Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR IMPLANTATION NERVE END BONE/MUSCLE

Professional

Both

$1,817.00

Service Code	HCPCS 64787
Min. Negotiated Rate	$136.83
Max. Negotiated Rate	$1,271.90
Rate for Payer: Aetna Commercial	$310.40
Rate for Payer: BCBS Complete	$155.21
Rate for Payer: BCBS Trust/PPO	$136.83
Rate for Payer: Cash Price	$1,453.60
Rate for Payer: Cash Price	$1,453.60
Rate for Payer: Meridian Medicaid	$155.21
Rate for Payer: Priority Health Choice Medicaid	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$1,271.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$395.79
Rate for Payer: Priority Health Narrow Network	$395.79
Rate for Payer: Priority Health SBD	$395.79
Rate for Payer: UMR Bronson Commercial	$835.82

PR IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER

Professional

Both

$618.00

Service Code	HCPCS 33282
Min. Negotiated Rate	$247.20
Max. Negotiated Rate	$432.60
Rate for Payer: BCBS Complete	$247.20
Rate for Payer: Cash Price	$494.40
Rate for Payer: Priority Health Cigna Priority Health	$432.60
Rate for Payer: UMR Bronson Commercial	$284.28

PR IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE

Professional

Both

$990.00

Service Code	HCPCS 49568
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$693.00
Rate for Payer: BCBS Complete	$396.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Priority Health Cigna Priority Health	$693.00
Rate for Payer: UMR Bronson Commercial	$455.40

PR IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT

Professional

Both

$439.00

Service Code	HCPCS 15777
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$307.30
Rate for Payer: Aetna Commercial	$234.53
Rate for Payer: BCBS Complete	$142.46
Rate for Payer: BCBS Trust/PPO	$150.00
Rate for Payer: Cash Price	$351.20
Rate for Payer: Cash Price	$351.20
Rate for Payer: Meridian Medicaid	$142.46
Rate for Payer: Priority Health Choice Medicaid	$135.68
Rate for Payer: Priority Health Cigna Priority Health	$307.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$261.83
Rate for Payer: Priority Health Narrow Network	$261.83
Rate for Payer: Priority Health SBD	$261.83
Rate for Payer: UMR Bronson Commercial	$201.94

PR IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP<100

Professional

Both

$1,317.00

Service Code	HCPCS 69716
Min. Negotiated Rate	$176.45
Max. Negotiated Rate	$921.90
Rate for Payer: Aetna Commercial	$688.61
Rate for Payer: BCBS Complete	$417.77
Rate for Payer: BCBS Trust/PPO	$176.45
Rate for Payer: Cash Price	$1,053.60
Rate for Payer: Cash Price	$1,053.60
Rate for Payer: Meridian Medicaid	$417.77
Rate for Payer: Priority Health Choice Medicaid	$397.88
Rate for Payer: Priority Health Cigna Priority Health	$921.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$878.33
Rate for Payer: Priority Health Narrow Network	$878.33
Rate for Payer: Priority Health SBD	$878.33
Rate for Payer: UMR Bronson Commercial	$605.82

PR IMPL OI IMPLT SKULL PERQ ATTACHMENT ESP

Professional

Both

$1,915.00

Service Code	HCPCS 69714
Min. Negotiated Rate	$318.01
Max. Negotiated Rate	$3,343.08
Rate for Payer: Aetna Commercial	$1,199.38
Rate for Payer: BCBS Complete	$333.91
Rate for Payer: BCBS Trust/PPO	$3,343.08
Rate for Payer: Cash Price	$1,532.00
Rate for Payer: Cash Price	$1,532.00
Rate for Payer: Meridian Medicaid	$333.91
Rate for Payer: Priority Health Choice Medicaid	$318.01
Rate for Payer: Priority Health Cigna Priority Health	$1,340.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$699.65
Rate for Payer: Priority Health Narrow Network	$699.65
Rate for Payer: Priority Health SBD	$699.65
Rate for Payer: UMR Bronson Commercial	$880.90

PR IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT

Professional

Both

$411.00

Service Code	HCPCS 61517
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$975.77
Rate for Payer: Aetna Commercial	$112.93
Rate for Payer: BCBS Complete	$58.60
Rate for Payer: BCBS Trust/PPO	$975.77
Rate for Payer: Cash Price	$328.80
Rate for Payer: Cash Price	$328.80
Rate for Payer: Meridian Medicaid	$58.60
Rate for Payer: Priority Health Choice Medicaid	$55.81
Rate for Payer: Priority Health Cigna Priority Health	$287.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.22
Rate for Payer: Priority Health Narrow Network	$147.22
Rate for Payer: Priority Health SBD	$147.22
Rate for Payer: UMR Bronson Commercial	$189.06

PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM

Professional

Both

$805.28

Service Code	HCPCS 62350
Min. Negotiated Rate	$256.45
Max. Negotiated Rate	$1,703.77
Rate for Payer: Aetna Commercial	$512.70
Rate for Payer: BCBS Complete	$269.27
Rate for Payer: BCBS Trust/PPO	$1,703.77
Rate for Payer: Cash Price	$644.22
Rate for Payer: Cash Price	$644.22
Rate for Payer: Meridian Medicaid	$269.27
Rate for Payer: Priority Health Choice Medicaid	$256.45
Rate for Payer: Priority Health Cigna Priority Health	$563.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$673.81
Rate for Payer: Priority Health Narrow Network	$673.81
Rate for Payer: Priority Health SBD	$673.81
Rate for Payer: UMR Bronson Commercial	$370.43

PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP

Professional

Both

$2,476.00

Service Code	HCPCS 62362
Min. Negotiated Rate	$248.78
Max. Negotiated Rate	$1,733.20
Rate for Payer: Aetna Commercial	$496.29
Rate for Payer: BCBS Complete	$261.22
Rate for Payer: BCBS Trust/PPO	$311.17
Rate for Payer: Cash Price	$1,980.80
Rate for Payer: Cash Price	$1,980.80
Rate for Payer: Meridian Medicaid	$261.22
Rate for Payer: Priority Health Choice Medicaid	$248.78
Rate for Payer: Priority Health Cigna Priority Health	$1,733.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$653.99
Rate for Payer: Priority Health Narrow Network	$653.99
Rate for Payer: Priority Health SBD	$653.99
Rate for Payer: UMR Bronson Commercial	$1,138.96

PR IMPREG GAUZE NO H20/SAL/YARD

Professional

Both

$7.00

Service Code	HCPCS A6266
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.90
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: UMR Bronson Commercial	$3.22

PR INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW

Professional

Both

$1,468.00

Service Code	HCPCS 23935
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,027.60
Rate for Payer: Aetna Commercial	$680.86
Rate for Payer: BCBS Complete	$352.02
Rate for Payer: BCBS Trust/PPO	$67.50
Rate for Payer: Cash Price	$1,174.40
Rate for Payer: Cash Price	$1,174.40
Rate for Payer: Meridian Medicaid	$352.02
Rate for Payer: Priority Health Choice Medicaid	$335.26
Rate for Payer: Priority Health Cigna Priority Health	$1,027.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$794.07
Rate for Payer: Priority Health Narrow Network	$794.07
Rate for Payer: Priority Health SBD	$794.07
Rate for Payer: UMR Bronson Commercial	$675.28

PR INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE

Professional

Both

$1,539.00

Service Code	HCPCS 27303
Min. Negotiated Rate	$415.99
Max. Negotiated Rate	$2,493.05
Rate for Payer: Aetna Commercial	$859.62
Rate for Payer: BCBS Complete	$436.79
Rate for Payer: BCBS Trust/PPO	$2,493.05
Rate for Payer: Cash Price	$1,231.20
Rate for Payer: Cash Price	$1,231.20
Rate for Payer: Meridian Medicaid	$436.79
Rate for Payer: Priority Health Choice Medicaid	$415.99
Rate for Payer: Priority Health Cigna Priority Health	$1,077.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$981.98
Rate for Payer: Priority Health Narrow Network	$981.98
Rate for Payer: Priority Health SBD	$981.98
Rate for Payer: UMR Bronson Commercial	$707.94

PR INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT

Professional

Both

$576.00

Service Code	HCPCS 62148
Min. Negotiated Rate	$50.72
Max. Negotiated Rate	$403.20
Rate for Payer: Aetna Commercial	$163.26
Rate for Payer: BCBS Complete	$84.54
Rate for Payer: BCBS Trust/PPO	$50.72
Rate for Payer: Cash Price	$460.80
Rate for Payer: Cash Price	$460.80
Rate for Payer: Meridian Medicaid	$84.54
Rate for Payer: Priority Health Choice Medicaid	$80.51
Rate for Payer: Priority Health Cigna Priority Health	$403.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.91
Rate for Payer: Priority Health Narrow Network	$212.91
Rate for Payer: Priority Health SBD	$212.91
Rate for Payer: UMR Bronson Commercial	$264.96

PR INCIS HEART SAC TUBE

Professional

Both

$1,650.00

Service Code	HCPCS 33015
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,155.00
Rate for Payer: BCBS Complete	$660.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Priority Health Cigna Priority Health	$1,155.00
Rate for Payer: UMR Bronson Commercial	$759.00

PR INCISIONAL BIOPSY EYELID SKIN & LID MARGIN

Professional

Both

$358.00

Service Code	HCPCS 67810
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$562.64
Rate for Payer: Aetna Commercial	$90.70
Rate for Payer: BCBS Complete	$44.95
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cash Price	$286.40
Rate for Payer: Meridian Medicaid	$44.95
Rate for Payer: Priority Health Choice Medicaid	$42.81
Rate for Payer: Priority Health Cigna Priority Health	$250.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.66
Rate for Payer: Priority Health Narrow Network	$117.66
Rate for Payer: Priority Health SBD	$117.66
Rate for Payer: UMR Bronson Commercial	$164.68

PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$139.00

Service Code	HCPCS 11107
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$97.30
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: BCBS Complete	$20.35
Rate for Payer: BCBS Trust/PPO	$11.47
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Meridian Medicaid	$20.35
Rate for Payer: Priority Health Choice Medicaid	$19.38
Rate for Payer: Priority Health Cigna Priority Health	$97.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.41
Rate for Payer: Priority Health Narrow Network	$37.41
Rate for Payer: Priority Health SBD	$37.41
Rate for Payer: UMR Bronson Commercial	$63.94

PR INCISIONAL BIOPSY SKIN SINGLE LESION

Professional

Both

$289.00

Service Code	HCPCS 11106
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$202.30
Rate for Payer: Aetna Commercial	$62.48
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCBS Trust/PPO	$13.57
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Cigna Priority Health	$202.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.64
Rate for Payer: Priority Health Narrow Network	$68.64
Rate for Payer: Priority Health SBD	$68.64
Rate for Payer: UMR Bronson Commercial	$132.94

PR INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN

Professional

Both

$1,359.00

Service Code	HCPCS 44900
Min. Negotiated Rate	$378.79
Max. Negotiated Rate	$1,382.33
Rate for Payer: Aetna Commercial	$1,060.30
Rate for Payer: BCBS Complete	$528.03
Rate for Payer: BCBS Trust/PPO	$378.79
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Cash Price	$1,087.20
Rate for Payer: Meridian Medicaid	$528.03
Rate for Payer: Priority Health Choice Medicaid	$502.89
Rate for Payer: Priority Health Cigna Priority Health	$951.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,382.33
Rate for Payer: Priority Health Narrow Network	$1,382.33
Rate for Payer: Priority Health SBD	$1,382.33
Rate for Payer: UMR Bronson Commercial	$625.14

PR INCISION BONE CORTEX FOOT

Professional

Both

$1,129.00

Service Code	HCPCS 28005
Min. Negotiated Rate	$367.00
Max. Negotiated Rate	$3,691.76
Rate for Payer: Aetna Commercial	$762.45
Rate for Payer: BCBS Complete	$385.35
Rate for Payer: BCBS Trust/PPO	$3,691.76
Rate for Payer: Cash Price	$903.20
Rate for Payer: Cash Price	$903.20
Rate for Payer: Meridian Medicaid	$385.35
Rate for Payer: Priority Health Choice Medicaid	$367.00
Rate for Payer: Priority Health Cigna Priority Health	$790.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$868.61
Rate for Payer: Priority Health Narrow Network	$868.61
Rate for Payer: Priority Health SBD	$868.61
Rate for Payer: UMR Bronson Commercial	$519.34

PR INCISION BONE CORTEX HAND/FINGER

Professional

Both

$933.00

Service Code	HCPCS 26034
Min. Negotiated Rate	$58.64
Max. Negotiated Rate	$852.79
Rate for Payer: Aetna Commercial	$729.44
Rate for Payer: BCBS Complete	$377.52
Rate for Payer: BCBS Trust/PPO	$58.64
Rate for Payer: Cash Price	$746.40
Rate for Payer: Cash Price	$746.40
Rate for Payer: Meridian Medicaid	$377.52
Rate for Payer: Priority Health Choice Medicaid	$359.54
Rate for Payer: Priority Health Cigna Priority Health	$653.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$852.79
Rate for Payer: Priority Health Narrow Network	$852.79
Rate for Payer: Priority Health SBD	$852.79
Rate for Payer: UMR Bronson Commercial	$429.18

PR INCISION BONE CORTEX PELVIS&/HIP JOINT

Professional

Both

$2,029.00

Service Code	HCPCS 26992
Min. Negotiated Rate	$651.57
Max. Negotiated Rate	$1,547.27
Rate for Payer: Aetna Commercial	$1,339.72
Rate for Payer: BCBS Complete	$684.15
Rate for Payer: BCBS Trust/PPO	$764.98
Rate for Payer: Cash Price	$1,623.20
Rate for Payer: Cash Price	$1,623.20
Rate for Payer: Meridian Medicaid	$684.15
Rate for Payer: Priority Health Choice Medicaid	$651.57
Rate for Payer: Priority Health Cigna Priority Health	$1,420.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,547.27
Rate for Payer: Priority Health Narrow Network	$1,547.27
Rate for Payer: Priority Health SBD	$1,547.27
Rate for Payer: UMR Bronson Commercial	$933.34

PR INCISION BONE CORTEX SHOULDER AREA

Professional

Both

$1,332.00

Service Code	HCPCS 23035
Min. Negotiated Rate	$438.99
Max. Negotiated Rate	$1,050.92
Rate for Payer: Aetna Commercial	$909.79
Rate for Payer: BCBS Complete	$460.94
Rate for Payer: BCBS Trust/PPO	$887.54
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Meridian Medicaid	$460.94
Rate for Payer: Priority Health Choice Medicaid	$438.99
Rate for Payer: Priority Health Cigna Priority Health	$932.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,050.92
Rate for Payer: Priority Health Narrow Network	$1,050.92
Rate for Payer: Priority Health SBD	$1,050.92
Rate for Payer: UMR Bronson Commercial	$612.72

PR INCISION DEEP BONE CORTEX FOREARM&/WRIST

Professional

Both

$1,600.00

Service Code	HCPCS 25035
Min. Negotiated Rate	$140.53
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$779.94
Rate for Payer: BCBS Complete	$403.24
Rate for Payer: BCBS Trust/PPO	$140.53
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Meridian Medicaid	$403.24
Rate for Payer: Priority Health Choice Medicaid	$384.04
Rate for Payer: Priority Health Cigna Priority Health	$1,120.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$905.89
Rate for Payer: Priority Health Narrow Network	$905.89
Rate for Payer: Priority Health SBD	$905.89
Rate for Payer: UMR Bronson Commercial	$736.00

PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE

Facility

$360.00

Service Code	CPT 10061
Hospital Charge Code	10061
Hospital Revenue Code	361
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$1,115.78
Rate for Payer: Aetna American Axle	$234.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare	$368.61
Rate for Payer: Aetna New Business (MI Preferred)	$234.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.04
Rate for Payer: Amish Plain Church Group Commercial	$443.04
Rate for Payer: BCBS Complete	$203.58
Rate for Payer: BCBS MAPPO	$354.43
Rate for Payer: BCBS Trust/PPO	$398.96
Rate for Payer: BCN Medicare Advantage	$354.43
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cofinity Commercial	$309.60
Rate for Payer: Cofinity Commercial	$252.00
Rate for Payer: Encore Health Key Benefits Commercial	$288.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.43
Rate for Payer: Healthscope Commercial	$324.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$252.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$270.00
Rate for Payer: Mclaren Medicaid	$193.87
Rate for Payer: Mclaren Medicare	$354.43
Rate for Payer: Meridian Medicaid	$203.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.15
Rate for Payer: MI Amish Medical Board Commercial	$407.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$306.00
Rate for Payer: PACE Medicare	$336.71
Rate for Payer: PACE SWMI	$354.43
Rate for Payer: PHP Commercial	$306.00
Rate for Payer: PHP Medicare Advantage	$354.43
Rate for Payer: Priority Health Choice Medicaid	$193.87
Rate for Payer: Priority Health Cigna Priority Health	$252.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,115.78
Rate for Payer: Priority Health Medicare	$354.43
Rate for Payer: Priority Health Narrow Network	$892.62
Rate for Payer: Priority Health SBD	$226.80
Rate for Payer: Railroad Medicare Medicare	$354.43
Rate for Payer: UHC All Payor (Choice/PPO)	$200.27
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$354.43
Rate for Payer: UHC Exchange	$182.06
Rate for Payer: UHC Medicare Advantage	$365.06
Rate for Payer: UMR Bronson Commercial	$133.20
Rate for Payer: VA VA	$354.43
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$270.00

PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE

Professional

Both

$360.00

Service Code	HCPCS 10061
Hospital Charge Code	10061
Min. Negotiated Rate	$118.43
Max. Negotiated Rate	$307.43
Rate for Payer: Aetna Commercial	$195.55
Rate for Payer: BCBS Complete	$124.35
Rate for Payer: BCBS Trust/PPO	$307.43
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Meridian Medicaid	$124.35
Rate for Payer: Priority Health Choice Medicaid	$118.43
Rate for Payer: Priority Health Cigna Priority Health	$252.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$224.83
Rate for Payer: Priority Health Narrow Network	$224.83
Rate for Payer: Priority Health SBD	$224.83
Rate for Payer: UMR Bronson Commercial	$165.60

Know your out-of-pocket cost for care.

All Charges