Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR HAIR REDUC FL FACE/SCALP/FL ABD

Professional

Both

$92.00

Service Code	HCPCS 00058
Hospital Revenue Code	990
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$59.80
Rate for Payer: Aetna Medicare	$46.00
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Priority Health Cigna Priority Health	$59.80
Rate for Payer: UMR Bronson Commercial	$42.32

PR HAIR REDUC FL LEGS

Professional

Both

$408.00

Service Code	HCPCS 00059
Hospital Revenue Code	990
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$265.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: UMR Bronson Commercial	$187.68

PR HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR

Professional

Both

$102.00

Service Code	HCPCS 00053
Hospital Revenue Code	990
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$66.30
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: UMR Bronson Commercial	$46.92

PR HAIR REDUC LIP

Professional

Both

$36.00

Service Code	HCPCS 00062
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: UMR Bronson Commercial	$16.56

PR HAIR REDUC LIP & CHIN

Professional

Both

$82.00

Service Code	HCPCS 00063
Hospital Revenue Code	990
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$53.30
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$53.30
Rate for Payer: UMR Bronson Commercial	$37.72

PR HAIR REDUC UDR ARMS OR BUTTOCKS

Professional

Both

$51.00

Service Code	HCPCS 00064
Hospital Revenue Code	990
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: UMR Bronson Commercial	$23.46

PR HAIR REDUC UP/LOW LEGS

Professional

Both

$204.00

Service Code	HCPCS 00065
Hospital Revenue Code	990
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$132.60
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: UMR Bronson Commercial	$93.84

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT

Professional

Both

$1,470.00

Service Code	HCPCS 28291
Min. Negotiated Rate	$456.65
Max. Negotiated Rate	$955.50
Rate for Payer: Aetna Commercial	$611.91
Rate for Payer: Aetna Medicare	$474.92
Rate for Payer: Aetna New Business (MI Preferred)	$611.91
Rate for Payer: Aetna New Business (MI Preferred)	$657.58
Rate for Payer: BCBS Complete	$588.00
Rate for Payer: BCBS MAPPO	$456.65
Rate for Payer: BCN Medicare Advantage	$456.65
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cofinity Commercial	$611.91
Rate for Payer: Cofinity Commercial	$657.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$456.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$479.48
Rate for Payer: Nomi Health Commercial	$547.98
Rate for Payer: PACE SWMI	$456.65
Rate for Payer: PHP Commercial	$639.31
Rate for Payer: PHP Medicare Advantage	$456.65
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health Medicare	$456.65
Rate for Payer: UHC Dual Complete DSNP	$456.65
Rate for Payer: UHC Medicare Advantage	$456.65
Rate for Payer: UMR Bronson Commercial	$676.20

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT

Professional

Both

$1,236.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$442.81
Max. Negotiated Rate	$803.40
Rate for Payer: Aetna Commercial	$593.37
Rate for Payer: Aetna Medicare	$460.52
Rate for Payer: Aetna New Business (MI Preferred)	$637.65
Rate for Payer: Aetna New Business (MI Preferred)	$593.37
Rate for Payer: BCBS Complete	$494.40
Rate for Payer: BCBS MAPPO	$442.81
Rate for Payer: BCN Medicare Advantage	$442.81
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cofinity Commercial	$637.65
Rate for Payer: Cofinity Commercial	$593.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$442.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$464.95
Rate for Payer: Nomi Health Commercial	$531.37
Rate for Payer: PACE SWMI	$442.81
Rate for Payer: PHP Commercial	$619.93
Rate for Payer: PHP Medicare Advantage	$442.81
Rate for Payer: Priority Health Cigna Priority Health	$803.40
Rate for Payer: Priority Health Medicare	$442.81
Rate for Payer: UHC Dual Complete DSNP	$442.81
Rate for Payer: UHC Medicare Advantage	$442.81
Rate for Payer: UMR Bronson Commercial	$568.56

PR HAMMER TOE CREST FELT - LARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00044
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - LARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00045
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - MEDIUM LT

Professional

Both

$7.00

Service Code	HCPCS 00042
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - MEDIUM RT

Professional

Both

$7.00

Service Code	HCPCS 00043
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - SMALL LT

Professional

Both

$7.00

Service Code	HCPCS 00040
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - SMALL RT

Professional

Both

$7.00

Service Code	HCPCS 00041
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - XLARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00046
Hospital Revenue Code	990
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 HAMMER TOE CREST FELT - XLARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00047
Hospital Revenue Code	990
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 HAND-HELD PEFR METER

Professional

Both

$51.00

Service Code	HCPCS A4614
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$47.85
Rate for Payer: Aetna Commercial	$44.53
Rate for Payer: Aetna Medicare	$34.56
Rate for Payer: Aetna New Business (MI Preferred)	$44.53
Rate for Payer: Aetna New Business (MI Preferred)	$47.85
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS MAPPO	$33.23
Rate for Payer: BCN Medicare Advantage	$33.23
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$44.53
Rate for Payer: Cofinity Commercial	$47.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$33.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$34.89
Rate for Payer: Nomi Health Commercial	$39.88
Rate for Payer: PACE SWMI	$33.23
Rate for Payer: PHP Commercial	$46.52
Rate for Payer: PHP Medicare Advantage	$33.23
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health Medicare	$33.23
Rate for Payer: UHC Dual Complete DSNP	$33.23
Rate for Payer: UHC Medicare Advantage	$33.23
Rate for Payer: UMR Bronson Commercial	$23.46

PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB

Professional

Both

$16.00

Service Code	HCPCS 99000
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Priority Health Cigna Priority Health	$10.40
Rate for Payer: UMR Bronson Commercial	$7.36

PR HAND MUSCLE TEST,MANUAL

Professional

Both

$86.00

Service Code	HCPCS 95832
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$55.90
Rate for Payer: Aetna Medicare	$43.00
Rate for Payer: BCBS Complete	$34.40
Rate for Payer: Cash Price	$68.80
Rate for Payer: Priority Health Cigna Priority Health	$55.90
Rate for Payer: UMR Bronson Commercial	$39.56

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,142.00

Service Code	HCPCS 35572
Min. Negotiated Rate	$329.15
Max. Negotiated Rate	$742.30
Rate for Payer: Aetna Commercial	$441.06
Rate for Payer: Aetna Medicare	$342.32
Rate for Payer: Aetna New Business (MI Preferred)	$473.98
Rate for Payer: Aetna New Business (MI Preferred)	$441.06
Rate for Payer: BCBS Complete	$456.80
Rate for Payer: BCBS MAPPO	$329.15
Rate for Payer: BCN Medicare Advantage	$329.15
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cofinity Commercial	$441.06
Rate for Payer: Cofinity Commercial	$473.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$329.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$345.61
Rate for Payer: Nomi Health Commercial	$394.98
Rate for Payer: PACE SWMI	$329.15
Rate for Payer: PHP Commercial	$460.81
Rate for Payer: PHP Medicare Advantage	$329.15
Rate for Payer: Priority Health Cigna Priority Health	$742.30
Rate for Payer: Priority Health Medicare	$329.15
Rate for Payer: UHC Dual Complete DSNP	$329.15
Rate for Payer: UHC Medicare Advantage	$329.15
Rate for Payer: UMR Bronson Commercial	$525.32

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$555.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$120.96
Max. Negotiated Rate	$360.75
Rate for Payer: Aetna Commercial	$162.09
Rate for Payer: Aetna Medicare	$125.80
Rate for Payer: Aetna New Business (MI Preferred)	$174.18
Rate for Payer: Aetna New Business (MI Preferred)	$162.09
Rate for Payer: BCBS Complete	$222.00
Rate for Payer: BCBS MAPPO	$120.96
Rate for Payer: BCN Medicare Advantage	$120.96
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cofinity Commercial	$174.18
Rate for Payer: Cofinity Commercial	$162.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$120.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$127.01
Rate for Payer: Nomi Health Commercial	$145.15
Rate for Payer: PACE SWMI	$120.96
Rate for Payer: PHP Commercial	$169.34
Rate for Payer: PHP Medicare Advantage	$120.96
Rate for Payer: Priority Health Cigna Priority Health	$360.75
Rate for Payer: Priority Health Medicare	$120.96
Rate for Payer: UHC Dual Complete DSNP	$120.96
Rate for Payer: UHC Medicare Advantage	$120.96
Rate for Payer: UMR Bronson Commercial	$255.30

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,127.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$305.60
Max. Negotiated Rate	$732.55
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: Aetna Medicare	$317.82
Rate for Payer: Aetna New Business (MI Preferred)	$440.06
Rate for Payer: Aetna New Business (MI Preferred)	$409.50
Rate for Payer: BCBS Complete	$450.80
Rate for Payer: BCBS MAPPO	$305.60
Rate for Payer: BCN Medicare Advantage	$305.60
Rate for Payer: Cash Price	$901.60
Rate for Payer: Cash Price	$901.60
Rate for Payer: Cofinity Commercial	$440.06
Rate for Payer: Cofinity Commercial	$409.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$320.88
Rate for Payer: Nomi Health Commercial	$366.72
Rate for Payer: PACE SWMI	$305.60
Rate for Payer: PHP Commercial	$427.84
Rate for Payer: PHP Medicare Advantage	$305.60
Rate for Payer: Priority Health Cigna Priority Health	$732.55
Rate for Payer: Priority Health Medicare	$305.60
Rate for Payer: UHC Dual Complete DSNP	$305.60
Rate for Payer: UHC Medicare Advantage	$305.60
Rate for Payer: UMR Bronson Commercial	$518.42

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$161.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$223.69
Rate for Payer: Aetna Commercial	$208.16
Rate for Payer: Aetna Medicare	$161.55
Rate for Payer: Aetna New Business (MI Preferred)	$223.69
Rate for Payer: Aetna New Business (MI Preferred)	$208.16
Rate for Payer: BCBS Complete	$64.40
Rate for Payer: BCBS MAPPO	$155.34
Rate for Payer: BCN Medicare Advantage	$155.34
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cofinity Commercial	$223.69
Rate for Payer: Cofinity Commercial	$208.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$155.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$163.11
Rate for Payer: Nomi Health Commercial	$186.41
Rate for Payer: PACE SWMI	$155.34
Rate for Payer: PHP Commercial	$217.48
Rate for Payer: PHP Medicare Advantage	$155.34
Rate for Payer: Priority Health Cigna Priority Health	$104.65
Rate for Payer: Priority Health Medicare	$155.34
Rate for Payer: UHC Dual Complete DSNP	$155.34
Rate for Payer: UHC Medicare Advantage	$155.34
Rate for Payer: UMR Bronson Commercial	$74.06

PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT

Professional

Both

$42.00

Service Code	HCPCS 96150
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: UMR Bronson Commercial	$19.32

Know your out-of-pocket cost for care.

All Charges