Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS

Professional

Both

$210.00

Service Code	HCPCS 64611
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$939.85
Rate for Payer: Aetna Commercial	$137.09
Rate for Payer: BCBS Complete	$76.71
Rate for Payer: BCBS Trust/PPO	$939.85
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Meridian Medicaid	$76.71
Rate for Payer: Priority Health Choice Medicaid	$73.06
Rate for Payer: Priority Health Cigna Priority Health	$147.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$188.55
Rate for Payer: Priority Health Narrow Network	$188.55
Rate for Payer: Priority Health SBD	$188.55
Rate for Payer: UMR Bronson Commercial	$96.60

PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE

Professional

Both

$410.00

Service Code	HCPCS 64615
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$2,950.03
Rate for Payer: Aetna Commercial	$158.88
Rate for Payer: BCBS Complete	$82.75
Rate for Payer: BCBS Trust/PPO	$2,950.03
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Meridian Medicaid	$82.75
Rate for Payer: Priority Health Choice Medicaid	$78.81
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$208.36
Rate for Payer: Priority Health Narrow Network	$208.36
Rate for Payer: Priority Health SBD	$208.36
Rate for Payer: UMR Bronson Commercial	$188.60

PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL

Professional

Both

$319.00

Service Code	HCPCS 64612
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$2,247.92
Rate for Payer: Aetna Commercial	$148.68
Rate for Payer: BCBS Complete	$80.51
Rate for Payer: BCBS Trust/PPO	$2,247.92
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Meridian Medicaid	$80.51
Rate for Payer: Priority Health Choice Medicaid	$76.68
Rate for Payer: Priority Health Cigna Priority Health	$223.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$200.44
Rate for Payer: Priority Health Narrow Network	$200.44
Rate for Payer: Priority Health SBD	$200.44
Rate for Payer: UMR Bronson Commercial	$146.74

PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR

Professional

Both

$130.00

Service Code	HCPCS 96415
Min. Negotiated Rate	$36.56
Max. Negotiated Rate	$1,570.64
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: BCBS Complete	$52.00
Rate for Payer: BCBS Trust/PPO	$1,570.64
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.73
Rate for Payer: Priority Health Narrow Network	$37.73
Rate for Payer: Priority Health SBD	$37.73
Rate for Payer: UMR Bronson Commercial	$59.80

PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE

Professional

Both

$719.00

Service Code	HCPCS 96450
Min. Negotiated Rate	$48.14
Max. Negotiated Rate	$889.66
Rate for Payer: Aetna Commercial	$96.12
Rate for Payer: BCBS Complete	$50.55
Rate for Payer: BCBS Trust/PPO	$889.66
Rate for Payer: Cash Price	$575.20
Rate for Payer: Cash Price	$575.20
Rate for Payer: Meridian Medicaid	$50.55
Rate for Payer: Priority Health Choice Medicaid	$48.14
Rate for Payer: Priority Health Cigna Priority Health	$503.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$101.95
Rate for Payer: Priority Health Narrow Network	$101.95
Rate for Payer: Priority Health SBD	$101.95
Rate for Payer: UMR Bronson Commercial	$330.74

PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR

Professional

Both

$129.00

Service Code	HCPCS 96417
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$82.79
Rate for Payer: BCBS Complete	$51.60
Rate for Payer: BCBS Trust/PPO	$1,846.41
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Priority Health Cigna Priority Health	$90.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.23
Rate for Payer: Priority Health Narrow Network	$86.23
Rate for Payer: Priority Health SBD	$86.23
Rate for Payer: UMR Bronson Commercial	$59.34

PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG

Professional

Both

$243.00

Service Code	HCPCS 96413
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$1,457.05
Rate for Payer: Aetna Commercial	$170.23
Rate for Payer: BCBS Complete	$97.20
Rate for Payer: BCBS Trust/PPO	$1,457.05
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Priority Health Cigna Priority Health	$170.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$175.17
Rate for Payer: Priority Health Narrow Network	$175.17
Rate for Payer: Priority Health SBD	$175.17
Rate for Payer: UMR Bronson Commercial	$111.78

PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG

Professional

Both

$203.00

Service Code	HCPCS 96409
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$1,506.18
Rate for Payer: Aetna Commercial	$130.25
Rate for Payer: BCBS Complete	$81.20
Rate for Payer: BCBS Trust/PPO	$1,506.18
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Priority Health Cigna Priority Health	$142.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.19
Rate for Payer: Priority Health Narrow Network	$135.19
Rate for Payer: Priority Health SBD	$135.19
Rate for Payer: UMR Bronson Commercial	$93.38

PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG

Professional

Both

$115.00

Service Code	HCPCS 96411
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$1,466.56
Rate for Payer: Aetna Commercial	$71.62
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: BCBS Trust/PPO	$1,466.56
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health SBD	$74.10
Rate for Payer: UMR Bronson Commercial	$52.90

PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO

Professional

Both

$81.00

Service Code	HCPCS 96402
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$1,217.73
Rate for Payer: Aetna Commercial	$38.54
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCBS Trust/PPO	$1,217.73
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$56.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.37
Rate for Payer: Priority Health Narrow Network	$45.37
Rate for Payer: Priority Health SBD	$45.37
Rate for Payer: UMR Bronson Commercial	$37.26

PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO

Professional

Both

$114.00

Service Code	HCPCS 96401
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$1,111.54
Rate for Payer: Aetna Commercial	$94.74
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS Trust/PPO	$1,111.54
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Priority Health Cigna Priority Health	$79.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.47
Rate for Payer: Priority Health Narrow Network	$97.47
Rate for Payer: Priority Health SBD	$97.47
Rate for Payer: UMR Bronson Commercial	$52.44

PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT

Professional

Both

$278.00

Service Code	HCPCS 96542
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$1,570.64
Rate for Payer: Aetna Commercial	$51.17
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$1,570.64
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$194.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.69
Rate for Payer: Priority Health Narrow Network	$55.69
Rate for Payer: Priority Health SBD	$55.69
Rate for Payer: UMR Bronson Commercial	$127.88

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS

Professional

Both

$61.00

Service Code	HCPCS 98941
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$583.77
Rate for Payer: Aetna Commercial	$29.14
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$583.77
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.92
Rate for Payer: Priority Health Narrow Network	$44.92
Rate for Payer: Priority Health SBD	$44.92
Rate for Payer: UMR Bronson Commercial	$28.06

PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL

Professional

Both

$147.00

Service Code	HCPCS 50688
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$2,900.37
Rate for Payer: Aetna Commercial	$97.34
Rate for Payer: BCBS Complete	$51.66
Rate for Payer: BCBS Trust/PPO	$2,900.37
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Meridian Medicaid	$51.66
Rate for Payer: Priority Health Choice Medicaid	$49.20
Rate for Payer: Priority Health Cigna Priority Health	$102.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.20
Rate for Payer: Priority Health Narrow Network	$123.20
Rate for Payer: Priority Health SBD	$123.20
Rate for Payer: UMR Bronson Commercial	$67.62

PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,078.00

Service Code	HCPCS 47620
Min. Negotiated Rate	$521.43
Max. Negotiated Rate	$2,414.81
Rate for Payer: Aetna Commercial	$1,866.04
Rate for Payer: BCBS Complete	$922.11
Rate for Payer: BCBS Trust/PPO	$521.43
Rate for Payer: Cash Price	$1,662.40
Rate for Payer: Cash Price	$1,662.40
Rate for Payer: Meridian Medicaid	$922.11
Rate for Payer: Priority Health Choice Medicaid	$878.20
Rate for Payer: Priority Health Cigna Priority Health	$1,454.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,414.81
Rate for Payer: Priority Health Narrow Network	$2,414.81
Rate for Payer: Priority Health SBD	$2,414.81
Rate for Payer: UMR Bronson Commercial	$955.88

PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM

Professional

Both

$2,592.00

Service Code	HCPCS 47741
Min. Negotiated Rate	$446.41
Max. Negotiated Rate	$2,592.97
Rate for Payer: Aetna Commercial	$2,001.81
Rate for Payer: BCBS Complete	$990.32
Rate for Payer: BCBS Trust/PPO	$446.41
Rate for Payer: Cash Price	$2,073.60
Rate for Payer: Cash Price	$2,073.60
Rate for Payer: Meridian Medicaid	$990.32
Rate for Payer: Priority Health Choice Medicaid	$943.16
Rate for Payer: Priority Health Cigna Priority Health	$1,814.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,592.97
Rate for Payer: Priority Health Narrow Network	$2,592.97
Rate for Payer: Priority Health SBD	$2,592.97
Rate for Payer: UMR Bronson Commercial	$1,192.32

PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX

Professional

Both

$2,572.00

Service Code	HCPCS 47480
Min. Negotiated Rate	$561.47
Max. Negotiated Rate	$1,800.40
Rate for Payer: Aetna Commercial	$1,185.52
Rate for Payer: BCBS Complete	$589.54
Rate for Payer: BCBS Trust/PPO	$1,405.28
Rate for Payer: Cash Price	$2,057.60
Rate for Payer: Cash Price	$2,057.60
Rate for Payer: Meridian Medicaid	$589.54
Rate for Payer: Priority Health Choice Medicaid	$561.47
Rate for Payer: Priority Health Cigna Priority Health	$1,800.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,544.61
Rate for Payer: Priority Health Narrow Network	$1,544.61
Rate for Payer: Priority Health SBD	$1,544.61
Rate for Payer: UMR Bronson Commercial	$1,183.12

PR CHOLECYSTECTOMY

Facility

$2,566.00

Service Code	CPT 47600
Hospital Charge Code	47600
Min. Negotiated Rate	$1,129.04
Max. Negotiated Rate	$2,309.40
Rate for Payer: Aetna American Axle	$1,667.90
Rate for Payer: Aetna Commercial	$2,181.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,667.90
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Cofinity Commercial	$1,796.20
Rate for Payer: Cofinity Commercial	$2,206.76
Rate for Payer: Encore Health Key Benefits Commercial	$2,052.80
Rate for Payer: Healthscope Commercial	$2,309.40
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,796.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,924.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,181.10
Rate for Payer: PHP Commercial	$2,181.10
Rate for Payer: Priority Health Cigna Priority Health	$1,796.20
Rate for Payer: Priority Health SBD	$1,616.58
Rate for Payer: UMR Bronson Commercial	$1,129.04
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,924.50

PR CHOLECYSTECTOMY

Professional

Both

$2,566.00

Service Code	HCPCS 47600
Hospital Charge Code	47600
Min. Negotiated Rate	$685.22
Max. Negotiated Rate	$2,558.03
Rate for Payer: Aetna Commercial	$1,444.32
Rate for Payer: BCBS Complete	$719.48
Rate for Payer: BCBS Trust/PPO	$2,558.03
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Meridian Medicaid	$719.48
Rate for Payer: Priority Health Choice Medicaid	$685.22
Rate for Payer: Priority Health Cigna Priority Health	$1,796.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,880.33
Rate for Payer: Priority Health Narrow Network	$1,880.33
Rate for Payer: Priority Health SBD	$1,880.33
Rate for Payer: UMR Bronson Commercial	$1,180.36

PR CHOLECYSTECTOMY

Professional

Both

$2,566.00

Service Code	HCPCS 47600
Min. Negotiated Rate	$685.22
Max. Negotiated Rate	$2,558.03
Rate for Payer: Aetna Commercial	$1,444.32
Rate for Payer: BCBS Complete	$719.48
Rate for Payer: BCBS Trust/PPO	$2,558.03
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Meridian Medicaid	$719.48
Rate for Payer: Priority Health Choice Medicaid	$685.22
Rate for Payer: Priority Health Cigna Priority Health	$1,796.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,880.33
Rate for Payer: Priority Health Narrow Network	$1,880.33
Rate for Payer: Priority Health SBD	$1,880.33
Rate for Payer: UMR Bronson Commercial	$1,180.36

PR CHOLECYSTECTOMY

Facility

$2,566.00

Service Code	CPT 47600
Hospital Charge Code	47600
Min. Negotiated Rate	$949.42
Max. Negotiated Rate	$3,722.43
Rate for Payer: Aetna American Axle	$1,667.90
Rate for Payer: Aetna Commercial	$2,181.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,667.90
Rate for Payer: BCBS Complete	$1,026.40
Rate for Payer: BCBS Trust/PPO	$3,722.43
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Cash Price	$2,052.80
Rate for Payer: Cofinity Commercial	$2,206.76
Rate for Payer: Cofinity Commercial	$1,796.20
Rate for Payer: Encore Health Key Benefits Commercial	$2,052.80
Rate for Payer: Healthscope Commercial	$2,309.40
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,796.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,924.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,181.10
Rate for Payer: PHP Commercial	$2,181.10
Rate for Payer: Priority Health Cigna Priority Health	$1,796.20
Rate for Payer: Priority Health SBD	$1,616.58
Rate for Payer: UHC All Payor (Choice/PPO)	$1,158.72
Rate for Payer: UHC Exchange	$1,053.38
Rate for Payer: UMR Bronson Commercial	$949.42
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,924.50

PR CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY

Professional

Both

$4,618.00

Service Code	HCPCS 47612
Min. Negotiated Rate	$676.22
Max. Negotiated Rate	$3,232.60
Rate for Payer: Aetna Commercial	$1,727.64
Rate for Payer: BCBS Complete	$854.34
Rate for Payer: BCBS Trust/PPO	$676.22
Rate for Payer: Cash Price	$3,694.40
Rate for Payer: Cash Price	$3,694.40
Rate for Payer: Meridian Medicaid	$854.34
Rate for Payer: Priority Health Choice Medicaid	$813.66
Rate for Payer: Priority Health Cigna Priority Health	$3,232.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,236.65
Rate for Payer: Priority Health Narrow Network	$2,236.65
Rate for Payer: Priority Health SBD	$2,236.65
Rate for Payer: UMR Bronson Commercial	$2,124.28

PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

Professional

Both

$2,950.00

Service Code	HCPCS 47605
Min. Negotiated Rate	$721.43
Max. Negotiated Rate	$2,065.00
Rate for Payer: Aetna Commercial	$1,522.79
Rate for Payer: BCBS Complete	$757.50
Rate for Payer: BCBS Trust/PPO	$1,918.79
Rate for Payer: Cash Price	$2,360.00
Rate for Payer: Cash Price	$2,360.00
Rate for Payer: Meridian Medicaid	$757.50
Rate for Payer: Priority Health Choice Medicaid	$721.43
Rate for Payer: Priority Health Cigna Priority Health	$2,065.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,983.24
Rate for Payer: Priority Health Narrow Network	$1,983.24
Rate for Payer: Priority Health SBD	$1,983.24
Rate for Payer: UMR Bronson Commercial	$1,357.00

PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT

Professional

Both

$3,245.00

Service Code	HCPCS 47610
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,271.50
Rate for Payer: Aetna Commercial	$1,695.84
Rate for Payer: BCBS Complete	$838.02
Rate for Payer: BCBS Trust/PPO	$141.58
Rate for Payer: Cash Price	$2,596.00
Rate for Payer: Cash Price	$2,596.00
Rate for Payer: Meridian Medicaid	$838.02
Rate for Payer: Priority Health Choice Medicaid	$798.11
Rate for Payer: Priority Health Cigna Priority Health	$2,271.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,200.79
Rate for Payer: Priority Health Narrow Network	$2,200.79
Rate for Payer: Priority Health SBD	$2,200.79
Rate for Payer: UMR Bronson Commercial	$1,492.70

PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT

Professional

Both

$664.00

Service Code	HCPCS 47490
Min. Negotiated Rate	$208.53
Max. Negotiated Rate	$4,357.95
Rate for Payer: Aetna Commercial	$438.85
Rate for Payer: BCBS Complete	$218.96
Rate for Payer: BCBS Trust/PPO	$4,357.95
Rate for Payer: Cash Price	$531.20
Rate for Payer: Cash Price	$531.20
Rate for Payer: Meridian Medicaid	$218.96
Rate for Payer: Priority Health Choice Medicaid	$208.53
Rate for Payer: Priority Health Cigna Priority Health	$464.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$577.98
Rate for Payer: Priority Health Narrow Network	$577.98
Rate for Payer: Priority Health SBD	$577.98
Rate for Payer: UMR Bronson Commercial	$305.44

Know your out-of-pocket cost for care.

All Charges