Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO

Professional

Both

$108.00

Service Code	HCPCS 99487
Min. Negotiated Rate	$50.45
Max. Negotiated Rate	$2,901.95
Rate for Payer: Aetna Commercial	$50.45
Rate for Payer: BCBS Complete	$59.93
Rate for Payer: BCBS Trust/PPO	$2,901.95
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Mclaren Medicaid	$57.08
Rate for Payer: Meridian Medicaid	$59.93
Rate for Payer: Priority Health Choice Medicaid	$57.08
Rate for Payer: Priority Health Cigna Priority Health	$75.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$114.79
Rate for Payer: Priority Health Narrow Network	$114.79
Rate for Payer: Priority Health SBD	$114.79

PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE

Professional

Both

$672.00

Service Code	HCPCS 51727
Min. Negotiated Rate	$168.05
Max. Negotiated Rate	$3,367.38
Rate for Payer: Aetna Commercial	$457.56
Rate for Payer: BCBS Complete	$268.80
Rate for Payer: BCBS Trust/PPO	$3,367.38
Rate for Payer: Cash Price	$537.60
Rate for Payer: Cash Price	$537.60
Rate for Payer: Priority Health Cigna Priority Health	$470.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$168.05
Rate for Payer: Priority Health Narrow Network	$168.05
Rate for Payer: Priority Health SBD	$592.77

PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES

Professional

Both

$647.00

Service Code	HCPCS 51728
Min. Negotiated Rate	$164.27
Max. Negotiated Rate	$2,796.82
Rate for Payer: Aetna Commercial	$461.60
Rate for Payer: BCBS Complete	$258.80
Rate for Payer: BCBS Trust/PPO	$2,796.82
Rate for Payer: Cash Price	$517.60
Rate for Payer: Cash Price	$517.60
Rate for Payer: Priority Health Cigna Priority Health	$452.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.27
Rate for Payer: Priority Health Narrow Network	$164.27
Rate for Payer: Priority Health SBD	$591.16

PR COMPLEX IMPLANT REMOVAL, BILATERAL

Professional

Both

$4,220.00

Service Code	HCPCS 00564
Hospital Revenue Code	990
Min. Negotiated Rate	$1,688.00
Max. Negotiated Rate	$2,954.00
Rate for Payer: BCBS Complete	$1,688.00
Rate for Payer: Cash Price	$3,376.00
Rate for Payer: Priority Health Cigna Priority Health	$2,954.00

PR COMPLEX UROFLOMETRY

Professional

Both

$167.00

Service Code	HCPCS 51741
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$2,933.12
Rate for Payer: Aetna Commercial	$17.72
Rate for Payer: BCBS Complete	$66.80
Rate for Payer: BCBS Trust/PPO	$2,933.12
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.18
Rate for Payer: Priority Health Narrow Network	$9.18
Rate for Payer: Priority Health SBD	$22.69

PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL

Professional

Both

$702.00

Service Code	HCPCS 51729
Min. Negotiated Rate	$199.39
Max. Negotiated Rate	$2,879.24
Rate for Payer: Aetna Commercial	$491.15
Rate for Payer: BCBS Complete	$280.80
Rate for Payer: BCBS Trust/PPO	$2,879.24
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$199.39
Rate for Payer: Priority Health Narrow Network	$199.39
Rate for Payer: Priority Health SBD	$625.73

PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION

Professional

Both

$10,100.00

Service Code	HCPCS 61697
Min. Negotiated Rate	$736.98
Max. Negotiated Rate	$7,191.03
Rate for Payer: Aetna Commercial	$5,432.97
Rate for Payer: BCBS Complete	$2,859.59
Rate for Payer: BCBS Trust/PPO	$736.98
Rate for Payer: Cash Price	$8,080.00
Rate for Payer: Cash Price	$8,080.00
Rate for Payer: Mclaren Medicaid	$2,723.42
Rate for Payer: Meridian Medicaid	$2,859.59
Rate for Payer: Priority Health Choice Medicaid	$2,723.42
Rate for Payer: Priority Health Cigna Priority Health	$7,070.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,191.03
Rate for Payer: Priority Health Narrow Network	$7,191.03
Rate for Payer: Priority Health SBD	$7,191.03

PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ

Professional

Both

$77.00

Service Code	HCPCS 92557
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$196.00
Rate for Payer: Aetna Commercial	$36.02
Rate for Payer: BCBS Complete	$21.02
Rate for Payer: BCBS Trust/PPO	$196.00
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Mclaren Medicaid	$20.02
Rate for Payer: Meridian Medicaid	$21.02
Rate for Payer: Priority Health Choice Medicaid	$20.02
Rate for Payer: Priority Health Cigna Priority Health	$53.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.21
Rate for Payer: Priority Health Narrow Network	$42.21
Rate for Payer: Priority Health SBD	$42.21

PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION

Professional

Both

$1,293.00

Service Code	HCPCS 93620
Min. Negotiated Rate	$286.56
Max. Negotiated Rate	$1,200.30
Rate for Payer: Aetna Commercial	$1,103.18
Rate for Payer: BCBS Complete	$517.20
Rate for Payer: BCBS Trust/PPO	$1,200.30
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Priority Health Cigna Priority Health	$905.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.56
Rate for Payer: Priority Health Narrow Network	$286.56
Rate for Payer: Priority Health SBD	$1,145.76

PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC

Professional

Both

$240.00

Service Code	HCPCS 93621
Min. Negotiated Rate	$37.83
Max. Negotiated Rate	$1,215.62
Rate for Payer: Aetna Commercial	$205.99
Rate for Payer: BCBS Complete	$96.00
Rate for Payer: BCBS Trust/PPO	$1,215.62
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Priority Health Cigna Priority Health	$168.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.83
Rate for Payer: Priority Health Narrow Network	$37.83
Rate for Payer: Priority Health SBD	$151.79

PR COMPRE EP EVAL ABLTJ 3D MAPG TX SVT

Professional

Both

$1,720.00

Service Code	HCPCS 93653
Min. Negotiated Rate	$520.15
Max. Negotiated Rate	$2,938.40
Rate for Payer: Aetna Commercial	$1,121.18
Rate for Payer: BCBS Complete	$546.16
Rate for Payer: BCBS Trust/PPO	$2,938.40
Rate for Payer: Cash Price	$1,376.00
Rate for Payer: Cash Price	$1,376.00
Rate for Payer: Mclaren Medicaid	$520.15
Rate for Payer: Meridian Medicaid	$546.16
Rate for Payer: Priority Health Choice Medicaid	$520.15
Rate for Payer: Priority Health Cigna Priority Health	$1,204.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,167.98
Rate for Payer: Priority Health Narrow Network	$1,167.98
Rate for Payer: Priority Health SBD	$1,167.98

PR COMPRE EP EVAL ABLTJ 3D MAPG TX VT

Professional

Both

$2,304.00

Service Code	HCPCS 93654
Min. Negotiated Rate	$626.65
Max. Negotiated Rate	$3,268.06
Rate for Payer: Aetna Commercial	$1,500.62
Rate for Payer: BCBS Complete	$657.98
Rate for Payer: BCBS Trust/PPO	$3,268.06
Rate for Payer: Cash Price	$1,843.20
Rate for Payer: Cash Price	$1,843.20
Rate for Payer: Mclaren Medicaid	$626.65
Rate for Payer: Meridian Medicaid	$657.98
Rate for Payer: Priority Health Choice Medicaid	$626.65
Rate for Payer: Priority Health Cigna Priority Health	$1,612.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,407.73
Rate for Payer: Priority Health Narrow Network	$1,407.73
Rate for Payer: Priority Health SBD	$1,407.73

PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION

Professional

Both

$1,806.00

Service Code	HCPCS 93656
Min. Negotiated Rate	$589.80
Max. Negotiated Rate	$3,385.35
Rate for Payer: Aetna Commercial	$1,505.46
Rate for Payer: BCBS Complete	$619.29
Rate for Payer: BCBS Trust/PPO	$3,385.35
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Mclaren Medicaid	$589.80
Rate for Payer: Meridian Medicaid	$619.29
Rate for Payer: Priority Health Choice Medicaid	$589.80
Rate for Payer: Priority Health Cigna Priority Health	$1,264.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,324.50
Rate for Payer: Priority Health Narrow Network	$1,324.50
Rate for Payer: Priority Health SBD	$1,324.50

PR CONDITIONING PLAY AUDIOMETRY

Professional

Both

$128.00

Service Code	HCPCS 92582
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$2,061.43
Rate for Payer: Aetna Commercial	$78.02
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$2,061.43
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$89.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$110.04
Rate for Payer: Priority Health Narrow Network	$110.04
Rate for Payer: Priority Health SBD	$110.04

PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC

Professional

Both

$906.00

Service Code	HCPCS 57522
Min. Negotiated Rate	$164.86
Max. Negotiated Rate	$3,117.50
Rate for Payer: Aetna Commercial	$300.68
Rate for Payer: BCBS Complete	$173.10
Rate for Payer: BCBS Trust/PPO	$3,117.50
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Mclaren Medicaid	$164.86
Rate for Payer: Meridian Medicaid	$173.10
Rate for Payer: Priority Health Choice Medicaid	$164.86
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$363.11
Rate for Payer: Priority Health Narrow Network	$363.11
Rate for Payer: Priority Health SBD	$363.11

PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC

Facility

$906.00

Service Code	CPT 57522
Hospital Charge Code	57522
Hospital Revenue Code	960
Min. Negotiated Rate	$570.78
Max. Negotiated Rate	$815.40
Rate for Payer: Aetna Commercial	$770.10
Rate for Payer: Aetna New Business (MI Preferred)	$588.90
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cofinity Commercial	$634.20
Rate for Payer: Cofinity Commercial	$779.16
Rate for Payer: Healthscope Commercial	$815.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$770.10
Rate for Payer: PHP Commercial	$770.10
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health SBD	$570.78

PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC

Professional

Both

$906.00

Service Code	HCPCS 57522
Hospital Charge Code	57522
Min. Negotiated Rate	$164.86
Max. Negotiated Rate	$3,117.50
Rate for Payer: Aetna Commercial	$300.68
Rate for Payer: BCBS Complete	$173.10
Rate for Payer: BCBS Trust/PPO	$3,117.50
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Mclaren Medicaid	$164.86
Rate for Payer: Meridian Medicaid	$173.10
Rate for Payer: Priority Health Choice Medicaid	$164.86
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$363.11
Rate for Payer: Priority Health Narrow Network	$363.11
Rate for Payer: Priority Health SBD	$363.11

PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC

Facility

$906.00

Service Code	CPT 57522
Hospital Charge Code	57522
Hospital Revenue Code	960
Min. Negotiated Rate	$253.44
Max. Negotiated Rate	$3,477.26
Rate for Payer: Aetna Commercial	$770.10
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$588.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$1,286.60
Rate for Payer: BCCCP Commercial	$322.14
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cofinity Commercial	$634.20
Rate for Payer: Cofinity Commercial	$779.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$815.40
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$770.10
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$770.10
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$570.78
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$278.78
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$253.44
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

PR CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER

Professional

Both

$1,019.00

Service Code	HCPCS 57520
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$1,148.52
Rate for Payer: Aetna Commercial	$346.33
Rate for Payer: BCBS Complete	$201.28
Rate for Payer: BCBS Trust/PPO	$1,148.52
Rate for Payer: Cash Price	$815.20
Rate for Payer: Cash Price	$815.20
Rate for Payer: Mclaren Medicaid	$191.70
Rate for Payer: Meridian Medicaid	$201.28
Rate for Payer: Priority Health Choice Medicaid	$191.70
Rate for Payer: Priority Health Cigna Priority Health	$713.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$422.29
Rate for Payer: Priority Health Narrow Network	$422.29
Rate for Payer: Priority Health SBD	$422.29

PR CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT

Professional

Both

$1,668.00

Service Code	HCPCS 57291
Min. Negotiated Rate	$354.43
Max. Negotiated Rate	$1,525.20
Rate for Payer: Aetna Commercial	$654.11
Rate for Payer: BCBS Complete	$372.15
Rate for Payer: BCBS Trust/PPO	$1,525.20
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Mclaren Medicaid	$354.43
Rate for Payer: Meridian Medicaid	$372.15
Rate for Payer: Priority Health Choice Medicaid	$354.43
Rate for Payer: Priority Health Cigna Priority Health	$1,167.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$782.58
Rate for Payer: Priority Health Narrow Network	$782.58
Rate for Payer: Priority Health SBD	$782.58

PR CONSULTS

Professional

Both

$500.00

Service Code	HCPCS 00125
Hospital Revenue Code	990
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$350.00
Rate for Payer: BCBS Complete	$200.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Priority Health Cigna Priority Health	$350.00

PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT

Professional

Both

$269.00

Service Code	HCPCS 95250
Min. Negotiated Rate	$107.60
Max. Negotiated Rate	$424.22
Rate for Payer: Aetna Commercial	$160.67
Rate for Payer: BCBS Complete	$107.60
Rate for Payer: BCBS Trust/PPO	$424.22
Rate for Payer: Cash Price	$215.20
Rate for Payer: Cash Price	$215.20
Rate for Payer: Priority Health Cigna Priority Health	$188.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.93
Rate for Payer: Priority Health Narrow Network	$194.93
Rate for Payer: Priority Health SBD	$194.93

PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT

Professional

Both

$90.00

Service Code	HCPCS 95249
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$234.04
Rate for Payer: Aetna Commercial	$59.92
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$234.04
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$81.74
Rate for Payer: Priority Health Narrow Network	$81.74
Rate for Payer: Priority Health SBD	$81.74

PR CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN

Professional

Both

$3,367.00

Service Code	HCPCS 50825
Min. Negotiated Rate	$1,040.51
Max. Negotiated Rate	$3,355.23
Rate for Payer: Aetna Commercial	$2,127.62
Rate for Payer: BCBS Complete	$1,092.54
Rate for Payer: BCBS Trust/PPO	$3,355.23
Rate for Payer: Cash Price	$2,693.60
Rate for Payer: Cash Price	$2,693.60
Rate for Payer: Mclaren Medicaid	$1,040.51
Rate for Payer: Meridian Medicaid	$1,092.54
Rate for Payer: Priority Health Choice Medicaid	$1,040.51
Rate for Payer: Priority Health Cigna Priority Health	$2,356.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,612.09
Rate for Payer: Priority Health Narrow Network	$2,612.09
Rate for Payer: Priority Health SBD	$2,612.09

PR CONTINENT ILEOSTOMY KOCK PROCEDURE SPX

Professional

Both

$3,962.00

Service Code	HCPCS 44316
Min. Negotiated Rate	$202.06
Max. Negotiated Rate	$2,773.40
Rate for Payer: Aetna Commercial	$1,914.59
Rate for Payer: BCBS Complete	$949.62
Rate for Payer: BCBS Trust/PPO	$202.06
Rate for Payer: Cash Price	$3,169.60
Rate for Payer: Cash Price	$3,169.60
Rate for Payer: Mclaren Medicaid	$904.40
Rate for Payer: Meridian Medicaid	$949.62
Rate for Payer: Priority Health Choice Medicaid	$904.40
Rate for Payer: Priority Health Cigna Priority Health	$2,773.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,484.18
Rate for Payer: Priority Health Narrow Network	$2,484.18
Rate for Payer: Priority Health SBD	$2,484.18

Know your out-of-pocket cost for care.

All Charges