Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS SEGMENT

Facility

$31,275.01

Service Code	CPT 36903
Hospital Revenue Code	360
Min. Negotiated Rate	$300.92
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$5,721.77
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$331.01
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$300.92
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY

Facility

$15,432.16

Service Code	CPT 36902
Hospital Revenue Code	360
Min. Negotiated Rate	$228.88
Max. Negotiated Rate	$15,432.16
Rate for Payer: Aetna Medicare	$5,289.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,357.20
Rate for Payer: Amish Plain Church Group Commercial	$6,357.20
Rate for Payer: BCBS Complete	$2,921.26
Rate for Payer: BCBS MAPPO	$5,085.76
Rate for Payer: BCBS Trust/PPO	$2,068.69
Rate for Payer: BCN Medicare Advantage	$5,085.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,085.76
Rate for Payer: Mclaren Medicaid	$2,781.91
Rate for Payer: Mclaren Medicare	$5,085.76
Rate for Payer: Meridian Medicaid	$2,921.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,340.05
Rate for Payer: MI Amish Medical Board Commercial	$5,848.62
Rate for Payer: PACE Medicare	$4,831.47
Rate for Payer: PACE SWMI	$5,085.76
Rate for Payer: PHP Medicare Advantage	$5,085.76
Rate for Payer: Priority Health Choice Medicaid	$2,781.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,432.16
Rate for Payer: Priority Health Medicare	$5,085.76
Rate for Payer: Priority Health Narrow Network	$12,345.73
Rate for Payer: Railroad Medicare Medicare	$5,085.76
Rate for Payer: UHC All Payor (Choice/PPO)	$251.77
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,085.76
Rate for Payer: UHC Exchange	$228.88
Rate for Payer: UHC Medicare Advantage	$5,238.33
Rate for Payer: VA VA	$5,085.76

IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION

Facility

$110.96

Service Code	NDC 48433-230-15
Hospital Charge Code	108150
Hospital Revenue Code	637
Min. Negotiated Rate	$69.90
Max. Negotiated Rate	$99.86
Rate for Payer: Aetna Commercial	$94.32
Rate for Payer: Aetna New Business (MI Preferred)	$72.12
Rate for Payer: Cash Price	$88.77
Rate for Payer: Cofinity Commercial	$77.67
Rate for Payer: Cofinity Commercial	$95.43
Rate for Payer: Healthscope Commercial	$99.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.32
Rate for Payer: PHP Commercial	$94.32
Rate for Payer: Priority Health Cigna Priority Health	$77.67
Rate for Payer: Priority Health SBD	$69.90

IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION

Facility

$61.88

Service Code	HCPCS Q9966
Hospital Charge Code	10325
Hospital Revenue Code	636
Min. Negotiated Rate	$38.98
Max. Negotiated Rate	$55.69
Rate for Payer: Aetna Commercial	$52.60
Rate for Payer: Aetna New Business (MI Preferred)	$40.22
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cofinity Commercial	$43.32
Rate for Payer: Cofinity Commercial	$53.22
Rate for Payer: Healthscope Commercial	$55.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.60
Rate for Payer: PHP Commercial	$52.60
Rate for Payer: Priority Health Cigna Priority Health	$43.32
Rate for Payer: Priority Health SBD	$38.98

IOPAMIDOL 250 MG IODINE/ML (51 %) INTRAVENOUS SOLUTION

Facility

$4.85

Service Code	HCPCS Q9966
Hospital Charge Code	10326
Hospital Revenue Code	636
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Commercial	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Healthscope Commercial	$4.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.12
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health Cigna Priority Health	$3.40
Rate for Payer: Priority Health SBD	$3.06

IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION

Facility

$72.90

Service Code	HCPCS Q9967
Hospital Charge Code	10327
Hospital Revenue Code	636
Min. Negotiated Rate	$45.93
Max. Negotiated Rate	$65.61
Rate for Payer: Aetna Commercial	$61.96
Rate for Payer: Aetna New Business (MI Preferred)	$47.38
Rate for Payer: Cash Price	$58.32
Rate for Payer: Cofinity Commercial	$51.03
Rate for Payer: Cofinity Commercial	$62.69
Rate for Payer: Healthscope Commercial	$65.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.96
Rate for Payer: PHP Commercial	$61.96
Rate for Payer: Priority Health Cigna Priority Health	$51.03
Rate for Payer: Priority Health SBD	$45.93

IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION

Facility

$42.00

Service Code	HCPCS Q9967
Hospital Charge Code	27737
Hospital Revenue Code	636
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$29.40
Rate for Payer: Priority Health SBD	$26.46

IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION

Facility

$140.00

Service Code	HCPCS Q9967
Hospital Charge Code	10328
Hospital Revenue Code	636
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$98.00
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.00
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: Priority Health Cigna Priority Health	$98.00
Rate for Payer: Priority Health SBD	$88.20

IOPAMIDOL 61 % ORAL SOLUTION

Facility

$11.20

Service Code	HCPCS Q9967
Hospital Charge Code	180462
Hospital Revenue Code	636
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna Commercial	$9.52
Rate for Payer: Aetna New Business (MI Preferred)	$7.28
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cofinity Commercial	$7.84
Rate for Payer: Cofinity Commercial	$9.63
Rate for Payer: Healthscope Commercial	$10.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9.52
Rate for Payer: PHP Commercial	$9.52
Rate for Payer: Priority Health Cigna Priority Health	$7.84
Rate for Payer: Priority Health SBD	$7.06

IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION

Facility

$88,737.69

Service Code	HCPCS J9228
Hospital Charge Code	152408
Hospital Revenue Code	636
Min. Negotiated Rate	$94.31
Max. Negotiated Rate	$79,863.92
Rate for Payer: Aetna Commercial	$75,427.04
Rate for Payer: Aetna Medicare	$179.32
Rate for Payer: Aetna New Business (MI Preferred)	$57,679.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$215.52
Rate for Payer: Amish Plain Church Group Commercial	$215.52
Rate for Payer: BCBS Complete	$99.04
Rate for Payer: BCBS MAPPO	$172.42
Rate for Payer: BCBS Trust/PPO	$510.44
Rate for Payer: BCN Medicare Advantage	$172.42
Rate for Payer: Cash Price	$70,990.15
Rate for Payer: Cash Price	$70,990.15
Rate for Payer: Cofinity Commercial	$76,314.41
Rate for Payer: Cofinity Commercial	$62,116.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$172.42
Rate for Payer: Healthscope Commercial	$79,863.92
Rate for Payer: Mclaren Medicaid	$94.31
Rate for Payer: Mclaren Medicare	$172.42
Rate for Payer: Meridian Medicaid	$99.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$181.04
Rate for Payer: MI Amish Medical Board Commercial	$198.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$75,427.04
Rate for Payer: PACE Medicare	$163.80
Rate for Payer: PACE SWMI	$172.42
Rate for Payer: PHP Commercial	$75,427.04
Rate for Payer: PHP Medicare Advantage	$172.42
Rate for Payer: Priority Health Choice Medicaid	$94.31
Rate for Payer: Priority Health Cigna Priority Health	$62,116.38
Rate for Payer: Priority Health Medicare	$172.42
Rate for Payer: Priority Health SBD	$55,904.74
Rate for Payer: Railroad Medicare Medicare	$172.42
Rate for Payer: UHC Dual Complete DSNP	$172.42
Rate for Payer: UHC Medicare Advantage	$177.59
Rate for Payer: VA VA	$172.42

IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION

Facility

$22,184.48

Service Code	HCPCS J9228
Hospital Charge Code	152407
Hospital Revenue Code	636
Min. Negotiated Rate	$94.31
Max. Negotiated Rate	$19,966.03
Rate for Payer: Aetna Commercial	$18,856.81
Rate for Payer: Aetna Medicare	$179.32
Rate for Payer: Aetna New Business (MI Preferred)	$14,419.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$215.52
Rate for Payer: Amish Plain Church Group Commercial	$215.52
Rate for Payer: BCBS Complete	$99.04
Rate for Payer: BCBS MAPPO	$172.42
Rate for Payer: BCBS Trust/PPO	$510.44
Rate for Payer: BCN Medicare Advantage	$172.42
Rate for Payer: Cash Price	$17,747.58
Rate for Payer: Cash Price	$17,747.58
Rate for Payer: Cofinity Commercial	$15,529.14
Rate for Payer: Cofinity Commercial	$19,078.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$172.42
Rate for Payer: Healthscope Commercial	$19,966.03
Rate for Payer: Mclaren Medicaid	$94.31
Rate for Payer: Mclaren Medicare	$172.42
Rate for Payer: Meridian Medicaid	$99.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$181.04
Rate for Payer: MI Amish Medical Board Commercial	$198.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18,856.81
Rate for Payer: PACE Medicare	$163.80
Rate for Payer: PACE SWMI	$172.42
Rate for Payer: PHP Commercial	$18,856.81
Rate for Payer: PHP Medicare Advantage	$172.42
Rate for Payer: Priority Health Choice Medicaid	$94.31
Rate for Payer: Priority Health Cigna Priority Health	$15,529.14
Rate for Payer: Priority Health Medicare	$172.42
Rate for Payer: Priority Health SBD	$13,976.22
Rate for Payer: Railroad Medicare Medicare	$172.42
Rate for Payer: UHC Dual Complete DSNP	$172.42
Rate for Payer: UHC Medicare Advantage	$177.59
Rate for Payer: VA VA	$172.42

IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION

Facility

$22,184.48

Service Code	HCPCS J9228
Hospital Charge Code	152407
Hospital Revenue Code	636
Min. Negotiated Rate	$13,976.22
Max. Negotiated Rate	$19,966.03
Rate for Payer: Aetna Commercial	$18,856.81
Rate for Payer: Aetna New Business (MI Preferred)	$14,419.91
Rate for Payer: Cash Price	$17,747.58
Rate for Payer: Cofinity Commercial	$15,529.14
Rate for Payer: Cofinity Commercial	$19,078.65
Rate for Payer: Healthscope Commercial	$19,966.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18,856.81
Rate for Payer: PHP Commercial	$18,856.81
Rate for Payer: Priority Health Cigna Priority Health	$15,529.14
Rate for Payer: Priority Health SBD	$13,976.22

IPL CHEEKS FIRST

Professional

Both

$125.00

Service Code	HCPCS 00126
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

IPL CHEST FIRST

Professional

Both

$300.00

Service Code	HCPCS 00128
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

IPL CHEST SECOND

Professional

Both

$200.00

Service Code	HCPCS 00129
Hospital Revenue Code	960
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

IPL FACE FIRST

Professional

Both

$225.00

Service Code	HCPCS 00130
Hospital Revenue Code	960
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$157.50
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Priority Health Cigna Priority Health	$157.50

IPL FACE, NECK, CHEST FIRST

Professional

Both

$400.00

Service Code	HCPCS 00132
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

IPL FACE, NECK, CHEST SECOND

Professional

Both

$275.00

Service Code	HCPCS 00133
Hospital Revenue Code	960
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$192.50
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50

IPL FACE & NECK FIRST

Professional

Both

$250.00

Service Code	HCPCS 00134
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

IPL FACE & NECK SECOND

Professional

Both

$175.00

Service Code	HCPCS 00135
Hospital Revenue Code	960
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$122.50
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Priority Health Cigna Priority Health	$122.50

IPL FACE SECOND

Professional

Both

$100.00

Service Code	HCPCS 00131
Hospital Revenue Code	960
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$70.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00

IPL HANDS & ARMS FIRST

Professional

Both

$350.00

Service Code	HCPCS 00136
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

IPL HANDS & ARMS SECOND

Professional

Both

$225.00

Service Code	HCPCS 00137
Hospital Revenue Code	960
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$157.50
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Priority Health Cigna Priority Health	$157.50

IPL NECK

Professional

Both

$100.00

Service Code	HCPCS 00138
Hospital Revenue Code	960
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$70.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00

IPL NOSE & CHEEKS FIRST

Professional

Both

$150.00

Service Code	HCPCS 00127
Hospital Revenue Code	960
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

Know your out-of-pocket cost for care.

All Charges