Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT

Professional

Both

$2,804.00

Service Code	HCPCS 26852
Min. Negotiated Rate	$539.96
Max. Negotiated Rate	$5,128.74
Rate for Payer: Aetna Commercial	$1,103.16
Rate for Payer: BCBS Complete	$566.96
Rate for Payer: BCBS Trust/PPO	$5,128.74
Rate for Payer: Cash Price	$2,243.20
Rate for Payer: Cash Price	$2,243.20
Rate for Payer: Meridian Medicaid	$566.96
Rate for Payer: Priority Health Choice Medicaid	$539.96
Rate for Payer: Priority Health Cigna Priority Health	$1,962.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,292.96
Rate for Payer: Priority Health Narrow Network	$1,292.96
Rate for Payer: Priority Health SBD	$1,292.96
Rate for Payer: UMR Bronson Commercial	$1,289.84

PR ARTHRODESIS PANTALAR

Professional

Both

$3,861.00

Service Code	HCPCS 28705
Min. Negotiated Rate	$644.53
Max. Negotiated Rate	$2,702.70
Rate for Payer: Aetna Commercial	$1,631.30
Rate for Payer: BCBS Complete	$821.25
Rate for Payer: BCBS Trust/PPO	$644.53
Rate for Payer: Cash Price	$3,088.80
Rate for Payer: Cash Price	$3,088.80
Rate for Payer: Meridian Medicaid	$821.25
Rate for Payer: Priority Health Choice Medicaid	$782.14
Rate for Payer: Priority Health Cigna Priority Health	$2,702.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,859.78
Rate for Payer: Priority Health Narrow Network	$1,859.78
Rate for Payer: Priority Health SBD	$1,859.78
Rate for Payer: UMR Bronson Commercial	$1,776.06

PR ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2

Professional

Both

$5,074.00

Service Code	HCPCS 22595
Min. Negotiated Rate	$986.19
Max. Negotiated Rate	$3,551.80
Rate for Payer: Aetna Commercial	$2,020.20
Rate for Payer: BCBS Complete	$1,035.50
Rate for Payer: BCBS Trust/PPO	$2,976.66
Rate for Payer: Cash Price	$4,059.20
Rate for Payer: Cash Price	$4,059.20
Rate for Payer: Meridian Medicaid	$1,035.50
Rate for Payer: Priority Health Choice Medicaid	$986.19
Rate for Payer: Priority Health Cigna Priority Health	$3,551.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,335.20
Rate for Payer: Priority Health Narrow Network	$2,335.20
Rate for Payer: Priority Health SBD	$2,335.20
Rate for Payer: UMR Bronson Commercial	$2,334.04

PR ARTHRODESIS POSTERIOR CRANIOCERVICAL

Professional

Both

$5,232.00

Service Code	HCPCS 22590
Min. Negotiated Rate	$1,031.56
Max. Negotiated Rate	$3,662.40
Rate for Payer: Aetna Commercial	$2,118.13
Rate for Payer: BCBS Complete	$1,083.14
Rate for Payer: BCBS Trust/PPO	$2,159.44
Rate for Payer: Cash Price	$4,185.60
Rate for Payer: Cash Price	$4,185.60
Rate for Payer: Meridian Medicaid	$1,083.14
Rate for Payer: Priority Health Choice Medicaid	$1,031.56
Rate for Payer: Priority Health Cigna Priority Health	$3,662.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,448.05
Rate for Payer: Priority Health Narrow Network	$2,448.05
Rate for Payer: Priority Health SBD	$2,448.05
Rate for Payer: UMR Bronson Commercial	$2,406.72

PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL

Professional

Both

$1,237.00

Service Code	HCPCS 22632
Min. Negotiated Rate	$204.91
Max. Negotiated Rate	$865.90
Rate for Payer: Aetna Commercial	$430.92
Rate for Payer: BCBS Complete	$215.16
Rate for Payer: BCBS Trust/PPO	$650.50
Rate for Payer: Cash Price	$989.60
Rate for Payer: Cash Price	$989.60
Rate for Payer: Meridian Medicaid	$215.16
Rate for Payer: Priority Health Choice Medicaid	$204.91
Rate for Payer: Priority Health Cigna Priority Health	$865.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$488.18
Rate for Payer: Priority Health Narrow Network	$488.18
Rate for Payer: Priority Health SBD	$488.18
Rate for Payer: UMR Bronson Commercial	$569.02

PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR

Professional

Both

$6,617.00

Service Code	HCPCS 22630
Min. Negotiated Rate	$650.50
Max. Negotiated Rate	$4,631.90
Rate for Payer: Aetna Commercial	$2,114.75
Rate for Payer: BCBS Complete	$1,059.88
Rate for Payer: BCBS Trust/PPO	$650.50
Rate for Payer: Cash Price	$5,293.60
Rate for Payer: Cash Price	$5,293.60
Rate for Payer: Meridian Medicaid	$1,059.88
Rate for Payer: Priority Health Choice Medicaid	$1,009.41
Rate for Payer: Priority Health Cigna Priority Health	$4,631.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,395.97
Rate for Payer: Priority Health Narrow Network	$2,395.97
Rate for Payer: Priority Health SBD	$2,395.97
Rate for Payer: UMR Bronson Commercial	$3,043.82

PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR

Professional

Both

$3,234.20

Service Code	HCPCS 22612
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$2,426.61
Rate for Payer: Aetna Commercial	$2,128.06
Rate for Payer: BCBS Complete	$1,068.83
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$2,587.36
Rate for Payer: Cash Price	$2,587.36
Rate for Payer: Meridian Medicaid	$1,068.83
Rate for Payer: Priority Health Choice Medicaid	$1,017.93
Rate for Payer: Priority Health Cigna Priority Health	$2,263.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,426.61
Rate for Payer: Priority Health Narrow Network	$2,426.61
Rate for Payer: Priority Health SBD	$2,426.61
Rate for Payer: UMR Bronson Commercial	$1,487.73

PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC

Professional

Both

$4,202.00

Service Code	HCPCS 22610
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$4,702.18
Rate for Payer: Aetna Commercial	$1,703.50
Rate for Payer: BCBS Complete	$872.24
Rate for Payer: BCBS Trust/PPO	$4,702.18
Rate for Payer: Cash Price	$3,361.60
Rate for Payer: Cash Price	$3,361.60
Rate for Payer: Meridian Medicaid	$872.24
Rate for Payer: Priority Health Choice Medicaid	$830.70
Rate for Payer: Priority Health Cigna Priority Health	$2,941.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,970.60
Rate for Payer: Priority Health Narrow Network	$1,970.60
Rate for Payer: Priority Health SBD	$1,970.60
Rate for Payer: UMR Bronson Commercial	$1,932.92

PR ARTHRODESIS POSTERIOR SPINAL DFRM 13+ VRT SGM

Professional

Both

$4,967.20

Service Code	HCPCS 22804
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$3,719.06
Rate for Payer: Aetna Commercial	$3,267.61
Rate for Payer: BCBS Complete	$1,639.58
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$3,973.76
Rate for Payer: Cash Price	$3,973.76
Rate for Payer: Meridian Medicaid	$1,639.58
Rate for Payer: Priority Health Choice Medicaid	$1,561.50
Rate for Payer: Priority Health Cigna Priority Health	$3,477.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,719.06
Rate for Payer: Priority Health Narrow Network	$3,719.06
Rate for Payer: Priority Health SBD	$3,719.06
Rate for Payer: UMR Bronson Commercial	$2,284.91

PR ARTHRODESIS POSTERIOR SPINAL DFRM <6 VRT SGM

Professional

Both

$2,756.40

Service Code	HCPCS 22800
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$2,098.27
Rate for Payer: Aetna Commercial	$1,815.55
Rate for Payer: BCBS Complete	$925.91
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$2,205.12
Rate for Payer: Cash Price	$2,205.12
Rate for Payer: Meridian Medicaid	$925.91
Rate for Payer: Priority Health Choice Medicaid	$881.82
Rate for Payer: Priority Health Cigna Priority Health	$1,929.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,098.27
Rate for Payer: Priority Health Narrow Network	$2,098.27
Rate for Payer: Priority Health SBD	$2,098.27
Rate for Payer: UMR Bronson Commercial	$1,267.94

PR ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SGM

Professional

Both

$4,293.76

Service Code	HCPCS 22802
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$3,240.07
Rate for Payer: Aetna Commercial	$2,838.39
Rate for Payer: BCBS Complete	$1,429.58
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$3,435.01
Rate for Payer: Cash Price	$3,435.01
Rate for Payer: Meridian Medicaid	$1,429.58
Rate for Payer: Priority Health Choice Medicaid	$1,361.50
Rate for Payer: Priority Health Cigna Priority Health	$3,005.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,240.07
Rate for Payer: Priority Health Narrow Network	$3,240.07
Rate for Payer: Priority Health SBD	$3,240.07
Rate for Payer: UMR Bronson Commercial	$1,975.13

PR ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC

Professional

Both

$1,838.00

Service Code	HCPCS 22614
Min. Negotiated Rate	$249.21
Max. Negotiated Rate	$1,286.60
Rate for Payer: Aetna Commercial	$526.48
Rate for Payer: BCBS Complete	$261.67
Rate for Payer: BCBS Trust/PPO	$934.38
Rate for Payer: Cash Price	$1,470.40
Rate for Payer: Cash Price	$1,470.40
Rate for Payer: Meridian Medicaid	$261.67
Rate for Payer: Priority Health Choice Medicaid	$249.21
Rate for Payer: Priority Health Cigna Priority Health	$1,286.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$594.40
Rate for Payer: Priority Health Narrow Network	$594.40
Rate for Payer: Priority Health SBD	$594.40
Rate for Payer: UMR Bronson Commercial	$845.48

PR ARTHRODESIS SI JOINT PERCUTANEOUS/MIN INVASIVE

Professional

Both

$1,290.00

Service Code	HCPCS 27279
Min. Negotiated Rate	$514.61
Max. Negotiated Rate	$3,376.37
Rate for Payer: Aetna Commercial	$1,152.73
Rate for Payer: BCBS Complete	$540.34
Rate for Payer: BCBS Trust/PPO	$3,376.37
Rate for Payer: Cash Price	$1,032.00
Rate for Payer: Cash Price	$1,032.00
Rate for Payer: Meridian Medicaid	$540.34
Rate for Payer: Priority Health Choice Medicaid	$514.61
Rate for Payer: Priority Health Cigna Priority Health	$903.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,245.99
Rate for Payer: Priority Health Narrow Network	$1,245.99
Rate for Payer: Priority Health SBD	$1,245.99
Rate for Payer: UMR Bronson Commercial	$593.40

PR ARTHRODESIS SI JT OPN W/OBTAINING B1 GRF INSTRMJ

Professional

Both

$3,176.00

Service Code	HCPCS 27280
Min. Negotiated Rate	$876.28
Max. Negotiated Rate	$3,839.22
Rate for Payer: Aetna Commercial	$1,822.56
Rate for Payer: BCBS Complete	$920.09
Rate for Payer: BCBS Trust/PPO	$3,839.22
Rate for Payer: Cash Price	$2,540.80
Rate for Payer: Cash Price	$2,540.80
Rate for Payer: Meridian Medicaid	$920.09
Rate for Payer: Priority Health Choice Medicaid	$876.28
Rate for Payer: Priority Health Cigna Priority Health	$2,223.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,087.54
Rate for Payer: Priority Health Narrow Network	$2,087.54
Rate for Payer: Priority Health SBD	$2,087.54
Rate for Payer: UMR Bronson Commercial	$1,460.96

PR ARTHRODESIS SUBTALAR

Professional

Both

$3,212.00

Service Code	HCPCS 28725
Min. Negotiated Rate	$501.83
Max. Negotiated Rate	$2,248.40
Rate for Payer: Aetna Commercial	$1,034.26
Rate for Payer: BCBS Complete	$526.92
Rate for Payer: BCBS Trust/PPO	$526.19
Rate for Payer: Cash Price	$2,569.60
Rate for Payer: Cash Price	$2,569.60
Rate for Payer: Meridian Medicaid	$526.92
Rate for Payer: Priority Health Choice Medicaid	$501.83
Rate for Payer: Priority Health Cigna Priority Health	$2,248.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,189.81
Rate for Payer: Priority Health Narrow Network	$1,189.81
Rate for Payer: Priority Health SBD	$1,189.81
Rate for Payer: UMR Bronson Commercial	$1,477.52

PR ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT

Professional

Both

$1,474.00

Service Code	HCPCS 27282
Min. Negotiated Rate	$555.72
Max. Negotiated Rate	$2,399.54
Rate for Payer: Aetna Commercial	$1,146.38
Rate for Payer: BCBS Complete	$583.51
Rate for Payer: BCBS Trust/PPO	$2,399.54
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Meridian Medicaid	$583.51
Rate for Payer: Priority Health Choice Medicaid	$555.72
Rate for Payer: Priority Health Cigna Priority Health	$1,031.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,322.07
Rate for Payer: Priority Health Narrow Network	$1,322.07
Rate for Payer: Priority Health SBD	$1,322.07
Rate for Payer: UMR Bronson Commercial	$678.04

PR ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL

Professional

Both

$2,946.00

Service Code	HCPCS 27871
Min. Negotiated Rate	$446.87
Max. Negotiated Rate	$2,282.01
Rate for Payer: Aetna Commercial	$918.06
Rate for Payer: BCBS Complete	$469.21
Rate for Payer: BCBS Trust/PPO	$2,282.01
Rate for Payer: Cash Price	$2,356.80
Rate for Payer: Cash Price	$2,356.80
Rate for Payer: Meridian Medicaid	$469.21
Rate for Payer: Priority Health Choice Medicaid	$446.87
Rate for Payer: Priority Health Cigna Priority Health	$2,062.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,062.66
Rate for Payer: Priority Health Narrow Network	$1,062.66
Rate for Payer: Priority Health SBD	$1,062.66
Rate for Payer: UMR Bronson Commercial	$1,355.16

PR ARTHRODESIS TRIPLE

Professional

Both

$4,004.00

Service Code	HCPCS 28715
Min. Negotiated Rate	$604.71
Max. Negotiated Rate	$2,802.80
Rate for Payer: Aetna Commercial	$1,252.63
Rate for Payer: BCBS Complete	$634.95
Rate for Payer: BCBS Trust/PPO	$1,099.92
Rate for Payer: Cash Price	$3,203.20
Rate for Payer: Cash Price	$3,203.20
Rate for Payer: Meridian Medicaid	$634.95
Rate for Payer: Priority Health Choice Medicaid	$604.71
Rate for Payer: Priority Health Cigna Priority Health	$2,802.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,438.50
Rate for Payer: Priority Health Narrow Network	$1,438.50
Rate for Payer: Priority Health SBD	$1,438.50
Rate for Payer: UMR Bronson Commercial	$1,841.84

PR ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT

Professional

Both

$2,411.00

Service Code	HCPCS 25800
Min. Negotiated Rate	$473.50
Max. Negotiated Rate	$1,687.70
Rate for Payer: Aetna Commercial	$976.75
Rate for Payer: BCBS Complete	$497.18
Rate for Payer: BCBS Trust/PPO	$1,424.30
Rate for Payer: Cash Price	$1,928.80
Rate for Payer: Cash Price	$1,928.80
Rate for Payer: Meridian Medicaid	$497.18
Rate for Payer: Priority Health Choice Medicaid	$473.50
Rate for Payer: Priority Health Cigna Priority Health	$1,687.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,128.54
Rate for Payer: Priority Health Narrow Network	$1,128.54
Rate for Payer: Priority Health SBD	$1,128.54
Rate for Payer: UMR Bronson Commercial	$1,109.06

PR ARTHRODESIS WRIST LIMITED W/AUTOGRAFT

Professional

Both

$13,812.00

Service Code	HCPCS 25825
Min. Negotiated Rate	$514.18
Max. Negotiated Rate	$9,668.40
Rate for Payer: Aetna Commercial	$1,048.19
Rate for Payer: BCBS Complete	$539.89
Rate for Payer: BCBS Trust/PPO	$1,865.96
Rate for Payer: Cash Price	$11,049.60
Rate for Payer: Cash Price	$11,049.60
Rate for Payer: Meridian Medicaid	$539.89
Rate for Payer: Priority Health Choice Medicaid	$514.18
Rate for Payer: Priority Health Cigna Priority Health	$9,668.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,225.04
Rate for Payer: Priority Health Narrow Network	$1,225.04
Rate for Payer: Priority Health SBD	$1,225.04
Rate for Payer: UMR Bronson Commercial	$6,353.52

PR ARTHRODESIS WRIST LIMITED W/O BONE GRAFT

Professional

Both

$2,781.00

Service Code	HCPCS 25820
Min. Negotiated Rate	$421.53
Max. Negotiated Rate	$1,946.70
Rate for Payer: Aetna Commercial	$857.48
Rate for Payer: BCBS Complete	$442.61
Rate for Payer: BCBS Trust/PPO	$1,840.07
Rate for Payer: Cash Price	$2,224.80
Rate for Payer: Cash Price	$2,224.80
Rate for Payer: Meridian Medicaid	$442.61
Rate for Payer: Priority Health Choice Medicaid	$421.53
Rate for Payer: Priority Health Cigna Priority Health	$1,946.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,005.47
Rate for Payer: Priority Health Narrow Network	$1,005.47
Rate for Payer: Priority Health SBD	$1,005.47
Rate for Payer: UMR Bronson Commercial	$1,279.26

PR ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT

Professional

Both

$3,345.00

Service Code	HCPCS 25810
Min. Negotiated Rate	$561.04
Max. Negotiated Rate	$2,341.50
Rate for Payer: Aetna Commercial	$1,152.99
Rate for Payer: BCBS Complete	$589.09
Rate for Payer: BCBS Trust/PPO	$1,598.11
Rate for Payer: Cash Price	$2,676.00
Rate for Payer: Cash Price	$2,676.00
Rate for Payer: Meridian Medicaid	$589.09
Rate for Payer: Priority Health Choice Medicaid	$561.04
Rate for Payer: Priority Health Cigna Priority Health	$2,341.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,333.81
Rate for Payer: Priority Health Narrow Network	$1,333.81
Rate for Payer: Priority Health SBD	$1,333.81
Rate for Payer: UMR Bronson Commercial	$1,538.70

PR ARTHRODESIS WRIST W/SLIDING GRAFT

Professional

Both

$2,917.00

Service Code	HCPCS 25805
Min. Negotiated Rate	$548.48
Max. Negotiated Rate	$2,041.90
Rate for Payer: Aetna Commercial	$1,131.59
Rate for Payer: BCBS Complete	$575.90
Rate for Payer: BCBS Trust/PPO	$1,451.24
Rate for Payer: Cash Price	$2,333.60
Rate for Payer: Cash Price	$2,333.60
Rate for Payer: Meridian Medicaid	$575.90
Rate for Payer: Priority Health Choice Medicaid	$548.48
Rate for Payer: Priority Health Cigna Priority Health	$2,041.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,304.20
Rate for Payer: Priority Health Narrow Network	$1,304.20
Rate for Payer: Priority Health SBD	$1,304.20
Rate for Payer: UMR Bronson Commercial	$1,341.82

PR ARTHRO, LOOSE BODY + CHONDRO

Professional

Both

$222.00

Service Code	HCPCS G0289
Hospital Charge Code	G0289
Min. Negotiated Rate	$85.90
Max. Negotiated Rate	$561.05
Rate for Payer: Aetna Commercial	$85.90
Rate for Payer: BCBS Complete	$88.80
Rate for Payer: BCBS Trust/PPO	$561.05
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Priority Health Cigna Priority Health	$155.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.19
Rate for Payer: Priority Health Narrow Network	$129.19
Rate for Payer: Priority Health SBD	$129.19
Rate for Payer: UMR Bronson Commercial	$102.12

PR ARTHRO, LOOSE BODY + CHONDRO

Facility

$222.00

Service Code	HCPCS G0289
Hospital Charge Code	G0289
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna American Axle	$144.30
Rate for Payer: Aetna Commercial	$188.70
Rate for Payer: Aetna New Business (MI Preferred)	$144.30
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cofinity Commercial	$155.40
Rate for Payer: Cofinity Commercial	$190.92
Rate for Payer: Encore Health Key Benefits Commercial	$177.60
Rate for Payer: Healthscope Commercial	$199.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$155.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$166.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.70
Rate for Payer: PHP Commercial	$188.70
Rate for Payer: Priority Health Cigna Priority Health	$155.40
Rate for Payer: Priority Health SBD	$139.86
Rate for Payer: UMR Bronson Commercial	$97.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$166.50

Know your out-of-pocket cost for care.

All Charges