Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$679.00

Service Code	HCPCS 75956
Min. Negotiated Rate	$271.60
Max. Negotiated Rate	$514.56
Rate for Payer: Aetna Commercial	$403.09
Rate for Payer: BCBS Complete	$271.60
Rate for Payer: BCBS Trust/PPO	$514.56
Rate for Payer: Cash Price	$543.20
Rate for Payer: Cash Price	$543.20
Rate for Payer: Priority Health Cigna Priority Health	$475.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$500.90
Rate for Payer: Priority Health Narrow Network	$500.90
Rate for Payer: Priority Health SBD	$500.90
Rate for Payer: UMR Bronson Commercial	$312.34

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$328.00

Service Code	HCPCS 76818
Min. Negotiated Rate	$76.82
Max. Negotiated Rate	$250.41
Rate for Payer: Aetna Commercial	$134.54
Rate for Payer: BCBS Complete	$131.20
Rate for Payer: BCBS Trust/PPO	$250.41
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Priority Health Cigna Priority Health	$229.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$76.82
Rate for Payer: Priority Health Narrow Network	$76.82
Rate for Payer: Priority Health SBD	$179.27
Rate for Payer: UMR Bronson Commercial	$150.88

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$225.00

Service Code	HCPCS 76819
Min. Negotiated Rate	$55.32
Max. Negotiated Rate	$173.81
Rate for Payer: Aetna Commercial	$99.52
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: BCBS Trust/PPO	$173.81
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.32
Rate for Payer: Priority Health Narrow Network	$55.32
Rate for Payer: Priority Health SBD	$129.07
Rate for Payer: UMR Bronson Commercial	$103.50

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$294.00

Service Code	HCPCS 77003
Min. Negotiated Rate	$43.53
Max. Negotiated Rate	$909.73
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: BCBS Complete	$117.60
Rate for Payer: BCBS Trust/PPO	$909.73
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cash Price	$235.20
Rate for Payer: Priority Health Cigna Priority Health	$205.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.53
Rate for Payer: Priority Health Narrow Network	$43.53
Rate for Payer: Priority Health SBD	$162.87
Rate for Payer: UMR Bronson Commercial	$135.24

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$146.00

Service Code	HCPCS 77001
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$154.68
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS Complete	$58.40
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Priority Health Cigna Priority Health	$102.20
Rate for Payer: Priority Health Cigna Priority Health	$117.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.14
Rate for Payer: Priority Health Narrow Network	$27.14
Rate for Payer: Priority Health Narrow Network	$27.14
Rate for Payer: Priority Health SBD	$154.68
Rate for Payer: Priority Health SBD	$154.68
Rate for Payer: UMR Bronson Commercial	$67.16
Rate for Payer: UMR Bronson Commercial	$77.28

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$112.00

Service Code	HCPCS 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$1,036.52
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$1,036.52
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.97
Rate for Payer: Priority Health Narrow Network	$40.97
Rate for Payer: Priority Health SBD	$179.27
Rate for Payer: UMR Bronson Commercial	$51.52

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Facility

$112.00

Service Code	CPT 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$171.04
Rate for Payer: Aetna American Axle	$72.80
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: Aetna New Business (MI Preferred)	$72.80
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$171.04
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cofinity Commercial	$78.40
Rate for Payer: Cofinity Commercial	$96.32
Rate for Payer: Encore Health Key Benefits Commercial	$89.60
Rate for Payer: Healthscope Commercial	$100.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$78.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$84.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.20
Rate for Payer: PHP Commercial	$95.20
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health SBD	$70.56
Rate for Payer: UHC All Payor (Choice/PPO)	$125.34
Rate for Payer: UHC Exchange	$113.95
Rate for Payer: UMR Bronson Commercial	$41.44
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$84.00

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Facility

$112.00

Service Code	CPT 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$49.28
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna American Axle	$72.80
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: Aetna New Business (MI Preferred)	$72.80
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cofinity Commercial	$78.40
Rate for Payer: Cofinity Commercial	$96.32
Rate for Payer: Encore Health Key Benefits Commercial	$89.60
Rate for Payer: Healthscope Commercial	$100.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$78.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$84.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.20
Rate for Payer: PHP Commercial	$95.20
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health SBD	$70.56
Rate for Payer: UMR Bronson Commercial	$49.28
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$84.00

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$112.00

Service Code	HCPCS 77002
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$1,036.52
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$1,036.52
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.97
Rate for Payer: Priority Health Narrow Network	$40.97
Rate for Payer: Priority Health SBD	$179.27
Rate for Payer: UMR Bronson Commercial	$51.52

CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME

Professional

Both

$66.00

Service Code	HCPCS 76001
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$46.20
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Priority Health Cigna Priority Health	$46.20
Rate for Payer: UMR Bronson Commercial	$30.36

CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

Professional

Both

$54.00

Service Code	HCPCS 76000
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$366.11
Rate for Payer: Aetna Commercial	$48.94
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS Trust/PPO	$366.11
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.56
Rate for Payer: Priority Health Narrow Network	$23.56
Rate for Payer: Priority Health SBD	$66.58
Rate for Payer: UMR Bronson Commercial	$24.84

CHG GASTROESOPHAGEAL REFLUX STUDY

Professional

Both

$101.00

Service Code	HCPCS 78262
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$653.51
Rate for Payer: Aetna Commercial	$274.74
Rate for Payer: BCBS Complete	$40.40
Rate for Payer: BCBS Trust/PPO	$653.51
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Priority Health Cigna Priority Health	$70.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.68
Rate for Payer: Priority Health Narrow Network	$49.68
Rate for Payer: Priority Health SBD	$353.39
Rate for Payer: UMR Bronson Commercial	$46.46

CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE

Professional

Both

$12.00

Service Code	HCPCS 82962
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$1,864.90
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$1,864.90
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.52
Rate for Payer: Priority Health Narrow Network	$3.52
Rate for Payer: Priority Health SBD	$3.52
Rate for Payer: UMR Bronson Commercial	$5.52

CHG GLUCOSE BLOOD REAGENT STRIP

Professional

Both

$14.00

Service Code	HCPCS 82948
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$2,965.35
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$2,965.35
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.27
Rate for Payer: Priority Health Narrow Network	$5.27
Rate for Payer: Priority Health SBD	$5.27
Rate for Payer: UMR Bronson Commercial	$6.44

CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP

Professional

Both

$17.00

Service Code	HCPCS 82947
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$2,179.24
Rate for Payer: Aetna Commercial	$3.73
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: BCBS Trust/PPO	$2,179.24
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cash Price	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.22
Rate for Payer: Priority Health Narrow Network	$4.22
Rate for Payer: Priority Health SBD	$4.22
Rate for Payer: UMR Bronson Commercial	$7.82

CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS

Professional

Both

$46.00

Service Code	HCPCS 82951
Min. Negotiated Rate	$12.23
Max. Negotiated Rate	$3,628.36
Rate for Payer: Aetna Commercial	$12.23
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$3,628.36
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.36
Rate for Payer: Priority Health Narrow Network	$13.36
Rate for Payer: Priority Health SBD	$13.36
Rate for Payer: UMR Bronson Commercial	$21.16

CHG GONADOTROPIN CHORIONIC QUALITATIVE

Professional

Both

$25.00

Service Code	HCPCS 84703
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$4,545.49
Rate for Payer: Aetna Commercial	$7.14
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$4,545.49
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.74
Rate for Payer: Priority Health Narrow Network	$7.74
Rate for Payer: Priority Health SBD	$7.74
Rate for Payer: UMR Bronson Commercial	$11.50

CHG GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR

Professional

Both

$59.00

Service Code	HCPCS 77387
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$2,278.56
Rate for Payer: Aetna Commercial	$130.08
Rate for Payer: BCBS Complete	$23.60
Rate for Payer: BCBS Trust/PPO	$2,278.56
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Priority Health Cigna Priority Health	$41.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.95
Rate for Payer: Priority Health Narrow Network	$39.95
Rate for Payer: Priority Health SBD	$195.65
Rate for Payer: UMR Bronson Commercial	$27.14

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

Professional

Both

$627.00

Service Code	HCPCS 77770
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$529.58
Rate for Payer: Aetna Commercial	$393.99
Rate for Payer: Aetna Commercial	$393.99
Rate for Payer: BCBS Complete	$250.80
Rate for Payer: BCBS Complete	$81.20
Rate for Payer: BCBS Trust/PPO	$406.79
Rate for Payer: BCBS Trust/PPO	$406.79
Rate for Payer: Cash Price	$501.60
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$501.60
Rate for Payer: Priority Health Cigna Priority Health	$142.10
Rate for Payer: Priority Health Cigna Priority Health	$438.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.70
Rate for Payer: Priority Health Narrow Network	$155.70
Rate for Payer: Priority Health Narrow Network	$155.70
Rate for Payer: Priority Health SBD	$529.58
Rate for Payer: Priority Health SBD	$529.58
Rate for Payer: UMR Bronson Commercial	$93.38
Rate for Payer: UMR Bronson Commercial	$288.42

CHG HEMOGLOBIN GLYCOSYLATED A1C

Professional

Both

$23.00

Service Code	HCPCS 83036
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$1,402.11
Rate for Payer: Aetna Commercial	$9.22
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$1,402.11
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.20
Rate for Payer: Priority Health Narrow Network	$10.20
Rate for Payer: Priority Health SBD	$10.20
Rate for Payer: UMR Bronson Commercial	$10.58

CHG HETEROPHILE ANTIBODIES SCREEN

Professional

Both

$15.00

Service Code	HCPCS 86308
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,818.41
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS Trust/PPO	$1,818.41
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.27
Rate for Payer: Priority Health Narrow Network	$5.27
Rate for Payer: Priority Health SBD	$5.27
Rate for Payer: UMR Bronson Commercial	$6.90

CHG HYSTEROSALPINGOGRAPHY RS&I

Professional

Both

$150.00

Service Code	HCPCS 74740
Min. Negotiated Rate	$27.66
Max. Negotiated Rate	$147.51
Rate for Payer: Aetna Commercial	$110.60
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$133.66
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.66
Rate for Payer: Priority Health Narrow Network	$27.66
Rate for Payer: Priority Health SBD	$147.51
Rate for Payer: UMR Bronson Commercial	$69.00

CHG IAADIADOO INFLUENZA

Professional

Both

$29.00

Service Code	HCPCS 87804
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$1,216.15
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCBS Trust/PPO	$1,216.15
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$20.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.22
Rate for Payer: Priority Health Narrow Network	$17.22
Rate for Payer: Priority Health SBD	$17.22
Rate for Payer: UMR Bronson Commercial	$13.34

CHG IAADIADOO RESPIRATORY SYNCTIAL VIRUS

Professional

Both

$18.00

Service Code	HCPCS 87807
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.11
Rate for Payer: Aetna Commercial	$12.45
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: BCBS Trust/PPO	$114.11
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$12.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.71
Rate for Payer: Priority Health Narrow Network	$13.71
Rate for Payer: Priority Health SBD	$13.71
Rate for Payer: UMR Bronson Commercial	$8.28

CHG IAADIADOO STREPTOCOCCUS GROUP A

Professional

Both

$28.00

Service Code	HCPCS 87880
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$164.83
Rate for Payer: Aetna Commercial	$15.70
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$164.83
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.22
Rate for Payer: Priority Health Narrow Network	$17.22
Rate for Payer: Priority Health SBD	$17.22
Rate for Payer: UMR Bronson Commercial	$12.88

Know your out-of-pocket cost for care.

All Charges