Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,358.00

Service Code	HCPCS 47420
Min. Negotiated Rate	$855.62
Max. Negotiated Rate	$2,338.95
Rate for Payer: Aetna Commercial	$1,804.45
Rate for Payer: BCBS Complete	$898.40
Rate for Payer: BCBS Trust/PPO	$1,478.71
Rate for Payer: Cash Price	$1,886.40
Rate for Payer: Cash Price	$1,886.40
Rate for Payer: Meridian Medicaid	$898.40
Rate for Payer: Priority Health Choice Medicaid	$855.62
Rate for Payer: Priority Health Cigna Priority Health	$1,650.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,338.95
Rate for Payer: Priority Health Narrow Network	$2,338.95
Rate for Payer: Priority Health SBD	$2,338.95
Rate for Payer: UMR Bronson Commercial	$1,084.68

PR CHOLERA IMMUNIZATION,INJECTABLE

Professional

Both

$12.00

Service Code	HCPCS 90725
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$8.40
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: UMR Bronson Commercial	$5.52

PR CHOLINESTERASE INHIBITOR CHALLENGE TEST

Professional

Both

$158.00

Service Code	HCPCS 95857
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$220.30
Rate for Payer: Aetna Commercial	$32.57
Rate for Payer: BCBS Complete	$18.78
Rate for Payer: BCBS Trust/PPO	$220.30
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Meridian Medicaid	$18.78
Rate for Payer: Priority Health Choice Medicaid	$17.89
Rate for Payer: Priority Health Cigna Priority Health	$110.60
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	$72.68

PR CHORIONIC VILLUS SAMPLING

Professional

Both

$390.00

Service Code	HCPCS 59015
Min. Negotiated Rate	$84.14
Max. Negotiated Rate	$273.00
Rate for Payer: Aetna Commercial	$144.10
Rate for Payer: BCBS Complete	$88.35
Rate for Payer: BCBS Trust/PPO	$143.17
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Meridian Medicaid	$88.35
Rate for Payer: Priority Health Choice Medicaid	$84.14
Rate for Payer: Priority Health Cigna Priority Health	$273.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.62
Rate for Payer: Priority Health Narrow Network	$184.62
Rate for Payer: Priority Health SBD	$184.62
Rate for Payer: UMR Bronson Commercial	$179.40

PR CHROMOTUBATION OVIDUCT W/MATERIALS

Professional

Both

$200.00

Service Code	HCPCS 58350
Min. Negotiated Rate	$61.34
Max. Negotiated Rate	$508.22
Rate for Payer: Aetna Commercial	$108.54
Rate for Payer: BCBS Complete	$64.41
Rate for Payer: BCBS Trust/PPO	$508.22
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Meridian Medicaid	$64.41
Rate for Payer: Priority Health Choice Medicaid	$61.34
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$136.35
Rate for Payer: Priority Health Narrow Network	$136.35
Rate for Payer: Priority Health SBD	$136.35
Rate for Payer: UMR Bronson Commercial	$92.00

PR CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE

Professional

Both

$3,466.00

Service Code	HCPCS 24940
Min. Negotiated Rate	$602.42
Max. Negotiated Rate	$2,426.20
Rate for Payer: Aetna Commercial	$1,439.82
Rate for Payer: BCBS Complete	$632.54
Rate for Payer: BCBS Trust/PPO	$730.11
Rate for Payer: Cash Price	$2,772.80
Rate for Payer: Cash Price	$2,772.80
Rate for Payer: Meridian Medicaid	$632.54
Rate for Payer: Priority Health Choice Medicaid	$602.42
Rate for Payer: Priority Health Cigna Priority Health	$2,426.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,668.80
Rate for Payer: Priority Health Narrow Network	$1,668.80
Rate for Payer: Priority Health SBD	$1,668.80
Rate for Payer: UMR Bronson Commercial	$1,594.36

PR CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT

Professional

Both

$633.00

Service Code	HCPCS 94772
Min. Negotiated Rate	$166.63
Max. Negotiated Rate	$518.79
Rate for Payer: Aetna Commercial	$318.52
Rate for Payer: BCBS Complete	$253.20
Rate for Payer: BCBS Trust/PPO	$518.79
Rate for Payer: Cash Price	$506.40
Rate for Payer: Cash Price	$506.40
Rate for Payer: Priority Health Cigna Priority Health	$443.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$166.63
Rate for Payer: Priority Health Narrow Network	$166.63
Rate for Payer: Priority Health SBD	$417.25
Rate for Payer: UMR Bronson Commercial	$291.18

PR CIRCUMCISION AGE >28 DAYS

Facility

$1,513.00

Service Code	CPT 54161
Hospital Charge Code	54161
Hospital Revenue Code	960
Min. Negotiated Rate	$665.72
Max. Negotiated Rate	$1,361.70
Rate for Payer: Aetna American Axle	$983.45
Rate for Payer: Aetna Commercial	$1,286.05
Rate for Payer: Aetna New Business (MI Preferred)	$983.45
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Cofinity Commercial	$1,059.10
Rate for Payer: Cofinity Commercial	$1,301.18
Rate for Payer: Encore Health Key Benefits Commercial	$1,210.40
Rate for Payer: Healthscope Commercial	$1,361.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,059.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,134.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,286.05
Rate for Payer: PHP Commercial	$1,286.05
Rate for Payer: Priority Health Cigna Priority Health	$1,059.10
Rate for Payer: Priority Health SBD	$953.19
Rate for Payer: UMR Bronson Commercial	$665.72
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,134.75

PR CIRCUMCISION AGE >28 DAYS

Facility

$1,513.00

Service Code	CPT 54161
Hospital Charge Code	54161
Hospital Revenue Code	960
Min. Negotiated Rate	$193.85
Max. Negotiated Rate	$5,699.47
Rate for Payer: Aetna American Axle	$983.45
Rate for Payer: Aetna Commercial	$1,286.05
Rate for Payer: Aetna Medicare	$1,882.90
Rate for Payer: Aetna New Business (MI Preferred)	$983.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,263.10
Rate for Payer: Amish Plain Church Group Commercial	$2,263.10
Rate for Payer: BCBS Complete	$1,039.94
Rate for Payer: BCBS MAPPO	$1,810.48
Rate for Payer: BCBS Trust/PPO	$2,840.75
Rate for Payer: BCN Medicare Advantage	$1,810.48
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Cofinity Commercial	$1,059.10
Rate for Payer: Cofinity Commercial	$1,301.18
Rate for Payer: Encore Health Key Benefits Commercial	$1,210.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,810.48
Rate for Payer: Healthscope Commercial	$1,361.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,059.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,134.75
Rate for Payer: Mclaren Medicaid	$990.33
Rate for Payer: Mclaren Medicare	$1,810.48
Rate for Payer: Meridian Medicaid	$1,039.94
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,901.00
Rate for Payer: MI Amish Medical Board Commercial	$2,082.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,286.05
Rate for Payer: PACE Medicare	$1,719.96
Rate for Payer: PACE SWMI	$1,810.48
Rate for Payer: PHP Commercial	$1,286.05
Rate for Payer: PHP Medicare Advantage	$1,810.48
Rate for Payer: Priority Health Choice Medicaid	$990.33
Rate for Payer: Priority Health Cigna Priority Health	$1,059.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,699.47
Rate for Payer: Priority Health Medicare	$1,810.48
Rate for Payer: Priority Health Narrow Network	$4,559.58
Rate for Payer: Priority Health SBD	$953.19
Rate for Payer: Railroad Medicare Medicare	$1,810.48
Rate for Payer: UHC All Payor (Choice/PPO)	$213.24
Rate for Payer: UHC Dual Complete DSNP	$1,810.48
Rate for Payer: UHC Exchange	$193.85
Rate for Payer: UHC Medicare Advantage	$1,864.79
Rate for Payer: UMR Bronson Commercial	$559.81
Rate for Payer: VA VA	$1,810.48
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,134.75

PR CIRCUMCISION AGE >28 DAYS

Professional

Both

$1,513.00

Service Code	HCPCS 54161
Min. Negotiated Rate	$126.10
Max. Negotiated Rate	$1,059.10
Rate for Payer: Aetna Commercial	$252.22
Rate for Payer: BCBS Complete	$132.40
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Meridian Medicaid	$132.40
Rate for Payer: Priority Health Choice Medicaid	$126.10
Rate for Payer: Priority Health Cigna Priority Health	$1,059.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$315.57
Rate for Payer: Priority Health Narrow Network	$315.57
Rate for Payer: Priority Health SBD	$315.57
Rate for Payer: UMR Bronson Commercial	$695.98

PR CIRCUMCISION AGE >28 DAYS

Professional

Both

$1,513.00

Service Code	HCPCS 54161
Hospital Charge Code	54161
Min. Negotiated Rate	$126.10
Max. Negotiated Rate	$1,059.10
Rate for Payer: Aetna Commercial	$252.22
Rate for Payer: BCBS Complete	$132.40
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Meridian Medicaid	$132.40
Rate for Payer: Priority Health Choice Medicaid	$126.10
Rate for Payer: Priority Health Cigna Priority Health	$1,059.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$315.57
Rate for Payer: Priority Health Narrow Network	$315.57
Rate for Payer: Priority Health SBD	$315.57
Rate for Payer: UMR Bronson Commercial	$695.98

PR CIRCUMCISION NEONATE

Professional

Both

$594.00

Service Code	HCPCS 54160
Min. Negotiated Rate	$92.87
Max. Negotiated Rate	$2,797.35
Rate for Payer: Aetna Commercial	$185.88
Rate for Payer: BCBS Complete	$97.51
Rate for Payer: BCBS Trust/PPO	$2,797.35
Rate for Payer: Cash Price	$475.20
Rate for Payer: Cash Price	$475.20
Rate for Payer: Meridian Medicaid	$97.51
Rate for Payer: Priority Health Choice Medicaid	$92.87
Rate for Payer: Priority Health Cigna Priority Health	$415.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$232.35
Rate for Payer: Priority Health Narrow Network	$232.35
Rate for Payer: Priority Health SBD	$232.35
Rate for Payer: UMR Bronson Commercial	$273.24

PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK

Professional

Both

$511.00

Service Code	HCPCS 54150
Min. Negotiated Rate	$60.71
Max. Negotiated Rate	$1,797.28
Rate for Payer: Aetna Commercial	$125.80
Rate for Payer: BCBS Complete	$63.75
Rate for Payer: BCBS Trust/PPO	$1,797.28
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Meridian Medicaid	$63.75
Rate for Payer: Priority Health Choice Medicaid	$60.71
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.00
Rate for Payer: Priority Health Narrow Network	$154.00
Rate for Payer: Priority Health SBD	$154.00
Rate for Payer: UMR Bronson Commercial	$235.06

PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX

Professional

Both

$470.00

Service Code	HCPCS 61050
Min. Negotiated Rate	$50.48
Max. Negotiated Rate	$519.32
Rate for Payer: Aetna Commercial	$105.74
Rate for Payer: BCBS Complete	$53.00
Rate for Payer: BCBS Trust/PPO	$519.32
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cash Price	$376.00
Rate for Payer: Meridian Medicaid	$53.00
Rate for Payer: Priority Health Choice Medicaid	$50.48
Rate for Payer: Priority Health Cigna Priority Health	$329.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.19
Rate for Payer: Priority Health Narrow Network	$134.19
Rate for Payer: Priority Health SBD	$134.19
Rate for Payer: UMR Bronson Commercial	$216.20

PR CLAVICULECTOMY PARTIAL

Professional

Both

$1,071.00

Service Code	HCPCS 23120
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$907.93
Rate for Payer: Aetna Commercial	$781.06
Rate for Payer: BCBS Complete	$402.57
Rate for Payer: BCBS Trust/PPO	$34.34
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cash Price	$856.80
Rate for Payer: Meridian Medicaid	$402.57
Rate for Payer: Priority Health Choice Medicaid	$383.40
Rate for Payer: Priority Health Cigna Priority Health	$749.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$907.93
Rate for Payer: Priority Health Narrow Network	$907.93
Rate for Payer: Priority Health SBD	$907.93
Rate for Payer: UMR Bronson Commercial	$492.66

PR CLAVICULECTOMY TOTAL

Professional

Both

$1,568.00

Service Code	HCPCS 23125
Min. Negotiated Rate	$44.38
Max. Negotiated Rate	$1,097.60
Rate for Payer: Aetna Commercial	$947.74
Rate for Payer: BCBS Complete	$483.76
Rate for Payer: BCBS Trust/PPO	$44.38
Rate for Payer: Cash Price	$1,254.40
Rate for Payer: Cash Price	$1,254.40
Rate for Payer: Meridian Medicaid	$483.76
Rate for Payer: Priority Health Choice Medicaid	$460.72
Rate for Payer: Priority Health Cigna Priority Health	$1,097.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,094.32
Rate for Payer: Priority Health Narrow Network	$1,094.32
Rate for Payer: Priority Health SBD	$1,094.32
Rate for Payer: UMR Bronson Commercial	$721.28

PR CLOSED RX PELVIC RING FX/SUBLUX

Professional

Both

$951.00

Service Code	HCPCS 27193
Min. Negotiated Rate	$380.40
Max. Negotiated Rate	$665.70
Rate for Payer: BCBS Complete	$380.40
Rate for Payer: Cash Price	$760.80
Rate for Payer: Priority Health Cigna Priority Health	$665.70
Rate for Payer: UMR Bronson Commercial	$437.46

PR CLOSED RX PELV RING FX/SUBLUX,MANIP

Professional

Both

$1,903.00

Service Code	HCPCS 27194
Min. Negotiated Rate	$761.20
Max. Negotiated Rate	$1,332.10
Rate for Payer: BCBS Complete	$761.20
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Priority Health Cigna Priority Health	$1,332.10
Rate for Payer: UMR Bronson Commercial	$875.38

PR CLOSED RX RIB FRACTURE

Professional

Both

$220.00

Service Code	HCPCS 21800
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$154.00
Rate for Payer: BCBS Complete	$88.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Priority Health Cigna Priority Health	$154.00
Rate for Payer: UMR Bronson Commercial	$101.20

PR CLOSED TREATMENT COCCYGEAL FRACTURE

Professional

Both

$382.00

Service Code	HCPCS 27200
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$1,904.52
Rate for Payer: Aetna Commercial	$246.94
Rate for Payer: BCBS Complete	$133.74
Rate for Payer: BCBS Trust/PPO	$1,904.52
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cash Price	$305.60
Rate for Payer: Meridian Medicaid	$133.74
Rate for Payer: Priority Health Choice Medicaid	$127.37
Rate for Payer: Priority Health Cigna Priority Health	$267.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$294.65
Rate for Payer: Priority Health Narrow Network	$294.65
Rate for Payer: Priority Health SBD	$294.65
Rate for Payer: UMR Bronson Commercial	$175.72

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ

Professional

Both

$750.00

Service Code	HCPCS 27768
Min. Negotiated Rate	$295.64
Max. Negotiated Rate	$3,241.12
Rate for Payer: Aetna Commercial	$593.02
Rate for Payer: BCBS Complete	$310.42
Rate for Payer: BCBS Trust/PPO	$3,241.12
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Meridian Medicaid	$310.42
Rate for Payer: Priority Health Choice Medicaid	$295.64
Rate for Payer: Priority Health Cigna Priority Health	$525.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$697.55
Rate for Payer: Priority Health Narrow Network	$697.55
Rate for Payer: Priority Health SBD	$697.55
Rate for Payer: UMR Bronson Commercial	$345.00

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ

Professional

Both

$713.00

Service Code	HCPCS 27767
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$563.09
Rate for Payer: Aetna Commercial	$380.80
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCBS Trust/PPO	$563.09
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$570.40
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health	$499.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$455.49
Rate for Payer: Priority Health Narrow Network	$455.49
Rate for Payer: Priority Health SBD	$455.49
Rate for Payer: UMR Bronson Commercial	$327.98

PR CLOSED TREATMENT SESAMOID FRACTURE

Professional

Both

$345.00

Service Code	HCPCS 28530
Min. Negotiated Rate	$67.31
Max. Negotiated Rate	$1,243.09
Rate for Payer: Aetna Commercial	$129.88
Rate for Payer: BCBS Complete	$70.68
Rate for Payer: BCBS Trust/PPO	$1,243.09
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Meridian Medicaid	$70.68
Rate for Payer: Priority Health Choice Medicaid	$67.31
Rate for Payer: Priority Health Cigna Priority Health	$241.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.24
Rate for Payer: Priority Health Narrow Network	$155.24
Rate for Payer: Priority Health SBD	$155.24
Rate for Payer: UMR Bronson Commercial	$158.70

PR CLOSED TREATMENT STERNUM FRACTURE

Professional

Both

$190.00

Service Code	HCPCS 21820
Min. Negotiated Rate	$87.40
Max. Negotiated Rate	$230.81
Rate for Payer: Aetna Commercial	$191.49
Rate for Payer: BCBS Complete	$103.10
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Meridian Medicaid	$103.10
Rate for Payer: Priority Health Choice Medicaid	$98.19
Rate for Payer: Priority Health Cigna Priority Health	$133.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$230.81
Rate for Payer: Priority Health Narrow Network	$230.81
Rate for Payer: Priority Health SBD	$230.81
Rate for Payer: UMR Bronson Commercial	$87.40

PR CLOSED TREATMENT ULNAR STYLOID FRACTURE

Professional

Both

$817.00

Service Code	HCPCS 25650
Min. Negotiated Rate	$204.05
Max. Negotiated Rate	$1,117.88
Rate for Payer: Aetna Commercial	$404.75
Rate for Payer: BCBS Complete	$214.25
Rate for Payer: BCBS Trust/PPO	$1,117.88
Rate for Payer: Cash Price	$653.60
Rate for Payer: Cash Price	$653.60
Rate for Payer: Meridian Medicaid	$214.25
Rate for Payer: Priority Health Choice Medicaid	$204.05
Rate for Payer: Priority Health Cigna Priority Health	$571.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$483.07
Rate for Payer: Priority Health Narrow Network	$483.07
Rate for Payer: Priority Health SBD	$483.07
Rate for Payer: UMR Bronson Commercial	$375.82

Know your out-of-pocket cost for care.

All Charges