Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR BALLN ANGIOPLASTY PERC,AORTIC

Professional

Both

$675.00

Service Code	HCPCS 35472
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$270.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50

PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH

Professional

Both

$1,999.00

Service Code	HCPCS 35475
Min. Negotiated Rate	$799.60
Max. Negotiated Rate	$1,399.30
Rate for Payer: BCBS Complete	$799.60
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30

PR BALLN ANGIOPLASTY,PERC VENOUS

Professional

Both

$3,374.00

Service Code	HCPCS 35476
Min. Negotiated Rate	$1,349.60
Max. Negotiated Rate	$2,361.80
Rate for Payer: BCBS Complete	$1,349.60
Rate for Payer: Cash Price	$2,699.20
Rate for Payer: Priority Health Cigna Priority Health	$2,361.80

PR BALLN ANGIOPLASTY PERC,VISCERAL

Professional

Both

$2,801.00

Service Code	HCPCS 35471
Min. Negotiated Rate	$1,120.40
Max. Negotiated Rate	$1,960.70
Rate for Payer: BCBS Complete	$1,120.40
Rate for Payer: Cash Price	$2,240.80
Rate for Payer: Priority Health Cigna Priority Health	$1,960.70

PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS

Professional

Both

$4,825.00

Service Code	HCPCS 61630
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$3,377.50
Rate for Payer: Aetna Commercial	$1,768.28
Rate for Payer: BCBS Complete	$1,930.00
Rate for Payer: BCBS Trust/PPO	$18.49
Rate for Payer: Cash Price	$3,860.00
Rate for Payer: Cash Price	$3,860.00
Rate for Payer: Priority Health Cigna Priority Health	$3,377.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,312.45
Rate for Payer: Priority Health Narrow Network	$2,312.45
Rate for Payer: Priority Health SBD	$2,312.45

PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

Professional

Both

$967.00

Service Code	HCPCS 61640
Min. Negotiated Rate	$73.96
Max. Negotiated Rate	$793.28
Rate for Payer: Aetna Commercial	$633.90
Rate for Payer: BCBS Complete	$386.80
Rate for Payer: BCBS Trust/PPO	$73.96
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$793.28
Rate for Payer: Priority Health Narrow Network	$793.28
Rate for Payer: Priority Health SBD	$793.28

PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

Professional

Both

$1,883.00

Service Code	HCPCS 50706
Min. Negotiated Rate	$111.83
Max. Negotiated Rate	$4,073.19
Rate for Payer: Aetna Commercial	$233.34
Rate for Payer: BCBS Complete	$117.42
Rate for Payer: BCBS Trust/PPO	$4,073.19
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Mclaren Medicaid	$111.83
Rate for Payer: Meridian Medicaid	$117.42
Rate for Payer: Priority Health Choice Medicaid	$111.83
Rate for Payer: Priority Health Cigna Priority Health	$1,318.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.23
Rate for Payer: Priority Health Narrow Network	$284.23
Rate for Payer: Priority Health SBD	$284.23

PR BCG LIVE INTRAVESICAL VAC

Professional

Both

$176.00

Service Code	HCPCS J9031
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$123.20
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$123.20

PR BCN APNEALINK PLUS

Professional

Both

$738.65

Service Code	HCPCS 00119
Hospital Revenue Code	960
Min. Negotiated Rate	$295.46
Max. Negotiated Rate	$517.06
Rate for Payer: BCBS Complete	$295.46
Rate for Payer: Cash Price	$590.92
Rate for Payer: Priority Health Cigna Priority Health	$517.06

PR BCN WATCHPAT

Professional

Both

$547.64

Service Code	HCPCS 00120
Hospital Revenue Code	960
Min. Negotiated Rate	$219.06
Max. Negotiated Rate	$383.35
Rate for Payer: BCBS Complete	$219.06
Rate for Payer: Cash Price	$438.11
Rate for Payer: Priority Health Cigna Priority Health	$383.35

PR BEDSIDE DRAINAGE BAG

Professional

Both

$15.00

Service Code	HCPCS A4357
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$986.86
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$986.86
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.89
Rate for Payer: Priority Health Narrow Network	$8.89
Rate for Payer: Priority Health SBD	$8.89

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$539.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$377.30
Rate for Payer: Aetna Commercial	$39.28
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Priority Health Cigna Priority Health	$377.30

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$176.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$1,450.71
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$1,450.71
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$146.87
Rate for Payer: Priority Health Narrow Network	$146.87
Rate for Payer: Priority Health SBD	$146.87

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$44.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$1,436.98
Rate for Payer: Aetna Commercial	$23.66
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$1,436.98
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.23
Rate for Payer: Priority Health Narrow Network	$27.23
Rate for Payer: Priority Health SBD	$27.23

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$61.00

Service Code	HCPCS 97151
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$1,118.41
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$1,118.41
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.41
Rate for Payer: Priority Health Narrow Network	$37.41
Rate for Payer: Priority Health SBD	$37.41

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$7.02
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$3.84
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00

PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT

Professional

Both

$165.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$184.91
Rate for Payer: Aetna Commercial	$48.12
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: BCBS Trust/PPO	$184.91
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.04
Rate for Payer: Priority Health Narrow Network	$65.04
Rate for Payer: Priority Health SBD	$65.04

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$31.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna Commercial	$29.66
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70

PR BILATERAL GYNECOMASTIA

Professional

Both

$3,200.00

Service Code	HCPCS 00524
Hospital Revenue Code	990
Min. Negotiated Rate	$1,280.00
Max. Negotiated Rate	$2,240.00
Rate for Payer: BCBS Complete	$1,280.00
Rate for Payer: Cash Price	$2,560.00
Rate for Payer: Priority Health Cigna Priority Health	$2,240.00

PR BILATERAL MASTOPEXY

Professional

Both

$3,800.00

Service Code	HCPCS 00525
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00

PR BILATERAL OTOPLASTY

Professional

Both

$3,100.00

Service Code	HCPCS 00533
Hospital Revenue Code	990
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: BCBS Complete	$1,240.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00

PR BILATERAL REDUCTION MAMMOPLASTY

Professional

Both

$3,800.00

Service Code	HCPCS 00526
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00

PR BILATERAL THORACIC ROLL EXCISION

Professional

Both

$2,700.00

Service Code	HCPCS 00543
Hospital Revenue Code	990
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: BCBS Complete	$1,080.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Priority Health Cigna Priority Health	$1,890.00

PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

Professional

Both

$898.00

Service Code	HCPCS 47554
Min. Negotiated Rate	$279.88
Max. Negotiated Rate	$7,499.75
Rate for Payer: Aetna Commercial	$696.48
Rate for Payer: BCBS Complete	$293.87
Rate for Payer: BCBS Trust/PPO	$7,499.75
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Mclaren Medicaid	$279.88
Rate for Payer: Meridian Medicaid	$293.87
Rate for Payer: Priority Health Choice Medicaid	$279.88
Rate for Payer: Priority Health Cigna Priority Health	$628.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$773.19
Rate for Payer: Priority Health Narrow Network	$773.19
Rate for Payer: Priority Health SBD	$773.19

Know your out-of-pocket cost for care.

All Charges