Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CERVICAL CAP CONTRACEPTIVE

Professional

Both

$100.00

Service Code	HCPCS A4261
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$1,481.35
Rate for Payer: Aetna Commercial	$26.50
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Trust/PPO	$1,481.35
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: UMR Bronson Commercial	$46.00

PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ

Professional

Both

$3,917.00

Service Code	HCPCS 38724
Min. Negotiated Rate	$928.68
Max. Negotiated Rate	$3,145.81
Rate for Payer: Aetna Commercial	$1,778.47
Rate for Payer: BCBS Complete	$975.11
Rate for Payer: BCBS Trust/PPO	$1,321.28
Rate for Payer: Cash Price	$3,133.60
Rate for Payer: Cash Price	$3,133.60
Rate for Payer: Meridian Medicaid	$975.11
Rate for Payer: Priority Health Choice Medicaid	$928.68
Rate for Payer: Priority Health Cigna Priority Health	$2,741.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,145.81
Rate for Payer: Priority Health Narrow Network	$3,145.81
Rate for Payer: Priority Health SBD	$3,145.81
Rate for Payer: UMR Bronson Commercial	$1,801.82

PR CERVICAL LYMPHADENECTOMY

Professional

Both

$2,396.00

Service Code	HCPCS 38720
Min. Negotiated Rate	$671.47
Max. Negotiated Rate	$2,903.16
Rate for Payer: Aetna Commercial	$1,646.91
Rate for Payer: BCBS Complete	$903.55
Rate for Payer: BCBS Trust/PPO	$671.47
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Meridian Medicaid	$903.55
Rate for Payer: Priority Health Choice Medicaid	$860.52
Rate for Payer: Priority Health Cigna Priority Health	$1,677.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,903.16
Rate for Payer: Priority Health Narrow Network	$2,903.16
Rate for Payer: Priority Health SBD	$2,903.16
Rate for Payer: UMR Bronson Commercial	$1,102.16

PR CESAREAN DELIVERY ATTEMPTED VBAC

Professional

Both

$2,450.00

Service Code	HCPCS 59620
Min. Negotiated Rate	$873.68
Max. Negotiated Rate	$1,715.00
Rate for Payer: Aetna Commercial	$1,034.69
Rate for Payer: BCBS Complete	$917.36
Rate for Payer: BCBS Trust/PPO	$1,066.64
Rate for Payer: Cash Price	$1,960.00
Rate for Payer: Cash Price	$1,960.00
Rate for Payer: Meridian Medicaid	$917.36
Rate for Payer: Priority Health Choice Medicaid	$873.68
Rate for Payer: Priority Health Cigna Priority Health	$1,715.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,325.39
Rate for Payer: Priority Health Narrow Network	$1,325.39
Rate for Payer: Priority Health SBD	$1,325.39
Rate for Payer: UMR Bronson Commercial	$1,127.00

PR CESAREAN DELIVERY ONLY

Professional

Both

$2,275.00

Service Code	HCPCS 59514
Min. Negotiated Rate	$164.30
Max. Negotiated Rate	$1,592.50
Rate for Payer: Aetna Commercial	$1,001.86
Rate for Payer: BCBS Complete	$884.87
Rate for Payer: BCBS Trust/PPO	$164.30
Rate for Payer: Cash Price	$1,820.00
Rate for Payer: Cash Price	$1,820.00
Rate for Payer: Meridian Medicaid	$884.87
Rate for Payer: Priority Health Choice Medicaid	$842.73
Rate for Payer: Priority Health Cigna Priority Health	$1,592.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,281.01
Rate for Payer: Priority Health Narrow Network	$1,281.01
Rate for Payer: Priority Health SBD	$1,281.01
Rate for Payer: UMR Bronson Commercial	$1,046.50

PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE

Professional

Both

$2,542.00

Service Code	HCPCS 59515
Min. Negotiated Rate	$181.74
Max. Negotiated Rate	$1,844.78
Rate for Payer: Aetna Commercial	$1,434.55
Rate for Payer: BCBS Complete	$1,307.82
Rate for Payer: BCBS Trust/PPO	$181.74
Rate for Payer: Cash Price	$2,033.60
Rate for Payer: Cash Price	$2,033.60
Rate for Payer: Meridian Medicaid	$1,307.82
Rate for Payer: Priority Health Choice Medicaid	$1,245.54
Rate for Payer: Priority Health Cigna Priority Health	$1,779.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,844.78
Rate for Payer: Priority Health Narrow Network	$1,844.78
Rate for Payer: Priority Health SBD	$1,844.78
Rate for Payer: UMR Bronson Commercial	$1,169.32

PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA

Professional

Both

$2,717.00

Service Code	HCPCS 59622
Min. Negotiated Rate	$1,128.98
Max. Negotiated Rate	$1,915.60
Rate for Payer: Aetna Commercial	$1,484.84
Rate for Payer: BCBS Complete	$1,355.37
Rate for Payer: BCBS Trust/PPO	$1,128.98
Rate for Payer: Cash Price	$2,173.60
Rate for Payer: Cash Price	$2,173.60
Rate for Payer: Meridian Medicaid	$1,355.37
Rate for Payer: Priority Health Choice Medicaid	$1,290.83
Rate for Payer: Priority Health Cigna Priority Health	$1,901.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,915.60
Rate for Payer: Priority Health Narrow Network	$1,915.60
Rate for Payer: Priority Health SBD	$1,915.60
Rate for Payer: UMR Bronson Commercial	$1,249.82

PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL

Professional

Both

$242.00

Service Code	HCPCS 37214
Min. Negotiated Rate	$75.62
Max. Negotiated Rate	$705.28
Rate for Payer: Aetna Commercial	$164.52
Rate for Payer: BCBS Complete	$79.40
Rate for Payer: BCBS Trust/PPO	$705.28
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Meridian Medicaid	$79.40
Rate for Payer: Priority Health Choice Medicaid	$75.62
Rate for Payer: Priority Health Cigna Priority Health	$169.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.38
Rate for Payer: Priority Health Narrow Network	$189.38
Rate for Payer: Priority Health SBD	$189.38
Rate for Payer: UMR Bronson Commercial	$111.32

PR CHANGE CYSTOSTOMY TUBE COMPLICATED

Professional

Both

$334.00

Service Code	HCPCS 51710
Min. Negotiated Rate	$50.91
Max. Negotiated Rate	$2,051.39
Rate for Payer: Aetna Commercial	$100.96
Rate for Payer: BCBS Complete	$53.46
Rate for Payer: BCBS Trust/PPO	$2,051.39
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Meridian Medicaid	$53.46
Rate for Payer: Priority Health Choice Medicaid	$50.91
Rate for Payer: Priority Health Cigna Priority Health	$233.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.52
Rate for Payer: Priority Health Narrow Network	$127.52
Rate for Payer: Priority Health SBD	$127.52
Rate for Payer: UMR Bronson Commercial	$153.64

PR CHANGE CYSTOSTOMY TUBE SIMPLE

Professional

Both

$194.00

Service Code	HCPCS 51705
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$1,992.75
Rate for Payer: Aetna Commercial	$65.96
Rate for Payer: BCBS Complete	$34.44
Rate for Payer: BCBS Trust/PPO	$1,992.75
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Meridian Medicaid	$34.44
Rate for Payer: Priority Health Choice Medicaid	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.14
Rate for Payer: Priority Health Narrow Network	$82.14
Rate for Payer: Priority Health SBD	$82.14
Rate for Payer: UMR Bronson Commercial	$89.24

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Facility

$819.00

Service Code	CPT 43760
Hospital Charge Code	43760
Hospital Revenue Code	960
Min. Negotiated Rate	$303.03
Max. Negotiated Rate	$737.10
Rate for Payer: Aetna American Axle	$532.35
Rate for Payer: Aetna Commercial	$696.15
Rate for Payer: Aetna New Business (MI Preferred)	$532.35
Rate for Payer: BCBS Complete	$327.60
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cofinity Commercial	$573.30
Rate for Payer: Cofinity Commercial	$704.34
Rate for Payer: Encore Health Key Benefits Commercial	$655.20
Rate for Payer: Healthscope Commercial	$737.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$573.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$614.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.15
Rate for Payer: PHP Commercial	$696.15
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health SBD	$515.97
Rate for Payer: UMR Bronson Commercial	$303.03
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$614.25

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Facility

$819.00

Service Code	CPT 43760
Hospital Charge Code	43760
Hospital Revenue Code	960
Min. Negotiated Rate	$360.36
Max. Negotiated Rate	$737.10
Rate for Payer: Aetna American Axle	$532.35
Rate for Payer: Aetna Commercial	$696.15
Rate for Payer: Aetna New Business (MI Preferred)	$532.35
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cofinity Commercial	$573.30
Rate for Payer: Cofinity Commercial	$704.34
Rate for Payer: Encore Health Key Benefits Commercial	$655.20
Rate for Payer: Healthscope Commercial	$737.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$573.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$614.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.15
Rate for Payer: PHP Commercial	$696.15
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health SBD	$515.97
Rate for Payer: UMR Bronson Commercial	$360.36
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$614.25

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Professional

Both

$819.00

Service Code	HCPCS 43760
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$573.30
Rate for Payer: BCBS Complete	$327.60
Rate for Payer: Cash Price	$655.20
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: UMR Bronson Commercial	$376.74

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Professional

Both

$819.00

Service Code	HCPCS 43760
Hospital Charge Code	43760
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$573.30
Rate for Payer: BCBS Complete	$327.60
Rate for Payer: Cash Price	$655.20
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: UMR Bronson Commercial	$376.74

PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE

Professional

Both

$142.00

Service Code	HCPCS 17250
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$4,160.00
Rate for Payer: Aetna Commercial	$38.93
Rate for Payer: BCBS Complete	$25.27
Rate for Payer: BCBS Trust/PPO	$4,160.00
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Meridian Medicaid	$25.27
Rate for Payer: Priority Health Choice Medicaid	$24.07
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.62
Rate for Payer: Priority Health Narrow Network	$45.62
Rate for Payer: Priority Health SBD	$45.62
Rate for Payer: UMR Bronson Commercial	$65.32

PR CHEMICAL PEEL FACIAL EPIDERMAL

Professional

Both

$874.00

Service Code	HCPCS 15788
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$611.80
Rate for Payer: Aetna Commercial	$232.57
Rate for Payer: BCBS Complete	$146.26
Rate for Payer: BCBS Trust/PPO	$25.00
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Meridian Medicaid	$146.26
Rate for Payer: Priority Health Choice Medicaid	$139.30
Rate for Payer: Priority Health Cigna Priority Health	$611.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.29
Rate for Payer: Priority Health Narrow Network	$264.29
Rate for Payer: Priority Health SBD	$264.29
Rate for Payer: UMR Bronson Commercial	$402.04

PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES

Professional

Both

$310.00

Service Code	HCPCS 64644
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$896.53
Rate for Payer: Aetna Commercial	$150.70
Rate for Payer: BCBS Complete	$77.83
Rate for Payer: BCBS Trust/PPO	$896.53
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Meridian Medicaid	$77.83
Rate for Payer: Priority Health Choice Medicaid	$74.12
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$195.35
Rate for Payer: Priority Health Narrow Network	$195.35
Rate for Payer: Priority Health SBD	$195.35
Rate for Payer: UMR Bronson Commercial	$142.60

PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE

Professional

Both

$180.00

Service Code	HCPCS 64643
Min. Negotiated Rate	$44.52
Max. Negotiated Rate	$151.09
Rate for Payer: Aetna Commercial	$91.59
Rate for Payer: BCBS Complete	$46.75
Rate for Payer: BCBS Trust/PPO	$151.09
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Meridian Medicaid	$46.75
Rate for Payer: Priority Health Choice Medicaid	$44.52
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.33
Rate for Payer: Priority Health Narrow Network	$118.33
Rate for Payer: Priority Health SBD	$118.33
Rate for Payer: UMR Bronson Commercial	$82.80

PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES

Professional

Both

$311.00

Service Code	HCPCS 64645
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$831.02
Rate for Payer: Aetna Commercial	$106.16
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCBS Trust/PPO	$831.02
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.60
Rate for Payer: Priority Health Narrow Network	$137.60
Rate for Payer: Priority Health SBD	$137.60
Rate for Payer: UMR Bronson Commercial	$143.06

PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE

Professional

Both

$460.00

Service Code	HCPCS 64614
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$322.00
Rate for Payer: BCBS Complete	$184.00
Rate for Payer: Cash Price	$368.00
Rate for Payer: Priority Health Cigna Priority Health	$322.00
Rate for Payer: UMR Bronson Commercial	$211.60

PR CHEMODENERVATION INTERNAL ANAL SPHINCTER

Professional

Both

$730.00

Service Code	HCPCS 46505
Min. Negotiated Rate	$160.82
Max. Negotiated Rate	$3,709.19
Rate for Payer: Aetna Commercial	$332.13
Rate for Payer: BCBS Complete	$168.86
Rate for Payer: BCBS Trust/PPO	$3,709.19
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Meridian Medicaid	$168.86
Rate for Payer: Priority Health Choice Medicaid	$160.82
Rate for Payer: Priority Health Cigna Priority Health	$511.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$442.74
Rate for Payer: Priority Health Narrow Network	$442.74
Rate for Payer: Priority Health SBD	$442.74
Rate for Payer: UMR Bronson Commercial	$335.80

PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG

Professional

Both

$316.00

Service Code	HCPCS 64617
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$525.13
Rate for Payer: Aetna Commercial	$138.64
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCBS Trust/PPO	$525.13
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health	$221.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.90
Rate for Payer: Priority Health Narrow Network	$182.90
Rate for Payer: Priority Health SBD	$182.90
Rate for Payer: UMR Bronson Commercial	$145.36

PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA

Professional

Both

$354.00

Service Code	HCPCS 64616
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$3,744.06
Rate for Payer: Aetna Commercial	$139.45
Rate for Payer: BCBS Complete	$74.02
Rate for Payer: BCBS Trust/PPO	$3,744.06
Rate for Payer: Cash Price	$283.20
Rate for Payer: Cash Price	$283.20
Rate for Payer: Meridian Medicaid	$74.02
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health	$247.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.02
Rate for Payer: Priority Health Narrow Network	$184.02
Rate for Payer: Priority Health SBD	$184.02
Rate for Payer: UMR Bronson Commercial	$162.84

PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES

Professional

Both

$303.00

Service Code	HCPCS 64646
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$2,036.60
Rate for Payer: Aetna Commercial	$148.68
Rate for Payer: BCBS Complete	$78.06
Rate for Payer: BCBS Trust/PPO	$2,036.60
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cash Price	$242.40
Rate for Payer: Meridian Medicaid	$78.06
Rate for Payer: Priority Health Choice Medicaid	$74.34
Rate for Payer: Priority Health Cigna Priority Health	$212.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$195.35
Rate for Payer: Priority Health Narrow Network	$195.35
Rate for Payer: Priority Health SBD	$195.35
Rate for Payer: UMR Bronson Commercial	$139.38

PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE

Professional

Both

$390.00

Service Code	HCPCS 64642
Min. Negotiated Rate	$68.59
Max. Negotiated Rate	$805.66
Rate for Payer: Aetna Commercial	$137.53
Rate for Payer: BCBS Complete	$72.02
Rate for Payer: BCBS Trust/PPO	$805.66
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Meridian Medicaid	$72.02
Rate for Payer: Priority Health Choice Medicaid	$68.59
Rate for Payer: Priority Health Cigna Priority Health	$273.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.92
Rate for Payer: Priority Health Narrow Network	$178.92
Rate for Payer: Priority Health SBD	$178.92
Rate for Payer: UMR Bronson Commercial	$179.40

Know your out-of-pocket cost for care.

All Charges