Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT

Professional

Both

$2,197.00

Service Code	HCPCS 28296
Min. Negotiated Rate	$330.79
Max. Negotiated Rate	$1,537.90
Rate for Payer: Aetna Commercial	$677.65
Rate for Payer: BCBS Complete	$347.33
Rate for Payer: BCBS Trust/PPO	$1,186.56
Rate for Payer: Cash Price	$1,757.60
Rate for Payer: Cash Price	$1,757.60
Rate for Payer: Meridian Medicaid	$347.33
Rate for Payer: Priority Health Choice Medicaid	$330.79
Rate for Payer: Priority Health Cigna Priority Health	$1,537.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$778.74
Rate for Payer: Priority Health Narrow Network	$778.74
Rate for Payer: Priority Health SBD	$778.74
Rate for Payer: UMR Bronson Commercial	$1,010.62

PR CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT

Professional

Both

$1,612.00

Service Code	HCPCS 28295
Min. Negotiated Rate	$388.30
Max. Negotiated Rate	$1,128.40
Rate for Payer: Aetna Commercial	$819.40
Rate for Payer: BCBS Complete	$407.72
Rate for Payer: BCBS Trust/PPO	$982.11
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Meridian Medicaid	$407.72
Rate for Payer: Priority Health Choice Medicaid	$388.30
Rate for Payer: Priority Health Cigna Priority Health	$1,128.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$931.42
Rate for Payer: Priority Health Narrow Network	$931.42
Rate for Payer: Priority Health SBD	$931.42
Rate for Payer: UMR Bronson Commercial	$741.52

PR CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT

Professional

Both

$1,874.00

Service Code	HCPCS 28298
Min. Negotiated Rate	$327.59
Max. Negotiated Rate	$1,491.48
Rate for Payer: Aetna Commercial	$662.21
Rate for Payer: BCBS Complete	$343.97
Rate for Payer: BCBS Trust/PPO	$1,491.48
Rate for Payer: Cash Price	$1,499.20
Rate for Payer: Cash Price	$1,499.20
Rate for Payer: Meridian Medicaid	$343.97
Rate for Payer: Priority Health Choice Medicaid	$327.59
Rate for Payer: Priority Health Cigna Priority Health	$1,311.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$769.04
Rate for Payer: Priority Health Narrow Network	$769.04
Rate for Payer: Priority Health SBD	$769.04
Rate for Payer: UMR Bronson Commercial	$862.04

PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL

Professional

Both

$1,745.00

Service Code	HCPCS 28292
Min. Negotiated Rate	$313.54
Max. Negotiated Rate	$1,544.75
Rate for Payer: Aetna Commercial	$635.54
Rate for Payer: BCBS Complete	$329.22
Rate for Payer: BCBS Trust/PPO	$1,544.75
Rate for Payer: Cash Price	$1,396.00
Rate for Payer: Cash Price	$1,396.00
Rate for Payer: Meridian Medicaid	$329.22
Rate for Payer: Priority Health Choice Medicaid	$313.54
Rate for Payer: Priority Health Cigna Priority Health	$1,221.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$734.83
Rate for Payer: Priority Health Narrow Network	$734.83
Rate for Payer: Priority Health SBD	$734.83
Rate for Payer: UMR Bronson Commercial	$802.70

PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS

Facility

$1,939.00

Service Code	CPT 28297
Hospital Charge Code	28297
Min. Negotiated Rate	$853.16
Max. Negotiated Rate	$1,745.10
Rate for Payer: Aetna American Axle	$1,260.35
Rate for Payer: Aetna Commercial	$1,648.15
Rate for Payer: Aetna New Business (MI Preferred)	$1,260.35
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Cofinity Commercial	$1,357.30
Rate for Payer: Cofinity Commercial	$1,667.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,551.20
Rate for Payer: Healthscope Commercial	$1,745.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,357.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,454.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,648.15
Rate for Payer: PHP Commercial	$1,648.15
Rate for Payer: Priority Health Cigna Priority Health	$1,357.30
Rate for Payer: Priority Health SBD	$1,221.57
Rate for Payer: UMR Bronson Commercial	$853.16
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,454.25

PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS

Facility

$1,939.00

Service Code	CPT 28297
Hospital Charge Code	28297
Min. Negotiated Rate	$595.62
Max. Negotiated Rate	$20,018.71
Rate for Payer: Aetna American Axle	$1,260.35
Rate for Payer: Aetna Commercial	$1,648.15
Rate for Payer: Aetna Medicare	$6,613.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,260.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,948.86
Rate for Payer: Amish Plain Church Group Commercial	$7,948.86
Rate for Payer: BCBS Complete	$3,652.66
Rate for Payer: BCBS MAPPO	$6,359.09
Rate for Payer: BCBS Trust/PPO	$6,281.22
Rate for Payer: BCN Medicare Advantage	$6,359.09
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Cofinity Commercial	$1,667.54
Rate for Payer: Cofinity Commercial	$1,357.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,551.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,359.09
Rate for Payer: Healthscope Commercial	$1,745.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,357.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,454.25
Rate for Payer: Mclaren Medicaid	$3,478.42
Rate for Payer: Mclaren Medicare	$6,359.09
Rate for Payer: Meridian Medicaid	$3,652.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,677.04
Rate for Payer: MI Amish Medical Board Commercial	$7,312.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,648.15
Rate for Payer: PACE Medicare	$6,041.14
Rate for Payer: PACE SWMI	$6,359.09
Rate for Payer: PHP Commercial	$1,648.15
Rate for Payer: PHP Medicare Advantage	$6,359.09
Rate for Payer: Priority Health Choice Medicaid	$3,478.42
Rate for Payer: Priority Health Cigna Priority Health	$1,357.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,018.71
Rate for Payer: Priority Health Medicare	$6,359.09
Rate for Payer: Priority Health Narrow Network	$16,014.97
Rate for Payer: Priority Health SBD	$1,221.57
Rate for Payer: Railroad Medicare Medicare	$6,359.09
Rate for Payer: UHC All Payor (Choice/PPO)	$655.18
Rate for Payer: UHC Dual Complete DSNP	$6,359.09
Rate for Payer: UHC Exchange	$595.62
Rate for Payer: UHC Medicare Advantage	$6,549.86
Rate for Payer: UMR Bronson Commercial	$717.43
Rate for Payer: VA VA	$6,359.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,454.25

PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS

Professional

Both

$3,110.00

Service Code	HCPCS 44055
Min. Negotiated Rate	$949.55
Max. Negotiated Rate	$2,603.55
Rate for Payer: Aetna Commercial	$2,013.07
Rate for Payer: BCBS Complete	$997.03
Rate for Payer: BCBS Trust/PPO	$1,321.81
Rate for Payer: Cash Price	$2,488.00
Rate for Payer: Cash Price	$2,488.00
Rate for Payer: Meridian Medicaid	$997.03
Rate for Payer: Priority Health Choice Medicaid	$949.55
Rate for Payer: Priority Health Cigna Priority Health	$2,177.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,603.55
Rate for Payer: Priority Health Narrow Network	$2,603.55
Rate for Payer: Priority Health SBD	$2,603.55
Rate for Payer: UMR Bronson Commercial	$1,430.60

PR COSMETIC CORRECTION OF INVERTED NIPPLES

Professional

Both

$1,500.00

Service Code	HCPCS 00557
Hospital Revenue Code	990
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: BCBS Complete	$600.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00
Rate for Payer: UMR Bronson Commercial	$690.00

PR COSMETIC SCLEROTHERAPY/LASER

Professional

Both

$250.00

Service Code	HCPCS 00122
Hospital Revenue Code	960
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: UMR Bronson Commercial	$115.00

PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT

Professional

Both

$75.00

Service Code	HCPCS 00123
Hospital Revenue Code	960
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$52.50
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: UMR Bronson Commercial	$34.50

PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG

Professional

Both

$6,133.00

Service Code	HCPCS 63064
Min. Negotiated Rate	$631.85
Max. Negotiated Rate	$4,293.10
Rate for Payer: Aetna Commercial	$2,309.28
Rate for Payer: BCBS Complete	$1,205.69
Rate for Payer: BCBS Trust/PPO	$631.85
Rate for Payer: Cash Price	$4,906.40
Rate for Payer: Cash Price	$4,906.40
Rate for Payer: Meridian Medicaid	$1,205.69
Rate for Payer: Priority Health Choice Medicaid	$1,148.28
Rate for Payer: Priority Health Cigna Priority Health	$4,293.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,038.93
Rate for Payer: Priority Health Narrow Network	$3,038.93
Rate for Payer: Priority Health SBD	$3,038.93
Rate for Payer: UMR Bronson Commercial	$2,821.18

PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG

Professional

Both

$2,103.00

Service Code	HCPCS 63066
Min. Negotiated Rate	$131.42
Max. Negotiated Rate	$1,472.10
Rate for Payer: Aetna Commercial	$266.49
Rate for Payer: BCBS Complete	$137.99
Rate for Payer: BCBS Trust/PPO	$766.04
Rate for Payer: Cash Price	$1,682.40
Rate for Payer: Cash Price	$1,682.40
Rate for Payer: Meridian Medicaid	$137.99
Rate for Payer: Priority Health Choice Medicaid	$131.42
Rate for Payer: Priority Health Cigna Priority Health	$1,472.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$348.23
Rate for Payer: Priority Health Narrow Network	$348.23
Rate for Payer: Priority Health SBD	$348.23
Rate for Payer: UMR Bronson Commercial	$967.38

PR COUDE TIP URINARY CATHETER

Professional

Both

$8.00

Service Code	HCPCS A4352
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna Commercial	$5.09
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: UMR Bronson Commercial	$3.68

PR COUNSEL IMMUNE <21 16-30 M

Professional

Both

$45.00

Service Code	HCPCS G0314
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$31.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: UMR Bronson Commercial	$20.70

PR COUNSEL IMMUNE <21 5-15 M

Professional

Both

$30.00

Service Code	HCPCS G0315
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: UMR Bronson Commercial	$13.80

PR COUNSEL LUNG SCRN LDCT

Professional

Both

$53.00

Service Code	HCPCS G0296
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$735.92
Rate for Payer: Aetna Commercial	$26.13
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCBS Trust/PPO	$735.92
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Priority Health Cigna Priority Health	$37.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.13
Rate for Payer: Priority Health Narrow Network	$34.13
Rate for Payer: Priority Health SBD	$34.13
Rate for Payer: UMR Bronson Commercial	$24.38

PR CPAP VENTILATION CPAP INITIATION&MGMT

Professional

Both

$228.00

Service Code	HCPCS 94660
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$313.28
Rate for Payer: Aetna Commercial	$41.58
Rate for Payer: BCBS Complete	$24.60
Rate for Payer: BCBS Trust/PPO	$313.28
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Meridian Medicaid	$24.60
Rate for Payer: Priority Health Choice Medicaid	$23.43
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$48.96
Rate for Payer: Priority Health Narrow Network	$48.96
Rate for Payer: Priority Health SBD	$48.96
Rate for Payer: UMR Bronson Commercial	$104.88

PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO

Professional

Both

$56.00

Service Code	HCPCS 99489
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$1,256.83
Rate for Payer: Aetna Commercial	$25.42
Rate for Payer: BCBS Complete	$33.33
Rate for Payer: BCBS Trust/PPO	$1,256.83
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Meridian Medicaid	$33.33
Rate for Payer: Priority Health Choice Medicaid	$31.74
Rate for Payer: Priority Health Cigna Priority Health	$39.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.39
Rate for Payer: Priority Health Narrow Network	$63.39
Rate for Payer: Priority Health SBD	$63.39
Rate for Payer: UMR Bronson Commercial	$25.76

PR CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

Professional

Both

$10,100.00

Service Code	HCPCS 61698
Min. Negotiated Rate	$905.51
Max. Negotiated Rate	$7,867.68
Rate for Payer: Aetna Commercial	$5,979.62
Rate for Payer: BCBS Complete	$3,129.08
Rate for Payer: BCBS Trust/PPO	$905.51
Rate for Payer: Cash Price	$8,080.00
Rate for Payer: Cash Price	$8,080.00
Rate for Payer: Meridian Medicaid	$3,129.08
Rate for Payer: Priority Health Choice Medicaid	$2,980.08
Rate for Payer: Priority Health Cigna Priority Health	$7,070.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,867.68
Rate for Payer: Priority Health Narrow Network	$7,867.68
Rate for Payer: Priority Health SBD	$7,867.68
Rate for Payer: UMR Bronson Commercial	$4,646.00

PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI

Professional

Both

$500.00

Service Code	HCPCS 0055T
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$448.43
Rate for Payer: Aetna Commercial	$210.14
Rate for Payer: BCBS Complete	$154.02
Rate for Payer: BCBS Trust/PPO	$448.43
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Meridian Medicaid	$154.02
Rate for Payer: Priority Health Choice Medicaid	$146.69
Rate for Payer: Priority Health Cigna Priority Health	$350.00
Rate for Payer: UMR Bronson Commercial	$230.00

PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES

Professional

Both

$261.87

Service Code	HCPCS 0054T
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$183.31
Rate for Payer: Aetna Commercial	$179.20
Rate for Payer: BCBS Complete	$96.34
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$209.50
Rate for Payer: Cash Price	$209.50
Rate for Payer: Meridian Medicaid	$96.34
Rate for Payer: Priority Health Choice Medicaid	$91.75
Rate for Payer: Priority Health Cigna Priority Health	$183.31
Rate for Payer: UMR Bronson Commercial	$120.46

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Facility

$277.00

Service Code	CPT 20985
Hospital Charge Code	20985
Min. Negotiated Rate	$121.88
Max. Negotiated Rate	$249.30
Rate for Payer: Aetna American Axle	$180.05
Rate for Payer: Aetna Commercial	$235.45
Rate for Payer: Aetna New Business (MI Preferred)	$180.05
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cofinity Commercial	$193.90
Rate for Payer: Cofinity Commercial	$238.22
Rate for Payer: Encore Health Key Benefits Commercial	$221.60
Rate for Payer: Healthscope Commercial	$249.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$193.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$207.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$235.45
Rate for Payer: PHP Commercial	$235.45
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health SBD	$174.51
Rate for Payer: UMR Bronson Commercial	$121.88
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$207.75

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Facility

$277.00

Service Code	CPT 20985
Hospital Charge Code	20985
Min. Negotiated Rate	$102.49
Max. Negotiated Rate	$249.30
Rate for Payer: Aetna American Axle	$180.05
Rate for Payer: Aetna Commercial	$235.45
Rate for Payer: Aetna New Business (MI Preferred)	$180.05
Rate for Payer: BCBS Complete	$110.80
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cofinity Commercial	$238.22
Rate for Payer: Cofinity Commercial	$193.90
Rate for Payer: Encore Health Key Benefits Commercial	$221.60
Rate for Payer: Healthscope Commercial	$249.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$193.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$207.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$235.45
Rate for Payer: PHP Commercial	$235.45
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health SBD	$174.51
Rate for Payer: UHC All Payor (Choice/PPO)	$154.88
Rate for Payer: UHC Exchange	$140.80
Rate for Payer: UMR Bronson Commercial	$102.49
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$207.75

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Professional

Both

$277.00

Service Code	HCPCS 20985
Hospital Charge Code	20985
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$219.57
Rate for Payer: Aetna Commercial	$194.83
Rate for Payer: BCBS Complete	$96.17
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Meridian Medicaid	$96.17
Rate for Payer: Priority Health Choice Medicaid	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$219.57
Rate for Payer: Priority Health Narrow Network	$219.57
Rate for Payer: Priority Health SBD	$219.57
Rate for Payer: UMR Bronson Commercial	$127.42

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Professional

Both

$277.00

Service Code	HCPCS 20985
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$219.57
Rate for Payer: Aetna Commercial	$194.83
Rate for Payer: BCBS Complete	$96.17
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Meridian Medicaid	$96.17
Rate for Payer: Priority Health Choice Medicaid	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$219.57
Rate for Payer: Priority Health Narrow Network	$219.57
Rate for Payer: Priority Health SBD	$219.57
Rate for Payer: UMR Bronson Commercial	$127.42

Know your out-of-pocket cost for care.

All Charges