Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG

Professional

Both

$190.00

Service Code	HCPCS 92604
Min. Negotiated Rate	$61.90
Max. Negotiated Rate	$123.50
Rate for Payer: Aetna Commercial	$82.95
Rate for Payer: Aetna Medicare	$64.38
Rate for Payer: Aetna New Business (MI Preferred)	$89.14
Rate for Payer: Aetna New Business (MI Preferred)	$82.95
Rate for Payer: BCBS Complete	$76.00
Rate for Payer: BCBS MAPPO	$61.90
Rate for Payer: BCN Medicare Advantage	$61.90
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cofinity Commercial	$89.14
Rate for Payer: Cofinity Commercial	$82.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$61.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65.00
Rate for Payer: Nomi Health Commercial	$74.28
Rate for Payer: PACE SWMI	$61.90
Rate for Payer: PHP Commercial	$86.66
Rate for Payer: PHP Medicare Advantage	$61.90
Rate for Payer: Priority Health Cigna Priority Health	$123.50
Rate for Payer: Priority Health Medicare	$61.90
Rate for Payer: UHC Dual Complete DSNP	$61.90
Rate for Payer: UHC Medicare Advantage	$61.90
Rate for Payer: UMR Bronson Commercial	$87.40

PR ANALYZE NEUROSTIM BRAIN, FIRST 1H

Professional

Both

$507.00

Service Code	HCPCS 95978
Min. Negotiated Rate	$202.80
Max. Negotiated Rate	$329.55
Rate for Payer: Aetna Medicare	$253.50
Rate for Payer: BCBS Complete	$202.80
Rate for Payer: Cash Price	$405.60
Rate for Payer: Priority Health Cigna Priority Health	$329.55
Rate for Payer: UMR Bronson Commercial	$233.22

PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN

Professional

Both

$218.00

Service Code	HCPCS 95979
Min. Negotiated Rate	$87.20
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Medicare	$109.00
Rate for Payer: BCBS Complete	$87.20
Rate for Payer: Cash Price	$174.40
Rate for Payer: Priority Health Cigna Priority Health	$141.70
Rate for Payer: UMR Bronson Commercial	$100.28

PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES

Professional

Both

$7,866.00

Service Code	HCPCS 61711
Min. Negotiated Rate	$2,586.63
Max. Negotiated Rate	$5,112.90
Rate for Payer: Aetna Commercial	$3,466.08
Rate for Payer: Aetna Medicare	$2,690.10
Rate for Payer: Aetna New Business (MI Preferred)	$3,724.75
Rate for Payer: Aetna New Business (MI Preferred)	$3,466.08
Rate for Payer: BCBS Complete	$3,146.40
Rate for Payer: BCBS MAPPO	$2,586.63
Rate for Payer: BCN Medicare Advantage	$2,586.63
Rate for Payer: Cash Price	$6,292.80
Rate for Payer: Cash Price	$6,292.80
Rate for Payer: Cofinity Commercial	$3,466.08
Rate for Payer: Cofinity Commercial	$3,724.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,586.63
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,715.96
Rate for Payer: Nomi Health Commercial	$3,103.96
Rate for Payer: PACE SWMI	$2,586.63
Rate for Payer: PHP Commercial	$3,621.28
Rate for Payer: PHP Medicare Advantage	$2,586.63
Rate for Payer: Priority Health Cigna Priority Health	$5,112.90
Rate for Payer: Priority Health Medicare	$2,586.63
Rate for Payer: UHC Dual Complete DSNP	$2,586.63
Rate for Payer: UHC Medicare Advantage	$2,586.63
Rate for Payer: UMR Bronson Commercial	$3,618.36

PR ANAST INTRAHEPATC DUCTS & GI TRACT

Professional

Both

$6,161.00

Service Code	HCPCS 47765
Min. Negotiated Rate	$2,464.40
Max. Negotiated Rate	$4,234.90
Rate for Payer: Aetna Commercial	$3,940.81
Rate for Payer: Aetna Medicare	$3,058.54
Rate for Payer: Aetna New Business (MI Preferred)	$4,234.90
Rate for Payer: Aetna New Business (MI Preferred)	$3,940.81
Rate for Payer: BCBS Complete	$2,464.40
Rate for Payer: BCBS MAPPO	$2,940.90
Rate for Payer: BCN Medicare Advantage	$2,940.90
Rate for Payer: Cash Price	$4,928.80
Rate for Payer: Cash Price	$4,928.80
Rate for Payer: Cofinity Commercial	$4,234.90
Rate for Payer: Cofinity Commercial	$3,940.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,940.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,087.95
Rate for Payer: Nomi Health Commercial	$3,529.08
Rate for Payer: PACE SWMI	$2,940.90
Rate for Payer: PHP Commercial	$4,117.26
Rate for Payer: PHP Medicare Advantage	$2,940.90
Rate for Payer: Priority Health Cigna Priority Health	$4,004.65
Rate for Payer: Priority Health Medicare	$2,940.90
Rate for Payer: UHC Dual Complete DSNP	$2,940.90
Rate for Payer: UHC Medicare Advantage	$2,940.90
Rate for Payer: UMR Bronson Commercial	$2,834.06

PR ANASTOMOSIS FACIAL HYPOGLOSSAL

Professional

Both

$1,858.00

Service Code	HCPCS 64868
Min. Negotiated Rate	$743.20
Max. Negotiated Rate	$1,353.25
Rate for Payer: Aetna Commercial	$1,259.28
Rate for Payer: Aetna Medicare	$977.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,353.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,259.28
Rate for Payer: BCBS Complete	$743.20
Rate for Payer: BCBS MAPPO	$939.76
Rate for Payer: BCN Medicare Advantage	$939.76
Rate for Payer: Cash Price	$1,486.40
Rate for Payer: Cash Price	$1,486.40
Rate for Payer: Cofinity Commercial	$1,353.25
Rate for Payer: Cofinity Commercial	$1,259.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$939.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$986.75
Rate for Payer: Nomi Health Commercial	$1,127.71
Rate for Payer: PACE SWMI	$939.76
Rate for Payer: PHP Commercial	$1,315.66
Rate for Payer: PHP Medicare Advantage	$939.76
Rate for Payer: Priority Health Cigna Priority Health	$1,207.70
Rate for Payer: Priority Health Medicare	$939.76
Rate for Payer: UHC Dual Complete DSNP	$939.76
Rate for Payer: UHC Medicare Advantage	$939.76
Rate for Payer: UMR Bronson Commercial	$854.68

PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI

Professional

Both

$4,710.00

Service Code	HCPCS 47780
Min. Negotiated Rate	$1,884.00
Max. Negotiated Rate	$3,456.50
Rate for Payer: Aetna Commercial	$3,216.47
Rate for Payer: Aetna Medicare	$2,496.36
Rate for Payer: Aetna New Business (MI Preferred)	$3,456.50
Rate for Payer: Aetna New Business (MI Preferred)	$3,216.47
Rate for Payer: BCBS Complete	$1,884.00
Rate for Payer: BCBS MAPPO	$2,400.35
Rate for Payer: BCN Medicare Advantage	$2,400.35
Rate for Payer: Cash Price	$3,768.00
Rate for Payer: Cash Price	$3,768.00
Rate for Payer: Cofinity Commercial	$3,456.50
Rate for Payer: Cofinity Commercial	$3,216.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,400.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,520.37
Rate for Payer: Nomi Health Commercial	$2,880.42
Rate for Payer: PACE SWMI	$2,400.35
Rate for Payer: PHP Commercial	$3,360.49
Rate for Payer: PHP Medicare Advantage	$2,400.35
Rate for Payer: Priority Health Cigna Priority Health	$3,061.50
Rate for Payer: Priority Health Medicare	$2,400.35
Rate for Payer: UHC Dual Complete DSNP	$2,400.35
Rate for Payer: UHC Medicare Advantage	$2,400.35
Rate for Payer: UMR Bronson Commercial	$2,166.60

PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT

Professional

Both

$4,268.00

Service Code	HCPCS 47760
Min. Negotiated Rate	$1,707.20
Max. Negotiated Rate	$3,140.25
Rate for Payer: Aetna Commercial	$2,922.18
Rate for Payer: Aetna Medicare	$2,267.96
Rate for Payer: Aetna New Business (MI Preferred)	$3,140.25
Rate for Payer: Aetna New Business (MI Preferred)	$2,922.18
Rate for Payer: BCBS Complete	$1,707.20
Rate for Payer: BCBS MAPPO	$2,180.73
Rate for Payer: BCN Medicare Advantage	$2,180.73
Rate for Payer: Cash Price	$3,414.40
Rate for Payer: Cash Price	$3,414.40
Rate for Payer: Cofinity Commercial	$3,140.25
Rate for Payer: Cofinity Commercial	$2,922.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,180.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,289.77
Rate for Payer: Nomi Health Commercial	$2,616.88
Rate for Payer: PACE SWMI	$2,180.73
Rate for Payer: PHP Commercial	$3,053.02
Rate for Payer: PHP Medicare Advantage	$2,180.73
Rate for Payer: Priority Health Cigna Priority Health	$2,774.20
Rate for Payer: Priority Health Medicare	$2,180.73
Rate for Payer: UHC Dual Complete DSNP	$2,180.73
Rate for Payer: UHC Medicare Advantage	$2,180.73
Rate for Payer: UMR Bronson Commercial	$1,963.28

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG 4-9% TBSA

Professional

Both

$5.00

Service Code	HCPCS 01952
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG <4% TBSA

Professional

Both

$3.00

Service Code	HCPCS 01951
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG EA 9%TBSA

Professional

Both

$1.00

Service Code	HCPCS 01953
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.65
Rate for Payer: UMR Bronson Commercial	$0.46

PR ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY

Professional

Both

$6.00

Service Code	HCPCS 01842
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANES ARTERIES OF KNEE & POPLITEAL AREA NOS

Professional

Both

$8.00

Service Code	HCPCS 01440
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01654
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT

Professional

Both

$10.00

Service Code	HCPCS 01638
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND

Professional

Both

$3.00

Service Code	HCPCS 01830
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS

Professional

Both

$5.00

Service Code	HCPCS 01630
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION

Professional

Both

$15.00

Service Code	HCPCS 01636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES ART KNEE POPLITEAL EXC&GRF/RPR OCCLS/ARYS

Professional

Both

$8.00

Service Code	HCPCS 01444
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES ART KNEE POPLITEAL TEAEC W/WO PATCH GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01442
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES ART LOWER LEG W/BYP GRAFT EMBLC DIR/W/CATH

Professional

Both

$6.00

Service Code	HCPCS 01502
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANES ART UPPER LEG W/BYPASS GRAFT FEM ART LIG

Professional

Both

$4.00

Service Code	HCPCS 01272
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST

Professional

Both

$5.00

Service Code	HCPCS 01112
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES CARDIAC ELECTROPHYSIOL STDY W/RF ABLATION

Professional

Both

$7.00

Service Code	HCPCS 00537
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES CAST APPLICATION REMOVAL/REPAIR KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01420
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UMR Bronson Commercial	$1.38

Know your out-of-pocket cost for care.

All Charges