Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CAST SUP SHT LEG SPLNT PED P

Professional

Both

$20.00

Service Code	HCPCS Q4047
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$4.84
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY

Professional

Both

$138.00

Service Code	HCPCS 36660
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$738.56
Rate for Payer: Aetna Commercial	$91.56
Rate for Payer: BCBS Complete	$44.95
Rate for Payer: BCBS Trust/PPO	$738.56
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Mclaren Medicaid	$42.81
Rate for Payer: Meridian Medicaid	$44.95
Rate for Payer: Priority Health Choice Medicaid	$42.81
Rate for Payer: Priority Health Cigna Priority Health	$96.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.92
Rate for Payer: Priority Health Narrow Network	$106.92
Rate for Payer: Priority Health SBD	$106.92

PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY

Professional

Both

$520.00

Service Code	HCPCS 31717
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$1,013.81
Rate for Payer: Aetna Commercial	$136.71
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS Trust/PPO	$1,013.81
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Mclaren Medicaid	$66.46
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$364.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.01
Rate for Payer: Priority Health Narrow Network	$144.01
Rate for Payer: Priority Health SBD	$144.01

PR CATHETERIZE FOR URINE SPEC

Professional

Both

$29.00

Service Code	HCPCS P9612
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$1,574.33
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCBS Trust/PPO	$1,574.33
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$20.30

PR CATHJ UMBILICAL VEIN DX/THER NB

Professional

Both

$283.00

Service Code	HCPCS 36510
Min. Negotiated Rate	$33.44
Max. Negotiated Rate	$947.77
Rate for Payer: Aetna Commercial	$70.85
Rate for Payer: BCBS Complete	$35.11
Rate for Payer: BCBS Trust/PPO	$947.77
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cash Price	$226.40
Rate for Payer: Mclaren Medicaid	$33.44
Rate for Payer: Meridian Medicaid	$35.11
Rate for Payer: Priority Health Choice Medicaid	$33.44
Rate for Payer: Priority Health Cigna Priority Health	$198.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.51
Rate for Payer: Priority Health Narrow Network	$83.51
Rate for Payer: Priority Health SBD	$83.51

PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I

Professional

Both

$1,679.00

Service Code	HCPCS 93454
Min. Negotiated Rate	$327.70
Max. Negotiated Rate	$2,147.01
Rate for Payer: Aetna Commercial	$1,231.58
Rate for Payer: Aetna Commercial	$1,231.58
Rate for Payer: BCBS Complete	$671.60
Rate for Payer: BCBS Complete	$306.80
Rate for Payer: BCBS Trust/PPO	$2,147.01
Rate for Payer: BCBS Trust/PPO	$2,147.01
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Priority Health Cigna Priority Health	$536.90
Rate for Payer: Priority Health Cigna Priority Health	$1,175.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.70
Rate for Payer: Priority Health Narrow Network	$327.70
Rate for Payer: Priority Health Narrow Network	$327.70
Rate for Payer: Priority Health SBD	$1,281.94
Rate for Payer: Priority Health SBD	$1,281.94

PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

Professional

Both

$2,157.00

Service Code	HCPCS 93459
Min. Negotiated Rate	$458.69
Max. Negotiated Rate	$1,584.58
Rate for Payer: Aetna Commercial	$1,542.00
Rate for Payer: Aetna Commercial	$1,542.00
Rate for Payer: BCBS Complete	$862.80
Rate for Payer: BCBS Complete	$435.60
Rate for Payer: BCBS Trust/PPO	$570.56
Rate for Payer: BCBS Trust/PPO	$570.56
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Cash Price	$871.20
Rate for Payer: Cash Price	$871.20
Rate for Payer: Cash Price	$1,725.60
Rate for Payer: Priority Health Cigna Priority Health	$762.30
Rate for Payer: Priority Health Cigna Priority Health	$1,509.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$458.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$458.69
Rate for Payer: Priority Health Narrow Network	$458.69
Rate for Payer: Priority Health Narrow Network	$458.69
Rate for Payer: Priority Health SBD	$1,584.58
Rate for Payer: Priority Health SBD	$1,584.58

PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I

Professional

Both

$1,945.00

Service Code	HCPCS 93458
Min. Negotiated Rate	$404.31
Max. Negotiated Rate	$1,472.99
Rate for Payer: Aetna Commercial	$1,424.59
Rate for Payer: Aetna Commercial	$1,424.59
Rate for Payer: BCBS Complete	$778.00
Rate for Payer: BCBS Complete	$380.40
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: BCBS Trust/PPO	$545.73
Rate for Payer: Cash Price	$760.80
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$760.80
Rate for Payer: Priority Health Cigna Priority Health	$665.70
Rate for Payer: Priority Health Cigna Priority Health	$1,361.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$404.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$404.31
Rate for Payer: Priority Health Narrow Network	$404.31
Rate for Payer: Priority Health Narrow Network	$404.31
Rate for Payer: Priority Health SBD	$1,472.99
Rate for Payer: Priority Health SBD	$1,472.99

PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I

Professional

Both

$571.00

Service Code	HCPCS 93455
Min. Negotiated Rate	$228.40
Max. Negotiated Rate	$1,428.06
Rate for Payer: Aetna Commercial	$1,384.11
Rate for Payer: BCBS Complete	$228.40
Rate for Payer: BCBS Trust/PPO	$472.30
Rate for Payer: Cash Price	$456.80
Rate for Payer: Cash Price	$456.80
Rate for Payer: Priority Health Cigna Priority Health	$399.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$382.08
Rate for Payer: Priority Health Narrow Network	$382.08
Rate for Payer: Priority Health SBD	$1,428.06

PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I

Professional

Both

$2,379.00

Service Code	HCPCS 93457
Min. Negotiated Rate	$479.49
Max. Negotiated Rate	$1,737.78
Rate for Payer: Aetna Commercial	$1,695.32
Rate for Payer: BCBS Complete	$951.60
Rate for Payer: BCBS Trust/PPO	$542.56
Rate for Payer: Cash Price	$1,903.20
Rate for Payer: Cash Price	$1,903.20
Rate for Payer: Priority Health Cigna Priority Health	$1,665.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$479.49
Rate for Payer: Priority Health Narrow Network	$479.49
Rate for Payer: Priority Health SBD	$1,737.78

PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I

Professional

Both

$2,128.00

Service Code	HCPCS 93456
Min. Negotiated Rate	$427.00
Max. Negotiated Rate	$1,594.99
Rate for Payer: Aetna Commercial	$1,544.51
Rate for Payer: BCBS Complete	$851.20
Rate for Payer: BCBS Trust/PPO	$503.47
Rate for Payer: Cash Price	$1,702.40
Rate for Payer: Cash Price	$1,702.40
Rate for Payer: Priority Health Cigna Priority Health	$1,489.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$427.00
Rate for Payer: Priority Health Narrow Network	$427.00
Rate for Payer: Priority Health SBD	$1,594.99

PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI

Professional

Both

$631.00

Service Code	HCPCS 58340
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$441.70
Rate for Payer: Aetna Commercial	$67.35
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCBS Trust/PPO	$441.13
Rate for Payer: Cash Price	$504.80
Rate for Payer: Cash Price	$504.80
Rate for Payer: Mclaren Medicaid	$36.85
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health	$441.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.96
Rate for Payer: Priority Health Narrow Network	$80.96
Rate for Payer: Priority Health SBD	$80.96

PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT

Professional

Both

$451.00

Service Code	HCPCS 57511
Min. Negotiated Rate	$95.21
Max. Negotiated Rate	$640.30
Rate for Payer: Aetna Commercial	$171.03
Rate for Payer: BCBS Complete	$99.97
Rate for Payer: BCBS Trust/PPO	$640.30
Rate for Payer: Cash Price	$360.80
Rate for Payer: Cash Price	$360.80
Rate for Payer: Mclaren Medicaid	$95.21
Rate for Payer: Meridian Medicaid	$99.97
Rate for Payer: Priority Health Choice Medicaid	$95.21
Rate for Payer: Priority Health Cigna Priority Health	$315.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$209.73
Rate for Payer: Priority Health Narrow Network	$209.73
Rate for Payer: Priority Health SBD	$209.73

PR CAUTERY CERVIX ELECTRO/THERMAL

Professional

Both

$471.00

Service Code	HCPCS 57510
Min. Negotiated Rate	$72.63
Max. Negotiated Rate	$689.96
Rate for Payer: Aetna Commercial	$134.58
Rate for Payer: BCBS Complete	$76.26
Rate for Payer: BCBS Trust/PPO	$689.96
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Mclaren Medicaid	$72.63
Rate for Payer: Meridian Medicaid	$76.26
Rate for Payer: Priority Health Choice Medicaid	$72.63
Rate for Payer: Priority Health Cigna Priority Health	$329.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$159.07
Rate for Payer: Priority Health Narrow Network	$159.07
Rate for Payer: Priority Health SBD	$159.07

PR CAUTERY CERVIX LASER ABLATION

Professional

Both

$543.00

Service Code	HCPCS 57513
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$646.64
Rate for Payer: Aetna Commercial	$170.65
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$646.64
Rate for Payer: Cash Price	$434.40
Rate for Payer: Cash Price	$434.40
Rate for Payer: Mclaren Medicaid	$94.79
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$380.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$209.25
Rate for Payer: Priority Health Narrow Network	$209.25
Rate for Payer: Priority Health SBD	$209.25

PR CBHC CONSULT FEE

Professional

Both

$300.00

Service Code	HCPCS 00585
Hospital Revenue Code	990
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00

PR CBHC IN HOUSE REPAIR

Professional

Both

$26.00

Service Code	HCPCS 00580
Hospital Revenue Code	990
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$18.20
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20

PR CBHC IN-HOUSE REPAIR

Professional

Both

$26.00

Service Code	HCPCS 00590
Hospital Revenue Code	990
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$18.20
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20

PR CBHC LOSS AND DAMAGE FEE

Professional

Both

$275.00

Service Code	HCPCS 00581
Hospital Revenue Code	990
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$192.50
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50

PR CBHC MAILING CHARGE

Professional

Both

$12.00

Service Code	HCPCS 00584
Hospital Revenue Code	990
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$8.40
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40

PR CBHC RECASE BTE

Professional

Both

$60.00

Service Code	HCPCS 00582
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 CBHC RECASE ITE

Professional

Both

$175.00

Service Code	HCPCS 00583
Hospital Revenue Code	990
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$122.50
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Priority Health Cigna Priority Health	$122.50

PR CBHC REPAIR 5 YRS AND OLDER

Professional

Both

$425.00

Service Code	HCPCS 00589
Hospital Revenue Code	990
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$297.50
Rate for Payer: BCBS Complete	$170.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Priority Health Cigna Priority Health	$297.50

PR CBHC REPAIR DIGITAL/CIC

Professional

Both

$300.00

Service Code	HCPCS 00588
Hospital Revenue Code	990
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00

PR CBHC REPAIR RECEIVER

Professional

Both

$100.00

Service Code	HCPCS 00587
Hospital Revenue Code	990
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$70.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00

Know your out-of-pocket cost for care.

All Charges