Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$274.00

Service Code	HCPCS 90650
Min. Negotiated Rate	$109.60
Max. Negotiated Rate	$191.80
Rate for Payer: Aetna Commercial	$141.25
Rate for Payer: BCBS Complete	$109.60
Rate for Payer: BCBS Trust/PPO	$133.16
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$219.20
Rate for Payer: Priority Health Cigna Priority Health	$191.80
Rate for Payer: UMR Bronson Commercial	$126.04

PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$258.00

Service Code	HCPCS 90649
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$180.60
Rate for Payer: Aetna Commercial	$163.24
Rate for Payer: BCBS Complete	$103.20
Rate for Payer: BCBS Trust/PPO	$160.17
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Priority Health Cigna Priority Health	$180.60
Rate for Payer: UMR Bronson Commercial	$118.68

PR 5% DEXTROSE IN LAC RINGERS

Professional

Both

$30.00

Service Code	HCPCS J7121
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$7.42
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$1.86
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: UMR Bronson Commercial	$13.80

PR 9VHPV VACC 2/3 DOSE SCHED IM USE

Professional

Both

$290.00

Service Code	HCPCS 90651
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$293.16
Rate for Payer: Aetna Commercial	$293.16
Rate for Payer: BCBS Complete	$116.00
Rate for Payer: BCBS Trust/PPO	$277.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Priority Health Cigna Priority Health	$203.00
Rate for Payer: UMR Bronson Commercial	$133.40

PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH

Professional

Both

$3,860.00

Service Code	HCPCS 34800
Min. Negotiated Rate	$1,544.00
Max. Negotiated Rate	$2,702.00
Rate for Payer: BCBS Complete	$1,544.00
Rate for Payer: Cash Price	$3,088.00
Rate for Payer: Priority Health Cigna Priority Health	$2,702.00
Rate for Payer: UMR Bronson Commercial	$1,775.60

PR AAA REPAIR,MODULR BIFURCATED PROSTH

Professional

Both

$2,505.00

Service Code	HCPCS 34802
Min. Negotiated Rate	$1,002.00
Max. Negotiated Rate	$1,753.50
Rate for Payer: BCBS Complete	$1,002.00
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Priority Health Cigna Priority Health	$1,753.50
Rate for Payer: UMR Bronson Commercial	$1,152.30

PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK

Professional

Both

$2,571.00

Service Code	HCPCS 34803
Min. Negotiated Rate	$1,028.40
Max. Negotiated Rate	$1,799.70
Rate for Payer: BCBS Complete	$1,028.40
Rate for Payer: Cash Price	$2,056.80
Rate for Payer: Priority Health Cigna Priority Health	$1,799.70
Rate for Payer: UMR Bronson Commercial	$1,182.66

PR AAA REPAIR,UNIBODY BIFURCATED PROSTH

Professional

Both

$5,404.00

Service Code	HCPCS 34804
Min. Negotiated Rate	$2,161.60
Max. Negotiated Rate	$3,782.80
Rate for Payer: BCBS Complete	$2,161.60
Rate for Payer: Cash Price	$4,323.20
Rate for Payer: Priority Health Cigna Priority Health	$3,782.80
Rate for Payer: UMR Bronson Commercial	$2,485.84

PR AAA REPR,1ST VESSEL,EXTENSION PROSTH

Professional

Both

$2,645.00

Service Code	HCPCS 34825
Min. Negotiated Rate	$1,058.00
Max. Negotiated Rate	$1,851.50
Rate for Payer: BCBS Complete	$1,058.00
Rate for Payer: Cash Price	$2,116.00
Rate for Payer: Priority Health Cigna Priority Health	$1,851.50
Rate for Payer: UMR Bronson Commercial	$1,216.70

PR AAA REPR,ADD VESSEL,EXTENSION PROSTH

Professional

Both

$427.00

Service Code	HCPCS 34826
Min. Negotiated Rate	$170.80
Max. Negotiated Rate	$298.90
Rate for Payer: BCBS Complete	$170.80
Rate for Payer: Cash Price	$341.60
Rate for Payer: Priority Health Cigna Priority Health	$298.90
Rate for Payer: UMR Bronson Commercial	$196.42

PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC

Professional

Both

$474.00

Service Code	HCPCS 38747
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$333.84
Rate for Payer: BCBS Complete	$177.14
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: Cash Price	$379.20
Rate for Payer: Cash Price	$379.20
Rate for Payer: Meridian Medicaid	$177.14
Rate for Payer: Priority Health Choice Medicaid	$168.70
Rate for Payer: Priority Health Cigna Priority Health	$331.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$570.05
Rate for Payer: Priority Health Narrow Network	$570.05
Rate for Payer: Priority Health SBD	$570.05
Rate for Payer: UMR Bronson Commercial	$218.04

PR ABDOMINOPLASTY (2HRS)

Professional

Both

$2,600.00

Service Code	HCPCS 00364
Hospital Revenue Code	990
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,820.00
Rate for Payer: BCBS Complete	$1,040.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Priority Health Cigna Priority Health	$1,820.00
Rate for Payer: UMR Bronson Commercial	$1,196.00

PR ABDOMINOPLASTY (3HRS)

Professional

Both

$4,200.00

Service Code	HCPCS 00365
Hospital Revenue Code	990
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,940.00
Rate for Payer: BCBS Complete	$1,680.00
Rate for Payer: Cash Price	$3,360.00
Rate for Payer: Priority Health Cigna Priority Health	$2,940.00
Rate for Payer: UMR Bronson Commercial	$1,932.00

PR ABDOMINOPLASTY W/ BREAST AUGMENT

Professional

Both

$7,300.00

Service Code	HCPCS 00256
Hospital Revenue Code	990
Min. Negotiated Rate	$2,920.00
Max. Negotiated Rate	$5,110.00
Rate for Payer: BCBS Complete	$2,920.00
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Priority Health Cigna Priority Health	$5,110.00
Rate for Payer: UMR Bronson Commercial	$3,358.00

PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL

Professional

Both

$2,576.00

Service Code	HCPCS 51845
Min. Negotiated Rate	$371.69
Max. Negotiated Rate	$3,525.87
Rate for Payer: Aetna Commercial	$747.51
Rate for Payer: BCBS Complete	$390.27
Rate for Payer: BCBS Trust/PPO	$3,525.87
Rate for Payer: Cash Price	$2,060.80
Rate for Payer: Cash Price	$2,060.80
Rate for Payer: Meridian Medicaid	$390.27
Rate for Payer: Priority Health Choice Medicaid	$371.69
Rate for Payer: Priority Health Cigna Priority Health	$1,803.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$930.50
Rate for Payer: Priority Health Narrow Network	$930.50
Rate for Payer: Priority Health SBD	$930.50
Rate for Payer: UMR Bronson Commercial	$1,184.96

PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE

Professional

Both

$466.00

Service Code	HCPCS 49083
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$759.70
Rate for Payer: Aetna Commercial	$141.10
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS Trust/PPO	$759.70
Rate for Payer: Cash Price	$372.80
Rate for Payer: Cash Price	$372.80
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$326.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.45
Rate for Payer: Priority Health Narrow Network	$183.45
Rate for Payer: Priority Health SBD	$183.45
Rate for Payer: UMR Bronson Commercial	$214.36

PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE

Professional

Both

$255.00

Service Code	HCPCS 49082
Min. Negotiated Rate	$46.43
Max. Negotiated Rate	$721.66
Rate for Payer: Aetna Commercial	$97.15
Rate for Payer: BCBS Complete	$48.75
Rate for Payer: BCBS Trust/PPO	$721.66
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Meridian Medicaid	$48.75
Rate for Payer: Priority Health Choice Medicaid	$46.43
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.01
Rate for Payer: Priority Health Narrow Network	$127.01
Rate for Payer: Priority Health SBD	$127.01
Rate for Payer: UMR Bronson Commercial	$117.30

PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN

Professional

Both

$859.00

Service Code	HCPCS 93657
Min. Negotiated Rate	$190.85
Max. Negotiated Rate	$3,654.78
Rate for Payer: Aetna Commercial	$570.20
Rate for Payer: BCBS Complete	$200.39
Rate for Payer: BCBS Trust/PPO	$3,654.78
Rate for Payer: Cash Price	$687.20
Rate for Payer: Cash Price	$687.20
Rate for Payer: Meridian Medicaid	$200.39
Rate for Payer: Priority Health Choice Medicaid	$190.85
Rate for Payer: Priority Health Cigna Priority Health	$601.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$428.42
Rate for Payer: Priority Health Narrow Network	$428.42
Rate for Payer: Priority Health SBD	$428.42
Rate for Payer: UMR Bronson Commercial	$395.14

PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS

Professional

Both

$3,692.00

Service Code	HCPCS 33256
Min. Negotiated Rate	$1,203.66
Max. Negotiated Rate	$3,001.31
Rate for Payer: Aetna Commercial	$2,606.31
Rate for Payer: BCBS Complete	$1,263.84
Rate for Payer: BCBS Trust/PPO	$1,285.88
Rate for Payer: Cash Price	$2,953.60
Rate for Payer: Cash Price	$2,953.60
Rate for Payer: Meridian Medicaid	$1,263.84
Rate for Payer: Priority Health Choice Medicaid	$1,203.66
Rate for Payer: Priority Health Cigna Priority Health	$2,584.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,001.31
Rate for Payer: Priority Health Narrow Network	$3,001.31
Rate for Payer: Priority Health SBD	$3,001.31
Rate for Payer: UMR Bronson Commercial	$1,698.32

PR ABLATION & RECONSTRUCTION ATRIA LIMITED

Professional

Both

$3,293.00

Service Code	HCPCS 33254
Min. Negotiated Rate	$856.47
Max. Negotiated Rate	$2,305.10
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: BCBS Complete	$899.29
Rate for Payer: BCBS Trust/PPO	$1,663.62
Rate for Payer: Cash Price	$2,634.40
Rate for Payer: Cash Price	$2,634.40
Rate for Payer: Meridian Medicaid	$899.29
Rate for Payer: Priority Health Choice Medicaid	$856.47
Rate for Payer: Priority Health Cigna Priority Health	$2,305.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,123.58
Rate for Payer: Priority Health Narrow Network	$2,123.58
Rate for Payer: Priority Health SBD	$2,123.58
Rate for Payer: UMR Bronson Commercial	$1,514.78

PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL

Professional

Both

$546.00

Service Code	HCPCS 30802
Min. Negotiated Rate	$130.36
Max. Negotiated Rate	$724.30
Rate for Payer: Aetna Commercial	$255.96
Rate for Payer: BCBS Complete	$136.88
Rate for Payer: BCBS Trust/PPO	$724.30
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Meridian Medicaid	$136.88
Rate for Payer: Priority Health Choice Medicaid	$130.36
Rate for Payer: Priority Health Cigna Priority Health	$382.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.31
Rate for Payer: Priority Health Narrow Network	$284.31
Rate for Payer: Priority Health SBD	$284.31
Rate for Payer: UMR Bronson Commercial	$251.16

PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC

Professional

Both

$365.00

Service Code	HCPCS 30801
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$959.39
Rate for Payer: Aetna Commercial	$190.20
Rate for Payer: BCBS Complete	$102.88
Rate for Payer: BCBS Trust/PPO	$959.39
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Meridian Medicaid	$102.88
Rate for Payer: Priority Health Choice Medicaid	$97.98
Rate for Payer: Priority Health Cigna Priority Health	$255.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.93
Rate for Payer: Priority Health Narrow Network	$213.93
Rate for Payer: Priority Health SBD	$213.93
Rate for Payer: UMR Bronson Commercial	$167.90

PR ABRASION 1 LESION

Facility

$433.00

Service Code	CPT 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$560.20
Rate for Payer: Aetna American Axle	$281.45
Rate for Payer: Aetna Commercial	$368.05
Rate for Payer: Aetna Medicare	$185.07
Rate for Payer: Aetna New Business (MI Preferred)	$281.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.44
Rate for Payer: Amish Plain Church Group Commercial	$222.44
Rate for Payer: BCBS Complete	$102.21
Rate for Payer: BCBS MAPPO	$177.95
Rate for Payer: BCBS Trust/PPO	$136.36
Rate for Payer: BCN Medicare Advantage	$177.95
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cofinity Commercial	$372.38
Rate for Payer: Cofinity Commercial	$303.10
Rate for Payer: Encore Health Key Benefits Commercial	$346.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$177.95
Rate for Payer: Healthscope Commercial	$389.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$303.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$324.75
Rate for Payer: Mclaren Medicaid	$97.34
Rate for Payer: Mclaren Medicare	$177.95
Rate for Payer: Meridian Medicaid	$102.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$186.85
Rate for Payer: MI Amish Medical Board Commercial	$204.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$368.05
Rate for Payer: PACE Medicare	$169.05
Rate for Payer: PACE SWMI	$177.95
Rate for Payer: PHP Commercial	$368.05
Rate for Payer: PHP Medicare Advantage	$177.95
Rate for Payer: Priority Health Choice Medicaid	$97.34
Rate for Payer: Priority Health Cigna Priority Health	$303.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$560.20
Rate for Payer: Priority Health Medicare	$177.95
Rate for Payer: Priority Health Narrow Network	$448.16
Rate for Payer: Priority Health SBD	$272.79
Rate for Payer: Railroad Medicare Medicare	$177.95
Rate for Payer: UHC All Payor (Choice/PPO)	$145.52
Rate for Payer: UHC Dual Complete DSNP	$177.95
Rate for Payer: UHC Exchange	$132.29
Rate for Payer: UHC Medicare Advantage	$183.29
Rate for Payer: UMR Bronson Commercial	$160.21
Rate for Payer: VA VA	$177.95
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$324.75

PR ABRASION 1 LESION

Facility

$433.00

Service Code	CPT 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$190.52
Max. Negotiated Rate	$389.70
Rate for Payer: Aetna American Axle	$281.45
Rate for Payer: Aetna Commercial	$368.05
Rate for Payer: Aetna New Business (MI Preferred)	$281.45
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cofinity Commercial	$303.10
Rate for Payer: Cofinity Commercial	$372.38
Rate for Payer: Encore Health Key Benefits Commercial	$346.40
Rate for Payer: Healthscope Commercial	$389.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$303.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$324.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$368.05
Rate for Payer: PHP Commercial	$368.05
Rate for Payer: Priority Health Cigna Priority Health	$303.10
Rate for Payer: Priority Health SBD	$272.79
Rate for Payer: UMR Bronson Commercial	$190.52
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$324.75

PR ACETABULOPLASTY RESECTION FEMORAL HEAD

Professional

Both

$1,937.00

Service Code	HCPCS 27122
Min. Negotiated Rate	$674.11
Max. Negotiated Rate	$1,687.70
Rate for Payer: Aetna Commercial	$1,473.67
Rate for Payer: BCBS Complete	$744.98
Rate for Payer: BCBS Trust/PPO	$674.11
Rate for Payer: Cash Price	$1,549.60
Rate for Payer: Cash Price	$1,549.60
Rate for Payer: Meridian Medicaid	$744.98
Rate for Payer: Priority Health Choice Medicaid	$709.50
Rate for Payer: Priority Health Cigna Priority Health	$1,355.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,687.70
Rate for Payer: Priority Health Narrow Network	$1,687.70
Rate for Payer: Priority Health SBD	$1,687.70
Rate for Payer: UMR Bronson Commercial	$891.02

Know your out-of-pocket cost for care.

All Charges