Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CONT INTRAOP NEURO MONITOR

Professional

Both

$125.00

Service Code	HCPCS G0453
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,643.01
Rate for Payer: Aetna Commercial	$32.50
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$1,643.01
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$87.50
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 CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R

Professional

Both

$73.00

Service Code	HCPCS 95251
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$534.11
Rate for Payer: Aetna Commercial	$38.86
Rate for Payer: BCBS Complete	$23.04
Rate for Payer: BCBS Trust/PPO	$534.11
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Mclaren Medicaid	$21.94
Rate for Payer: Meridian Medicaid	$23.04
Rate for Payer: Priority Health Choice Medicaid	$21.94
Rate for Payer: Priority Health Cigna Priority Health	$51.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.81
Rate for Payer: Priority Health Narrow Network	$45.81
Rate for Payer: Priority Health SBD	$45.81

PR CONTINUOUS INHALATION TREATMENT 1ST HR

Professional

Both

$82.00

Service Code	HCPCS 94644
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$270.49
Rate for Payer: Aetna Commercial	$62.69
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: BCBS Trust/PPO	$270.49
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$57.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.95
Rate for Payer: Priority Health Narrow Network	$79.95
Rate for Payer: Priority Health SBD	$79.95

PR CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE

Professional

Both

$60.68

Service Code	HCPCS 49465
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$1,618.71
Rate for Payer: Aetna Commercial	$40.95
Rate for Payer: BCBS Complete	$19.91
Rate for Payer: BCBS Trust/PPO	$1,618.71
Rate for Payer: Cash Price	$48.54
Rate for Payer: Cash Price	$48.54
Rate for Payer: Mclaren Medicaid	$18.96
Rate for Payer: Meridian Medicaid	$19.91
Rate for Payer: Priority Health Choice Medicaid	$18.96
Rate for Payer: Priority Health Cigna Priority Health	$42.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$52.92
Rate for Payer: Priority Health Narrow Network	$52.92
Rate for Payer: Priority Health SBD	$52.92

PR CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX

Professional

Both

$388.00

Service Code	HCPCS 30903
Min. Negotiated Rate	$48.99
Max. Negotiated Rate	$798.79
Rate for Payer: Aetna Commercial	$100.82
Rate for Payer: BCBS Complete	$51.44
Rate for Payer: BCBS Trust/PPO	$798.79
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Mclaren Medicaid	$48.99
Rate for Payer: Meridian Medicaid	$51.44
Rate for Payer: Priority Health Choice Medicaid	$48.99
Rate for Payer: Priority Health Cigna Priority Health	$271.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.96
Rate for Payer: Priority Health Narrow Network	$106.96
Rate for Payer: Priority Health SBD	$106.96

PR CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE

Professional

Both

$259.00

Service Code	HCPCS 30901
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$897.05
Rate for Payer: Aetna Commercial	$72.74
Rate for Payer: BCBS Complete	$37.80
Rate for Payer: BCBS Trust/PPO	$897.05
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Mclaren Medicaid	$36.00
Rate for Payer: Meridian Medicaid	$37.80
Rate for Payer: Priority Health Choice Medicaid	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$181.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$78.26
Rate for Payer: Priority Health Narrow Network	$78.26
Rate for Payer: Priority Health SBD	$78.26

PR CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE

Professional

Both

$320.00

Service Code	HCPCS 42960
Min. Negotiated Rate	$103.73
Max. Negotiated Rate	$283.41
Rate for Payer: Aetna Commercial	$214.84
Rate for Payer: BCBS Complete	$108.92
Rate for Payer: BCBS Trust/PPO	$278.94
Rate for Payer: Cash Price	$256.00
Rate for Payer: Cash Price	$256.00
Rate for Payer: Mclaren Medicaid	$103.73
Rate for Payer: Meridian Medicaid	$108.92
Rate for Payer: Priority Health Choice Medicaid	$103.73
Rate for Payer: Priority Health Cigna Priority Health	$224.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$283.41
Rate for Payer: Priority Health Narrow Network	$283.41
Rate for Payer: Priority Health SBD	$283.41

PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ

Professional

Both

$2,055.00

Service Code	HCPCS 49446
Min. Negotiated Rate	$90.74
Max. Negotiated Rate	$1,438.50
Rate for Payer: Aetna Commercial	$196.04
Rate for Payer: BCBS Complete	$95.28
Rate for Payer: BCBS Trust/PPO	$605.43
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Mclaren Medicaid	$90.74
Rate for Payer: Meridian Medicaid	$95.28
Rate for Payer: Priority Health Choice Medicaid	$90.74
Rate for Payer: Priority Health Cigna Priority Health	$1,438.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$251.66
Rate for Payer: Priority Health Narrow Network	$251.66
Rate for Payer: Priority Health SBD	$251.66

PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT

Professional

Both

$3,387.18

Service Code	HCPCS 27132
Min. Negotiated Rate	$429.51
Max. Negotiated Rate	$2,546.60
Rate for Payer: Aetna Commercial	$2,237.15
Rate for Payer: BCBS Complete	$1,121.83
Rate for Payer: BCBS Trust/PPO	$429.51
Rate for Payer: Cash Price	$2,709.74
Rate for Payer: Cash Price	$2,709.74
Rate for Payer: Mclaren Medicaid	$1,068.41
Rate for Payer: Meridian Medicaid	$1,121.83
Rate for Payer: Priority Health Choice Medicaid	$1,068.41
Rate for Payer: Priority Health Cigna Priority Health	$2,371.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,546.60
Rate for Payer: Priority Health Narrow Network	$2,546.60
Rate for Payer: Priority Health SBD	$2,546.60

PR CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY

Professional

Both

$1,740.00

Service Code	HCPCS 23415
Min. Negotiated Rate	$94.66
Max. Negotiated Rate	$1,218.00
Rate for Payer: Aetna Commercial	$929.83
Rate for Payer: BCBS Complete	$475.48
Rate for Payer: BCBS Trust/PPO	$94.66
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Mclaren Medicaid	$452.84
Rate for Payer: Meridian Medicaid	$475.48
Rate for Payer: Priority Health Choice Medicaid	$452.84
Rate for Payer: Priority Health Cigna Priority Health	$1,218.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,076.45
Rate for Payer: Priority Health Narrow Network	$1,076.45
Rate for Payer: Priority Health SBD	$1,076.45

PR CORDOCENTESIS INTRAUTERINE

Professional

Both

$525.00

Service Code	HCPCS 59012
Min. Negotiated Rate	$128.87
Max. Negotiated Rate	$556.83
Rate for Payer: Aetna Commercial	$220.91
Rate for Payer: BCBS Complete	$135.31
Rate for Payer: BCBS Trust/PPO	$556.83
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Mclaren Medicaid	$128.87
Rate for Payer: Meridian Medicaid	$135.31
Rate for Payer: Priority Health Choice Medicaid	$128.87
Rate for Payer: Priority Health Cigna Priority Health	$367.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$283.77
Rate for Payer: Priority Health Narrow Network	$283.77
Rate for Payer: Priority Health SBD	$283.77

PR CORF RELATED SERV 15 MINS EA

Professional

Both

$31.00

Service Code	HCPCS G0409
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$1,772.97
Rate for Payer: Aetna Commercial	$13.19
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$1,772.97
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70

PR CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT

Professional

Both

$3,966.72

Service Code	HCPCS 33510
Min. Negotiated Rate	$1,211.54
Max. Negotiated Rate	$3,016.19
Rate for Payer: Aetna Commercial	$2,596.25
Rate for Payer: BCBS Complete	$1,272.12
Rate for Payer: BCBS Trust/PPO	$1,333.43
Rate for Payer: Cash Price	$3,173.38
Rate for Payer: Cash Price	$3,173.38
Rate for Payer: Mclaren Medicaid	$1,211.54
Rate for Payer: Meridian Medicaid	$1,272.12
Rate for Payer: Priority Health Choice Medicaid	$1,211.54
Rate for Payer: Priority Health Cigna Priority Health	$2,776.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,016.19
Rate for Payer: Priority Health Narrow Network	$3,016.19
Rate for Payer: Priority Health SBD	$3,016.19

PR CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS

Professional

Both

$4,357.00

Service Code	HCPCS 33511
Min. Negotiated Rate	$1,241.51
Max. Negotiated Rate	$3,310.37
Rate for Payer: Aetna Commercial	$2,850.71
Rate for Payer: BCBS Complete	$1,396.92
Rate for Payer: BCBS Trust/PPO	$1,241.51
Rate for Payer: Cash Price	$3,485.60
Rate for Payer: Cash Price	$3,485.60
Rate for Payer: Mclaren Medicaid	$1,330.40
Rate for Payer: Meridian Medicaid	$1,396.92
Rate for Payer: Priority Health Choice Medicaid	$1,330.40
Rate for Payer: Priority Health Cigna Priority Health	$3,049.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,310.37
Rate for Payer: Priority Health Narrow Network	$3,310.37
Rate for Payer: Priority Health SBD	$3,310.37

PR CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS

Professional

Both

$9,723.00

Service Code	HCPCS 33512
Min. Negotiated Rate	$1,337.66
Max. Negotiated Rate	$6,806.10
Rate for Payer: Aetna Commercial	$3,251.77
Rate for Payer: BCBS Complete	$1,591.28
Rate for Payer: BCBS Trust/PPO	$1,337.66
Rate for Payer: Cash Price	$7,778.40
Rate for Payer: Cash Price	$7,778.40
Rate for Payer: Mclaren Medicaid	$1,515.50
Rate for Payer: Meridian Medicaid	$1,591.28
Rate for Payer: Priority Health Choice Medicaid	$1,515.50
Rate for Payer: Priority Health Cigna Priority Health	$6,806.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,774.78
Rate for Payer: Priority Health Narrow Network	$3,774.78
Rate for Payer: Priority Health SBD	$3,774.78

PR CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS

Professional

Both

$9,922.00

Service Code	HCPCS 33513
Min. Negotiated Rate	$1,257.88
Max. Negotiated Rate	$6,945.40
Rate for Payer: Aetna Commercial	$3,340.84
Rate for Payer: BCBS Complete	$1,624.82
Rate for Payer: BCBS Trust/PPO	$1,257.88
Rate for Payer: Cash Price	$7,937.60
Rate for Payer: Cash Price	$7,937.60
Rate for Payer: Mclaren Medicaid	$1,547.45
Rate for Payer: Meridian Medicaid	$1,624.82
Rate for Payer: Priority Health Choice Medicaid	$1,547.45
Rate for Payer: Priority Health Cigna Priority Health	$6,945.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,861.48
Rate for Payer: Priority Health Narrow Network	$3,861.48
Rate for Payer: Priority Health SBD	$3,861.48

PR CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT

Professional

Both

$11,159.00

Service Code	HCPCS 33516
Min. Negotiated Rate	$1,382.03
Max. Negotiated Rate	$7,811.30
Rate for Payer: Aetna Commercial	$3,631.83
Rate for Payer: BCBS Complete	$1,767.96
Rate for Payer: BCBS Trust/PPO	$1,382.03
Rate for Payer: Cash Price	$8,927.20
Rate for Payer: Cash Price	$8,927.20
Rate for Payer: Mclaren Medicaid	$1,683.77
Rate for Payer: Meridian Medicaid	$1,767.96
Rate for Payer: Priority Health Choice Medicaid	$1,683.77
Rate for Payer: Priority Health Cigna Priority Health	$7,811.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,200.33
Rate for Payer: Priority Health Narrow Network	$4,200.33
Rate for Payer: Priority Health SBD	$4,200.33

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN

Professional

Both

$788.00

Service Code	HCPCS 33517
Min. Negotiated Rate	$116.72
Max. Negotiated Rate	$1,181.81
Rate for Payer: Aetna Commercial	$252.04
Rate for Payer: BCBS Complete	$122.56
Rate for Payer: BCBS Trust/PPO	$1,181.81
Rate for Payer: Cash Price	$630.40
Rate for Payer: Cash Price	$630.40
Rate for Payer: Mclaren Medicaid	$116.72
Rate for Payer: Meridian Medicaid	$122.56
Rate for Payer: Priority Health Choice Medicaid	$116.72
Rate for Payer: Priority Health Cigna Priority Health	$551.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$289.92
Rate for Payer: Priority Health Narrow Network	$289.92
Rate for Payer: Priority Health SBD	$289.92

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN

Professional

Both

$1,299.00

Service Code	HCPCS 33518
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$1,337.66
Rate for Payer: Aetna Commercial	$554.43
Rate for Payer: BCBS Complete	$268.38
Rate for Payer: BCBS Trust/PPO	$1,337.66
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Mclaren Medicaid	$255.60
Rate for Payer: Meridian Medicaid	$268.38
Rate for Payer: Priority Health Choice Medicaid	$255.60
Rate for Payer: Priority Health Cigna Priority Health	$909.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$638.89
Rate for Payer: Priority Health Narrow Network	$638.89
Rate for Payer: Priority Health SBD	$638.89

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN

Professional

Both

$1,892.00

Service Code	HCPCS 33519
Min. Negotiated Rate	$338.24
Max. Negotiated Rate	$1,324.40
Rate for Payer: Aetna Commercial	$733.06
Rate for Payer: BCBS Complete	$355.15
Rate for Payer: BCBS Trust/PPO	$987.39
Rate for Payer: Cash Price	$1,513.60
Rate for Payer: Cash Price	$1,513.60
Rate for Payer: Mclaren Medicaid	$338.24
Rate for Payer: Meridian Medicaid	$355.15
Rate for Payer: Priority Health Choice Medicaid	$338.24
Rate for Payer: Priority Health Cigna Priority Health	$1,324.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$844.22
Rate for Payer: Priority Health Narrow Network	$844.22
Rate for Payer: Priority Health SBD	$844.22

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN

Professional

Both

$2,540.00

Service Code	HCPCS 33521
Min. Negotiated Rate	$158.49
Max. Negotiated Rate	$1,778.00
Rate for Payer: Aetna Commercial	$879.90
Rate for Payer: BCBS Complete	$425.61
Rate for Payer: BCBS Trust/PPO	$158.49
Rate for Payer: Cash Price	$2,032.00
Rate for Payer: Cash Price	$2,032.00
Rate for Payer: Mclaren Medicaid	$405.34
Rate for Payer: Meridian Medicaid	$425.61
Rate for Payer: Priority Health Choice Medicaid	$405.34
Rate for Payer: Priority Health Cigna Priority Health	$1,778.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,011.78
Rate for Payer: Priority Health Narrow Network	$1,011.78
Rate for Payer: Priority Health SBD	$1,011.78

PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN

Professional

Both

$3,227.00

Service Code	HCPCS 33522
Min. Negotiated Rate	$455.61
Max. Negotiated Rate	$2,258.90
Rate for Payer: Aetna Commercial	$988.00
Rate for Payer: BCBS Complete	$478.39
Rate for Payer: BCBS Trust/PPO	$1,230.94
Rate for Payer: Cash Price	$2,581.60
Rate for Payer: Cash Price	$2,581.60
Rate for Payer: Mclaren Medicaid	$455.61
Rate for Payer: Meridian Medicaid	$478.39
Rate for Payer: Priority Health Choice Medicaid	$455.61
Rate for Payer: Priority Health Cigna Priority Health	$2,258.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,136.79
Rate for Payer: Priority Health Narrow Network	$1,136.79
Rate for Payer: Priority Health SBD	$1,136.79

PR CORONARY ENDARTERCOMY OPEN ANY METHOD

Professional

Both

$1,270.00

Service Code	HCPCS 33572
Min. Negotiated Rate	$143.78
Max. Negotiated Rate	$889.00
Rate for Payer: Aetna Commercial	$310.69
Rate for Payer: BCBS Complete	$150.97
Rate for Payer: BCBS Trust/PPO	$863.77
Rate for Payer: Cash Price	$1,016.00
Rate for Payer: Cash Price	$1,016.00
Rate for Payer: Mclaren Medicaid	$143.78
Rate for Payer: Meridian Medicaid	$150.97
Rate for Payer: Priority Health Choice Medicaid	$143.78
Rate for Payer: Priority Health Cigna Priority Health	$889.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$358.54
Rate for Payer: Priority Health Narrow Network	$358.54
Rate for Payer: Priority Health SBD	$358.54

PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI

Professional

Both

$1,837.00

Service Code	HCPCS 54430
Min. Negotiated Rate	$407.68
Max. Negotiated Rate	$3,265.16
Rate for Payer: Aetna Commercial	$819.70
Rate for Payer: BCBS Complete	$428.06
Rate for Payer: BCBS Trust/PPO	$3,265.16
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Cash Price	$1,469.60
Rate for Payer: Mclaren Medicaid	$407.68
Rate for Payer: Meridian Medicaid	$428.06
Rate for Payer: Priority Health Choice Medicaid	$407.68
Rate for Payer: Priority Health Cigna Priority Health	$1,285.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,020.20
Rate for Payer: Priority Health Narrow Network	$1,020.20
Rate for Payer: Priority Health SBD	$1,020.20

PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM

Professional

Both

$738.00

Service Code	HCPCS 54435
Min. Negotiated Rate	$265.61
Max. Negotiated Rate	$1,738.11
Rate for Payer: Aetna Commercial	$529.89
Rate for Payer: BCBS Complete	$278.89
Rate for Payer: BCBS Trust/PPO	$1,738.11
Rate for Payer: Cash Price	$590.40
Rate for Payer: Cash Price	$590.40
Rate for Payer: Mclaren Medicaid	$265.61
Rate for Payer: Meridian Medicaid	$278.89
Rate for Payer: Priority Health Choice Medicaid	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$516.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$663.55
Rate for Payer: Priority Health Narrow Network	$663.55
Rate for Payer: Priority Health SBD	$663.55

Know your out-of-pocket cost for care.

All Charges