Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ

Professional

Both

$781.00

Service Code	HCPCS 24670
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$1,283.24
Rate for Payer: Aetna Commercial	$353.21
Rate for Payer: BCBS Complete	$187.87
Rate for Payer: BCBS Trust/PPO	$1,283.24
Rate for Payer: Cash Price	$624.80
Rate for Payer: Cash Price	$624.80
Rate for Payer: Mclaren Medicaid	$178.92
Rate for Payer: Meridian Medicaid	$187.87
Rate for Payer: Priority Health Choice Medicaid	$178.92
Rate for Payer: Priority Health Cigna Priority Health	$546.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$421.80
Rate for Payer: Priority Health Narrow Network	$421.80
Rate for Payer: Priority Health SBD	$421.80

PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION

Professional

Both

$1,167.00

Service Code	HCPCS 25535
Min. Negotiated Rate	$302.46
Max. Negotiated Rate	$1,028.60
Rate for Payer: Aetna Commercial	$608.96
Rate for Payer: BCBS Complete	$317.58
Rate for Payer: BCBS Trust/PPO	$1,028.60
Rate for Payer: Cash Price	$933.60
Rate for Payer: Cash Price	$933.60
Rate for Payer: Mclaren Medicaid	$302.46
Rate for Payer: Meridian Medicaid	$317.58
Rate for Payer: Priority Health Choice Medicaid	$302.46
Rate for Payer: Priority Health Cigna Priority Health	$816.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$714.40
Rate for Payer: Priority Health Narrow Network	$714.40
Rate for Payer: Priority Health SBD	$714.40

PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$642.00

Service Code	HCPCS 25530
Min. Negotiated Rate	$162.95
Max. Negotiated Rate	$1,133.73
Rate for Payer: Aetna Commercial	$319.74
Rate for Payer: BCBS Complete	$171.10
Rate for Payer: BCBS Trust/PPO	$1,133.73
Rate for Payer: Cash Price	$513.60
Rate for Payer: Cash Price	$513.60
Rate for Payer: Mclaren Medicaid	$162.95
Rate for Payer: Meridian Medicaid	$171.10
Rate for Payer: Priority Health Choice Medicaid	$162.95
Rate for Payer: Priority Health Cigna Priority Health	$449.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$382.48
Rate for Payer: Priority Health Narrow Network	$382.48
Rate for Payer: Priority Health SBD	$382.48

PR CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX

Professional

Both

$2,053.00

Service Code	HCPCS 21750
Min. Negotiated Rate	$430.05
Max. Negotiated Rate	$1,437.10
Rate for Payer: Aetna Commercial	$910.89
Rate for Payer: BCBS Complete	$451.55
Rate for Payer: BCBS Trust/PPO	$1,388.14
Rate for Payer: Cash Price	$1,642.40
Rate for Payer: Cash Price	$1,642.40
Rate for Payer: Mclaren Medicaid	$430.05
Rate for Payer: Meridian Medicaid	$451.55
Rate for Payer: Priority Health Choice Medicaid	$430.05
Rate for Payer: Priority Health Cigna Priority Health	$1,437.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,025.89
Rate for Payer: Priority Health Narrow Network	$1,025.89
Rate for Payer: Priority Health SBD	$1,025.89

PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE

Professional

Both

$1,392.00

Service Code	HCPCS 51880
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$1,691.09
Rate for Payer: Aetna Commercial	$598.61
Rate for Payer: BCBS Complete	$313.11
Rate for Payer: BCBS Trust/PPO	$1,691.09
Rate for Payer: Cash Price	$1,113.60
Rate for Payer: Cash Price	$1,113.60
Rate for Payer: Mclaren Medicaid	$298.20
Rate for Payer: Meridian Medicaid	$313.11
Rate for Payer: Priority Health Choice Medicaid	$298.20
Rate for Payer: Priority Health Cigna Priority Health	$974.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$742.99
Rate for Payer: Priority Health Narrow Network	$742.99
Rate for Payer: Priority Health SBD	$742.99

PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE

Professional

Both

$2,217.00

Service Code	HCPCS 44620
Min. Negotiated Rate	$210.79
Max. Negotiated Rate	$1,551.90
Rate for Payer: Aetna Commercial	$1,162.18
Rate for Payer: BCBS Complete	$578.36
Rate for Payer: BCBS Trust/PPO	$210.79
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Mclaren Medicaid	$550.82
Rate for Payer: Meridian Medicaid	$578.36
Rate for Payer: Priority Health Choice Medicaid	$550.82
Rate for Payer: Priority Health Cigna Priority Health	$1,551.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,514.61
Rate for Payer: Priority Health Narrow Network	$1,514.61
Rate for Payer: Priority Health SBD	$1,514.61

PR CLOSURE GASTROCOLIC FISTULA

Professional

Both

$3,817.00

Service Code	HCPCS 43880
Min. Negotiated Rate	$198.11
Max. Negotiated Rate	$2,781.10
Rate for Payer: Aetna Commercial	$2,144.57
Rate for Payer: BCBS Complete	$1,077.32
Rate for Payer: BCBS Trust/PPO	$198.11
Rate for Payer: Cash Price	$3,053.60
Rate for Payer: Cash Price	$3,053.60
Rate for Payer: Mclaren Medicaid	$1,026.02
Rate for Payer: Meridian Medicaid	$1,077.32
Rate for Payer: Priority Health Choice Medicaid	$1,026.02
Rate for Payer: Priority Health Cigna Priority Health	$2,671.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,781.10
Rate for Payer: Priority Health Narrow Network	$2,781.10
Rate for Payer: Priority Health SBD	$2,781.10

PR CLOSURE GASTROSTOMY SURG

Professional

Both

$1,917.00

Service Code	HCPCS 43870
Min. Negotiated Rate	$202.87
Max. Negotiated Rate	$1,341.90
Rate for Payer: Aetna Commercial	$958.29
Rate for Payer: BCBS Complete	$477.27
Rate for Payer: BCBS Trust/PPO	$202.87
Rate for Payer: Cash Price	$1,533.60
Rate for Payer: Cash Price	$1,533.60
Rate for Payer: Mclaren Medicaid	$454.54
Rate for Payer: Meridian Medicaid	$477.27
Rate for Payer: Priority Health Choice Medicaid	$454.54
Rate for Payer: Priority Health Cigna Priority Health	$1,341.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,250.03
Rate for Payer: Priority Health Narrow Network	$1,250.03
Rate for Payer: Priority Health SBD	$1,250.03

PR CLOSURE INTESTINAL CUTANEOUS FISTULA

Professional

Both

$2,496.00

Service Code	HCPCS 44640
Min. Negotiated Rate	$175.40
Max. Negotiated Rate	$2,437.73
Rate for Payer: Aetna Commercial	$1,881.85
Rate for Payer: BCBS Complete	$931.51
Rate for Payer: BCBS Trust/PPO	$175.40
Rate for Payer: Cash Price	$1,996.80
Rate for Payer: Cash Price	$1,996.80
Rate for Payer: Mclaren Medicaid	$887.15
Rate for Payer: Meridian Medicaid	$931.51
Rate for Payer: Priority Health Choice Medicaid	$887.15
Rate for Payer: Priority Health Cigna Priority Health	$1,747.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,437.73
Rate for Payer: Priority Health Narrow Network	$2,437.73
Rate for Payer: Priority Health SBD	$2,437.73

PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<

Professional

Both

$526.00

Service Code	HCPCS 40830
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$805.66
Rate for Payer: Aetna Commercial	$217.18
Rate for Payer: BCBS Complete	$97.73
Rate for Payer: BCBS Trust/PPO	$805.66
Rate for Payer: Cash Price	$420.80
Rate for Payer: Cash Price	$420.80
Rate for Payer: Mclaren Medicaid	$93.08
Rate for Payer: Meridian Medicaid	$97.73
Rate for Payer: Priority Health Choice Medicaid	$93.08
Rate for Payer: Priority Health Cigna Priority Health	$368.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$256.36
Rate for Payer: Priority Health Narrow Network	$256.36
Rate for Payer: Priority Health SBD	$256.36

PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL

Professional

Both

$677.00

Service Code	HCPCS 40831
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$949.88
Rate for Payer: Aetna Commercial	$299.67
Rate for Payer: BCBS Complete	$134.86
Rate for Payer: BCBS Trust/PPO	$949.88
Rate for Payer: Cash Price	$541.60
Rate for Payer: Cash Price	$541.60
Rate for Payer: Mclaren Medicaid	$128.44
Rate for Payer: Meridian Medicaid	$134.86
Rate for Payer: Priority Health Choice Medicaid	$128.44
Rate for Payer: Priority Health Cigna Priority Health	$473.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$353.96
Rate for Payer: Priority Health Narrow Network	$353.96
Rate for Payer: Priority Health SBD	$353.96

PR CLOSURE RECTOURETHRAL FISTULA

Professional

Both

$3,219.00

Service Code	HCPCS 45820
Min. Negotiated Rate	$527.24
Max. Negotiated Rate	$2,253.30
Rate for Payer: Aetna Commercial	$1,722.58
Rate for Payer: BCBS Complete	$855.47
Rate for Payer: BCBS Trust/PPO	$527.24
Rate for Payer: Cash Price	$2,575.20
Rate for Payer: Cash Price	$2,575.20
Rate for Payer: Mclaren Medicaid	$814.73
Rate for Payer: Meridian Medicaid	$855.47
Rate for Payer: Priority Health Choice Medicaid	$814.73
Rate for Payer: Priority Health Cigna Priority Health	$2,253.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,240.76
Rate for Payer: Priority Health Narrow Network	$2,240.76
Rate for Payer: Priority Health SBD	$2,240.76

PR CLOSURE RECTOVESICAL FISTULA

Professional

Both

$2,803.00

Service Code	HCPCS 45800
Min. Negotiated Rate	$812.60
Max. Negotiated Rate	$2,234.88
Rate for Payer: Aetna Commercial	$1,718.44
Rate for Payer: BCBS Complete	$853.23
Rate for Payer: BCBS Trust/PPO	$1,277.43
Rate for Payer: Cash Price	$2,242.40
Rate for Payer: Cash Price	$2,242.40
Rate for Payer: Mclaren Medicaid	$812.60
Rate for Payer: Meridian Medicaid	$853.23
Rate for Payer: Priority Health Choice Medicaid	$812.60
Rate for Payer: Priority Health Cigna Priority Health	$1,962.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,234.88
Rate for Payer: Priority Health Narrow Network	$2,234.88
Rate for Payer: Priority Health SBD	$2,234.88

PR CLOSURE SALIVARY FISTULA

Professional

Both

$802.00

Service Code	HCPCS 42600
Min. Negotiated Rate	$230.47
Max. Negotiated Rate	$630.90
Rate for Payer: Aetna Commercial	$464.04
Rate for Payer: BCBS Complete	$241.99
Rate for Payer: BCBS Trust/PPO	$547.85
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cash Price	$641.60
Rate for Payer: Mclaren Medicaid	$230.47
Rate for Payer: Meridian Medicaid	$241.99
Rate for Payer: Priority Health Choice Medicaid	$230.47
Rate for Payer: Priority Health Cigna Priority Health	$561.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$630.90
Rate for Payer: Priority Health Narrow Network	$630.90
Rate for Payer: Priority Health SBD	$630.90

PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH

Professional

Both

$944.00

Service Code	HCPCS 57320
Min. Negotiated Rate	$364.02
Max. Negotiated Rate	$1,656.75
Rate for Payer: Aetna Commercial	$662.82
Rate for Payer: BCBS Complete	$382.22
Rate for Payer: BCBS Trust/PPO	$1,656.75
Rate for Payer: Cash Price	$755.20
Rate for Payer: Cash Price	$755.20
Rate for Payer: Mclaren Medicaid	$364.02
Rate for Payer: Meridian Medicaid	$382.22
Rate for Payer: Priority Health Choice Medicaid	$364.02
Rate for Payer: Priority Health Cigna Priority Health	$660.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$805.77
Rate for Payer: Priority Health Narrow Network	$805.77
Rate for Payer: Priority Health SBD	$805.77

PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION

Professional

Both

$586.00

Service Code	HCPCS 23540
Min. Negotiated Rate	$158.26
Max. Negotiated Rate	$410.20
Rate for Payer: Aetna Commercial	$308.76
Rate for Payer: BCBS Complete	$166.17
Rate for Payer: BCBS Trust/PPO	$393.06
Rate for Payer: Cash Price	$468.80
Rate for Payer: Cash Price	$468.80
Rate for Payer: Mclaren Medicaid	$158.26
Rate for Payer: Meridian Medicaid	$166.17
Rate for Payer: Priority Health Choice Medicaid	$158.26
Rate for Payer: Priority Health Cigna Priority Health	$410.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$372.78
Rate for Payer: Priority Health Narrow Network	$372.78
Rate for Payer: Priority Health SBD	$372.78

PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION

Professional

Both

$506.00

Service Code	HCPCS 23500
Min. Negotiated Rate	$152.93
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$299.45
Rate for Payer: BCBS Complete	$160.58
Rate for Payer: BCBS Trust/PPO	$226.26
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$404.80
Rate for Payer: Mclaren Medicaid	$152.93
Rate for Payer: Meridian Medicaid	$160.58
Rate for Payer: Priority Health Choice Medicaid	$152.93
Rate for Payer: Priority Health Cigna Priority Health	$354.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$360.00
Rate for Payer: Priority Health Narrow Network	$360.00
Rate for Payer: Priority Health SBD	$360.00

PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$827.00

Service Code	HCPCS 24500
Min. Negotiated Rate	$223.22
Max. Negotiated Rate	$578.90
Rate for Payer: Aetna Commercial	$439.50
Rate for Payer: BCBS Complete	$234.38
Rate for Payer: BCBS Trust/PPO	$266.26
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$661.60
Rate for Payer: Mclaren Medicaid	$223.22
Rate for Payer: Meridian Medicaid	$234.38
Rate for Payer: Priority Health Choice Medicaid	$223.22
Rate for Payer: Priority Health Cigna Priority Health	$578.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$524.95
Rate for Payer: Priority Health Narrow Network	$524.95
Rate for Payer: Priority Health SBD	$524.95

PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES

Professional

Both

$450.00

Service Code	HCPCS 27198
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$2,080.97
Rate for Payer: Aetna Commercial	$423.91
Rate for Payer: BCBS Complete	$212.47
Rate for Payer: BCBS Trust/PPO	$2,080.97
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Mclaren Medicaid	$202.35
Rate for Payer: Meridian Medicaid	$212.47
Rate for Payer: Priority Health Choice Medicaid	$202.35
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$482.06
Rate for Payer: Priority Health Narrow Network	$482.06
Rate for Payer: Priority Health SBD	$482.06

PR CLSD TX PELVIC RING FX W/O MANIPULATION

Professional

Both

$231.00

Service Code	HCPCS 27197
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$1,831.62
Rate for Payer: Aetna Commercial	$174.74
Rate for Payer: BCBS Complete	$90.35
Rate for Payer: BCBS Trust/PPO	$1,831.62
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Mclaren Medicaid	$86.05
Rate for Payer: Meridian Medicaid	$90.35
Rate for Payer: Priority Health Choice Medicaid	$86.05
Rate for Payer: Priority Health Cigna Priority Health	$161.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.29
Rate for Payer: Priority Health Narrow Network	$205.29
Rate for Payer: Priority Health SBD	$205.29

PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES

Professional

Both

$1,011.00

Service Code	HCPCS 23655
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$707.70
Rate for Payer: Aetna Commercial	$542.19
Rate for Payer: BCBS Complete	$281.80
Rate for Payer: BCBS Trust/PPO	$372.98
Rate for Payer: Cash Price	$808.80
Rate for Payer: Cash Price	$808.80
Rate for Payer: Mclaren Medicaid	$268.38
Rate for Payer: Meridian Medicaid	$281.80
Rate for Payer: Priority Health Choice Medicaid	$268.38
Rate for Payer: Priority Health Cigna Priority Health	$707.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$634.74
Rate for Payer: Priority Health Narrow Network	$634.74
Rate for Payer: Priority Health SBD	$634.74

PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

Professional

Both

$680.00

Service Code	HCPCS 23650
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$476.00
Rate for Payer: Aetna Commercial	$390.39
Rate for Payer: BCBS Complete	$210.23
Rate for Payer: BCBS Trust/PPO	$328.60
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Mclaren Medicaid	$200.22
Rate for Payer: Meridian Medicaid	$210.23
Rate for Payer: Priority Health Choice Medicaid	$200.22
Rate for Payer: Priority Health Cigna Priority Health	$476.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$470.31
Rate for Payer: Priority Health Narrow Network	$470.31
Rate for Payer: Priority Health SBD	$470.31

PR CLSR ANAL FSTL W/RCT ADVMNT FLAP

Professional

Both

$1,645.00

Service Code	HCPCS 46288
Min. Negotiated Rate	$359.54
Max. Negotiated Rate	$2,458.18
Rate for Payer: Aetna Commercial	$741.11
Rate for Payer: BCBS Complete	$377.52
Rate for Payer: BCBS Trust/PPO	$2,458.18
Rate for Payer: Cash Price	$1,316.00
Rate for Payer: Cash Price	$1,316.00
Rate for Payer: Mclaren Medicaid	$359.54
Rate for Payer: Meridian Medicaid	$377.52
Rate for Payer: Priority Health Choice Medicaid	$359.54
Rate for Payer: Priority Health Cigna Priority Health	$1,151.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$984.85
Rate for Payer: Priority Health Narrow Network	$984.85
Rate for Payer: Priority Health SBD	$984.85

PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA

Professional

Both

$1,835.00

Service Code	HCPCS 32810
Min. Negotiated Rate	$570.84
Max. Negotiated Rate	$1,284.50
Rate for Payer: Aetna Commercial	$1,159.79
Rate for Payer: BCBS Complete	$599.38
Rate for Payer: BCBS Trust/PPO	$807.77
Rate for Payer: Cash Price	$1,468.00
Rate for Payer: Cash Price	$1,468.00
Rate for Payer: Mclaren Medicaid	$570.84
Rate for Payer: Meridian Medicaid	$599.38
Rate for Payer: Priority Health Choice Medicaid	$570.84
Rate for Payer: Priority Health Cigna Priority Health	$1,284.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,231.70
Rate for Payer: Priority Health Narrow Network	$1,231.70
Rate for Payer: Priority Health SBD	$1,231.70

PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL

Professional

Both

$2,528.00

Service Code	HCPCS 44650
Min. Negotiated Rate	$245.13
Max. Negotiated Rate	$2,514.18
Rate for Payer: Aetna Commercial	$1,939.64
Rate for Payer: BCBS Complete	$960.35
Rate for Payer: BCBS Trust/PPO	$245.13
Rate for Payer: Cash Price	$2,022.40
Rate for Payer: Cash Price	$2,022.40
Rate for Payer: Mclaren Medicaid	$914.62
Rate for Payer: Meridian Medicaid	$960.35
Rate for Payer: Priority Health Choice Medicaid	$914.62
Rate for Payer: Priority Health Cigna Priority Health	$1,769.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,514.18
Rate for Payer: Priority Health Narrow Network	$2,514.18
Rate for Payer: Priority Health SBD	$2,514.18

Know your out-of-pocket cost for care.

All Charges