Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE

Professional

Both

$255.00

Service Code	HCPCS 49082
Min. Negotiated Rate	$46.43
Max. Negotiated Rate	$721.66
Rate for Payer: Aetna Commercial	$97.15
Rate for Payer: BCBS Complete	$48.75
Rate for Payer: BCBS Trust/PPO	$721.66
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Mclaren Medicaid	$46.43
Rate for Payer: Meridian Medicaid	$48.75
Rate for Payer: Priority Health Choice Medicaid	$46.43
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.01
Rate for Payer: Priority Health Narrow Network	$127.01
Rate for Payer: Priority Health SBD	$127.01

PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN

Professional

Both

$859.00

Service Code	HCPCS 93657
Min. Negotiated Rate	$190.85
Max. Negotiated Rate	$3,654.78
Rate for Payer: Aetna Commercial	$570.20
Rate for Payer: BCBS Complete	$200.39
Rate for Payer: BCBS Trust/PPO	$3,654.78
Rate for Payer: Cash Price	$687.20
Rate for Payer: Cash Price	$687.20
Rate for Payer: Mclaren Medicaid	$190.85
Rate for Payer: Meridian Medicaid	$200.39
Rate for Payer: Priority Health Choice Medicaid	$190.85
Rate for Payer: Priority Health Cigna Priority Health	$601.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$428.42
Rate for Payer: Priority Health Narrow Network	$428.42
Rate for Payer: Priority Health SBD	$428.42

PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS

Professional

Both

$3,692.00

Service Code	HCPCS 33256
Min. Negotiated Rate	$1,203.66
Max. Negotiated Rate	$3,001.31
Rate for Payer: Aetna Commercial	$2,606.31
Rate for Payer: BCBS Complete	$1,263.84
Rate for Payer: BCBS Trust/PPO	$1,285.88
Rate for Payer: Cash Price	$2,953.60
Rate for Payer: Cash Price	$2,953.60
Rate for Payer: Mclaren Medicaid	$1,203.66
Rate for Payer: Meridian Medicaid	$1,263.84
Rate for Payer: Priority Health Choice Medicaid	$1,203.66
Rate for Payer: Priority Health Cigna Priority Health	$2,584.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,001.31
Rate for Payer: Priority Health Narrow Network	$3,001.31
Rate for Payer: Priority Health SBD	$3,001.31

PR ABLATION & RECONSTRUCTION ATRIA LIMITED

Professional

Both

$3,293.00

Service Code	HCPCS 33254
Min. Negotiated Rate	$856.47
Max. Negotiated Rate	$2,305.10
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: BCBS Complete	$899.29
Rate for Payer: BCBS Trust/PPO	$1,663.62
Rate for Payer: Cash Price	$2,634.40
Rate for Payer: Cash Price	$2,634.40
Rate for Payer: Mclaren Medicaid	$856.47
Rate for Payer: Meridian Medicaid	$899.29
Rate for Payer: Priority Health Choice Medicaid	$856.47
Rate for Payer: Priority Health Cigna Priority Health	$2,305.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,123.58
Rate for Payer: Priority Health Narrow Network	$2,123.58
Rate for Payer: Priority Health SBD	$2,123.58

PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL

Professional

Both

$546.00

Service Code	HCPCS 30802
Min. Negotiated Rate	$130.36
Max. Negotiated Rate	$724.30
Rate for Payer: Aetna Commercial	$255.96
Rate for Payer: BCBS Complete	$136.88
Rate for Payer: BCBS Trust/PPO	$724.30
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Mclaren Medicaid	$130.36
Rate for Payer: Meridian Medicaid	$136.88
Rate for Payer: Priority Health Choice Medicaid	$130.36
Rate for Payer: Priority Health Cigna Priority Health	$382.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.31
Rate for Payer: Priority Health Narrow Network	$284.31
Rate for Payer: Priority Health SBD	$284.31

PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC

Professional

Both

$365.00

Service Code	HCPCS 30801
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$959.39
Rate for Payer: Aetna Commercial	$190.20
Rate for Payer: BCBS Complete	$102.88
Rate for Payer: BCBS Trust/PPO	$959.39
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Mclaren Medicaid	$97.98
Rate for Payer: Meridian Medicaid	$102.88
Rate for Payer: Priority Health Choice Medicaid	$97.98
Rate for Payer: Priority Health Cigna Priority Health	$255.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.93
Rate for Payer: Priority Health Narrow Network	$213.93
Rate for Payer: Priority Health SBD	$213.93

PR ABRASION 1 LESION

Facility

$433.00

Service Code	CPT 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$79.71
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$368.05
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$281.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$79.71
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cofinity Commercial	$372.38
Rate for Payer: Cofinity Commercial	$303.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$389.70
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$368.05
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$368.05
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$303.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$272.79
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$145.52
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$132.29
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

PR ABRASION 1 LESION

Facility

$433.00

Service Code	CPT 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$272.79
Max. Negotiated Rate	$389.70
Rate for Payer: Aetna Commercial	$368.05
Rate for Payer: Aetna New Business (MI Preferred)	$281.45
Rate for Payer: Cash Price	$346.40
Rate for Payer: Cofinity Commercial	$372.38
Rate for Payer: Cofinity Commercial	$303.10
Rate for Payer: Healthscope Commercial	$389.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$368.05
Rate for Payer: PHP Commercial	$368.05
Rate for Payer: Priority Health Cigna Priority Health	$303.10
Rate for Payer: Priority Health SBD	$272.79

PR ACETABULOPLASTY RESECTION FEMORAL HEAD

Professional

Both

$1,937.00

Service Code	HCPCS 27122
Min. Negotiated Rate	$674.11
Max. Negotiated Rate	$1,687.70
Rate for Payer: Aetna Commercial	$1,473.67
Rate for Payer: BCBS Complete	$744.98
Rate for Payer: BCBS Trust/PPO	$674.11
Rate for Payer: Cash Price	$1,549.60
Rate for Payer: Cash Price	$1,549.60
Rate for Payer: Mclaren Medicaid	$709.50
Rate for Payer: Meridian Medicaid	$744.98
Rate for Payer: Priority Health Choice Medicaid	$709.50
Rate for Payer: Priority Health Cigna Priority Health	$1,355.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,687.70
Rate for Payer: Priority Health Narrow Network	$1,687.70
Rate for Payer: Priority Health SBD	$1,687.70

PR ACNE SURGERY

Professional

Both

$177.00

Service Code	HCPCS 10040
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$123.90
Rate for Payer: Aetna Commercial	$56.49
Rate for Payer: BCBS Complete	$34.67
Rate for Payer: BCBS Trust/PPO	$22.20
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Mclaren Medicaid	$33.02
Rate for Payer: Meridian Medicaid	$34.67
Rate for Payer: Priority Health Choice Medicaid	$33.02
Rate for Payer: Priority Health Cigna Priority Health	$123.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.30
Rate for Payer: Priority Health Narrow Network	$63.30
Rate for Payer: Priority Health SBD	$63.30

PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY

Professional

Both

$57.00

Service Code	HCPCS 92570
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$1,989.05
Rate for Payer: Aetna Commercial	$32.99
Rate for Payer: BCBS Complete	$19.24
Rate for Payer: BCBS Trust/PPO	$1,989.05
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Mclaren Medicaid	$18.32
Rate for Payer: Meridian Medicaid	$19.24
Rate for Payer: Priority Health Choice Medicaid	$18.32
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.62
Rate for Payer: Priority Health Narrow Network	$38.62
Rate for Payer: Priority Health SBD	$38.62

PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R

Professional

Both

$592.00

Service Code	HCPCS 95803
Min. Negotiated Rate	$56.14
Max. Negotiated Rate	$641.88
Rate for Payer: Aetna Commercial	$160.55
Rate for Payer: Aetna Commercial	$160.55
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: BCBS Complete	$236.80
Rate for Payer: BCBS Trust/PPO	$641.88
Rate for Payer: BCBS Trust/PPO	$641.88
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$473.60
Rate for Payer: Cash Price	$473.60
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$62.30
Rate for Payer: Priority Health Cigna Priority Health	$414.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.14
Rate for Payer: Priority Health Narrow Network	$56.14
Rate for Payer: Priority Health Narrow Network	$56.14
Rate for Payer: Priority Health SBD	$186.39
Rate for Payer: Priority Health SBD	$186.39

PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN

Professional

Both

$52.00

Service Code	HCPCS 97155
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$1,401.05
Rate for Payer: Aetna Commercial	$20.80
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Trust/PPO	$1,401.05
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32.84
Rate for Payer: Priority Health Narrow Network	$32.84
Rate for Payer: Priority Health SBD	$32.84

PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA

Professional

Both

$200.00

Service Code	HCPCS 00673
Hospital Revenue Code	990
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

PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA

Professional

Both

$300.00

Service Code	HCPCS 00674
Hospital Revenue Code	990
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

PR ADENOIDECTOMY PRIMARY <AGE 12

Professional

Both

$372.00

Service Code	HCPCS 42830
Min. Negotiated Rate	$138.24
Max. Negotiated Rate	$1,152.22
Rate for Payer: Aetna Commercial	$274.50
Rate for Payer: BCBS Complete	$145.15
Rate for Payer: BCBS Trust/PPO	$1,152.22
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Mclaren Medicaid	$138.24
Rate for Payer: Meridian Medicaid	$145.15
Rate for Payer: Priority Health Choice Medicaid	$138.24
Rate for Payer: Priority Health Cigna Priority Health	$260.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$376.31
Rate for Payer: Priority Health Narrow Network	$376.31
Rate for Payer: Priority Health SBD	$376.31

PR ADENOIDECTOMY PRIMARY AGE 12/>

Professional

Both

$633.00

Service Code	HCPCS 42831
Min. Negotiated Rate	$150.17
Max. Negotiated Rate	$1,232.52
Rate for Payer: Aetna Commercial	$297.97
Rate for Payer: BCBS Complete	$157.68
Rate for Payer: BCBS Trust/PPO	$1,232.52
Rate for Payer: Cash Price	$506.40
Rate for Payer: Cash Price	$506.40
Rate for Payer: Mclaren Medicaid	$150.17
Rate for Payer: Meridian Medicaid	$157.68
Rate for Payer: Priority Health Choice Medicaid	$150.17
Rate for Payer: Priority Health Cigna Priority Health	$443.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$409.81
Rate for Payer: Priority Health Narrow Network	$409.81
Rate for Payer: Priority Health SBD	$409.81

PR ADENOIDECTOMY SECONDARY AGE 12/>

Professional

Both

$595.00

Service Code	HCPCS 42836
Min. Negotiated Rate	$159.11
Max. Negotiated Rate	$975.24
Rate for Payer: Aetna Commercial	$318.51
Rate for Payer: BCBS Complete	$167.07
Rate for Payer: BCBS Trust/PPO	$975.24
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Mclaren Medicaid	$159.11
Rate for Payer: Meridian Medicaid	$167.07
Rate for Payer: Priority Health Choice Medicaid	$159.11
Rate for Payer: Priority Health Cigna Priority Health	$416.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$434.52
Rate for Payer: Priority Health Narrow Network	$434.52
Rate for Payer: Priority Health SBD	$434.52

PR ADENOIDECTOMY SECONDARY<AGE 12

Professional

Both

$503.00

Service Code	HCPCS 42835
Min. Negotiated Rate	$129.08
Max. Negotiated Rate	$1,082.49
Rate for Payer: Aetna Commercial	$254.78
Rate for Payer: BCBS Complete	$135.53
Rate for Payer: BCBS Trust/PPO	$1,082.49
Rate for Payer: Cash Price	$402.40
Rate for Payer: Cash Price	$402.40
Rate for Payer: Mclaren Medicaid	$129.08
Rate for Payer: Meridian Medicaid	$135.53
Rate for Payer: Priority Health Choice Medicaid	$129.08
Rate for Payer: Priority Health Cigna Priority Health	$352.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.62
Rate for Payer: Priority Health Narrow Network	$351.62
Rate for Payer: Priority Health SBD	$351.62

PR ADENOSINE INJ 1MG

Professional

Both

$1.00

Service Code	HCPCS J0153
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna Commercial	$0.62
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$0.28
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.70

PR ADENOSINE INJECTION

Professional

Both

$117.00

Service Code	HCPCS J0152
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$81.90
Rate for Payer: BCBS Complete	$46.80
Rate for Payer: Cash Price	$93.60
Rate for Payer: Priority Health Cigna Priority Health	$81.90

PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<

Professional

Both

$1,020.00

Service Code	HCPCS 14000
Min. Negotiated Rate	$323.76
Max. Negotiated Rate	$979.03
Rate for Payer: Aetna Commercial	$533.56
Rate for Payer: BCBS Complete	$339.95
Rate for Payer: BCBS Trust/PPO	$979.03
Rate for Payer: Cash Price	$816.00
Rate for Payer: Cash Price	$816.00
Rate for Payer: Mclaren Medicaid	$323.76
Rate for Payer: Meridian Medicaid	$339.95
Rate for Payer: Priority Health Choice Medicaid	$323.76
Rate for Payer: Priority Health Cigna Priority Health	$714.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$617.39
Rate for Payer: Priority Health Narrow Network	$617.39
Rate for Payer: Priority Health SBD	$617.39

PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM

Professional

Both

$1,327.00

Service Code	HCPCS 14001
Min. Negotiated Rate	$418.76
Max. Negotiated Rate	$1,002.07
Rate for Payer: Aetna Commercial	$696.49
Rate for Payer: BCBS Complete	$439.70
Rate for Payer: BCBS Trust/PPO	$1,002.07
Rate for Payer: Cash Price	$1,061.60
Rate for Payer: Cash Price	$1,061.60
Rate for Payer: Mclaren Medicaid	$418.76
Rate for Payer: Meridian Medicaid	$439.70
Rate for Payer: Priority Health Choice Medicaid	$418.76
Rate for Payer: Priority Health Cigna Priority Health	$928.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$800.29
Rate for Payer: Priority Health Narrow Network	$800.29
Rate for Payer: Priority Health SBD	$800.29

PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM

Professional

Both

$1,693.00

Service Code	HCPCS 14301
Min. Negotiated Rate	$226.01
Max. Negotiated Rate	$1,185.10
Rate for Payer: Aetna Commercial	$932.47
Rate for Payer: BCBS Complete	$582.61
Rate for Payer: BCBS Trust/PPO	$226.01
Rate for Payer: Cash Price	$1,354.40
Rate for Payer: Cash Price	$1,354.40
Rate for Payer: Mclaren Medicaid	$554.87
Rate for Payer: Meridian Medicaid	$582.61
Rate for Payer: Priority Health Choice Medicaid	$554.87
Rate for Payer: Priority Health Cigna Priority Health	$1,185.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,062.53
Rate for Payer: Priority Health Narrow Network	$1,062.53
Rate for Payer: Priority Health SBD	$1,062.53

PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM

Professional

Both

$1,583.00

Service Code	HCPCS 14041
Min. Negotiated Rate	$486.49
Max. Negotiated Rate	$1,457.41
Rate for Payer: Aetna Commercial	$811.62
Rate for Payer: BCBS Complete	$510.81
Rate for Payer: BCBS Trust/PPO	$1,457.41
Rate for Payer: Cash Price	$1,266.40
Rate for Payer: Cash Price	$1,266.40
Rate for Payer: Mclaren Medicaid	$486.49
Rate for Payer: Meridian Medicaid	$510.81
Rate for Payer: Priority Health Choice Medicaid	$486.49
Rate for Payer: Priority Health Cigna Priority Health	$1,108.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$930.18
Rate for Payer: Priority Health Narrow Network	$930.18
Rate for Payer: Priority Health SBD	$930.18

Know your out-of-pocket cost for care.

All Charges