Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T

Professional

Both

$1,510.00

Service Code	HCPCS 26727
Min. Negotiated Rate	$311.62
Max. Negotiated Rate	$1,057.00
Rate for Payer: Aetna Commercial	$629.68
Rate for Payer: BCBS Complete	$327.20
Rate for Payer: BCBS Trust/PPO	$765.51
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Meridian Medicaid	$327.20
Rate for Payer: Priority Health Choice Medicaid	$311.62
Rate for Payer: Priority Health Cigna Priority Health	$1,057.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$737.89
Rate for Payer: Priority Health Narrow Network	$737.89
Rate for Payer: Priority Health SBD	$737.89
Rate for Payer: UMR Bronson Commercial	$694.60

PR PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX

Professional

Both

$2,526.00

Service Code	HCPCS 24538
Min. Negotiated Rate	$512.27
Max. Negotiated Rate	$1,768.20
Rate for Payer: Aetna Commercial	$1,038.87
Rate for Payer: BCBS Complete	$537.88
Rate for Payer: BCBS Trust/PPO	$660.38
Rate for Payer: Cash Price	$2,020.80
Rate for Payer: Cash Price	$2,020.80
Rate for Payer: Meridian Medicaid	$537.88
Rate for Payer: Priority Health Choice Medicaid	$512.27
Rate for Payer: Priority Health Cigna Priority Health	$1,768.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,219.95
Rate for Payer: Priority Health Narrow Network	$1,219.95
Rate for Payer: Priority Health SBD	$1,219.95
Rate for Payer: UMR Bronson Commercial	$1,161.96

PR PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ

Professional

Both

$959.00

Service Code	HCPCS 28576
Min. Negotiated Rate	$254.75
Max. Negotiated Rate	$1,476.60
Rate for Payer: Aetna Commercial	$511.48
Rate for Payer: BCBS Complete	$267.49
Rate for Payer: BCBS Trust/PPO	$1,476.60
Rate for Payer: Cash Price	$767.20
Rate for Payer: Cash Price	$767.20
Rate for Payer: Meridian Medicaid	$267.49
Rate for Payer: Priority Health Choice Medicaid	$254.75
Rate for Payer: Priority Health Cigna Priority Health	$671.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$598.48
Rate for Payer: Priority Health Narrow Network	$598.48
Rate for Payer: Priority Health SBD	$598.48
Rate for Payer: UMR Bronson Commercial	$441.14

PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ

Professional

Both

$1,320.00

Service Code	HCPCS 28606
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$2,188.75
Rate for Payer: Aetna Commercial	$504.07
Rate for Payer: BCBS Complete	$268.38
Rate for Payer: BCBS Trust/PPO	$2,188.75
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Meridian Medicaid	$268.38
Rate for Payer: Priority Health Choice Medicaid	$255.60
Rate for Payer: Priority Health Cigna Priority Health	$924.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$593.38
Rate for Payer: Priority Health Narrow Network	$593.38
Rate for Payer: Priority Health SBD	$593.38
Rate for Payer: UMR Bronson Commercial	$607.20

PR PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ

Professional

Both

$782.00

Service Code	HCPCS 28546
Min. Negotiated Rate	$231.74
Max. Negotiated Rate	$938.26
Rate for Payer: Aetna Commercial	$459.30
Rate for Payer: BCBS Complete	$243.33
Rate for Payer: BCBS Trust/PPO	$938.26
Rate for Payer: Cash Price	$625.60
Rate for Payer: Cash Price	$625.60
Rate for Payer: Meridian Medicaid	$243.33
Rate for Payer: Priority Health Choice Medicaid	$231.74
Rate for Payer: Priority Health Cigna Priority Health	$547.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$544.87
Rate for Payer: Priority Health Narrow Network	$544.87
Rate for Payer: Priority Health SBD	$544.87
Rate for Payer: UMR Bronson Commercial	$359.72

PR PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ

Professional

Both

$455.00

Service Code	HCPCS 28456
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$577.04
Rate for Payer: Aetna Commercial	$473.02
Rate for Payer: BCBS Complete	$254.96
Rate for Payer: BCBS Trust/PPO	$385.66
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Meridian Medicaid	$254.96
Rate for Payer: Priority Health Choice Medicaid	$242.82
Rate for Payer: Priority Health Cigna Priority Health	$318.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$577.04
Rate for Payer: Priority Health Narrow Network	$577.04
Rate for Payer: Priority Health SBD	$577.04
Rate for Payer: UMR Bronson Commercial	$209.30

PR PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT

Professional

Both

$2,013.00

Service Code	HCPCS 93580
Min. Negotiated Rate	$222.94
Max. Negotiated Rate	$1,409.10
Rate for Payer: Aetna Commercial	$1,305.02
Rate for Payer: BCBS Complete	$637.85
Rate for Payer: BCBS Trust/PPO	$222.94
Rate for Payer: Cash Price	$1,610.40
Rate for Payer: Cash Price	$1,610.40
Rate for Payer: Meridian Medicaid	$637.85
Rate for Payer: Priority Health Choice Medicaid	$607.48
Rate for Payer: Priority Health Cigna Priority Health	$1,409.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,342.95
Rate for Payer: Priority Health Narrow Network	$1,342.95
Rate for Payer: Priority Health SBD	$1,342.95
Rate for Payer: UMR Bronson Commercial	$925.98

PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING

Professional

Both

$503.00

Service Code	HCPCS 37197
Min. Negotiated Rate	$186.59
Max. Negotiated Rate	$922.41
Rate for Payer: Aetna Commercial	$402.50
Rate for Payer: BCBS Complete	$195.92
Rate for Payer: BCBS Trust/PPO	$922.41
Rate for Payer: Cash Price	$402.40
Rate for Payer: Cash Price	$402.40
Rate for Payer: Meridian Medicaid	$195.92
Rate for Payer: Priority Health Choice Medicaid	$186.59
Rate for Payer: Priority Health Cigna Priority Health	$352.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$464.92
Rate for Payer: Priority Health Narrow Network	$464.92
Rate for Payer: Priority Health SBD	$464.92
Rate for Payer: UMR Bronson Commercial	$231.38

PR PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY

Professional

Both

$1,025.00

Service Code	HCPCS 92973
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$717.50
Rate for Payer: Aetna Commercial	$237.55
Rate for Payer: BCBS Complete	$115.18
Rate for Payer: BCBS Trust/PPO	$315.92
Rate for Payer: Cash Price	$820.00
Rate for Payer: Cash Price	$820.00
Rate for Payer: Meridian Medicaid	$115.18
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health	$717.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$242.11
Rate for Payer: Priority Health Narrow Network	$242.11
Rate for Payer: Priority Health SBD	$242.11
Rate for Payer: UMR Bronson Commercial	$471.50

PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN

Professional

Both

$1,805.00

Service Code	HCPCS 37187
Min. Negotiated Rate	$243.89
Max. Negotiated Rate	$1,263.50
Rate for Payer: Aetna Commercial	$525.11
Rate for Payer: BCBS Complete	$256.08
Rate for Payer: BCBS Trust/PPO	$1,128.98
Rate for Payer: Cash Price	$1,444.00
Rate for Payer: Cash Price	$1,444.00
Rate for Payer: Meridian Medicaid	$256.08
Rate for Payer: Priority Health Choice Medicaid	$243.89
Rate for Payer: Priority Health Cigna Priority Health	$1,263.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$608.03
Rate for Payer: Priority Health Narrow Network	$608.03
Rate for Payer: Priority Health SBD	$608.03
Rate for Payer: UMR Bronson Commercial	$830.30

PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH

Professional

Both

$2,500.00

Service Code	HCPCS 92924
Min. Negotiated Rate	$350.79
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$703.51
Rate for Payer: BCBS Complete	$412.19
Rate for Payer: BCBS Trust/PPO	$350.79
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Meridian Medicaid	$412.19
Rate for Payer: Priority Health Choice Medicaid	$392.56
Rate for Payer: Priority Health Cigna Priority Health	$1,750.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$869.61
Rate for Payer: Priority Health Narrow Network	$869.61
Rate for Payer: Priority Health SBD	$869.61
Rate for Payer: UMR Bronson Commercial	$1,150.00

PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH

Professional

Both

$1,057.00

Service Code	HCPCS 92921
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$739.90
Rate for Payer: Aetna Commercial	$300.69
Rate for Payer: BCBS Complete	$422.80
Rate for Payer: BCBS Trust/PPO	$388.83
Rate for Payer: Cash Price	$845.60
Rate for Payer: Cash Price	$845.60
Rate for Payer: Priority Health Cigna Priority Health	$739.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$249.00
Rate for Payer: Priority Health Narrow Network	$249.00
Rate for Payer: Priority Health SBD	$249.00
Rate for Payer: UMR Bronson Commercial	$486.22

PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH

Professional

Both

$1,097.00

Service Code	HCPCS 92920
Min. Negotiated Rate	$329.09
Max. Negotiated Rate	$3,219.99
Rate for Payer: Aetna Commercial	$590.08
Rate for Payer: BCBS Complete	$345.54
Rate for Payer: BCBS Trust/PPO	$3,219.99
Rate for Payer: Cash Price	$877.60
Rate for Payer: Cash Price	$877.60
Rate for Payer: Meridian Medicaid	$345.54
Rate for Payer: Priority Health Choice Medicaid	$329.09
Rate for Payer: Priority Health Cigna Priority Health	$767.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$727.74
Rate for Payer: Priority Health Narrow Network	$727.74
Rate for Payer: Priority Health SBD	$727.74
Rate for Payer: UMR Bronson Commercial	$504.62

PR PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL

Professional

Both

$275.00

Service Code	HCPCS 92938
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna Commercial	$316.80
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: BCBS Trust/PPO	$151.09
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$249.00
Rate for Payer: Priority Health Narrow Network	$249.00
Rate for Payer: Priority Health SBD	$249.00
Rate for Payer: UMR Bronson Commercial	$126.50

PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL

Professional

Both

$1,219.00

Service Code	HCPCS 92937
Min. Negotiated Rate	$146.34
Max. Negotiated Rate	$853.30
Rate for Payer: Aetna Commercial	$655.81
Rate for Payer: BCBS Complete	$384.46
Rate for Payer: BCBS Trust/PPO	$146.34
Rate for Payer: Cash Price	$975.20
Rate for Payer: Cash Price	$975.20
Rate for Payer: Meridian Medicaid	$384.46
Rate for Payer: Priority Health Choice Medicaid	$366.15
Rate for Payer: Priority Health Cigna Priority Health	$853.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$810.50
Rate for Payer: Priority Health Narrow Network	$810.50
Rate for Payer: Priority Health SBD	$810.50
Rate for Payer: UMR Bronson Commercial	$560.74

PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH

Professional

Both

$1,221.00

Service Code	HCPCS 92934
Min. Negotiated Rate	$82.41
Max. Negotiated Rate	$854.70
Rate for Payer: Aetna Commercial	$273.84
Rate for Payer: BCBS Complete	$488.40
Rate for Payer: BCBS Trust/PPO	$82.41
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Priority Health Cigna Priority Health	$854.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$310.00
Rate for Payer: Priority Health Narrow Network	$310.00
Rate for Payer: Priority Health SBD	$310.00
Rate for Payer: UMR Bronson Commercial	$561.66

PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH

Professional

Both

$1,189.00

Service Code	HCPCS 92929
Min. Negotiated Rate	$250.41
Max. Negotiated Rate	$832.30
Rate for Payer: Aetna Commercial	$352.65
Rate for Payer: BCBS Complete	$475.60
Rate for Payer: BCBS Trust/PPO	$250.41
Rate for Payer: Cash Price	$951.20
Rate for Payer: Cash Price	$951.20
Rate for Payer: Priority Health Cigna Priority Health	$832.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$275.00
Rate for Payer: Priority Health Narrow Network	$275.00
Rate for Payer: Priority Health SBD	$275.00
Rate for Payer: UMR Bronson Commercial	$546.94

PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH

Professional

Both

$1,220.00

Service Code	HCPCS 92928
Min. Negotiated Rate	$334.41
Max. Negotiated Rate	$854.00
Rate for Payer: Aetna Commercial	$656.55
Rate for Payer: BCBS Complete	$384.46
Rate for Payer: BCBS Trust/PPO	$334.41
Rate for Payer: Cash Price	$976.00
Rate for Payer: Cash Price	$976.00
Rate for Payer: Meridian Medicaid	$384.46
Rate for Payer: Priority Health Choice Medicaid	$366.15
Rate for Payer: Priority Health Cigna Priority Health	$854.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$811.44
Rate for Payer: Priority Health Narrow Network	$811.44
Rate for Payer: Priority Health SBD	$811.44
Rate for Payer: UMR Bronson Commercial	$561.20

PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL

Professional

Both

$1,365.00

Service Code	HCPCS 92943
Min. Negotiated Rate	$411.09
Max. Negotiated Rate	$1,794.11
Rate for Payer: Aetna Commercial	$738.29
Rate for Payer: BCBS Complete	$431.64
Rate for Payer: BCBS Trust/PPO	$1,794.11
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Meridian Medicaid	$431.64
Rate for Payer: Priority Health Choice Medicaid	$411.09
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$911.22
Rate for Payer: Priority Health Narrow Network	$911.22
Rate for Payer: Priority Health SBD	$911.22
Rate for Payer: UMR Bronson Commercial	$627.90

PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH

Professional

Both

$1,409.00

Service Code	HCPCS 92933
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$986.30
Rate for Payer: Aetna Commercial	$737.15
Rate for Payer: BCBS Complete	$431.19
Rate for Payer: BCBS Trust/PPO	$128.38
Rate for Payer: Cash Price	$1,127.20
Rate for Payer: Cash Price	$1,127.20
Rate for Payer: Meridian Medicaid	$431.19
Rate for Payer: Priority Health Choice Medicaid	$410.66
Rate for Payer: Priority Health Cigna Priority Health	$986.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$909.32
Rate for Payer: Priority Health Narrow Network	$909.32
Rate for Payer: Priority Health SBD	$909.32
Rate for Payer: UMR Bronson Commercial	$648.14

PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL

Professional

Both

$1,371.00

Service Code	HCPCS 92941
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$959.70
Rate for Payer: Aetna Commercial	$737.52
Rate for Payer: BCBS Complete	$431.64
Rate for Payer: BCBS Trust/PPO	$180.15
Rate for Payer: Cash Price	$1,096.80
Rate for Payer: Cash Price	$1,096.80
Rate for Payer: Meridian Medicaid	$431.64
Rate for Payer: Priority Health Choice Medicaid	$411.09
Rate for Payer: Priority Health Cigna Priority Health	$959.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$910.27
Rate for Payer: Priority Health Narrow Network	$910.27
Rate for Payer: Priority Health SBD	$910.27
Rate for Payer: UMR Bronson Commercial	$630.66

PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX

Professional

Both

$531.00

Service Code	HCPCS 37188
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$1,237.28
Rate for Payer: Aetna Commercial	$371.46
Rate for Payer: BCBS Complete	$183.17
Rate for Payer: BCBS Trust/PPO	$1,237.28
Rate for Payer: Cash Price	$424.80
Rate for Payer: Cash Price	$424.80
Rate for Payer: Meridian Medicaid	$183.17
Rate for Payer: Priority Health Choice Medicaid	$174.45
Rate for Payer: Priority Health Cigna Priority Health	$371.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$435.15
Rate for Payer: Priority Health Narrow Network	$435.15
Rate for Payer: Priority Health SBD	$435.15
Rate for Payer: UMR Bronson Commercial	$244.26

PR PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF

Professional

Both

$9,273.00

Service Code	HCPCS 43116
Min. Negotiated Rate	$216.60
Max. Negotiated Rate	$8,572.64
Rate for Payer: Aetna Commercial	$6,701.66
Rate for Payer: BCBS Complete	$3,268.65
Rate for Payer: BCBS Trust/PPO	$216.60
Rate for Payer: Cash Price	$7,418.40
Rate for Payer: Cash Price	$7,418.40
Rate for Payer: Meridian Medicaid	$3,268.65
Rate for Payer: Priority Health Choice Medicaid	$3,113.00
Rate for Payer: Priority Health Cigna Priority Health	$6,491.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,572.64
Rate for Payer: Priority Health Narrow Network	$8,572.64
Rate for Payer: Priority Health SBD	$8,572.64
Rate for Payer: UMR Bronson Commercial	$4,265.58

PR PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY

Professional

Both

$5,892.00

Service Code	HCPCS 43121
Min. Negotiated Rate	$86.60
Max. Negotiated Rate	$4,939.55
Rate for Payer: Aetna Commercial	$3,841.89
Rate for Payer: BCBS Complete	$1,887.39
Rate for Payer: BCBS Trust/PPO	$86.60
Rate for Payer: Cash Price	$4,713.60
Rate for Payer: Cash Price	$4,713.60
Rate for Payer: Meridian Medicaid	$1,887.39
Rate for Payer: Priority Health Choice Medicaid	$1,797.51
Rate for Payer: Priority Health Cigna Priority Health	$4,124.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,939.55
Rate for Payer: Priority Health Narrow Network	$4,939.55
Rate for Payer: Priority Health SBD	$4,939.55
Rate for Payer: UMR Bronson Commercial	$2,710.32

PR PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY

Professional

Both

$6,210.00

Service Code	HCPCS 43117
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$5,636.31
Rate for Payer: Aetna Commercial	$4,374.05
Rate for Payer: BCBS Complete	$2,154.42
Rate for Payer: BCBS Trust/PPO	$147.40
Rate for Payer: Cash Price	$4,968.00
Rate for Payer: Cash Price	$4,968.00
Rate for Payer: Meridian Medicaid	$2,154.42
Rate for Payer: Priority Health Choice Medicaid	$2,051.83
Rate for Payer: Priority Health Cigna Priority Health	$4,347.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,636.31
Rate for Payer: Priority Health Narrow Network	$5,636.31
Rate for Payer: Priority Health SBD	$5,636.31
Rate for Payer: UMR Bronson Commercial	$2,856.60

Know your out-of-pocket cost for care.

All Charges