Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ANES DIAG ARTHROSCOPIC SHOULDER JOINT PROC NOS

Professional

Both

$4.00

Service Code	HCPCS 01622
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 DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE

Professional

Both

$4.00

Service Code	HCPCS 00635
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 DIRECT CABG W/O PUMP OXYGENATOR

Professional

Both

$25.00

Service Code	HCPCS 00566
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50

PR ANES DIRECT CABG W/PUMP OXYGENATOR

Professional

Both

$18.00

Service Code	HCPCS 00567
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$12.60
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$12.60

PR ANES DX/THER NERVE BLOCK/INJECTION PRONE POS

Professional

Both

$5.00

Service Code	HCPCS 01992
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 DX/THER NRV BLK/NJX OTH/THN PRONE POS

Professional

Both

$3.00

Service Code	HCPCS 01991
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 ESOPH THYRD LARX TRACH & LYMPH NCK BX THYRD

Professional

Both

$3.00

Service Code	HCPCS 00322
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 ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR

Professional

Both

$6.00

Service Code	HCPCS 00320
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 EXTERNAL MIDDLE & INNER EAR W/BX OTOSCOPY

Professional

Both

$4.00

Service Code	HCPCS 00124
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 EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS

Professional

Both

$6.00

Service Code	HCPCS 00860
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 FACIAL BONES/SKULL RAD SURG W/PROGNATHISM

Professional

Both

$7.00

Service Code	HCPCS 00192
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 FOREARM WRIST/HAND CAST APPL RMVL/REPAIR

Professional

Both

$3.00

Service Code	HCPCS 01860
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 HEART TRANSPLANT/HEART/LUNG TRANSPLANT

Professional

Both

$20.00

Service Code	HCPCS 00580
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR ANES HERNIA REPAIR LOWER ABDOMEN NOS & 1YR AGE

Professional

Both

$5.00

Service Code	HCPCS 00834
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 HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE

Professional

Both

$7.00

Service Code	HCPCS 00754
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 HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA

Professional

Both

$7.00

Service Code	HCPCS 00756
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 HRNA RPR LWR ABD NOS INFTS <37WK BRTH/50WK

Professional

Both

$6.00

Service Code	HCPCS 00836
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 HRNA RPR UPR ABD LMBR&VENTRAL HERNIA&DEHISC

Professional

Both

$6.00

Service Code	HCPCS 00752
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 HRT PERICARDIAL SAC& GRT VESLS W/O PMP OXT

Professional

Both

$15.00

Service Code	HCPCS 00560
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 HRT PERICARD SAC&GREAT VSLS W/PMP OXTJ <1YR

Professional

Both

$25.00

Service Code	HCPCS 00561
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50

PR ANES HRT PERICRD SAC&GRT VSLS W/PMP OXTJ >1MO PO

Professional

Both

$20.00

Service Code	HCPCS 00562
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR ANES HRT PRCRD SAC & GREAT VSL W/PUMP OXTJ HYPTH

Professional

Both

$25.00

Service Code	HCPCS 00563
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50

PR ANES HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY W/BX

Professional

Both

$4.00

Service Code	HCPCS 00952
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 ICRA ICAR/AORTIC THER IVNTL RAD ARTL

Professional

Both

$8.00

Service Code	HCPCS 01926
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 INSJ PENILE PROSTH PRNL INCL OPEN URTL

Professional

Both

$4.00

Service Code	HCPCS 00938
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