Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE

Professional

Both

$180.00

Service Code	HCPCS 64643
Min. Negotiated Rate	$44.52
Max. Negotiated Rate	$151.09
Rate for Payer: Aetna Commercial	$91.59
Rate for Payer: BCBS Complete	$46.75
Rate for Payer: BCBS Trust/PPO	$151.09
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Mclaren Medicaid	$44.52
Rate for Payer: Meridian Medicaid	$46.75
Rate for Payer: Priority Health Choice Medicaid	$44.52
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.33
Rate for Payer: Priority Health Narrow Network	$118.33
Rate for Payer: Priority Health SBD	$118.33

PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES

Professional

Both

$311.00

Service Code	HCPCS 64645
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$831.02
Rate for Payer: Aetna Commercial	$106.16
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCBS Trust/PPO	$831.02
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Mclaren Medicaid	$51.76
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.60
Rate for Payer: Priority Health Narrow Network	$137.60
Rate for Payer: Priority Health SBD	$137.60

PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE

Professional

Both

$460.00

Service Code	HCPCS 64614
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$322.00
Rate for Payer: BCBS Complete	$184.00
Rate for Payer: Cash Price	$368.00
Rate for Payer: Priority Health Cigna Priority Health	$322.00

PR CHEMODENERVATION INTERNAL ANAL SPHINCTER

Professional

Both

$730.00

Service Code	HCPCS 46505
Min. Negotiated Rate	$160.82
Max. Negotiated Rate	$3,709.19
Rate for Payer: Aetna Commercial	$332.13
Rate for Payer: BCBS Complete	$168.86
Rate for Payer: BCBS Trust/PPO	$3,709.19
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Mclaren Medicaid	$160.82
Rate for Payer: Meridian Medicaid	$168.86
Rate for Payer: Priority Health Choice Medicaid	$160.82
Rate for Payer: Priority Health Cigna Priority Health	$511.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$442.74
Rate for Payer: Priority Health Narrow Network	$442.74
Rate for Payer: Priority Health SBD	$442.74

PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG

Professional

Both

$316.00

Service Code	HCPCS 64617
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$525.13
Rate for Payer: Aetna Commercial	$138.64
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCBS Trust/PPO	$525.13
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Mclaren Medicaid	$69.01
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health	$221.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.90
Rate for Payer: Priority Health Narrow Network	$182.90
Rate for Payer: Priority Health SBD	$182.90

PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA

Professional

Both

$354.00

Service Code	HCPCS 64616
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$3,744.06
Rate for Payer: Aetna Commercial	$139.45
Rate for Payer: BCBS Complete	$74.02
Rate for Payer: BCBS Trust/PPO	$3,744.06
Rate for Payer: Cash Price	$283.20
Rate for Payer: Cash Price	$283.20
Rate for Payer: Mclaren Medicaid	$70.50
Rate for Payer: Meridian Medicaid	$74.02
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health	$247.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.02
Rate for Payer: Priority Health Narrow Network	$184.02
Rate for Payer: Priority Health SBD	$184.02

PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES

Professional

Both

$303.00

Service Code	HCPCS 64646
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$2,036.60
Rate for Payer: Aetna Commercial	$148.68
Rate for Payer: BCBS Complete	$78.06
Rate for Payer: BCBS Trust/PPO	$2,036.60
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cash Price	$242.40
Rate for Payer: Mclaren Medicaid	$74.34
Rate for Payer: Meridian Medicaid	$78.06
Rate for Payer: Priority Health Choice Medicaid	$74.34
Rate for Payer: Priority Health Cigna Priority Health	$212.10
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

PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE

Professional

Both

$390.00

Service Code	HCPCS 64642
Min. Negotiated Rate	$68.59
Max. Negotiated Rate	$805.66
Rate for Payer: Aetna Commercial	$137.53
Rate for Payer: BCBS Complete	$72.02
Rate for Payer: BCBS Trust/PPO	$805.66
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Mclaren Medicaid	$68.59
Rate for Payer: Meridian Medicaid	$72.02
Rate for Payer: Priority Health Choice Medicaid	$68.59
Rate for Payer: Priority Health Cigna Priority Health	$273.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.92
Rate for Payer: Priority Health Narrow Network	$178.92
Rate for Payer: Priority Health SBD	$178.92

PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS

Professional

Both

$210.00

Service Code	HCPCS 64611
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$939.85
Rate for Payer: Aetna Commercial	$137.09
Rate for Payer: BCBS Complete	$76.71
Rate for Payer: BCBS Trust/PPO	$939.85
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Mclaren Medicaid	$73.06
Rate for Payer: Meridian Medicaid	$76.71
Rate for Payer: Priority Health Choice Medicaid	$73.06
Rate for Payer: Priority Health Cigna Priority Health	$147.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$188.55
Rate for Payer: Priority Health Narrow Network	$188.55
Rate for Payer: Priority Health SBD	$188.55

PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE

Professional

Both

$410.00

Service Code	HCPCS 64615
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$2,950.03
Rate for Payer: Aetna Commercial	$158.88
Rate for Payer: BCBS Complete	$82.75
Rate for Payer: BCBS Trust/PPO	$2,950.03
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Mclaren Medicaid	$78.81
Rate for Payer: Meridian Medicaid	$82.75
Rate for Payer: Priority Health Choice Medicaid	$78.81
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$208.36
Rate for Payer: Priority Health Narrow Network	$208.36
Rate for Payer: Priority Health SBD	$208.36

PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL

Professional

Both

$319.00

Service Code	HCPCS 64612
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$2,247.92
Rate for Payer: Aetna Commercial	$148.68
Rate for Payer: BCBS Complete	$80.51
Rate for Payer: BCBS Trust/PPO	$2,247.92
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Mclaren Medicaid	$76.68
Rate for Payer: Meridian Medicaid	$80.51
Rate for Payer: Priority Health Choice Medicaid	$76.68
Rate for Payer: Priority Health Cigna Priority Health	$223.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$200.44
Rate for Payer: Priority Health Narrow Network	$200.44
Rate for Payer: Priority Health SBD	$200.44

PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR

Professional

Both

$130.00

Service Code	HCPCS 96415
Min. Negotiated Rate	$36.56
Max. Negotiated Rate	$1,570.64
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: BCBS Complete	$52.00
Rate for Payer: BCBS Trust/PPO	$1,570.64
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.73
Rate for Payer: Priority Health Narrow Network	$37.73
Rate for Payer: Priority Health SBD	$37.73

PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE

Professional

Both

$719.00

Service Code	HCPCS 96450
Min. Negotiated Rate	$48.14
Max. Negotiated Rate	$889.66
Rate for Payer: Aetna Commercial	$96.12
Rate for Payer: BCBS Complete	$50.55
Rate for Payer: BCBS Trust/PPO	$889.66
Rate for Payer: Cash Price	$575.20
Rate for Payer: Cash Price	$575.20
Rate for Payer: Mclaren Medicaid	$48.14
Rate for Payer: Meridian Medicaid	$50.55
Rate for Payer: Priority Health Choice Medicaid	$48.14
Rate for Payer: Priority Health Cigna Priority Health	$503.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$101.95
Rate for Payer: Priority Health Narrow Network	$101.95
Rate for Payer: Priority Health SBD	$101.95

PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR

Professional

Both

$129.00

Service Code	HCPCS 96417
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$82.79
Rate for Payer: BCBS Complete	$51.60
Rate for Payer: BCBS Trust/PPO	$1,846.41
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Priority Health Cigna Priority Health	$90.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.23
Rate for Payer: Priority Health Narrow Network	$86.23
Rate for Payer: Priority Health SBD	$86.23

PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG

Professional

Both

$243.00

Service Code	HCPCS 96413
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$1,457.05
Rate for Payer: Aetna Commercial	$170.23
Rate for Payer: BCBS Complete	$97.20
Rate for Payer: BCBS Trust/PPO	$1,457.05
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Priority Health Cigna Priority Health	$170.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$175.17
Rate for Payer: Priority Health Narrow Network	$175.17
Rate for Payer: Priority Health SBD	$175.17

PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG

Professional

Both

$203.00

Service Code	HCPCS 96409
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$1,506.18
Rate for Payer: Aetna Commercial	$130.25
Rate for Payer: BCBS Complete	$81.20
Rate for Payer: BCBS Trust/PPO	$1,506.18
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Priority Health Cigna Priority Health	$142.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.19
Rate for Payer: Priority Health Narrow Network	$135.19
Rate for Payer: Priority Health SBD	$135.19

PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG

Professional

Both

$115.00

Service Code	HCPCS 96411
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$1,466.56
Rate for Payer: Aetna Commercial	$71.62
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: BCBS Trust/PPO	$1,466.56
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health SBD	$74.10

PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO

Professional

Both

$81.00

Service Code	HCPCS 96402
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$1,217.73
Rate for Payer: Aetna Commercial	$38.54
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCBS Trust/PPO	$1,217.73
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$56.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.37
Rate for Payer: Priority Health Narrow Network	$45.37
Rate for Payer: Priority Health SBD	$45.37

PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO

Professional

Both

$114.00

Service Code	HCPCS 96401
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$1,111.54
Rate for Payer: Aetna Commercial	$94.74
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS Trust/PPO	$1,111.54
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Priority Health Cigna Priority Health	$79.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.47
Rate for Payer: Priority Health Narrow Network	$97.47
Rate for Payer: Priority Health SBD	$97.47

PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT

Professional

Both

$278.00

Service Code	HCPCS 96542
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$1,570.64
Rate for Payer: Aetna Commercial	$51.17
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$1,570.64
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Mclaren Medicaid	$26.63
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$194.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.69
Rate for Payer: Priority Health Narrow Network	$55.69
Rate for Payer: Priority Health SBD	$55.69

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS

Professional

Both

$61.00

Service Code	HCPCS 98941
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$583.77
Rate for Payer: Aetna Commercial	$29.14
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$583.77
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	$44.92
Rate for Payer: Priority Health Narrow Network	$44.92
Rate for Payer: Priority Health SBD	$44.92

PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL

Professional

Both

$147.00

Service Code	HCPCS 50688
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$2,900.37
Rate for Payer: Aetna Commercial	$97.34
Rate for Payer: BCBS Complete	$51.66
Rate for Payer: BCBS Trust/PPO	$2,900.37
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Mclaren Medicaid	$49.20
Rate for Payer: Meridian Medicaid	$51.66
Rate for Payer: Priority Health Choice Medicaid	$49.20
Rate for Payer: Priority Health Cigna Priority Health	$102.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.20
Rate for Payer: Priority Health Narrow Network	$123.20
Rate for Payer: Priority Health SBD	$123.20

PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,078.00

Service Code	HCPCS 47620
Min. Negotiated Rate	$521.43
Max. Negotiated Rate	$2,414.81
Rate for Payer: Aetna Commercial	$1,866.04
Rate for Payer: BCBS Complete	$922.11
Rate for Payer: BCBS Trust/PPO	$521.43
Rate for Payer: Cash Price	$1,662.40
Rate for Payer: Cash Price	$1,662.40
Rate for Payer: Mclaren Medicaid	$878.20
Rate for Payer: Meridian Medicaid	$922.11
Rate for Payer: Priority Health Choice Medicaid	$878.20
Rate for Payer: Priority Health Cigna Priority Health	$1,454.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,414.81
Rate for Payer: Priority Health Narrow Network	$2,414.81
Rate for Payer: Priority Health SBD	$2,414.81

PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM

Professional

Both

$2,592.00

Service Code	HCPCS 47741
Min. Negotiated Rate	$446.41
Max. Negotiated Rate	$2,592.97
Rate for Payer: Aetna Commercial	$2,001.81
Rate for Payer: BCBS Complete	$990.32
Rate for Payer: BCBS Trust/PPO	$446.41
Rate for Payer: Cash Price	$2,073.60
Rate for Payer: Cash Price	$2,073.60
Rate for Payer: Mclaren Medicaid	$943.16
Rate for Payer: Meridian Medicaid	$990.32
Rate for Payer: Priority Health Choice Medicaid	$943.16
Rate for Payer: Priority Health Cigna Priority Health	$1,814.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,592.97
Rate for Payer: Priority Health Narrow Network	$2,592.97
Rate for Payer: Priority Health SBD	$2,592.97

PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX

Professional

Both

$2,572.00

Service Code	HCPCS 47480
Min. Negotiated Rate	$561.47
Max. Negotiated Rate	$1,800.40
Rate for Payer: Aetna Commercial	$1,185.52
Rate for Payer: BCBS Complete	$589.54
Rate for Payer: BCBS Trust/PPO	$1,405.28
Rate for Payer: Cash Price	$2,057.60
Rate for Payer: Cash Price	$2,057.60
Rate for Payer: Mclaren Medicaid	$561.47
Rate for Payer: Meridian Medicaid	$589.54
Rate for Payer: Priority Health Choice Medicaid	$561.47
Rate for Payer: Priority Health Cigna Priority Health	$1,800.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,544.61
Rate for Payer: Priority Health Narrow Network	$1,544.61
Rate for Payer: Priority Health SBD	$1,544.61

Know your out-of-pocket cost for care.

All Charges