Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST

Professional

Both

$438.00

Service Code	HCPCS 30905
Min. Negotiated Rate	$67.31
Max. Negotiated Rate	$835.24
Rate for Payer: Aetna Commercial	$136.69
Rate for Payer: BCBS Complete	$70.68
Rate for Payer: BCBS Trust/PPO	$835.24
Rate for Payer: Cash Price	$350.40
Rate for Payer: Cash Price	$350.40
Rate for Payer: Mclaren Medicaid	$67.31
Rate for Payer: Meridian Medicaid	$70.68
Rate for Payer: Priority Health Choice Medicaid	$67.31
Rate for Payer: Priority Health Cigna Priority Health	$306.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$146.32
Rate for Payer: Priority Health Narrow Network	$146.32
Rate for Payer: Priority Health SBD	$146.32

PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ

Professional

Both

$587.00

Service Code	HCPCS 30906
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$907.62
Rate for Payer: Aetna Commercial	$174.23
Rate for Payer: BCBS Complete	$88.57
Rate for Payer: BCBS Trust/PPO	$907.62
Rate for Payer: Cash Price	$469.60
Rate for Payer: Cash Price	$469.60
Rate for Payer: Mclaren Medicaid	$84.35
Rate for Payer: Meridian Medicaid	$88.57
Rate for Payer: Priority Health Choice Medicaid	$84.35
Rate for Payer: Priority Health Cigna Priority Health	$410.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.83
Rate for Payer: Priority Health Narrow Network	$183.83
Rate for Payer: Priority Health SBD	$183.83

PR CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ

Professional

Both

$765.00

Service Code	HCPCS 42961
Min. Negotiated Rate	$269.96
Max. Negotiated Rate	$742.62
Rate for Payer: Aetna Commercial	$551.09
Rate for Payer: BCBS Complete	$284.49
Rate for Payer: BCBS Trust/PPO	$269.96
Rate for Payer: Cash Price	$612.00
Rate for Payer: Cash Price	$612.00
Rate for Payer: Mclaren Medicaid	$270.94
Rate for Payer: Meridian Medicaid	$284.49
Rate for Payer: Priority Health Choice Medicaid	$270.94
Rate for Payer: Priority Health Cigna Priority Health	$535.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$742.62
Rate for Payer: Priority Health Narrow Network	$742.62
Rate for Payer: Priority Health SBD	$742.62

PR CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Professional

Both

$1,864.00

Service Code	HCPCS 42962
Min. Negotiated Rate	$333.56
Max. Negotiated Rate	$1,304.80
Rate for Payer: Aetna Commercial	$682.74
Rate for Payer: BCBS Complete	$350.24
Rate for Payer: BCBS Trust/PPO	$346.04
Rate for Payer: Cash Price	$1,491.20
Rate for Payer: Cash Price	$1,491.20
Rate for Payer: Mclaren Medicaid	$333.56
Rate for Payer: Meridian Medicaid	$350.24
Rate for Payer: Priority Health Choice Medicaid	$333.56
Rate for Payer: Priority Health Cigna Priority Health	$1,304.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$918.42
Rate for Payer: Priority Health Narrow Network	$918.42
Rate for Payer: Priority Health SBD	$918.42

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS

Professional

Both

$528.00

Service Code	HCPCS 95929
Min. Negotiated Rate	$103.30
Max. Negotiated Rate	$369.60
Rate for Payer: Aetna Commercial	$260.29
Rate for Payer: BCBS Complete	$211.20
Rate for Payer: BCBS Trust/PPO	$111.47
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Priority Health Cigna Priority Health	$369.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.30
Rate for Payer: Priority Health Narrow Network	$103.30
Rate for Payer: Priority Health SBD	$321.13

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS

Professional

Both

$333.00

Service Code	HCPCS 95928
Min. Negotiated Rate	$99.85
Max. Negotiated Rate	$316.20
Rate for Payer: Aetna Commercial	$253.19
Rate for Payer: Aetna Commercial	$253.19
Rate for Payer: BCBS Complete	$194.80
Rate for Payer: BCBS Complete	$133.20
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$389.60
Rate for Payer: Priority Health Cigna Priority Health	$340.90
Rate for Payer: Priority Health Cigna Priority Health	$233.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.75
Rate for Payer: Priority Health Narrow Network	$103.75
Rate for Payer: Priority Health Narrow Network	$103.75
Rate for Payer: Priority Health SBD	$316.20
Rate for Payer: Priority Health SBD	$316.20

PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI

Professional

Both

$322.00

Service Code	HCPCS 95939
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$732.55
Rate for Payer: Aetna Commercial	$578.57
Rate for Payer: BCBS Complete	$128.80
Rate for Payer: BCBS Trust/PPO	$596.45
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.95
Rate for Payer: Priority Health Narrow Network	$154.95
Rate for Payer: Priority Health SBD	$732.55

PR CURETTAGE POSTPARTUM

Professional

Both

$535.00

Service Code	HCPCS 59160
Min. Negotiated Rate	$121.84
Max. Negotiated Rate	$516.15
Rate for Payer: Aetna Commercial	$203.67
Rate for Payer: BCBS Complete	$127.93
Rate for Payer: BCBS Trust/PPO	$516.15
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cash Price	$428.00
Rate for Payer: Mclaren Medicaid	$121.84
Rate for Payer: Meridian Medicaid	$127.93
Rate for Payer: Priority Health Choice Medicaid	$121.84
Rate for Payer: Priority Health Cigna Priority Health	$374.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.14
Rate for Payer: Priority Health Narrow Network	$269.14
Rate for Payer: Priority Health SBD	$269.14

PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ

Professional

Both

$328.00

Service Code	HCPCS 46942
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$1,144.83
Rate for Payer: Aetna Commercial	$172.65
Rate for Payer: BCBS Complete	$87.68
Rate for Payer: BCBS Trust/PPO	$1,144.83
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Mclaren Medicaid	$83.50
Rate for Payer: Meridian Medicaid	$87.68
Rate for Payer: Priority Health Choice Medicaid	$83.50
Rate for Payer: Priority Health Cigna Priority Health	$229.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$228.72
Rate for Payer: Priority Health Narrow Network	$228.72
Rate for Payer: Priority Health SBD	$228.72

PR CUSTOM EAR PLUGS

Professional

Both

$140.00

Service Code	HCPCS 00592
Hospital Revenue Code	990
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$98.00
Rate for Payer: BCBS Complete	$56.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Priority Health Cigna Priority Health	$98.00

PR CUTANEOUS VESICOSTOMY

Professional

Both

$1,431.00

Service Code	HCPCS 51980
Min. Negotiated Rate	$454.54
Max. Negotiated Rate	$2,370.48
Rate for Payer: Aetna Commercial	$916.03
Rate for Payer: BCBS Complete	$477.27
Rate for Payer: BCBS Trust/PPO	$2,370.48
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Cash Price	$1,144.80
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	$1,001.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,139.07
Rate for Payer: Priority Health Narrow Network	$1,139.07
Rate for Payer: Priority Health SBD	$1,139.07

PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY

Professional

Both

$167.00

Service Code	HCPCS 93018
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$1,814.71
Rate for Payer: Aetna Commercial	$19.31
Rate for Payer: BCBS Complete	$9.17
Rate for Payer: BCBS Trust/PPO	$1,814.71
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Mclaren Medicaid	$8.73
Rate for Payer: Meridian Medicaid	$9.17
Rate for Payer: Priority Health Choice Medicaid	$8.73
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.38
Rate for Payer: Priority Health Narrow Network	$19.38
Rate for Payer: Priority Health SBD	$19.38

PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY

Professional

Both

$111.00

Service Code	HCPCS 93017
Min. Negotiated Rate	$43.41
Max. Negotiated Rate	$1,426.94
Rate for Payer: Aetna Commercial	$43.41
Rate for Payer: BCBS Complete	$44.40
Rate for Payer: BCBS Trust/PPO	$1,426.94
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Priority Health Cigna Priority Health	$77.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.60
Rate for Payer: Priority Health Narrow Network	$50.60
Rate for Payer: Priority Health SBD	$50.60

PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R

Professional

Both

$111.00

Service Code	HCPCS 93016
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$1,780.90
Rate for Payer: Aetna Commercial	$28.99
Rate for Payer: BCBS Complete	$13.87
Rate for Payer: BCBS Trust/PPO	$1,780.90
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Mclaren Medicaid	$13.21
Rate for Payer: Meridian Medicaid	$13.87
Rate for Payer: Priority Health Choice Medicaid	$13.21
Rate for Payer: Priority Health Cigna Priority Health	$77.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.32
Rate for Payer: Priority Health Narrow Network	$29.32
Rate for Payer: Priority Health SBD	$29.32

PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R

Professional

Both

$443.00

Service Code	HCPCS 93015
Min. Negotiated Rate	$91.71
Max. Negotiated Rate	$2,485.65
Rate for Payer: Aetna Commercial	$91.71
Rate for Payer: BCBS Complete	$177.20
Rate for Payer: BCBS Trust/PPO	$2,485.65
Rate for Payer: Cash Price	$354.40
Rate for Payer: Cash Price	$354.40
Rate for Payer: Priority Health Cigna Priority Health	$310.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.30
Rate for Payer: Priority Health Narrow Network	$99.30
Rate for Payer: Priority Health SBD	$99.30

PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE

Professional

Both

$2,756.00

Service Code	HCPCS 51570
Min. Negotiated Rate	$931.24
Max. Negotiated Rate	$3,145.50
Rate for Payer: Aetna Commercial	$1,887.68
Rate for Payer: BCBS Complete	$977.80
Rate for Payer: BCBS Trust/PPO	$3,145.50
Rate for Payer: Cash Price	$2,204.80
Rate for Payer: Cash Price	$2,204.80
Rate for Payer: Mclaren Medicaid	$931.24
Rate for Payer: Meridian Medicaid	$977.80
Rate for Payer: Priority Health Choice Medicaid	$931.24
Rate for Payer: Priority Health Cigna Priority Health	$1,929.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,339.76
Rate for Payer: Priority Health Narrow Network	$2,339.76
Rate for Payer: Priority Health SBD	$2,339.76

PR CYSTECTOMY PARTIAL COMPLICATED

Professional

Both

$7,600.00

Service Code	HCPCS 51555
Min. Negotiated Rate	$798.96
Max. Negotiated Rate	$5,320.00
Rate for Payer: Aetna Commercial	$1,622.71
Rate for Payer: BCBS Complete	$838.91
Rate for Payer: BCBS Trust/PPO	$2,383.69
Rate for Payer: Cash Price	$6,080.00
Rate for Payer: Cash Price	$6,080.00
Rate for Payer: Mclaren Medicaid	$798.96
Rate for Payer: Meridian Medicaid	$838.91
Rate for Payer: Priority Health Choice Medicaid	$798.96
Rate for Payer: Priority Health Cigna Priority Health	$5,320.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,002.57
Rate for Payer: Priority Health Narrow Network	$2,002.57
Rate for Payer: Priority Health SBD	$2,002.57

PR CYSTECTOMY PARTIAL SIMPLE

Professional

Both

$1,515.00

Service Code	HCPCS 51550
Min. Negotiated Rate	$612.38
Max. Negotiated Rate	$2,405.35
Rate for Payer: Aetna Commercial	$1,235.96
Rate for Payer: BCBS Complete	$643.00
Rate for Payer: BCBS Trust/PPO	$2,405.35
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Mclaren Medicaid	$612.38
Rate for Payer: Meridian Medicaid	$643.00
Rate for Payer: Priority Health Choice Medicaid	$612.38
Rate for Payer: Priority Health Cigna Priority Health	$1,060.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,534.62
Rate for Payer: Priority Health Narrow Network	$1,534.62
Rate for Payer: Priority Health SBD	$1,534.62

PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY

Professional

Both

$3,722.00

Service Code	HCPCS 51575
Min. Negotiated Rate	$1,146.37
Max. Negotiated Rate	$3,111.16
Rate for Payer: Aetna Commercial	$2,337.60
Rate for Payer: BCBS Complete	$1,203.69
Rate for Payer: BCBS Trust/PPO	$3,111.16
Rate for Payer: Cash Price	$2,977.60
Rate for Payer: Cash Price	$2,977.60
Rate for Payer: Mclaren Medicaid	$1,146.37
Rate for Payer: Meridian Medicaid	$1,203.69
Rate for Payer: Priority Health Choice Medicaid	$1,146.37
Rate for Payer: Priority Health Cigna Priority Health	$2,605.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,886.06
Rate for Payer: Priority Health Narrow Network	$2,886.06
Rate for Payer: Priority Health SBD	$2,886.06

PR CYSTO BLADDER W/URETERAL CATHETERIZATION

Professional

Both

$548.00

Service Code	HCPCS 52005
Min. Negotiated Rate	$84.14
Max. Negotiated Rate	$2,077.80
Rate for Payer: Aetna Commercial	$169.08
Rate for Payer: BCBS Complete	$88.35
Rate for Payer: BCBS Trust/PPO	$2,077.80
Rate for Payer: Cash Price	$438.40
Rate for Payer: Cash Price	$438.40
Rate for Payer: Mclaren Medicaid	$84.14
Rate for Payer: Meridian Medicaid	$88.35
Rate for Payer: Priority Health Choice Medicaid	$84.14
Rate for Payer: Priority Health Cigna Priority Health	$383.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$209.11
Rate for Payer: Priority Health Narrow Network	$209.11
Rate for Payer: Priority Health SBD	$209.11

PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS

Professional

Both

$758.00

Service Code	HCPCS 52281
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$2,364.67
Rate for Payer: Aetna Commercial	$193.91
Rate for Payer: BCBS Complete	$100.64
Rate for Payer: BCBS Trust/PPO	$2,364.67
Rate for Payer: Cash Price	$606.40
Rate for Payer: Cash Price	$606.40
Rate for Payer: Mclaren Medicaid	$95.85
Rate for Payer: Meridian Medicaid	$100.64
Rate for Payer: Priority Health Choice Medicaid	$95.85
Rate for Payer: Priority Health Cigna Priority Health	$530.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$240.46
Rate for Payer: Priority Health Narrow Network	$240.46
Rate for Payer: Priority Health SBD	$240.46

PR CYSTO FRAGMENTATION URETERAL STONE

Professional

Both

$652.00

Service Code	HCPCS 52325
Min. Negotiated Rate	$200.65
Max. Negotiated Rate	$4,083.76
Rate for Payer: Aetna Commercial	$410.09
Rate for Payer: BCBS Complete	$210.68
Rate for Payer: BCBS Trust/PPO	$4,083.76
Rate for Payer: Cash Price	$521.60
Rate for Payer: Cash Price	$521.60
Rate for Payer: Mclaren Medicaid	$200.65
Rate for Payer: Meridian Medicaid	$210.68
Rate for Payer: Priority Health Choice Medicaid	$200.65
Rate for Payer: Priority Health Cigna Priority Health	$456.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$504.70
Rate for Payer: Priority Health Narrow Network	$504.70
Rate for Payer: Priority Health SBD	$504.70

PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT

Professional

Both

$536.00

Service Code	HCPCS 52305
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$894.94
Rate for Payer: Aetna Commercial	$356.38
Rate for Payer: BCBS Complete	$183.17
Rate for Payer: BCBS Trust/PPO	$894.94
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cash Price	$428.80
Rate for Payer: Mclaren Medicaid	$174.45
Rate for Payer: Meridian Medicaid	$183.17
Rate for Payer: Priority Health Choice Medicaid	$174.45
Rate for Payer: Priority Health Cigna Priority Health	$375.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$439.85
Rate for Payer: Priority Health Narrow Network	$439.85
Rate for Payer: Priority Health SBD	$439.85

PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL

Professional

Both

$1,686.00

Service Code	HCPCS 52442
Min. Negotiated Rate	$31.74
Max. Negotiated Rate	$1,180.20
Rate for Payer: Aetna Commercial	$66.05
Rate for Payer: BCBS Complete	$33.33
Rate for Payer: BCBS Trust/PPO	$367.70
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Mclaren Medicaid	$31.74
Rate for Payer: Meridian Medicaid	$33.33
Rate for Payer: Priority Health Choice Medicaid	$31.74
Rate for Payer: Priority Health Cigna Priority Health	$1,180.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.97
Rate for Payer: Priority Health Narrow Network	$79.97
Rate for Payer: Priority Health SBD	$79.97

PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE

Professional

Both

$2,204.00

Service Code	HCPCS 52441
Min. Negotiated Rate	$131.63
Max. Negotiated Rate	$1,542.80
Rate for Payer: Aetna Commercial	$268.82
Rate for Payer: BCBS Complete	$138.21
Rate for Payer: BCBS Trust/PPO	$528.83
Rate for Payer: Cash Price	$1,763.20
Rate for Payer: Cash Price	$1,763.20
Rate for Payer: Mclaren Medicaid	$131.63
Rate for Payer: Meridian Medicaid	$138.21
Rate for Payer: Priority Health Choice Medicaid	$131.63
Rate for Payer: Priority Health Cigna Priority Health	$1,542.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$330.70
Rate for Payer: Priority Health Narrow Network	$330.70
Rate for Payer: Priority Health SBD	$330.70

Know your out-of-pocket cost for care.

All Charges