Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR REMV TISSUE FOR GRAFT OTHR

Professional

Both

$803.00

Service Code	HCPCS 20926
Min. Negotiated Rate	$321.20
Max. Negotiated Rate	$562.10
Rate for Payer: BCBS Complete	$321.20
Rate for Payer: Cash Price	$642.40
Rate for Payer: Priority Health Cigna Priority Health	$562.10
Rate for Payer: UMR Bronson Commercial	$369.38

PR RENAL ANGIO, CARDIAC CATH

Professional

Both

$35.00

Service Code	HCPCS G0275
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR RENAL BIOPSY SURG EXPOSURE KIDNEY

Professional

Both

$1,666.00

Service Code	HCPCS 50205
Min. Negotiated Rate	$483.72
Max. Negotiated Rate	$2,575.99
Rate for Payer: Aetna Commercial	$974.57
Rate for Payer: BCBS Complete	$507.91
Rate for Payer: BCBS Trust/PPO	$2,575.99
Rate for Payer: Cash Price	$1,332.80
Rate for Payer: Cash Price	$1,332.80
Rate for Payer: Meridian Medicaid	$507.91
Rate for Payer: Priority Health Choice Medicaid	$483.72
Rate for Payer: Priority Health Cigna Priority Health	$1,166.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,217.97
Rate for Payer: Priority Health Narrow Network	$1,217.97
Rate for Payer: Priority Health SBD	$1,217.97
Rate for Payer: UMR Bronson Commercial	$766.36

PR RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION

Professional

Both

$712.00

Service Code	HCPCS 50551
Min. Negotiated Rate	$184.46
Max. Negotiated Rate	$3,748.82
Rate for Payer: Aetna Commercial	$376.62
Rate for Payer: BCBS Complete	$193.68
Rate for Payer: BCBS Trust/PPO	$3,748.82
Rate for Payer: Cash Price	$569.60
Rate for Payer: Cash Price	$569.60
Rate for Payer: Meridian Medicaid	$193.68
Rate for Payer: Priority Health Choice Medicaid	$184.46
Rate for Payer: Priority Health Cigna Priority Health	$498.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$464.71
Rate for Payer: Priority Health Narrow Network	$464.71
Rate for Payer: Priority Health SBD	$464.71
Rate for Payer: UMR Bronson Commercial	$327.52

PR RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY

Professional

Both

$769.00

Service Code	HCPCS 50555
Min. Negotiated Rate	$214.07
Max. Negotiated Rate	$4,030.40
Rate for Payer: Aetna Commercial	$436.06
Rate for Payer: BCBS Complete	$224.77
Rate for Payer: BCBS Trust/PPO	$4,030.40
Rate for Payer: Cash Price	$615.20
Rate for Payer: Cash Price	$615.20
Rate for Payer: Meridian Medicaid	$224.77
Rate for Payer: Priority Health Choice Medicaid	$214.07
Rate for Payer: Priority Health Cigna Priority Health	$538.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$538.20
Rate for Payer: Priority Health Narrow Network	$538.20
Rate for Payer: Priority Health SBD	$538.20
Rate for Payer: UMR Bronson Commercial	$353.74

PR RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI

Professional

Both

$815.00

Service Code	HCPCS 50557
Min. Negotiated Rate	$216.83
Max. Negotiated Rate	$4,171.46
Rate for Payer: Aetna Commercial	$442.24
Rate for Payer: BCBS Complete	$227.67
Rate for Payer: BCBS Trust/PPO	$4,171.46
Rate for Payer: Cash Price	$652.00
Rate for Payer: Cash Price	$652.00
Rate for Payer: Meridian Medicaid	$227.67
Rate for Payer: Priority Health Choice Medicaid	$216.83
Rate for Payer: Priority Health Cigna Priority Health	$570.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$545.22
Rate for Payer: Priority Health Narrow Network	$545.22
Rate for Payer: Priority Health SBD	$545.22
Rate for Payer: UMR Bronson Commercial	$374.90

PR RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS

Professional

Both

$890.00

Service Code	HCPCS 50561
Min. Negotiated Rate	$247.72
Max. Negotiated Rate	$623.00
Rate for Payer: Aetna Commercial	$505.20
Rate for Payer: BCBS Complete	$260.11
Rate for Payer: BCBS Trust/PPO	$287.92
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cash Price	$712.00
Rate for Payer: Meridian Medicaid	$260.11
Rate for Payer: Priority Health Choice Medicaid	$247.72
Rate for Payer: Priority Health Cigna Priority Health	$623.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$621.41
Rate for Payer: Priority Health Narrow Network	$621.41
Rate for Payer: Priority Health SBD	$621.41
Rate for Payer: UMR Bronson Commercial	$409.40

PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA

Professional

Both

$712.00

Service Code	HCPCS 50553
Min. Negotiated Rate	$197.24
Max. Negotiated Rate	$3,834.93
Rate for Payer: Aetna Commercial	$402.76
Rate for Payer: BCBS Complete	$207.10
Rate for Payer: BCBS Trust/PPO	$3,834.93
Rate for Payer: Cash Price	$569.60
Rate for Payer: Cash Price	$569.60
Rate for Payer: Meridian Medicaid	$207.10
Rate for Payer: Priority Health Choice Medicaid	$197.24
Rate for Payer: Priority Health Cigna Priority Health	$498.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$496.58
Rate for Payer: Priority Health Narrow Network	$496.58
Rate for Payer: Priority Health SBD	$496.58
Rate for Payer: UMR Bronson Commercial	$327.52

PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION

Professional

Both

$935.00

Service Code	HCPCS 50570
Min. Negotiated Rate	$308.21
Max. Negotiated Rate	$773.26
Rate for Payer: Aetna Commercial	$629.91
Rate for Payer: BCBS Complete	$323.62
Rate for Payer: BCBS Trust/PPO	$634.49
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cash Price	$748.00
Rate for Payer: Meridian Medicaid	$323.62
Rate for Payer: Priority Health Choice Medicaid	$308.21
Rate for Payer: Priority Health Cigna Priority Health	$654.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$773.26
Rate for Payer: Priority Health Narrow Network	$773.26
Rate for Payer: Priority Health SBD	$773.26
Rate for Payer: UMR Bronson Commercial	$430.10

PR REOPENING RECENT LAPAROTOMY

Professional

Both

$2,085.00

Service Code	HCPCS 49002
Min. Negotiated Rate	$611.24
Max. Negotiated Rate	$1,827.41
Rate for Payer: Aetna Commercial	$1,409.38
Rate for Payer: BCBS Complete	$698.68
Rate for Payer: BCBS Trust/PPO	$611.24
Rate for Payer: Cash Price	$1,668.00
Rate for Payer: Cash Price	$1,668.00
Rate for Payer: Meridian Medicaid	$698.68
Rate for Payer: Priority Health Choice Medicaid	$665.41
Rate for Payer: Priority Health Cigna Priority Health	$1,459.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,827.41
Rate for Payer: Priority Health Narrow Network	$1,827.41
Rate for Payer: Priority Health SBD	$1,827.41
Rate for Payer: UMR Bronson Commercial	$959.10

PR REPAIR ANAL FISTULA W/FIBRIN GLUE

Professional

Both

$334.00

Service Code	HCPCS 46706
Min. Negotiated Rate	$116.09
Max. Negotiated Rate	$316.32
Rate for Payer: Aetna Commercial	$238.77
Rate for Payer: BCBS Complete	$121.89
Rate for Payer: BCBS Trust/PPO	$169.58
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Meridian Medicaid	$121.89
Rate for Payer: Priority Health Choice Medicaid	$116.09
Rate for Payer: Priority Health Cigna Priority Health	$233.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$316.32
Rate for Payer: Priority Health Narrow Network	$316.32
Rate for Payer: Priority Health SBD	$316.32
Rate for Payer: UMR Bronson Commercial	$153.64

PR REPAIR ANORECTAL FISTULA PLUG

Professional

Both

$1,017.00

Service Code	HCPCS 46707
Min. Negotiated Rate	$192.83
Max. Negotiated Rate	$891.96
Rate for Payer: Aetna Commercial	$673.80
Rate for Payer: BCBS Complete	$341.29
Rate for Payer: BCBS Trust/PPO	$192.83
Rate for Payer: Cash Price	$813.60
Rate for Payer: Cash Price	$813.60
Rate for Payer: Meridian Medicaid	$341.29
Rate for Payer: Priority Health Choice Medicaid	$325.04
Rate for Payer: Priority Health Cigna Priority Health	$711.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$891.96
Rate for Payer: Priority Health Narrow Network	$891.96
Rate for Payer: Priority Health SBD	$891.96
Rate for Payer: UMR Bronson Commercial	$467.82

PR REPAIR BIFID EARLOBES - BILATERAL

Professional

Both

$1,000.00

Service Code	HCPCS 00535
Hospital Revenue Code	990
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$700.00
Rate for Payer: BCBS Complete	$400.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Priority Health Cigna Priority Health	$700.00
Rate for Payer: UMR Bronson Commercial	$460.00

PR REPAIR BIFID EARLOBES - UNILATERAL

Professional

Both

$600.00

Service Code	HCPCS 00534
Hospital Revenue Code	990
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: UMR Bronson Commercial	$276.00

PR REPAIR BLOOD VESSEL DIRECT HAND FINGER

Professional

Both

$1,326.00

Service Code	HCPCS 35207
Min. Negotiated Rate	$292.68
Max. Negotiated Rate	$1,208.08
Rate for Payer: Aetna Commercial	$1,002.58
Rate for Payer: BCBS Complete	$508.81
Rate for Payer: BCBS Trust/PPO	$292.68
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Meridian Medicaid	$508.81
Rate for Payer: Priority Health Choice Medicaid	$484.58
Rate for Payer: Priority Health Cigna Priority Health	$928.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,208.08
Rate for Payer: Priority Health Narrow Network	$1,208.08
Rate for Payer: Priority Health SBD	$1,208.08
Rate for Payer: UMR Bronson Commercial	$609.96

PR REPAIR BLOOD VESSEL DIRECT NECK

Professional

Both

$4,157.00

Service Code	HCPCS 35201
Min. Negotiated Rate	$586.18
Max. Negotiated Rate	$2,909.90
Rate for Payer: Aetna Commercial	$1,265.63
Rate for Payer: BCBS Complete	$615.49
Rate for Payer: BCBS Trust/PPO	$871.17
Rate for Payer: Cash Price	$3,325.60
Rate for Payer: Cash Price	$3,325.60
Rate for Payer: Meridian Medicaid	$615.49
Rate for Payer: Priority Health Choice Medicaid	$586.18
Rate for Payer: Priority Health Cigna Priority Health	$2,909.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,459.68
Rate for Payer: Priority Health Narrow Network	$1,459.68
Rate for Payer: Priority Health SBD	$1,459.68
Rate for Payer: UMR Bronson Commercial	$1,912.22

PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY

Professional

Both

$2,735.00

Service Code	HCPCS 35206
Min. Negotiated Rate	$497.99
Max. Negotiated Rate	$1,959.46
Rate for Payer: Aetna Commercial	$1,048.65
Rate for Payer: BCBS Complete	$522.89
Rate for Payer: BCBS Trust/PPO	$1,959.46
Rate for Payer: Cash Price	$2,188.00
Rate for Payer: Cash Price	$2,188.00
Rate for Payer: Meridian Medicaid	$522.89
Rate for Payer: Priority Health Choice Medicaid	$497.99
Rate for Payer: Priority Health Cigna Priority Health	$1,914.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,229.35
Rate for Payer: Priority Health Narrow Network	$1,229.35
Rate for Payer: Priority Health SBD	$1,229.35
Rate for Payer: UMR Bronson Commercial	$1,258.10

PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL

Professional

Both

$3,764.00

Service Code	HCPCS 35251
Min. Negotiated Rate	$808.30
Max. Negotiated Rate	$2,736.93
Rate for Payer: Aetna Commercial	$2,327.60
Rate for Payer: BCBS Complete	$1,146.21
Rate for Payer: BCBS Trust/PPO	$808.30
Rate for Payer: Cash Price	$3,011.20
Rate for Payer: Cash Price	$3,011.20
Rate for Payer: Meridian Medicaid	$1,146.21
Rate for Payer: Priority Health Choice Medicaid	$1,091.63
Rate for Payer: Priority Health Cigna Priority Health	$2,634.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,736.93
Rate for Payer: Priority Health Narrow Network	$2,736.93
Rate for Payer: Priority Health SBD	$2,736.93
Rate for Payer: UMR Bronson Commercial	$1,731.44

PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY

Professional

Both

$4,485.00

Service Code	HCPCS 35256
Min. Negotiated Rate	$632.40
Max. Negotiated Rate	$3,139.50
Rate for Payer: Aetna Commercial	$1,380.04
Rate for Payer: BCBS Complete	$664.02
Rate for Payer: BCBS Trust/PPO	$1,015.92
Rate for Payer: Cash Price	$3,588.00
Rate for Payer: Cash Price	$3,588.00
Rate for Payer: Meridian Medicaid	$664.02
Rate for Payer: Priority Health Choice Medicaid	$632.40
Rate for Payer: Priority Health Cigna Priority Health	$3,139.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,588.42
Rate for Payer: Priority Health Narrow Network	$1,588.42
Rate for Payer: Priority Health SBD	$1,588.42
Rate for Payer: UMR Bronson Commercial	$2,063.10

PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK

Professional

Both

$4,600.00

Service Code	HCPCS 35261
Min. Negotiated Rate	$613.23
Max. Negotiated Rate	$3,220.00
Rate for Payer: Aetna Commercial	$1,315.04
Rate for Payer: BCBS Complete	$643.89
Rate for Payer: BCBS Trust/PPO	$773.96
Rate for Payer: Cash Price	$3,680.00
Rate for Payer: Cash Price	$3,680.00
Rate for Payer: Meridian Medicaid	$643.89
Rate for Payer: Priority Health Choice Medicaid	$613.23
Rate for Payer: Priority Health Cigna Priority Health	$3,220.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,522.46
Rate for Payer: Priority Health Narrow Network	$1,522.46
Rate for Payer: Priority Health SBD	$1,522.46
Rate for Payer: UMR Bronson Commercial	$2,116.00

PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK

Professional

Both

$1,859.00

Service Code	HCPCS 35231
Min. Negotiated Rate	$788.95
Max. Negotiated Rate	$2,591.31
Rate for Payer: Aetna Commercial	$1,673.50
Rate for Payer: BCBS Complete	$828.40
Rate for Payer: BCBS Trust/PPO	$2,591.31
Rate for Payer: Cash Price	$1,487.20
Rate for Payer: Cash Price	$1,487.20
Rate for Payer: Meridian Medicaid	$828.40
Rate for Payer: Priority Health Choice Medicaid	$788.95
Rate for Payer: Priority Health Cigna Priority Health	$1,301.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,970.37
Rate for Payer: Priority Health Narrow Network	$1,970.37
Rate for Payer: Priority Health SBD	$1,970.37
Rate for Payer: UMR Bronson Commercial	$855.14

PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY

Professional

Both

$3,625.00

Service Code	HCPCS 35236
Min. Negotiated Rate	$627.07
Max. Negotiated Rate	$2,563.84
Rate for Payer: Aetna Commercial	$1,348.22
Rate for Payer: BCBS Complete	$658.42
Rate for Payer: BCBS Trust/PPO	$2,563.84
Rate for Payer: Cash Price	$2,900.00
Rate for Payer: Cash Price	$2,900.00
Rate for Payer: Meridian Medicaid	$658.42
Rate for Payer: Priority Health Choice Medicaid	$627.07
Rate for Payer: Priority Health Cigna Priority Health	$2,537.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,554.37
Rate for Payer: Priority Health Narrow Network	$1,554.37
Rate for Payer: Priority Health SBD	$1,554.37
Rate for Payer: UMR Bronson Commercial	$1,667.50

PR REPAIR BROW PTOSIS

Professional

Both

$1,300.00

Service Code	HCPCS 67900
Min. Negotiated Rate	$183.32
Max. Negotiated Rate	$910.00
Rate for Payer: Aetna Commercial	$658.86
Rate for Payer: BCBS Complete	$335.93
Rate for Payer: BCBS Trust/PPO	$183.32
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Meridian Medicaid	$335.93
Rate for Payer: Priority Health Choice Medicaid	$319.93
Rate for Payer: Priority Health Cigna Priority Health	$910.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$870.52
Rate for Payer: Priority Health Narrow Network	$870.52
Rate for Payer: Priority Health SBD	$870.52
Rate for Payer: UMR Bronson Commercial	$598.00

PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS

Professional

Both

$7,535.00

Service Code	HCPCS 33305
Min. Negotiated Rate	$786.64
Max. Negotiated Rate	$6,356.36
Rate for Payer: Aetna Commercial	$5,503.81
Rate for Payer: BCBS Complete	$2,687.82
Rate for Payer: BCBS Trust/PPO	$786.64
Rate for Payer: Cash Price	$6,028.00
Rate for Payer: Cash Price	$6,028.00
Rate for Payer: Meridian Medicaid	$2,687.82
Rate for Payer: Priority Health Choice Medicaid	$2,559.83
Rate for Payer: Priority Health Cigna Priority Health	$5,274.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,356.36
Rate for Payer: Priority Health Narrow Network	$6,356.36
Rate for Payer: Priority Health SBD	$6,356.36
Rate for Payer: UMR Bronson Commercial	$3,466.10

PR REPAIR CARDIAC WOUND W/O BYPASS

Professional

Both

$4,507.00

Service Code	HCPCS 33300
Min. Negotiated Rate	$1,529.34
Max. Negotiated Rate	$3,794.45
Rate for Payer: Aetna Commercial	$3,287.49
Rate for Payer: BCBS Complete	$1,605.81
Rate for Payer: BCBS Trust/PPO	$2,283.84
Rate for Payer: Cash Price	$3,605.60
Rate for Payer: Cash Price	$3,605.60
Rate for Payer: Meridian Medicaid	$1,605.81
Rate for Payer: Priority Health Choice Medicaid	$1,529.34
Rate for Payer: Priority Health Cigna Priority Health	$3,154.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,794.45
Rate for Payer: Priority Health Narrow Network	$3,794.45
Rate for Payer: Priority Health SBD	$3,794.45
Rate for Payer: UMR Bronson Commercial	$2,073.22

Know your out-of-pocket cost for care.

All Charges