Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM

Professional

Both

$331.00

Service Code	HCPCS 17282
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$3,247.68
Rate for Payer: Aetna Commercial	$146.15
Rate for Payer: BCBS Complete	$91.24
Rate for Payer: BCBS Trust/PPO	$3,247.68
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Meridian Medicaid	$91.24
Rate for Payer: Priority Health Choice Medicaid	$86.90
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$166.47
Rate for Payer: Priority Health Narrow Network	$166.47
Rate for Payer: Priority Health SBD	$166.47
Rate for Payer: UMR Bronson Commercial	$152.26

PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM

Professional

Both

$396.00

Service Code	HCPCS 17283
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$456.13
Rate for Payer: Aetna Commercial	$182.60
Rate for Payer: BCBS Complete	$114.06
Rate for Payer: BCBS Trust/PPO	$456.13
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Meridian Medicaid	$114.06
Rate for Payer: Priority Health Choice Medicaid	$108.63
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$207.16
Rate for Payer: Priority Health Narrow Network	$207.16
Rate for Payer: Priority Health SBD	$207.16
Rate for Payer: UMR Bronson Commercial	$182.16

PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM

Professional

Both

$421.00

Service Code	HCPCS 17284
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$294.70
Rate for Payer: Aetna Commercial	$213.50
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cash Price	$336.80
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health	$294.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$242.11
Rate for Payer: Priority Health Narrow Network	$242.11
Rate for Payer: Priority Health SBD	$242.11
Rate for Payer: UMR Bronson Commercial	$193.66

PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM

Professional

Both

$2,750.00

Service Code	HCPCS 17286
Min. Negotiated Rate	$171.47
Max. Negotiated Rate	$1,925.00
Rate for Payer: Aetna Commercial	$290.59
Rate for Payer: BCBS Complete	$180.04
Rate for Payer: BCBS Trust/PPO	$456.13
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Meridian Medicaid	$180.04
Rate for Payer: Priority Health Choice Medicaid	$171.47
Rate for Payer: Priority Health Cigna Priority Health	$1,925.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$326.77
Rate for Payer: Priority Health Narrow Network	$326.77
Rate for Payer: Priority Health SBD	$326.77
Rate for Payer: UMR Bronson Commercial	$1,265.00

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM

Professional

Both

$265.00

Service Code	HCPCS 17261
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$4,160.00
Rate for Payer: Aetna Commercial	$92.62
Rate for Payer: BCBS Complete	$58.60
Rate for Payer: BCBS Trust/PPO	$4,160.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Meridian Medicaid	$58.60
Rate for Payer: Priority Health Choice Medicaid	$55.81
Rate for Payer: Priority Health Cigna Priority Health	$185.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$105.64
Rate for Payer: Priority Health Narrow Network	$105.64
Rate for Payer: Priority Health SBD	$105.64
Rate for Payer: UMR Bronson Commercial	$121.90

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM

Professional

Both

$350.00

Service Code	HCPCS 17262
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$4,106.85
Rate for Payer: Aetna Commercial	$117.15
Rate for Payer: BCBS Complete	$74.02
Rate for Payer: BCBS Trust/PPO	$4,106.85
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Meridian Medicaid	$74.02
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.82
Rate for Payer: Priority Health Narrow Network	$134.82
Rate for Payer: Priority Health SBD	$134.82
Rate for Payer: UMR Bronson Commercial	$161.00

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM

Professional

Both

$400.00

Service Code	HCPCS 17263
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$29,358.48
Rate for Payer: Aetna Commercial	$130.16
Rate for Payer: BCBS Complete	$81.86
Rate for Payer: BCBS Trust/PPO	$29,358.48
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Meridian Medicaid	$81.86
Rate for Payer: Priority Health Choice Medicaid	$77.96
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$148.79
Rate for Payer: Priority Health Narrow Network	$148.79
Rate for Payer: Priority Health SBD	$148.79
Rate for Payer: UMR Bronson Commercial	$184.00

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM

Professional

Both

$333.00

Service Code	HCPCS 17264
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$139.47
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$2,400.00
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$233.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$158.66
Rate for Payer: Priority Health Narrow Network	$158.66
Rate for Payer: Priority Health SBD	$158.66
Rate for Payer: UMR Bronson Commercial	$153.18

PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG

Professional

Both

$778.00

Service Code	HCPCS 64624
Hospital Charge Code	64624
Min. Negotiated Rate	$92.87
Max. Negotiated Rate	$1,520.45
Rate for Payer: Aetna Commercial	$188.14
Rate for Payer: BCBS Complete	$97.51
Rate for Payer: BCBS Trust/PPO	$1,520.45
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$622.40
Rate for Payer: Meridian Medicaid	$97.51
Rate for Payer: Priority Health Choice Medicaid	$92.87
Rate for Payer: Priority Health Cigna Priority Health	$544.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$244.04
Rate for Payer: Priority Health Narrow Network	$244.04
Rate for Payer: Priority Health SBD	$244.04
Rate for Payer: UMR Bronson Commercial	$357.88

PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG

Facility

$778.00

Service Code	CPT 64624
Hospital Charge Code	64624
Min. Negotiated Rate	$142.76
Max. Negotiated Rate	$5,402.75
Rate for Payer: Aetna American Axle	$505.70
Rate for Payer: Aetna Commercial	$661.30
Rate for Payer: Aetna Medicare	$1,784.88
Rate for Payer: Aetna New Business (MI Preferred)	$505.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,145.29
Rate for Payer: Amish Plain Church Group Commercial	$2,145.29
Rate for Payer: BCBS Complete	$985.80
Rate for Payer: BCBS MAPPO	$1,716.23
Rate for Payer: BCN Medicare Advantage	$1,716.23
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cofinity Commercial	$669.08
Rate for Payer: Cofinity Commercial	$544.60
Rate for Payer: Encore Health Key Benefits Commercial	$622.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,716.23
Rate for Payer: Healthscope Commercial	$700.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$544.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$583.50
Rate for Payer: Mclaren Medicaid	$938.78
Rate for Payer: Mclaren Medicare	$1,716.23
Rate for Payer: Meridian Medicaid	$985.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,802.04
Rate for Payer: MI Amish Medical Board Commercial	$1,973.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$661.30
Rate for Payer: PACE Medicare	$1,630.42
Rate for Payer: PACE SWMI	$1,716.23
Rate for Payer: PHP Commercial	$661.30
Rate for Payer: PHP Medicare Advantage	$1,716.23
Rate for Payer: Priority Health Choice Medicaid	$938.78
Rate for Payer: Priority Health Cigna Priority Health	$544.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,402.75
Rate for Payer: Priority Health Medicare	$1,716.23
Rate for Payer: Priority Health Narrow Network	$4,322.20
Rate for Payer: Priority Health SBD	$490.14
Rate for Payer: Railroad Medicare Medicare	$1,716.23
Rate for Payer: UHC All Payor (Choice/PPO)	$157.04
Rate for Payer: UHC Dual Complete DSNP	$1,716.23
Rate for Payer: UHC Exchange	$142.76
Rate for Payer: UHC Medicare Advantage	$1,767.72
Rate for Payer: UMR Bronson Commercial	$287.86
Rate for Payer: VA VA	$1,716.23
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$583.50

PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG

Facility

$778.00

Service Code	CPT 64624
Hospital Charge Code	64624
Min. Negotiated Rate	$342.32
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna American Axle	$505.70
Rate for Payer: Aetna Commercial	$661.30
Rate for Payer: Aetna New Business (MI Preferred)	$505.70
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cofinity Commercial	$544.60
Rate for Payer: Cofinity Commercial	$669.08
Rate for Payer: Encore Health Key Benefits Commercial	$622.40
Rate for Payer: Healthscope Commercial	$700.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$544.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$583.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$661.30
Rate for Payer: PHP Commercial	$661.30
Rate for Payer: Priority Health Cigna Priority Health	$544.60
Rate for Payer: Priority Health SBD	$490.14
Rate for Payer: UMR Bronson Commercial	$342.32
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$583.50

PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG

Professional

Both

$778.00

Service Code	HCPCS 64624
Min. Negotiated Rate	$92.87
Max. Negotiated Rate	$1,520.45
Rate for Payer: Aetna Commercial	$188.14
Rate for Payer: BCBS Complete	$97.51
Rate for Payer: BCBS Trust/PPO	$1,520.45
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$622.40
Rate for Payer: Meridian Medicaid	$97.51
Rate for Payer: Priority Health Choice Medicaid	$92.87
Rate for Payer: Priority Health Cigna Priority Health	$544.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$244.04
Rate for Payer: Priority Health Narrow Network	$244.04
Rate for Payer: Priority Health SBD	$244.04
Rate for Payer: UMR Bronson Commercial	$357.88

PR DESTRUCTION PREMALIGNANT LESION 15/>

Professional

Both

$305.00

Service Code	HCPCS 17004
Min. Negotiated Rate	$39.53
Max. Negotiated Rate	$213.50
Rate for Payer: Aetna Commercial	$104.32
Rate for Payer: BCBS Complete	$65.98
Rate for Payer: BCBS Trust/PPO	$39.53
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Meridian Medicaid	$65.98
Rate for Payer: Priority Health Choice Medicaid	$62.84
Rate for Payer: Priority Health Cigna Priority Health	$213.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$121.26
Rate for Payer: Priority Health Narrow Network	$121.26
Rate for Payer: Priority Health SBD	$121.26
Rate for Payer: UMR Bronson Commercial	$140.30

PR DESTRUCTION PREMALIGNANT LESION 1ST

Professional

Both

$132.00

Service Code	HCPCS 17000
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$534.35
Rate for Payer: Aetna Commercial	$56.76
Rate for Payer: BCBS Complete	$37.13
Rate for Payer: BCBS Trust/PPO	$534.35
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Meridian Medicaid	$37.13
Rate for Payer: Priority Health Choice Medicaid	$35.36
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.00
Rate for Payer: Priority Health Narrow Network	$67.00
Rate for Payer: Priority Health SBD	$67.00
Rate for Payer: UMR Bronson Commercial	$60.72

PR DESTRUCTION PREMALIGNANT LESION 2-14 EA

Professional

Both

$28.00

Service Code	HCPCS 17003
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$2,756.25
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: BCBS Complete	$1.34
Rate for Payer: BCBS Trust/PPO	$2,756.25
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Meridian Medicaid	$1.34
Rate for Payer: Priority Health Choice Medicaid	$1.28
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.46
Rate for Payer: Priority Health Narrow Network	$2.46
Rate for Payer: Priority Health SBD	$2.46
Rate for Payer: UMR Bronson Commercial	$12.88

PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH

Professional

Both

$1,534.00

Service Code	HCPCS 45190
Min. Negotiated Rate	$446.66
Max. Negotiated Rate	$1,225.34
Rate for Payer: Aetna Commercial	$942.76
Rate for Payer: BCBS Complete	$468.99
Rate for Payer: BCBS Trust/PPO	$706.34
Rate for Payer: Cash Price	$1,227.20
Rate for Payer: Cash Price	$1,227.20
Rate for Payer: Meridian Medicaid	$468.99
Rate for Payer: Priority Health Choice Medicaid	$446.66
Rate for Payer: Priority Health Cigna Priority Health	$1,073.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,225.34
Rate for Payer: Priority Health Narrow Network	$1,225.34
Rate for Payer: Priority Health SBD	$1,225.34
Rate for Payer: UMR Bronson Commercial	$705.64

PR DESTRUCTION VAGINAL LESIONS EXTENSIVE

Professional

Both

$714.00

Service Code	HCPCS 57065
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$2,603.46
Rate for Payer: Aetna Commercial	$218.65
Rate for Payer: BCBS Complete	$125.92
Rate for Payer: BCBS Trust/PPO	$2,603.46
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Meridian Medicaid	$125.92
Rate for Payer: Priority Health Choice Medicaid	$119.92
Rate for Payer: Priority Health Cigna Priority Health	$499.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$265.12
Rate for Payer: Priority Health Narrow Network	$265.12
Rate for Payer: Priority Health SBD	$265.12
Rate for Payer: UMR Bronson Commercial	$328.44

PR DESTRUCTION VAGINAL LESIONS SIMPLE

Professional

Both

$355.00

Service Code	HCPCS 57061
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$2,929.42
Rate for Payer: Aetna Commercial	$131.70
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: BCBS Trust/PPO	$2,929.42
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Meridian Medicaid	$78.28
Rate for Payer: Priority Health Choice Medicaid	$74.55
Rate for Payer: Priority Health Cigna Priority Health	$248.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.76
Rate for Payer: Priority Health Narrow Network	$164.76
Rate for Payer: Priority Health SBD	$164.76
Rate for Payer: UMR Bronson Commercial	$163.30

PR DETERMINATION REFRACTIVE STATE

Professional

Both

$94.00

Service Code	HCPCS 92015
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$1,164.90
Rate for Payer: Aetna Commercial	$21.33
Rate for Payer: BCBS Complete	$12.31
Rate for Payer: BCBS Trust/PPO	$1,164.90
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Meridian Medicaid	$12.31
Rate for Payer: Priority Health Choice Medicaid	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$65.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.08
Rate for Payer: Priority Health Narrow Network	$22.08
Rate for Payer: Priority Health SBD	$22.08
Rate for Payer: UMR Bronson Commercial	$43.24

PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM

Professional

Both

$26.00

Service Code	HCPCS 96110
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$974.19
Rate for Payer: Aetna Commercial	$10.35
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$974.19
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.37
Rate for Payer: Priority Health Narrow Network	$14.37
Rate for Payer: Priority Health SBD	$14.37
Rate for Payer: UMR Bronson Commercial	$11.96

PR DEVELOPMENTAL TESTING W/INTERP & REPORT

Professional

Both

$237.00

Service Code	HCPCS 96111
Min. Negotiated Rate	$94.80
Max. Negotiated Rate	$165.90
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: Cash Price	$189.60
Rate for Payer: Priority Health Cigna Priority Health	$165.90
Rate for Payer: UMR Bronson Commercial	$109.02

PR DEXAMETHASONE SODIUM PHOS

Professional

Both

$10.00

Service Code	HCPCS J1100
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$0.12
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

PR DIABETES PREVENTION PROGRAM

Professional

Both

$130.00

Service Code	HCPCS 00268
Hospital Revenue Code	990
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$91.00
Rate for Payer: BCBS Complete	$52.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: UMR Bronson Commercial	$59.80

PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM

Professional

Both

$32.00

Service Code	HCPCS 0403T
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$131.11
Rate for Payer: Aetna Commercial	$32.06
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$131.11
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: UMR Bronson Commercial	$14.72

PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX

Professional

Both

$1,269.00

Service Code	HCPCS 29805
Min. Negotiated Rate	$303.74
Max. Negotiated Rate	$888.30
Rate for Payer: Aetna Commercial	$626.78
Rate for Payer: BCBS Complete	$318.93
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Meridian Medicaid	$318.93
Rate for Payer: Priority Health Choice Medicaid	$303.74
Rate for Payer: Priority Health Cigna Priority Health	$888.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$723.59
Rate for Payer: Priority Health Narrow Network	$723.59
Rate for Payer: Priority Health SBD	$723.59
Rate for Payer: UMR Bronson Commercial	$583.74

Know your out-of-pocket cost for care.

All Charges