Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN

Professional

Both

$900.00

Service Code	HCPCS 15823
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$672.45
Rate for Payer: Aetna Commercial	$584.27
Rate for Payer: BCBS Complete	$369.47
Rate for Payer: BCBS Trust/PPO	$46.61
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Mclaren Medicaid	$351.88
Rate for Payer: Meridian Medicaid	$369.47
Rate for Payer: Priority Health Choice Medicaid	$351.88
Rate for Payer: Priority Health Cigna Priority Health	$630.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$672.45
Rate for Payer: Priority Health Narrow Network	$672.45
Rate for Payer: Priority Health SBD	$672.45

PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID

Professional

Both

$434.00

Service Code	HCPCS 67700
Min. Negotiated Rate	$73.91
Max. Negotiated Rate	$498.19
Rate for Payer: Aetna Commercial	$149.98
Rate for Payer: BCBS Complete	$77.61
Rate for Payer: BCBS Trust/PPO	$498.19
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$347.20
Rate for Payer: Mclaren Medicaid	$73.91
Rate for Payer: Meridian Medicaid	$77.61
Rate for Payer: Priority Health Choice Medicaid	$73.91
Rate for Payer: Priority Health Cigna Priority Health	$303.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$200.79
Rate for Payer: Priority Health Narrow Network	$200.79
Rate for Payer: Priority Health SBD	$200.79

PR BLUE TIDAL

Professional

Both

$60.00

Service Code	HCPCS 00072
Hospital Revenue Code	990
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00

PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE

Professional

Both

$1,228.00

Service Code	HCPCS 20902
Min. Negotiated Rate	$175.09
Max. Negotiated Rate	$859.60
Rate for Payer: Aetna Commercial	$373.38
Rate for Payer: BCBS Complete	$183.84
Rate for Payer: BCBS Trust/PPO	$580.95
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cash Price	$982.40
Rate for Payer: Mclaren Medicaid	$175.09
Rate for Payer: Meridian Medicaid	$183.84
Rate for Payer: Priority Health Choice Medicaid	$175.09
Rate for Payer: Priority Health Cigna Priority Health	$859.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$418.74
Rate for Payer: Priority Health Narrow Network	$418.74
Rate for Payer: Priority Health SBD	$418.74

PR BONE GRAFT ANY DONOR AREA MINOR/SMALL

Professional

Both

$891.00

Service Code	HCPCS 20900
Min. Negotiated Rate	$114.81
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna Commercial	$244.23
Rate for Payer: BCBS Complete	$120.55
Rate for Payer: BCBS Trust/PPO	$580.95
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cash Price	$712.80
Rate for Payer: Mclaren Medicaid	$114.81
Rate for Payer: Meridian Medicaid	$120.55
Rate for Payer: Priority Health Choice Medicaid	$114.81
Rate for Payer: Priority Health Cigna Priority Health	$623.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$275.75
Rate for Payer: Priority Health Narrow Network	$275.75
Rate for Payer: Priority Health SBD	$275.75

PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR

Professional

Both

$4,498.00

Service Code	HCPCS 20962
Min. Negotiated Rate	$1,706.77
Max. Negotiated Rate	$4,061.20
Rate for Payer: Aetna Commercial	$3,549.97
Rate for Payer: BCBS Complete	$1,792.11
Rate for Payer: BCBS Trust/PPO	$3,247.68
Rate for Payer: Cash Price	$3,598.40
Rate for Payer: Cash Price	$3,598.40
Rate for Payer: Mclaren Medicaid	$1,706.77
Rate for Payer: Meridian Medicaid	$1,792.11
Rate for Payer: Priority Health Choice Medicaid	$1,706.77
Rate for Payer: Priority Health Cigna Priority Health	$3,148.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,061.20
Rate for Payer: Priority Health Narrow Network	$4,061.20
Rate for Payer: Priority Health SBD	$4,061.20

PR BOTOX UNIT

Professional

Both

$13.00

Service Code	HCPCS 00084
Hospital Revenue Code	990
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 BRACHIOPLASTY

Professional

Both

$4,500.00

Service Code	HCPCS 00537
Hospital Revenue Code	990
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: BCBS Complete	$1,800.00
Rate for Payer: Cash Price	$3,600.00
Rate for Payer: Priority Health Cigna Priority Health	$3,150.00

PR BREAST AUGMENTATION WITH IMPLANT

Professional

Both

$2,000.00

Service Code	HCPCS 19325
Min. Negotiated Rate	$395.33
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$661.62
Rate for Payer: BCBS Complete	$415.10
Rate for Payer: BCBS Trust/PPO	$630.49
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Mclaren Medicaid	$395.33
Rate for Payer: Meridian Medicaid	$415.10
Rate for Payer: Priority Health Choice Medicaid	$395.33
Rate for Payer: Priority Health Cigna Priority Health	$1,400.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$757.96
Rate for Payer: Priority Health Narrow Network	$757.96
Rate for Payer: Priority Health SBD	$757.96

PR BREAST AUGMENT W MASTOPEXY-GEL 2.5

Professional

Both

$6,540.00

Service Code	HCPCS 00258
Hospital Revenue Code	990
Min. Negotiated Rate	$2,616.00
Max. Negotiated Rate	$4,578.00
Rate for Payer: BCBS Complete	$2,616.00
Rate for Payer: Cash Price	$5,232.00
Rate for Payer: Priority Health Cigna Priority Health	$4,578.00

PR BREAST AUGMENT W MASTOPEXY-GEL 3.5

Professional

Both

$7,440.00

Service Code	HCPCS 00260
Hospital Revenue Code	990
Min. Negotiated Rate	$2,976.00
Max. Negotiated Rate	$5,208.00
Rate for Payer: BCBS Complete	$2,976.00
Rate for Payer: Cash Price	$5,952.00
Rate for Payer: Priority Health Cigna Priority Health	$5,208.00

PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5

Professional

Both

$5,500.00

Service Code	HCPCS 00257
Hospital Revenue Code	990
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: BCBS Complete	$2,200.00
Rate for Payer: Cash Price	$4,400.00
Rate for Payer: Priority Health Cigna Priority Health	$3,850.00

PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5

Professional

Both

$6,400.00

Service Code	HCPCS 00259
Hospital Revenue Code	990
Min. Negotiated Rate	$2,560.00
Max. Negotiated Rate	$4,480.00
Rate for Payer: BCBS Complete	$2,560.00
Rate for Payer: Cash Price	$5,120.00
Rate for Payer: Priority Health Cigna Priority Health	$4,480.00

PR BREAST IMPLANT WARRANTY

Professional

Both

$350.00

Service Code	HCPCS 00523
Hospital Revenue Code	990
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$245.00
Rate for Payer: BCBS Complete	$140.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Priority Health Cigna Priority Health	$245.00

PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST

Professional

Both

$4,715.00

Service Code	HCPCS 19368
Min. Negotiated Rate	$1,327.27
Max. Negotiated Rate	$3,300.50
Rate for Payer: Aetna Commercial	$2,367.91
Rate for Payer: BCBS Complete	$1,449.47
Rate for Payer: BCBS Trust/PPO	$1,327.27
Rate for Payer: Cash Price	$3,772.00
Rate for Payer: Cash Price	$3,772.00
Rate for Payer: Mclaren Medicaid	$1,380.45
Rate for Payer: Meridian Medicaid	$1,449.47
Rate for Payer: Priority Health Choice Medicaid	$1,380.45
Rate for Payer: Priority Health Cigna Priority Health	$3,300.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,661.07
Rate for Payer: Priority Health Narrow Network	$2,661.07
Rate for Payer: Priority Health SBD	$2,661.07

PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP

Professional

Both

$4,130.00

Service Code	HCPCS 19369
Min. Negotiated Rate	$199.98
Max. Negotiated Rate	$2,891.00
Rate for Payer: Aetna Commercial	$2,199.14
Rate for Payer: BCBS Complete	$1,347.04
Rate for Payer: BCBS Trust/PPO	$199.98
Rate for Payer: Cash Price	$3,304.00
Rate for Payer: Cash Price	$3,304.00
Rate for Payer: Mclaren Medicaid	$1,282.90
Rate for Payer: Meridian Medicaid	$1,347.04
Rate for Payer: Priority Health Choice Medicaid	$1,282.90
Rate for Payer: Priority Health Cigna Priority Health	$2,891.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,472.80
Rate for Payer: Priority Health Narrow Network	$2,472.80
Rate for Payer: Priority Health SBD	$2,472.80

PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP

Professional

Both

$2,973.00

Service Code	HCPCS 19367
Min. Negotiated Rate	$1,128.69
Max. Negotiated Rate	$2,172.75
Rate for Payer: Aetna Commercial	$1,924.16
Rate for Payer: BCBS Complete	$1,185.12
Rate for Payer: BCBS Trust/PPO	$1,327.27
Rate for Payer: Cash Price	$2,378.40
Rate for Payer: Cash Price	$2,378.40
Rate for Payer: Mclaren Medicaid	$1,128.69
Rate for Payer: Meridian Medicaid	$1,185.12
Rate for Payer: Priority Health Choice Medicaid	$1,128.69
Rate for Payer: Priority Health Cigna Priority Health	$2,081.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,172.75
Rate for Payer: Priority Health Narrow Network	$2,172.75
Rate for Payer: Priority Health SBD	$2,172.75

PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP

Professional

Both

$2,863.00

Service Code	HCPCS 19361
Min. Negotiated Rate	$312.59
Max. Negotiated Rate	$2,004.10
Rate for Payer: Aetna Commercial	$1,693.89
Rate for Payer: BCBS Complete	$1,043.99
Rate for Payer: BCBS Trust/PPO	$312.59
Rate for Payer: Cash Price	$2,290.40
Rate for Payer: Cash Price	$2,290.40
Rate for Payer: Mclaren Medicaid	$994.28
Rate for Payer: Meridian Medicaid	$1,043.99
Rate for Payer: Priority Health Choice Medicaid	$994.28
Rate for Payer: Priority Health Cigna Priority Health	$2,004.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,912.97
Rate for Payer: Priority Health Narrow Network	$1,912.97
Rate for Payer: Priority Health SBD	$1,912.97

PR BREAST RECONSTRUC W OTHR TECHNIQ

Professional

Both

$2,846.00

Service Code	HCPCS 19366
Min. Negotiated Rate	$1,138.40
Max. Negotiated Rate	$1,992.20
Rate for Payer: BCBS Complete	$1,138.40
Rate for Payer: Cash Price	$2,276.80
Rate for Payer: Priority Health Cigna Priority Health	$1,992.20

PR BREAST REDUCTION

Professional

Both

$1,900.00

Service Code	HCPCS 19318
Min. Negotiated Rate	$293.06
Max. Negotiated Rate	$1,344.10
Rate for Payer: Aetna Commercial	$1,186.12
Rate for Payer: BCBS Complete	$734.24
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Mclaren Medicaid	$699.28
Rate for Payer: Meridian Medicaid	$734.24
Rate for Payer: Priority Health Choice Medicaid	$699.28
Rate for Payer: Priority Health Cigna Priority Health	$1,330.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,344.10
Rate for Payer: Priority Health Narrow Network	$1,344.10
Rate for Payer: Priority Health SBD	$1,344.10

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$164.00

Service Code	HCPCS 91065
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$1,135.85
Rate for Payer: Aetna Commercial	$96.87
Rate for Payer: BCBS Complete	$65.60
Rate for Payer: BCBS Trust/PPO	$1,135.85
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Priority Health Cigna Priority Health	$114.80
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	$113.19

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$176.00

Service Code	HCPCS 94450
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$1,113.66
Rate for Payer: Aetna Commercial	$65.23
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$1,113.66
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	$26.04
Rate for Payer: Priority Health Narrow Network	$26.04
Rate for Payer: Priority Health SBD	$110.04

PR BRIEF CHECK IN BY MD/QHP

Professional

Both

$29.00

Service Code	HCPCS G2012
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$403.09
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: BCBS Trust/PPO	$403.09
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Mclaren Medicaid	$8.09
Rate for Payer: Meridian Medicaid	$8.49
Rate for Payer: Priority Health Choice Medicaid	$8.09
Rate for Payer: Priority Health Cigna Priority Health	$20.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.85
Rate for Payer: Priority Health Narrow Network	$15.85
Rate for Payer: Priority Health SBD	$15.85

PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN

Professional

Both

$121.00

Service Code	HCPCS 94060
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$1,399.47
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$18.90
Rate for Payer: Priority Health Cigna Priority Health	$84.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.98
Rate for Payer: Priority Health Narrow Network	$18.98
Rate for Payer: Priority Health Narrow Network	$18.98
Rate for Payer: Priority Health SBD	$85.70
Rate for Payer: Priority Health SBD	$85.70

PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS

Professional

Both

$636.00

Service Code	HCPCS 31623
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$720.60
Rate for Payer: Aetna Commercial	$170.36
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$720.60
Rate for Payer: Cash Price	$508.80
Rate for Payer: Cash Price	$508.80
Rate for Payer: Mclaren Medicaid	$82.43
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$445.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$177.81
Rate for Payer: Priority Health Narrow Network	$177.81
Rate for Payer: Priority Health SBD	$177.81

Know your out-of-pocket cost for care.

All Charges