Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN

Professional

Both

$140.00

Service Code	HCPCS 90833
Min. Negotiated Rate	$40.90
Max. Negotiated Rate	$300.07
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: BCBS Complete	$42.94
Rate for Payer: BCBS Trust/PPO	$300.07
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Meridian Medicaid	$42.94
Rate for Payer: Priority Health Choice Medicaid	$40.90
Rate for Payer: Priority Health Cigna Priority Health	$98.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.27
Rate for Payer: Priority Health Narrow Network	$56.27
Rate for Payer: Priority Health SBD	$56.27
Rate for Payer: UMR Bronson Commercial	$64.40

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN

Professional

Both

$169.00

Service Code	HCPCS 90836
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$318.04
Rate for Payer: Aetna Commercial	$126.88
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCBS Trust/PPO	$318.04
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health	$118.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.08
Rate for Payer: Priority Health Narrow Network	$92.08
Rate for Payer: Priority Health SBD	$92.08
Rate for Payer: UMR Bronson Commercial	$77.74

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN

Professional

Both

$232.00

Service Code	HCPCS 90838
Min. Negotiated Rate	$68.59
Max. Negotiated Rate	$183.04
Rate for Payer: Aetna Commercial	$183.04
Rate for Payer: BCBS Complete	$72.02
Rate for Payer: BCBS Trust/PPO	$128.38
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cash Price	$185.60
Rate for Payer: Meridian Medicaid	$72.02
Rate for Payer: Priority Health Choice Medicaid	$68.59
Rate for Payer: Priority Health Cigna Priority Health	$162.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.89
Rate for Payer: Priority Health Narrow Network	$147.89
Rate for Payer: Priority Health SBD	$147.89
Rate for Payer: UMR Bronson Commercial	$106.72

PR PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT

Professional

Both

$4.00

Service Code	HCPCS 96146
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$303.77
Rate for Payer: Aetna Commercial	$2.16
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCBS Trust/PPO	$303.77
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: Priority Health HMO/PPO/Tiered Network	$3.14
Rate for Payer: Priority Health Narrow Network	$3.14
Rate for Payer: Priority Health SBD	$3.14
Rate for Payer: UMR Bronson Commercial	$1.84

PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN

Professional

Both

$84.00

Service Code	HCPCS 96137
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$308.53
Rate for Payer: Aetna Commercial	$20.88
Rate for Payer: BCBS Complete	$11.85
Rate for Payer: BCBS Trust/PPO	$308.53
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Meridian Medicaid	$11.85
Rate for Payer: Priority Health Choice Medicaid	$11.29
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.80
Rate for Payer: Priority Health Narrow Network	$23.80
Rate for Payer: Priority Health SBD	$23.80
Rate for Payer: UMR Bronson Commercial	$38.64

PR PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN

Professional

Both

$72.00

Service Code	HCPCS 96138
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$313.81
Rate for Payer: Aetna Commercial	$38.12
Rate for Payer: BCBS Complete	$28.80
Rate for Payer: BCBS Trust/PPO	$313.81
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Priority Health Cigna Priority Health	$50.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.37
Rate for Payer: Priority Health Narrow Network	$45.37
Rate for Payer: Priority Health SBD	$45.37
Rate for Payer: UMR Bronson Commercial	$33.12

PR PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN

Professional

Both

$72.00

Service Code	HCPCS 96139
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$342.87
Rate for Payer: Aetna Commercial	$38.12
Rate for Payer: BCBS Complete	$28.80
Rate for Payer: BCBS Trust/PPO	$342.87
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Priority Health Cigna Priority Health	$50.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46.71
Rate for Payer: Priority Health Narrow Network	$46.71
Rate for Payer: Priority Health SBD	$46.71
Rate for Payer: UMR Bronson Commercial	$33.12

PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN

Professional

Both

$92.00

Service Code	HCPCS 96136
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$227.17
Rate for Payer: Aetna Commercial	$26.94
Rate for Payer: BCBS Complete	$15.44
Rate for Payer: BCBS Trust/PPO	$227.17
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Meridian Medicaid	$15.44
Rate for Payer: Priority Health Choice Medicaid	$14.70
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.99
Rate for Payer: Priority Health Narrow Network	$30.99
Rate for Payer: Priority Health SBD	$30.99
Rate for Payer: UMR Bronson Commercial	$42.32

PR PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH

Professional

Both

$2,175.00

Service Code	HCPCS 31040
Min. Negotiated Rate	$518.66
Max. Negotiated Rate	$1,522.50
Rate for Payer: Aetna Commercial	$1,025.23
Rate for Payer: BCBS Complete	$544.59
Rate for Payer: BCBS Trust/PPO	$1,147.47
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Meridian Medicaid	$544.59
Rate for Payer: Priority Health Choice Medicaid	$518.66
Rate for Payer: Priority Health Cigna Priority Health	$1,522.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,128.44
Rate for Payer: Priority Health Narrow Network	$1,128.44
Rate for Payer: Priority Health SBD	$1,128.44
Rate for Payer: UMR Bronson Commercial	$1,000.50

PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM

Professional

Both

$50.00

Service Code	HCPCS 96160
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$124.15
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$124.15
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.43
Rate for Payer: Priority Health Narrow Network	$5.43
Rate for Payer: Priority Health SBD	$5.43
Rate for Payer: UMR Bronson Commercial	$23.00

PR PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS

Professional

Both

$5,465.00

Service Code	HCPCS 33910
Min. Negotiated Rate	$727.47
Max. Negotiated Rate	$4,112.03
Rate for Payer: Aetna Commercial	$3,520.01
Rate for Payer: BCBS Complete	$1,711.59
Rate for Payer: BCBS Trust/PPO	$727.47
Rate for Payer: Cash Price	$4,372.00
Rate for Payer: Cash Price	$4,372.00
Rate for Payer: Meridian Medicaid	$1,711.59
Rate for Payer: Priority Health Choice Medicaid	$1,630.09
Rate for Payer: Priority Health Cigna Priority Health	$3,825.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,112.03
Rate for Payer: Priority Health Narrow Network	$4,112.03
Rate for Payer: Priority Health SBD	$4,112.03
Rate for Payer: UMR Bronson Commercial	$2,513.90

PR PULMONARY COMPLIANCE STUDY

Professional

Both

$169.00

Service Code	HCPCS 94750
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 PULMONARY STRESS TESTING

Professional

Both

$46.00

Service Code	HCPCS 94618
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$442.72
Rate for Payer: Aetna Commercial	$36.28
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$442.72
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.72
Rate for Payer: Priority Health Narrow Network	$15.72
Rate for Payer: Priority Health SBD	$44.92
Rate for Payer: UMR Bronson Commercial	$21.16

PR PULMONARY STRESS TESTING,SIMPLE

Professional

Both

$351.00

Service Code	HCPCS 94620
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$245.70
Rate for Payer: BCBS Complete	$140.40
Rate for Payer: Cash Price	$280.80
Rate for Payer: Priority Health Cigna Priority Health	$245.70
Rate for Payer: UMR Bronson Commercial	$161.46

PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$178.00

Service Code	HCPCS 11105
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$124.60
Rate for Payer: Aetna Commercial	$27.89
Rate for Payer: BCBS Complete	$17.00
Rate for Payer: BCBS Trust/PPO	$23.50
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cash Price	$142.40
Rate for Payer: Meridian Medicaid	$17.00
Rate for Payer: Priority Health Choice Medicaid	$16.19
Rate for Payer: Priority Health Cigna Priority Health	$124.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.23
Rate for Payer: Priority Health Narrow Network	$31.23
Rate for Payer: Priority Health SBD	$31.23
Rate for Payer: UMR Bronson Commercial	$81.88

PR PUNCH BIOPSY SKIN SINGLE LESION

Professional

Both

$239.00

Service Code	HCPCS 11104
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$167.30
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: BCBS Complete	$31.09
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$191.20
Rate for Payer: Meridian Medicaid	$31.09
Rate for Payer: Priority Health Choice Medicaid	$29.61
Rate for Payer: Priority Health Cigna Priority Health	$167.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.13
Rate for Payer: Priority Health Narrow Network	$57.13
Rate for Payer: Priority Health SBD	$57.13
Rate for Payer: UMR Bronson Commercial	$109.94

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Facility

$211.00

Service Code	CPT 10160
Hospital Charge Code	10160
Hospital Revenue Code	521
Min. Negotiated Rate	$92.84
Max. Negotiated Rate	$189.90
Rate for Payer: Aetna American Axle	$137.15
Rate for Payer: Aetna Commercial	$179.35
Rate for Payer: Aetna New Business (MI Preferred)	$137.15
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cofinity Commercial	$147.70
Rate for Payer: Cofinity Commercial	$181.46
Rate for Payer: Encore Health Key Benefits Commercial	$168.80
Rate for Payer: Healthscope Commercial	$189.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$147.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$158.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$179.35
Rate for Payer: PHP Commercial	$179.35
Rate for Payer: Priority Health Cigna Priority Health	$147.70
Rate for Payer: Priority Health SBD	$132.93
Rate for Payer: UMR Bronson Commercial	$92.84
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$158.25

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Facility

$211.00

Service Code	CPT 10160
Hospital Charge Code	10160
Hospital Revenue Code	521
Min. Negotiated Rate	$78.07
Max. Negotiated Rate	$1,115.78
Rate for Payer: Aetna American Axle	$137.15
Rate for Payer: Aetna Commercial	$179.35
Rate for Payer: Aetna Medicare	$368.61
Rate for Payer: Aetna New Business (MI Preferred)	$137.15
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	$277.63
Rate for Payer: BCN Medicare Advantage	$354.43
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cofinity Commercial	$147.70
Rate for Payer: Cofinity Commercial	$181.46
Rate for Payer: Encore Health Key Benefits Commercial	$168.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.43
Rate for Payer: Healthscope Commercial	$189.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$147.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$158.25
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	$179.35
Rate for Payer: PACE Medicare	$336.71
Rate for Payer: PACE SWMI	$354.43
Rate for Payer: PHP Commercial	$179.35
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	$147.70
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	$132.93
Rate for Payer: Railroad Medicare Medicare	$354.43
Rate for Payer: UHC All Payor (Choice/PPO)	$104.82
Rate for Payer: UHC Dual Complete DSNP	$354.43
Rate for Payer: UHC Exchange	$95.29
Rate for Payer: UHC Medicare Advantage	$365.06
Rate for Payer: UMR Bronson Commercial	$78.07
Rate for Payer: VA VA	$354.43
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$158.25

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Professional

Both

$211.00

Service Code	HCPCS 10160
Hospital Charge Code	10160
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$147.70
Rate for Payer: Aetna Commercial	$101.52
Rate for Payer: BCBS Complete	$65.08
Rate for Payer: BCBS Trust/PPO	$11.15
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Meridian Medicaid	$65.08
Rate for Payer: Priority Health Choice Medicaid	$61.98
Rate for Payer: Priority Health Cigna Priority Health	$147.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.39
Rate for Payer: Priority Health Narrow Network	$118.39
Rate for Payer: Priority Health SBD	$118.39
Rate for Payer: UMR Bronson Commercial	$97.06

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Professional

Both

$211.00

Service Code	HCPCS 10160
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$147.70
Rate for Payer: Aetna Commercial	$101.52
Rate for Payer: BCBS Complete	$65.08
Rate for Payer: BCBS Trust/PPO	$11.15
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Meridian Medicaid	$65.08
Rate for Payer: Priority Health Choice Medicaid	$61.98
Rate for Payer: Priority Health Cigna Priority Health	$147.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.39
Rate for Payer: Priority Health Narrow Network	$118.39
Rate for Payer: Priority Health SBD	$118.39
Rate for Payer: UMR Bronson Commercial	$97.06

PR PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST

Professional

Both

$74.00

Service Code	HCPCS 19001
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$456.13
Rate for Payer: Aetna Commercial	$23.24
Rate for Payer: BCBS Complete	$13.87
Rate for Payer: BCBS Trust/PPO	$456.13
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Meridian Medicaid	$13.87
Rate for Payer: Priority Health Choice Medicaid	$13.21
Rate for Payer: Priority Health Cigna Priority Health	$51.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.07
Rate for Payer: Priority Health Narrow Network	$25.07
Rate for Payer: Priority Health SBD	$25.07
Rate for Payer: UMR Bronson Commercial	$34.04

PR PUNCTURE ASPIRATION CYST BREAST

Professional

Both

$187.00

Service Code	HCPCS 19000
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$6,614.63
Rate for Payer: Aetna Commercial	$47.21
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$6,614.63
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$130.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.79
Rate for Payer: Priority Health Narrow Network	$51.79
Rate for Payer: Priority Health SBD	$51.79
Rate for Payer: UMR Bronson Commercial	$86.02

PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX

Professional

Both

$393.00

Service Code	HCPCS 61070
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$355.02
Rate for Payer: Aetna Commercial	$71.83
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCBS Trust/PPO	$355.02
Rate for Payer: Cash Price	$314.40
Rate for Payer: Cash Price	$314.40
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Cigna Priority Health	$275.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$95.12
Rate for Payer: Priority Health Narrow Network	$95.12
Rate for Payer: Priority Health SBD	$95.12
Rate for Payer: UMR Bronson Commercial	$180.78

PR PURE TONE AUDIOMETRY AIR & BONE

Professional

Both

$64.00

Service Code	HCPCS 92553
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$1,526.79
Rate for Payer: Aetna Commercial	$40.97
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: BCBS Trust/PPO	$1,526.79
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Priority Health Cigna Priority Health	$44.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58.38
Rate for Payer: Priority Health Narrow Network	$58.38
Rate for Payer: Priority Health SBD	$58.38
Rate for Payer: UMR Bronson Commercial	$29.44

PR PURE TONE AUDIOMETRY AIR ONLY

Professional

Both

$53.00

Service Code	HCPCS 92552
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$1,476.07
Rate for Payer: Aetna Commercial	$33.49
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCBS Trust/PPO	$1,476.07
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Priority Health Cigna Priority Health	$37.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.61
Rate for Payer: Priority Health Narrow Network	$47.61
Rate for Payer: Priority Health SBD	$47.61
Rate for Payer: UMR Bronson Commercial	$24.38

Know your out-of-pocket cost for care.

All Charges