Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$15,294.44

Service Code	MS-DRG 563
Min. Negotiated Rate	$6,595.52
Max. Negotiated Rate	$15,294.44
Rate for Payer: Aetna Medicare	$7,220.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,678.31
Rate for Payer: Amish Plain Church Group Commercial	$8,678.31
Rate for Payer: BCBS MAPPO	$6,942.65
Rate for Payer: BCBS Trust/PPO	$15,294.44
Rate for Payer: BCN Medicare Advantage	$6,942.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,942.65
Rate for Payer: Mclaren Medicare	$6,942.65
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,289.78
Rate for Payer: MI Amish Medical Board Commercial	$7,984.05
Rate for Payer: PACE Medicare	$6,595.52
Rate for Payer: PACE SWMI	$6,942.65
Rate for Payer: PHP Medicare Advantage	$6,942.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12,851.79
Rate for Payer: Priority Health Medicare	$6,942.65
Rate for Payer: Priority Health Narrow Network	$10,281.43
Rate for Payer: Railroad Medicare Medicare	$6,942.65
Rate for Payer: UHC All Payor (Choice/PPO)	$13,661.48
Rate for Payer: UHC Core	$8,382.82
Rate for Payer: UHC Dual Complete DSNP	$6,942.65
Rate for Payer: UHC Exchange	$8,978.39
Rate for Payer: UHC Medicare Advantage	$7,150.93
Rate for Payer: VA VA	$6,942.65

FRAXEL ARMS - BILATERAL

Professional

Both

$1,000.00

Service Code	HCPCS 00166
Hospital Revenue Code	960
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$700.00
Rate for Payer: BCBS Complete	$400.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Priority Health Cigna Priority Health	$700.00

FRAXEL CHEST

Professional

Both

$800.00

Service Code	HCPCS 00155
Hospital Revenue Code	960
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$560.00
Rate for Payer: BCBS Complete	$320.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Priority Health Cigna Priority Health	$560.00

FRAXEL FACE & NECK

Professional

Both

$1,000.00

Service Code	HCPCS 00162
Hospital Revenue Code	960
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$700.00
Rate for Payer: BCBS Complete	$400.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Priority Health Cigna Priority Health	$700.00

FRAXEL FULL FACE

Professional

Both

$600.00

Service Code	HCPCS 00152
Hospital Revenue Code	960
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

FRAXEL HANDS

Professional

Both

$350.00

Service Code	HCPCS 00154
Hospital Revenue Code	960
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$245.00
Rate for Payer: BCBS Complete	$140.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Priority Health Cigna Priority Health	$245.00

FRAXEL LARGE SCAR

Professional

Both

$800.00

Service Code	HCPCS 00161
Hospital Revenue Code	960
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$560.00
Rate for Payer: BCBS Complete	$320.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Priority Health Cigna Priority Health	$560.00

FRAXEL MEDIUM SCAR

Professional

Both

$300.00

Service Code	HCPCS 00160
Hospital Revenue Code	960
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

FRAXEL NECK

Professional

Both

$400.00

Service Code	HCPCS 00153
Hospital Revenue Code	960
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00

FRAXEL NECK & CHEST

Professional

Both

$1,200.00

Service Code	HCPCS 00163
Hospital Revenue Code	960
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$840.00
Rate for Payer: BCBS Complete	$480.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Priority Health Cigna Priority Health	$840.00

FRAXEL PARTIAL TREATMENT - BILATERAL EYES

Professional

Both

$300.00

Service Code	HCPCS 00157
Hospital Revenue Code	960
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

FRAXEL PARTIAL TREATMENT - PERI-ORAL

Professional

Both

$500.00

Service Code	HCPCS 00156
Hospital Revenue Code	960
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$350.00
Rate for Payer: BCBS Complete	$200.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Priority Health Cigna Priority Health	$350.00

FRAXEL PARTIAL TREATMENT - UPPER LIP

Professional

Both

$250.00

Service Code	HCPCS 00158
Hospital Revenue Code	960
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00

FRAXEL RESTORE

Professional

Both

$250.00

Service Code	HCPCS 00168
Hospital Revenue Code	960
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00

FRAXEL SMALL SCAR

Professional

Both

$125.00

Service Code	HCPCS 00159
Hospital Revenue Code	960
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

FRAXEL STRETCH MARKS - ENTIRE ABDOMEN

Professional

Both

$800.00

Service Code	HCPCS 00165
Hospital Revenue Code	960
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$560.00
Rate for Payer: BCBS Complete	$320.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Priority Health Cigna Priority Health	$560.00

FRAXEL STRETCH MARKS - PERI-UMBILICAL

Professional

Both

$600.00

Service Code	HCPCS 00164
Hospital Revenue Code	960
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)

Facility

$8,517.99

Service Code	CPT 41520
Hospital Revenue Code	360
Min. Negotiated Rate	$249.18
Max. Negotiated Rate	$8,517.99
Rate for Payer: Aetna Medicare	$2,979.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,580.99
Rate for Payer: Amish Plain Church Group Commercial	$3,580.99
Rate for Payer: BCBS Complete	$1,645.54
Rate for Payer: BCBS MAPPO	$2,864.79
Rate for Payer: BCBS Trust/PPO	$1,427.34
Rate for Payer: BCN Medicare Advantage	$2,864.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,864.79
Rate for Payer: Mclaren Medicaid	$1,567.04
Rate for Payer: Mclaren Medicare	$2,864.79
Rate for Payer: Meridian Medicaid	$1,645.54
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,008.03
Rate for Payer: MI Amish Medical Board Commercial	$3,294.51
Rate for Payer: PACE Medicare	$2,721.55
Rate for Payer: PACE SWMI	$2,864.79
Rate for Payer: PHP Medicare Advantage	$2,864.79
Rate for Payer: Priority Health Choice Medicaid	$1,567.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,517.99
Rate for Payer: Priority Health Medicare	$2,864.79
Rate for Payer: Priority Health Narrow Network	$6,814.39
Rate for Payer: Railroad Medicare Medicare	$2,864.79
Rate for Payer: UHC All Payor (Choice/PPO)	$274.10
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$2,864.79
Rate for Payer: UHC Exchange	$249.18
Rate for Payer: UHC Medicare Advantage	$2,950.73
Rate for Payer: VA VA	$2,864.79

FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$64,208.66

Service Code	MS-DRG 793
Min. Negotiated Rate	$827.00
Max. Negotiated Rate	$64,208.66
Rate for Payer: Aetna Medicare	$32,039.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$38,509.06
Rate for Payer: Amish Plain Church Group Commercial	$38,509.06
Rate for Payer: BCBS MAPPO	$30,807.25
Rate for Payer: BCBS Trust/PPO	$4,710.21
Rate for Payer: BCN Medicare Advantage	$30,807.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$30,807.25
Rate for Payer: Mclaren Medicare	$30,807.25
Rate for Payer: Meridian Wellcare - Medicare Advantage	$32,347.61
Rate for Payer: MI Amish Medical Board Commercial	$35,428.34
Rate for Payer: PACE Medicare	$29,266.89
Rate for Payer: PACE SWMI	$30,807.25
Rate for Payer: PHP Medicare Advantage	$30,807.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60,403.12
Rate for Payer: Priority Health Medicare	$30,807.25
Rate for Payer: Priority Health Narrow Network	$48,322.50
Rate for Payer: Railroad Medicare Medicare	$30,807.25
Rate for Payer: UHC All Payor (Choice/PPO)	$64,208.66
Rate for Payer: UHC Core	$827.00
Rate for Payer: UHC Dual Complete DSNP	$30,807.25
Rate for Payer: UHC Medicare Advantage	$31,731.47
Rate for Payer: VA VA	$30,807.25

FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$31,919.00

Service Code	MS-DRG 934
Min. Negotiated Rate	$14,784.36
Max. Negotiated Rate	$31,919.00
Rate for Payer: Aetna Medicare	$16,184.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,453.10
Rate for Payer: Amish Plain Church Group Commercial	$19,453.10
Rate for Payer: BCBS MAPPO	$15,562.48
Rate for Payer: BCBS Trust/PPO	$21,724.04
Rate for Payer: BCN Medicare Advantage	$15,562.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,562.48
Rate for Payer: Mclaren Medicare	$15,562.48
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16,340.60
Rate for Payer: MI Amish Medical Board Commercial	$17,896.85
Rate for Payer: PACE Medicare	$14,784.36
Rate for Payer: PACE SWMI	$15,562.48
Rate for Payer: PHP Medicare Advantage	$15,562.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30,027.21
Rate for Payer: Priority Health Medicare	$15,562.48
Rate for Payer: Priority Health Narrow Network	$24,021.77
Rate for Payer: Railroad Medicare Medicare	$15,562.48
Rate for Payer: UHC All Payor (Choice/PPO)	$31,919.00
Rate for Payer: UHC Core	$19,585.80
Rate for Payer: UHC Dual Complete DSNP	$15,562.48
Rate for Payer: UHC Exchange	$20,977.31
Rate for Payer: UHC Medicare Advantage	$16,029.35
Rate for Payer: VA VA	$15,562.48

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$105,553.10

Service Code	MS-DRG 928
Min. Negotiated Rate	$47,810.61
Max. Negotiated Rate	$105,553.10
Rate for Payer: Aetna Medicare	$52,340.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$62,908.70
Rate for Payer: Amish Plain Church Group Commercial	$62,908.70
Rate for Payer: BCBS MAPPO	$50,326.96
Rate for Payer: BCBS Trust/PPO	$96,452.71
Rate for Payer: BCN Medicare Advantage	$50,326.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$50,326.96
Rate for Payer: Mclaren Medicare	$50,326.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$52,843.31
Rate for Payer: MI Amish Medical Board Commercial	$57,876.00
Rate for Payer: PACE Medicare	$47,810.61
Rate for Payer: PACE SWMI	$50,326.96
Rate for Payer: PHP Medicare Advantage	$50,326.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99,297.14
Rate for Payer: Priority Health Medicare	$50,326.96
Rate for Payer: Priority Health Narrow Network	$79,437.71
Rate for Payer: Railroad Medicare Medicare	$50,326.96
Rate for Payer: UHC All Payor (Choice/PPO)	$105,553.10
Rate for Payer: UHC Core	$64,768.39
Rate for Payer: UHC Dual Complete DSNP	$50,326.96
Rate for Payer: UHC Exchange	$69,369.99
Rate for Payer: UHC Medicare Advantage	$51,836.77
Rate for Payer: VA VA	$50,326.96

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$49,049.24

Service Code	MS-DRG 929
Min. Negotiated Rate	$22,467.59
Max. Negotiated Rate	$49,049.24
Rate for Payer: Aetna Medicare	$24,596.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$29,562.61
Rate for Payer: Amish Plain Church Group Commercial	$29,562.61
Rate for Payer: BCBS MAPPO	$23,650.09
Rate for Payer: BCBS Trust/PPO	$44,820.51
Rate for Payer: BCN Medicare Advantage	$23,650.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$23,650.09
Rate for Payer: Mclaren Medicare	$23,650.09
Rate for Payer: Meridian Wellcare - Medicare Advantage	$24,832.59
Rate for Payer: MI Amish Medical Board Commercial	$27,197.60
Rate for Payer: PACE Medicare	$22,467.59
Rate for Payer: PACE SWMI	$23,650.09
Rate for Payer: PHP Medicare Advantage	$23,650.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46,142.17
Rate for Payer: Priority Health Medicare	$23,650.09
Rate for Payer: Priority Health Narrow Network	$36,913.74
Rate for Payer: Railroad Medicare Medicare	$23,650.09
Rate for Payer: UHC All Payor (Choice/PPO)	$49,049.24
Rate for Payer: UHC Core	$30,097.08
Rate for Payer: UHC Dual Complete DSNP	$23,650.09
Rate for Payer: UHC Exchange	$32,235.39
Rate for Payer: UHC Medicare Advantage	$24,359.59
Rate for Payer: VA VA	$23,650.09

FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS

Facility

$5,175.07

Service Code	CPT 15240
Hospital Revenue Code	360
Min. Negotiated Rate	$783.24
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$1,662.20
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$861.56
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$783.24
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; 20 SQ CM OR LESS

Facility

$5,175.07

Service Code	CPT 15260
Hospital Revenue Code	360
Min. Negotiated Rate	$796.18
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$796.18
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$913.08
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$830.07
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE

Facility

$796.01

Service Code	HCPCS J9395
Hospital Charge Code	32767
Hospital Revenue Code	636
Min. Negotiated Rate	$501.49
Max. Negotiated Rate	$716.41
Rate for Payer: Aetna Commercial	$676.61
Rate for Payer: Aetna Commercial	$787.16
Rate for Payer: Aetna Commercial	$727.24
Rate for Payer: Aetna New Business (MI Preferred)	$556.13
Rate for Payer: Aetna New Business (MI Preferred)	$517.41
Rate for Payer: Aetna New Business (MI Preferred)	$601.95
Rate for Payer: Cash Price	$684.46
Rate for Payer: Cash Price	$636.81
Rate for Payer: Cash Price	$740.86
Rate for Payer: Cofinity Commercial	$557.21
Rate for Payer: Cofinity Commercial	$648.25
Rate for Payer: Cofinity Commercial	$598.91
Rate for Payer: Cofinity Commercial	$735.80
Rate for Payer: Cofinity Commercial	$796.42
Rate for Payer: Cofinity Commercial	$684.57
Rate for Payer: Healthscope Commercial	$770.02
Rate for Payer: Healthscope Commercial	$833.46
Rate for Payer: Healthscope Commercial	$716.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$727.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$787.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$676.61
Rate for Payer: PHP Commercial	$787.16
Rate for Payer: PHP Commercial	$727.24
Rate for Payer: PHP Commercial	$676.61
Rate for Payer: Priority Health Cigna Priority Health	$598.91
Rate for Payer: Priority Health Cigna Priority Health	$557.21
Rate for Payer: Priority Health Cigna Priority Health	$648.25
Rate for Payer: Priority Health SBD	$583.42
Rate for Payer: Priority Health SBD	$501.49
Rate for Payer: Priority Health SBD	$539.02

Know your out-of-pocket cost for care.

All Charges