Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC

Professional

Both

$139.00

Service Code	HCPCS 29125
Min. Negotiated Rate	$25.99
Max. Negotiated Rate	$1,005.88
Rate for Payer: Aetna Commercial	$52.16
Rate for Payer: BCBS Complete	$27.29
Rate for Payer: BCBS Trust/PPO	$1,005.88
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Mclaren Medicaid	$25.99
Rate for Payer: Meridian Medicaid	$27.29
Rate for Payer: Priority Health Choice Medicaid	$25.99
Rate for Payer: Priority Health Cigna Priority Health	$97.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.78
Rate for Payer: Priority Health Narrow Network	$61.78
Rate for Payer: Priority Health SBD	$61.78

PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE

Professional

Both

$228.00

Service Code	HCPCS 29405
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$1,199.24
Rate for Payer: Aetna Commercial	$77.15
Rate for Payer: BCBS Complete	$39.58
Rate for Payer: BCBS Trust/PPO	$1,199.24
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Mclaren Medicaid	$37.70
Rate for Payer: Meridian Medicaid	$39.58
Rate for Payer: Priority Health Choice Medicaid	$37.70
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$88.85
Rate for Payer: Priority Health Narrow Network	$88.85
Rate for Payer: Priority Health SBD	$88.85

PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY

Professional

Both

$266.00

Service Code	HCPCS 29425
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$925.58
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: BCBS Complete	$36.46
Rate for Payer: BCBS Trust/PPO	$925.58
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Mclaren Medicaid	$34.72
Rate for Payer: Meridian Medicaid	$36.46
Rate for Payer: Priority Health Choice Medicaid	$34.72
Rate for Payer: Priority Health Cigna Priority Health	$186.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.22
Rate for Payer: Priority Health Narrow Network	$82.22
Rate for Payer: Priority Health SBD	$82.22

PR APPLICATION SHORT LEG SPLINT CALF FOOT

Professional

Both

$124.00

Service Code	HCPCS 29515
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$1,249.96
Rate for Payer: Aetna Commercial	$64.78
Rate for Payer: BCBS Complete	$33.55
Rate for Payer: BCBS Trust/PPO	$1,249.96
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Mclaren Medicaid	$31.95
Rate for Payer: Meridian Medicaid	$33.55
Rate for Payer: Priority Health Choice Medicaid	$31.95
Rate for Payer: Priority Health Cigna Priority Health	$86.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.06
Rate for Payer: Priority Health Narrow Network	$75.06
Rate for Payer: Priority Health SBD	$75.06

PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP

Professional

Both

$34.00

Service Code	HCPCS 99188
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$413.66
Rate for Payer: Aetna Commercial	$11.43
Rate for Payer: BCBS Complete	$6.49
Rate for Payer: BCBS Trust/PPO	$413.66
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Mclaren Medicaid	$6.18
Rate for Payer: Meridian Medicaid	$6.49
Rate for Payer: Priority Health Choice Medicaid	$6.18
Rate for Payer: Priority Health Cigna Priority Health	$23.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.03
Rate for Payer: Priority Health Narrow Network	$13.03
Rate for Payer: Priority Health SBD	$13.03

PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM

Professional

Both

$1,005.00

Service Code	HCPCS 20690
Min. Negotiated Rate	$384.25
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$796.08
Rate for Payer: BCBS Complete	$403.46
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$804.00
Rate for Payer: Cash Price	$804.00
Rate for Payer: Mclaren Medicaid	$384.25
Rate for Payer: Meridian Medicaid	$403.46
Rate for Payer: Priority Health Choice Medicaid	$384.25
Rate for Payer: Priority Health Cigna Priority Health	$703.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$913.55
Rate for Payer: Priority Health Narrow Network	$913.55
Rate for Payer: Priority Health SBD	$913.55

PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC

Professional

Both

$1,768.00

Service Code	HCPCS 21110
Min. Negotiated Rate	$580.95
Max. Negotiated Rate	$1,237.60
Rate for Payer: Aetna Commercial	$941.72
Rate for Payer: BCBS Complete	$707.20
Rate for Payer: BCBS Trust/PPO	$580.95
Rate for Payer: Cash Price	$1,414.40
Rate for Payer: Cash Price	$1,414.40
Rate for Payer: Priority Health Cigna Priority Health	$1,237.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,099.43
Rate for Payer: Priority Health Narrow Network	$1,099.43
Rate for Payer: Priority Health SBD	$1,099.43

PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT

Professional

Both

$191.00

Service Code	HCPCS 29581
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$1,232.52
Rate for Payer: Aetna Commercial	$36.91
Rate for Payer: BCBS Complete	$17.67
Rate for Payer: BCBS Trust/PPO	$1,232.52
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Mclaren Medicaid	$16.83
Rate for Payer: Meridian Medicaid	$17.67
Rate for Payer: Priority Health Choice Medicaid	$16.83
Rate for Payer: Priority Health Cigna Priority Health	$133.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.34
Rate for Payer: Priority Health Narrow Network	$40.34
Rate for Payer: Priority Health SBD	$40.34

PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM

Professional

Both

$81.00

Service Code	HCPCS 29583
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$56.70
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$56.70

PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING

Professional

Both

$129.00

Service Code	HCPCS 29584
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$1,140.60
Rate for Payer: Aetna Commercial	$21.24
Rate for Payer: BCBS Complete	$10.29
Rate for Payer: BCBS Trust/PPO	$1,140.60
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Mclaren Medicaid	$9.80
Rate for Payer: Meridian Medicaid	$10.29
Rate for Payer: Priority Health Choice Medicaid	$9.80
Rate for Payer: Priority Health Cigna Priority Health	$90.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24.01
Rate for Payer: Priority Health Narrow Network	$24.01
Rate for Payer: Priority Health SBD	$24.01

PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE

Professional

Both

$129.00

Service Code	HCPCS 29582
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$90.30
Rate for Payer: BCBS Complete	$51.60
Rate for Payer: Cash Price	$103.20
Rate for Payer: Priority Health Cigna Priority Health	$90.30

PR APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN

Professional

Both

$30.00

Service Code	HCPCS 97032
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$831.54
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$831.54
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00

PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED

Professional

Both

$25.00

Service Code	HCPCS 97014
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$1,449.66
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$1,449.66
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00

PR APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN

Professional

Both

$46.00

Service Code	HCPCS 97033
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$1,039.69
Rate for Payer: Aetna Commercial	$14.69
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$1,039.69
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00

PR APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN

Professional

Both

$22.00

Service Code	HCPCS 97035
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$1,260.00
Rate for Payer: Aetna Commercial	$10.52
Rate for Payer: BCBS Complete	$8.80
Rate for Payer: BCBS Trust/PPO	$1,260.00
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Priority Health Cigna Priority Health	$15.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00

PR APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM

Professional

Both

$138.00

Service Code	HCPCS 15274
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$96.60
Rate for Payer: Aetna Commercial	$49.31
Rate for Payer: BCBS Complete	$29.53
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Mclaren Medicaid	$28.12
Rate for Payer: Meridian Medicaid	$29.53
Rate for Payer: Priority Health Choice Medicaid	$28.12
Rate for Payer: Priority Health Cigna Priority Health	$96.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$54.67
Rate for Payer: Priority Health Narrow Network	$54.67
Rate for Payer: Priority Health SBD	$54.67

PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM

Professional

Both

$604.00

Service Code	HCPCS 15273
Min. Negotiated Rate	$123.54
Max. Negotiated Rate	$422.80
Rate for Payer: Aetna Commercial	$216.78
Rate for Payer: BCBS Complete	$129.72
Rate for Payer: BCBS Trust/PPO	$383.40
Rate for Payer: Cash Price	$483.20
Rate for Payer: Cash Price	$483.20
Rate for Payer: Mclaren Medicaid	$123.54
Rate for Payer: Meridian Medicaid	$129.72
Rate for Payer: Priority Health Choice Medicaid	$123.54
Rate for Payer: Priority Health Cigna Priority Health	$422.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$238.41
Rate for Payer: Priority Health Narrow Network	$238.41
Rate for Payer: Priority Health SBD	$238.41

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

Professional

Both

$273.00

Service Code	HCPCS 15271
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$1,661.55
Rate for Payer: Aetna Commercial	$91.37
Rate for Payer: BCBS Complete	$55.91
Rate for Payer: BCBS Trust/PPO	$1,661.55
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Mclaren Medicaid	$53.25
Rate for Payer: Meridian Medicaid	$55.91
Rate for Payer: Priority Health Choice Medicaid	$53.25
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$101.52
Rate for Payer: Priority Health Narrow Network	$101.52
Rate for Payer: Priority Health SBD	$101.52

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

Facility

$273.00

Service Code	CPT 15271
Hospital Charge Code	15271
Min. Negotiated Rate	$81.86
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Commercial	$232.05
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Aetna New Business (MI Preferred)	$177.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$1,152.52
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cofinity Commercial	$191.10
Rate for Payer: Cofinity Commercial	$234.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Healthscope Commercial	$245.70
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$232.05
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Commercial	$232.05
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Priority Health SBD	$171.99
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$90.05
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$81.86
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

Professional

Both

$273.00

Service Code	HCPCS 15271
Hospital Charge Code	15271
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$1,661.55
Rate for Payer: Aetna Commercial	$91.37
Rate for Payer: BCBS Complete	$55.91
Rate for Payer: BCBS Trust/PPO	$1,661.55
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Mclaren Medicaid	$53.25
Rate for Payer: Meridian Medicaid	$55.91
Rate for Payer: Priority Health Choice Medicaid	$53.25
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$101.52
Rate for Payer: Priority Health Narrow Network	$101.52
Rate for Payer: Priority Health SBD	$101.52

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

Facility

$273.00

Service Code	CPT 15271
Hospital Charge Code	15271
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$245.70
Rate for Payer: Aetna Commercial	$232.05
Rate for Payer: Aetna New Business (MI Preferred)	$177.45
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cofinity Commercial	$191.10
Rate for Payer: Cofinity Commercial	$234.78
Rate for Payer: Healthscope Commercial	$245.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$232.05
Rate for Payer: PHP Commercial	$232.05
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health SBD	$171.99

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC

Professional

Both

$48.00

Service Code	HCPCS 15272
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$116.11
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: BCBS Complete	$11.18
Rate for Payer: BCBS Trust/PPO	$116.11
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Mclaren Medicaid	$10.65
Rate for Payer: Meridian Medicaid	$11.18
Rate for Payer: Priority Health Choice Medicaid	$10.65
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.14
Rate for Payer: Priority Health Narrow Network	$20.14
Rate for Payer: Priority Health SBD	$20.14

PR ARREST EPIPHYSEAL DISTAL FEMUR

Professional

Both

$1,665.00

Service Code	HCPCS 27475
Min. Negotiated Rate	$430.69
Max. Negotiated Rate	$1,165.50
Rate for Payer: Aetna Commercial	$885.07
Rate for Payer: BCBS Complete	$452.22
Rate for Payer: BCBS Trust/PPO	$925.58
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Mclaren Medicaid	$430.69
Rate for Payer: Meridian Medicaid	$452.22
Rate for Payer: Priority Health Choice Medicaid	$430.69
Rate for Payer: Priority Health Cigna Priority Health	$1,165.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,022.83
Rate for Payer: Priority Health Narrow Network	$1,022.83
Rate for Payer: Priority Health SBD	$1,022.83

PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA

Professional

Both

$1,492.00

Service Code	HCPCS 27732
Min. Negotiated Rate	$296.92
Max. Negotiated Rate	$1,044.40
Rate for Payer: Aetna Commercial	$602.74
Rate for Payer: BCBS Complete	$311.77
Rate for Payer: BCBS Trust/PPO	$512.98
Rate for Payer: Cash Price	$1,193.60
Rate for Payer: Cash Price	$1,193.60
Rate for Payer: Mclaren Medicaid	$296.92
Rate for Payer: Meridian Medicaid	$311.77
Rate for Payer: Priority Health Choice Medicaid	$296.92
Rate for Payer: Priority Health Cigna Priority Health	$1,044.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$703.68
Rate for Payer: Priority Health Narrow Network	$703.68
Rate for Payer: Priority Health SBD	$703.68

PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA

Professional

Both

$1,402.00

Service Code	HCPCS 27730
Min. Negotiated Rate	$341.28
Max. Negotiated Rate	$981.40
Rate for Payer: Aetna Commercial	$784.73
Rate for Payer: BCBS Complete	$402.12
Rate for Payer: BCBS Trust/PPO	$341.28
Rate for Payer: Cash Price	$1,121.60
Rate for Payer: Cash Price	$1,121.60
Rate for Payer: Mclaren Medicaid	$382.97
Rate for Payer: Meridian Medicaid	$402.12
Rate for Payer: Priority Health Choice Medicaid	$382.97
Rate for Payer: Priority Health Cigna Priority Health	$981.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$908.44
Rate for Payer: Priority Health Narrow Network	$908.44
Rate for Payer: Priority Health SBD	$908.44

Know your out-of-pocket cost for care.

All Charges