Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Professional

Both

$2,210.00

Service Code	HCPCS 64721
Hospital Charge Code	64721
Min. Negotiated Rate	$284.78
Max. Negotiated Rate	$6,985.18
Rate for Payer: Aetna Commercial	$553.21
Rate for Payer: BCBS Complete	$299.02
Rate for Payer: BCBS Trust/PPO	$6,985.18
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Meridian Medicaid	$299.02
Rate for Payer: Priority Health Choice Medicaid	$284.78
Rate for Payer: Priority Health Cigna Priority Health	$1,547.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$747.41
Rate for Payer: Priority Health Narrow Network	$747.41
Rate for Payer: Priority Health SBD	$747.41
Rate for Payer: UMR Bronson Commercial	$1,016.60

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Facility

$2,210.00

Service Code	CPT 64721
Hospital Charge Code	64721
Hospital Revenue Code	960
Min. Negotiated Rate	$972.40
Max. Negotiated Rate	$1,989.00
Rate for Payer: Aetna American Axle	$1,436.50
Rate for Payer: Aetna Commercial	$1,878.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,436.50
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cofinity Commercial	$1,547.00
Rate for Payer: Cofinity Commercial	$1,900.60
Rate for Payer: Encore Health Key Benefits Commercial	$1,768.00
Rate for Payer: Healthscope Commercial	$1,989.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,547.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,657.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,878.50
Rate for Payer: PHP Commercial	$1,878.50
Rate for Payer: Priority Health Cigna Priority Health	$1,547.00
Rate for Payer: Priority Health SBD	$1,392.30
Rate for Payer: UMR Bronson Commercial	$972.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,657.50

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Professional

Both

$2,210.00

Service Code	HCPCS 64721
Min. Negotiated Rate	$284.78
Max. Negotiated Rate	$6,985.18
Rate for Payer: Aetna Commercial	$553.21
Rate for Payer: BCBS Complete	$299.02
Rate for Payer: BCBS Trust/PPO	$6,985.18
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Meridian Medicaid	$299.02
Rate for Payer: Priority Health Choice Medicaid	$284.78
Rate for Payer: Priority Health Cigna Priority Health	$1,547.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$747.41
Rate for Payer: Priority Health Narrow Network	$747.41
Rate for Payer: Priority Health SBD	$747.41
Rate for Payer: UMR Bronson Commercial	$1,016.60

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Facility

$2,210.00

Service Code	CPT 64721
Hospital Charge Code	64721
Hospital Revenue Code	960
Min. Negotiated Rate	$437.79
Max. Negotiated Rate	$5,402.75
Rate for Payer: Aetna American Axle	$1,436.50
Rate for Payer: Aetna Commercial	$1,878.50
Rate for Payer: Aetna Medicare	$1,784.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,436.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,145.29
Rate for Payer: Amish Plain Church Group Commercial	$2,145.29
Rate for Payer: BCBS Complete	$985.80
Rate for Payer: BCBS MAPPO	$1,716.23
Rate for Payer: BCBS Trust/PPO	$1,906.50
Rate for Payer: BCN Medicare Advantage	$1,716.23
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cofinity Commercial	$1,547.00
Rate for Payer: Cofinity Commercial	$1,900.60
Rate for Payer: Encore Health Key Benefits Commercial	$1,768.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,716.23
Rate for Payer: Healthscope Commercial	$1,989.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,547.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,657.50
Rate for Payer: Mclaren Medicaid	$938.78
Rate for Payer: Mclaren Medicare	$1,716.23
Rate for Payer: Meridian Medicaid	$985.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,802.04
Rate for Payer: MI Amish Medical Board Commercial	$1,973.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,878.50
Rate for Payer: PACE Medicare	$1,630.42
Rate for Payer: PACE SWMI	$1,716.23
Rate for Payer: PHP Commercial	$1,878.50
Rate for Payer: PHP Medicare Advantage	$1,716.23
Rate for Payer: Priority Health Choice Medicaid	$938.78
Rate for Payer: Priority Health Cigna Priority Health	$1,547.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,402.75
Rate for Payer: Priority Health Medicare	$1,716.23
Rate for Payer: Priority Health Narrow Network	$4,322.20
Rate for Payer: Priority Health SBD	$1,392.30
Rate for Payer: Railroad Medicare Medicare	$1,716.23
Rate for Payer: UHC All Payor (Choice/PPO)	$481.57
Rate for Payer: UHC Dual Complete DSNP	$1,716.23
Rate for Payer: UHC Exchange	$437.79
Rate for Payer: UHC Medicare Advantage	$1,767.72
Rate for Payer: UMR Bronson Commercial	$817.70
Rate for Payer: VA VA	$1,716.23
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,657.50

PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR

Professional

Both

$261.00

Service Code	HCPCS 96132
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$2,343.54
Rate for Payer: Aetna Commercial	$117.40
Rate for Payer: BCBS Complete	$70.22
Rate for Payer: BCBS Trust/PPO	$2,343.54
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Meridian Medicaid	$70.22
Rate for Payer: Priority Health Choice Medicaid	$66.88
Rate for Payer: Priority Health Cigna Priority Health	$182.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.59
Rate for Payer: Priority Health Narrow Network	$140.59
Rate for Payer: Priority Health SBD	$140.59
Rate for Payer: UMR Bronson Commercial	$120.06

PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR

Professional

Both

$199.00

Service Code	HCPCS 96133
Min. Negotiated Rate	$48.14
Max. Negotiated Rate	$150.57
Rate for Payer: Aetna Commercial	$88.51
Rate for Payer: BCBS Complete	$50.55
Rate for Payer: BCBS Trust/PPO	$150.57
Rate for Payer: Cash Price	$159.20
Rate for Payer: Cash Price	$159.20
Rate for Payer: Meridian Medicaid	$50.55
Rate for Payer: Priority Health Choice Medicaid	$48.14
Rate for Payer: Priority Health Cigna Priority Health	$139.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$101.51
Rate for Payer: Priority Health Narrow Network	$101.51
Rate for Payer: Priority Health SBD	$101.51
Rate for Payer: UMR Bronson Commercial	$91.54

PR NEUROPSYCH TESTING BY COMPUTER

Professional

Both

$169.00

Service Code	HCPCS 96120
Min. Negotiated Rate	$67.60
Max. Negotiated Rate	$118.30
Rate for Payer: BCBS Complete	$67.60
Rate for Payer: Cash Price	$135.20
Rate for Payer: Priority Health Cigna Priority Health	$118.30
Rate for Payer: UMR Bronson Commercial	$77.74

PR NEUROPSYCH TESTING BY PSYCH/PHYS

Professional

Both

$219.00

Service Code	HCPCS 96118
Min. Negotiated Rate	$87.60
Max. Negotiated Rate	$153.30
Rate for Payer: BCBS Complete	$87.60
Rate for Payer: Cash Price	$175.20
Rate for Payer: Priority Health Cigna Priority Health	$153.30
Rate for Payer: UMR Bronson Commercial	$100.74

PR NEUROPSYCH TESTING BY TECHNICIAN

Professional

Both

$123.00

Service Code	HCPCS 96119
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$86.10
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: Cash Price	$98.40
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: UMR Bronson Commercial	$56.58

PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC

Professional

Both

$2,594.00

Service Code	HCPCS 64708
Min. Negotiated Rate	$329.51
Max. Negotiated Rate	$5,401.87
Rate for Payer: Aetna Commercial	$649.68
Rate for Payer: BCBS Complete	$345.99
Rate for Payer: BCBS Trust/PPO	$5,401.87
Rate for Payer: Cash Price	$2,075.20
Rate for Payer: Cash Price	$2,075.20
Rate for Payer: Meridian Medicaid	$345.99
Rate for Payer: Priority Health Choice Medicaid	$329.51
Rate for Payer: Priority Health Cigna Priority Health	$1,815.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$853.30
Rate for Payer: Priority Health Narrow Network	$853.30
Rate for Payer: Priority Health SBD	$853.30
Rate for Payer: UMR Bronson Commercial	$1,193.24

PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS

Professional

Both

$2,720.00

Service Code	HCPCS 64713
Min. Negotiated Rate	$517.38
Max. Negotiated Rate	$7,702.61
Rate for Payer: Aetna Commercial	$1,010.20
Rate for Payer: BCBS Complete	$543.25
Rate for Payer: BCBS Trust/PPO	$7,702.61
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Meridian Medicaid	$543.25
Rate for Payer: Priority Health Choice Medicaid	$517.38
Rate for Payer: Priority Health Cigna Priority Health	$1,904.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,353.84
Rate for Payer: Priority Health Narrow Network	$1,353.84
Rate for Payer: Priority Health SBD	$1,353.84
Rate for Payer: UMR Bronson Commercial	$1,251.20

PR NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS

Professional

Both

$3,341.00

Service Code	HCPCS 64714
Min. Negotiated Rate	$494.59
Max. Negotiated Rate	$5,064.28
Rate for Payer: Aetna Commercial	$974.07
Rate for Payer: BCBS Complete	$519.32
Rate for Payer: BCBS Trust/PPO	$5,064.28
Rate for Payer: Cash Price	$2,672.80
Rate for Payer: Cash Price	$2,672.80
Rate for Payer: Meridian Medicaid	$519.32
Rate for Payer: Priority Health Choice Medicaid	$494.59
Rate for Payer: Priority Health Cigna Priority Health	$2,338.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,292.68
Rate for Payer: Priority Health Narrow Network	$1,292.68
Rate for Payer: Priority Health SBD	$1,292.68
Rate for Payer: UMR Bronson Commercial	$1,536.86

PR NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV

Professional

Both

$977.00

Service Code	HCPCS 64712
Min. Negotiated Rate	$384.68
Max. Negotiated Rate	$6,738.47
Rate for Payer: Aetna Commercial	$761.95
Rate for Payer: BCBS Complete	$403.91
Rate for Payer: BCBS Trust/PPO	$6,738.47
Rate for Payer: Cash Price	$781.60
Rate for Payer: Cash Price	$781.60
Rate for Payer: Meridian Medicaid	$403.91
Rate for Payer: Priority Health Choice Medicaid	$384.68
Rate for Payer: Priority Health Cigna Priority Health	$683.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,012.40
Rate for Payer: Priority Health Narrow Network	$1,012.40
Rate for Payer: Priority Health SBD	$1,012.40
Rate for Payer: UMR Bronson Commercial	$449.42

PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI

Professional

Both

$313.00

Service Code	HCPCS 93924
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$577.96
Rate for Payer: Aetna Commercial	$172.82
Rate for Payer: BCBS Complete	$125.20
Rate for Payer: BCBS Trust/PPO	$577.96
Rate for Payer: Cash Price	$250.40
Rate for Payer: Cash Price	$250.40
Rate for Payer: Priority Health Cigna Priority Health	$219.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.89
Rate for Payer: Priority Health Narrow Network	$31.89
Rate for Payer: Priority Health SBD	$212.00
Rate for Payer: UMR Bronson Commercial	$143.98

PR NIPPLE/AREOLA RECONSTRUCTION

Professional

Both

$1,500.00

Service Code	HCPCS 19350
Min. Negotiated Rate	$432.18
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$725.23
Rate for Payer: BCBS Complete	$453.79
Rate for Payer: BCBS Trust/PPO	$596.25
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Meridian Medicaid	$453.79
Rate for Payer: Priority Health Choice Medicaid	$432.18
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$829.47
Rate for Payer: Priority Health Narrow Network	$829.47
Rate for Payer: Priority Health SBD	$829.47
Rate for Payer: UMR Bronson Commercial	$690.00

PR NIPPLE EXPLORATION

Professional

Both

$753.00

Service Code	HCPCS 19110
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$527.10
Rate for Payer: Aetna Commercial	$381.31
Rate for Payer: BCBS Complete	$239.31
Rate for Payer: BCBS Trust/PPO	$12.95
Rate for Payer: Cash Price	$602.40
Rate for Payer: Cash Price	$602.40
Rate for Payer: Meridian Medicaid	$239.31
Rate for Payer: Priority Health Choice Medicaid	$227.91
Rate for Payer: Priority Health Cigna Priority Health	$527.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$435.30
Rate for Payer: Priority Health Narrow Network	$435.30
Rate for Payer: Priority Health SBD	$435.30
Rate for Payer: UMR Bronson Commercial	$346.38

PR NITRIC OXIDE EXPIRED GAS DETERMINATION

Professional

Both

$35.00

Service Code	HCPCS 95012
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$310.64
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$310.64
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	$23.41
Rate for Payer: Priority Health Narrow Network	$23.41
Rate for Payer: Priority Health SBD	$23.41
Rate for Payer: UMR Bronson Commercial	$16.10

PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES

Professional

Both

$311.00

Service Code	HCPCS 64455
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$730.11
Rate for Payer: Aetna Commercial	$43.68
Rate for Payer: BCBS Complete	$22.14
Rate for Payer: BCBS Trust/PPO	$730.11
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Meridian Medicaid	$22.14
Rate for Payer: Priority Health Choice Medicaid	$21.09
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.06
Rate for Payer: Priority Health Narrow Network	$56.06
Rate for Payer: Priority Health SBD	$56.06
Rate for Payer: UMR Bronson Commercial	$143.06

PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL

Professional

Both

$875.00

Service Code	HCPCS 64479
Min. Negotiated Rate	$82.86
Max. Negotiated Rate	$1,300.67
Rate for Payer: Aetna Commercial	$167.75
Rate for Payer: BCBS Complete	$87.00
Rate for Payer: BCBS Trust/PPO	$1,300.67
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Meridian Medicaid	$87.00
Rate for Payer: Priority Health Choice Medicaid	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$612.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$218.00
Rate for Payer: Priority Health Narrow Network	$218.00
Rate for Payer: Priority Health SBD	$218.00
Rate for Payer: UMR Bronson Commercial	$402.50

PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL

Professional

Both

$339.00

Service Code	HCPCS 64480
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$967.32
Rate for Payer: Aetna Commercial	$80.46
Rate for Payer: BCBS Complete	$40.48
Rate for Payer: BCBS Trust/PPO	$967.32
Rate for Payer: Cash Price	$271.20
Rate for Payer: Cash Price	$271.20
Rate for Payer: Meridian Medicaid	$40.48
Rate for Payer: Priority Health Choice Medicaid	$38.55
Rate for Payer: Priority Health Cigna Priority Health	$237.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.49
Rate for Payer: Priority Health Narrow Network	$102.49
Rate for Payer: Priority Health SBD	$102.49
Rate for Payer: UMR Bronson Commercial	$155.94

PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL

Professional

Both

$1,000.00

Service Code	HCPCS 64483
Min. Negotiated Rate	$70.72
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: BCBS Complete	$74.26
Rate for Payer: BCBS Trust/PPO	$96.15
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Meridian Medicaid	$74.26
Rate for Payer: Priority Health Choice Medicaid	$70.72
Rate for Payer: Priority Health Cigna Priority Health	$700.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$185.15
Rate for Payer: Priority Health Narrow Network	$185.15
Rate for Payer: Priority Health SBD	$185.15
Rate for Payer: UMR Bronson Commercial	$460.00

PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL

Professional

Both

$436.00

Service Code	HCPCS 64484
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$566.87
Rate for Payer: Aetna Commercial	$67.16
Rate for Payer: BCBS Complete	$34.22
Rate for Payer: BCBS Trust/PPO	$566.87
Rate for Payer: Cash Price	$348.80
Rate for Payer: Cash Price	$348.80
Rate for Payer: Meridian Medicaid	$34.22
Rate for Payer: Priority Health Choice Medicaid	$32.59
Rate for Payer: Priority Health Cigna Priority Health	$305.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.07
Rate for Payer: Priority Health Narrow Network	$86.07
Rate for Payer: Priority Health SBD	$86.07
Rate for Payer: UMR Bronson Commercial	$200.56

PR NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT

Professional

Both

$3,000.00

Service Code	HCPCS 0707T
Min. Negotiated Rate	$262.22
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$368.07
Rate for Payer: BCBS Complete	$1,200.00
Rate for Payer: BCBS Trust/PPO	$262.22
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Priority Health Cigna Priority Health	$2,100.00
Rate for Payer: UMR Bronson Commercial	$1,380.00

PR NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT

Professional

Both

$172.00

Service Code	HCPCS 54235
Min. Negotiated Rate	$47.07
Max. Negotiated Rate	$573.21
Rate for Payer: Aetna Commercial	$92.84
Rate for Payer: BCBS Complete	$49.42
Rate for Payer: BCBS Trust/PPO	$573.21
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Meridian Medicaid	$49.42
Rate for Payer: Priority Health Choice Medicaid	$47.07
Rate for Payer: Priority Health Cigna Priority Health	$120.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.33
Rate for Payer: Priority Health Narrow Network	$118.33
Rate for Payer: Priority Health SBD	$118.33
Rate for Payer: UMR Bronson Commercial	$79.12

PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY

Professional

Both

$675.00

Service Code	HCPCS 51600
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$2,020.75
Rate for Payer: Aetna Commercial	$56.72
Rate for Payer: BCBS Complete	$28.62
Rate for Payer: BCBS Trust/PPO	$2,020.75
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Meridian Medicaid	$28.62
Rate for Payer: Priority Health Choice Medicaid	$27.26
Rate for Payer: Priority Health Cigna Priority Health	$472.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.70
Rate for Payer: Priority Health Narrow Network	$69.70
Rate for Payer: Priority Health SBD	$69.70
Rate for Payer: UMR Bronson Commercial	$310.50

Know your out-of-pocket cost for care.

All Charges