Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP

Facility

$1,107.00

Service Code	CPT 46250
Hospital Charge Code	46250
Hospital Revenue Code	960
Min. Negotiated Rate	$487.08
Max. Negotiated Rate	$996.30
Rate for Payer: Aetna American Axle	$719.55
Rate for Payer: Aetna Commercial	$940.95
Rate for Payer: Aetna New Business (MI Preferred)	$719.55
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cofinity Commercial	$774.90
Rate for Payer: Cofinity Commercial	$952.02
Rate for Payer: Encore Health Key Benefits Commercial	$885.60
Rate for Payer: Healthscope Commercial	$996.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$774.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$830.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$940.95
Rate for Payer: PHP Commercial	$940.95
Rate for Payer: Priority Health Cigna Priority Health	$774.90
Rate for Payer: Priority Health SBD	$697.41
Rate for Payer: UMR Bronson Commercial	$487.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$830.25

PR HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO

Professional

Both

$728.00

Service Code	HCPCS 46257
Min. Negotiated Rate	$267.95
Max. Negotiated Rate	$1,554.26
Rate for Payer: Aetna Commercial	$570.73
Rate for Payer: BCBS Complete	$281.35
Rate for Payer: BCBS Trust/PPO	$1,554.26
Rate for Payer: Cash Price	$582.40
Rate for Payer: Cash Price	$582.40
Rate for Payer: Meridian Medicaid	$281.35
Rate for Payer: Priority Health Choice Medicaid	$267.95
Rate for Payer: Priority Health Cigna Priority Health	$509.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$734.38
Rate for Payer: Priority Health Narrow Network	$734.38
Rate for Payer: Priority Health SBD	$734.38
Rate for Payer: UMR Bronson Commercial	$334.88

PR HEMORRHOIDOPEXY STAPLING

Professional

Both

$633.00

Service Code	HCPCS 46947
Min. Negotiated Rate	$250.91
Max. Negotiated Rate	$2,172.37
Rate for Payer: Aetna Commercial	$517.14
Rate for Payer: BCBS Complete	$263.46
Rate for Payer: BCBS Trust/PPO	$2,172.37
Rate for Payer: Cash Price	$506.40
Rate for Payer: Cash Price	$506.40
Rate for Payer: Meridian Medicaid	$263.46
Rate for Payer: Priority Health Choice Medicaid	$250.91
Rate for Payer: Priority Health Cigna Priority Health	$443.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$686.16
Rate for Payer: Priority Health Narrow Network	$686.16
Rate for Payer: Priority Health SBD	$686.16
Rate for Payer: UMR Bronson Commercial	$291.18

PR HEPATECTOMY RESCJ PARTIAL LOBECTOMY

Professional

Both

$4,542.00

Service Code	HCPCS 47120
Min. Negotiated Rate	$1,489.08
Max. Negotiated Rate	$4,093.47
Rate for Payer: Aetna Commercial	$3,154.10
Rate for Payer: BCBS Complete	$1,563.53
Rate for Payer: BCBS Trust/PPO	$2,491.46
Rate for Payer: Cash Price	$3,633.60
Rate for Payer: Cash Price	$3,633.60
Rate for Payer: Meridian Medicaid	$1,563.53
Rate for Payer: Priority Health Choice Medicaid	$1,489.08
Rate for Payer: Priority Health Cigna Priority Health	$3,179.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,093.47
Rate for Payer: Priority Health Narrow Network	$4,093.47
Rate for Payer: Priority Health SBD	$4,093.47
Rate for Payer: UMR Bronson Commercial	$2,089.32

PR HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY

Professional

Both

$6,038.00

Service Code	HCPCS 47130
Min. Negotiated Rate	$2,100.18
Max. Negotiated Rate	$5,780.36
Rate for Payer: Aetna Commercial	$4,470.87
Rate for Payer: BCBS Complete	$2,205.19
Rate for Payer: BCBS Trust/PPO	$2,750.86
Rate for Payer: Cash Price	$4,830.40
Rate for Payer: Cash Price	$4,830.40
Rate for Payer: Meridian Medicaid	$2,205.19
Rate for Payer: Priority Health Choice Medicaid	$2,100.18
Rate for Payer: Priority Health Cigna Priority Health	$4,226.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,780.36
Rate for Payer: Priority Health Narrow Network	$5,780.36
Rate for Payer: Priority Health SBD	$5,780.36
Rate for Payer: UMR Bronson Commercial	$2,777.48

PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM

Professional

Both

$150.00

Service Code	HCPCS 90636
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$134.53
Rate for Payer: Aetna Commercial	$123.57
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$134.53
Rate for Payer: Cash Price	$120.00
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 HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES

Professional

Both

$2,199.00

Service Code	HCPCS 47010
Min. Negotiated Rate	$241.96
Max. Negotiated Rate	$2,131.40
Rate for Payer: Aetna Commercial	$1,637.45
Rate for Payer: BCBS Complete	$814.54
Rate for Payer: BCBS Trust/PPO	$241.96
Rate for Payer: Cash Price	$1,759.20
Rate for Payer: Cash Price	$1,759.20
Rate for Payer: Meridian Medicaid	$814.54
Rate for Payer: Priority Health Choice Medicaid	$775.75
Rate for Payer: Priority Health Cigna Priority Health	$1,539.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,131.40
Rate for Payer: Priority Health Narrow Network	$2,131.40
Rate for Payer: Priority Health SBD	$2,131.40
Rate for Payer: UMR Bronson Commercial	$1,011.54

PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE

Professional

Both

$50.00

Service Code	HCPCS 90633
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$38.42
Rate for Payer: Aetna Commercial	$38.42
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$31.32
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UMR Bronson Commercial	$23.00

PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE

Professional

Both

$88.00

Service Code	HCPCS 90632
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$72.34
Rate for Payer: Aetna Commercial	$70.26
Rate for Payer: BCBS Complete	$35.20
Rate for Payer: BCBS Trust/PPO	$72.34
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Priority Health Cigna Priority Health	$61.60
Rate for Payer: UMR Bronson Commercial	$40.48

PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM

Professional

Both

$101.00

Service Code	HCPCS 90743
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$76.66
Rate for Payer: Aetna Commercial	$75.15
Rate for Payer: BCBS Complete	$40.40
Rate for Payer: BCBS Trust/PPO	$76.66
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Priority Health Cigna Priority Health	$70.70
Rate for Payer: UMR Bronson Commercial	$46.46

PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE

Professional

Both

$320.00

Service Code	HCPCS 90739
Min. Negotiated Rate	$128.00
Max. Negotiated Rate	$224.00
Rate for Payer: Aetna Commercial	$160.28
Rate for Payer: BCBS Complete	$128.00
Rate for Payer: BCBS Trust/PPO	$166.39
Rate for Payer: Cash Price	$256.00
Rate for Payer: Cash Price	$256.00
Rate for Payer: Priority Health Cigna Priority Health	$224.00
Rate for Payer: UMR Bronson Commercial	$147.20

PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$81.00

Service Code	HCPCS 90746
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$73.05
Rate for Payer: Aetna Commercial	$70.38
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCBS Trust/PPO	$73.05
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$56.70
Rate for Payer: UMR Bronson Commercial	$37.26

PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM

Professional

Both

$35.00

Service Code	HCPCS 90744
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$31.03
Rate for Payer: Aetna Commercial	$30.77
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$31.03
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR HFO FLEXION GLOVE PRE OTS

Professional

Both

$97.00

Service Code	HCPCS L3912
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$67.90
Rate for Payer: Aetna Commercial	$57.75
Rate for Payer: BCBS Complete	$38.80
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Priority Health Cigna Priority Health	$67.90
Rate for Payer: UMR Bronson Commercial	$44.62

PR HFO NONTORSION JNTS PRE CST

Professional

Both

$84.00

Service Code	HCPCS L3929
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$58.80
Rate for Payer: Aetna Commercial	$50.06
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: UMR Bronson Commercial	$38.64

PR HFO W/JOINT(S) CF

Professional

Both

$294.00

Service Code	HCPCS L3921
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$205.80
Rate for Payer: Aetna Commercial	$176.08
Rate for Payer: BCBS Complete	$117.60
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cash Price	$235.20
Rate for Payer: Priority Health Cigna Priority Health	$205.80
Rate for Payer: UMR Bronson Commercial	$135.24

PR HFO W/O JOINTS CF

Professional

Both

$248.00

Service Code	HCPCS L3913
Min. Negotiated Rate	$99.20
Max. Negotiated Rate	$173.60
Rate for Payer: Aetna Commercial	$148.45
Rate for Payer: BCBS Complete	$99.20
Rate for Payer: Cash Price	$198.40
Rate for Payer: Cash Price	$198.40
Rate for Payer: Priority Health Cigna Priority Health	$173.60
Rate for Payer: UMR Bronson Commercial	$114.08

PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE

Professional

Both

$260.00

Service Code	HCPCS 90748
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: BCBS Complete	$104.00
Rate for Payer: BCBS Trust/PPO	$42.85
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Priority Health Cigna Priority Health	$182.00
Rate for Payer: UMR Bronson Commercial	$119.60

PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE

Professional

Both

$36.00

Service Code	HCPCS 90647
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$30.53
Rate for Payer: Aetna Commercial	$30.53
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS Trust/PPO	$28.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$25.20
Rate for Payer: UMR Bronson Commercial	$16.56

PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE

Professional

Both

$32.00

Service Code	HCPCS 90648
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$13.32
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$18.57
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 HIB VACCINE, HBOC, IM

Professional

Both

$31.00

Service Code	HCPCS 90645
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$21.70
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70
Rate for Payer: UMR Bronson Commercial	$14.26

PR HIB VACCINE, PRP-D, IM

Professional

Both

$32.00

Service Code	HCPCS 90646
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$22.40
Rate for Payer: BCBS Complete	$12.80
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 HINGE EXTENSION/FLEX WRIST/F

Professional

Both

$1,482.00

Service Code	HCPCS L3900
Min. Negotiated Rate	$592.80
Max. Negotiated Rate	$1,037.40
Rate for Payer: Aetna Commercial	$887.96
Rate for Payer: BCBS Complete	$592.80
Rate for Payer: Cash Price	$1,185.60
Rate for Payer: Cash Price	$1,185.60
Rate for Payer: Priority Health Cigna Priority Health	$1,037.40
Rate for Payer: UMR Bronson Commercial	$681.72

PR HOME HEALTH CARE SUPERVISION

Professional

Both

$180.00

Service Code	HCPCS G0181
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$138.33
Rate for Payer: Aetna Commercial	$103.61
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: BCBS Trust/PPO	$90.87
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.33
Rate for Payer: Priority Health Narrow Network	$138.33
Rate for Payer: Priority Health SBD	$138.33
Rate for Payer: UMR Bronson Commercial	$82.80

PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES

Professional

Both

$300.00

Service Code	HCPCS 99350
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$507.70
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Trust/PPO	$507.70
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.58
Rate for Payer: Priority Health Narrow Network	$235.58
Rate for Payer: Priority Health SBD	$235.58
Rate for Payer: UMR Bronson Commercial	$138.00

Know your out-of-pocket cost for care.

All Charges