Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI

Professional

Both

$28.00

Service Code	HCPCS 97804
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$20.68
Rate for Payer: Aetna Commercial	$19.24
Rate for Payer: Aetna Medicare	$14.93
Rate for Payer: Aetna New Business (MI Preferred)	$20.68
Rate for Payer: Aetna New Business (MI Preferred)	$19.24
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS MAPPO	$14.36
Rate for Payer: BCN Medicare Advantage	$14.36
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cofinity Commercial	$20.68
Rate for Payer: Cofinity Commercial	$19.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.08
Rate for Payer: Nomi Health Commercial	$17.23
Rate for Payer: PACE SWMI	$14.36
Rate for Payer: PHP Commercial	$20.10
Rate for Payer: PHP Medicare Advantage	$14.36
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health Medicare	$14.36
Rate for Payer: UHC Dual Complete DSNP	$14.36
Rate for Payer: UHC Medicare Advantage	$14.36
Rate for Payer: UMR Bronson Commercial	$12.88

PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Professional

Both

$328.00

Service Code	HCPCS 93463
Min. Negotiated Rate	$91.69
Max. Negotiated Rate	$213.20
Rate for Payer: Aetna Commercial	$122.86
Rate for Payer: Aetna Medicare	$95.36
Rate for Payer: Aetna New Business (MI Preferred)	$132.03
Rate for Payer: Aetna New Business (MI Preferred)	$122.86
Rate for Payer: BCBS Complete	$131.20
Rate for Payer: BCBS MAPPO	$91.69
Rate for Payer: BCN Medicare Advantage	$91.69
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cofinity Commercial	$132.03
Rate for Payer: Cofinity Commercial	$122.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$91.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$96.27
Rate for Payer: Nomi Health Commercial	$110.03
Rate for Payer: PACE SWMI	$91.69
Rate for Payer: PHP Commercial	$128.37
Rate for Payer: PHP Medicare Advantage	$91.69
Rate for Payer: Priority Health Cigna Priority Health	$213.20
Rate for Payer: Priority Health Medicare	$91.69
Rate for Payer: UHC Dual Complete DSNP	$91.69
Rate for Payer: UHC Medicare Advantage	$91.69
Rate for Payer: UMR Bronson Commercial	$150.88

PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN

Professional

Both

$13.00

Service Code	HCPCS 99607
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45
Rate for Payer: UMR Bronson Commercial	$5.98

PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT

Professional

Both

$32.00

Service Code	HCPCS 99606
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$20.80
Rate for Payer: UMR Bronson Commercial	$14.72

PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT

Professional

Both

$64.00

Service Code	HCPCS 99605
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$41.60
Rate for Payer: Aetna Medicare	$32.00
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Priority Health Cigna Priority Health	$41.60
Rate for Payer: UMR Bronson Commercial	$29.44

PR MEDROXYPROGESTERONE ACETATE

Professional

Both

$1.00

Service Code	HCPCS J1050
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.65
Rate for Payer: UMR Bronson Commercial	$0.46

PR MEDROXYPROGESTERONE INJ

Professional

Both

$31.00

Service Code	HCPCS J1051
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15
Rate for Payer: UMR Bronson Commercial	$14.26

PR MEDRXYPROGESTER ACETATE INJ

Professional

Both

$82.00

Service Code	HCPCS J1055
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 MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE

Professional

Both

$143.00

Service Code	HCPCS 90734
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$92.95
Rate for Payer: Aetna Medicare	$71.50
Rate for Payer: BCBS Complete	$57.20
Rate for Payer: Cash Price	$114.40
Rate for Payer: Priority Health Cigna Priority Health	$92.95
Rate for Payer: UMR Bronson Commercial	$65.78

PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Professional

Both

$184.00

Service Code	HCPCS 90619
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$119.60
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: UMR Bronson Commercial	$84.64

PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Professional

Both

$263.00

Service Code	HCPCS 90620
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$170.95
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Priority Health Cigna Priority Health	$170.95
Rate for Payer: UMR Bronson Commercial	$120.98

PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM

Professional

Both

$184.00

Service Code	HCPCS 90621
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$119.60
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: UMR Bronson Commercial	$84.64

PR MEPERIDINE HYDROCHL /100 MG

Professional

Both

$10.00

Service Code	HCPCS J2175
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$22.59
Rate for Payer: Aetna Commercial	$21.02
Rate for Payer: Aetna Medicare	$16.32
Rate for Payer: Aetna New Business (MI Preferred)	$21.02
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS MAPPO	$15.69
Rate for Payer: BCN Medicare Advantage	$15.69
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$21.02
Rate for Payer: Cofinity Commercial	$22.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.47
Rate for Payer: Nomi Health Commercial	$18.83
Rate for Payer: PACE SWMI	$15.69
Rate for Payer: PHP Commercial	$21.97
Rate for Payer: PHP Medicare Advantage	$15.69
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: Priority Health Medicare	$15.69
Rate for Payer: UHC Dual Complete DSNP	$15.69
Rate for Payer: UHC Medicare Advantage	$15.69
Rate for Payer: UMR Bronson Commercial	$4.60

PR MEPERIDINE/PROMETHAZINE INJ

Professional

Both

$11.00

Service Code	HCPCS J2180
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$7.15
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.15
Rate for Payer: UMR Bronson Commercial	$5.06

PR METATARSECTOMY

Professional

Both

$1,071.00

Service Code	HCPCS 28140
Min. Negotiated Rate	$407.56
Max. Negotiated Rate	$696.15
Rate for Payer: Aetna Commercial	$546.13
Rate for Payer: Aetna Medicare	$423.86
Rate for Payer: Aetna New Business (MI Preferred)	$586.89
Rate for Payer: Aetna New Business (MI Preferred)	$546.13
Rate for Payer: BCBS Complete	$428.40
Rate for Payer: BCBS MAPPO	$407.56
Rate for Payer: BCN Medicare Advantage	$407.56
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$586.89
Rate for Payer: Cofinity Commercial	$546.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$407.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$427.94
Rate for Payer: Nomi Health Commercial	$489.07
Rate for Payer: PACE SWMI	$407.56
Rate for Payer: PHP Commercial	$570.58
Rate for Payer: PHP Medicare Advantage	$407.56
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: Priority Health Medicare	$407.56
Rate for Payer: UHC Dual Complete DSNP	$407.56
Rate for Payer: UHC Medicare Advantage	$407.56
Rate for Payer: UMR Bronson Commercial	$492.66

PR METHYLPREDNISOLONE 20 MG INJ

Professional

Both

$10.00

Service Code	HCPCS J1020
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR METHYLPREDNISOLONE 40 MG INJ

Professional

Both

$15.00

Service Code	HCPCS J1030
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: UMR Bronson Commercial	$6.90

PR METHYLPREDNISOLONE 80 MG INJ

Professional

Both

$26.00

Service Code	HCPCS J1040
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90
Rate for Payer: UMR Bronson Commercial	$11.96

PR METHYLPREDNISOLONE INJECTION

Professional

Both

$10.00

Service Code	HCPCS J2920
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR METHYLPREDNISOLONE INJECTION

Professional

Both

$26.00

Service Code	HCPCS J2930
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90
Rate for Payer: UMR Bronson Commercial	$11.96

PR MGMT LVR HEMRRG CPLX SUTR WND/INJ

Professional

Both

$3,454.00

Service Code	HCPCS 47360
Min. Negotiated Rate	$1,381.60
Max. Negotiated Rate	$2,618.55
Rate for Payer: Aetna Commercial	$2,436.71
Rate for Payer: Aetna Medicare	$1,891.18
Rate for Payer: Aetna New Business (MI Preferred)	$2,618.55
Rate for Payer: Aetna New Business (MI Preferred)	$2,436.71
Rate for Payer: BCBS Complete	$1,381.60
Rate for Payer: BCBS MAPPO	$1,818.44
Rate for Payer: BCN Medicare Advantage	$1,818.44
Rate for Payer: Cash Price	$2,763.20
Rate for Payer: Cash Price	$2,763.20
Rate for Payer: Cofinity Commercial	$2,618.55
Rate for Payer: Cofinity Commercial	$2,436.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,818.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,909.36
Rate for Payer: Nomi Health Commercial	$2,182.13
Rate for Payer: PACE SWMI	$1,818.44
Rate for Payer: PHP Commercial	$2,545.82
Rate for Payer: PHP Medicare Advantage	$1,818.44
Rate for Payer: Priority Health Cigna Priority Health	$2,245.10
Rate for Payer: Priority Health Medicare	$1,818.44
Rate for Payer: UHC Dual Complete DSNP	$1,818.44
Rate for Payer: UHC Medicare Advantage	$1,818.44
Rate for Payer: UMR Bronson Commercial	$1,588.84

PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

Professional

Both

$6,375.00

Service Code	HCPCS 47361
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$4,200.35
Rate for Payer: Aetna Commercial	$3,908.66
Rate for Payer: Aetna Medicare	$3,033.59
Rate for Payer: Aetna New Business (MI Preferred)	$4,200.35
Rate for Payer: Aetna New Business (MI Preferred)	$3,908.66
Rate for Payer: BCBS Complete	$2,550.00
Rate for Payer: BCBS MAPPO	$2,916.91
Rate for Payer: BCN Medicare Advantage	$2,916.91
Rate for Payer: Cash Price	$5,100.00
Rate for Payer: Cash Price	$5,100.00
Rate for Payer: Cofinity Commercial	$4,200.35
Rate for Payer: Cofinity Commercial	$3,908.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,916.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,062.76
Rate for Payer: Nomi Health Commercial	$3,500.29
Rate for Payer: PACE SWMI	$2,916.91
Rate for Payer: PHP Commercial	$4,083.67
Rate for Payer: PHP Medicare Advantage	$2,916.91
Rate for Payer: Priority Health Cigna Priority Health	$4,143.75
Rate for Payer: Priority Health Medicare	$2,916.91
Rate for Payer: UHC Dual Complete DSNP	$2,916.91
Rate for Payer: UHC Medicare Advantage	$2,916.91
Rate for Payer: UMR Bronson Commercial	$2,932.50

PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING

Professional

Both

$2,999.00

Service Code	HCPCS 47362
Min. Negotiated Rate	$1,199.60
Max. Negotiated Rate	$1,977.09
Rate for Payer: Aetna Commercial	$1,839.79
Rate for Payer: Aetna Medicare	$1,427.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,977.09
Rate for Payer: Aetna New Business (MI Preferred)	$1,839.79
Rate for Payer: BCBS Complete	$1,199.60
Rate for Payer: BCBS MAPPO	$1,372.98
Rate for Payer: BCN Medicare Advantage	$1,372.98
Rate for Payer: Cash Price	$2,399.20
Rate for Payer: Cash Price	$2,399.20
Rate for Payer: Cofinity Commercial	$1,977.09
Rate for Payer: Cofinity Commercial	$1,839.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,372.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,441.63
Rate for Payer: Nomi Health Commercial	$1,647.58
Rate for Payer: PACE SWMI	$1,372.98
Rate for Payer: PHP Commercial	$1,922.17
Rate for Payer: PHP Medicare Advantage	$1,372.98
Rate for Payer: Priority Health Cigna Priority Health	$1,949.35
Rate for Payer: Priority Health Medicare	$1,372.98
Rate for Payer: UHC Dual Complete DSNP	$1,372.98
Rate for Payer: UHC Medicare Advantage	$1,372.98
Rate for Payer: UMR Bronson Commercial	$1,379.54

PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ

Professional

Both

$2,903.00

Service Code	HCPCS 47350
Min. Negotiated Rate	$1,161.20
Max. Negotiated Rate	$1,897.50
Rate for Payer: Aetna Commercial	$1,765.73
Rate for Payer: Aetna Medicare	$1,370.42
Rate for Payer: Aetna New Business (MI Preferred)	$1,897.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,765.73
Rate for Payer: BCBS Complete	$1,161.20
Rate for Payer: BCBS MAPPO	$1,317.71
Rate for Payer: BCN Medicare Advantage	$1,317.71
Rate for Payer: Cash Price	$2,322.40
Rate for Payer: Cash Price	$2,322.40
Rate for Payer: Cofinity Commercial	$1,897.50
Rate for Payer: Cofinity Commercial	$1,765.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,317.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,383.60
Rate for Payer: Nomi Health Commercial	$1,581.25
Rate for Payer: PACE SWMI	$1,317.71
Rate for Payer: PHP Commercial	$1,844.79
Rate for Payer: PHP Medicare Advantage	$1,317.71
Rate for Payer: Priority Health Cigna Priority Health	$1,886.95
Rate for Payer: Priority Health Medicare	$1,317.71
Rate for Payer: UHC Dual Complete DSNP	$1,317.71
Rate for Payer: UHC Medicare Advantage	$1,317.71
Rate for Payer: UMR Bronson Commercial	$1,335.38

PR MH PARTIAL HOSP TX UNDER 24H

Professional

Both

$259.00

Service Code	HCPCS H0035
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$168.35
Rate for Payer: Aetna Medicare	$129.50
Rate for Payer: BCBS Complete	$103.60
Rate for Payer: Cash Price	$207.20
Rate for Payer: Priority Health Cigna Priority Health	$168.35
Rate for Payer: UMR Bronson Commercial	$119.14

Know your out-of-pocket cost for care.

All Charges