Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES

Facility

$828.79

Service Code	CPT 20553
Hospital Revenue Code	360
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$828.79
Rate for Payer: Aetna Medicare	$273.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.09
Rate for Payer: Amish Plain Church Group Commercial	$329.09
Rate for Payer: BCBS Complete	$151.22
Rate for Payer: BCBS MAPPO	$263.27
Rate for Payer: BCBS Trust/PPO	$290.76
Rate for Payer: BCN Medicare Advantage	$263.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.27
Rate for Payer: Mclaren Medicaid	$144.01
Rate for Payer: Mclaren Medicare	$263.27
Rate for Payer: Meridian Medicaid	$151.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.43
Rate for Payer: MI Amish Medical Board Commercial	$302.76
Rate for Payer: PACE Medicare	$250.11
Rate for Payer: PACE SWMI	$263.27
Rate for Payer: PHP Medicare Advantage	$263.27
Rate for Payer: Priority Health Choice Medicaid	$144.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.79
Rate for Payer: Priority Health Medicare	$263.27
Rate for Payer: Priority Health Narrow Network	$663.03
Rate for Payer: Railroad Medicare Medicare	$263.27
Rate for Payer: UHC All Payor (Choice/PPO)	$45.02
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$263.27
Rate for Payer: UHC Exchange	$40.93
Rate for Payer: UHC Medicare Advantage	$271.17
Rate for Payer: VA VA	$263.27

INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")

Facility

$828.79

Service Code	CPT 20550
Hospital Revenue Code	361
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$828.79
Rate for Payer: Aetna Medicare	$273.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.09
Rate for Payer: Amish Plain Church Group Commercial	$329.09
Rate for Payer: BCBS Complete	$151.22
Rate for Payer: BCBS MAPPO	$263.27
Rate for Payer: BCBS Trust/PPO	$290.76
Rate for Payer: BCN Medicare Advantage	$263.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.27
Rate for Payer: Mclaren Medicaid	$144.01
Rate for Payer: Mclaren Medicare	$263.27
Rate for Payer: Meridian Medicaid	$151.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.43
Rate for Payer: MI Amish Medical Board Commercial	$302.76
Rate for Payer: PACE Medicare	$250.11
Rate for Payer: PACE SWMI	$263.27
Rate for Payer: PHP Medicare Advantage	$263.27
Rate for Payer: Priority Health Choice Medicaid	$144.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.79
Rate for Payer: Priority Health Medicare	$263.27
Rate for Payer: Priority Health Narrow Network	$663.03
Rate for Payer: Railroad Medicare Medicare	$263.27
Rate for Payer: UHC All Payor (Choice/PPO)	$41.78
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$263.27
Rate for Payer: UHC Exchange	$37.98
Rate for Payer: UHC Medicare Advantage	$271.17
Rate for Payer: VA VA	$263.27

INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")

Facility

$828.79

Service Code	CPT 20550
Hospital Revenue Code	360
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$828.79
Rate for Payer: Aetna Medicare	$273.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.09
Rate for Payer: Amish Plain Church Group Commercial	$329.09
Rate for Payer: BCBS Complete	$151.22
Rate for Payer: BCBS MAPPO	$263.27
Rate for Payer: BCBS Trust/PPO	$290.76
Rate for Payer: BCN Medicare Advantage	$263.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.27
Rate for Payer: Mclaren Medicaid	$144.01
Rate for Payer: Mclaren Medicare	$263.27
Rate for Payer: Meridian Medicaid	$151.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.43
Rate for Payer: MI Amish Medical Board Commercial	$302.76
Rate for Payer: PACE Medicare	$250.11
Rate for Payer: PACE SWMI	$263.27
Rate for Payer: PHP Medicare Advantage	$263.27
Rate for Payer: Priority Health Choice Medicaid	$144.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.79
Rate for Payer: Priority Health Medicare	$263.27
Rate for Payer: Priority Health Narrow Network	$663.03
Rate for Payer: Railroad Medicare Medicare	$263.27
Rate for Payer: UHC All Payor (Choice/PPO)	$41.78
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$263.27
Rate for Payer: UHC Exchange	$37.98
Rate for Payer: UHC Medicare Advantage	$271.17
Rate for Payer: VA VA	$263.27

INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL

Facility

$828.79

Service Code	CPT 20526
Hospital Revenue Code	360
Min. Negotiated Rate	$55.67
Max. Negotiated Rate	$828.79
Rate for Payer: Aetna Medicare	$273.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.09
Rate for Payer: Amish Plain Church Group Commercial	$329.09
Rate for Payer: BCBS Complete	$151.22
Rate for Payer: BCBS MAPPO	$263.27
Rate for Payer: BCBS Trust/PPO	$290.76
Rate for Payer: BCN Medicare Advantage	$263.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.27
Rate for Payer: Mclaren Medicaid	$144.01
Rate for Payer: Mclaren Medicare	$263.27
Rate for Payer: Meridian Medicaid	$151.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.43
Rate for Payer: MI Amish Medical Board Commercial	$302.76
Rate for Payer: PACE Medicare	$250.11
Rate for Payer: PACE SWMI	$263.27
Rate for Payer: PHP Medicare Advantage	$263.27
Rate for Payer: Priority Health Choice Medicaid	$144.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.79
Rate for Payer: Priority Health Medicare	$263.27
Rate for Payer: Priority Health Narrow Network	$663.03
Rate for Payer: Railroad Medicare Medicare	$263.27
Rate for Payer: UHC All Payor (Choice/PPO)	$61.24
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$263.27
Rate for Payer: UHC Exchange	$55.67
Rate for Payer: UHC Medicare Advantage	$271.17
Rate for Payer: VA VA	$263.27

INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL

Facility

$828.79

Service Code	CPT 20526
Hospital Revenue Code	361
Min. Negotiated Rate	$55.67
Max. Negotiated Rate	$828.79
Rate for Payer: Aetna Medicare	$273.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.09
Rate for Payer: Amish Plain Church Group Commercial	$329.09
Rate for Payer: BCBS Complete	$151.22
Rate for Payer: BCBS MAPPO	$263.27
Rate for Payer: BCBS Trust/PPO	$290.76
Rate for Payer: BCN Medicare Advantage	$263.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.27
Rate for Payer: Mclaren Medicaid	$144.01
Rate for Payer: Mclaren Medicare	$263.27
Rate for Payer: Meridian Medicaid	$151.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.43
Rate for Payer: MI Amish Medical Board Commercial	$302.76
Rate for Payer: PACE Medicare	$250.11
Rate for Payer: PACE SWMI	$263.27
Rate for Payer: PHP Medicare Advantage	$263.27
Rate for Payer: Priority Health Choice Medicaid	$144.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.79
Rate for Payer: Priority Health Medicare	$263.27
Rate for Payer: Priority Health Narrow Network	$663.03
Rate for Payer: Railroad Medicare Medicare	$263.27
Rate for Payer: UHC All Payor (Choice/PPO)	$61.24
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$263.27
Rate for Payer: UHC Exchange	$55.67
Rate for Payer: UHC Medicare Advantage	$271.17
Rate for Payer: VA VA	$263.27

INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN

Facility

$99,837.36

Service Code	HCPCS J9229
Hospital Charge Code	184358
Hospital Revenue Code	636
Min. Negotiated Rate	$1,411.34
Max. Negotiated Rate	$89,853.62
Rate for Payer: Aetna American Axle	$64,894.28
Rate for Payer: Aetna Commercial	$84,861.76
Rate for Payer: Aetna Medicare	$2,683.35
Rate for Payer: Aetna New Business (MI Preferred)	$64,894.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,225.18
Rate for Payer: Amish Plain Church Group Commercial	$3,225.18
Rate for Payer: BCBS Complete	$1,482.04
Rate for Payer: BCBS MAPPO	$2,580.14
Rate for Payer: BCBS Trust/PPO	$8,337.83
Rate for Payer: BCN Medicare Advantage	$2,580.14
Rate for Payer: Cash Price	$79,869.89
Rate for Payer: Cash Price	$79,869.89
Rate for Payer: Cofinity Commercial	$85,860.13
Rate for Payer: Cofinity Commercial	$69,886.15
Rate for Payer: Encore Health Key Benefits Commercial	$79,869.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,580.14
Rate for Payer: Healthscope Commercial	$89,853.62
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$69,886.15
Rate for Payer: Lakeland Regional Health Systems Commercial	$74,878.02
Rate for Payer: Mclaren Medicaid	$1,411.34
Rate for Payer: Mclaren Medicare	$2,580.14
Rate for Payer: Meridian Medicaid	$1,482.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,709.15
Rate for Payer: MI Amish Medical Board Commercial	$2,967.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84,861.76
Rate for Payer: PACE Medicare	$2,451.14
Rate for Payer: PACE SWMI	$2,580.14
Rate for Payer: PHP Commercial	$84,861.76
Rate for Payer: PHP Medicare Advantage	$2,580.14
Rate for Payer: Priority Health Choice Medicaid	$1,411.34
Rate for Payer: Priority Health Cigna Priority Health	$69,886.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,428.98
Rate for Payer: Priority Health Medicare	$2,580.14
Rate for Payer: Priority Health Narrow Network	$5,943.18
Rate for Payer: Priority Health SBD	$62,897.54
Rate for Payer: Railroad Medicare Medicare	$2,580.14
Rate for Payer: UHC Dual Complete DSNP	$2,580.14
Rate for Payer: UHC Medicare Advantage	$2,657.55
Rate for Payer: UMR Bronson Commercial	$36,939.82
Rate for Payer: VA VA	$2,580.14
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$74,878.02

INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN

Facility

$99,837.36

Service Code	HCPCS J9229
Hospital Charge Code	184358
Hospital Revenue Code	636
Min. Negotiated Rate	$43,928.44
Max. Negotiated Rate	$89,853.62
Rate for Payer: Aetna American Axle	$64,894.28
Rate for Payer: Aetna Commercial	$84,861.76
Rate for Payer: Aetna New Business (MI Preferred)	$64,894.28
Rate for Payer: Cash Price	$79,869.89
Rate for Payer: Cofinity Commercial	$69,886.15
Rate for Payer: Cofinity Commercial	$85,860.13
Rate for Payer: Encore Health Key Benefits Commercial	$79,869.89
Rate for Payer: Healthscope Commercial	$89,853.62
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$69,886.15
Rate for Payer: Lakeland Regional Health Systems Commercial	$74,878.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84,861.76
Rate for Payer: PHP Commercial	$84,861.76
Rate for Payer: Priority Health Cigna Priority Health	$69,886.15
Rate for Payer: Priority Health SBD	$62,897.54
Rate for Payer: UMR Bronson Commercial	$43,928.44
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$74,878.02

INPATIENT APRDRG 0041: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$35,174.40

Service Code	APR-DRG 0041
Hospital Charge Code	APRDRG 0041
Min. Negotiated Rate	$33,499.43
Max. Negotiated Rate	$35,174.40
Rate for Payer: BCBS Complete	$35,174.40
Rate for Payer: Mclaren Medicaid	$33,499.43
Rate for Payer: Meridian Medicaid	$35,174.40
Rate for Payer: Priority Health Choice Medicaid	$33,499.43

INPATIENT APRDRG 0042: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$39,362.56

Service Code	APR-DRG 0042
Hospital Charge Code	APRDRG 0042
Min. Negotiated Rate	$37,488.15
Max. Negotiated Rate	$39,362.56
Rate for Payer: BCBS Complete	$39,362.56
Rate for Payer: Mclaren Medicaid	$37,488.15
Rate for Payer: Meridian Medicaid	$39,362.56
Rate for Payer: Priority Health Choice Medicaid	$37,488.15

INPATIENT APRDRG 0043: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$64,013.67

Service Code	APR-DRG 0043
Hospital Charge Code	APRDRG 0043
Min. Negotiated Rate	$60,965.40
Max. Negotiated Rate	$64,013.67
Rate for Payer: BCBS Complete	$64,013.67
Rate for Payer: Mclaren Medicaid	$60,965.40
Rate for Payer: Meridian Medicaid	$64,013.67
Rate for Payer: Priority Health Choice Medicaid	$60,965.40

INPATIENT APRDRG 0044: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$103,404.40

Service Code	APR-DRG 0044
Hospital Charge Code	APRDRG 0044
Min. Negotiated Rate	$98,480.38
Max. Negotiated Rate	$103,404.40
Rate for Payer: BCBS Complete	$103,404.40
Rate for Payer: Mclaren Medicaid	$98,480.38
Rate for Payer: Meridian Medicaid	$103,404.40
Rate for Payer: Priority Health Choice Medicaid	$98,480.38

INPATIENT APRDRG 0051: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$18,043.45

Service Code	APR-DRG 0051
Hospital Charge Code	APRDRG 0051
Min. Negotiated Rate	$17,184.24
Max. Negotiated Rate	$18,043.45
Rate for Payer: BCBS Complete	$18,043.45
Rate for Payer: Mclaren Medicaid	$17,184.24
Rate for Payer: Meridian Medicaid	$18,043.45
Rate for Payer: Priority Health Choice Medicaid	$17,184.24

INPATIENT APRDRG 0052: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$23,240.69

Service Code	APR-DRG 0052
Hospital Charge Code	APRDRG 0052
Min. Negotiated Rate	$22,133.99
Max. Negotiated Rate	$23,240.69
Rate for Payer: BCBS Complete	$23,240.69
Rate for Payer: Mclaren Medicaid	$22,133.99
Rate for Payer: Meridian Medicaid	$23,240.69
Rate for Payer: Priority Health Choice Medicaid	$22,133.99

INPATIENT APRDRG 0053: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$53,255.80

Service Code	APR-DRG 0053
Hospital Charge Code	APRDRG 0053
Min. Negotiated Rate	$50,719.81
Max. Negotiated Rate	$53,255.80
Rate for Payer: BCBS Complete	$53,255.80
Rate for Payer: Mclaren Medicaid	$50,719.81
Rate for Payer: Meridian Medicaid	$53,255.80
Rate for Payer: Priority Health Choice Medicaid	$50,719.81

INPATIENT APRDRG 0054: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$62,357.74

Service Code	APR-DRG 0054
Hospital Charge Code	APRDRG 0054
Min. Negotiated Rate	$59,388.32
Max. Negotiated Rate	$62,357.74
Rate for Payer: BCBS Complete	$62,357.74
Rate for Payer: Mclaren Medicaid	$59,388.32
Rate for Payer: Meridian Medicaid	$62,357.74
Rate for Payer: Priority Health Choice Medicaid	$59,388.32

INPATIENT APRDRG 0071: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$58,539.28

Service Code	APR-DRG 0071
Hospital Charge Code	APRDRG 0071
Min. Negotiated Rate	$55,751.70
Max. Negotiated Rate	$58,539.28
Rate for Payer: BCBS Complete	$58,539.28
Rate for Payer: Mclaren Medicaid	$55,751.70
Rate for Payer: Meridian Medicaid	$58,539.28
Rate for Payer: Priority Health Choice Medicaid	$55,751.70

INPATIENT APRDRG 0072: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$51,816.62

Service Code	APR-DRG 0072
Hospital Charge Code	APRDRG 0072
Min. Negotiated Rate	$49,349.16
Max. Negotiated Rate	$51,816.62
Rate for Payer: BCBS Complete	$51,816.62
Rate for Payer: Mclaren Medicaid	$49,349.16
Rate for Payer: Meridian Medicaid	$51,816.62
Rate for Payer: Priority Health Choice Medicaid	$49,349.16

INPATIENT APRDRG 0073: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$64,617.98

Service Code	APR-DRG 0073
Hospital Charge Code	APRDRG 0073
Min. Negotiated Rate	$61,540.93
Max. Negotiated Rate	$64,617.98
Rate for Payer: BCBS Complete	$64,617.98
Rate for Payer: Mclaren Medicaid	$61,540.93
Rate for Payer: Meridian Medicaid	$64,617.98
Rate for Payer: Priority Health Choice Medicaid	$61,540.93

INPATIENT APRDRG 0074: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$131,559.45

Service Code	APR-DRG 0074
Hospital Charge Code	APRDRG 0074
Min. Negotiated Rate	$125,294.71
Max. Negotiated Rate	$131,559.45
Rate for Payer: BCBS Complete	$131,559.45
Rate for Payer: Mclaren Medicaid	$125,294.71
Rate for Payer: Meridian Medicaid	$131,559.45
Rate for Payer: Priority Health Choice Medicaid	$125,294.71

INPATIENT APRDRG 0081: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$16,505.95

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG 0081
Min. Negotiated Rate	$15,719.95
Max. Negotiated Rate	$16,505.95
Rate for Payer: BCBS Complete	$16,505.95
Rate for Payer: Mclaren Medicaid	$15,719.95
Rate for Payer: Meridian Medicaid	$16,505.95
Rate for Payer: Priority Health Choice Medicaid	$15,719.95

INPATIENT APRDRG 0082: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$25,089.26

Service Code	APR-DRG 0082
Hospital Charge Code	APRDRG 0082
Min. Negotiated Rate	$23,894.53
Max. Negotiated Rate	$25,089.26
Rate for Payer: BCBS Complete	$25,089.26
Rate for Payer: Mclaren Medicaid	$23,894.53
Rate for Payer: Meridian Medicaid	$25,089.26
Rate for Payer: Priority Health Choice Medicaid	$23,894.53

INPATIENT APRDRG 0083: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$34,070.44

Service Code	APR-DRG 0083
Hospital Charge Code	APRDRG 0083
Min. Negotiated Rate	$32,448.04
Max. Negotiated Rate	$34,070.44
Rate for Payer: BCBS Complete	$34,070.44
Rate for Payer: Mclaren Medicaid	$32,448.04
Rate for Payer: Meridian Medicaid	$34,070.44
Rate for Payer: Priority Health Choice Medicaid	$32,448.04

INPATIENT APRDRG 0084: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$66,775.31

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG 0084
Min. Negotiated Rate	$63,595.53
Max. Negotiated Rate	$66,775.31
Rate for Payer: BCBS Complete	$66,775.31
Rate for Payer: Mclaren Medicaid	$63,595.53
Rate for Payer: Meridian Medicaid	$66,775.31
Rate for Payer: Priority Health Choice Medicaid	$63,595.53

INPATIENT APRDRG 0091: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$32,342.62

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG 0091
Min. Negotiated Rate	$30,802.50
Max. Negotiated Rate	$32,342.62
Rate for Payer: BCBS Complete	$32,342.62
Rate for Payer: Mclaren Medicaid	$30,802.50
Rate for Payer: Meridian Medicaid	$32,342.62
Rate for Payer: Priority Health Choice Medicaid	$30,802.50

INPATIENT APRDRG 0092: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$34,841.49

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG 0092
Min. Negotiated Rate	$33,182.37
Max. Negotiated Rate	$34,841.49
Rate for Payer: BCBS Complete	$34,841.49
Rate for Payer: Mclaren Medicaid	$33,182.37
Rate for Payer: Meridian Medicaid	$34,841.49
Rate for Payer: Priority Health Choice Medicaid	$33,182.37

Know your out-of-pocket cost for care.

All Charges