Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS

Professional

Both

$309.00

Service Code	HCPCS 93923
Min. Negotiated Rate	$28.75
Max. Negotiated Rate	$415.24
Rate for Payer: Aetna Commercial	$139.53
Rate for Payer: Aetna Commercial	$139.53
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Complete	$123.60
Rate for Payer: BCBS Trust/PPO	$415.24
Rate for Payer: BCBS Trust/PPO	$415.24
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health Cigna Priority Health	$216.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.75
Rate for Payer: Priority Health Narrow Network	$28.75
Rate for Payer: Priority Health Narrow Network	$28.75
Rate for Payer: Priority Health SBD	$172.47
Rate for Payer: Priority Health SBD	$172.47
Rate for Payer: UMR Bronson Commercial	$142.14
Rate for Payer: UMR Bronson Commercial	$20.24

PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL

Professional

Both

$26.00

Service Code	HCPCS 93922
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$131.55
Rate for Payer: Aetna Commercial	$90.01
Rate for Payer: Aetna Commercial	$90.01
Rate for Payer: BCBS Complete	$80.40
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Priority Health Cigna Priority Health	$140.70
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.17
Rate for Payer: Priority Health Narrow Network	$16.17
Rate for Payer: Priority Health Narrow Network	$16.17
Rate for Payer: Priority Health SBD	$110.49
Rate for Payer: Priority Health SBD	$110.49
Rate for Payer: UMR Bronson Commercial	$11.96
Rate for Payer: UMR Bronson Commercial	$92.46

PR NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN

Professional

Both

$55.00

Service Code	HCPCS 98967
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$1,248.37
Rate for Payer: Aetna Commercial	$27.83
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$1,248.37
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.20
Rate for Payer: Priority Health Narrow Network	$29.20
Rate for Payer: Priority Health SBD	$29.20
Rate for Payer: UMR Bronson Commercial	$25.30

PR NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN

Professional

Both

$80.00

Service Code	HCPCS 98968
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$1,647.77
Rate for Payer: Aetna Commercial	$41.55
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$1,647.77
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.33
Rate for Payer: Priority Health Narrow Network	$41.33
Rate for Payer: Priority Health SBD	$41.33
Rate for Payer: UMR Bronson Commercial	$36.80

PR NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN

Professional

Both

$28.00

Service Code	HCPCS 98966
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$564.75
Rate for Payer: Aetna Commercial	$14.10
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$564.75
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.82
Rate for Payer: Priority Health Narrow Network	$14.82
Rate for Payer: Priority Health SBD	$14.82
Rate for Payer: UMR Bronson Commercial	$12.88

PR NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART

Professional

Both

$1,118.00

Service Code	HCPCS 36221
Min. Negotiated Rate	$124.61
Max. Negotiated Rate	$1,320.46
Rate for Payer: Aetna Commercial	$269.74
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: BCBS Trust/PPO	$1,320.46
Rate for Payer: Cash Price	$894.40
Rate for Payer: Cash Price	$894.40
Rate for Payer: Meridian Medicaid	$130.84
Rate for Payer: Priority Health Choice Medicaid	$124.61
Rate for Payer: Priority Health Cigna Priority Health	$782.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$309.59
Rate for Payer: Priority Health Narrow Network	$309.59
Rate for Payer: Priority Health SBD	$309.59
Rate for Payer: UMR Bronson Commercial	$514.28

PR NORMAL SALINE SOLUTION INFUS

Professional

Both

$5.00

Service Code	HCPCS J7050
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$0.69
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCBS Trust/PPO	$0.39
Rate for Payer: Cash Price	$4.00
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 NORMAL SALINE SOLUTION INFUS

Professional

Both

$10.00

Service Code	HCPCS J7030
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$0.64
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: UMR Bronson Commercial	$4.60

PR NORMAL SALINE SOLUTION INFUS

Professional

Both

$8.00

Service Code	HCPCS J7040
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna Commercial	$1.39
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCBS Trust/PPO	$0.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: UMR Bronson Commercial	$3.68

PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS

Professional

Both

$793.00

Service Code	HCPCS 31267
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$1,047.62
Rate for Payer: Aetna Commercial	$338.24
Rate for Payer: BCBS Complete	$177.14
Rate for Payer: BCBS Trust/PPO	$1,047.62
Rate for Payer: Cash Price	$634.40
Rate for Payer: Cash Price	$634.40
Rate for Payer: Meridian Medicaid	$177.14
Rate for Payer: Priority Health Choice Medicaid	$168.70
Rate for Payer: Priority Health Cigna Priority Health	$555.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$365.34
Rate for Payer: Priority Health Narrow Network	$365.34
Rate for Payer: Priority Health SBD	$365.34
Rate for Payer: UMR Bronson Commercial	$364.78

PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS

Professional

Both

$754.00

Service Code	HCPCS 31288
Min. Negotiated Rate	$148.67
Max. Negotiated Rate	$1,515.16
Rate for Payer: Aetna Commercial	$298.93
Rate for Payer: BCBS Complete	$156.10
Rate for Payer: BCBS Trust/PPO	$1,515.16
Rate for Payer: Cash Price	$603.20
Rate for Payer: Cash Price	$603.20
Rate for Payer: Meridian Medicaid	$156.10
Rate for Payer: Priority Health Choice Medicaid	$148.67
Rate for Payer: Priority Health Cigna Priority Health	$527.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$322.74
Rate for Payer: Priority Health Narrow Network	$322.74
Rate for Payer: Priority Health SBD	$322.74
Rate for Payer: UMR Bronson Commercial	$346.84

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN

Professional

Both

$73.00

Service Code	HCPCS 99447
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$873.81
Rate for Payer: Aetna Commercial	$35.14
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: BCBS Trust/PPO	$873.81
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Meridian Medicaid	$24.15
Rate for Payer: Priority Health Choice Medicaid	$23.00
Rate for Payer: Priority Health Cigna Priority Health	$51.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.54
Rate for Payer: Priority Health Narrow Network	$36.54
Rate for Payer: Priority Health SBD	$36.54
Rate for Payer: UMR Bronson Commercial	$33.58

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN

Professional

Both

$90.00

Service Code	HCPCS 99448
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$899.17
Rate for Payer: Aetna Commercial	$55.57
Rate for Payer: BCBS Complete	$35.78
Rate for Payer: BCBS Trust/PPO	$899.17
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Meridian Medicaid	$35.78
Rate for Payer: Priority Health Choice Medicaid	$34.08
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.68
Rate for Payer: Priority Health Narrow Network	$55.68
Rate for Payer: Priority Health SBD	$55.68
Rate for Payer: UMR Bronson Commercial	$41.40

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN

Professional

Both

$145.00

Service Code	HCPCS 99449
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$1,202.41
Rate for Payer: Aetna Commercial	$75.64
Rate for Payer: BCBS Complete	$47.64
Rate for Payer: BCBS Trust/PPO	$1,202.41
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Meridian Medicaid	$47.64
Rate for Payer: Priority Health Choice Medicaid	$45.37
Rate for Payer: Priority Health Cigna Priority Health	$101.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$73.78
Rate for Payer: Priority Health Narrow Network	$73.78
Rate for Payer: Priority Health SBD	$73.78
Rate for Payer: UMR Bronson Commercial	$66.70

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN

Professional

Both

$36.00

Service Code	HCPCS 99446
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$776.07
Rate for Payer: Aetna Commercial	$19.45
Rate for Payer: BCBS Complete	$11.85
Rate for Payer: BCBS Trust/PPO	$776.07
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Meridian Medicaid	$11.85
Rate for Payer: Priority Health Choice Medicaid	$11.29
Rate for Payer: Priority Health Cigna Priority Health	$25.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.44
Rate for Payer: Priority Health Narrow Network	$18.44
Rate for Payer: Priority Health SBD	$18.44
Rate for Payer: UMR Bronson Commercial	$16.56

PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS

Professional

Both

$6,970.00

Service Code	HCPCS 62161
Min. Negotiated Rate	$214.49
Max. Negotiated Rate	$4,879.00
Rate for Payer: Aetna Commercial	$1,957.24
Rate for Payer: BCBS Complete	$1,041.99
Rate for Payer: BCBS Trust/PPO	$214.49
Rate for Payer: Cash Price	$5,576.00
Rate for Payer: Cash Price	$5,576.00
Rate for Payer: Meridian Medicaid	$1,041.99
Rate for Payer: Priority Health Choice Medicaid	$992.37
Rate for Payer: Priority Health Cigna Priority Health	$4,879.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,604.63
Rate for Payer: Priority Health Narrow Network	$2,604.63
Rate for Payer: Priority Health SBD	$2,604.63
Rate for Payer: UMR Bronson Commercial	$3,206.20

PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID

Professional

Both

$2,769.00

Service Code	HCPCS 62165
Min. Negotiated Rate	$978.74
Max. Negotiated Rate	$2,589.34
Rate for Payer: Aetna Commercial	$1,955.95
Rate for Payer: BCBS Complete	$1,027.68
Rate for Payer: BCBS Trust/PPO	$1,355.62
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Meridian Medicaid	$1,027.68
Rate for Payer: Priority Health Choice Medicaid	$978.74
Rate for Payer: Priority Health Cigna Priority Health	$1,938.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,589.34
Rate for Payer: Priority Health Narrow Network	$2,589.34
Rate for Payer: Priority Health SBD	$2,589.34
Rate for Payer: UMR Bronson Commercial	$1,273.74

PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG

Professional

Both

$7,680.00

Service Code	HCPCS 62162
Min. Negotiated Rate	$757.05
Max. Negotiated Rate	$5,376.00
Rate for Payer: Aetna Commercial	$2,441.45
Rate for Payer: BCBS Complete	$1,288.68
Rate for Payer: BCBS Trust/PPO	$757.05
Rate for Payer: Cash Price	$6,144.00
Rate for Payer: Cash Price	$6,144.00
Rate for Payer: Meridian Medicaid	$1,288.68
Rate for Payer: Priority Health Choice Medicaid	$1,227.31
Rate for Payer: Priority Health Cigna Priority Health	$5,376.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,232.57
Rate for Payer: Priority Health Narrow Network	$3,232.57
Rate for Payer: Priority Health SBD	$3,232.57
Rate for Payer: UMR Bronson Commercial	$3,532.80

PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS

Professional

Both

$800.00

Service Code	HCPCS 62160
Min. Negotiated Rate	$120.35
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$245.74
Rate for Payer: BCBS Complete	$126.37
Rate for Payer: BCBS Trust/PPO	$437.96
Rate for Payer: Cash Price	$640.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Meridian Medicaid	$126.37
Rate for Payer: Priority Health Choice Medicaid	$120.35
Rate for Payer: Priority Health Cigna Priority Health	$560.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$318.78
Rate for Payer: Priority Health Narrow Network	$318.78
Rate for Payer: Priority Health SBD	$318.78
Rate for Payer: UMR Bronson Commercial	$368.00

PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME

Professional

Both

$155.00

Service Code	HCPCS 99316
Min. Negotiated Rate	$71.30
Max. Negotiated Rate	$1,849.05
Rate for Payer: Aetna Commercial	$102.91
Rate for Payer: BCBS Complete	$118.00
Rate for Payer: BCBS Trust/PPO	$1,849.05
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Meridian Medicaid	$118.00
Rate for Payer: Priority Health Choice Medicaid	$112.38
Rate for Payer: Priority Health Cigna Priority Health	$108.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$166.19
Rate for Payer: Priority Health Narrow Network	$166.19
Rate for Payer: Priority Health SBD	$166.19
Rate for Payer: UMR Bronson Commercial	$71.30

PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME

Professional

Both

$108.00

Service Code	HCPCS 99315
Min. Negotiated Rate	$49.68
Max. Negotiated Rate	$402.56
Rate for Payer: Aetna Commercial	$71.33
Rate for Payer: BCBS Complete	$73.52
Rate for Payer: BCBS Trust/PPO	$402.56
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Meridian Medicaid	$73.52
Rate for Payer: Priority Health Choice Medicaid	$70.02
Rate for Payer: Priority Health Cigna Priority Health	$75.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.23
Rate for Payer: Priority Health Narrow Network	$103.23
Rate for Payer: Priority Health SBD	$103.23
Rate for Payer: UMR Bronson Commercial	$49.68

PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX

Professional

Both

$127.00

Service Code	HCPCS 94690
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$603.85
Rate for Payer: Aetna Commercial	$45.87
Rate for Payer: BCBS Complete	$50.80
Rate for Payer: BCBS Trust/PPO	$603.85
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cash Price	$101.60
Rate for Payer: Priority Health Cigna Priority Health	$88.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.94
Rate for Payer: Priority Health Narrow Network	$4.94
Rate for Payer: Priority Health SBD	$63.78
Rate for Payer: UMR Bronson Commercial	$58.42

PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP

Professional

Both

$112.00

Service Code	HCPCS 94680
Min. Negotiated Rate	$16.62
Max. Negotiated Rate	$444.83
Rate for Payer: Aetna Commercial	$56.14
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$444.83
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.62
Rate for Payer: Priority Health Narrow Network	$16.62
Rate for Payer: Priority Health SBD	$70.51
Rate for Payer: UMR Bronson Commercial	$51.52

PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$116.90

Service Code	NDC 0093-3174-31
Hospital Charge Code	76821
Hospital Revenue Code	637
Min. Negotiated Rate	$51.44
Max. Negotiated Rate	$105.21
Rate for Payer: Aetna American Axle	$75.98
Rate for Payer: Aetna Commercial	$99.36
Rate for Payer: Aetna New Business (MI Preferred)	$75.98
Rate for Payer: Cash Price	$93.52
Rate for Payer: Cofinity Commercial	$100.53
Rate for Payer: Cofinity Commercial	$81.83
Rate for Payer: Encore Health Key Benefits Commercial	$93.52
Rate for Payer: Healthscope Commercial	$105.21
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$81.83
Rate for Payer: Lakeland Regional Health Systems Commercial	$87.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.36
Rate for Payer: PHP Commercial	$99.36
Rate for Payer: Priority Health Cigna Priority Health	$81.83
Rate for Payer: Priority Health SBD	$73.65
Rate for Payer: UMR Bronson Commercial	$51.44
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$87.68

PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

Professional

Both

$4,166.00

Service Code	HCPCS 59510
Min. Negotiated Rate	$69.21
Max. Negotiated Rate	$3,755.20
Rate for Payer: Aetna Commercial	$2,150.00
Rate for Payer: BCBS Complete	$2,607.95
Rate for Payer: BCBS Trust/PPO	$69.21
Rate for Payer: Cash Price	$3,332.80
Rate for Payer: Cash Price	$3,332.80
Rate for Payer: Meridian Medicaid	$2,607.95
Rate for Payer: Priority Health Choice Medicaid	$2,483.76
Rate for Payer: Priority Health Cigna Priority Health	$2,916.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,755.20
Rate for Payer: Priority Health Narrow Network	$3,755.20
Rate for Payer: Priority Health SBD	$3,755.20
Rate for Payer: UMR Bronson Commercial	$1,916.36

Know your out-of-pocket cost for care.

All Charges