Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR COCHLEAR DEVICE/SOFT BAND FITTING FEE

Professional

Both

$500.00

Service Code	HCPCS 00593
Hospital Revenue Code	990
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$350.00
Rate for Payer: BCBS Complete	$200.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Priority Health Cigna Priority Health	$350.00
Rate for Payer: UMR Bronson Commercial	$230.00

PR COCM BY RHC/FQHC 60 MIN MO

Professional

Both

$347.00

Service Code	HCPCS G0512
Min. Negotiated Rate	$138.80
Max. Negotiated Rate	$536.22
Rate for Payer: Aetna Commercial	$148.37
Rate for Payer: BCBS Complete	$138.80
Rate for Payer: BCBS Trust/PPO	$536.22
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Priority Health Cigna Priority Health	$242.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$270.00
Rate for Payer: Priority Health Narrow Network	$270.00
Rate for Payer: Priority Health SBD	$270.00
Rate for Payer: UMR Bronson Commercial	$159.62

PR CO DIFFUSING CAPACITY

Professional

Both

$153.00

Service Code	HCPCS 94729
Min. Negotiated Rate	$11.68
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$62.31
Rate for Payer: Aetna Commercial	$62.31
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCBS Trust/PPO	$280.00
Rate for Payer: BCBS Trust/PPO	$280.00
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cash Price	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.90
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.68
Rate for Payer: Priority Health Narrow Network	$11.68
Rate for Payer: Priority Health Narrow Network	$11.68
Rate for Payer: Priority Health SBD	$75.91
Rate for Payer: Priority Health SBD	$75.91
Rate for Payer: UMR Bronson Commercial	$7.82
Rate for Payer: UMR Bronson Commercial	$70.38

PR COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST

Professional

Both

$3,765.00

Service Code	HCPCS 44151
Min. Negotiated Rate	$1,369.38
Max. Negotiated Rate	$3,767.73
Rate for Payer: Aetna Commercial	$2,916.77
Rate for Payer: BCBS Complete	$1,437.85
Rate for Payer: BCBS Trust/PPO	$1,395.77
Rate for Payer: Cash Price	$3,012.00
Rate for Payer: Cash Price	$3,012.00
Rate for Payer: Meridian Medicaid	$1,437.85
Rate for Payer: Priority Health Choice Medicaid	$1,369.38
Rate for Payer: Priority Health Cigna Priority Health	$2,635.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,767.73
Rate for Payer: Priority Health Narrow Network	$3,767.73
Rate for Payer: Priority Health SBD	$3,767.73
Rate for Payer: UMR Bronson Commercial	$1,731.90

PR COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS

Professional

Both

$4,521.00

Service Code	HCPCS 44150
Min. Negotiated Rate	$965.20
Max. Negotiated Rate	$3,240.31
Rate for Payer: Aetna Commercial	$2,499.17
Rate for Payer: BCBS Complete	$1,236.33
Rate for Payer: BCBS Trust/PPO	$965.20
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Meridian Medicaid	$1,236.33
Rate for Payer: Priority Health Choice Medicaid	$1,177.46
Rate for Payer: Priority Health Cigna Priority Health	$3,164.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,240.31
Rate for Payer: Priority Health Narrow Network	$3,240.31
Rate for Payer: Priority Health SBD	$3,240.31
Rate for Payer: UMR Bronson Commercial	$2,079.66

PR COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR

Professional

Both

$4,607.00

Service Code	HCPCS 44158
Min. Negotiated Rate	$565.81
Max. Negotiated Rate	$3,924.13
Rate for Payer: Aetna Commercial	$3,035.01
Rate for Payer: BCBS Complete	$1,498.00
Rate for Payer: BCBS Trust/PPO	$565.81
Rate for Payer: Cash Price	$3,685.60
Rate for Payer: Cash Price	$3,685.60
Rate for Payer: Meridian Medicaid	$1,498.00
Rate for Payer: Priority Health Choice Medicaid	$1,426.67
Rate for Payer: Priority Health Cigna Priority Health	$3,224.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,924.13
Rate for Payer: Priority Health Narrow Network	$3,924.13
Rate for Payer: Priority Health SBD	$3,924.13
Rate for Payer: UMR Bronson Commercial	$2,119.22

PR COLECTOMY PARTIAL W/ANASTOMOSIS

Facility

$3,798.00

Service Code	CPT 44140
Hospital Charge Code	44140
Hospital Revenue Code	960
Min. Negotiated Rate	$1,671.12
Max. Negotiated Rate	$3,418.20
Rate for Payer: Aetna American Axle	$2,468.70
Rate for Payer: Aetna Commercial	$3,228.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,468.70
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Cofinity Commercial	$2,658.60
Rate for Payer: Cofinity Commercial	$3,266.28
Rate for Payer: Encore Health Key Benefits Commercial	$3,038.40
Rate for Payer: Healthscope Commercial	$3,418.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,658.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,848.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,228.30
Rate for Payer: PHP Commercial	$3,228.30
Rate for Payer: Priority Health Cigna Priority Health	$2,658.60
Rate for Payer: Priority Health SBD	$2,392.74
Rate for Payer: UMR Bronson Commercial	$1,671.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,848.50

PR COLECTOMY PARTIAL W/ANASTOMOSIS

Professional

Both

$3,798.00

Service Code	HCPCS 44140
Hospital Charge Code	44140
Min. Negotiated Rate	$855.83
Max. Negotiated Rate	$2,658.60
Rate for Payer: Aetna Commercial	$1,809.58
Rate for Payer: BCBS Complete	$898.62
Rate for Payer: BCBS Trust/PPO	$1,076.15
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Meridian Medicaid	$898.62
Rate for Payer: Priority Health Choice Medicaid	$855.83
Rate for Payer: Priority Health Cigna Priority Health	$2,658.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,349.54
Rate for Payer: Priority Health Narrow Network	$2,349.54
Rate for Payer: Priority Health SBD	$2,349.54
Rate for Payer: UMR Bronson Commercial	$1,747.08

PR COLECTOMY PARTIAL W/ANASTOMOSIS

Facility

$3,798.00

Service Code	CPT 44140
Hospital Charge Code	44140
Hospital Revenue Code	960
Min. Negotiated Rate	$1,315.66
Max. Negotiated Rate	$4,683.77
Rate for Payer: Aetna American Axle	$2,468.70
Rate for Payer: Aetna Commercial	$3,228.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,468.70
Rate for Payer: BCBS Complete	$1,519.20
Rate for Payer: BCBS Trust/PPO	$4,683.77
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Cofinity Commercial	$3,266.28
Rate for Payer: Cofinity Commercial	$2,658.60
Rate for Payer: Encore Health Key Benefits Commercial	$3,038.40
Rate for Payer: Healthscope Commercial	$3,418.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,658.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,848.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,228.30
Rate for Payer: PHP Commercial	$3,228.30
Rate for Payer: Priority Health Cigna Priority Health	$2,658.60
Rate for Payer: Priority Health SBD	$2,392.74
Rate for Payer: UHC All Payor (Choice/PPO)	$1,447.23
Rate for Payer: UHC Exchange	$1,315.66
Rate for Payer: UMR Bronson Commercial	$1,405.26
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,848.50

PR COLECTOMY PARTIAL W/ANASTOMOSIS

Professional

Both

$3,798.00

Service Code	HCPCS 44140
Min. Negotiated Rate	$855.83
Max. Negotiated Rate	$2,658.60
Rate for Payer: Aetna Commercial	$1,809.58
Rate for Payer: BCBS Complete	$898.62
Rate for Payer: BCBS Trust/PPO	$1,076.15
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Cash Price	$3,038.40
Rate for Payer: Meridian Medicaid	$898.62
Rate for Payer: Priority Health Choice Medicaid	$855.83
Rate for Payer: Priority Health Cigna Priority Health	$2,658.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,349.54
Rate for Payer: Priority Health Narrow Network	$2,349.54
Rate for Payer: Priority Health SBD	$2,349.54
Rate for Payer: UMR Bronson Commercial	$1,747.08

PR COLECTOMY PRTL ABDOMINAL & TRANSANAL APPROACH

Professional

Both

$2,698.00

Service Code	HCPCS 44147
Min. Negotiated Rate	$209.74
Max. Negotiated Rate	$3,370.25
Rate for Payer: Aetna Commercial	$2,607.12
Rate for Payer: BCBS Complete	$1,289.12
Rate for Payer: BCBS Trust/PPO	$209.74
Rate for Payer: Cash Price	$2,158.40
Rate for Payer: Cash Price	$2,158.40
Rate for Payer: Meridian Medicaid	$1,289.12
Rate for Payer: Priority Health Choice Medicaid	$1,227.73
Rate for Payer: Priority Health Cigna Priority Health	$1,888.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,370.25
Rate for Payer: Priority Health Narrow Network	$3,370.25
Rate for Payer: Priority Health SBD	$3,370.25
Rate for Payer: UMR Bronson Commercial	$1,241.08

PR COLECTOMY PRTL W/COLOPROCTOSTOMY

Professional

Both

$3,352.00

Service Code	HCPCS 44145
Min. Negotiated Rate	$122.04
Max. Negotiated Rate	$2,881.06
Rate for Payer: Aetna Commercial	$2,219.92
Rate for Payer: BCBS Complete	$1,100.81
Rate for Payer: BCBS Trust/PPO	$122.04
Rate for Payer: Cash Price	$2,681.60
Rate for Payer: Cash Price	$2,681.60
Rate for Payer: Meridian Medicaid	$1,100.81
Rate for Payer: Priority Health Choice Medicaid	$1,048.39
Rate for Payer: Priority Health Cigna Priority Health	$2,346.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,881.06
Rate for Payer: Priority Health Narrow Network	$2,881.06
Rate for Payer: Priority Health SBD	$2,881.06
Rate for Payer: UMR Bronson Commercial	$1,541.92

PR COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY

Professional

Both

$5,044.00

Service Code	HCPCS 44146
Min. Negotiated Rate	$166.94
Max. Negotiated Rate	$3,661.89
Rate for Payer: Aetna Commercial	$2,830.09
Rate for Payer: BCBS Complete	$1,399.38
Rate for Payer: BCBS Trust/PPO	$166.94
Rate for Payer: Cash Price	$4,035.20
Rate for Payer: Cash Price	$4,035.20
Rate for Payer: Meridian Medicaid	$1,399.38
Rate for Payer: Priority Health Choice Medicaid	$1,332.74
Rate for Payer: Priority Health Cigna Priority Health	$3,530.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,661.89
Rate for Payer: Priority Health Narrow Network	$3,661.89
Rate for Payer: Priority Health SBD	$3,661.89
Rate for Payer: UMR Bronson Commercial	$2,320.24

PR COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA

Professional

Both

$3,905.00

Service Code	HCPCS 44144
Min. Negotiated Rate	$89.28
Max. Negotiated Rate	$3,086.86
Rate for Payer: Aetna Commercial	$2,380.76
Rate for Payer: BCBS Complete	$1,177.74
Rate for Payer: BCBS Trust/PPO	$89.28
Rate for Payer: Cash Price	$3,124.00
Rate for Payer: Cash Price	$3,124.00
Rate for Payer: Meridian Medicaid	$1,177.74
Rate for Payer: Priority Health Choice Medicaid	$1,121.66
Rate for Payer: Priority Health Cigna Priority Health	$2,733.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,086.86
Rate for Payer: Priority Health Narrow Network	$3,086.86
Rate for Payer: Priority Health SBD	$3,086.86
Rate for Payer: UMR Bronson Commercial	$1,796.30

PR COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT

Professional

Both

$4,118.00

Service Code	HCPCS 44143
Min. Negotiated Rate	$324.38
Max. Negotiated Rate	$2,893.42
Rate for Payer: Aetna Commercial	$2,239.80
Rate for Payer: BCBS Complete	$1,103.49
Rate for Payer: BCBS Trust/PPO	$324.38
Rate for Payer: Cash Price	$3,294.40
Rate for Payer: Cash Price	$3,294.40
Rate for Payer: Meridian Medicaid	$1,103.49
Rate for Payer: Priority Health Choice Medicaid	$1,050.94
Rate for Payer: Priority Health Cigna Priority Health	$2,882.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,893.42
Rate for Payer: Priority Health Narrow Network	$2,893.42
Rate for Payer: Priority Health SBD	$2,893.42
Rate for Payer: UMR Bronson Commercial	$1,894.28

PR COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS

Professional

Both

$3,887.00

Service Code	HCPCS 44160
Min. Negotiated Rate	$791.72
Max. Negotiated Rate	$2,720.90
Rate for Payer: Aetna Commercial	$1,670.76
Rate for Payer: BCBS Complete	$831.31
Rate for Payer: BCBS Trust/PPO	$813.05
Rate for Payer: Cash Price	$3,109.60
Rate for Payer: Cash Price	$3,109.60
Rate for Payer: Meridian Medicaid	$831.31
Rate for Payer: Priority Health Choice Medicaid	$791.72
Rate for Payer: Priority Health Cigna Priority Health	$2,720.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,174.33
Rate for Payer: Priority Health Narrow Network	$2,174.33
Rate for Payer: Priority Health SBD	$2,174.33
Rate for Payer: UMR Bronson Commercial	$1,788.02

PR COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY

Professional

Both

$3,760.00

Service Code	HCPCS 44141
Min. Negotiated Rate	$244.07
Max. Negotiated Rate	$3,172.11
Rate for Payer: Aetna Commercial	$2,453.21
Rate for Payer: BCBS Complete	$1,211.51
Rate for Payer: BCBS Trust/PPO	$244.07
Rate for Payer: Cash Price	$3,008.00
Rate for Payer: Cash Price	$3,008.00
Rate for Payer: Meridian Medicaid	$1,211.51
Rate for Payer: Priority Health Choice Medicaid	$1,153.82
Rate for Payer: Priority Health Cigna Priority Health	$2,632.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,172.11
Rate for Payer: Priority Health Narrow Network	$3,172.11
Rate for Payer: Priority Health SBD	$3,172.11
Rate for Payer: UMR Bronson Commercial	$1,729.60

PR COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST

Professional

Both

$6,686.00

Service Code	HCPCS 44156
Min. Negotiated Rate	$175.40
Max. Negotiated Rate	$4,680.20
Rate for Payer: Aetna Commercial	$3,121.82
Rate for Payer: BCBS Complete	$1,536.93
Rate for Payer: BCBS Trust/PPO	$175.40
Rate for Payer: Cash Price	$5,348.80
Rate for Payer: Cash Price	$5,348.80
Rate for Payer: Meridian Medicaid	$1,536.93
Rate for Payer: Priority Health Choice Medicaid	$1,463.74
Rate for Payer: Priority Health Cigna Priority Health	$4,680.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,029.38
Rate for Payer: Priority Health Narrow Network	$4,029.38
Rate for Payer: Priority Health SBD	$4,029.38
Rate for Payer: UMR Bronson Commercial	$3,075.56

PR COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY

Professional

Both

$5,708.00

Service Code	HCPCS 44155
Min. Negotiated Rate	$187.55
Max. Negotiated Rate	$3,995.60
Rate for Payer: Aetna Commercial	$2,777.17
Rate for Payer: BCBS Complete	$1,377.90
Rate for Payer: BCBS Trust/PPO	$187.55
Rate for Payer: Cash Price	$4,566.40
Rate for Payer: Cash Price	$4,566.40
Rate for Payer: Meridian Medicaid	$1,377.90
Rate for Payer: Priority Health Choice Medicaid	$1,312.29
Rate for Payer: Priority Health Cigna Priority Health	$3,995.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,603.69
Rate for Payer: Priority Health Narrow Network	$3,603.69
Rate for Payer: Priority Health SBD	$3,603.69
Rate for Payer: UMR Bronson Commercial	$2,625.68

PR COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST

Professional

Both

$4,477.00

Service Code	HCPCS 44157
Min. Negotiated Rate	$305.36
Max. Negotiated Rate	$3,828.30
Rate for Payer: Aetna Commercial	$2,961.88
Rate for Payer: BCBS Complete	$1,461.56
Rate for Payer: BCBS Trust/PPO	$305.36
Rate for Payer: Cash Price	$3,581.60
Rate for Payer: Cash Price	$3,581.60
Rate for Payer: Meridian Medicaid	$1,461.56
Rate for Payer: Priority Health Choice Medicaid	$1,391.96
Rate for Payer: Priority Health Cigna Priority Health	$3,133.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,828.30
Rate for Payer: Priority Health Narrow Network	$3,828.30
Rate for Payer: Priority Health SBD	$3,828.30
Rate for Payer: UMR Bronson Commercial	$2,059.42

PR COLLAGENASE, CLOST HIST INJ

Professional

Both

$65.00

Service Code	HCPCS J0775
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$68.26
Rate for Payer: Aetna Commercial	$68.26
Rate for Payer: BCBS Complete	$26.00
Rate for Payer: BCBS Trust/PPO	$67.51
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$45.50
Rate for Payer: UMR Bronson Commercial	$29.90

PR COLLECTION CAPILLARY BLOOD SPECIMEN

Professional

Both

$11.00

Service Code	HCPCS 36416
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$1,055.02
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$1,055.02
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.30
Rate for Payer: Priority Health Narrow Network	$13.30
Rate for Payer: Priority Health SBD	$13.30
Rate for Payer: UMR Bronson Commercial	$5.06

PR COLLECTION VENOUS BLOOD VENIPUNCTURE

Professional

Both

$15.00

Service Code	HCPCS 36415
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$1,529.43
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS Trust/PPO	$1,529.43
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.30
Rate for Payer: Priority Health Narrow Network	$13.30
Rate for Payer: Priority Health SBD	$13.30
Rate for Payer: UMR Bronson Commercial	$6.90

PR COLLJ & INTERPJ PHYSIOL DATA MIN 30 MIN EA 30 D

Professional

Both

$115.00

Service Code	HCPCS 99091
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$780.83
Rate for Payer: Aetna Commercial	$62.02
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: BCBS Trust/PPO	$780.83
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	$71.86
Rate for Payer: Priority Health Narrow Network	$71.86
Rate for Payer: Priority Health SBD	$71.86
Rate for Payer: UMR Bronson Commercial	$52.90

PR COLON CA SCREEN;BARIUM ENEMA

Professional

Both

$617.00

Service Code	HCPCS G0106
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$1,824.22
Rate for Payer: Aetna Commercial	$220.17
Rate for Payer: BCBS Complete	$39.36
Rate for Payer: BCBS Trust/PPO	$1,824.22
Rate for Payer: Cash Price	$493.60
Rate for Payer: Cash Price	$493.60
Rate for Payer: Meridian Medicaid	$39.36
Rate for Payer: Priority Health Choice Medicaid	$37.49
Rate for Payer: Priority Health Cigna Priority Health	$431.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$104.66
Rate for Payer: Priority Health Narrow Network	$104.66
Rate for Payer: Priority Health SBD	$395.70
Rate for Payer: UMR Bronson Commercial	$283.82

Know your out-of-pocket cost for care.

All Charges