Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID

Professional

Both

$311.00

Service Code	HCPCS 64463
Min. Negotiated Rate	$51.33
Max. Negotiated Rate	$788.75
Rate for Payer: Aetna Commercial	$107.31
Rate for Payer: BCBS Complete	$53.90
Rate for Payer: BCBS Trust/PPO	$788.75
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Meridian Medicaid	$53.90
Rate for Payer: Priority Health Choice Medicaid	$51.33
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.03
Rate for Payer: Priority Health Narrow Network	$137.03
Rate for Payer: Priority Health SBD	$137.03
Rate for Payer: UMR Bronson Commercial	$143.06

PR PYELOPLASTY COMPLICATED

Professional

Both

$2,616.00

Service Code	HCPCS 50405
Min. Negotiated Rate	$882.46
Max. Negotiated Rate	$2,215.47
Rate for Payer: Aetna Commercial	$1,790.90
Rate for Payer: BCBS Complete	$926.58
Rate for Payer: BCBS Trust/PPO	$2,085.73
Rate for Payer: Cash Price	$2,092.80
Rate for Payer: Cash Price	$2,092.80
Rate for Payer: Meridian Medicaid	$926.58
Rate for Payer: Priority Health Choice Medicaid	$882.46
Rate for Payer: Priority Health Cigna Priority Health	$1,831.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,215.47
Rate for Payer: Priority Health Narrow Network	$2,215.47
Rate for Payer: Priority Health SBD	$2,215.47
Rate for Payer: UMR Bronson Commercial	$1,203.36

PR PYELOPLASTY SIMPLE

Professional

Both

$1,760.00

Service Code	HCPCS 50400
Min. Negotiated Rate	$731.66
Max. Negotiated Rate	$2,368.90
Rate for Payer: Aetna Commercial	$1,482.71
Rate for Payer: BCBS Complete	$768.24
Rate for Payer: BCBS Trust/PPO	$2,368.90
Rate for Payer: Cash Price	$1,408.00
Rate for Payer: Cash Price	$1,408.00
Rate for Payer: Meridian Medicaid	$768.24
Rate for Payer: Priority Health Choice Medicaid	$731.66
Rate for Payer: Priority Health Cigna Priority Health	$1,232.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,835.06
Rate for Payer: Priority Health Narrow Network	$1,835.06
Rate for Payer: Priority Health SBD	$1,835.06
Rate for Payer: UMR Bronson Commercial	$809.60

PR PYLOROMYOTOMY CUTTING PYLORIC MUSC

Professional

Both

$2,212.00

Service Code	HCPCS 43520
Min. Negotiated Rate	$443.04
Max. Negotiated Rate	$1,548.40
Rate for Payer: Aetna Commercial	$925.56
Rate for Payer: BCBS Complete	$465.19
Rate for Payer: BCBS Trust/PPO	$1,015.39
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Meridian Medicaid	$465.19
Rate for Payer: Priority Health Choice Medicaid	$443.04
Rate for Payer: Priority Health Cigna Priority Health	$1,548.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,212.39
Rate for Payer: Priority Health Narrow Network	$1,212.39
Rate for Payer: Priority Health SBD	$1,212.39
Rate for Payer: UMR Bronson Commercial	$1,017.52

PR PYLOROPLASTY

Professional

Both

$2,507.00

Service Code	HCPCS 43800
Min. Negotiated Rate	$595.34
Max. Negotiated Rate	$1,754.90
Rate for Payer: Aetna Commercial	$1,258.80
Rate for Payer: BCBS Complete	$625.11
Rate for Payer: BCBS Trust/PPO	$665.13
Rate for Payer: Cash Price	$2,005.60
Rate for Payer: Cash Price	$2,005.60
Rate for Payer: Meridian Medicaid	$625.11
Rate for Payer: Priority Health Choice Medicaid	$595.34
Rate for Payer: Priority Health Cigna Priority Health	$1,754.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,632.80
Rate for Payer: Priority Health Narrow Network	$1,632.80
Rate for Payer: Priority Health SBD	$1,632.80
Rate for Payer: UMR Bronson Commercial	$1,153.22

PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN

Professional

Both

$66.00

Service Code	HCPCS 98971
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$529.88
Rate for Payer: Aetna Commercial	$22.59
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: BCBS Trust/PPO	$529.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Priority Health Cigna Priority Health	$46.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.49
Rate for Payer: Priority Health Narrow Network	$26.49
Rate for Payer: Priority Health SBD	$26.49
Rate for Payer: UMR Bronson Commercial	$30.36

PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN

Professional

Both

$91.00

Service Code	HCPCS 98972
Min. Negotiated Rate	$35.97
Max. Negotiated Rate	$800.90
Rate for Payer: Aetna Commercial	$35.97
Rate for Payer: BCBS Complete	$36.40
Rate for Payer: BCBS Trust/PPO	$800.90
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Priority Health Cigna Priority Health	$63.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.88
Rate for Payer: Priority Health Narrow Network	$40.88
Rate for Payer: Priority Health SBD	$40.88
Rate for Payer: UMR Bronson Commercial	$41.86

PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN

Professional

Both

$34.00

Service Code	HCPCS 98970
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$131.55
Rate for Payer: Aetna Commercial	$12.64
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Priority Health Cigna Priority Health	$23.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.27
Rate for Payer: Priority Health Narrow Network	$15.27
Rate for Payer: Priority Health SBD	$15.27
Rate for Payer: UMR Bronson Commercial	$15.64

PR QUADRICEPSPLASTY

Professional

Both

$2,009.00

Service Code	HCPCS 27430
Min. Negotiated Rate	$481.17
Max. Negotiated Rate	$1,406.30
Rate for Payer: Aetna Commercial	$990.95
Rate for Payer: BCBS Complete	$505.23
Rate for Payer: BCBS Trust/PPO	$1,015.92
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Meridian Medicaid	$505.23
Rate for Payer: Priority Health Choice Medicaid	$481.17
Rate for Payer: Priority Health Cigna Priority Health	$1,406.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,142.84
Rate for Payer: Priority Health Narrow Network	$1,142.84
Rate for Payer: Priority Health SBD	$1,142.84
Rate for Payer: UMR Bronson Commercial	$924.14

PR QUAL NONMD EST PT 11-20M

Professional

Both

$35.00

Service Code	HCPCS G2062
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.64
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24.64
Rate for Payer: Priority Health Narrow Network	$24.64
Rate for Payer: Priority Health SBD	$24.64
Rate for Payer: UMR Bronson Commercial	$16.10

PR QUAL NONMD EST PT 21>MIN

Professional

Both

$35.00

Service Code	HCPCS G2063
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$38.19
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.19
Rate for Payer: Priority Health Narrow Network	$38.19
Rate for Payer: Priority Health SBD	$38.19
Rate for Payer: UMR Bronson Commercial	$16.10

PR QUAL NONMD EST PT 5-10M

Professional

Both

$35.00

Service Code	HCPCS G2061
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.96
Rate for Payer: Priority Health Narrow Network	$13.96
Rate for Payer: Priority Health SBD	$13.96
Rate for Payer: UMR Bronson Commercial	$16.10

PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ

Professional

Both

$216.00

Service Code	HCPCS 90375
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$298.09
Rate for Payer: Aetna Commercial	$289.98
Rate for Payer: BCBS Complete	$86.40
Rate for Payer: BCBS Trust/PPO	$298.09
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Priority Health Cigna Priority Health	$151.20
Rate for Payer: UMR Bronson Commercial	$99.36

PR RABIES VACCINE INTRAMUSCULAR

Professional

Both

$204.00

Service Code	HCPCS 90675
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$345.74
Rate for Payer: Aetna Commercial	$324.74
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: BCBS Trust/PPO	$345.74
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$142.80
Rate for Payer: UMR Bronson Commercial	$93.84

PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY

Professional

Both

$5,910.00

Service Code	HCPCS 58210
Min. Negotiated Rate	$166.94
Max. Negotiated Rate	$4,137.00
Rate for Payer: Aetna Commercial	$2,168.52
Rate for Payer: BCBS Complete	$1,226.27
Rate for Payer: BCBS Trust/PPO	$166.94
Rate for Payer: Cash Price	$4,728.00
Rate for Payer: Cash Price	$4,728.00
Rate for Payer: Meridian Medicaid	$1,226.27
Rate for Payer: Priority Health Choice Medicaid	$1,167.88
Rate for Payer: Priority Health Cigna Priority Health	$4,137.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,575.90
Rate for Payer: Priority Health Narrow Network	$2,575.90
Rate for Payer: Priority Health SBD	$2,575.90
Rate for Payer: UMR Bronson Commercial	$2,718.60

PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS

Professional

Both

$2,666.00

Service Code	HCPCS 25115
Min. Negotiated Rate	$306.41
Max. Negotiated Rate	$1,866.20
Rate for Payer: Aetna Commercial	$1,005.89
Rate for Payer: BCBS Complete	$515.74
Rate for Payer: BCBS Trust/PPO	$306.41
Rate for Payer: Cash Price	$2,132.80
Rate for Payer: Cash Price	$2,132.80
Rate for Payer: Meridian Medicaid	$515.74
Rate for Payer: Priority Health Choice Medicaid	$491.18
Rate for Payer: Priority Health Cigna Priority Health	$1,866.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,166.32
Rate for Payer: Priority Health Narrow Network	$1,166.32
Rate for Payer: Priority Health SBD	$1,166.32
Rate for Payer: UMR Bronson Commercial	$1,226.36

PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS

Professional

Both

$2,284.00

Service Code	HCPCS 25116
Min. Negotiated Rate	$70.26
Max. Negotiated Rate	$1,598.80
Rate for Payer: Aetna Commercial	$800.80
Rate for Payer: BCBS Complete	$413.97
Rate for Payer: BCBS Trust/PPO	$70.26
Rate for Payer: Cash Price	$1,827.20
Rate for Payer: Cash Price	$1,827.20
Rate for Payer: Meridian Medicaid	$413.97
Rate for Payer: Priority Health Choice Medicaid	$394.26
Rate for Payer: Priority Health Cigna Priority Health	$1,598.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$933.47
Rate for Payer: Priority Health Narrow Network	$933.47
Rate for Payer: Priority Health SBD	$933.47
Rate for Payer: UMR Bronson Commercial	$1,050.64

PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ

Professional

Both

$1,865.00

Service Code	HCPCS 69150
Min. Negotiated Rate	$645.82
Max. Negotiated Rate	$2,143.84
Rate for Payer: Aetna Commercial	$1,163.90
Rate for Payer: BCBS Complete	$678.11
Rate for Payer: BCBS Trust/PPO	$2,143.84
Rate for Payer: Cash Price	$1,492.00
Rate for Payer: Cash Price	$1,492.00
Rate for Payer: Meridian Medicaid	$678.11
Rate for Payer: Priority Health Choice Medicaid	$645.82
Rate for Payer: Priority Health Cigna Priority Health	$1,305.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,433.71
Rate for Payer: Priority Health Narrow Network	$1,433.71
Rate for Payer: Priority Health SBD	$1,433.71
Rate for Payer: UMR Bronson Commercial	$857.90

PR RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP

Professional

Both

$2,980.00

Service Code	HCPCS 42844
Min. Negotiated Rate	$526.72
Max. Negotiated Rate	$2,428.33
Rate for Payer: Aetna Commercial	$1,833.58
Rate for Payer: BCBS Complete	$923.00
Rate for Payer: BCBS Trust/PPO	$526.72
Rate for Payer: Cash Price	$2,384.00
Rate for Payer: Cash Price	$2,384.00
Rate for Payer: Meridian Medicaid	$923.00
Rate for Payer: Priority Health Choice Medicaid	$879.05
Rate for Payer: Priority Health Cigna Priority Health	$2,086.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,428.33
Rate for Payer: Priority Health Narrow Network	$2,428.33
Rate for Payer: Priority Health SBD	$2,428.33
Rate for Payer: UMR Bronson Commercial	$1,370.80

PR RADICAL RESECTION STERNUM

Professional

Both

$2,622.00

Service Code	HCPCS 21630
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$2,006.86
Rate for Payer: Aetna Commercial	$1,601.13
Rate for Payer: BCBS Complete	$881.85
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$2,097.60
Rate for Payer: Cash Price	$2,097.60
Rate for Payer: Meridian Medicaid	$881.85
Rate for Payer: Priority Health Choice Medicaid	$839.86
Rate for Payer: Priority Health Cigna Priority Health	$1,835.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,006.86
Rate for Payer: Priority Health Narrow Network	$2,006.86
Rate for Payer: Priority Health SBD	$2,006.86
Rate for Payer: UMR Bronson Commercial	$1,206.12

PR RADICAL RESECTION TONSIL W/O CLOSURE

Professional

Both

$1,767.00

Service Code	HCPCS 42842
Min. Negotiated Rate	$646.46
Max. Negotiated Rate	$1,786.26
Rate for Payer: Aetna Commercial	$1,341.57
Rate for Payer: BCBS Complete	$678.78
Rate for Payer: BCBS Trust/PPO	$911.85
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Meridian Medicaid	$678.78
Rate for Payer: Priority Health Choice Medicaid	$646.46
Rate for Payer: Priority Health Cigna Priority Health	$1,236.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,786.26
Rate for Payer: Priority Health Narrow Network	$1,786.26
Rate for Payer: Priority Health SBD	$1,786.26
Rate for Payer: UMR Bronson Commercial	$812.82

PR RADICAL RESECTION TUMOR CLAVICLE

Professional

Both

$2,578.00

Service Code	HCPCS 23200
Min. Negotiated Rate	$42.87
Max. Negotiated Rate	$2,296.40
Rate for Payer: Aetna Commercial	$2,014.21
Rate for Payer: BCBS Complete	$1,012.02
Rate for Payer: BCBS Trust/PPO	$42.87
Rate for Payer: Cash Price	$2,062.40
Rate for Payer: Cash Price	$2,062.40
Rate for Payer: Meridian Medicaid	$1,012.02
Rate for Payer: Priority Health Choice Medicaid	$963.83
Rate for Payer: Priority Health Cigna Priority Health	$1,804.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,296.40
Rate for Payer: Priority Health Narrow Network	$2,296.40
Rate for Payer: Priority Health SBD	$2,296.40
Rate for Payer: UMR Bronson Commercial	$1,185.88

PR RADICAL RESECTION TUMOR FEMOR OR KNEE

Professional

Both

$5,403.00

Service Code	HCPCS 27365
Min. Negotiated Rate	$1,309.95
Max. Negotiated Rate	$3,832.29
Rate for Payer: Aetna Commercial	$2,752.84
Rate for Payer: BCBS Complete	$1,375.45
Rate for Payer: BCBS Trust/PPO	$3,832.29
Rate for Payer: Cash Price	$4,322.40
Rate for Payer: Cash Price	$4,322.40
Rate for Payer: Meridian Medicaid	$1,375.45
Rate for Payer: Priority Health Choice Medicaid	$1,309.95
Rate for Payer: Priority Health Cigna Priority Health	$3,782.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,122.62
Rate for Payer: Priority Health Narrow Network	$3,122.62
Rate for Payer: Priority Health SBD	$3,122.62
Rate for Payer: UMR Bronson Commercial	$2,485.38

PR RADICAL RESECTION TUMOR METACARPAL

Professional

Both

$2,970.00

Service Code	HCPCS 26250
Min. Negotiated Rate	$120.98
Max. Negotiated Rate	$2,079.00
Rate for Payer: Aetna Commercial	$1,422.27
Rate for Payer: BCBS Complete	$720.82
Rate for Payer: BCBS Trust/PPO	$120.98
Rate for Payer: Cash Price	$2,376.00
Rate for Payer: Cash Price	$2,376.00
Rate for Payer: Meridian Medicaid	$720.82
Rate for Payer: Priority Health Choice Medicaid	$686.50
Rate for Payer: Priority Health Cigna Priority Health	$2,079.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,631.53
Rate for Payer: Priority Health Narrow Network	$1,631.53
Rate for Payer: Priority Health SBD	$1,631.53
Rate for Payer: UMR Bronson Commercial	$1,366.20

PR RADICAL RESECTION TUMOR METATARSAL

Professional

Both

$1,352.00

Service Code	HCPCS 28173
Min. Negotiated Rate	$463.28
Max. Negotiated Rate	$1,110.49
Rate for Payer: Aetna Commercial	$974.37
Rate for Payer: BCBS Complete	$486.44
Rate for Payer: BCBS Trust/PPO	$1,110.49
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Meridian Medicaid	$486.44
Rate for Payer: Priority Health Choice Medicaid	$463.28
Rate for Payer: Priority Health Cigna Priority Health	$946.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,096.88
Rate for Payer: Priority Health Narrow Network	$1,096.88
Rate for Payer: Priority Health SBD	$1,096.88
Rate for Payer: UMR Bronson Commercial	$621.92

Know your out-of-pocket cost for care.

All Charges