Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS

Facility

$322.00

Service Code	CPT 24200
Hospital Charge Code	24200
Min. Negotiated Rate	$141.68
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna American Axle	$209.30
Rate for Payer: Aetna Commercial	$273.70
Rate for Payer: Aetna New Business (MI Preferred)	$209.30
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cofinity Commercial	$276.92
Rate for Payer: Cofinity Commercial	$225.40
Rate for Payer: Encore Health Key Benefits Commercial	$257.60
Rate for Payer: Healthscope Commercial	$289.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$225.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$241.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.70
Rate for Payer: PHP Commercial	$273.70
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health SBD	$202.86
Rate for Payer: UMR Bronson Commercial	$141.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$241.50

PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS

Professional

Both

$322.00

Service Code	HCPCS 24200
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$225.40
Rate for Payer: Aetna Commercial	$187.10
Rate for Payer: BCBS Complete	$96.17
Rate for Payer: BCBS Trust/PPO	$116.23
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Meridian Medicaid	$96.17
Rate for Payer: Priority Health Choice Medicaid	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.97
Rate for Payer: Priority Health Narrow Network	$213.97
Rate for Payer: Priority Health SBD	$213.97
Rate for Payer: UMR Bronson Commercial	$148.12

PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA

Professional

Both

$3,227.94

Service Code	HCPCS 27091
Min. Negotiated Rate	$538.87
Max. Negotiated Rate	$2,429.16
Rate for Payer: Aetna Commercial	$2,131.08
Rate for Payer: BCBS Complete	$1,069.94
Rate for Payer: BCBS Trust/PPO	$538.87
Rate for Payer: Cash Price	$2,582.35
Rate for Payer: Cash Price	$2,582.35
Rate for Payer: Meridian Medicaid	$1,069.94
Rate for Payer: Priority Health Choice Medicaid	$1,018.99
Rate for Payer: Priority Health Cigna Priority Health	$2,259.56
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,429.16
Rate for Payer: Priority Health Narrow Network	$2,429.16
Rate for Payer: Priority Health SBD	$2,429.16
Rate for Payer: UMR Bronson Commercial	$1,484.85

PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF

Professional

Both

$2,574.00

Service Code	HCPCS 33971
Min. Negotiated Rate	$446.02
Max. Negotiated Rate	$1,801.80
Rate for Payer: Aetna Commercial	$939.89
Rate for Payer: BCBS Complete	$468.32
Rate for Payer: BCBS Trust/PPO	$1,321.81
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Meridian Medicaid	$468.32
Rate for Payer: Priority Health Choice Medicaid	$446.02
Rate for Payer: Priority Health Cigna Priority Health	$1,801.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,107.00
Rate for Payer: Priority Health Narrow Network	$1,107.00
Rate for Payer: Priority Health SBD	$1,107.00
Rate for Payer: UMR Bronson Commercial	$1,184.04

PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER

Professional

Both

$480.00

Service Code	HCPCS 33284
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$336.00
Rate for Payer: BCBS Complete	$192.00
Rate for Payer: Cash Price	$384.00
Rate for Payer: Priority Health Cigna Priority Health	$336.00
Rate for Payer: UMR Bronson Commercial	$220.80

PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD

Professional

Both

$658.00

Service Code	HCPCS 33262
Min. Negotiated Rate	$234.09
Max. Negotiated Rate	$5,175.23
Rate for Payer: Aetna Commercial	$501.00
Rate for Payer: BCBS Complete	$245.79
Rate for Payer: BCBS Trust/PPO	$5,175.23
Rate for Payer: Cash Price	$526.40
Rate for Payer: Cash Price	$526.40
Rate for Payer: Meridian Medicaid	$245.79
Rate for Payer: Priority Health Choice Medicaid	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$460.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$587.27
Rate for Payer: Priority Health Narrow Network	$587.27
Rate for Payer: Priority Health SBD	$587.27
Rate for Payer: UMR Bronson Commercial	$302.68

PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD

Professional

Both

$772.00

Service Code	HCPCS 33263
Min. Negotiated Rate	$243.25
Max. Negotiated Rate	$6,021.04
Rate for Payer: Aetna Commercial	$521.20
Rate for Payer: BCBS Complete	$255.41
Rate for Payer: BCBS Trust/PPO	$6,021.04
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cash Price	$617.60
Rate for Payer: Meridian Medicaid	$255.41
Rate for Payer: Priority Health Choice Medicaid	$243.25
Rate for Payer: Priority Health Cigna Priority Health	$540.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$609.63
Rate for Payer: Priority Health Narrow Network	$609.63
Rate for Payer: Priority Health SBD	$609.63
Rate for Payer: UMR Bronson Commercial	$355.12

PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD

Professional

Both

$806.00

Service Code	HCPCS 33264
Min. Negotiated Rate	$253.68
Max. Negotiated Rate	$2,214.63
Rate for Payer: Aetna Commercial	$544.48
Rate for Payer: BCBS Complete	$266.36
Rate for Payer: BCBS Trust/PPO	$2,214.63
Rate for Payer: Cash Price	$644.80
Rate for Payer: Cash Price	$644.80
Rate for Payer: Meridian Medicaid	$266.36
Rate for Payer: Priority Health Choice Medicaid	$253.68
Rate for Payer: Priority Health Cigna Priority Health	$564.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$635.69
Rate for Payer: Priority Health Narrow Network	$635.69
Rate for Payer: Priority Health SBD	$635.69
Rate for Payer: UMR Bronson Commercial	$370.76

PR RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH

Professional

Both

$1,365.00

Service Code	HCPCS 54406
Min. Negotiated Rate	$466.04
Max. Negotiated Rate	$1,959.10
Rate for Payer: Aetna Commercial	$938.52
Rate for Payer: BCBS Complete	$489.34
Rate for Payer: BCBS Trust/PPO	$1,959.10
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Meridian Medicaid	$489.34
Rate for Payer: Priority Health Choice Medicaid	$466.04
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,167.17
Rate for Payer: Priority Health Narrow Network	$1,167.17
Rate for Payer: Priority Health SBD	$1,167.17
Rate for Payer: UMR Bronson Commercial	$627.90

PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY

Professional

Both

$3,619.00

Service Code	HCPCS 32484
Min. Negotiated Rate	$524.07
Max. Negotiated Rate	$2,533.30
Rate for Payer: Aetna Commercial	$1,853.16
Rate for Payer: BCBS Complete	$946.93
Rate for Payer: BCBS Trust/PPO	$524.07
Rate for Payer: Cash Price	$2,895.20
Rate for Payer: Cash Price	$2,895.20
Rate for Payer: Meridian Medicaid	$946.93
Rate for Payer: Priority Health Choice Medicaid	$901.84
Rate for Payer: Priority Health Cigna Priority Health	$2,533.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,951.74
Rate for Payer: Priority Health Narrow Network	$1,951.74
Rate for Payer: Priority Health SBD	$1,951.74
Rate for Payer: UMR Bronson Commercial	$1,664.74

PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC

Professional

Both

$5,257.00

Service Code	HCPCS 32482
Min. Negotiated Rate	$550.49
Max. Negotiated Rate	$3,679.90
Rate for Payer: Aetna Commercial	$2,045.67
Rate for Payer: BCBS Complete	$1,045.57
Rate for Payer: BCBS Trust/PPO	$550.49
Rate for Payer: Cash Price	$4,205.60
Rate for Payer: Cash Price	$4,205.60
Rate for Payer: Meridian Medicaid	$1,045.57
Rate for Payer: Priority Health Choice Medicaid	$995.78
Rate for Payer: Priority Health Cigna Priority Health	$3,679.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,154.55
Rate for Payer: Priority Health Narrow Network	$2,154.55
Rate for Payer: Priority Health SBD	$2,154.55
Rate for Payer: UMR Bronson Commercial	$2,418.22

PR RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT

Professional

Both

$4,673.00

Service Code	HCPCS 32480
Min. Negotiated Rate	$546.26
Max. Negotiated Rate	$3,271.10
Rate for Payer: Aetna Commercial	$1,911.03
Rate for Payer: BCBS Complete	$978.24
Rate for Payer: BCBS Trust/PPO	$546.26
Rate for Payer: Cash Price	$3,738.40
Rate for Payer: Cash Price	$3,738.40
Rate for Payer: Meridian Medicaid	$978.24
Rate for Payer: Priority Health Choice Medicaid	$931.66
Rate for Payer: Priority Health Cigna Priority Health	$3,271.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,016.10
Rate for Payer: Priority Health Narrow Network	$2,016.10
Rate for Payer: Priority Health SBD	$2,016.10
Rate for Payer: UMR Bronson Commercial	$2,149.58

PR RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC

Professional

Both

$4,395.00

Service Code	HCPCS 32488
Min. Negotiated Rate	$873.28
Max. Negotiated Rate	$3,251.04
Rate for Payer: Aetna Commercial	$3,091.30
Rate for Payer: BCBS Complete	$1,577.18
Rate for Payer: BCBS Trust/PPO	$873.28
Rate for Payer: Cash Price	$3,516.00
Rate for Payer: Cash Price	$3,516.00
Rate for Payer: Meridian Medicaid	$1,577.18
Rate for Payer: Priority Health Choice Medicaid	$1,502.08
Rate for Payer: Priority Health Cigna Priority Health	$3,076.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,251.04
Rate for Payer: Priority Health Narrow Network	$3,251.04
Rate for Payer: Priority Health SBD	$3,251.04
Rate for Payer: UMR Bronson Commercial	$2,021.70

PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY

Professional

Both

$4,349.00

Service Code	HCPCS 32486
Min. Negotiated Rate	$663.54
Max. Negotiated Rate	$3,180.65
Rate for Payer: Aetna Commercial	$3,031.83
Rate for Payer: BCBS Complete	$1,541.84
Rate for Payer: BCBS Trust/PPO	$663.54
Rate for Payer: Cash Price	$3,479.20
Rate for Payer: Cash Price	$3,479.20
Rate for Payer: Meridian Medicaid	$1,541.84
Rate for Payer: Priority Health Choice Medicaid	$1,468.42
Rate for Payer: Priority Health Cigna Priority Health	$3,044.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,180.65
Rate for Payer: Priority Health Narrow Network	$3,180.65
Rate for Payer: Priority Health SBD	$3,180.65
Rate for Payer: UMR Bronson Commercial	$2,000.54

PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF

Professional

Both

$339.00

Service Code	HCPCS 32552
Min. Negotiated Rate	$99.26
Max. Negotiated Rate	$887.54
Rate for Payer: Aetna Commercial	$202.65
Rate for Payer: BCBS Complete	$104.22
Rate for Payer: BCBS Trust/PPO	$887.54
Rate for Payer: Cash Price	$271.20
Rate for Payer: Cash Price	$271.20
Rate for Payer: Meridian Medicaid	$104.22
Rate for Payer: Priority Health Choice Medicaid	$99.26
Rate for Payer: Priority Health Cigna Priority Health	$237.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$214.86
Rate for Payer: Priority Health Narrow Network	$214.86
Rate for Payer: Priority Health SBD	$214.86
Rate for Payer: UMR Bronson Commercial	$155.94

PR RMVL NFROS TUBE REQ FLUORO GUIDANCE

Professional

Both

$296.00

Service Code	HCPCS 50389
Min. Negotiated Rate	$33.23
Max. Negotiated Rate	$3,593.50
Rate for Payer: Aetna Commercial	$68.80
Rate for Payer: BCBS Complete	$34.89
Rate for Payer: BCBS Trust/PPO	$3,593.50
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cash Price	$236.80
Rate for Payer: Meridian Medicaid	$34.89
Rate for Payer: Priority Health Choice Medicaid	$33.23
Rate for Payer: Priority Health Cigna Priority Health	$207.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.29
Rate for Payer: Priority Health Narrow Network	$84.29
Rate for Payer: Priority Health SBD	$84.29
Rate for Payer: UMR Bronson Commercial	$136.16

PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR

Professional

Both

$394.00

Service Code	HCPCS 49623
Min. Negotiated Rate	$125.24
Max. Negotiated Rate	$3,514.78
Rate for Payer: Aetna Commercial	$266.29
Rate for Payer: BCBS Complete	$131.50
Rate for Payer: BCBS Trust/PPO	$3,514.78
Rate for Payer: Cash Price	$315.20
Rate for Payer: Cash Price	$315.20
Rate for Payer: Meridian Medicaid	$131.50
Rate for Payer: Priority Health Choice Medicaid	$125.24
Rate for Payer: Priority Health Cigna Priority Health	$275.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$345.73
Rate for Payer: Priority Health Narrow Network	$345.73
Rate for Payer: Priority Health SBD	$345.73
Rate for Payer: UMR Bronson Commercial	$181.24

PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT

Professional

Both

$1,063.00

Service Code	HCPCS 54415
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$1,959.10
Rate for Payer: Aetna Commercial	$679.13
Rate for Payer: BCBS Complete	$357.84
Rate for Payer: BCBS Trust/PPO	$1,959.10
Rate for Payer: Cash Price	$850.40
Rate for Payer: Cash Price	$850.40
Rate for Payer: Meridian Medicaid	$357.84
Rate for Payer: Priority Health Choice Medicaid	$340.80
Rate for Payer: Priority Health Cigna Priority Health	$744.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$849.99
Rate for Payer: Priority Health Narrow Network	$849.99
Rate for Payer: Priority Health SBD	$849.99
Rate for Payer: UMR Bronson Commercial	$488.98

PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE

Professional

Both

$706.00

Service Code	HCPCS 33272
Min. Negotiated Rate	$218.54
Max. Negotiated Rate	$2,196.14
Rate for Payer: Aetna Commercial	$464.31
Rate for Payer: BCBS Complete	$229.47
Rate for Payer: BCBS Trust/PPO	$2,196.14
Rate for Payer: Cash Price	$564.80
Rate for Payer: Cash Price	$564.80
Rate for Payer: Meridian Medicaid	$229.47
Rate for Payer: Priority Health Choice Medicaid	$218.54
Rate for Payer: Priority Health Cigna Priority Health	$494.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$545.78
Rate for Payer: Priority Health Narrow Network	$545.78
Rate for Payer: Priority Health SBD	$545.78
Rate for Payer: UMR Bronson Commercial	$324.76

PR RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH

Professional

Both

$2,251.00

Service Code	HCPCS 62355
Min. Negotiated Rate	$178.49
Max. Negotiated Rate	$1,575.70
Rate for Payer: Aetna Commercial	$348.09
Rate for Payer: BCBS Complete	$187.41
Rate for Payer: BCBS Trust/PPO	$187.02
Rate for Payer: Cash Price	$1,800.80
Rate for Payer: Cash Price	$1,800.80
Rate for Payer: Meridian Medicaid	$187.41
Rate for Payer: Priority Health Choice Medicaid	$178.49
Rate for Payer: Priority Health Cigna Priority Health	$1,575.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$467.70
Rate for Payer: Priority Health Narrow Network	$467.70
Rate for Payer: Priority Health SBD	$467.70
Rate for Payer: UMR Bronson Commercial	$1,035.46

PR RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY

Professional

Both

$2,588.00

Service Code	HCPCS 33237
Min. Negotiated Rate	$530.16
Max. Negotiated Rate	$1,811.60
Rate for Payer: Aetna Commercial	$1,121.51
Rate for Payer: BCBS Complete	$556.67
Rate for Payer: BCBS Trust/PPO	$1,126.34
Rate for Payer: Cash Price	$2,070.40
Rate for Payer: Cash Price	$2,070.40
Rate for Payer: Meridian Medicaid	$556.67
Rate for Payer: Priority Health Choice Medicaid	$530.16
Rate for Payer: Priority Health Cigna Priority Health	$1,811.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,318.72
Rate for Payer: Priority Health Narrow Network	$1,318.72
Rate for Payer: Priority Health SBD	$1,318.72
Rate for Payer: UMR Bronson Commercial	$1,190.48

PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER

Professional

Both

$3,301.00

Service Code	HCPCS 27488
Min. Negotiated Rate	$771.27
Max. Negotiated Rate	$2,310.70
Rate for Payer: Aetna Commercial	$1,603.73
Rate for Payer: BCBS Complete	$809.83
Rate for Payer: BCBS Trust/PPO	$995.85
Rate for Payer: Cash Price	$2,640.80
Rate for Payer: Cash Price	$2,640.80
Rate for Payer: Meridian Medicaid	$809.83
Rate for Payer: Priority Health Choice Medicaid	$771.27
Rate for Payer: Priority Health Cigna Priority Health	$2,310.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,835.28
Rate for Payer: Priority Health Narrow Network	$1,835.28
Rate for Payer: Priority Health SBD	$1,835.28
Rate for Payer: UMR Bronson Commercial	$1,518.46

PR RMVL/REVJ SLING MALE URINARY INCONTINENCE

Professional

Both

$1,556.00

Service Code	HCPCS 53442
Min. Negotiated Rate	$501.19
Max. Negotiated Rate	$1,276.37
Rate for Payer: Aetna Commercial	$1,005.18
Rate for Payer: BCBS Complete	$526.25
Rate for Payer: BCBS Trust/PPO	$1,276.37
Rate for Payer: Cash Price	$1,244.80
Rate for Payer: Cash Price	$1,244.80
Rate for Payer: Meridian Medicaid	$526.25
Rate for Payer: Priority Health Choice Medicaid	$501.19
Rate for Payer: Priority Health Cigna Priority Health	$1,089.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,254.17
Rate for Payer: Priority Health Narrow Network	$1,254.17
Rate for Payer: Priority Health SBD	$1,254.17
Rate for Payer: UMR Bronson Commercial	$715.76

PR RMVL/REVJ SLING STRESS INCONTINENCE

Professional

Both

$1,210.00

Service Code	HCPCS 57287
Min. Negotiated Rate	$477.33
Max. Negotiated Rate	$2,457.12
Rate for Payer: Aetna Commercial	$871.45
Rate for Payer: BCBS Complete	$501.20
Rate for Payer: BCBS Trust/PPO	$2,457.12
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Meridian Medicaid	$501.20
Rate for Payer: Priority Health Choice Medicaid	$477.33
Rate for Payer: Priority Health Cigna Priority Health	$847.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,053.84
Rate for Payer: Priority Health Narrow Network	$1,053.84
Rate for Payer: Priority Health SBD	$1,053.84
Rate for Payer: UMR Bronson Commercial	$556.60

PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS

Professional

Both

$1,640.00

Service Code	HCPCS 54410
Min. Negotiated Rate	$549.75
Max. Negotiated Rate	$2,612.13
Rate for Payer: Aetna Commercial	$1,106.42
Rate for Payer: BCBS Complete	$577.24
Rate for Payer: BCBS Trust/PPO	$2,612.13
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Meridian Medicaid	$577.24
Rate for Payer: Priority Health Choice Medicaid	$549.75
Rate for Payer: Priority Health Cigna Priority Health	$1,148.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,376.30
Rate for Payer: Priority Health Narrow Network	$1,376.30
Rate for Payer: Priority Health SBD	$1,376.30
Rate for Payer: UMR Bronson Commercial	$754.40

Know your out-of-pocket cost for care.

All Charges