Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY

Professional

Both

$3,761.00

Service Code	HCPCS 43632
Min. Negotiated Rate	$979.00
Max. Negotiated Rate	$3,633.26
Rate for Payer: Aetna Commercial	$2,652.74
Rate for Payer: Aetna Medicare	$2,058.85
Rate for Payer: Aetna New Business (MI Preferred)	$2,652.74
Rate for Payer: Aetna New Business (MI Preferred)	$2,850.71
Rate for Payer: BCBS Complete	$1,369.63
Rate for Payer: BCBS MAPPO	$1,979.66
Rate for Payer: BCBS Trust/PPO	$979.00
Rate for Payer: BCN Commercial	$2,963.34
Rate for Payer: BCN Medicare Advantage	$1,979.66
Rate for Payer: Cash Price	$3,008.80
Rate for Payer: Cash Price	$3,008.80
Rate for Payer: Cofinity Commercial	$2,652.74
Rate for Payer: Cofinity Commercial	$2,850.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,979.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,078.64
Rate for Payer: Meridian Medicaid	$1,369.63
Rate for Payer: Nomi Health Commercial	$2,375.59
Rate for Payer: PACE SWMI	$1,979.66
Rate for Payer: PHP Commercial	$2,771.52
Rate for Payer: PHP Medicare Advantage	$1,979.66
Rate for Payer: Priority Health Choice Medicaid	$1,304.41
Rate for Payer: Priority Health Cigna Priority Health	$2,444.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,633.26
Rate for Payer: Priority Health Medicare	$1,979.66
Rate for Payer: Priority Health Narrow Network	$3,633.26
Rate for Payer: Priority Health SBD	$3,633.26
Rate for Payer: UHC Dual Complete DSNP	$1,979.66
Rate for Payer: UHC Medicare Advantage	$1,979.66
Rate for Payer: UHCCP Medicaid	$1,304.41
Rate for Payer: UMR Bronson Commercial	$1,730.06

PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ

Professional

Both

$3,446.00

Service Code	HCPCS 43633
Min. Negotiated Rate	$1,233.70
Max. Negotiated Rate	$3,437.58
Rate for Payer: Aetna Commercial	$2,507.69
Rate for Payer: Aetna Medicare	$1,946.27
Rate for Payer: Aetna New Business (MI Preferred)	$2,507.69
Rate for Payer: Aetna New Business (MI Preferred)	$2,694.83
Rate for Payer: BCBS Complete	$1,295.38
Rate for Payer: BCBS MAPPO	$1,871.41
Rate for Payer: BCBS Trust/PPO	$1,591.24
Rate for Payer: BCN Commercial	$2,799.14
Rate for Payer: BCN Medicare Advantage	$1,871.41
Rate for Payer: Cash Price	$2,756.80
Rate for Payer: Cash Price	$2,756.80
Rate for Payer: Cofinity Commercial	$2,507.69
Rate for Payer: Cofinity Commercial	$2,694.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,871.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,964.98
Rate for Payer: Meridian Medicaid	$1,295.38
Rate for Payer: Nomi Health Commercial	$2,245.69
Rate for Payer: PACE SWMI	$1,871.41
Rate for Payer: PHP Commercial	$2,619.97
Rate for Payer: PHP Medicare Advantage	$1,871.41
Rate for Payer: Priority Health Choice Medicaid	$1,233.70
Rate for Payer: Priority Health Cigna Priority Health	$2,239.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,437.58
Rate for Payer: Priority Health Medicare	$1,871.41
Rate for Payer: Priority Health Narrow Network	$3,437.58
Rate for Payer: Priority Health SBD	$3,437.58
Rate for Payer: UHC Dual Complete DSNP	$1,871.41
Rate for Payer: UHC Medicare Advantage	$1,871.41
Rate for Payer: UHCCP Medicaid	$1,233.70
Rate for Payer: UMR Bronson Commercial	$1,585.16

PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY

Professional

Both

$6,616.00

Service Code	HCPCS 43620
Min. Negotiated Rate	$734.87
Max. Negotiated Rate	$4,300.40
Rate for Payer: Aetna Commercial	$2,583.96
Rate for Payer: Aetna Medicare	$2,005.46
Rate for Payer: Aetna New Business (MI Preferred)	$2,583.96
Rate for Payer: Aetna New Business (MI Preferred)	$2,776.80
Rate for Payer: BCBS Complete	$1,333.41
Rate for Payer: BCBS MAPPO	$1,928.33
Rate for Payer: BCBS Trust/PPO	$734.87
Rate for Payer: BCN Commercial	$2,887.11
Rate for Payer: BCN Medicare Advantage	$1,928.33
Rate for Payer: Cash Price	$5,292.80
Rate for Payer: Cash Price	$5,292.80
Rate for Payer: Cofinity Commercial	$2,583.96
Rate for Payer: Cofinity Commercial	$2,776.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,928.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,024.75
Rate for Payer: Meridian Medicaid	$1,333.41
Rate for Payer: Nomi Health Commercial	$2,314.00
Rate for Payer: PACE SWMI	$1,928.33
Rate for Payer: PHP Commercial	$2,699.66
Rate for Payer: PHP Medicare Advantage	$1,928.33
Rate for Payer: Priority Health Choice Medicaid	$1,269.91
Rate for Payer: Priority Health Cigna Priority Health	$4,300.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,539.60
Rate for Payer: Priority Health Medicare	$1,928.33
Rate for Payer: Priority Health Narrow Network	$3,539.60
Rate for Payer: Priority Health SBD	$3,539.60
Rate for Payer: UHC Dual Complete DSNP	$1,928.33
Rate for Payer: UHC Medicare Advantage	$1,928.33
Rate for Payer: UHCCP Medicaid	$1,269.91
Rate for Payer: UMR Bronson Commercial	$3,043.36

PR HAIR REDUC 1/2 LEGS

Professional

Both

$204.00

Service Code	HCPCS 00060
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 HAIR REDUC ABD TRAIL

Professional

Both

$51.00

Service Code	HCPCS 00052
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 BACK

Professional

Both

$306.00

Service Code	HCPCS 00054
Hospital Revenue Code	990
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: Cash Price	$244.80
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: UMR Bronson Commercial	$140.76

PR HAIR REDUC BIKINI LN

Professional

Both

$51.00

Service Code	HCPCS 00055
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 BRAZ

Professional

Both

$128.00

Service Code	HCPCS 00056
Hospital Revenue Code	990
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$83.20
Rate for Payer: UMR Bronson Commercial	$58.88

PR HAIR REDUC BROW/NOSE/EARS/TOE/HND

Professional

Both

$36.00

Service Code	HCPCS 00061
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 CHIN/NECK

Professional

Both

$51.00

Service Code	HCPCS 00057
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 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	$309.06
Max. Negotiated Rate	$1,803.62
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	$324.51
Rate for Payer: BCBS MAPPO	$456.65
Rate for Payer: BCBS Trust/PPO	$1,803.62
Rate for Payer: BCN Commercial	$1,013.03
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: Meridian Medicaid	$324.51
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 Choice Medicaid	$309.06
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$738.86
Rate for Payer: Priority Health Medicare	$456.65
Rate for Payer: Priority Health Narrow Network	$738.86
Rate for Payer: Priority Health SBD	$738.86
Rate for Payer: UHC Dual Complete DSNP	$456.65
Rate for Payer: UHC Medicare Advantage	$456.65
Rate for Payer: UHCCP Medicaid	$309.06
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	$300.76
Max. Negotiated Rate	$2,027.62
Rate for Payer: Aetna Commercial	$593.37
Rate for Payer: Aetna Medicare	$460.52
Rate for Payer: Aetna New Business (MI Preferred)	$593.37
Rate for Payer: Aetna New Business (MI Preferred)	$637.65
Rate for Payer: BCBS Complete	$315.80
Rate for Payer: BCBS MAPPO	$442.81
Rate for Payer: BCBS Trust/PPO	$2,027.62
Rate for Payer: BCN Commercial	$1,002.27
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	$593.37
Rate for Payer: Cofinity Commercial	$637.65
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: Meridian Medicaid	$315.80
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 Choice Medicaid	$300.76
Rate for Payer: Priority Health Cigna Priority Health	$803.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$711.39
Rate for Payer: Priority Health Medicare	$442.81
Rate for Payer: Priority Health Narrow Network	$711.39
Rate for Payer: Priority Health SBD	$711.39
Rate for Payer: UHC Dual Complete DSNP	$442.81
Rate for Payer: UHC Medicare Advantage	$442.81
Rate for Payer: UHCCP Medicaid	$300.76
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

Know your out-of-pocket cost for care.

All Charges