Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT

Professional

Both

$166.00

Service Code	HCPCS 92653
Min. Negotiated Rate	$66.40
Max. Negotiated Rate	$1,917.20
Rate for Payer: Aetna Commercial	$93.15
Rate for Payer: BCBS Complete	$66.40
Rate for Payer: BCBS Trust/PPO	$1,917.20
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$132.80
Rate for Payer: Priority Health Cigna Priority Health	$116.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.19
Rate for Payer: Priority Health Narrow Network	$113.19
Rate for Payer: Priority Health SBD	$113.19

PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS

Professional

Both

$54.00

Service Code	HCPCS 92650
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$1,517.28
Rate for Payer: Aetna Commercial	$30.47
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS Trust/PPO	$1,517.28
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.28
Rate for Payer: Priority Health Narrow Network	$37.28
Rate for Payer: Priority Health SBD	$37.28

PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R

Professional

Both

$228.00

Service Code	HCPCS 92652
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$4,564.51
Rate for Payer: Aetna Commercial	$127.57
Rate for Payer: BCBS Complete	$91.20
Rate for Payer: BCBS Trust/PPO	$4,564.51
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$151.81
Rate for Payer: Priority Health Narrow Network	$151.81
Rate for Payer: Priority Health SBD	$151.81

PR AFO ANKLE GAUNTLET PRE OTS

Professional

Both

$72.00

Service Code	HCPCS L1902
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna Commercial	$44.96
Rate for Payer: BCBS Complete	$28.80
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Priority Health Cigna Priority Health	$50.40

PR AFO MULTILIG ANK SUP PRE OTS

Professional

Both

$108.00

Service Code	HCPCS L1906
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna Commercial	$67.73
Rate for Payer: BCBS Complete	$43.20
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Priority Health Cigna Priority Health	$75.60

PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE

Professional

Both

$178.26

Service Code	HCPCS 90694
Min. Negotiated Rate	$71.30
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$77.36
Rate for Payer: BCBS Complete	$71.30
Rate for Payer: BCBS Trust/PPO	$77.36
Rate for Payer: Cash Price	$142.61
Rate for Payer: Cash Price	$142.61
Rate for Payer: Priority Health Cigna Priority Health	$124.78

PR AK SLEEVE SUSP NEOPRENE/EQUA

Professional

Both

$156.00

Service Code	HCPCS L5695
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$109.20
Rate for Payer: Aetna Commercial	$97.85
Rate for Payer: BCBS Complete	$62.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Priority Health Cigna Priority Health	$109.20

PR ALBUTEROL IPRATROP NON-COMP

Professional

Both

$2.00

Service Code	HCPCS J7620
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna Commercial	$0.18
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.40

PR ALBUTEROL NON-COMP CON

Professional

Both

$2.00

Service Code	HCPCS J7611
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna Commercial	$0.15
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.40

PR ALBUTEROL NON-COMP UNIT

Professional

Both

$2.00

Service Code	HCPCS J7613
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna Commercial	$0.04
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.40

PR ALCOHOL AND/OR DRUG SERVICES

Professional

Both

$242.00

Service Code	HCPCS H0015
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$169.40
Rate for Payer: Aetna Commercial	$134.33
Rate for Payer: BCBS Complete	$96.80
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Priority Health Cigna Priority Health	$169.40

PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN

Professional

Both

$53.00

Service Code	HCPCS 99408
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$1,099.92
Rate for Payer: Aetna Commercial	$33.63
Rate for Payer: BCBS Complete	$21.02
Rate for Payer: BCBS Trust/PPO	$1,099.92
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Mclaren Medicaid	$20.02
Rate for Payer: Meridian Medicaid	$21.02
Rate for Payer: Priority Health Choice Medicaid	$20.02
Rate for Payer: Priority Health Cigna Priority Health	$37.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.26
Rate for Payer: Priority Health Narrow Network	$40.26
Rate for Payer: Priority Health SBD	$40.26

PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN

Professional

Both

$102.00

Service Code	HCPCS 99409
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$1,109.43
Rate for Payer: Aetna Commercial	$67.61
Rate for Payer: BCBS Complete	$42.04
Rate for Payer: BCBS Trust/PPO	$1,109.43
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Mclaren Medicaid	$40.04
Rate for Payer: Meridian Medicaid	$42.04
Rate for Payer: Priority Health Choice Medicaid	$40.04
Rate for Payer: Priority Health Cigna Priority Health	$71.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.53
Rate for Payer: Priority Health Narrow Network	$80.53
Rate for Payer: Priority Health SBD	$80.53

PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION

Facility

$286.25

Service Code	HCPCS J2730
Hospital Charge Code	151068
Hospital Revenue Code	636
Min. Negotiated Rate	$180.34
Max. Negotiated Rate	$257.62
Rate for Payer: Aetna Commercial	$243.31
Rate for Payer: Aetna New Business (MI Preferred)	$186.06
Rate for Payer: Cash Price	$229.00
Rate for Payer: Cofinity Commercial	$200.38
Rate for Payer: Cofinity Commercial	$246.18
Rate for Payer: Healthscope Commercial	$257.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.31
Rate for Payer: PHP Commercial	$243.31
Rate for Payer: Priority Health Cigna Priority Health	$200.38
Rate for Payer: Priority Health SBD	$180.34

PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION

Facility

$286.25

Service Code	HCPCS J2730
Hospital Charge Code	6462
Hospital Revenue Code	636
Min. Negotiated Rate	$180.34
Max. Negotiated Rate	$257.62
Rate for Payer: Aetna Commercial	$243.31
Rate for Payer: Aetna New Business (MI Preferred)	$186.06
Rate for Payer: Cash Price	$229.00
Rate for Payer: Cofinity Commercial	$200.38
Rate for Payer: Cofinity Commercial	$246.18
Rate for Payer: Healthscope Commercial	$257.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.31
Rate for Payer: PHP Commercial	$243.31
Rate for Payer: Priority Health Cigna Priority Health	$200.38
Rate for Payer: Priority Health SBD	$180.34

PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED

Professional

Both

$479.00

Service Code	HCPCS 20930
Min. Negotiated Rate	$155.86
Max. Negotiated Rate	$11,952.59
Rate for Payer: Aetna Commercial	$155.86
Rate for Payer: BCBS Complete	$191.60
Rate for Payer: BCBS Trust/PPO	$11,952.59
Rate for Payer: Cash Price	$383.20
Rate for Payer: Cash Price	$383.20
Rate for Payer: Priority Health Cigna Priority Health	$335.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.73
Rate for Payer: Priority Health Narrow Network	$178.73
Rate for Payer: Priority Health SBD	$178.73

PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL

Professional

Both

$437.00

Service Code	HCPCS 20931
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$29,358.48
Rate for Payer: Aetna Commercial	$148.79
Rate for Payer: BCBS Complete	$73.80
Rate for Payer: BCBS Trust/PPO	$29,358.48
Rate for Payer: Cash Price	$349.60
Rate for Payer: Cash Price	$349.60
Rate for Payer: Mclaren Medicaid	$70.29
Rate for Payer: Meridian Medicaid	$73.80
Rate for Payer: Priority Health Choice Medicaid	$70.29
Rate for Payer: Priority Health Cigna Priority Health	$305.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$168.01
Rate for Payer: Priority Health Narrow Network	$168.01
Rate for Payer: Priority Health SBD	$168.01

PR ALTEPLASE RECOMBINANT

Professional

Both

$89.00

Service Code	HCPCS J2997
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$91.64
Rate for Payer: Aetna Commercial	$91.64
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: BCBS Trust/PPO	$88.53
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$62.30

PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R

Professional

Both

$252.00

Service Code	HCPCS 93784
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna Commercial	$49.46
Rate for Payer: BCBS Complete	$100.80
Rate for Payer: BCBS Trust/PPO	$37.78
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Priority Health Cigna Priority Health	$176.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.31
Rate for Payer: Priority Health Narrow Network	$64.31
Rate for Payer: Priority Health SBD	$64.31

PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R

Professional

Both

$35.00

Service Code	HCPCS 93790
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$31.84
Rate for Payer: Aetna Commercial	$20.22
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$31.84
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.06
Rate for Payer: Priority Health Narrow Network	$25.06
Rate for Payer: Priority Health SBD	$25.06

PR AMBULATORY EEG MONITORING

Professional

Both

$573.00

Service Code	HCPCS 95950
Min. Negotiated Rate	$229.20
Max. Negotiated Rate	$401.10
Rate for Payer: BCBS Complete	$229.20
Rate for Payer: Cash Price	$458.40
Rate for Payer: Priority Health Cigna Priority Health	$401.10

PR AMINOLEVULINIC ACID HCL TOP

Professional

Both

$174.00

Service Code	HCPCS J7308
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$404.09
Rate for Payer: Aetna Commercial	$404.09
Rate for Payer: BCBS Complete	$69.60
Rate for Payer: BCBS Trust/PPO	$399.72
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Priority Health Cigna Priority Health	$121.80

PRAMIPEXOLE 0.125 MG TABLET

Facility

$217.85

Service Code	NDC 57237-180-90
Hospital Charge Code	21287
Hospital Revenue Code	637
Min. Negotiated Rate	$137.25
Max. Negotiated Rate	$196.06
Rate for Payer: Aetna Commercial	$185.17
Rate for Payer: Aetna New Business (MI Preferred)	$141.60
Rate for Payer: Cash Price	$174.28
Rate for Payer: Cofinity Commercial	$187.35
Rate for Payer: Cofinity Commercial	$152.50
Rate for Payer: Healthscope Commercial	$196.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.17
Rate for Payer: PHP Commercial	$185.17
Rate for Payer: Priority Health Cigna Priority Health	$152.50
Rate for Payer: Priority Health SBD	$137.25

PRAMIPEXOLE 0.125 MG TABLET

Facility

$217.85

Service Code	NDC 68462-330-90
Hospital Charge Code	21287
Hospital Revenue Code	637
Min. Negotiated Rate	$137.25
Max. Negotiated Rate	$196.06
Rate for Payer: Aetna Commercial	$185.17
Rate for Payer: Aetna New Business (MI Preferred)	$141.60
Rate for Payer: Cash Price	$174.28
Rate for Payer: Cofinity Commercial	$152.50
Rate for Payer: Cofinity Commercial	$187.35
Rate for Payer: Healthscope Commercial	$196.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.17
Rate for Payer: PHP Commercial	$185.17
Rate for Payer: Priority Health Cigna Priority Health	$152.50
Rate for Payer: Priority Health SBD	$137.25

PRAMIPEXOLE 0.125 MG TABLET

Facility

$109.98

Service Code	NDC 13668-091-90
Hospital Charge Code	21287
Hospital Revenue Code	637
Min. Negotiated Rate	$69.29
Max. Negotiated Rate	$98.98
Rate for Payer: Aetna Commercial	$93.48
Rate for Payer: Aetna New Business (MI Preferred)	$71.49
Rate for Payer: Cash Price	$87.98
Rate for Payer: Cofinity Commercial	$76.99
Rate for Payer: Cofinity Commercial	$94.58
Rate for Payer: Healthscope Commercial	$98.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.48
Rate for Payer: PHP Commercial	$93.48
Rate for Payer: Priority Health Cigna Priority Health	$76.99
Rate for Payer: Priority Health SBD	$69.29

Know your out-of-pocket cost for care.

All Charges