Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY

Professional

Both

$559.00

Service Code	HCPCS 31511
Min. Negotiated Rate	$168.39
Max. Negotiated Rate	$1,223.54
Rate for Payer: Aetna Commercial	$168.39
Rate for Payer: BCBS Complete	$223.60
Rate for Payer: BCBS Trust/PPO	$1,223.54
Rate for Payer: Cash Price	$447.20
Rate for Payer: Cash Price	$447.20
Rate for Payer: Priority Health Cigna Priority Health	$391.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.76
Rate for Payer: Priority Health Narrow Network	$184.76
Rate for Payer: Priority Health SBD	$184.76
Rate for Payer: UMR Bronson Commercial	$257.14

PR LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE

Professional

Both

$931.00

Service Code	HCPCS 31536
Min. Negotiated Rate	$133.34
Max. Negotiated Rate	$987.92
Rate for Payer: Aetna Commercial	$265.82
Rate for Payer: BCBS Complete	$140.01
Rate for Payer: BCBS Trust/PPO	$987.92
Rate for Payer: Cash Price	$744.80
Rate for Payer: Cash Price	$744.80
Rate for Payer: Meridian Medicaid	$140.01
Rate for Payer: Priority Health Choice Medicaid	$133.34
Rate for Payer: Priority Health Cigna Priority Health	$651.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$289.41
Rate for Payer: Priority Health Narrow Network	$289.41
Rate for Payer: Priority Health SBD	$289.41
Rate for Payer: UMR Bronson Commercial	$428.26

PR LARYNGOSCOPY W/FOREIGN BODY REMOVAL

Professional

Both

$357.00

Service Code	HCPCS 31530
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$1,856.45
Rate for Payer: Aetna Commercial	$251.91
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCBS Trust/PPO	$1,856.45
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health	$249.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$273.65
Rate for Payer: Priority Health Narrow Network	$273.65
Rate for Payer: Priority Health SBD	$273.65
Rate for Payer: UMR Bronson Commercial	$164.22

PR LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION

Professional

Both

$365.00

Service Code	HCPCS 31515
Min. Negotiated Rate	$70.72
Max. Negotiated Rate	$1,491.39
Rate for Payer: Aetna Commercial	$140.69
Rate for Payer: BCBS Complete	$74.26
Rate for Payer: BCBS Trust/PPO	$1,491.39
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Meridian Medicaid	$74.26
Rate for Payer: Priority Health Choice Medicaid	$70.72
Rate for Payer: Priority Health Cigna Priority Health	$255.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$153.74
Rate for Payer: Priority Health Narrow Network	$153.74
Rate for Payer: Priority Health SBD	$153.74
Rate for Payer: UMR Bronson Commercial	$167.90

PR LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ

Professional

Both

$322.00

Service Code	HCPCS 31529
Min. Negotiated Rate	$102.45
Max. Negotiated Rate	$1,150.11
Rate for Payer: Aetna Commercial	$204.12
Rate for Payer: BCBS Complete	$107.57
Rate for Payer: BCBS Trust/PPO	$1,150.11
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Meridian Medicaid	$107.57
Rate for Payer: Priority Health Choice Medicaid	$102.45
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$220.87
Rate for Payer: Priority Health Narrow Network	$220.87
Rate for Payer: Priority Health SBD	$220.87
Rate for Payer: UMR Bronson Commercial	$148.12

PR LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN

Professional

Both

$612.00

Service Code	HCPCS 31525
Min. Negotiated Rate	$102.03
Max. Negotiated Rate	$1,289.05
Rate for Payer: Aetna Commercial	$202.26
Rate for Payer: BCBS Complete	$107.13
Rate for Payer: BCBS Trust/PPO	$1,289.05
Rate for Payer: Cash Price	$489.60
Rate for Payer: Cash Price	$489.60
Rate for Payer: Meridian Medicaid	$107.13
Rate for Payer: Priority Health Choice Medicaid	$102.03
Rate for Payer: Priority Health Cigna Priority Health	$428.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$219.49
Rate for Payer: Priority Health Narrow Network	$219.49
Rate for Payer: Priority Health SBD	$219.49
Rate for Payer: UMR Bronson Commercial	$281.52

PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN

Professional

Both

$776.00

Service Code	HCPCS 31528
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$1,317.05
Rate for Payer: Aetna Commercial	$182.08
Rate for Payer: BCBS Complete	$96.39
Rate for Payer: BCBS Trust/PPO	$1,317.05
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cash Price	$620.80
Rate for Payer: Meridian Medicaid	$96.39
Rate for Payer: Priority Health Choice Medicaid	$91.80
Rate for Payer: Priority Health Cigna Priority Health	$543.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$198.65
Rate for Payer: Priority Health Narrow Network	$198.65
Rate for Payer: Priority Health SBD	$198.65
Rate for Payer: UMR Bronson Commercial	$356.96

PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE

Professional

Both

$316.00

Service Code	HCPCS 31526
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$1,251.54
Rate for Payer: Aetna Commercial	$198.68
Rate for Payer: BCBS Complete	$104.90
Rate for Payer: BCBS Trust/PPO	$1,251.54
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Meridian Medicaid	$104.90
Rate for Payer: Priority Health Choice Medicaid	$99.90
Rate for Payer: Priority Health Cigna Priority Health	$221.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$215.77
Rate for Payer: Priority Health Narrow Network	$215.77
Rate for Payer: Priority Health SBD	$215.77
Rate for Payer: UMR Bronson Commercial	$145.36

PR LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY

Professional

Both

$2,226.00

Service Code	HCPCS 31300
Min. Negotiated Rate	$801.31
Max. Negotiated Rate	$1,744.75
Rate for Payer: Aetna Commercial	$1,611.16
Rate for Payer: BCBS Complete	$841.38
Rate for Payer: BCBS Trust/PPO	$1,537.35
Rate for Payer: Cash Price	$1,780.80
Rate for Payer: Cash Price	$1,780.80
Rate for Payer: Meridian Medicaid	$841.38
Rate for Payer: Priority Health Choice Medicaid	$801.31
Rate for Payer: Priority Health Cigna Priority Health	$1,558.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,744.75
Rate for Payer: Priority Health Narrow Network	$1,744.75
Rate for Payer: Priority Health SBD	$1,744.75
Rate for Payer: UMR Bronson Commercial	$1,023.96

PR LASER CO2 - FULL FACE

Professional

Both

$2,750.00

Service Code	HCPCS 00263
Hospital Revenue Code	990
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,925.00
Rate for Payer: BCBS Complete	$1,100.00
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Priority Health Cigna Priority Health	$1,925.00
Rate for Payer: UMR Bronson Commercial	$1,265.00

PR LASER CO2 - ONE AREA

Professional

Both

$1,750.00

Service Code	HCPCS 00181
Hospital Revenue Code	990
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,225.00
Rate for Payer: BCBS Complete	$700.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Priority Health Cigna Priority Health	$1,225.00
Rate for Payer: UMR Bronson Commercial	$805.00

PR LASER CO2 - TWO AREAS

Professional

Both

$2,250.00

Service Code	HCPCS 00182
Hospital Revenue Code	990
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: BCBS Complete	$900.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Priority Health Cigna Priority Health	$1,575.00
Rate for Payer: UMR Bronson Commercial	$1,035.00

PR LASER ENUCLEATION PROSTATE W/MORCELLATION

Professional

Both

$1,675.00

Service Code	HCPCS 52649
Min. Negotiated Rate	$524.83
Max. Negotiated Rate	$1,315.77
Rate for Payer: Aetna Commercial	$1,059.01
Rate for Payer: BCBS Complete	$551.07
Rate for Payer: BCBS Trust/PPO	$1,289.05
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Meridian Medicaid	$551.07
Rate for Payer: Priority Health Choice Medicaid	$524.83
Rate for Payer: Priority Health Cigna Priority Health	$1,172.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,315.77
Rate for Payer: Priority Health Narrow Network	$1,315.77
Rate for Payer: Priority Health SBD	$1,315.77
Rate for Payer: UMR Bronson Commercial	$770.50

PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW

Professional

Both

$3,242.78

Service Code	HCPCS 52648
Min. Negotiated Rate	$441.34
Max. Negotiated Rate	$2,269.95
Rate for Payer: Aetna Commercial	$886.93
Rate for Payer: BCBS Complete	$463.41
Rate for Payer: BCBS Trust/PPO	$1,272.67
Rate for Payer: Cash Price	$2,594.22
Rate for Payer: Cash Price	$2,594.22
Rate for Payer: Meridian Medicaid	$463.41
Rate for Payer: Priority Health Choice Medicaid	$441.34
Rate for Payer: Priority Health Cigna Priority Health	$2,269.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,104.48
Rate for Payer: Priority Health Narrow Network	$1,104.48
Rate for Payer: Priority Health SBD	$1,104.48
Rate for Payer: UMR Bronson Commercial	$1,491.68

PR LATERAL RETINACULAR RELEASE OPEN

Facility

$1,664.00

Service Code	CPT 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$457.11
Max. Negotiated Rate	$9,057.42
Rate for Payer: Aetna American Axle	$1,081.60
Rate for Payer: Aetna Commercial	$1,414.40
Rate for Payer: Aetna Medicare	$2,992.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,081.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,596.44
Rate for Payer: Amish Plain Church Group Commercial	$3,596.44
Rate for Payer: BCBS Complete	$1,652.63
Rate for Payer: BCBS MAPPO	$2,877.15
Rate for Payer: BCBS Trust/PPO	$2,111.70
Rate for Payer: BCN Medicare Advantage	$2,877.15
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Cofinity Commercial	$1,164.80
Rate for Payer: Cofinity Commercial	$1,431.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,331.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,877.15
Rate for Payer: Healthscope Commercial	$1,497.60
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,164.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,248.00
Rate for Payer: Mclaren Medicaid	$1,573.80
Rate for Payer: Mclaren Medicare	$2,877.15
Rate for Payer: Meridian Medicaid	$1,652.63
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,021.01
Rate for Payer: MI Amish Medical Board Commercial	$3,308.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,414.40
Rate for Payer: PACE Medicare	$2,733.29
Rate for Payer: PACE SWMI	$2,877.15
Rate for Payer: PHP Commercial	$1,414.40
Rate for Payer: PHP Medicare Advantage	$2,877.15
Rate for Payer: Priority Health Choice Medicaid	$1,573.80
Rate for Payer: Priority Health Cigna Priority Health	$1,164.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,057.42
Rate for Payer: Priority Health Medicare	$2,877.15
Rate for Payer: Priority Health Narrow Network	$7,245.94
Rate for Payer: Priority Health SBD	$1,048.32
Rate for Payer: Railroad Medicare Medicare	$2,877.15
Rate for Payer: UHC All Payor (Choice/PPO)	$502.82
Rate for Payer: UHC Dual Complete DSNP	$2,877.15
Rate for Payer: UHC Exchange	$457.11
Rate for Payer: UHC Medicare Advantage	$2,963.46
Rate for Payer: UMR Bronson Commercial	$615.68
Rate for Payer: VA VA	$2,877.15
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,248.00

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,664.00

Service Code	HCPCS 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$297.35
Max. Negotiated Rate	$1,208.75
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: BCBS Complete	$312.22
Rate for Payer: BCBS Trust/PPO	$1,208.75
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Meridian Medicaid	$312.22
Rate for Payer: Priority Health Choice Medicaid	$297.35
Rate for Payer: Priority Health Cigna Priority Health	$1,164.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$703.68
Rate for Payer: Priority Health Narrow Network	$703.68
Rate for Payer: Priority Health SBD	$703.68
Rate for Payer: UMR Bronson Commercial	$765.44

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,664.00

Service Code	HCPCS 27425
Min. Negotiated Rate	$297.35
Max. Negotiated Rate	$1,208.75
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: BCBS Complete	$312.22
Rate for Payer: BCBS Trust/PPO	$1,208.75
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Meridian Medicaid	$312.22
Rate for Payer: Priority Health Choice Medicaid	$297.35
Rate for Payer: Priority Health Cigna Priority Health	$1,164.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$703.68
Rate for Payer: Priority Health Narrow Network	$703.68
Rate for Payer: Priority Health SBD	$703.68
Rate for Payer: UMR Bronson Commercial	$765.44

PR LATERAL RETINACULAR RELEASE OPEN

Facility

$1,664.00

Service Code	CPT 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$732.16
Max. Negotiated Rate	$1,497.60
Rate for Payer: Aetna American Axle	$1,081.60
Rate for Payer: Aetna Commercial	$1,414.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,081.60
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Cofinity Commercial	$1,164.80
Rate for Payer: Cofinity Commercial	$1,431.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,331.20
Rate for Payer: Healthscope Commercial	$1,497.60
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,164.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,248.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,414.40
Rate for Payer: PHP Commercial	$1,414.40
Rate for Payer: Priority Health Cigna Priority Health	$1,164.80
Rate for Payer: Priority Health SBD	$1,048.32
Rate for Payer: UMR Bronson Commercial	$732.16
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,248.00

PR LATISSE

Professional

Both

$179.00

Service Code	HCPCS 00267
Hospital Revenue Code	990
Min. Negotiated Rate	$71.60
Max. Negotiated Rate	$125.30
Rate for Payer: BCBS Complete	$71.60
Rate for Payer: Cash Price	$143.20
Rate for Payer: Priority Health Cigna Priority Health	$125.30
Rate for Payer: UMR Bronson Commercial	$82.34

PR LAVAGE CANNULATION MAXILLARY SINUS

Professional

Both

$286.00

Service Code	HCPCS 31000
Min. Negotiated Rate	$71.36
Max. Negotiated Rate	$694.71
Rate for Payer: Aetna Commercial	$134.27
Rate for Payer: BCBS Complete	$74.93
Rate for Payer: BCBS Trust/PPO	$694.71
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Meridian Medicaid	$74.93
Rate for Payer: Priority Health Choice Medicaid	$71.36
Rate for Payer: Priority Health Cigna Priority Health	$200.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$153.74
Rate for Payer: Priority Health Narrow Network	$153.74
Rate for Payer: Priority Health SBD	$153.74
Rate for Payer: UMR Bronson Commercial	$131.56

PR LAVAGE CANNULATION SPHENOID SINUS

Professional

Both

$330.00

Service Code	HCPCS 31002
Min. Negotiated Rate	$121.62
Max. Negotiated Rate	$689.96
Rate for Payer: Aetna Commercial	$246.23
Rate for Payer: BCBS Complete	$127.70
Rate for Payer: BCBS Trust/PPO	$689.96
Rate for Payer: Cash Price	$264.00
Rate for Payer: Cash Price	$264.00
Rate for Payer: Meridian Medicaid	$127.70
Rate for Payer: Priority Health Choice Medicaid	$121.62
Rate for Payer: Priority Health Cigna Priority Health	$231.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$267.64
Rate for Payer: Priority Health Narrow Network	$267.64
Rate for Payer: Priority Health SBD	$267.64
Rate for Payer: UMR Bronson Commercial	$151.80

PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE

Professional

Both

$433.00

Service Code	HCPCS 93462
Min. Negotiated Rate	$129.08
Max. Negotiated Rate	$548.90
Rate for Payer: Aetna Commercial	$282.18
Rate for Payer: BCBS Complete	$135.53
Rate for Payer: BCBS Trust/PPO	$548.90
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cash Price	$346.40
Rate for Payer: Meridian Medicaid	$135.53
Rate for Payer: Priority Health Choice Medicaid	$129.08
Rate for Payer: Priority Health Cigna Priority Health	$303.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$288.92
Rate for Payer: Priority Health Narrow Network	$288.92
Rate for Payer: Priority Health SBD	$288.92
Rate for Payer: UMR Bronson Commercial	$199.18

PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH

Professional

Both

$1,322.00

Service Code	HCPCS 26476
Min. Negotiated Rate	$418.12
Max. Negotiated Rate	$1,727.54
Rate for Payer: Aetna Commercial	$846.36
Rate for Payer: BCBS Complete	$439.03
Rate for Payer: BCBS Trust/PPO	$1,727.54
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Meridian Medicaid	$439.03
Rate for Payer: Priority Health Choice Medicaid	$418.12
Rate for Payer: Priority Health Cigna Priority Health	$925.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,002.91
Rate for Payer: Priority Health Narrow Network	$1,002.91
Rate for Payer: Priority Health SBD	$1,002.91
Rate for Payer: UMR Bronson Commercial	$608.12

PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH

Professional

Both

$2,000.00

Service Code	HCPCS 26478
Min. Negotiated Rate	$426.64
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$874.34
Rate for Payer: BCBS Complete	$447.97
Rate for Payer: BCBS Trust/PPO	$878.03
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Meridian Medicaid	$447.97
Rate for Payer: Priority Health Choice Medicaid	$426.64
Rate for Payer: Priority Health Cigna Priority Health	$1,400.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,033.56
Rate for Payer: Priority Health Narrow Network	$1,033.56
Rate for Payer: Priority Health SBD	$1,033.56
Rate for Payer: UMR Bronson Commercial	$920.00

PR LESION <15

Professional

Both

$125.00

Service Code	HCPCS 00074
Hospital Revenue Code	990
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$87.50
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: UMR Bronson Commercial	$57.50

Know your out-of-pocket cost for care.

All Charges