Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS

Professional

Both

$1,972.94

Service Code	HCPCS 54324
Min. Negotiated Rate	$517.21
Max. Negotiated Rate	$1,540.55
Rate for Payer: Aetna Commercial	$1,242.77
Rate for Payer: BCBS Complete	$645.46
Rate for Payer: BCBS Trust/PPO	$517.21
Rate for Payer: Cash Price	$1,578.35
Rate for Payer: Cash Price	$1,578.35
Rate for Payer: Mclaren Medicaid	$614.72
Rate for Payer: Meridian Medicaid	$645.46
Rate for Payer: Priority Health Choice Medicaid	$614.72
Rate for Payer: Priority Health Cigna Priority Health	$1,381.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,540.55
Rate for Payer: Priority Health Narrow Network	$1,540.55
Rate for Payer: Priority Health SBD	$1,540.55

PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB

Professional

Both

$155.00

Service Code	HCPCS 99460
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$190.72
Rate for Payer: Aetna Commercial	$94.30
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS Trust/PPO	$190.72
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Mclaren Medicaid	$58.58
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$108.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.36
Rate for Payer: Priority Health Narrow Network	$117.36
Rate for Payer: Priority Health SBD	$117.36

PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT

Professional

Both

$169.00

Service Code	HCPCS 99463
Min. Negotiated Rate	$68.37
Max. Negotiated Rate	$1,537.35
Rate for Payer: Aetna Commercial	$108.47
Rate for Payer: BCBS Complete	$71.79
Rate for Payer: BCBS Trust/PPO	$1,537.35
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Mclaren Medicaid	$68.37
Rate for Payer: Meridian Medicaid	$71.79
Rate for Payer: Priority Health Choice Medicaid	$68.37
Rate for Payer: Priority Health Cigna Priority Health	$118.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.92
Rate for Payer: Priority Health Narrow Network	$137.92
Rate for Payer: Priority Health SBD	$137.92

PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES

Professional

Both

$346.00

Service Code	HCPCS 99223
Min. Negotiated Rate	$109.48
Max. Negotiated Rate	$1,363.01
Rate for Payer: Aetna Commercial	$197.06
Rate for Payer: BCBS Complete	$114.95
Rate for Payer: BCBS Trust/PPO	$1,363.01
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cash Price	$276.80
Rate for Payer: Mclaren Medicaid	$109.48
Rate for Payer: Meridian Medicaid	$114.95
Rate for Payer: Priority Health Choice Medicaid	$109.48
Rate for Payer: Priority Health Cigna Priority Health	$242.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$219.73
Rate for Payer: Priority Health Narrow Network	$219.73
Rate for Payer: Priority Health SBD	$219.73

PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES

Professional

Both

$236.00

Service Code	HCPCS 99222
Min. Negotiated Rate	$82.64
Max. Negotiated Rate	$2,113.20
Rate for Payer: Aetna Commercial	$133.90
Rate for Payer: BCBS Complete	$86.77
Rate for Payer: BCBS Trust/PPO	$2,113.20
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Mclaren Medicaid	$82.64
Rate for Payer: Meridian Medicaid	$86.77
Rate for Payer: Priority Health Choice Medicaid	$82.64
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.91
Rate for Payer: Priority Health Narrow Network	$164.91
Rate for Payer: Priority Health SBD	$164.91

PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES

Professional

Both

$174.00

Service Code	HCPCS 99221
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$1,817.88
Rate for Payer: Aetna Commercial	$99.61
Rate for Payer: BCBS Complete	$55.02
Rate for Payer: BCBS Trust/PPO	$1,817.88
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Mclaren Medicaid	$52.40
Rate for Payer: Meridian Medicaid	$55.02
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health	$121.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$105.36
Rate for Payer: Priority Health Narrow Network	$105.36
Rate for Payer: Priority Health SBD	$105.36

PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<

Professional

Both

$1,642.00

Service Code	HCPCS 99468
Min. Negotiated Rate	$127.77
Max. Negotiated Rate	$1,149.40
Rate for Payer: Aetna Commercial	$902.56
Rate for Payer: BCBS Complete	$881.36
Rate for Payer: BCBS Trust/PPO	$127.77
Rate for Payer: Cash Price	$1,313.60
Rate for Payer: Cash Price	$1,313.60
Rate for Payer: Mclaren Medicaid	$839.39
Rate for Payer: Meridian Medicaid	$881.36
Rate for Payer: Priority Health Choice Medicaid	$839.39
Rate for Payer: Priority Health Cigna Priority Health	$1,149.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,131.19
Rate for Payer: Priority Health Narrow Network	$1,131.19
Rate for Payer: Priority Health SBD	$1,131.19

PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS

Professional

Both

$309.00

Service Code	HCPCS 99492
Min. Negotiated Rate	$59.43
Max. Negotiated Rate	$1,323.39
Rate for Payer: Aetna Commercial	$92.57
Rate for Payer: BCBS Complete	$62.40
Rate for Payer: BCBS Trust/PPO	$1,323.39
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Mclaren Medicaid	$59.43
Rate for Payer: Meridian Medicaid	$62.40
Rate for Payer: Priority Health Choice Medicaid	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$216.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$172.40
Rate for Payer: Priority Health Narrow Network	$172.40
Rate for Payer: Priority Health SBD	$172.40

PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS

Professional

Both

$126.00

Service Code	HCPCS 99494
Min. Negotiated Rate	$25.99
Max. Negotiated Rate	$984.75
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: BCBS Complete	$27.29
Rate for Payer: BCBS Trust/PPO	$984.75
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Mclaren Medicaid	$25.99
Rate for Payer: Meridian Medicaid	$27.29
Rate for Payer: Priority Health Choice Medicaid	$25.99
Rate for Payer: Priority Health Cigna Priority Health	$88.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.71
Rate for Payer: Priority Health Narrow Network	$82.71
Rate for Payer: Priority Health SBD	$82.71

PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$274.00

Service Code	HCPCS 90650
Min. Negotiated Rate	$109.60
Max. Negotiated Rate	$191.80
Rate for Payer: Aetna Commercial	$141.25
Rate for Payer: BCBS Complete	$109.60
Rate for Payer: BCBS Trust/PPO	$133.16
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$219.20
Rate for Payer: Priority Health Cigna Priority Health	$191.80

PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$258.00

Service Code	HCPCS 90649
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$180.60
Rate for Payer: Aetna Commercial	$163.24
Rate for Payer: BCBS Complete	$103.20
Rate for Payer: BCBS Trust/PPO	$160.17
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Priority Health Cigna Priority Health	$180.60

PR 5% DEXTROSE IN LAC RINGERS

Professional

Both

$30.00

Service Code	HCPCS J7121
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$7.42
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$1.86
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

PR 9VHPV VACC 2/3 DOSE SCHED IM USE

Professional

Both

$290.00

Service Code	HCPCS 90651
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$293.16
Rate for Payer: Aetna Commercial	$293.16
Rate for Payer: BCBS Complete	$116.00
Rate for Payer: BCBS Trust/PPO	$277.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Priority Health Cigna Priority Health	$203.00

PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH

Professional

Both

$3,860.00

Service Code	HCPCS 34800
Min. Negotiated Rate	$1,544.00
Max. Negotiated Rate	$2,702.00
Rate for Payer: BCBS Complete	$1,544.00
Rate for Payer: Cash Price	$3,088.00
Rate for Payer: Priority Health Cigna Priority Health	$2,702.00

PR AAA REPAIR,MODULR BIFURCATED PROSTH

Professional

Both

$2,505.00

Service Code	HCPCS 34802
Min. Negotiated Rate	$1,002.00
Max. Negotiated Rate	$1,753.50
Rate for Payer: BCBS Complete	$1,002.00
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Priority Health Cigna Priority Health	$1,753.50

PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK

Professional

Both

$2,571.00

Service Code	HCPCS 34803
Min. Negotiated Rate	$1,028.40
Max. Negotiated Rate	$1,799.70
Rate for Payer: BCBS Complete	$1,028.40
Rate for Payer: Cash Price	$2,056.80
Rate for Payer: Priority Health Cigna Priority Health	$1,799.70

PR AAA REPAIR,UNIBODY BIFURCATED PROSTH

Professional

Both

$5,404.00

Service Code	HCPCS 34804
Min. Negotiated Rate	$2,161.60
Max. Negotiated Rate	$3,782.80
Rate for Payer: BCBS Complete	$2,161.60
Rate for Payer: Cash Price	$4,323.20
Rate for Payer: Priority Health Cigna Priority Health	$3,782.80

PR AAA REPR,1ST VESSEL,EXTENSION PROSTH

Professional

Both

$2,645.00

Service Code	HCPCS 34825
Min. Negotiated Rate	$1,058.00
Max. Negotiated Rate	$1,851.50
Rate for Payer: BCBS Complete	$1,058.00
Rate for Payer: Cash Price	$2,116.00
Rate for Payer: Priority Health Cigna Priority Health	$1,851.50

PR AAA REPR,ADD VESSEL,EXTENSION PROSTH

Professional

Both

$427.00

Service Code	HCPCS 34826
Min. Negotiated Rate	$170.80
Max. Negotiated Rate	$298.90
Rate for Payer: BCBS Complete	$170.80
Rate for Payer: Cash Price	$341.60
Rate for Payer: Priority Health Cigna Priority Health	$298.90

PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC

Professional

Both

$474.00

Service Code	HCPCS 38747
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$333.84
Rate for Payer: BCBS Complete	$177.14
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: Cash Price	$379.20
Rate for Payer: Cash Price	$379.20
Rate for Payer: Mclaren Medicaid	$168.70
Rate for Payer: Meridian Medicaid	$177.14
Rate for Payer: Priority Health Choice Medicaid	$168.70
Rate for Payer: Priority Health Cigna Priority Health	$331.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$570.05
Rate for Payer: Priority Health Narrow Network	$570.05
Rate for Payer: Priority Health SBD	$570.05

PR ABDOMINOPLASTY (2HRS)

Professional

Both

$2,600.00

Service Code	HCPCS 00364
Hospital Revenue Code	990
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,820.00
Rate for Payer: BCBS Complete	$1,040.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Priority Health Cigna Priority Health	$1,820.00

PR ABDOMINOPLASTY (3HRS)

Professional

Both

$4,200.00

Service Code	HCPCS 00365
Hospital Revenue Code	990
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,940.00
Rate for Payer: BCBS Complete	$1,680.00
Rate for Payer: Cash Price	$3,360.00
Rate for Payer: Priority Health Cigna Priority Health	$2,940.00

PR ABDOMINOPLASTY W/ BREAST AUGMENT

Professional

Both

$7,300.00

Service Code	HCPCS 00256
Hospital Revenue Code	990
Min. Negotiated Rate	$2,920.00
Max. Negotiated Rate	$5,110.00
Rate for Payer: BCBS Complete	$2,920.00
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Priority Health Cigna Priority Health	$5,110.00

PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL

Professional

Both

$2,576.00

Service Code	HCPCS 51845
Min. Negotiated Rate	$371.69
Max. Negotiated Rate	$3,525.87
Rate for Payer: Aetna Commercial	$747.51
Rate for Payer: BCBS Complete	$390.27
Rate for Payer: BCBS Trust/PPO	$3,525.87
Rate for Payer: Cash Price	$2,060.80
Rate for Payer: Cash Price	$2,060.80
Rate for Payer: Mclaren Medicaid	$371.69
Rate for Payer: Meridian Medicaid	$390.27
Rate for Payer: Priority Health Choice Medicaid	$371.69
Rate for Payer: Priority Health Cigna Priority Health	$1,803.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$930.50
Rate for Payer: Priority Health Narrow Network	$930.50
Rate for Payer: Priority Health SBD	$930.50

PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE

Professional

Both

$466.00

Service Code	HCPCS 49083
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$759.70
Rate for Payer: Aetna Commercial	$141.10
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS Trust/PPO	$759.70
Rate for Payer: Cash Price	$372.80
Rate for Payer: Cash Price	$372.80
Rate for Payer: Mclaren Medicaid	$66.46
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$326.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.45
Rate for Payer: Priority Health Narrow Network	$183.45
Rate for Payer: Priority Health SBD	$183.45

Know your out-of-pocket cost for care.

All Charges