow Network	$661.81
Rate for Payer: Priority Health SBD	$661.81
Rate for Payer: UMR Bronson Commercial	$495.88

PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK

Professional

Both

$3,293.00

Service Code	HCPCS 27235
Min. Negotiated Rate	$584.26
Max. Negotiated Rate	$2,305.10
Rate for Payer: Aetna Commercial	$1,211.46
Rate for Payer: BCBS Complete	$613.47
Rate for Payer: BCBS Trust/PPO	$1,187.62
Rate for Payer: Cash Price	$2,634.40
Rate for Payer: Cash Price	$2,634.40
Rate for Payer: Meridian Medicaid	$613.47
Rate for Payer: Priority Health Choice Medicaid	$584.26
Rate for Payer: Priority Health Cigna Priority Health	$2,305.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,388.97
Rate for Payer: Priority Health Narrow Network	$1,388.97
Rate for Payer: Priority Health SBD	$1,388.97
Rate for Payer: UMR Bronson Commercial	$1,514.78

PR PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ

Professional

Both

$1,100.00

Service Code	HCPCS 28496
Min. Negotiated Rate	$179.56
Max. Negotiated Rate	$770.00
Rate for Payer: Aetna Commercial	$319.73
Rate for Payer: BCBS Complete	$188.54
Rate for Payer: BCBS Trust/PPO	$690.49
Rate for Payer: Cash Price	$880.00
Rate for Payer: Cash Price	$880.00
Rate for Payer: Meridian Medicaid	$188.54
Rate for Payer: Priority Health Choice Medicaid	$179.56
Rate for Payer: Priority Health Cigna Priority Health	$770.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$382.48
Rate for Payer: Priority Health Narrow Network	$382.48
Rate for Payer: Priority Health SBD	$382.48
Rate for Payer: UMR Bronson Commercial	$506.00

PR PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ

Professional

Both

$2,328.00

Service Code	HCPCS 24582
Min. Negotiated Rate	$473.89
Max. Negotiated Rate	$1,629.60
Rate for Payer: Aetna Commercial	$1,082.70
Rate for Payer: BCBS Complete	$557.56
Rate for Payer: BCBS Trust/PPO	$473.89
Rate for Payer: Cash Price	$1,862.40
Rate for Payer: Cash Price	$1,862.40
Rate for Payer: Meridian Medicaid	$557.56
Rate for Payer: Priority Health Choice Medicaid	$531.01
Rate for Payer: Priority Health Cigna Priority Health	$1,629.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,259.78
Rate for Payer: Priority Health Narrow Network	$1,259.78
Rate for Payer: Priority Health SBD	$1,259.78
Rate for Payer: UMR Bronson Commercial	$1,070.88

PR PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ

Professional

Both

$1,849.00

Service Code	HCPCS 24566
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,294.30
Rate for Payer: Aetna Commercial	$959.55
Rate for Payer: BCBS Complete	$492.48
Rate for Payer: BCBS Trust/PPO	$364.00
Rate for Payer: Cash Price	$1,479.20
Rate for Payer: Cash Price	$1,479.20
Rate for Payer: Meridian Medicaid	$492.48
Rate for Payer: Priority Health Choice Medicaid	$469.03
Rate for Payer: Priority Health Cigna Priority Health	$1,294.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,112.70
Rate for Payer: Priority Health Narrow Network	$1,112.70
Rate for Payer: Priority Health SBD	$1,112.70
Rate for Payer: UMR Bronson Commercial	$850.54

PR PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ

Professional

Both

$579.00

Service Code	HCPCS 28666
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$405.30
Rate for Payer: Aetna Commercial	$229.82
Rate for Payer: BCBS Complete	$118.53
Rate for Payer: BCBS Trust/PPO	$256.75
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Meridian Medicaid	$118.53
Rate for Payer: Priority Health Choice Medicaid	$112.89
Rate for Payer: Priority Health Cigna Priority Health	$405.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.12
Rate for Payer: Priority Health Narrow Network	$269.12
Rate for Payer: Priority Health SBD	$269.12
Rate for Payer: UMR Bronson Commercial	$266.34

PR PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ

Professional

Both

$1,362.00

Service Code	HCPCS 26776
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$953.40
Rate for Payer: Aetna Commercial	$596.33
Rate for Payer: BCBS Complete	$310.20
Rate for Payer: BCBS Trust/PPO	$132.60
Rate for Payer: Cash Price	$1,089.60
Rate for Payer: Cash Price	$1,089.60
Rate for Payer: Meridian Medicaid	$310.20
Rate for Payer: Priority Health Choice Medicaid	$295.43
Rate for Payer: Priority Health Cigna Priority Health	$953.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$700.10
Rate for Payer: Priority Health Narrow Network	$700.10
Rate for Payer: Priority Health SBD	$700.10
Rate for Payer: UMR Bronson Commercial	$626.52

PR PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ

Professional

Both

$1,348.00

Service Code	HCPCS 26706
Min. Negotiated Rate	$258.87
Max. Negotiated Rate	$943.60
Rate for Payer: Aetna Commercial	$592.71
Rate for Payer: BCBS Complete	$308.19
Rate for Payer: BCBS Trust/PPO	$258.87
Rate for Payer: Cash Price	$1,078.40
Rate for Payer: Cash Price	$1,078.40
Rate for Payer: Meridian Medicaid	$308.19
Rate for Payer: Priority Health Choice Medicaid	$293.51
Rate for Payer: Priority Health Cigna Priority Health	$943.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$694.49
Rate for Payer: Priority Health Narrow Network	$694.49
Rate for Payer: Priority Health SBD	$694.49
Rate for Payer: UMR Bronson Commercial	$620.08

PR PRQ SKEL FIXJ METAR FX W/MANJ

Professional

Both

$1,056.00

Service Code	HCPCS 28476
Min. Negotiated Rate	$252.41
Max. Negotiated Rate	$739.20
Rate for Payer: Aetna Commercial	$503.59
Rate for Payer: BCBS Complete	$265.03
Rate for Payer: BCBS Trust/PPO	$394.11
Rate for Payer: Cash Price	$844.80
Rate for Payer: Cash Price	$844.80
Rate for Payer: Meridian Medicaid	$265.03
Rate for Payer: Priority Health Choice Medicaid	$252.41
Rate for Payer: Priority Health Cigna Priority Health	$739.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$601.54
Rate for Payer: Priority Health Narrow Network	$601.54
Rate for Payer: Priority Health SBD	$601.54
Rate for Payer: UMR Bronson Commercial	$485.76

PR PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ

Professional

Both

$644.00

Service Code	HCPCS 28636
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$450.80
Rate for Payer: Aetna Commercial	$263.14
Rate for Payer: BCBS Complete	$152.08
Rate for Payer: BCBS Trust/PPO	$256.75
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cash Price	$515.20
Rate for Payer: Meridian Medicaid	$152.08
Rate for Payer: Priority Health Choice Medicaid	$144.84
Rate for Payer: Priority Health Cigna Priority Health	$450.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$303.84
Rate for Payer: Priority Health Narrow Network	$303.84
Rate for Payer: Priority Health SBD	$303.84
Rate for Payer: UMR Bronson Commercial	$296.24

Know your out-of-pocket cost for care.

All Charges