Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE

Professional

Both

$66.69

Service Code	HCPCS 90756
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$46.68
Rate for Payer: Aetna Commercial	$32.37
Rate for Payer: BCBS Complete	$26.68
Rate for Payer: BCBS Trust/PPO	$33.00
Rate for Payer: Cash Price	$53.35
Rate for Payer: Cash Price	$53.35
Rate for Payer: Priority Health Cigna Priority Health	$46.68

PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE

Professional

Both

$71.40

Service Code	HCPCS 90674
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Commercial	$34.17
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$33.98
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cash Price	$57.12
Rate for Payer: Priority Health Cigna Priority Health	$49.98

PR Ccm/bhi by rhc/fqhc 20min mo

Professional

Both

$246.00

Service Code	HCPCS G0511
Min. Negotiated Rate	$56.54
Max. Negotiated Rate	$589.58
Rate for Payer: Aetna Commercial	$63.19
Rate for Payer: BCBS Complete	$98.40
Rate for Payer: BCBS Trust/PPO	$589.58
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Priority Health Cigna Priority Health	$172.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.54
Rate for Payer: Priority Health Narrow Network	$56.54
Rate for Payer: Priority Health SBD	$56.54

PR CEFTRIAXONE SODIUM INJECTION

Professional

Both

$20.00

Service Code	HCPCS J0696
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$0.51
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$0.03
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 CERCLAGE CERVIX PREGNANCY VAGINAL

Professional

Both

$720.00

Service Code	HCPCS 59320
Min. Negotiated Rate	$97.13
Max. Negotiated Rate	$504.00
Rate for Payer: Aetna Commercial	$165.15
Rate for Payer: BCBS Complete	$101.99
Rate for Payer: BCBS Trust/PPO	$213.43
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Mclaren Medicaid	$97.13
Rate for Payer: Meridian Medicaid	$101.99
Rate for Payer: Priority Health Choice Medicaid	$97.13
Rate for Payer: Priority Health Cigna Priority Health	$504.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.42
Rate for Payer: Priority Health Narrow Network	$213.42
Rate for Payer: Priority Health SBD	$213.42

PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL

Professional

Both

$811.00

Service Code	HCPCS 57700
Min. Negotiated Rate	$230.89
Max. Negotiated Rate	$915.54
Rate for Payer: Aetna Commercial	$412.98
Rate for Payer: BCBS Complete	$242.43
Rate for Payer: BCBS Trust/PPO	$915.54
Rate for Payer: Cash Price	$648.80
Rate for Payer: Cash Price	$648.80
Rate for Payer: Mclaren Medicaid	$230.89
Rate for Payer: Meridian Medicaid	$242.43
Rate for Payer: Priority Health Choice Medicaid	$230.89
Rate for Payer: Priority Health Cigna Priority Health	$567.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$510.35
Rate for Payer: Priority Health Narrow Network	$510.35
Rate for Payer: Priority Health SBD	$510.35

PR CERTOLIZUMAB PEGOL INJ 1MG

Professional

Both

$10.00

Service Code	HCPCS J0717
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$4.90
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 CERV FLEX N/ADJ FOAM PRE OTS

Professional

Both

$26.00

Service Code	HCPCS L0120
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$18.20
Rate for Payer: Aetna Commercial	$15.93
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20

PR CERVICAL CAP CONTRACEPTIVE

Professional

Both

$100.00

Service Code	HCPCS A4261
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$1,481.35
Rate for Payer: Aetna Commercial	$26.50
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Trust/PPO	$1,481.35
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00

PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ

Professional

Both

$3,917.00

Service Code	HCPCS 38724
Min. Negotiated Rate	$928.68
Max. Negotiated Rate	$3,145.81
Rate for Payer: Aetna Commercial	$1,778.47
Rate for Payer: BCBS Complete	$975.11
Rate for Payer: BCBS Trust/PPO	$1,321.28
Rate for Payer: Cash Price	$3,133.60
Rate for Payer: Cash Price	$3,133.60
Rate for Payer: Mclaren Medicaid	$928.68
Rate for Payer: Meridian Medicaid	$975.11
Rate for Payer: Priority Health Choice Medicaid	$928.68
Rate for Payer: Priority Health Cigna Priority Health	$2,741.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,145.81
Rate for Payer: Priority Health Narrow Network	$3,145.81
Rate for Payer: Priority Health SBD	$3,145.81

PR CERVICAL LYMPHADENECTOMY

Professional

Both

$2,396.00

Service Code	HCPCS 38720
Min. Negotiated Rate	$671.47
Max. Negotiated Rate	$2,903.16
Rate for Payer: Aetna Commercial	$1,646.91
Rate for Payer: BCBS Complete	$903.55
Rate for Payer: BCBS Trust/PPO	$671.47
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Mclaren Medicaid	$860.52
Rate for Payer: Meridian Medicaid	$903.55
Rate for Payer: Priority Health Choice Medicaid	$860.52
Rate for Payer: Priority Health Cigna Priority Health	$1,677.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,903.16
Rate for Payer: Priority Health Narrow Network	$2,903.16
Rate for Payer: Priority Health SBD	$2,903.16

PR CESAREAN DELIVERY ATTEMPTED VBAC

Professional

Both

$2,450.00

Service Code	HCPCS 59620
Min. Negotiated Rate	$873.68
Max. Negotiated Rate	$1,715.00
Rate for Payer: Aetna Commercial	$1,034.69
Rate for Payer: BCBS Complete	$917.36
Rate for Payer: BCBS Trust/PPO	$1,066.64
Rate for Payer: Cash Price	$1,960.00
Rate for Payer: Cash Price	$1,960.00
Rate for Payer: Mclaren Medicaid	$873.68
Rate for Payer: Meridian Medicaid	$917.36
Rate for Payer: Priority Health Choice Medicaid	$873.68
Rate for Payer: Priority Health Cigna Priority Health	$1,715.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,325.39
Rate for Payer: Priority Health Narrow Network	$1,325.39
Rate for Payer: Priority Health SBD	$1,325.39

PR CESAREAN DELIVERY ONLY

Professional

Both

$2,275.00

Service Code	HCPCS 59514
Min. Negotiated Rate	$164.30
Max. Negotiated Rate	$1,592.50
Rate for Payer: Aetna Commercial	$1,001.86
Rate for Payer: BCBS Complete	$884.87
Rate for Payer: BCBS Trust/PPO	$164.30
Rate for Payer: Cash Price	$1,820.00
Rate for Payer: Cash Price	$1,820.00
Rate for Payer: Mclaren Medicaid	$842.73
Rate for Payer: Meridian Medicaid	$884.87
Rate for Payer: Priority Health Choice Medicaid	$842.73
Rate for Payer: Priority Health Cigna Priority Health	$1,592.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,281.01
Rate for Payer: Priority Health Narrow Network	$1,281.01
Rate for Payer: Priority Health SBD	$1,281.01

PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE

Professional

Both

$2,542.00

Service Code	HCPCS 59515
Min. Negotiated Rate	$181.74
Max. Negotiated Rate	$1,844.78
Rate for Payer: Aetna Commercial	$1,434.55
Rate for Payer: BCBS Complete	$1,307.82
Rate for Payer: BCBS Trust/PPO	$181.74
Rate for Payer: Cash Price	$2,033.60
Rate for Payer: Cash Price	$2,033.60
Rate for Payer: Mclaren Medicaid	$1,245.54
Rate for Payer: Meridian Medicaid	$1,307.82
Rate for Payer: Priority Health Choice Medicaid	$1,245.54
Rate for Payer: Priority Health Cigna Priority Health	$1,779.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,844.78
Rate for Payer: Priority Health Narrow Network	$1,844.78
Rate for Payer: Priority Health SBD	$1,844.78

PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA

Professional

Both

$2,717.00

Service Code	HCPCS 59622
Min. Negotiated Rate	$1,128.98
Max. Negotiated Rate	$1,915.60
Rate for Payer: Aetna Commercial	$1,484.84
Rate for Payer: BCBS Complete	$1,355.37
Rate for Payer: BCBS Trust/PPO	$1,128.98
Rate for Payer: Cash Price	$2,173.60
Rate for Payer: Cash Price	$2,173.60
Rate for Payer: Mclaren Medicaid	$1,290.83
Rate for Payer: Meridian Medicaid	$1,355.37
Rate for Payer: Priority Health Choice Medicaid	$1,290.83
Rate for Payer: Priority Health Cigna Priority Health	$1,901.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,915.60
Rate for Payer: Priority Health Narrow Network	$1,915.60
Rate for Payer: Priority Health SBD	$1,915.60

PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL

Professional

Both

$242.00

Service Code	HCPCS 37214
Min. Negotiated Rate	$75.62
Max. Negotiated Rate	$705.28
Rate for Payer: Aetna Commercial	$164.52
Rate for Payer: BCBS Complete	$79.40
Rate for Payer: BCBS Trust/PPO	$705.28
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Mclaren Medicaid	$75.62
Rate for Payer: Meridian Medicaid	$79.40
Rate for Payer: Priority Health Choice Medicaid	$75.62
Rate for Payer: Priority Health Cigna Priority Health	$169.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.38
Rate for Payer: Priority Health Narrow Network	$189.38
Rate for Payer: Priority Health SBD	$189.38

PR CHANGE CYSTOSTOMY TUBE COMPLICATED

Professional

Both

$334.00

Service Code	HCPCS 51710
Min. Negotiated Rate	$50.91
Max. Negotiated Rate	$2,051.39
Rate for Payer: Aetna Commercial	$100.96
Rate for Payer: BCBS Complete	$53.46
Rate for Payer: BCBS Trust/PPO	$2,051.39
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Mclaren Medicaid	$50.91
Rate for Payer: Meridian Medicaid	$53.46
Rate for Payer: Priority Health Choice Medicaid	$50.91
Rate for Payer: Priority Health Cigna Priority Health	$233.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.52
Rate for Payer: Priority Health Narrow Network	$127.52
Rate for Payer: Priority Health SBD	$127.52

PR CHANGE CYSTOSTOMY TUBE SIMPLE

Professional

Both

$194.00

Service Code	HCPCS 51705
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$1,992.75
Rate for Payer: Aetna Commercial	$65.96
Rate for Payer: BCBS Complete	$34.44
Rate for Payer: BCBS Trust/PPO	$1,992.75
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Mclaren Medicaid	$32.80
Rate for Payer: Meridian Medicaid	$34.44
Rate for Payer: Priority Health Choice Medicaid	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.14
Rate for Payer: Priority Health Narrow Network	$82.14
Rate for Payer: Priority Health SBD	$82.14

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Facility

$819.00

Service Code	CPT 43760
Hospital Charge Code	43760
Hospital Revenue Code	960
Min. Negotiated Rate	$515.97
Max. Negotiated Rate	$737.10
Rate for Payer: Aetna Commercial	$696.15
Rate for Payer: Aetna New Business (MI Preferred)	$532.35
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cofinity Commercial	$573.30
Rate for Payer: Cofinity Commercial	$704.34
Rate for Payer: Healthscope Commercial	$737.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.15
Rate for Payer: PHP Commercial	$696.15
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health SBD	$515.97

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Facility

$819.00

Service Code	CPT 43760
Hospital Charge Code	43760
Hospital Revenue Code	960
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$737.10
Rate for Payer: Aetna Commercial	$696.15
Rate for Payer: Aetna New Business (MI Preferred)	$532.35
Rate for Payer: BCBS Complete	$327.60
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cofinity Commercial	$573.30
Rate for Payer: Cofinity Commercial	$704.34
Rate for Payer: Healthscope Commercial	$737.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.15
Rate for Payer: PHP Commercial	$696.15
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health SBD	$515.97

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Professional

Both

$819.00

Service Code	HCPCS 43760
Hospital Charge Code	43760
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$573.30
Rate for Payer: BCBS Complete	$327.60
Rate for Payer: Cash Price	$655.20
Rate for Payer: Priority Health Cigna Priority Health	$573.30

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Professional

Both

$819.00

Service Code	HCPCS 43760
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$573.30
Rate for Payer: BCBS Complete	$327.60
Rate for Payer: Cash Price	$655.20
Rate for Payer: Priority Health Cigna Priority Health	$573.30

PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE

Professional

Both

$142.00

Service Code	HCPCS 17250
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$4,160.00
Rate for Payer: Aetna Commercial	$38.93
Rate for Payer: BCBS Complete	$25.27
Rate for Payer: BCBS Trust/PPO	$4,160.00
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Mclaren Medicaid	$24.07
Rate for Payer: Meridian Medicaid	$25.27
Rate for Payer: Priority Health Choice Medicaid	$24.07
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.62
Rate for Payer: Priority Health Narrow Network	$45.62
Rate for Payer: Priority Health SBD	$45.62

PR CHEMICAL PEEL FACIAL EPIDERMAL

Professional

Both

$874.00

Service Code	HCPCS 15788
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$611.80
Rate for Payer: Aetna Commercial	$232.57
Rate for Payer: BCBS Complete	$146.26
Rate for Payer: BCBS Trust/PPO	$25.00
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Mclaren Medicaid	$139.30
Rate for Payer: Meridian Medicaid	$146.26
Rate for Payer: Priority Health Choice Medicaid	$139.30
Rate for Payer: Priority Health Cigna Priority Health	$611.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.29
Rate for Payer: Priority Health Narrow Network	$264.29
Rate for Payer: Priority Health SBD	$264.29

PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES

Professional

Both

$310.00

Service Code	HCPCS 64644
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$896.53
Rate for Payer: Aetna Commercial	$150.70
Rate for Payer: BCBS Complete	$77.83
Rate for Payer: BCBS Trust/PPO	$896.53
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Mclaren Medicaid	$74.12
Rate for Payer: Meridian Medicaid	$77.83
Rate for Payer: Priority Health Choice Medicaid	$74.12
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$195.35
Rate for Payer: Priority Health Narrow Network	$195.35
Rate for Payer: Priority Health SBD	$195.35

Know your out-of-pocket cost for care.

All Charges