Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4-9 % TBSA

Professional

Both

$5.00

Service Code	HCPCS 01952
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50

PR ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4 % TBSA

Professional

Both

$3.00

Service Code	HCPCS 01951
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10

PR ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY

Professional

Both

$6.00

Service Code	HCPCS 01842
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.20
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$4.20

PR ANES ARTERIES OF KNEE & POPLITEAL AREA NOS

Professional

Both

$8.00

Service Code	HCPCS 01440
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01654
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT

Professional

Both

$10.00

Service Code	HCPCS 01638
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00

PR ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND

Professional

Both

$3.00

Service Code	HCPCS 01830
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10

PR ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS

Professional

Both

$5.00

Service Code	HCPCS 01630
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50

PR ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION

Professional

Both

$15.00

Service Code	HCPCS 01636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50

PR ANES ART KNEE POPLITEAL EXC&GRF/RPR OCCLS/ARYS

Professional

Both

$8.00

Service Code	HCPCS 01444
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANES ART KNEE POPLITEAL TEAEC W/WO PATCH GRAFT

Professional

Both

$8.00

Service Code	HCPCS 01442
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.60
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR ANES ART LOWER LEG W/BYP GRAFT EMBLC DIR/W/CATH

Professional

Both

$6.00

Service Code	HCPCS 01502
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.20
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$4.20

PR ANES ART UPPER LEG W/BYPASS GRAFT FEM ART LIG

Professional

Both

$4.00

Service Code	HCPCS 01272
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

PR ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST

Professional

Both

$5.00

Service Code	HCPCS 01112
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50

PR ANES CARDIAC ELECTROPHYSIOL STDY W/RF ABLATION

Professional

Both

$7.00

Service Code	HCPCS 00537
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR ANES CAST APPLICATION REMOVAL/REPAIR KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01420
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10

PR ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY

Professional

Both

$7.00

Service Code	HCPCS 01920
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR ANES CERVICAL SPINE & CORD W/PATIENT SITTING

Professional

Both

$13.00

Service Code	HCPCS 00604
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.10
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$9.10

PR ANES CESARN DLVR FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$2.00

Service Code	HCPCS 01968
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.40
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.40

PR ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$5.00

Service Code	HCPCS 01969
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50

PR ANES CLOSED HUMRL H/N STRNCLAV JOINT& SHO JOINT

Professional

Both

$4.00

Service Code	HCPCS 01620
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

PR ANES CLOSED PROC UPPER END TIBIA FIBULA/PATELLA

Professional

Both

$3.00

Service Code	HCPCS 01390
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.10
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10

PR ANES CLOSED SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$4.00

Service Code	HCPCS 01160
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

PR ANES COLPTMY VAGNC COLPRPHY INCL BX W/OPN URTL

Professional

Both

$4.00

Service Code	HCPCS 00942
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

PR ANES COMPLETE AMPUTATION PENIS INCL OPEN URTL

Professional

Both

$4.00

Service Code	HCPCS 00932
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.80
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

Know your out-of-pocket cost for care.

All Charges