Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON

Professional

Both

$828.00

Service Code	HCPCS 27307
Min. Negotiated Rate	$264.76
Max. Negotiated Rate	$2,244.75
Rate for Payer: Aetna Commercial	$639.94
Rate for Payer: BCBS Complete	$278.00
Rate for Payer: BCBS Trust/PPO	$2,244.75
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cash Price	$662.40
Rate for Payer: Meridian Medicaid	$278.00
Rate for Payer: Priority Health Choice Medicaid	$264.76
Rate for Payer: Priority Health Cigna Priority Health	$579.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$629.12
Rate for Payer: Priority Health Narrow Network	$629.12
Rate for Payer: Priority Health SBD	$629.12
Rate for Payer: UMR Bronson Commercial	$380.88

PR TENOTOMY SHOULDER AREA 1 TENDON

Professional

Both

$1,698.00

Service Code	HCPCS 23405
Min. Negotiated Rate	$87.87
Max. Negotiated Rate	$1,188.60
Rate for Payer: Aetna Commercial	$826.45
Rate for Payer: BCBS Complete	$418.45
Rate for Payer: BCBS Trust/PPO	$87.87
Rate for Payer: Cash Price	$1,358.40
Rate for Payer: Cash Price	$1,358.40
Rate for Payer: Meridian Medicaid	$418.45
Rate for Payer: Priority Health Choice Medicaid	$398.52
Rate for Payer: Priority Health Cigna Priority Health	$1,188.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$949.29
Rate for Payer: Priority Health Narrow Network	$949.29
Rate for Payer: Priority Health SBD	$949.29
Rate for Payer: UMR Bronson Commercial	$781.08

PR TERBUTALINE SULFATE INJ

Professional

Both

$38.00

Service Code	HCPCS J3105
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$8.03
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$0.50
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: UMR Bronson Commercial	$17.48

PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION

Professional

Both

$430.00

Service Code	HCPCS 95923
Min. Negotiated Rate	$58.83
Max. Negotiated Rate	$759.17
Rate for Payer: Aetna Commercial	$139.62
Rate for Payer: BCBS Complete	$172.00
Rate for Payer: BCBS Trust/PPO	$759.17
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cash Price	$344.00
Rate for Payer: Priority Health Cigna Priority Health	$301.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58.83
Rate for Payer: Priority Health Narrow Network	$58.83
Rate for Payer: Priority Health SBD	$165.28
Rate for Payer: UMR Bronson Commercial	$197.80

PR TESTOSTERONE CYPIONAT 100 MG

Professional

Both

$10.00

Service Code	HCPCS J1070
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

PR TESTOSTERONE CYPIONAT 200 MG

Professional

Both

$32.00

Service Code	HCPCS J1080
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$22.40
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: UMR Bronson Commercial	$14.72

PR TESTOSTERONE CYPIONATE 1 ML

Professional

Both

$6.00

Service Code	HCPCS J1060
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.20
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$4.20
Rate for Payer: UMR Bronson Commercial	$2.76

PR TESTOSTERONE ENANTHATE INJ

Professional

Both

$32.00

Service Code	HCPCS J3130
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$22.40
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: UMR Bronson Commercial	$14.72

PR TESTOSTERONE PELLET 75 MG

Professional

Both

$120.00

Service Code	HCPCS S0189
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$106.47
Rate for Payer: Aetna Commercial	$100.93
Rate for Payer: BCBS Complete	$48.00
Rate for Payer: BCBS Trust/PPO	$106.47
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Priority Health Cigna Priority Health	$84.00
Rate for Payer: UMR Bronson Commercial	$55.20

PR TESTOSTERONE UNDECANOATE 1MG

Professional

Both

$5.00

Service Code	HCPCS J3145
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$1.89
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCBS Trust/PPO	$1.87
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR TETANUS IMMUNIZATION, IM

Professional

Both

$44.00

Service Code	HCPCS 90703
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$30.80
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: UMR Bronson Commercial	$20.24

PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN

Professional

Both

$55.00

Service Code	HCPCS 97530
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$3,205.12
Rate for Payer: Aetna Commercial	$28.00
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$3,205.12
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$25.30

PR THERAPEUTIC APHERESIS PLASMA PHERESIS

Professional

Both

$852.00

Service Code	HCPCS 36514
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$1,024.37
Rate for Payer: Aetna Commercial	$126.08
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS Trust/PPO	$1,024.37
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$596.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$145.75
Rate for Payer: Priority Health Narrow Network	$145.75
Rate for Payer: Priority Health SBD	$145.75
Rate for Payer: UMR Bronson Commercial	$391.92

PR THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS

Professional

Both

$33.00

Service Code	HCPCS 97150
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$831.02
Rate for Payer: Aetna Commercial	$13.09
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCBS Trust/PPO	$831.02
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$23.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$15.18

PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM

Professional

Both

$43.00

Service Code	HCPCS 96372
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$1,275.84
Rate for Payer: Aetna Commercial	$15.21
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCBS Trust/PPO	$1,275.84
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Priority Health Cigna Priority Health	$30.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.86
Rate for Payer: Priority Health Narrow Network	$18.86
Rate for Payer: Priority Health SBD	$18.86
Rate for Payer: UMR Bronson Commercial	$19.78

PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES

Professional

Both

$52.00

Service Code	HCPCS 97110
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$1,141.13
Rate for Payer: Aetna Commercial	$21.83
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Trust/PPO	$1,141.13
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$23.92

PR THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT

Professional

Both

$224.00

Service Code	HCPCS 62329
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$1,621.88
Rate for Payer: Aetna Commercial	$145.51
Rate for Payer: BCBS Complete	$69.11
Rate for Payer: BCBS Trust/PPO	$1,621.88
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cash Price	$179.20
Rate for Payer: Meridian Medicaid	$69.11
Rate for Payer: Priority Health Choice Medicaid	$65.82
Rate for Payer: Priority Health Cigna Priority Health	$156.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.76
Rate for Payer: Priority Health Narrow Network	$181.76
Rate for Payer: Priority Health SBD	$181.76
Rate for Payer: UMR Bronson Commercial	$103.04

PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF

Professional

Both

$462.00

Service Code	HCPCS 62272
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$996.90
Rate for Payer: Aetna Commercial	$113.63
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS Trust/PPO	$996.90
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cash Price	$369.60
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$323.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$152.89
Rate for Payer: Priority Health Narrow Network	$152.89
Rate for Payer: Priority Health SBD	$152.89
Rate for Payer: UMR Bronson Commercial	$212.52

PR THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG

Professional

Both

$105.00

Service Code	HCPCS 96374
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$1,546.86
Rate for Payer: Aetna Commercial	$43.40
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCBS Trust/PPO	$1,546.86
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Priority Health Cigna Priority Health	$73.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.85
Rate for Payer: Priority Health Narrow Network	$49.85
Rate for Payer: Priority Health SBD	$49.85
Rate for Payer: UMR Bronson Commercial	$48.30

PR THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA

Professional

Both

$54.00

Service Code	HCPCS 97112
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$1,233.58
Rate for Payer: Aetna Commercial	$25.28
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS Trust/PPO	$1,233.58
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$24.84

PR THER PX 1/> AREAS EACH 15 MINUTES MASSAGE

Professional

Both

$42.00

Service Code	HCPCS 97124
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$1,345.58
Rate for Payer: Aetna Commercial	$21.10
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$1,345.58
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$29.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00
Rate for Payer: UMR Bronson Commercial	$19.32

PR THIGHPLASTY

Professional

Both

$4,500.00

Service Code	HCPCS 00538
Hospital Revenue Code	990
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: BCBS Complete	$1,800.00
Rate for Payer: Cash Price	$3,600.00
Rate for Payer: Priority Health Cigna Priority Health	$3,150.00
Rate for Payer: UMR Bronson Commercial	$2,070.00

PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING

Professional

Both

$519.00

Service Code	HCPCS 32555
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$826.79
Rate for Payer: Aetna Commercial	$142.84
Rate for Payer: BCBS Complete	$71.57
Rate for Payer: BCBS Trust/PPO	$826.79
Rate for Payer: Cash Price	$415.20
Rate for Payer: Cash Price	$415.20
Rate for Payer: Meridian Medicaid	$71.57
Rate for Payer: Priority Health Choice Medicaid	$68.16
Rate for Payer: Priority Health Cigna Priority Health	$363.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$148.64
Rate for Payer: Priority Health Narrow Network	$148.64
Rate for Payer: Priority Health SBD	$148.64
Rate for Payer: UMR Bronson Commercial	$238.74

PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING

Professional

Both

$745.00

Service Code	HCPCS 32554
Hospital Charge Code	32554
Min. Negotiated Rate	$55.59
Max. Negotiated Rate	$813.58
Rate for Payer: Aetna Commercial	$115.79
Rate for Payer: BCBS Complete	$58.37
Rate for Payer: BCBS Trust/PPO	$813.58
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Meridian Medicaid	$58.37
Rate for Payer: Priority Health Choice Medicaid	$55.59
Rate for Payer: Priority Health Cigna Priority Health	$521.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$120.40
Rate for Payer: Priority Health Narrow Network	$120.40
Rate for Payer: Priority Health SBD	$120.40
Rate for Payer: UMR Bronson Commercial	$342.70

PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING

Facility

$745.00

Service Code	CPT 32554
Hospital Charge Code	32554
Min. Negotiated Rate	$85.46
Max. Negotiated Rate	$1,757.86
Rate for Payer: Aetna American Axle	$484.25
Rate for Payer: Aetna Commercial	$633.25
Rate for Payer: Aetna Medicare	$580.74
Rate for Payer: Aetna New Business (MI Preferred)	$484.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$698.00
Rate for Payer: Amish Plain Church Group Commercial	$698.00
Rate for Payer: BCBS Complete	$320.74
Rate for Payer: BCBS MAPPO	$558.40
Rate for Payer: BCBS Trust/PPO	$434.10
Rate for Payer: BCN Medicare Advantage	$558.40
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cofinity Commercial	$521.50
Rate for Payer: Cofinity Commercial	$640.70
Rate for Payer: Encore Health Key Benefits Commercial	$596.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$558.40
Rate for Payer: Healthscope Commercial	$670.50
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$521.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$558.75
Rate for Payer: Mclaren Medicaid	$305.44
Rate for Payer: Mclaren Medicare	$558.40
Rate for Payer: Meridian Medicaid	$320.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$586.32
Rate for Payer: MI Amish Medical Board Commercial	$642.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$633.25
Rate for Payer: PACE Medicare	$530.48
Rate for Payer: PACE SWMI	$558.40
Rate for Payer: PHP Commercial	$633.25
Rate for Payer: PHP Medicare Advantage	$558.40
Rate for Payer: Priority Health Choice Medicaid	$305.44
Rate for Payer: Priority Health Cigna Priority Health	$521.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,757.86
Rate for Payer: Priority Health Medicare	$558.40
Rate for Payer: Priority Health Narrow Network	$1,406.29
Rate for Payer: Priority Health SBD	$469.35
Rate for Payer: Railroad Medicare Medicare	$558.40
Rate for Payer: UHC All Payor (Choice/PPO)	$94.01
Rate for Payer: UHC Dual Complete DSNP	$558.40
Rate for Payer: UHC Exchange	$85.46
Rate for Payer: UHC Medicare Advantage	$575.15
Rate for Payer: UMR Bronson Commercial	$275.65
Rate for Payer: VA VA	$558.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$558.75

Know your out-of-pocket cost for care.

All Charges