Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE

Professional

Both

$822.00

Service Code	HCPCS 43239
Hospital Charge Code	43239
Min. Negotiated Rate	$33.11
Max. Negotiated Rate	$575.40
Rate for Payer: Aetna Commercial	$183.36
Rate for Payer: BCBS Complete	$91.70
Rate for Payer: BCBS Trust/PPO	$33.11
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cash Price	$657.60
Rate for Payer: Meridian Medicaid	$91.70
Rate for Payer: Priority Health Choice Medicaid	$87.33
Rate for Payer: Priority Health Cigna Priority Health	$575.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$238.71
Rate for Payer: Priority Health Narrow Network	$238.71
Rate for Payer: Priority Health SBD	$238.71
Rate for Payer: UMR Bronson Commercial	$378.12

PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE

Professional

Both

$822.00

Service Code	HCPCS 43239
Min. Negotiated Rate	$33.11
Max. Negotiated Rate	$575.40
Rate for Payer: Aetna Commercial	$183.36
Rate for Payer: BCBS Complete	$91.70
Rate for Payer: BCBS Trust/PPO	$33.11
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cash Price	$657.60
Rate for Payer: Meridian Medicaid	$91.70
Rate for Payer: Priority Health Choice Medicaid	$87.33
Rate for Payer: Priority Health Cigna Priority Health	$575.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$238.71
Rate for Payer: Priority Health Narrow Network	$238.71
Rate for Payer: Priority Health SBD	$238.71
Rate for Payer: UMR Bronson Commercial	$378.12

PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE

Facility

$822.00

Service Code	CPT 43239
Hospital Charge Code	43239
Hospital Revenue Code	960
Min. Negotiated Rate	$361.68
Max. Negotiated Rate	$739.80
Rate for Payer: Aetna American Axle	$534.30
Rate for Payer: Aetna Commercial	$698.70
Rate for Payer: Aetna New Business (MI Preferred)	$534.30
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cofinity Commercial	$575.40
Rate for Payer: Cofinity Commercial	$706.92
Rate for Payer: Encore Health Key Benefits Commercial	$657.60
Rate for Payer: Healthscope Commercial	$739.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$575.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$616.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$698.70
Rate for Payer: PHP Commercial	$698.70
Rate for Payer: Priority Health Cigna Priority Health	$575.40
Rate for Payer: Priority Health SBD	$517.86
Rate for Payer: UMR Bronson Commercial	$361.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$616.50

PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD

Professional

Both

$1,130.00

Service Code	HCPCS 43255
Min. Negotiated Rate	$125.67
Max. Negotiated Rate	$935.09
Rate for Payer: Aetna Commercial	$266.36
Rate for Payer: BCBS Complete	$131.95
Rate for Payer: BCBS Trust/PPO	$935.09
Rate for Payer: Cash Price	$904.00
Rate for Payer: Cash Price	$904.00
Rate for Payer: Meridian Medicaid	$131.95
Rate for Payer: Priority Health Choice Medicaid	$125.67
Rate for Payer: Priority Health Cigna Priority Health	$791.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$345.14
Rate for Payer: Priority Health Narrow Network	$345.14
Rate for Payer: Priority Health SBD	$345.14
Rate for Payer: UMR Bronson Commercial	$519.80

PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION

Professional

Both

$818.00

Service Code	HCPCS 43254
Min. Negotiated Rate	$169.34
Max. Negotiated Rate	$1,640.37
Rate for Payer: Aetna Commercial	$358.95
Rate for Payer: BCBS Complete	$177.81
Rate for Payer: BCBS Trust/PPO	$1,640.37
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$654.40
Rate for Payer: Meridian Medicaid	$177.81
Rate for Payer: Priority Health Choice Medicaid	$169.34
Rate for Payer: Priority Health Cigna Priority Health	$572.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$465.09
Rate for Payer: Priority Health Narrow Network	$465.09
Rate for Payer: Priority Health SBD	$465.09
Rate for Payer: UMR Bronson Commercial	$376.28

PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST

Professional

Both

$1,165.00

Service Code	HCPCS 43240
Min. Negotiated Rate	$41.74
Max. Negotiated Rate	$815.50
Rate for Payer: Aetna Commercial	$521.19
Rate for Payer: BCBS Complete	$258.09
Rate for Payer: BCBS Trust/PPO	$41.74
Rate for Payer: Cash Price	$932.00
Rate for Payer: Cash Price	$932.00
Rate for Payer: Meridian Medicaid	$258.09
Rate for Payer: Priority Health Choice Medicaid	$245.80
Rate for Payer: Priority Health Cigna Priority Health	$815.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$673.82
Rate for Payer: Priority Health Narrow Network	$673.82
Rate for Payer: Priority Health SBD	$673.82
Rate for Payer: UMR Bronson Commercial	$535.90

PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER

Professional

Both

$788.00

Service Code	HCPCS 43253
Min. Negotiated Rate	$164.65
Max. Negotiated Rate	$1,676.30
Rate for Payer: Aetna Commercial	$348.83
Rate for Payer: BCBS Complete	$172.88
Rate for Payer: BCBS Trust/PPO	$1,676.30
Rate for Payer: Cash Price	$630.40
Rate for Payer: Cash Price	$630.40
Rate for Payer: Meridian Medicaid	$172.88
Rate for Payer: Priority Health Choice Medicaid	$164.65
Rate for Payer: Priority Health Cigna Priority Health	$551.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$452.74
Rate for Payer: Priority Health Narrow Network	$452.74
Rate for Payer: Priority Health SBD	$452.74
Rate for Payer: UMR Bronson Commercial	$362.48

PR EKG FOR INITIAL PREVENT EXAM

Professional

Both

$42.00

Service Code	HCPCS G0403
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$1,763.47
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$1,763.47
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$29.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.33
Rate for Payer: Priority Health Narrow Network	$20.33
Rate for Payer: Priority Health SBD	$20.33
Rate for Payer: UMR Bronson Commercial	$19.32

PR EKG INTERPRET & REPORT PREVE

Professional

Both

$21.00

Service Code	HCPCS G0405
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$1,397.35
Rate for Payer: Aetna Commercial	$11.04
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$1,397.35
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.34
Rate for Payer: Priority Health Narrow Network	$11.34
Rate for Payer: Priority Health SBD	$11.34
Rate for Payer: UMR Bronson Commercial	$9.66

PR EKG TRACING FOR INITIAL PREV

Professional

Both

$21.00

Service Code	HCPCS G0404
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$2,970.10
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$2,970.10
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.99
Rate for Payer: Priority Health Narrow Network	$8.99
Rate for Payer: Priority Health SBD	$8.99
Rate for Payer: UMR Bronson Commercial	$9.66

PR ELASTIC GARMENT/COVERING

Professional

Both

$17.00

Service Code	HCPCS A4466
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$11.90
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: Cash Price	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.90
Rate for Payer: UMR Bronson Commercial	$7.82

PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN

Professional

Both

$103.00

Service Code	HCPCS 95983
Min. Negotiated Rate	$31.10
Max. Negotiated Rate	$205.51
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: BCBS Complete	$32.66
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Meridian Medicaid	$32.66
Rate for Payer: Priority Health Choice Medicaid	$31.10
Rate for Payer: Priority Health Cigna Priority Health	$72.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.58
Rate for Payer: Priority Health Narrow Network	$65.58
Rate for Payer: Priority Health SBD	$65.58
Rate for Payer: UMR Bronson Commercial	$47.38

PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN

Professional

Both

$89.00

Service Code	HCPCS 95984
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$269.43
Rate for Payer: Aetna Commercial	$48.95
Rate for Payer: BCBS Complete	$28.62
Rate for Payer: BCBS Trust/PPO	$269.43
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Meridian Medicaid	$28.62
Rate for Payer: Priority Health Choice Medicaid	$27.26
Rate for Payer: Priority Health Cigna Priority Health	$62.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.50
Rate for Payer: Priority Health Narrow Network	$57.50
Rate for Payer: Priority Health SBD	$57.50
Rate for Payer: UMR Bronson Commercial	$40.94

PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG

Professional

Both

$108.00

Service Code	HCPCS 95977
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$154.26
Rate for Payer: Aetna Commercial	$58.47
Rate for Payer: BCBS Complete	$34.22
Rate for Payer: BCBS Trust/PPO	$154.26
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Meridian Medicaid	$34.22
Rate for Payer: Priority Health Choice Medicaid	$32.59
Rate for Payer: Priority Health Cigna Priority Health	$75.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.17
Rate for Payer: Priority Health Narrow Network	$69.17
Rate for Payer: Priority Health SBD	$69.17
Rate for Payer: UMR Bronson Commercial	$49.68

PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG

Professional

Both

$470.00

Service Code	HCPCS 95972
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$329.00
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: BCBS Complete	$26.62
Rate for Payer: BCBS Complete	$26.62
Rate for Payer: BCBS Trust/PPO	$168.53
Rate for Payer: BCBS Trust/PPO	$168.53
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Meridian Medicaid	$26.62
Rate for Payer: Meridian Medicaid	$26.62
Rate for Payer: Priority Health Choice Medicaid	$25.35
Rate for Payer: Priority Health Choice Medicaid	$25.35
Rate for Payer: Priority Health Cigna Priority Health	$329.00
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.89
Rate for Payer: Priority Health Narrow Network	$53.89
Rate for Payer: Priority Health Narrow Network	$53.89
Rate for Payer: Priority Health SBD	$53.89
Rate for Payer: Priority Health SBD	$53.89
Rate for Payer: UMR Bronson Commercial	$75.90
Rate for Payer: UMR Bronson Commercial	$216.20

PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING

Professional

Both

$150.00

Service Code	HCPCS 95970
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$219.77
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: BCBS Complete	$12.08
Rate for Payer: BCBS Trust/PPO	$219.77
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Meridian Medicaid	$12.08
Rate for Payer: Priority Health Choice Medicaid	$11.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24.71
Rate for Payer: Priority Health Narrow Network	$24.71
Rate for Payer: Priority Health SBD	$24.71
Rate for Payer: UMR Bronson Commercial	$69.00

PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG

Professional

Both

$165.00

Service Code	HCPCS 95971
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$475.47
Rate for Payer: Aetna Commercial	$44.17
Rate for Payer: BCBS Complete	$25.72
Rate for Payer: BCBS Trust/PPO	$475.47
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Meridian Medicaid	$25.72
Rate for Payer: Priority Health Choice Medicaid	$24.50
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.65
Rate for Payer: Priority Health Narrow Network	$51.65
Rate for Payer: Priority Health SBD	$51.65
Rate for Payer: UMR Bronson Commercial	$75.90

PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG

Professional

Both

$82.00

Service Code	HCPCS 95976
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$140.93
Rate for Payer: Aetna Commercial	$43.64
Rate for Payer: BCBS Complete	$25.72
Rate for Payer: BCBS Trust/PPO	$140.93
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Meridian Medicaid	$25.72
Rate for Payer: Priority Health Choice Medicaid	$24.50
Rate for Payer: Priority Health Cigna Priority Health	$57.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.65
Rate for Payer: Priority Health Narrow Network	$51.65
Rate for Payer: Priority Health SBD	$51.65
Rate for Payer: UMR Bronson Commercial	$37.72

PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR

Professional

Both

$940.00

Service Code	HCPCS 95974
Min. Negotiated Rate	$376.00
Max. Negotiated Rate	$658.00
Rate for Payer: BCBS Complete	$376.00
Rate for Payer: Cash Price	$752.00
Rate for Payer: Priority Health Cigna Priority Health	$658.00
Rate for Payer: UMR Bronson Commercial	$432.40

PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN

Professional

Both

$165.00

Service Code	HCPCS 95973
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$115.50
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: UMR Bronson Commercial	$75.90

PR ELEC STIM OTHER THAN WOUND

Professional

Both

$25.00

Service Code	HCPCS G0283
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$367.70
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$367.70
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.99
Rate for Payer: Priority Health Narrow Network	$11.99
Rate for Payer: Priority Health SBD	$11.99
Rate for Payer: UMR Bronson Commercial	$11.50

PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG

Professional

Both

$206.00

Service Code	HCPCS 62368
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$144.20
Rate for Payer: Aetna Commercial	$45.55
Rate for Payer: BCBS Complete	$22.82
Rate for Payer: BCBS Trust/PPO	$45.43
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Meridian Medicaid	$22.82
Rate for Payer: Priority Health Choice Medicaid	$21.73
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.75
Rate for Payer: Priority Health Narrow Network	$57.75
Rate for Payer: Priority Health SBD	$57.75
Rate for Payer: UMR Bronson Commercial	$94.76

PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL

Professional

Both

$375.00

Service Code	HCPCS 62367
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$310.64
Rate for Payer: Aetna Commercial	$31.85
Rate for Payer: BCBS Complete	$16.55
Rate for Payer: BCBS Trust/PPO	$310.64
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Meridian Medicaid	$16.55
Rate for Payer: Priority Health Choice Medicaid	$15.76
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.34
Rate for Payer: Priority Health Narrow Network	$41.34
Rate for Payer: Priority Health SBD	$41.34
Rate for Payer: UMR Bronson Commercial	$172.50

PR ELECTROACOUS EVAL HEARING AID BINAURAL

Professional

Both

$77.00

Service Code	HCPCS 92595
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$338.64
Rate for Payer: Aetna Commercial	$49.30
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: BCBS Trust/PPO	$338.64
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$53.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.54
Rate for Payer: Priority Health Narrow Network	$61.54
Rate for Payer: Priority Health SBD	$61.54
Rate for Payer: UMR Bronson Commercial	$35.42

PR ELECTROACOUS EVAL HEARING AID MONAURAL

Professional

Both

$26.00

Service Code	HCPCS 92594
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$231.15
Rate for Payer: Aetna Commercial	$22.43
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$231.15
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	$28.75
Rate for Payer: Priority Health Narrow Network	$28.75
Rate for Payer: Priority Health SBD	$28.75
Rate for Payer: UMR Bronson Commercial	$11.96

Know your out-of-pocket cost for care.

All Charges