Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR MICRONEEDLING SCARS - UP TO 4 INCHES

Professional

Both

$50.00

Service Code	HCPCS 00109
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES

Professional

Both

$450.00

Service Code	HCPCS 00122
Hospital Revenue Code	990
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$315.00
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: UMR Bronson Commercial	$207.00

PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES

Professional

Both

$300.00

Service Code	HCPCS 00123
Hospital Revenue Code	990
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: UMR Bronson Commercial	$138.00

PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES

Professional

Both

$200.00

Service Code	HCPCS 00124
Hospital Revenue Code	990
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$140.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: UMR Bronson Commercial	$92.00

PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH

Professional

Both

$150.00

Service Code	HCPCS 00110
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 MICROSURG TQS REQ USE OPERATING MICROSCOPE

Professional

Both

$491.00

Service Code	HCPCS 69990
Min. Negotiated Rate	$138.88
Max. Negotiated Rate	$11,952.59
Rate for Payer: Aetna Commercial	$223.01
Rate for Payer: BCBS Complete	$145.82
Rate for Payer: BCBS Trust/PPO	$11,952.59
Rate for Payer: Cash Price	$392.80
Rate for Payer: Cash Price	$392.80
Rate for Payer: Meridian Medicaid	$145.82
Rate for Payer: Priority Health Choice Medicaid	$138.88
Rate for Payer: Priority Health Cigna Priority Health	$343.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$305.98
Rate for Payer: Priority Health Narrow Network	$305.98
Rate for Payer: Priority Health SBD	$305.98
Rate for Payer: UMR Bronson Commercial	$225.86

PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

Professional

Both

$1,671.00

Service Code	HCPCS 69440
Min. Negotiated Rate	$446.02
Max. Negotiated Rate	$1,668.90
Rate for Payer: Aetna Commercial	$785.70
Rate for Payer: BCBS Complete	$468.32
Rate for Payer: BCBS Trust/PPO	$1,668.90
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Meridian Medicaid	$468.32
Rate for Payer: Priority Health Choice Medicaid	$446.02
Rate for Payer: Priority Health Cigna Priority Health	$1,169.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$988.18
Rate for Payer: Priority Health Narrow Network	$988.18
Rate for Payer: Priority Health SBD	$988.18
Rate for Payer: UMR Bronson Commercial	$768.66

PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES

Professional

Both

$2,914.00

Service Code	HCPCS 15730
Min. Negotiated Rate	$583.41
Max. Negotiated Rate	$2,039.80
Rate for Payer: Aetna Commercial	$982.33
Rate for Payer: BCBS Complete	$612.58
Rate for Payer: BCBS Trust/PPO	$1,930.99
Rate for Payer: Cash Price	$2,331.20
Rate for Payer: Cash Price	$2,331.20
Rate for Payer: Meridian Medicaid	$612.58
Rate for Payer: Priority Health Choice Medicaid	$583.41
Rate for Payer: Priority Health Cigna Priority Health	$2,039.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,118.02
Rate for Payer: Priority Health Narrow Network	$1,118.02
Rate for Payer: Priority Health SBD	$1,118.02
Rate for Payer: UMR Bronson Commercial	$1,340.44

PR MIRENA, 52 MG

Professional

Both

$1,443.00

Service Code	HCPCS J7298
Min. Negotiated Rate	$663.78
Max. Negotiated Rate	$1,156.78
Rate for Payer: Aetna Commercial	$1,101.70
Rate for Payer: BCBS Complete	$1,156.78
Rate for Payer: BCBS Trust/PPO	$1,103.90
Rate for Payer: Cash Price	$1,154.40
Rate for Payer: Cash Price	$1,154.40
Rate for Payer: Meridian Medicaid	$1,156.78
Rate for Payer: Priority Health Choice Medicaid	$1,101.70
Rate for Payer: Priority Health Cigna Priority Health	$1,010.10
Rate for Payer: UMR Bronson Commercial	$663.78

PR MISCELLANEOUS VISION SERVICE

Professional

Both

$5.00

Service Code	HCPCS V2799
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR MISOPROSTOL, ORAL, 200 MCG

Professional

Both

$4.00

Service Code	HCPCS S0191
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCBS Trust/PPO	$0.64
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: UMR Bronson Commercial	$1.84

PR MITOMYCIN INJECTION

Professional

Both

$150.00

Service Code	HCPCS J9280
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$65.25
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$10.36
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 MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG

Professional

Both

$240.00

Service Code	HCPCS 95805
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$639.77
Rate for Payer: Aetna Commercial	$434.52
Rate for Payer: Aetna Commercial	$434.52
Rate for Payer: BCBS Complete	$390.00
Rate for Payer: BCBS Complete	$96.00
Rate for Payer: BCBS Trust/PPO	$639.77
Rate for Payer: BCBS Trust/PPO	$639.77
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$780.00
Rate for Payer: Cash Price	$780.00
Rate for Payer: Priority Health Cigna Priority Health	$682.50
Rate for Payer: Priority Health Cigna Priority Health	$168.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$560.98
Rate for Payer: Priority Health SBD	$560.98
Rate for Payer: UMR Bronson Commercial	$110.40
Rate for Payer: UMR Bronson Commercial	$448.50

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Professional

Both

$903.00

Service Code	HCPCS 23700
Hospital Charge Code	23700
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$632.10
Rate for Payer: Aetna Commercial	$259.49
Rate for Payer: BCBS Complete	$133.30
Rate for Payer: BCBS Trust/PPO	$286.11
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Meridian Medicaid	$133.30
Rate for Payer: Priority Health Choice Medicaid	$126.95
Rate for Payer: Priority Health Cigna Priority Health	$632.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$301.79
Rate for Payer: Priority Health Narrow Network	$301.79
Rate for Payer: Priority Health SBD	$301.79
Rate for Payer: UMR Bronson Commercial	$415.38

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Facility

$903.00

Service Code	CPT 23700
Hospital Charge Code	23700
Min. Negotiated Rate	$397.32
Max. Negotiated Rate	$812.70
Rate for Payer: Aetna American Axle	$586.95
Rate for Payer: Aetna Commercial	$767.55
Rate for Payer: Aetna New Business (MI Preferred)	$586.95
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cofinity Commercial	$632.10
Rate for Payer: Cofinity Commercial	$776.58
Rate for Payer: Encore Health Key Benefits Commercial	$722.40
Rate for Payer: Healthscope Commercial	$812.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$632.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$677.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$767.55
Rate for Payer: PHP Commercial	$767.55
Rate for Payer: Priority Health Cigna Priority Health	$632.10
Rate for Payer: Priority Health SBD	$568.89
Rate for Payer: UMR Bronson Commercial	$397.32
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$677.25

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Facility

$903.00

Service Code	CPT 23700
Hospital Charge Code	23700
Min. Negotiated Rate	$195.16
Max. Negotiated Rate	$4,497.31
Rate for Payer: Aetna American Axle	$586.95
Rate for Payer: Aetna Commercial	$767.55
Rate for Payer: Aetna Medicare	$1,485.75
Rate for Payer: Aetna New Business (MI Preferred)	$586.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,785.76
Rate for Payer: Amish Plain Church Group Commercial	$1,785.76
Rate for Payer: BCBS Complete	$820.59
Rate for Payer: BCBS MAPPO	$1,428.61
Rate for Payer: BCBS Trust/PPO	$1,204.96
Rate for Payer: BCN Medicare Advantage	$1,428.61
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cofinity Commercial	$632.10
Rate for Payer: Cofinity Commercial	$776.58
Rate for Payer: Encore Health Key Benefits Commercial	$722.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,428.61
Rate for Payer: Healthscope Commercial	$812.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$632.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$677.25
Rate for Payer: Mclaren Medicaid	$781.45
Rate for Payer: Mclaren Medicare	$1,428.61
Rate for Payer: Meridian Medicaid	$820.59
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,500.04
Rate for Payer: MI Amish Medical Board Commercial	$1,642.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$767.55
Rate for Payer: PACE Medicare	$1,357.18
Rate for Payer: PACE SWMI	$1,428.61
Rate for Payer: PHP Commercial	$767.55
Rate for Payer: PHP Medicare Advantage	$1,428.61
Rate for Payer: Priority Health Choice Medicaid	$781.45
Rate for Payer: Priority Health Cigna Priority Health	$632.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,497.31
Rate for Payer: Priority Health Medicare	$1,428.61
Rate for Payer: Priority Health Narrow Network	$3,597.85
Rate for Payer: Priority Health SBD	$568.89
Rate for Payer: Railroad Medicare Medicare	$1,428.61
Rate for Payer: UHC All Payor (Choice/PPO)	$214.68
Rate for Payer: UHC Dual Complete DSNP	$1,428.61
Rate for Payer: UHC Exchange	$195.16
Rate for Payer: UHC Medicare Advantage	$1,471.47
Rate for Payer: UMR Bronson Commercial	$334.11
Rate for Payer: VA VA	$1,428.61
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$677.25

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Professional

Both

$903.00

Service Code	HCPCS 23700
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$632.10
Rate for Payer: Aetna Commercial	$259.49
Rate for Payer: BCBS Complete	$133.30
Rate for Payer: BCBS Trust/PPO	$286.11
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Meridian Medicaid	$133.30
Rate for Payer: Priority Health Choice Medicaid	$126.95
Rate for Payer: Priority Health Cigna Priority Health	$632.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$301.79
Rate for Payer: Priority Health Narrow Network	$301.79
Rate for Payer: Priority Health SBD	$301.79
Rate for Payer: UMR Bronson Commercial	$415.38

PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME

Professional

Both

$475.00

Service Code	HCPCS 20950
Min. Negotiated Rate	$116.27
Max. Negotiated Rate	$29,358.48
Rate for Payer: Aetna Commercial	$116.27
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: BCBS Trust/PPO	$29,358.48
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Priority Health Cigna Priority Health	$332.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$133.29
Rate for Payer: Priority Health Narrow Network	$133.29
Rate for Payer: Priority Health SBD	$133.29
Rate for Payer: UMR Bronson Commercial	$218.50

PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT

Professional

Both

$404.00

Service Code	HCPCS 44139
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$1,085.13
Rate for Payer: Aetna Commercial	$162.80
Rate for Payer: BCBS Complete	$79.62
Rate for Payer: BCBS Trust/PPO	$1,085.13
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Meridian Medicaid	$79.62
Rate for Payer: Priority Health Choice Medicaid	$75.83
Rate for Payer: Priority Health Cigna Priority Health	$282.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$209.32
Rate for Payer: Priority Health Narrow Network	$209.32
Rate for Payer: Priority Health SBD	$209.32
Rate for Payer: UMR Bronson Commercial	$185.84

PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN

Professional

Both

$131.00

Service Code	HCPCS 99149
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$91.70
Rate for Payer: BCBS Complete	$52.40
Rate for Payer: Cash Price	$104.80
Rate for Payer: Priority Health Cigna Priority Health	$91.70
Rate for Payer: UMR Bronson Commercial	$60.26

PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN

Professional

Both

$35.00

Service Code	HCPCS 99150
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
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 MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN

Professional

Both

$182.00

Service Code	HCPCS 99143
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$127.40
Rate for Payer: BCBS Complete	$72.80
Rate for Payer: Cash Price	$145.60
Rate for Payer: Priority Health Cigna Priority Health	$127.40
Rate for Payer: UMR Bronson Commercial	$83.72

PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN

Professional

Both

$135.00

Service Code	HCPCS 99144
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$94.50
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: UMR Bronson Commercial	$62.10

PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN

Professional

Both

$54.00

Service Code	HCPCS 99145
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$37.80
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: UMR Bronson Commercial	$24.84

PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS

Professional

Both

$115.00

Service Code	HCPCS 99157
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$660.90
Rate for Payer: Aetna Commercial	$69.79
Rate for Payer: BCBS Complete	$39.36
Rate for Payer: BCBS Trust/PPO	$660.90
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Meridian Medicaid	$39.36
Rate for Payer: Priority Health Choice Medicaid	$37.49
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.14
Rate for Payer: Priority Health Narrow Network	$138.14
Rate for Payer: Priority Health SBD	$138.14
Rate for Payer: UMR Bronson Commercial	$52.90

Know your out-of-pocket cost for care.

All Charges