Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE

Professional

Both

$24.00

Service Code	HCPCS 90656
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$17.69
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Priority Health Cigna Priority Health	$16.80
Rate for Payer: UMR Bronson Commercial	$11.04

PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE

Professional

Both

$23.00

Service Code	HCPCS 90655
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$16.30
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: UMR Bronson Commercial	$10.58

PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90686
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.65
Rate for Payer: Aetna Commercial	$22.35
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$22.65
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: UMR Bronson Commercial	$11.50

PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90685
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.05
Rate for Payer: Aetna Commercial	$19.36
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$22.05
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: UMR Bronson Commercial	$11.50

PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90687
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$10.44
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$10.78
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: UMR Bronson Commercial	$11.50

PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90688
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$21.56
Rate for Payer: Aetna Commercial	$20.88
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$21.56
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: UMR Bronson Commercial	$11.50

PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM

Professional

Both

$68.00

Service Code	HCPCS 90662
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$73.40
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: BCBS Trust/PPO	$73.62
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: UMR Bronson Commercial	$31.28

PR ILEOSCOPY STOMA W/BALLOON DILATION

Professional

Both

$230.00

Service Code	HCPCS 44381
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$282.11
Rate for Payer: Aetna Commercial	$110.61
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCBS Trust/PPO	$282.11
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health	$161.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.00
Rate for Payer: Priority Health Narrow Network	$147.00
Rate for Payer: Priority Health SBD	$147.00
Rate for Payer: UMR Bronson Commercial	$105.80

PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE

Professional

Both

$919.00

Service Code	HCPCS 44382
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$643.30
Rate for Payer: Aetna Commercial	$97.19
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS Trust/PPO	$226.11
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cash Price	$735.20
Rate for Payer: Meridian Medicaid	$49.20
Rate for Payer: Priority Health Choice Medicaid	$46.86
Rate for Payer: Priority Health Cigna Priority Health	$643.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$128.76
Rate for Payer: Priority Health Narrow Network	$128.76
Rate for Payer: Priority Health SBD	$128.76
Rate for Payer: UMR Bronson Commercial	$422.74

PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT

Professional

Both

$235.00

Service Code	HCPCS 44384
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$402.56
Rate for Payer: Aetna Commercial	$205.72
Rate for Payer: BCBS Complete	$100.64
Rate for Payer: BCBS Trust/PPO	$402.56
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Meridian Medicaid	$100.64
Rate for Payer: Priority Health Choice Medicaid	$95.85
Rate for Payer: Priority Health Cigna Priority Health	$164.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$267.53
Rate for Payer: Priority Health Narrow Network	$267.53
Rate for Payer: Priority Health SBD	$267.53
Rate for Payer: UMR Bronson Commercial	$108.10

PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD

Professional

Both

$822.00

Service Code	HCPCS 44380
Min. Negotiated Rate	$36.42
Max. Negotiated Rate	$575.40
Rate for Payer: Aetna Commercial	$74.35
Rate for Payer: BCBS Complete	$38.24
Rate for Payer: BCBS Trust/PPO	$247.77
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cash Price	$657.60
Rate for Payer: Meridian Medicaid	$38.24
Rate for Payer: Priority Health Choice Medicaid	$36.42
Rate for Payer: Priority Health Cigna Priority Health	$575.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.78
Rate for Payer: Priority Health Narrow Network	$98.78
Rate for Payer: Priority Health SBD	$98.78
Rate for Payer: UMR Bronson Commercial	$378.12

PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT

Professional

Both

$1,066.00

Service Code	HCPCS 44383
Min. Negotiated Rate	$426.40
Max. Negotiated Rate	$746.20
Rate for Payer: BCBS Complete	$426.40
Rate for Payer: Cash Price	$852.80
Rate for Payer: Priority Health Cigna Priority Health	$746.20
Rate for Payer: UMR Bronson Commercial	$490.36

PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE

Professional

Both

$2,504.00

Service Code	HCPCS 44310
Min. Negotiated Rate	$81.93
Max. Negotiated Rate	$1,819.78
Rate for Payer: Aetna Commercial	$1,396.74
Rate for Payer: BCBS Complete	$695.55
Rate for Payer: BCBS Trust/PPO	$81.93
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Meridian Medicaid	$695.55
Rate for Payer: Priority Health Choice Medicaid	$662.43
Rate for Payer: Priority Health Cigna Priority Health	$1,752.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,819.78
Rate for Payer: Priority Health Narrow Network	$1,819.78
Rate for Payer: Priority Health SBD	$1,819.78
Rate for Payer: UMR Bronson Commercial	$1,151.84

PR ILIAC ART ANGIO,CARDIAC CATH

Professional

Both

$35.00

Service Code	HCPCS G0278
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$152.15
Rate for Payer: Aetna Commercial	$17.94
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$152.15
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: Priority Health HMO/PPO/Tiered Network	$20.48
Rate for Payer: Priority Health Narrow Network	$20.48
Rate for Payer: Priority Health SBD	$20.48
Rate for Payer: UMR Bronson Commercial	$16.10

PR IM ADM INTRANSL/ORAL 1 VACCINE

Professional

Both

$32.00

Service Code	HCPCS 90473
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$611.77
Rate for Payer: Aetna Commercial	$5.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$611.77
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: Priority Health HMO/PPO/Tiered Network	$26.75
Rate for Payer: Priority Health Narrow Network	$26.75
Rate for Payer: Priority Health SBD	$26.75
Rate for Payer: UMR Bronson Commercial	$14.72

PR IM ADM INTRANSL/ORAL EA VACCINE

Professional

Both

$23.00

Service Code	HCPCS 90474
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$652.45
Rate for Payer: Aetna Commercial	$5.00
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$652.45
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.72
Rate for Payer: Priority Health Narrow Network	$15.72
Rate for Payer: Priority Health SBD	$15.72
Rate for Payer: UMR Bronson Commercial	$10.58

PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE

Professional

Both

$32.00

Service Code	HCPCS 90471
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$593.28
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$593.28
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: Priority Health HMO/PPO/Tiered Network	$26.75
Rate for Payer: Priority Health Narrow Network	$26.75
Rate for Payer: Priority Health SBD	$26.75
Rate for Payer: UMR Bronson Commercial	$14.72

PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE

Professional

Both

$23.00

Service Code	HCPCS 90472
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$1,006.41
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$1,006.41
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.31
Rate for Payer: Priority Health Narrow Network	$19.31
Rate for Payer: Priority Health SBD	$19.31
Rate for Payer: UMR Bronson Commercial	$10.58

PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX

Professional

Both

$35.00

Service Code	HCPCS 90460
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$519.85
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$519.85
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: Priority Health HMO/PPO/Tiered Network	$26.75
Rate for Payer: Priority Health Narrow Network	$26.75
Rate for Payer: Priority Health SBD	$26.75
Rate for Payer: UMR Bronson Commercial	$16.10

PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT

Professional

Both

$23.00

Service Code	HCPCS 90461
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$544.68
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$544.68
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.48
Rate for Payer: Priority Health Narrow Network	$13.48
Rate for Payer: Priority Health SBD	$13.48
Rate for Payer: UMR Bronson Commercial	$10.58

PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE

Professional

Both

$739.00

Service Code	HCPCS 10030
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$148.19
Rate for Payer: BCBS Complete	$88.79
Rate for Payer: BCBS Trust/PPO	$2,625.00
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Meridian Medicaid	$88.79
Rate for Payer: Priority Health Choice Medicaid	$84.56
Rate for Payer: Priority Health Cigna Priority Health	$517.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$163.59
Rate for Payer: Priority Health Narrow Network	$163.59
Rate for Payer: Priority Health SBD	$163.59
Rate for Payer: UMR Bronson Commercial	$339.94

PRIMAQUINE 26.3 MG TABLET

Facility

$913.44

Service Code	NDC 0024-1596-01
Hospital Charge Code	6541
Hospital Revenue Code	637
Min. Negotiated Rate	$401.91
Max. Negotiated Rate	$822.10
Rate for Payer: Aetna American Axle	$593.74
Rate for Payer: Aetna Commercial	$776.42
Rate for Payer: Aetna New Business (MI Preferred)	$593.74
Rate for Payer: Cash Price	$730.75
Rate for Payer: Cofinity Commercial	$639.41
Rate for Payer: Cofinity Commercial	$785.56
Rate for Payer: Encore Health Key Benefits Commercial	$730.75
Rate for Payer: Healthscope Commercial	$822.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$639.41
Rate for Payer: Lakeland Regional Health Systems Commercial	$685.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$776.42
Rate for Payer: PHP Commercial	$776.42
Rate for Payer: Priority Health Cigna Priority Health	$639.41
Rate for Payer: Priority Health SBD	$575.47
Rate for Payer: UMR Bronson Commercial	$401.91
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$685.08

PRIMAQUINE 26.3 MG TABLET

Facility

$597.12

Service Code	NDC 76385-102-01
Hospital Charge Code	6541
Hospital Revenue Code	637
Min. Negotiated Rate	$262.73
Max. Negotiated Rate	$537.41
Rate for Payer: Aetna American Axle	$388.13
Rate for Payer: Aetna Commercial	$507.55
Rate for Payer: Aetna New Business (MI Preferred)	$388.13
Rate for Payer: Cash Price	$477.70
Rate for Payer: Cofinity Commercial	$417.98
Rate for Payer: Cofinity Commercial	$513.52
Rate for Payer: Encore Health Key Benefits Commercial	$477.70
Rate for Payer: Healthscope Commercial	$537.41
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$417.98
Rate for Payer: Lakeland Regional Health Systems Commercial	$447.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$507.55
Rate for Payer: PHP Commercial	$507.55
Rate for Payer: Priority Health Cigna Priority Health	$417.98
Rate for Payer: Priority Health SBD	$376.19
Rate for Payer: UMR Bronson Commercial	$262.73
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$447.84

PR IMBRICATION DIAPHRAGM EVENTRATION

Professional

Both

$5,313.00

Service Code	HCPCS 39545
Min. Negotiated Rate	$568.07
Max. Negotiated Rate	$3,719.10
Rate for Payer: Aetna Commercial	$914.62
Rate for Payer: BCBS Complete	$596.47
Rate for Payer: BCBS Trust/PPO	$671.47
Rate for Payer: Cash Price	$4,250.40
Rate for Payer: Cash Price	$4,250.40
Rate for Payer: Meridian Medicaid	$596.47
Rate for Payer: Priority Health Choice Medicaid	$568.07
Rate for Payer: Priority Health Cigna Priority Health	$3,719.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,410.75
Rate for Payer: Priority Health Narrow Network	$1,410.75
Rate for Payer: Priority Health SBD	$1,410.75
Rate for Payer: UMR Bronson Commercial	$2,443.98

PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

Professional

Both

$400.00

Service Code	HCPCS 49406
Min. Negotiated Rate	$120.77
Max. Negotiated Rate	$2,515.24
Rate for Payer: Aetna Commercial	$260.75
Rate for Payer: BCBS Complete	$126.81
Rate for Payer: BCBS Trust/PPO	$2,515.24
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Meridian Medicaid	$126.81
Rate for Payer: Priority Health Choice Medicaid	$120.77
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$333.97
Rate for Payer: Priority Health Narrow Network	$333.97
Rate for Payer: Priority Health SBD	$333.97
Rate for Payer: UMR Bronson Commercial	$184.00

Know your out-of-pocket cost for care.

All Charges