Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX

Professional

Both

$473.00

Service Code	HCPCS 31652
Min. Negotiated Rate	$137.39
Max. Negotiated Rate	$853.73
Rate for Payer: Aetna Commercial	$286.67
Rate for Payer: BCBS Complete	$144.26
Rate for Payer: BCBS Trust/PPO	$853.73
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cash Price	$378.40
Rate for Payer: Mclaren Medicaid	$137.39
Rate for Payer: Meridian Medicaid	$144.26
Rate for Payer: Priority Health Choice Medicaid	$137.39
Rate for Payer: Priority Health Cigna Priority Health	$331.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$297.73
Rate for Payer: Priority Health Narrow Network	$297.73
Rate for Payer: Priority Health SBD	$297.73

PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX

Professional

Both

$522.00

Service Code	HCPCS 31653
Min. Negotiated Rate	$152.30
Max. Negotiated Rate	$1,172.30
Rate for Payer: Aetna Commercial	$316.88
Rate for Payer: BCBS Complete	$159.92
Rate for Payer: BCBS Trust/PPO	$1,172.30
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Mclaren Medicaid	$152.30
Rate for Payer: Meridian Medicaid	$159.92
Rate for Payer: Priority Health Choice Medicaid	$152.30
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$330.16
Rate for Payer: Priority Health Narrow Network	$330.16
Rate for Payer: Priority Health SBD	$330.16

PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

Professional

Both

$584.00

Service Code	HCPCS 31622
Min. Negotiated Rate	$83.07
Max. Negotiated Rate	$408.80
Rate for Payer: Aetna Commercial	$169.32
Rate for Payer: BCBS Complete	$87.22
Rate for Payer: BCBS Trust/PPO	$372.29
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Mclaren Medicaid	$83.07
Rate for Payer: Meridian Medicaid	$87.22
Rate for Payer: Priority Health Choice Medicaid	$83.07
Rate for Payer: Priority Health Cigna Priority Health	$408.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.28
Rate for Payer: Priority Health Narrow Network	$178.28
Rate for Payer: Priority Health SBD	$178.28

PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE

Professional

Both

$593.00

Service Code	HCPCS 31624
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$1,147.47
Rate for Payer: Aetna Commercial	$172.05
Rate for Payer: BCBS Complete	$87.68
Rate for Payer: BCBS Trust/PPO	$1,147.47
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Mclaren Medicaid	$83.50
Rate for Payer: Meridian Medicaid	$87.68
Rate for Payer: Priority Health Choice Medicaid	$83.50
Rate for Payer: Priority Health Cigna Priority Health	$415.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.05
Rate for Payer: Priority Health Narrow Network	$181.05
Rate for Payer: Priority Health SBD	$181.05

PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX

Professional

Both

$370.00

Service Code	HCPCS 31630
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$786.64
Rate for Payer: Aetna Commercial	$255.59
Rate for Payer: BCBS Complete	$130.17
Rate for Payer: BCBS Trust/PPO	$786.64
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Mclaren Medicaid	$123.97
Rate for Payer: Meridian Medicaid	$130.17
Rate for Payer: Priority Health Choice Medicaid	$123.97
Rate for Payer: Priority Health Cigna Priority Health	$259.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.57
Rate for Payer: Priority Health Narrow Network	$268.57
Rate for Payer: Priority Health SBD	$268.57

PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT

Professional

Both

$52.00

Service Code	HCPCS 94070
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$1,284.30
Rate for Payer: Aetna Commercial	$66.61
Rate for Payer: Aetna Commercial	$66.61
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Trust/PPO	$1,284.30
Rate for Payer: BCBS Trust/PPO	$1,284.30
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$41.60
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.38
Rate for Payer: Priority Health Narrow Network	$36.38
Rate for Payer: Priority Health Narrow Network	$36.38
Rate for Payer: Priority Health SBD	$81.74
Rate for Payer: Priority Health SBD	$81.74

PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES

Professional

Both

$212.00

Service Code	HCPCS 31654
Min. Negotiated Rate	$41.75
Max. Negotiated Rate	$791.92
Rate for Payer: Aetna Commercial	$86.57
Rate for Payer: BCBS Complete	$43.84
Rate for Payer: BCBS Trust/PPO	$791.92
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Mclaren Medicaid	$41.75
Rate for Payer: Meridian Medicaid	$43.84
Rate for Payer: Priority Health Choice Medicaid	$41.75
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$89.83
Rate for Payer: Priority Health Narrow Network	$89.83
Rate for Payer: Priority Health SBD	$89.83

PR BRONCHOPLASTY GRAFT REPAIR

Professional

Both

$2,895.00

Service Code	HCPCS 31770
Min. Negotiated Rate	$835.81
Max. Negotiated Rate	$2,026.50
Rate for Payer: Aetna Commercial	$1,717.54
Rate for Payer: BCBS Complete	$877.60
Rate for Payer: BCBS Trust/PPO	$1,379.92
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Mclaren Medicaid	$835.81
Rate for Payer: Meridian Medicaid	$877.60
Rate for Payer: Priority Health Choice Medicaid	$835.81
Rate for Payer: Priority Health Cigna Priority Health	$2,026.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,809.58
Rate for Payer: Priority Health Narrow Network	$1,809.58
Rate for Payer: Priority Health SBD	$1,809.58

PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES

Professional

Both

$635.00

Service Code	HCPCS 31625
Min. Negotiated Rate	$97.55
Max. Negotiated Rate	$463.32
Rate for Payer: Aetna Commercial	$200.97
Rate for Payer: BCBS Complete	$102.43
Rate for Payer: BCBS Trust/PPO	$463.32
Rate for Payer: Cash Price	$508.00
Rate for Payer: Cash Price	$508.00
Rate for Payer: Mclaren Medicaid	$97.55
Rate for Payer: Meridian Medicaid	$102.43
Rate for Payer: Priority Health Choice Medicaid	$97.55
Rate for Payer: Priority Health Cigna Priority Health	$444.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$210.23
Rate for Payer: Priority Health Narrow Network	$210.23
Rate for Payer: Priority Health SBD	$210.23

PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON

Professional

Both

$1,234.00

Service Code	HCPCS 31629
Min. Negotiated Rate	$116.51
Max. Negotiated Rate	$863.80
Rate for Payer: Aetna Commercial	$240.07
Rate for Payer: BCBS Complete	$122.34
Rate for Payer: BCBS Trust/PPO	$499.77
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cash Price	$987.20
Rate for Payer: Mclaren Medicaid	$116.51
Rate for Payer: Meridian Medicaid	$122.34
Rate for Payer: Priority Health Choice Medicaid	$116.51
Rate for Payer: Priority Health Cigna Priority Health	$863.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$251.44
Rate for Payer: Priority Health Narrow Network	$251.44
Rate for Payer: Priority Health SBD	$251.44

PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION

Professional

Both

$170.00

Service Code	HCPCS 31627
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$684.15
Rate for Payer: Aetna Commercial	$125.22
Rate for Payer: BCBS Complete	$63.07
Rate for Payer: BCBS Trust/PPO	$684.15
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Mclaren Medicaid	$60.07
Rate for Payer: Meridian Medicaid	$63.07
Rate for Payer: Priority Health Choice Medicaid	$60.07
Rate for Payer: Priority Health Cigna Priority Health	$119.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.65
Rate for Payer: Priority Health Narrow Network	$129.65
Rate for Payer: Priority Health SBD	$129.65

PR BRONCHOSCOPY W/EXCISION TUMOR

Professional

Both

$511.00

Service Code	HCPCS 31640
Min. Negotiated Rate	$154.21
Max. Negotiated Rate	$852.15
Rate for Payer: Aetna Commercial	$320.57
Rate for Payer: BCBS Complete	$161.92
Rate for Payer: BCBS Trust/PPO	$852.15
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Mclaren Medicaid	$154.21
Rate for Payer: Meridian Medicaid	$161.92
Rate for Payer: Priority Health Choice Medicaid	$154.21
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$335.70
Rate for Payer: Priority Health Narrow Network	$335.70
Rate for Payer: Priority Health SBD	$335.70

PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY

Professional

Both

$1,115.00

Service Code	HCPCS 31635
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$972.60
Rate for Payer: Aetna Commercial	$225.61
Rate for Payer: BCBS Complete	$115.18
Rate for Payer: BCBS Trust/PPO	$972.60
Rate for Payer: Cash Price	$892.00
Rate for Payer: Cash Price	$892.00
Rate for Payer: Mclaren Medicaid	$109.70
Rate for Payer: Meridian Medicaid	$115.18
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health	$780.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$236.15
Rate for Payer: Priority Health Narrow Network	$236.15
Rate for Payer: Priority Health SBD	$236.15

PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST

Professional

Both

$675.00

Service Code	HCPCS 31645
Min. Negotiated Rate	$92.02
Max. Negotiated Rate	$667.24
Rate for Payer: Aetna Commercial	$188.88
Rate for Payer: BCBS Complete	$96.62
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Mclaren Medicaid	$92.02
Rate for Payer: Meridian Medicaid	$96.62
Rate for Payer: Priority Health Choice Medicaid	$92.02
Rate for Payer: Priority Health Cigna Priority Health	$472.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$198.19
Rate for Payer: Priority Health Narrow Network	$198.19
Rate for Payer: Priority Health SBD	$198.19

PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ

Professional

Both

$602.00

Service Code	HCPCS 31646
Min. Negotiated Rate	$88.82
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: BCBS Complete	$93.26
Rate for Payer: BCBS Trust/PPO	$1,008.00
Rate for Payer: Cash Price	$481.60
Rate for Payer: Cash Price	$481.60
Rate for Payer: Mclaren Medicaid	$88.82
Rate for Payer: Meridian Medicaid	$93.26
Rate for Payer: Priority Health Choice Medicaid	$88.82
Rate for Payer: Priority Health Cigna Priority Health	$421.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$191.23
Rate for Payer: Priority Health Narrow Network	$191.23
Rate for Payer: Priority Health SBD	$191.23

PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE

Professional

Both

$745.00

Service Code	HCPCS 31628
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$915.54
Rate for Payer: Aetna Commercial	$226.30
Rate for Payer: BCBS Complete	$115.18
Rate for Payer: BCBS Trust/PPO	$915.54
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Mclaren Medicaid	$109.70
Rate for Payer: Meridian Medicaid	$115.18
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health	$521.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$237.08
Rate for Payer: Priority Health Narrow Network	$237.08
Rate for Payer: Priority Health SBD	$237.08

PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE

Professional

Both

$126.00

Service Code	HCPCS 31632
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$996.90
Rate for Payer: Aetna Commercial	$63.94
Rate for Payer: BCBS Complete	$31.98
Rate for Payer: BCBS Trust/PPO	$996.90
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Mclaren Medicaid	$30.46
Rate for Payer: Meridian Medicaid	$31.98
Rate for Payer: Priority Health Choice Medicaid	$30.46
Rate for Payer: Priority Health Cigna Priority Health	$88.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.68
Rate for Payer: Priority Health Narrow Network	$66.68
Rate for Payer: Priority Health SBD	$66.68

PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE

Professional

Both

$97.00

Service Code	HCPCS 31633
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$724.83
Rate for Payer: Aetna Commercial	$82.12
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Mclaren Medicaid	$39.19
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health	$67.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.73
Rate for Payer: Priority Health Narrow Network	$84.73
Rate for Payer: Priority Health SBD	$84.73

PR BROWLIFT

Professional

Both

$2,600.00

Service Code	HCPCS 00532
Hospital Revenue Code	990
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,820.00
Rate for Payer: BCBS Complete	$1,040.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Priority Health Cigna Priority Health	$1,820.00

PR BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY

Professional

Both

$5,875.00

Service Code	HCPCS 58954
Min. Negotiated Rate	$131.02
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$2,579.73
Rate for Payer: BCBS Complete	$1,458.87
Rate for Payer: BCBS Trust/PPO	$131.02
Rate for Payer: Cash Price	$4,700.00
Rate for Payer: Cash Price	$4,700.00
Rate for Payer: Mclaren Medicaid	$1,389.40
Rate for Payer: Meridian Medicaid	$1,458.87
Rate for Payer: Priority Health Choice Medicaid	$1,389.40
Rate for Payer: Priority Health Cigna Priority Health	$4,112.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,060.22
Rate for Payer: Priority Health Narrow Network	$3,060.22
Rate for Payer: Priority Health SBD	$3,060.22

PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION

Professional

Both

$5,137.00

Service Code	HCPCS 58953
Min. Negotiated Rate	$131.55
Max. Negotiated Rate	$3,595.90
Rate for Payer: Aetna Commercial	$2,383.00
Rate for Payer: BCBS Complete	$1,348.16
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: Cash Price	$4,109.60
Rate for Payer: Cash Price	$4,109.60
Rate for Payer: Mclaren Medicaid	$1,283.96
Rate for Payer: Meridian Medicaid	$1,348.16
Rate for Payer: Priority Health Choice Medicaid	$1,283.96
Rate for Payer: Priority Health Cigna Priority Health	$3,595.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,830.61
Rate for Payer: Priority Health Narrow Network	$2,830.61
Rate for Payer: Priority Health SBD	$2,830.61

PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC

Professional

Both

$2,382.00

Service Code	HCPCS 58956
Min. Negotiated Rate	$502.94
Max. Negotiated Rate	$1,924.46
Rate for Payer: Aetna Commercial	$1,617.38
Rate for Payer: BCBS Complete	$917.64
Rate for Payer: BCBS Trust/PPO	$502.94
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Mclaren Medicaid	$873.94
Rate for Payer: Meridian Medicaid	$917.64
Rate for Payer: Priority Health Choice Medicaid	$873.94
Rate for Payer: Priority Health Cigna Priority Health	$1,667.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,924.46
Rate for Payer: Priority Health Narrow Network	$1,924.46
Rate for Payer: Priority Health SBD	$1,924.46

PR BUDESONIDE NON-COMP UNIT

Professional

Both

$9.00

Service Code	HCPCS J7626
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna Commercial	$1.04
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$6.30

PR BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE

Professional

Both

$2,504.00

Service Code	HCPCS 61210
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$1,752.80
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: BCBS Complete	$246.69
Rate for Payer: BCBS Trust/PPO	$324.90
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Mclaren Medicaid	$234.94
Rate for Payer: Meridian Medicaid	$246.69
Rate for Payer: Priority Health Choice Medicaid	$234.94
Rate for Payer: Priority Health Cigna Priority Health	$1,752.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$622.28
Rate for Payer: Priority Health Narrow Network	$622.28
Rate for Payer: Priority Health SBD	$622.28

PR BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG

Professional

Both

$2,672.00

Service Code	HCPCS 61250
Min. Negotiated Rate	$566.58
Max. Negotiated Rate	$1,870.40
Rate for Payer: Aetna Commercial	$1,119.93
Rate for Payer: BCBS Complete	$594.91
Rate for Payer: BCBS Trust/PPO	$918.19
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Mclaren Medicaid	$566.58
Rate for Payer: Meridian Medicaid	$594.91
Rate for Payer: Priority Health Choice Medicaid	$566.58
Rate for Payer: Priority Health Cigna Priority Health	$1,870.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,492.57
Rate for Payer: Priority Health Narrow Network	$1,492.57
Rate for Payer: Priority Health SBD	$1,492.57

Know your out-of-pocket cost for care.

All Charges