Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR DIAGNOSTIC BONE MARROW ASPIRATIONS

Professional

Both

$350.00

Service Code	HCPCS 38220
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$437.96
Rate for Payer: Aetna Commercial	$85.82
Rate for Payer: BCBS Complete	$44.51
Rate for Payer: BCBS Trust/PPO	$437.96
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Meridian Medicaid	$44.51
Rate for Payer: Priority Health Choice Medicaid	$42.39
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.86
Rate for Payer: Priority Health Narrow Network	$144.86
Rate for Payer: Priority Health SBD	$144.86
Rate for Payer: UMR Bronson Commercial	$161.00

PR DIAGNOSTIC BONE MARROW BIOPSIES

Professional

Both

$360.00

Service Code	HCPCS 38221
Min. Negotiated Rate	$44.30
Max. Negotiated Rate	$400.45
Rate for Payer: Aetna Commercial	$85.90
Rate for Payer: BCBS Complete	$46.52
Rate for Payer: BCBS Trust/PPO	$400.45
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Meridian Medicaid	$46.52
Rate for Payer: Priority Health Choice Medicaid	$44.30
Rate for Payer: Priority Health Cigna Priority Health	$252.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$149.95
Rate for Payer: Priority Health Narrow Network	$149.95
Rate for Payer: Priority Health SBD	$149.95
Rate for Payer: UMR Bronson Commercial	$165.60

PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Professional

Both

$380.00

Service Code	HCPCS 38222
Min. Negotiated Rate	$47.29
Max. Negotiated Rate	$367.17
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: BCBS Complete	$49.65
Rate for Payer: BCBS Trust/PPO	$367.17
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Meridian Medicaid	$49.65
Rate for Payer: Priority Health Choice Medicaid	$47.29
Rate for Payer: Priority Health Cigna Priority Health	$266.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$161.53
Rate for Payer: Priority Health Narrow Network	$161.53
Rate for Payer: Priority Health SBD	$161.53
Rate for Payer: UMR Bronson Commercial	$174.80

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE

Professional

Both

$555.00

Service Code	HCPCS 62270
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$874.34
Rate for Payer: Aetna Commercial	$79.39
Rate for Payer: BCBS Complete	$42.49
Rate for Payer: BCBS Trust/PPO	$874.34
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Meridian Medicaid	$42.49
Rate for Payer: Priority Health Choice Medicaid	$40.47
Rate for Payer: Priority Health Cigna Priority Health	$388.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$105.32
Rate for Payer: Priority Health Narrow Network	$105.32
Rate for Payer: Priority Health SBD	$105.32
Rate for Payer: UMR Bronson Commercial	$255.30

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT

Professional

Both

$174.00

Service Code	HCPCS 62328
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$1,578.56
Rate for Payer: Aetna Commercial	$114.31
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCBS Trust/PPO	$1,578.56
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health	$121.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.38
Rate for Payer: Priority Health Narrow Network	$144.38
Rate for Payer: Priority Health SBD	$144.38
Rate for Payer: UMR Bronson Commercial	$80.04

PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

Professional

Both

$1,512.00

Service Code	HCPCS 36909
Min. Negotiated Rate	$124.61
Max. Negotiated Rate	$1,517.28
Rate for Payer: Aetna Commercial	$270.76
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: BCBS Trust/PPO	$1,517.28
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Meridian Medicaid	$130.84
Rate for Payer: Priority Health Choice Medicaid	$124.61
Rate for Payer: Priority Health Cigna Priority Health	$1,058.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$311.73
Rate for Payer: Priority Health Narrow Network	$311.73
Rate for Payer: Priority Health SBD	$311.73
Rate for Payer: UMR Bronson Commercial	$695.52

PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL

Professional

Both

$205.00

Service Code	HCPCS 90945
Min. Negotiated Rate	$54.10
Max. Negotiated Rate	$370.34
Rate for Payer: Aetna Commercial	$94.34
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: BCBS Trust/PPO	$370.34
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Meridian Medicaid	$56.80
Rate for Payer: Priority Health Choice Medicaid	$54.10
Rate for Payer: Priority Health Cigna Priority Health	$143.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.19
Rate for Payer: Priority Health Narrow Network	$113.19
Rate for Payer: Priority Health SBD	$113.19
Rate for Payer: UMR Bronson Commercial	$94.30

PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS

Professional

Both

$325.00

Service Code	HCPCS 90947
Min. Negotiated Rate	$77.11
Max. Negotiated Rate	$319.62
Rate for Payer: Aetna Commercial	$136.62
Rate for Payer: BCBS Complete	$80.97
Rate for Payer: BCBS Trust/PPO	$319.62
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Meridian Medicaid	$80.97
Rate for Payer: Priority Health Choice Medicaid	$77.11
Rate for Payer: Priority Health Cigna Priority Health	$227.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.14
Rate for Payer: Priority Health Narrow Network	$162.14
Rate for Payer: Priority Health SBD	$162.14
Rate for Payer: UMR Bronson Commercial	$149.50

PR DIAPHRAGM

Professional

Both

$70.00

Service Code	HCPCS A4266
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$32.28
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: UMR Bronson Commercial	$32.20

PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS

Professional

Both

$223.00

Service Code	HCPCS 57170
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$2,039.77
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: BCBS Complete	$31.53
Rate for Payer: BCBS Trust/PPO	$2,039.77
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cash Price	$178.40
Rate for Payer: Meridian Medicaid	$31.53
Rate for Payer: Priority Health Choice Medicaid	$30.03
Rate for Payer: Priority Health Cigna Priority Health	$156.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.70
Rate for Payer: Priority Health Narrow Network	$67.70
Rate for Payer: Priority Health SBD	$67.70
Rate for Payer: UMR Bronson Commercial	$102.58

PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM

Professional

Both

$763.00

Service Code	HCPCS 95957
Min. Negotiated Rate	$133.39
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$270.69
Rate for Payer: BCBS Complete	$305.20
Rate for Payer: BCBS Trust/PPO	$346.56
Rate for Payer: Cash Price	$610.40
Rate for Payer: Cash Price	$610.40
Rate for Payer: Priority Health Cigna Priority Health	$534.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$133.39
Rate for Payer: Priority Health Narrow Network	$133.39
Rate for Payer: Priority Health SBD	$369.19
Rate for Payer: UMR Bronson Commercial	$350.98

PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL

Professional

Both

$352.00

Service Code	HCPCS 45905
Min. Negotiated Rate	$109.48
Max. Negotiated Rate	$585.88
Rate for Payer: Aetna Commercial	$224.91
Rate for Payer: BCBS Complete	$114.95
Rate for Payer: BCBS Trust/PPO	$585.88
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Meridian Medicaid	$114.95
Rate for Payer: Priority Health Choice Medicaid	$109.48
Rate for Payer: Priority Health Cigna Priority Health	$246.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$299.86
Rate for Payer: Priority Health Narrow Network	$299.86
Rate for Payer: Priority Health SBD	$299.86
Rate for Payer: UMR Bronson Commercial	$161.92

PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION

Professional

Both

$223.00

Service Code	HCPCS 42660
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$1,102.03
Rate for Payer: Aetna Commercial	$114.17
Rate for Payer: BCBS Complete	$58.15
Rate for Payer: BCBS Trust/PPO	$1,102.03
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cash Price	$178.40
Rate for Payer: Meridian Medicaid	$58.15
Rate for Payer: Priority Health Choice Medicaid	$55.38
Rate for Payer: Priority Health Cigna Priority Health	$156.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.81
Rate for Payer: Priority Health Narrow Network	$155.81
Rate for Payer: Priority Health SBD	$155.81
Rate for Payer: UMR Bronson Commercial	$102.58

PR DILATE ESOPHAGUS,BALLOON RETROGRADE

Professional

Both

$812.00

Service Code	HCPCS 43456
Min. Negotiated Rate	$324.80
Max. Negotiated Rate	$568.40
Rate for Payer: BCBS Complete	$324.80
Rate for Payer: Cash Price	$649.60
Rate for Payer: Priority Health Cigna Priority Health	$568.40
Rate for Payer: UMR Bronson Commercial	$373.52

PR DILATE ESOPH,BALLN,>30MM ACHALASIA

Professional

Both

$1,009.00

Service Code	HCPCS 43458
Min. Negotiated Rate	$403.60
Max. Negotiated Rate	$706.30
Rate for Payer: BCBS Complete	$403.60
Rate for Payer: Cash Price	$807.20
Rate for Payer: Priority Health Cigna Priority Health	$706.30
Rate for Payer: UMR Bronson Commercial	$464.14

PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI

Professional

Both

$141.00

Service Code	HCPCS 53660
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$927.17
Rate for Payer: Aetna Commercial	$53.15
Rate for Payer: BCBS Complete	$27.73
Rate for Payer: BCBS Trust/PPO	$927.17
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Meridian Medicaid	$27.73
Rate for Payer: Priority Health Choice Medicaid	$26.41
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.46
Rate for Payer: Priority Health Narrow Network	$66.46
Rate for Payer: Priority Health SBD	$66.46
Rate for Payer: UMR Bronson Commercial	$64.86

PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ

Professional

Both

$142.00

Service Code	HCPCS 53661
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$2,149.12
Rate for Payer: Aetna Commercial	$51.53
Rate for Payer: BCBS Complete	$26.84
Rate for Payer: BCBS Trust/PPO	$2,149.12
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Meridian Medicaid	$26.84
Rate for Payer: Priority Health Choice Medicaid	$25.56
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.84
Rate for Payer: Priority Health Narrow Network	$64.84
Rate for Payer: Priority Health SBD	$64.84
Rate for Payer: UMR Bronson Commercial	$65.32

PR DILATION CERVICAL CANAL INSTRUMENTAL SPX

Professional

Both

$201.00

Service Code	HCPCS 57800
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$1,422.71
Rate for Payer: Aetna Commercial	$57.02
Rate for Payer: BCBS Complete	$32.43
Rate for Payer: BCBS Trust/PPO	$1,422.71
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Meridian Medicaid	$32.43
Rate for Payer: Priority Health Choice Medicaid	$30.89
Rate for Payer: Priority Health Cigna Priority Health	$140.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.23
Rate for Payer: Priority Health Narrow Network	$67.23
Rate for Payer: Priority Health SBD	$67.23
Rate for Payer: UMR Bronson Commercial	$92.46

PR DILATION & CURETTAGE CERVICAL STUMP

Professional

Both

$267.00

Service Code	HCPCS 57558
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$1,924.60
Rate for Payer: Aetna Commercial	$149.43
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$1,924.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.69
Rate for Payer: Priority Health Narrow Network	$183.69
Rate for Payer: Priority Health SBD	$183.69
Rate for Payer: UMR Bronson Commercial	$122.82

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Professional

Both

$845.00

Service Code	HCPCS 58120
Min. Negotiated Rate	$150.38
Max. Negotiated Rate	$1,908.75
Rate for Payer: Aetna Commercial	$275.18
Rate for Payer: BCBS Complete	$157.90
Rate for Payer: BCBS Trust/PPO	$1,908.75
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Meridian Medicaid	$157.90
Rate for Payer: Priority Health Choice Medicaid	$150.38
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$331.87
Rate for Payer: Priority Health Narrow Network	$331.87
Rate for Payer: Priority Health SBD	$331.87
Rate for Payer: UMR Bronson Commercial	$388.70

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Facility

$845.00

Service Code	CPT 58120
Hospital Charge Code	58120
Min. Negotiated Rate	$231.17
Max. Negotiated Rate	$8,748.29
Rate for Payer: Aetna American Axle	$549.25
Rate for Payer: Aetna Commercial	$718.25
Rate for Payer: Aetna Medicare	$2,890.11
Rate for Payer: Aetna New Business (MI Preferred)	$549.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,473.69
Rate for Payer: Amish Plain Church Group Commercial	$3,473.69
Rate for Payer: BCBS Complete	$1,596.23
Rate for Payer: BCBS MAPPO	$2,778.95
Rate for Payer: BCBS Trust/PPO	$2,332.98
Rate for Payer: BCN Medicare Advantage	$2,778.95
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cofinity Commercial	$591.50
Rate for Payer: Cofinity Commercial	$726.70
Rate for Payer: Encore Health Key Benefits Commercial	$676.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,778.95
Rate for Payer: Healthscope Commercial	$760.50
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$591.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$633.75
Rate for Payer: Mclaren Medicaid	$1,520.09
Rate for Payer: Mclaren Medicare	$2,778.95
Rate for Payer: Meridian Medicaid	$1,596.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,917.90
Rate for Payer: MI Amish Medical Board Commercial	$3,195.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$718.25
Rate for Payer: PACE Medicare	$2,640.00
Rate for Payer: PACE SWMI	$2,778.95
Rate for Payer: PHP Commercial	$718.25
Rate for Payer: PHP Medicare Advantage	$2,778.95
Rate for Payer: Priority Health Choice Medicaid	$1,520.09
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,748.29
Rate for Payer: Priority Health Medicare	$2,778.95
Rate for Payer: Priority Health Narrow Network	$6,998.63
Rate for Payer: Priority Health SBD	$532.35
Rate for Payer: Railroad Medicare Medicare	$2,778.95
Rate for Payer: UHC All Payor (Choice/PPO)	$254.29
Rate for Payer: UHC Dual Complete DSNP	$2,778.95
Rate for Payer: UHC Exchange	$231.17
Rate for Payer: UHC Medicare Advantage	$2,862.32
Rate for Payer: UMR Bronson Commercial	$312.65
Rate for Payer: VA VA	$2,778.95
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$633.75

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Professional

Both

$845.00

Service Code	HCPCS 58120
Hospital Charge Code	58120
Min. Negotiated Rate	$150.38
Max. Negotiated Rate	$1,908.75
Rate for Payer: Aetna Commercial	$275.18
Rate for Payer: BCBS Complete	$157.90
Rate for Payer: BCBS Trust/PPO	$1,908.75
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Meridian Medicaid	$157.90
Rate for Payer: Priority Health Choice Medicaid	$150.38
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$331.87
Rate for Payer: Priority Health Narrow Network	$331.87
Rate for Payer: Priority Health SBD	$331.87
Rate for Payer: UMR Bronson Commercial	$388.70

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Facility

$845.00

Service Code	CPT 58120
Hospital Charge Code	58120
Min. Negotiated Rate	$371.80
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna American Axle	$549.25
Rate for Payer: Aetna Commercial	$718.25
Rate for Payer: Aetna New Business (MI Preferred)	$549.25
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cofinity Commercial	$591.50
Rate for Payer: Cofinity Commercial	$726.70
Rate for Payer: Encore Health Key Benefits Commercial	$676.00
Rate for Payer: Healthscope Commercial	$760.50
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$591.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$633.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$718.25
Rate for Payer: PHP Commercial	$718.25
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health SBD	$532.35
Rate for Payer: UMR Bronson Commercial	$371.80
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$633.75

PR DILATION ESOPHAGUS GUIDE WIRE

Professional

Both

$507.00

Service Code	HCPCS 43453
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$1,014.34
Rate for Payer: Aetna Commercial	$113.71
Rate for Payer: BCBS Complete	$57.70
Rate for Payer: BCBS Trust/PPO	$1,014.34
Rate for Payer: Cash Price	$405.60
Rate for Payer: Cash Price	$405.60
Rate for Payer: Meridian Medicaid	$57.70
Rate for Payer: Priority Health Choice Medicaid	$54.95
Rate for Payer: Priority Health Cigna Priority Health	$354.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$149.93
Rate for Payer: Priority Health Narrow Network	$149.93
Rate for Payer: Priority Health SBD	$149.93
Rate for Payer: UMR Bronson Commercial	$233.22

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Facility

$322.00

Service Code	CPT 43450
Hospital Charge Code	43450
Min. Negotiated Rate	$141.68
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna American Axle	$209.30
Rate for Payer: Aetna Commercial	$273.70
Rate for Payer: Aetna New Business (MI Preferred)	$209.30
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cofinity Commercial	$225.40
Rate for Payer: Cofinity Commercial	$276.92
Rate for Payer: Encore Health Key Benefits Commercial	$257.60
Rate for Payer: Healthscope Commercial	$289.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$225.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$241.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.70
Rate for Payer: PHP Commercial	$273.70
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health SBD	$202.86
Rate for Payer: UMR Bronson Commercial	$141.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$241.50

Know your out-of-pocket cost for care.

All Charges