Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT

Professional

Both

$734.00

Service Code	HCPCS 40500
Min. Negotiated Rate	$239.20
Max. Negotiated Rate	$652.65
Rate for Payer: Aetna Commercial	$478.94
Rate for Payer: BCBS Complete	$251.16
Rate for Payer: BCBS Trust/PPO	$449.06
Rate for Payer: Cash Price	$587.20
Rate for Payer: Cash Price	$587.20
Rate for Payer: Meridian Medicaid	$251.16
Rate for Payer: Priority Health Choice Medicaid	$239.20
Rate for Payer: Priority Health Cigna Priority Health	$513.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$652.65
Rate for Payer: Priority Health Narrow Network	$652.65
Rate for Payer: Priority Health SBD	$652.65
Rate for Payer: UMR Bronson Commercial	$337.64

PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG

Professional

Both

$8,406.00

Service Code	HCPCS 63102
Min. Negotiated Rate	$1,473.32
Max. Negotiated Rate	$5,884.20
Rate for Payer: Aetna Commercial	$2,933.25
Rate for Payer: BCBS Complete	$1,546.99
Rate for Payer: BCBS Trust/PPO	$3,448.21
Rate for Payer: Cash Price	$6,724.80
Rate for Payer: Cash Price	$6,724.80
Rate for Payer: Meridian Medicaid	$1,546.99
Rate for Payer: Priority Health Choice Medicaid	$1,473.32
Rate for Payer: Priority Health Cigna Priority Health	$5,884.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,892.23
Rate for Payer: Priority Health Narrow Network	$3,892.23
Rate for Payer: Priority Health SBD	$3,892.23
Rate for Payer: UMR Bronson Commercial	$3,866.76

PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG

Professional

Both

$4,775.10

Service Code	HCPCS 63101
Min. Negotiated Rate	$1,501.86
Max. Negotiated Rate	$3,960.17
Rate for Payer: Aetna Commercial	$3,005.13
Rate for Payer: BCBS Complete	$1,576.95
Rate for Payer: BCBS Trust/PPO	$3,418.10
Rate for Payer: Cash Price	$3,820.08
Rate for Payer: Cash Price	$3,820.08
Rate for Payer: Meridian Medicaid	$1,576.95
Rate for Payer: Priority Health Choice Medicaid	$1,501.86
Rate for Payer: Priority Health Cigna Priority Health	$3,342.57
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,960.17
Rate for Payer: Priority Health Narrow Network	$3,960.17
Rate for Payer: Priority Health SBD	$3,960.17
Rate for Payer: UMR Bronson Commercial	$2,196.55

PR VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG

Professional

Both

$6,311.00

Service Code	HCPCS 63081
Min. Negotiated Rate	$206.57
Max. Negotiated Rate	$4,417.70
Rate for Payer: Aetna Commercial	$2,269.94
Rate for Payer: BCBS Complete	$1,194.51
Rate for Payer: BCBS Trust/PPO	$206.57
Rate for Payer: Cash Price	$5,048.80
Rate for Payer: Cash Price	$5,048.80
Rate for Payer: Meridian Medicaid	$1,194.51
Rate for Payer: Priority Health Choice Medicaid	$1,137.63
Rate for Payer: Priority Health Cigna Priority Health	$4,417.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,992.49
Rate for Payer: Priority Health Narrow Network	$2,992.49
Rate for Payer: Priority Health SBD	$2,992.49
Rate for Payer: UMR Bronson Commercial	$2,903.06

PR VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG

Professional

Both

$2,104.00

Service Code	HCPCS 63082
Min. Negotiated Rate	$169.55
Max. Negotiated Rate	$1,472.80
Rate for Payer: Aetna Commercial	$343.91
Rate for Payer: BCBS Complete	$178.03
Rate for Payer: BCBS Trust/PPO	$385.66
Rate for Payer: Cash Price	$1,683.20
Rate for Payer: Cash Price	$1,683.20
Rate for Payer: Meridian Medicaid	$178.03
Rate for Payer: Priority Health Choice Medicaid	$169.55
Rate for Payer: Priority Health Cigna Priority Health	$1,472.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$446.75
Rate for Payer: Priority Health Narrow Network	$446.75
Rate for Payer: Priority Health SBD	$446.75
Rate for Payer: UMR Bronson Commercial	$967.84

PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG

Professional

Both

$6,953.00

Service Code	HCPCS 63085
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$4,867.10
Rate for Payer: Aetna Commercial	$2,486.89
Rate for Payer: BCBS Complete	$1,315.06
Rate for Payer: BCBS Trust/PPO	$420.00
Rate for Payer: Cash Price	$5,562.40
Rate for Payer: Cash Price	$5,562.40
Rate for Payer: Meridian Medicaid	$1,315.06
Rate for Payer: Priority Health Choice Medicaid	$1,252.44
Rate for Payer: Priority Health Cigna Priority Health	$4,867.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,273.34
Rate for Payer: Priority Health Narrow Network	$3,273.34
Rate for Payer: Priority Health SBD	$3,273.34
Rate for Payer: UMR Bronson Commercial	$3,198.38

PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG

Professional

Both

$2,318.00

Service Code	HCPCS 63086
Min. Negotiated Rate	$122.05
Max. Negotiated Rate	$1,622.60
Rate for Payer: Aetna Commercial	$245.29
Rate for Payer: BCBS Complete	$128.15
Rate for Payer: BCBS Trust/PPO	$985.81
Rate for Payer: Cash Price	$1,854.40
Rate for Payer: Cash Price	$1,854.40
Rate for Payer: Meridian Medicaid	$128.15
Rate for Payer: Priority Health Choice Medicaid	$122.05
Rate for Payer: Priority Health Cigna Priority Health	$1,622.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$318.78
Rate for Payer: Priority Health Narrow Network	$318.78
Rate for Payer: Priority Health SBD	$318.78
Rate for Payer: UMR Bronson Commercial	$1,066.28

PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG

Professional

Both

$1,533.00

Service Code	HCPCS 63308
Min. Negotiated Rate	$204.69
Max. Negotiated Rate	$1,073.10
Rate for Payer: Aetna Commercial	$416.97
Rate for Payer: BCBS Complete	$214.92
Rate for Payer: BCBS Trust/PPO	$257.81
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Meridian Medicaid	$214.92
Rate for Payer: Priority Health Choice Medicaid	$204.69
Rate for Payer: Priority Health Cigna Priority Health	$1,073.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$539.62
Rate for Payer: Priority Health Narrow Network	$539.62
Rate for Payer: Priority Health SBD	$539.62
Rate for Payer: UMR Bronson Commercial	$705.18

PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

Professional

Both

$1,723.00

Service Code	HCPCS 22512
Min. Negotiated Rate	$130.57
Max. Negotiated Rate	$1,206.10
Rate for Payer: Aetna Commercial	$277.49
Rate for Payer: BCBS Complete	$137.10
Rate for Payer: BCBS Trust/PPO	$214.49
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Meridian Medicaid	$137.10
Rate for Payer: Priority Health Choice Medicaid	$130.57
Rate for Payer: Priority Health Cigna Priority Health	$1,206.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$312.01
Rate for Payer: Priority Health Narrow Network	$312.01
Rate for Payer: Priority Health SBD	$312.01
Rate for Payer: UMR Bronson Commercial	$792.58

PR VESICULOTOMY COMPLICATED

Professional

Both

$814.00

Service Code	HCPCS 55605
Min. Negotiated Rate	$335.69
Max. Negotiated Rate	$2,259.54
Rate for Payer: Aetna Commercial	$670.35
Rate for Payer: BCBS Complete	$352.47
Rate for Payer: BCBS Trust/PPO	$2,259.54
Rate for Payer: Cash Price	$651.20
Rate for Payer: Cash Price	$651.20
Rate for Payer: Meridian Medicaid	$352.47
Rate for Payer: Priority Health Choice Medicaid	$335.69
Rate for Payer: Priority Health Cigna Priority Health	$569.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$839.18
Rate for Payer: Priority Health Narrow Network	$839.18
Rate for Payer: Priority Health SBD	$839.18
Rate for Payer: UMR Bronson Commercial	$374.44

PR VESSEL MAPPING HEMO ACCESS

Professional

Both

$359.00

Service Code	HCPCS G0365
Min. Negotiated Rate	$143.60
Max. Negotiated Rate	$251.30
Rate for Payer: BCBS Complete	$143.60
Rate for Payer: Cash Price	$287.20
Rate for Payer: Priority Health Cigna Priority Health	$251.30
Rate for Payer: UMR Bronson Commercial	$165.14

PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV

Professional

Both

$3,558.00

Service Code	HCPCS 43640
Min. Negotiated Rate	$762.75
Max. Negotiated Rate	$2,490.60
Rate for Payer: Aetna Commercial	$1,594.37
Rate for Payer: BCBS Complete	$800.89
Rate for Payer: BCBS Trust/PPO	$864.30
Rate for Payer: Cash Price	$2,846.40
Rate for Payer: Cash Price	$2,846.40
Rate for Payer: Meridian Medicaid	$800.89
Rate for Payer: Priority Health Choice Medicaid	$762.75
Rate for Payer: Priority Health Cigna Priority Health	$2,490.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,094.36
Rate for Payer: Priority Health Narrow Network	$2,094.36
Rate for Payer: Priority Health SBD	$2,094.36
Rate for Payer: UMR Bronson Commercial	$1,636.68

PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS

Professional

Both

$854.00

Service Code	HCPCS 34845
Min. Negotiated Rate	$392.84
Max. Negotiated Rate	$2,929.49
Rate for Payer: Aetna Commercial	$2,344.71
Rate for Payer: BCBS Complete	$1,424.60
Rate for Payer: BCBS Trust/PPO	$660.38
Rate for Payer: Cash Price	$683.20
Rate for Payer: Cash Price	$683.20
Rate for Payer: Meridian Medicaid	$1,424.60
Rate for Payer: Priority Health Choice Medicaid	$1,356.76
Rate for Payer: Priority Health Cigna Priority Health	$597.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,929.49
Rate for Payer: Priority Health Narrow Network	$2,929.49
Rate for Payer: Priority Health SBD	$2,929.49
Rate for Payer: UMR Bronson Commercial	$392.84

PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS

Professional

Both

$3,000.00

Service Code	HCPCS 34846
Min. Negotiated Rate	$1,380.00
Max. Negotiated Rate	$3,102.91
Rate for Payer: Aetna Commercial	$2,496.07
Rate for Payer: BCBS Complete	$1,567.05
Rate for Payer: BCBS Trust/PPO	$1,564.30
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Meridian Medicaid	$1,567.05
Rate for Payer: Priority Health Choice Medicaid	$1,492.43
Rate for Payer: Priority Health Cigna Priority Health	$2,100.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,102.91
Rate for Payer: Priority Health Narrow Network	$3,102.91
Rate for Payer: Priority Health SBD	$3,102.91
Rate for Payer: UMR Bronson Commercial	$1,380.00

PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS

Professional

Both

$5,000.00

Service Code	HCPCS 34847
Min. Negotiated Rate	$1,628.11
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,642.90
Rate for Payer: BCBS Complete	$1,709.52
Rate for Payer: BCBS Trust/PPO	$1,672.07
Rate for Payer: Cash Price	$4,000.00
Rate for Payer: Cash Price	$4,000.00
Rate for Payer: Meridian Medicaid	$1,709.52
Rate for Payer: Priority Health Choice Medicaid	$1,628.11
Rate for Payer: Priority Health Cigna Priority Health	$3,500.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,284.31
Rate for Payer: Priority Health Narrow Network	$3,284.31
Rate for Payer: Priority Health SBD	$3,284.31
Rate for Payer: UMR Bronson Commercial	$2,300.00

PR VISCO GEL SPACER - LARGE

Professional

Both

$7.00

Service Code	HCPCS 00039
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR VISCO GEL SPACER - MEDIUM

Professional

Both

$7.00

Service Code	HCPCS 00038
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR VISCO GEL SPACER - SMALL

Professional

Both

$7.00

Service Code	HCPCS 00037
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR VISION EXAM

Facility

$50.00

Service Code	CPT 99173
Hospital Charge Code	51000008
Hospital Revenue Code	510
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna American Axle	$32.50
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$13.42
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$35.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$37.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health SBD	$31.50
Rate for Payer: UHC All Payor (Choice/PPO)	$3.60
Rate for Payer: UHC Exchange	$3.27
Rate for Payer: UMR Bronson Commercial	$18.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$37.50

PR VISION EXAM

Facility

$50.00

Service Code	CPT 99173
Hospital Charge Code	51000008
Hospital Revenue Code	510
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna American Axle	$32.50
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$35.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$37.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health SBD	$31.50
Rate for Payer: UMR Bronson Commercial	$22.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$37.50

PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R

Professional

Both

$268.00

Service Code	HCPCS 95930
Min. Negotiated Rate	$24.25
Max. Negotiated Rate	$187.60
Rate for Payer: Aetna Commercial	$71.41
Rate for Payer: BCBS Complete	$107.20
Rate for Payer: BCBS Trust/PPO	$64.98
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Priority Health Cigna Priority Health	$187.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24.25
Rate for Payer: Priority Health Narrow Network	$24.25
Rate for Payer: Priority Health SBD	$88.93
Rate for Payer: UMR Bronson Commercial	$123.28

PR VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM

Professional

Both

$115.00

Service Code	HCPCS 92083
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$1,352.98
Rate for Payer: Aetna Commercial	$66.10
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: BCBS Trust/PPO	$1,352.98
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.37
Rate for Payer: Priority Health Narrow Network	$45.37
Rate for Payer: Priority Health SBD	$91.34
Rate for Payer: UMR Bronson Commercial	$52.90

PR VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM

Professional

Both

$76.00

Service Code	HCPCS 92081
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$1,007.47
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: BCBS Complete	$30.40
Rate for Payer: BCBS Trust/PPO	$1,007.47
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Priority Health Cigna Priority Health	$53.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.87
Rate for Payer: Priority Health Narrow Network	$18.87
Rate for Payer: Priority Health SBD	$39.75
Rate for Payer: UMR Bronson Commercial	$34.96

PR VISUAL REINFORCEMENT AUDIOMETRY

Professional

Both

$75.00

Service Code	HCPCS 92579
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$2,273.80
Rate for Payer: Aetna Commercial	$42.06
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Trust/PPO	$2,273.80
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.41
Rate for Payer: Priority Health Narrow Network	$49.41
Rate for Payer: Priority Health SBD	$49.41
Rate for Payer: UMR Bronson Commercial	$34.50

PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE

Professional

Both

$43.00

Service Code	HCPCS 94150
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$1,708.52
Rate for Payer: Aetna Commercial	$26.29
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCBS Trust/PPO	$1,708.52
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	$4.94
Rate for Payer: Priority Health Narrow Network	$4.94
Rate for Payer: Priority Health SBD	$33.24
Rate for Payer: UMR Bronson Commercial	$19.78

Know your out-of-pocket cost for care.

All Charges