Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 9302: MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$5,359.39

Service Code	APR-DRG 9302
Hospital Charge Code	APRDRG 9302
Min. Negotiated Rate	$5,104.18
Max. Negotiated Rate	$5,359.39
Rate for Payer: BCBS Complete	$5,359.39
Rate for Payer: Mclaren Medicaid	$5,104.18
Rate for Payer: Meridian Medicaid	$5,359.39
Rate for Payer: Priority Health Choice Medicaid	$5,104.18

INPATIENT APRDRG 9303: MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$10,277.77

Service Code	APR-DRG 9303
Hospital Charge Code	APRDRG 9303
Min. Negotiated Rate	$9,788.35
Max. Negotiated Rate	$10,277.77
Rate for Payer: BCBS Complete	$10,277.77
Rate for Payer: Mclaren Medicaid	$9,788.35
Rate for Payer: Meridian Medicaid	$10,277.77
Rate for Payer: Priority Health Choice Medicaid	$9,788.35

INPATIENT APRDRG 9304: MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$15,661.88

Service Code	APR-DRG 9304
Hospital Charge Code	APRDRG 9304
Min. Negotiated Rate	$14,916.08
Max. Negotiated Rate	$15,661.88
Rate for Payer: BCBS Complete	$15,661.88
Rate for Payer: Mclaren Medicaid	$14,916.08
Rate for Payer: Meridian Medicaid	$15,661.88
Rate for Payer: Priority Health Choice Medicaid	$14,916.08

INPATIENT APRDRG 9501: EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$8,982.91

Service Code	APR-DRG 9501
Hospital Charge Code	APRDRG 9501
Min. Negotiated Rate	$8,555.15
Max. Negotiated Rate	$8,982.91
Rate for Payer: BCBS Complete	$8,982.91
Rate for Payer: Mclaren Medicaid	$8,555.15
Rate for Payer: Meridian Medicaid	$8,982.91
Rate for Payer: Priority Health Choice Medicaid	$8,555.15

INPATIENT APRDRG 9502: EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,894.50

Service Code	APR-DRG 9502
Hospital Charge Code	APRDRG 9502
Min. Negotiated Rate	$12,280.48
Max. Negotiated Rate	$12,894.50
Rate for Payer: BCBS Complete	$12,894.50
Rate for Payer: Mclaren Medicaid	$12,280.48
Rate for Payer: Meridian Medicaid	$12,894.50
Rate for Payer: Priority Health Choice Medicaid	$12,280.48

INPATIENT APRDRG 9503: EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$18,391.88

Service Code	APR-DRG 9503
Hospital Charge Code	APRDRG 9503
Min. Negotiated Rate	$17,516.08
Max. Negotiated Rate	$18,391.88
Rate for Payer: BCBS Complete	$18,391.88
Rate for Payer: Mclaren Medicaid	$17,516.08
Rate for Payer: Meridian Medicaid	$18,391.88
Rate for Payer: Priority Health Choice Medicaid	$17,516.08

INPATIENT APRDRG 9504: EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$32,091.36

Service Code	APR-DRG 9504
Hospital Charge Code	APRDRG 9504
Min. Negotiated Rate	$30,563.20
Max. Negotiated Rate	$32,091.36
Rate for Payer: BCBS Complete	$32,091.36
Rate for Payer: Mclaren Medicaid	$30,563.20
Rate for Payer: Meridian Medicaid	$32,091.36
Rate for Payer: Priority Health Choice Medicaid	$30,563.20

INPATIENT APRDRG 9511: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,943.92

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG 9511
Min. Negotiated Rate	$7,565.64
Max. Negotiated Rate	$7,943.92
Rate for Payer: BCBS Complete	$7,943.92
Rate for Payer: Mclaren Medicaid	$7,565.64
Rate for Payer: Meridian Medicaid	$7,943.92
Rate for Payer: Priority Health Choice Medicaid	$7,565.64

INPATIENT APRDRG 9512: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$9,611.36

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG 9512
Min. Negotiated Rate	$9,153.68
Max. Negotiated Rate	$9,611.36
Rate for Payer: BCBS Complete	$9,611.36
Rate for Payer: Mclaren Medicaid	$9,153.68
Rate for Payer: Meridian Medicaid	$9,611.36
Rate for Payer: Priority Health Choice Medicaid	$9,153.68

INPATIENT APRDRG 9513: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$13,480.98

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG 9513
Min. Negotiated Rate	$12,839.03
Max. Negotiated Rate	$13,480.98
Rate for Payer: BCBS Complete	$13,480.98
Rate for Payer: Mclaren Medicaid	$12,839.03
Rate for Payer: Meridian Medicaid	$13,480.98
Rate for Payer: Priority Health Choice Medicaid	$12,839.03

INPATIENT APRDRG 9514: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$23,646.05

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG 9514
Min. Negotiated Rate	$22,520.05
Max. Negotiated Rate	$23,646.05
Rate for Payer: BCBS Complete	$23,646.05
Rate for Payer: Mclaren Medicaid	$22,520.05
Rate for Payer: Meridian Medicaid	$23,646.05
Rate for Payer: Priority Health Choice Medicaid	$22,520.05

INPATIENT APRDRG 9521: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$6,551.90

Service Code	APR-DRG 9521
Hospital Charge Code	APRDRG 9521
Min. Negotiated Rate	$6,239.90
Max. Negotiated Rate	$6,551.90
Rate for Payer: BCBS Complete	$6,551.90
Rate for Payer: Mclaren Medicaid	$6,239.90
Rate for Payer: Meridian Medicaid	$6,551.90
Rate for Payer: Priority Health Choice Medicaid	$6,239.90

INPATIENT APRDRG 9522: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$8,434.38

Service Code	APR-DRG 9522
Hospital Charge Code	APRDRG 9522
Min. Negotiated Rate	$8,032.74
Max. Negotiated Rate	$8,434.38
Rate for Payer: BCBS Complete	$8,434.38
Rate for Payer: Mclaren Medicaid	$8,032.74
Rate for Payer: Meridian Medicaid	$8,434.38
Rate for Payer: Priority Health Choice Medicaid	$8,032.74

INPATIENT APRDRG 9523: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$11,358.15

Service Code	APR-DRG 9523
Hospital Charge Code	APRDRG 9523
Min. Negotiated Rate	$10,817.29
Max. Negotiated Rate	$11,358.15
Rate for Payer: BCBS Complete	$11,358.15
Rate for Payer: Mclaren Medicaid	$10,817.29
Rate for Payer: Meridian Medicaid	$11,358.15
Rate for Payer: Priority Health Choice Medicaid	$10,817.29

INPATIENT APRDRG 9524: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$22,772.66

Service Code	APR-DRG 9524
Hospital Charge Code	APRDRG 9524
Min. Negotiated Rate	$21,688.25
Max. Negotiated Rate	$22,772.66
Rate for Payer: BCBS Complete	$22,772.66
Rate for Payer: Mclaren Medicaid	$21,688.25
Rate for Payer: Meridian Medicaid	$22,772.66
Rate for Payer: Priority Health Choice Medicaid	$21,688.25

INPT/ED TELECONSULT30

Professional

Both

$197.00

Service Code	HCPCS G0425
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$491.32
Rate for Payer: Aetna Commercial	$99.61
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS Trust/PPO	$491.32
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.79
Rate for Payer: Priority Health Narrow Network	$117.79
Rate for Payer: Priority Health SBD	$117.79
Rate for Payer: UMR Bronson Commercial	$90.62

INPT/ED TELECONSULT50

Professional

Both

$267.00

Service Code	HCPCS G0426
Min. Negotiated Rate	$82.86
Max. Negotiated Rate	$562.64
Rate for Payer: Aetna Commercial	$133.90
Rate for Payer: BCBS Complete	$87.00
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Meridian Medicaid	$87.00
Rate for Payer: Priority Health Choice Medicaid	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.33
Rate for Payer: Priority Health Narrow Network	$165.33
Rate for Payer: Priority Health SBD	$165.33
Rate for Payer: UMR Bronson Commercial	$122.82

INPT/ED TELECONSULT70

Professional

Both

$396.00

Service Code	HCPCS G0427
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$348.68
Rate for Payer: Aetna Commercial	$197.06
Rate for Payer: BCBS Complete	$123.01
Rate for Payer: BCBS Trust/PPO	$348.68
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Meridian Medicaid	$123.01
Rate for Payer: Priority Health Choice Medicaid	$117.15
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.15
Rate for Payer: Priority Health Narrow Network	$235.15
Rate for Payer: Priority Health SBD	$235.15
Rate for Payer: UMR Bronson Commercial	$182.16

INPT/TELE FOLLOW UP 35

Professional

Both

$180.00

Service Code	HCPCS G0408
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$1,554.26
Rate for Payer: Aetna Commercial	$101.64
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS Trust/PPO	$1,554.26
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.14
Rate for Payer: Priority Health Narrow Network	$140.14
Rate for Payer: Priority Health SBD	$140.14
Rate for Payer: UMR Bronson Commercial	$82.80

INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)

Facility

$700.00

Service Code	CPT 11981
Hospital Revenue Code	360
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Medicare	$118.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$141.94
Rate for Payer: Amish Plain Church Group Commercial	$141.94
Rate for Payer: BCBS Complete	$65.22
Rate for Payer: BCBS MAPPO	$113.55
Rate for Payer: BCBS Trust/PPO	$124.17
Rate for Payer: BCN Medicare Advantage	$113.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.55
Rate for Payer: Mclaren Medicaid	$62.11
Rate for Payer: Mclaren Medicare	$113.55
Rate for Payer: Meridian Medicaid	$65.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.23
Rate for Payer: MI Amish Medical Board Commercial	$130.58
Rate for Payer: PACE Medicare	$107.87
Rate for Payer: PACE SWMI	$113.55
Rate for Payer: PHP Medicare Advantage	$113.55
Rate for Payer: Priority Health Choice Medicaid	$62.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$357.43
Rate for Payer: Priority Health Medicare	$113.55
Rate for Payer: Priority Health Narrow Network	$285.94
Rate for Payer: Railroad Medicare Medicare	$113.55
Rate for Payer: UHC All Payor (Choice/PPO)	$67.35
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$113.55
Rate for Payer: UHC Exchange	$61.23
Rate for Payer: UHC Medicare Advantage	$116.96
Rate for Payer: VA VA	$113.55

INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, EXTERNAL APPROACH

Facility

$11,377.15

Service Code	CPT 66183
Hospital Revenue Code	360
Min. Negotiated Rate	$1,002.63
Max. Negotiated Rate	$11,377.15
Rate for Payer: Aetna Medicare	$3,758.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,517.55
Rate for Payer: Amish Plain Church Group Commercial	$4,517.55
Rate for Payer: BCBS Complete	$2,075.90
Rate for Payer: BCBS MAPPO	$3,614.04
Rate for Payer: BCBS Trust/PPO	$3,030.24
Rate for Payer: BCN Medicare Advantage	$3,614.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,614.04
Rate for Payer: Mclaren Medicaid	$1,976.88
Rate for Payer: Mclaren Medicare	$3,614.04
Rate for Payer: Meridian Medicaid	$2,075.90
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,794.74
Rate for Payer: MI Amish Medical Board Commercial	$4,156.15
Rate for Payer: PACE Medicare	$3,433.34
Rate for Payer: PACE SWMI	$3,614.04
Rate for Payer: PHP Medicare Advantage	$3,614.04
Rate for Payer: Priority Health Choice Medicaid	$1,976.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,377.15
Rate for Payer: Priority Health Medicare	$3,614.04
Rate for Payer: Priority Health Narrow Network	$9,101.72
Rate for Payer: Railroad Medicare Medicare	$3,614.04
Rate for Payer: UHC All Payor (Choice/PPO)	$1,102.89
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$3,614.04
Rate for Payer: UHC Exchange	$1,002.63
Rate for Payer: UHC Medicare Advantage	$3,722.46
Rate for Payer: VA VA	$3,614.04

INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; INITIAL DEVICE

Facility

$14,625.04

Service Code	CPT 0449T
Hospital Revenue Code	360
Min. Negotiated Rate	$2,541.23
Max. Negotiated Rate	$14,625.04
Rate for Payer: Aetna Medicare	$4,831.59
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,807.20
Rate for Payer: Amish Plain Church Group Commercial	$5,807.20
Rate for Payer: BCBS Complete	$2,668.52
Rate for Payer: BCBS MAPPO	$4,645.76
Rate for Payer: BCBS Trust/PPO	$4,085.67
Rate for Payer: BCN Medicare Advantage	$4,645.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,645.76
Rate for Payer: Mclaren Medicaid	$2,541.23
Rate for Payer: Mclaren Medicare	$4,645.76
Rate for Payer: Meridian Medicaid	$2,668.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,878.05
Rate for Payer: MI Amish Medical Board Commercial	$5,342.62
Rate for Payer: PACE Medicare	$4,413.47
Rate for Payer: PACE SWMI	$4,645.76
Rate for Payer: PHP Medicare Advantage	$4,645.76
Rate for Payer: Priority Health Choice Medicaid	$2,541.23
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,625.04
Rate for Payer: Priority Health Medicare	$4,645.76
Rate for Payer: Priority Health Narrow Network	$11,700.03
Rate for Payer: Railroad Medicare Medicare	$4,645.76
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$4,645.76
Rate for Payer: UHC Medicare Advantage	$4,785.13
Rate for Payer: VA VA	$4,645.76

INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)

Facility

$18,247.50

Service Code	CPT 19340
Hospital Revenue Code	360
Min. Negotiated Rate	$748.86
Max. Negotiated Rate	$18,247.50
Rate for Payer: Aetna Medicare	$6,028.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,245.58
Rate for Payer: Amish Plain Church Group Commercial	$7,245.58
Rate for Payer: BCBS Complete	$3,329.49
Rate for Payer: BCBS MAPPO	$5,796.46
Rate for Payer: BCBS Trust/PPO	$8,972.72
Rate for Payer: BCN Medicare Advantage	$5,796.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,796.46
Rate for Payer: Mclaren Medicaid	$3,170.66
Rate for Payer: Mclaren Medicare	$5,796.46
Rate for Payer: Meridian Medicaid	$3,329.49
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,086.28
Rate for Payer: MI Amish Medical Board Commercial	$6,665.93
Rate for Payer: PACE Medicare	$5,506.64
Rate for Payer: PACE SWMI	$5,796.46
Rate for Payer: PHP Medicare Advantage	$5,796.46
Rate for Payer: Priority Health Choice Medicaid	$3,170.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18,247.50
Rate for Payer: Priority Health Medicare	$5,796.46
Rate for Payer: Priority Health Narrow Network	$14,598.00
Rate for Payer: Railroad Medicare Medicare	$5,796.46
Rate for Payer: UHC All Payor (Choice/PPO)	$823.75
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$5,796.46
Rate for Payer: UHC Exchange	$748.86
Rate for Payer: UHC Medicare Advantage	$5,970.35
Rate for Payer: VA VA	$5,796.46

INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)

Facility

$897.69

Service Code	CPT 59200
Hospital Revenue Code	360
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$897.69
Rate for Payer: Aetna Medicare	$296.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$356.45
Rate for Payer: Amish Plain Church Group Commercial	$356.45
Rate for Payer: BCBS Complete	$163.80
Rate for Payer: BCBS MAPPO	$285.16
Rate for Payer: BCBS Trust/PPO	$312.22
Rate for Payer: BCN Medicare Advantage	$285.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$285.16
Rate for Payer: Mclaren Medicaid	$155.98
Rate for Payer: Mclaren Medicare	$285.16
Rate for Payer: Meridian Medicaid	$163.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$299.42
Rate for Payer: MI Amish Medical Board Commercial	$327.93
Rate for Payer: PACE Medicare	$270.90
Rate for Payer: PACE SWMI	$285.16
Rate for Payer: PHP Medicare Advantage	$285.16
Rate for Payer: Priority Health Choice Medicaid	$155.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$897.69
Rate for Payer: Priority Health Medicare	$285.16
Rate for Payer: Priority Health Narrow Network	$718.15
Rate for Payer: Railroad Medicare Medicare	$285.16
Rate for Payer: UHC All Payor (Choice/PPO)	$47.90
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$285.16
Rate for Payer: UHC Exchange	$43.55
Rate for Payer: UHC Medicare Advantage	$293.71
Rate for Payer: VA VA	$285.16

INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$9,680.93

Service Code	CPT 32550
Hospital Revenue Code	360
Min. Negotiated Rate	$196.47
Max. Negotiated Rate	$9,680.93
Rate for Payer: Aetna Medicare	$3,198.23
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,844.02
Rate for Payer: Amish Plain Church Group Commercial	$3,844.02
Rate for Payer: BCBS Complete	$1,766.41
Rate for Payer: BCBS MAPPO	$3,075.22
Rate for Payer: BCBS Trust/PPO	$3,019.18
Rate for Payer: BCN Medicare Advantage	$3,075.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,075.22
Rate for Payer: Mclaren Medicaid	$1,682.15
Rate for Payer: Mclaren Medicare	$3,075.22
Rate for Payer: Meridian Medicaid	$1,766.41
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,228.98
Rate for Payer: MI Amish Medical Board Commercial	$3,536.50
Rate for Payer: PACE Medicare	$2,921.46
Rate for Payer: PACE SWMI	$3,075.22
Rate for Payer: PHP Medicare Advantage	$3,075.22
Rate for Payer: Priority Health Choice Medicaid	$1,682.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,680.93
Rate for Payer: Priority Health Medicare	$3,075.22
Rate for Payer: Priority Health Narrow Network	$7,744.74
Rate for Payer: Railroad Medicare Medicare	$3,075.22
Rate for Payer: UHC All Payor (Choice/PPO)	$216.12
Rate for Payer: UHC Core	$5,042.00
Rate for Payer: UHC Dual Complete DSNP	$3,075.22
Rate for Payer: UHC Exchange	$196.47
Rate for Payer: UHC Medicare Advantage	$3,167.48
Rate for Payer: VA VA	$3,075.22

Know your out-of-pocket cost for care.

All Charges