Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PRAMIPEXOLE 0.25 MG TABLET

Facility

$217.85

Service Code	NDC 68462-331-90
Hospital Charge Code	21290
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 0.25 MG TABLET

Facility

$432.40

Service Code	NDC 0904-6704-61
Hospital Charge Code	21290
Hospital Revenue Code	637
Min. Negotiated Rate	$272.41
Max. Negotiated Rate	$389.16
Rate for Payer: Aetna Commercial	$367.54
Rate for Payer: Aetna New Business (MI Preferred)	$281.06
Rate for Payer: Cash Price	$345.92
Rate for Payer: Cofinity Commercial	$302.68
Rate for Payer: Cofinity Commercial	$371.86
Rate for Payer: Healthscope Commercial	$389.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$367.54
Rate for Payer: PHP Commercial	$367.54
Rate for Payer: Priority Health Cigna Priority Health	$302.68
Rate for Payer: Priority Health SBD	$272.41

PRAMIPEXOLE 0.5 MG TABLET

Facility

$2.99

Service Code	NDC 60687-581-11
Hospital Charge Code	22719
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna New Business (MI Preferred)	$1.94
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Healthscope Commercial	$2.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.54
Rate for Payer: PHP Commercial	$2.54
Rate for Payer: Priority Health Cigna Priority Health	$2.09
Rate for Payer: Priority Health SBD	$1.88

PRAMIPEXOLE 0.5 MG TABLET

Facility

$103.64

Service Code	NDC 13668-093-90
Hospital Charge Code	22719
Hospital Revenue Code	637
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$93.28
Rate for Payer: Aetna Commercial	$88.09
Rate for Payer: Aetna New Business (MI Preferred)	$67.37
Rate for Payer: Cash Price	$82.91
Rate for Payer: Cofinity Commercial	$72.55
Rate for Payer: Cofinity Commercial	$89.13
Rate for Payer: Healthscope Commercial	$93.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.09
Rate for Payer: PHP Commercial	$88.09
Rate for Payer: Priority Health Cigna Priority Health	$72.55
Rate for Payer: Priority Health SBD	$65.29

PRAMIPEXOLE 0.5 MG TABLET

Facility

$89.57

Service Code	NDC 60687-581-21
Hospital Charge Code	22719
Hospital Revenue Code	637
Min. Negotiated Rate	$56.43
Max. Negotiated Rate	$80.61
Rate for Payer: Aetna Commercial	$76.13
Rate for Payer: Aetna New Business (MI Preferred)	$58.22
Rate for Payer: Cash Price	$71.66
Rate for Payer: Cofinity Commercial	$62.70
Rate for Payer: Cofinity Commercial	$77.03
Rate for Payer: Healthscope Commercial	$80.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.13
Rate for Payer: PHP Commercial	$76.13
Rate for Payer: Priority Health Cigna Priority Health	$62.70
Rate for Payer: Priority Health SBD	$56.43

PRAMIPEXOLE 0.5 MG TABLET

Facility

$217.85

Service Code	NDC 68462-332-90
Hospital Charge Code	22719
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

PR AMNIOCENTESIS DIAGNOSIC

Professional

Both

$235.00

Service Code	HCPCS 59000
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$570.04
Rate for Payer: Aetna Commercial	$86.80
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCBS Trust/PPO	$570.04
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Mclaren Medicaid	$51.76
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health	$164.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.32
Rate for Payer: Priority Health Narrow Network	$113.32
Rate for Payer: Priority Health SBD	$113.32

PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID

Professional

Both

$410.00

Service Code	HCPCS 59001
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$523.55
Rate for Payer: Aetna Commercial	$194.91
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCBS Trust/PPO	$523.55
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Priority Health Choice Medicaid	$113.96
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$251.20
Rate for Payer: Priority Health Narrow Network	$251.20
Rate for Payer: Priority Health SBD	$251.20

PRAMOXINE 1 % TOPICAL FOAM

Facility

$133.41

Service Code	NDC 51862-180-15
Hospital Charge Code	19749
Hospital Revenue Code	637
Min. Negotiated Rate	$84.05
Max. Negotiated Rate	$120.07
Rate for Payer: Aetna Commercial	$113.40
Rate for Payer: Aetna New Business (MI Preferred)	$86.72
Rate for Payer: Cash Price	$106.73
Rate for Payer: Cofinity Commercial	$114.73
Rate for Payer: Cofinity Commercial	$93.39
Rate for Payer: Healthscope Commercial	$120.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.40
Rate for Payer: PHP Commercial	$113.40
Rate for Payer: Priority Health Cigna Priority Health	$93.39
Rate for Payer: Priority Health SBD	$84.05

PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ

Professional

Both

$1,560.00

Service Code	HCPCS 24925
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$1,092.00
Rate for Payer: Aetna Commercial	$758.37
Rate for Payer: BCBS Complete	$389.60
Rate for Payer: BCBS Trust/PPO	$140.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Mclaren Medicaid	$371.05
Rate for Payer: Meridian Medicaid	$389.60
Rate for Payer: Priority Health Choice Medicaid	$371.05
Rate for Payer: Priority Health Cigna Priority Health	$1,092.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$880.86
Rate for Payer: Priority Health Narrow Network	$880.86
Rate for Payer: Priority Health SBD	$880.86

PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE

Professional

Both

$1,584.00

Service Code	HCPCS 25907
Min. Negotiated Rate	$206.57
Max. Negotiated Rate	$1,108.80
Rate for Payer: Aetna Commercial	$820.99
Rate for Payer: BCBS Complete	$420.24
Rate for Payer: BCBS Trust/PPO	$206.57
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Mclaren Medicaid	$400.23
Rate for Payer: Meridian Medicaid	$420.24
Rate for Payer: Priority Health Choice Medicaid	$400.23
Rate for Payer: Priority Health Cigna Priority Health	$1,108.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$949.29
Rate for Payer: Priority Health Narrow Network	$949.29
Rate for Payer: Priority Health SBD	$949.29

PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR

Professional

Both

$1,882.00

Service Code	HCPCS 25905
Min. Negotiated Rate	$173.28
Max. Negotiated Rate	$1,317.40
Rate for Payer: Aetna Commercial	$938.09
Rate for Payer: BCBS Complete	$478.16
Rate for Payer: BCBS Trust/PPO	$173.28
Rate for Payer: Cash Price	$1,505.60
Rate for Payer: Cash Price	$1,505.60
Rate for Payer: Mclaren Medicaid	$455.39
Rate for Payer: Meridian Medicaid	$478.16
Rate for Payer: Priority Health Choice Medicaid	$455.39
Rate for Payer: Priority Health Cigna Priority Health	$1,317.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,081.56
Rate for Payer: Priority Health Narrow Network	$1,081.56
Rate for Payer: Priority Health SBD	$1,081.56

PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION

Professional

Both

$1,213.00

Service Code	HCPCS 25909
Min. Negotiated Rate	$304.30
Max. Negotiated Rate	$1,057.55
Rate for Payer: Aetna Commercial	$915.24
Rate for Payer: BCBS Complete	$466.76
Rate for Payer: BCBS Trust/PPO	$304.30
Rate for Payer: Cash Price	$970.40
Rate for Payer: Cash Price	$970.40
Rate for Payer: Mclaren Medicaid	$444.53
Rate for Payer: Meridian Medicaid	$466.76
Rate for Payer: Priority Health Choice Medicaid	$444.53
Rate for Payer: Priority Health Cigna Priority Health	$849.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,057.55
Rate for Payer: Priority Health Narrow Network	$1,057.55
Rate for Payer: Priority Health SBD	$1,057.55

PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP

Professional

Both

$2,157.00

Service Code	HCPCS 26952
Min. Negotiated Rate	$285.28
Max. Negotiated Rate	$1,509.90
Rate for Payer: Aetna Commercial	$900.77
Rate for Payer: BCBS Complete	$465.19
Rate for Payer: BCBS Trust/PPO	$285.28
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Mclaren Medicaid	$443.04
Rate for Payer: Meridian Medicaid	$465.19
Rate for Payer: Priority Health Choice Medicaid	$443.04
Rate for Payer: Priority Health Cigna Priority Health	$1,509.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,064.20
Rate for Payer: Priority Health Narrow Network	$1,064.20
Rate for Payer: Priority Health SBD	$1,064.20

PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR

Professional

Both

$1,618.00

Service Code	HCPCS 26951
Min. Negotiated Rate	$455.82
Max. Negotiated Rate	$4,383.83
Rate for Payer: Aetna Commercial	$916.42
Rate for Payer: BCBS Complete	$478.61
Rate for Payer: BCBS Trust/PPO	$4,383.83
Rate for Payer: Cash Price	$1,294.40
Rate for Payer: Cash Price	$1,294.40
Rate for Payer: Mclaren Medicaid	$455.82
Rate for Payer: Meridian Medicaid	$478.61
Rate for Payer: Priority Health Choice Medicaid	$455.82
Rate for Payer: Priority Health Cigna Priority Health	$1,132.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,089.21
Rate for Payer: Priority Health Narrow Network	$1,089.21
Rate for Payer: Priority Health SBD	$1,089.21

PR AMPICILLIN 500 MG INJ

Professional

Both

$20.00

Service Code	HCPCS J0290
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$1.04
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$0.17
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION

Professional

Both

$1,954.00

Service Code	HCPCS 27886
Min. Negotiated Rate	$414.71
Max. Negotiated Rate	$1,367.80
Rate for Payer: Aetna Commercial	$873.61
Rate for Payer: BCBS Complete	$435.45
Rate for Payer: BCBS Trust/PPO	$527.77
Rate for Payer: Cash Price	$1,563.20
Rate for Payer: Cash Price	$1,563.20
Rate for Payer: Mclaren Medicaid	$414.71
Rate for Payer: Meridian Medicaid	$435.45
Rate for Payer: Priority Health Choice Medicaid	$414.71
Rate for Payer: Priority Health Cigna Priority Health	$1,367.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$987.09
Rate for Payer: Priority Health Narrow Network	$987.09
Rate for Payer: Priority Health SBD	$987.09

PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV

Professional

Both

$1,687.00

Service Code	HCPCS 27884
Min. Negotiated Rate	$370.41
Max. Negotiated Rate	$1,180.90
Rate for Payer: Aetna Commercial	$767.81
Rate for Payer: BCBS Complete	$388.93
Rate for Payer: BCBS Trust/PPO	$405.73
Rate for Payer: Cash Price	$1,349.60
Rate for Payer: Cash Price	$1,349.60
Rate for Payer: Mclaren Medicaid	$370.41
Rate for Payer: Meridian Medicaid	$388.93
Rate for Payer: Priority Health Choice Medicaid	$370.41
Rate for Payer: Priority Health Cigna Priority Health	$1,180.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$881.38
Rate for Payer: Priority Health Narrow Network	$881.38
Rate for Payer: Priority Health SBD	$881.38

PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER

Professional

Both

$2,426.00

Service Code	HCPCS 26910
Min. Negotiated Rate	$493.10
Max. Negotiated Rate	$2,869.73
Rate for Payer: Aetna Commercial	$1,007.60
Rate for Payer: BCBS Complete	$517.76
Rate for Payer: BCBS Trust/PPO	$2,869.73
Rate for Payer: Cash Price	$1,940.80
Rate for Payer: Cash Price	$1,940.80
Rate for Payer: Mclaren Medicaid	$493.10
Rate for Payer: Meridian Medicaid	$517.76
Rate for Payer: Priority Health Choice Medicaid	$493.10
Rate for Payer: Priority Health Cigna Priority Health	$1,698.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,184.70
Rate for Payer: Priority Health Narrow Network	$1,184.70
Rate for Payer: Priority Health SBD	$1,184.70

PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION

Professional

Both

$1,090.00

Service Code	HCPCS 27594
Min. Negotiated Rate	$324.19
Max. Negotiated Rate	$977.88
Rate for Payer: Aetna Commercial	$678.16
Rate for Payer: BCBS Complete	$340.40
Rate for Payer: BCBS Trust/PPO	$977.88
Rate for Payer: Cash Price	$872.00
Rate for Payer: Cash Price	$872.00
Rate for Payer: Mclaren Medicaid	$324.19
Rate for Payer: Meridian Medicaid	$340.40
Rate for Payer: Priority Health Choice Medicaid	$324.19
Rate for Payer: Priority Health Cigna Priority Health	$763.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$768.52
Rate for Payer: Priority Health Narrow Network	$768.52
Rate for Payer: Priority Health SBD	$768.52

PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR

Professional

Both

$1,238.00

Service Code	HCPCS 24920
Min. Negotiated Rate	$407.32
Max. Negotiated Rate	$1,129.05
Rate for Payer: Aetna Commercial	$978.81
Rate for Payer: BCBS Complete	$498.52
Rate for Payer: BCBS Trust/PPO	$407.32
Rate for Payer: Cash Price	$990.40
Rate for Payer: Cash Price	$990.40
Rate for Payer: Mclaren Medicaid	$474.78
Rate for Payer: Meridian Medicaid	$498.52
Rate for Payer: Priority Health Choice Medicaid	$474.78
Rate for Payer: Priority Health Cigna Priority Health	$866.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,129.05
Rate for Payer: Priority Health Narrow Network	$1,129.05
Rate for Payer: Priority Health SBD	$1,129.05

PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION

Professional

Both

$2,327.00

Service Code	HCPCS 24930
Min. Negotiated Rate	$194.41
Max. Negotiated Rate	$1,628.90
Rate for Payer: Aetna Commercial	$1,034.61
Rate for Payer: BCBS Complete	$525.36
Rate for Payer: BCBS Trust/PPO	$194.41
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Mclaren Medicaid	$500.34
Rate for Payer: Meridian Medicaid	$525.36
Rate for Payer: Priority Health Choice Medicaid	$500.34
Rate for Payer: Priority Health Cigna Priority Health	$1,628.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,189.30
Rate for Payer: Priority Health Narrow Network	$1,189.30
Rate for Payer: Priority Health SBD	$1,189.30

PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE

Professional

Both

$2,268.00

Service Code	HCPCS 24900
Min. Negotiated Rate	$70.79
Max. Negotiated Rate	$1,587.60
Rate for Payer: Aetna Commercial	$983.83
Rate for Payer: BCBS Complete	$502.54
Rate for Payer: BCBS Trust/PPO	$70.79
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Mclaren Medicaid	$478.61
Rate for Payer: Meridian Medicaid	$502.54
Rate for Payer: Priority Health Choice Medicaid	$478.61
Rate for Payer: Priority Health Cigna Priority Health	$1,587.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,133.65
Rate for Payer: Priority Health Narrow Network	$1,133.65
Rate for Payer: Priority Health SBD	$1,133.65

PR AMPUTATION FOOT MIDTARSAL

Professional

Both

$1,601.00

Service Code	HCPCS 28800
Min. Negotiated Rate	$338.24
Max. Negotiated Rate	$1,120.70
Rate for Payer: Aetna Commercial	$707.25
Rate for Payer: BCBS Complete	$355.15
Rate for Payer: BCBS Trust/PPO	$945.13
Rate for Payer: Cash Price	$1,280.80
Rate for Payer: Cash Price	$1,280.80
Rate for Payer: Mclaren Medicaid	$338.24
Rate for Payer: Meridian Medicaid	$355.15
Rate for Payer: Priority Health Choice Medicaid	$338.24
Rate for Payer: Priority Health Cigna Priority Health	$1,120.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$801.72
Rate for Payer: Priority Health Narrow Network	$801.72
Rate for Payer: Priority Health SBD	$801.72

PR AMPUTATION FOOT TRANSMETARSAL

Professional

Both

$1,892.00

Service Code	HCPCS 28805
Min. Negotiated Rate	$450.92
Max. Negotiated Rate	$1,324.40
Rate for Payer: Aetna Commercial	$954.20
Rate for Payer: BCBS Complete	$473.47
Rate for Payer: BCBS Trust/PPO	$1,175.47
Rate for Payer: Cash Price	$1,513.60
Rate for Payer: Cash Price	$1,513.60
Rate for Payer: Mclaren Medicaid	$450.92
Rate for Payer: Meridian Medicaid	$473.47
Rate for Payer: Priority Health Choice Medicaid	$450.92
Rate for Payer: Priority Health Cigna Priority Health	$1,324.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,073.39
Rate for Payer: Priority Health Narrow Network	$1,073.39
Rate for Payer: Priority Health SBD	$1,073.39

Know your out-of-pocket cost for care.

All Charges