Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST

Professional

Both

$1,640.00

Service Code	HCPCS 55860
Min. Negotiated Rate	$555.29
Max. Negotiated Rate	$2,253.73
Rate for Payer: Aetna Commercial	$1,124.18
Rate for Payer: BCBS Complete	$583.05
Rate for Payer: BCBS Trust/PPO	$2,253.73
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Meridian Medicaid	$583.05
Rate for Payer: Priority Health Choice Medicaid	$555.29
Rate for Payer: Priority Health Cigna Priority Health	$1,148.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,394.12
Rate for Payer: Priority Health Narrow Network	$1,394.12
Rate for Payer: Priority Health SBD	$1,394.12
Rate for Payer: UMR Bronson Commercial	$754.40

PR EXPRESS FACIAL REFINEMENT OR RELAXATION

Professional

Both

$150.00

Service Code	HCPCS 00126
Hospital Revenue Code	990
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$105.00
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: UMR Bronson Commercial	$69.00

PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD

Professional

Both

$185.00

Service Code	HCPCS 0296T
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$129.50
Rate for Payer: BCBS Complete	$74.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Priority Health Cigna Priority Health	$129.50
Rate for Payer: UMR Bronson Commercial	$85.10

PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN

Professional

Both

$60.00

Service Code	HCPCS 0298T
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UMR Bronson Commercial	$27.60

PR EXTENDED ABDOMINOPLASTY

Professional

Both

$5,200.00

Service Code	HCPCS 00366
Hospital Revenue Code	990
Min. Negotiated Rate	$2,080.00
Max. Negotiated Rate	$3,640.00
Rate for Payer: BCBS Complete	$2,080.00
Rate for Payer: Cash Price	$4,160.00
Rate for Payer: Priority Health Cigna Priority Health	$3,640.00
Rate for Payer: UMR Bronson Commercial	$2,392.00

PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS

Professional

Both

$284.00

Service Code	HCPCS 59412
Min. Negotiated Rate	$95.21
Max. Negotiated Rate	$279.47
Rate for Payer: Aetna Commercial	$112.32
Rate for Payer: BCBS Complete	$99.97
Rate for Payer: BCBS Trust/PPO	$279.47
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cash Price	$227.20
Rate for Payer: Meridian Medicaid	$99.97
Rate for Payer: Priority Health Choice Medicaid	$95.21
Rate for Payer: Priority Health Cigna Priority Health	$198.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.95
Rate for Payer: Priority Health Narrow Network	$144.95
Rate for Payer: Priority Health SBD	$144.95
Rate for Payer: UMR Bronson Commercial	$130.64

PR EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN

Professional

Both

$3,021.00

Service Code	HCPCS 48510
Min. Negotiated Rate	$250.41
Max. Negotiated Rate	$2,114.70
Rate for Payer: Aetna Commercial	$1,486.24
Rate for Payer: BCBS Complete	$737.59
Rate for Payer: BCBS Trust/PPO	$250.41
Rate for Payer: Cash Price	$2,416.80
Rate for Payer: Cash Price	$2,416.80
Rate for Payer: Meridian Medicaid	$737.59
Rate for Payer: Priority Health Choice Medicaid	$702.47
Rate for Payer: Priority Health Cigna Priority Health	$2,114.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,931.48
Rate for Payer: Priority Health Narrow Network	$1,931.48
Rate for Payer: Priority Health SBD	$1,931.48
Rate for Payer: UMR Bronson Commercial	$1,389.66

PR EXTERNAL ECG REC>48HR<7D RECORDING

Professional

Both

$30.00

Service Code	HCPCS 93242
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$526.19
Rate for Payer: Aetna Commercial	$18.91
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$526.19
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.02
Rate for Payer: Priority Health Narrow Network	$17.02
Rate for Payer: Priority Health SBD	$17.02
Rate for Payer: UMR Bronson Commercial	$13.80

PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION

Professional

Both

$48.00

Service Code	HCPCS 93244
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$533.05
Rate for Payer: Aetna Commercial	$32.63
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$533.05
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Meridian Medicaid	$15.20
Rate for Payer: Priority Health Choice Medicaid	$14.48
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32.62
Rate for Payer: Priority Health Narrow Network	$32.62
Rate for Payer: Priority Health SBD	$32.62
Rate for Payer: UMR Bronson Commercial	$22.08

PR EXTERNAL ECG REC>48HR<7D SCAN ALYS REPORT R&I

Professional

Both

$306.00

Service Code	HCPCS 93241
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$485.51
Rate for Payer: Aetna Commercial	$142.76
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: BCBS Trust/PPO	$485.51
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Priority Health Cigna Priority Health	$214.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$373.09
Rate for Payer: Priority Health Narrow Network	$373.09
Rate for Payer: Priority Health SBD	$373.09
Rate for Payer: UMR Bronson Commercial	$140.76

PR EXTERNAL ECG REC>7D<15D RECORDING

Professional

Both

$30.00

Service Code	HCPCS 93246
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$607.55
Rate for Payer: Aetna Commercial	$18.91
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$607.55
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.02
Rate for Payer: Priority Health Narrow Network	$17.02
Rate for Payer: Priority Health SBD	$17.02
Rate for Payer: UMR Bronson Commercial	$13.80

PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION

Professional

Both

$53.00

Service Code	HCPCS 93248
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$892.83
Rate for Payer: Aetna Commercial	$35.84
Rate for Payer: BCBS Complete	$16.78
Rate for Payer: BCBS Trust/PPO	$892.83
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Meridian Medicaid	$16.78
Rate for Payer: Priority Health Choice Medicaid	$15.98
Rate for Payer: Priority Health Cigna Priority Health	$37.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.93
Rate for Payer: Priority Health Narrow Network	$35.93
Rate for Payer: Priority Health SBD	$35.93
Rate for Payer: UMR Bronson Commercial	$24.38

PR EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY

Professional

Both

$3,153.00

Service Code	HCPCS 32540
Min. Negotiated Rate	$1,088.00
Max. Negotiated Rate	$2,351.34
Rate for Payer: Aetna Commercial	$2,228.79
Rate for Payer: BCBS Complete	$1,142.40
Rate for Payer: BCBS Trust/PPO	$1,336.07
Rate for Payer: Cash Price	$2,522.40
Rate for Payer: Cash Price	$2,522.40
Rate for Payer: Meridian Medicaid	$1,142.40
Rate for Payer: Priority Health Choice Medicaid	$1,088.00
Rate for Payer: Priority Health Cigna Priority Health	$2,207.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,351.34
Rate for Payer: Priority Health Narrow Network	$2,351.34
Rate for Payer: Priority Health SBD	$2,351.34
Rate for Payer: UMR Bronson Commercial	$1,450.38

PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>

Professional

Both

$1,180.00

Service Code	HCPCS 26111
Min. Negotiated Rate	$210.98
Max. Negotiated Rate	$826.00
Rate for Payer: Aetna Commercial	$552.97
Rate for Payer: BCBS Complete	$284.26
Rate for Payer: BCBS Trust/PPO	$210.98
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cash Price	$944.00
Rate for Payer: Meridian Medicaid	$284.26
Rate for Payer: Priority Health Choice Medicaid	$270.72
Rate for Payer: Priority Health Cigna Priority Health	$826.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$641.37
Rate for Payer: Priority Health Narrow Network	$641.37
Rate for Payer: Priority Health SBD	$641.37
Rate for Payer: UMR Bronson Commercial	$542.80

PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>

Professional

Both

$1,803.00

Service Code	HCPCS 26113
Min. Negotiated Rate	$254.28
Max. Negotiated Rate	$1,262.10
Rate for Payer: Aetna Commercial	$726.61
Rate for Payer: BCBS Complete	$373.72
Rate for Payer: BCBS Trust/PPO	$254.28
Rate for Payer: Cash Price	$1,442.40
Rate for Payer: Cash Price	$1,442.40
Rate for Payer: Meridian Medicaid	$373.72
Rate for Payer: Priority Health Choice Medicaid	$355.92
Rate for Payer: Priority Health Cigna Priority Health	$1,262.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$844.11
Rate for Payer: Priority Health Narrow Network	$844.11
Rate for Payer: Priority Health SBD	$844.11
Rate for Payer: UMR Bronson Commercial	$829.38

PR FAA PHYSICAL

Professional

Both

$130.00

Service Code	HCPCS 00180
Hospital Revenue Code	983
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 FACIAL NERVE FUNCTION STUDIES

Professional

Both

$125.00

Service Code	HCPCS 92516
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$2,145.40
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$2,145.40
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.54
Rate for Payer: Priority Health Narrow Network	$30.54
Rate for Payer: Priority Health SBD	$30.54
Rate for Payer: UMR Bronson Commercial	$57.50

PR FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN

Professional

Both

$53.00

Service Code	HCPCS 97156
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$1,096.22
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCBS Trust/PPO	$1,096.22
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	$31.73
Rate for Payer: Priority Health Narrow Network	$31.73
Rate for Payer: Priority Health SBD	$31.73
Rate for Payer: UMR Bronson Commercial	$24.38

PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS

Professional

Both

$158.00

Service Code	HCPCS 90846
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$346.04
Rate for Payer: Aetna Commercial	$114.40
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: BCBS Trust/PPO	$346.04
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.43
Rate for Payer: Priority Health Narrow Network	$107.43
Rate for Payer: Priority Health SBD	$107.43
Rate for Payer: UMR Bronson Commercial	$72.68

PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS

Professional

Both

$200.00

Service Code	HCPCS 90847
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$114.40
Rate for Payer: BCBS Complete	$68.22
Rate for Payer: BCBS Trust/PPO	$109.89
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Meridian Medicaid	$68.22
Rate for Payer: Priority Health Choice Medicaid	$64.97
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.88
Rate for Payer: Priority Health Narrow Network	$127.88
Rate for Payer: Priority Health SBD	$127.88
Rate for Payer: UMR Bronson Commercial	$92.00

PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE

Professional

Both

$1,056.00

Service Code	HCPCS 20922
Min. Negotiated Rate	$321.84
Max. Negotiated Rate	$55,000.50
Rate for Payer: Aetna Commercial	$646.18
Rate for Payer: BCBS Complete	$337.93
Rate for Payer: BCBS Trust/PPO	$55,000.50
Rate for Payer: Cash Price	$844.80
Rate for Payer: Cash Price	$844.80
Rate for Payer: Meridian Medicaid	$337.93
Rate for Payer: Priority Health Choice Medicaid	$321.84
Rate for Payer: Priority Health Cigna Priority Health	$739.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$755.25
Rate for Payer: Priority Health Narrow Network	$755.25
Rate for Payer: Priority Health SBD	$755.25
Rate for Payer: UMR Bronson Commercial	$485.76

PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX

Professional

Both

$956.00

Service Code	HCPCS 28060
Min. Negotiated Rate	$232.60
Max. Negotiated Rate	$2,093.12
Rate for Payer: Aetna Commercial	$477.23
Rate for Payer: BCBS Complete	$244.23
Rate for Payer: BCBS Trust/PPO	$2,093.12
Rate for Payer: Cash Price	$764.80
Rate for Payer: Cash Price	$764.80
Rate for Payer: Meridian Medicaid	$244.23
Rate for Payer: Priority Health Choice Medicaid	$232.60
Rate for Payer: Priority Health Cigna Priority Health	$669.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$546.90
Rate for Payer: Priority Health Narrow Network	$546.90
Rate for Payer: Priority Health SBD	$546.90
Rate for Payer: UMR Bronson Commercial	$439.76

PR FASCIOTOMY FOOT&/TOE

Professional

Both

$705.00

Service Code	HCPCS 28008
Min. Negotiated Rate	$189.78
Max. Negotiated Rate	$3,296.59
Rate for Payer: Aetna Commercial	$390.96
Rate for Payer: BCBS Complete	$199.27
Rate for Payer: BCBS Trust/PPO	$3,296.59
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cash Price	$564.00
Rate for Payer: Meridian Medicaid	$199.27
Rate for Payer: Priority Health Choice Medicaid	$189.78
Rate for Payer: Priority Health Cigna Priority Health	$493.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$448.35
Rate for Payer: Priority Health Narrow Network	$448.35
Rate for Payer: Priority Health SBD	$448.35
Rate for Payer: UMR Bronson Commercial	$324.30

PR FASCIOTOMY FOOT&/TOE

Facility

$705.00

Service Code	CPT 28008
Hospital Charge Code	28008
Min. Negotiated Rate	$310.20
Max. Negotiated Rate	$634.50
Rate for Payer: Aetna American Axle	$458.25
Rate for Payer: Aetna Commercial	$599.25
Rate for Payer: Aetna New Business (MI Preferred)	$458.25
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cofinity Commercial	$493.50
Rate for Payer: Cofinity Commercial	$606.30
Rate for Payer: Encore Health Key Benefits Commercial	$564.00
Rate for Payer: Healthscope Commercial	$634.50
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$493.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$528.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$599.25
Rate for Payer: PHP Commercial	$599.25
Rate for Payer: Priority Health Cigna Priority Health	$493.50
Rate for Payer: Priority Health SBD	$444.15
Rate for Payer: UMR Bronson Commercial	$310.20
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$528.75

PR FASCIOTOMY FOOT&/TOE

Professional

Both

$705.00

Service Code	HCPCS 28008
Hospital Charge Code	28008
Min. Negotiated Rate	$189.78
Max. Negotiated Rate	$3,296.59
Rate for Payer: Aetna Commercial	$390.96
Rate for Payer: BCBS Complete	$199.27
Rate for Payer: BCBS Trust/PPO	$3,296.59
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cash Price	$564.00
Rate for Payer: Meridian Medicaid	$199.27
Rate for Payer: Priority Health Choice Medicaid	$189.78
Rate for Payer: Priority Health Cigna Priority Health	$493.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$448.35
Rate for Payer: Priority Health Narrow Network	$448.35
Rate for Payer: Priority Health SBD	$448.35
Rate for Payer: UMR Bronson Commercial	$324.30

Know your out-of-pocket cost for care.

All Charges