Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR

Professional

Both

$925.00

Service Code	HCPCS 52334
Min. Negotiated Rate	$114.81
Max. Negotiated Rate	$2,807.39
Rate for Payer: Aetna Commercial	$233.82
Rate for Payer: BCBS Complete	$120.55
Rate for Payer: BCBS Trust/PPO	$2,807.39
Rate for Payer: Cash Price	$740.00
Rate for Payer: Cash Price	$740.00
Rate for Payer: Mclaren Medicaid	$114.81
Rate for Payer: Meridian Medicaid	$120.55
Rate for Payer: Priority Health Choice Medicaid	$114.81
Rate for Payer: Priority Health Cigna Priority Health	$647.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$289.10
Rate for Payer: Priority Health Narrow Network	$289.10
Rate for Payer: Priority Health SBD	$289.10

PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS

Professional

Both

$1,018.00

Service Code	HCPCS 51050
Min. Negotiated Rate	$302.03
Max. Negotiated Rate	$3,253.27
Rate for Payer: Aetna Commercial	$604.90
Rate for Payer: BCBS Complete	$317.13
Rate for Payer: BCBS Trust/PPO	$3,253.27
Rate for Payer: Cash Price	$814.40
Rate for Payer: Cash Price	$814.40
Rate for Payer: Mclaren Medicaid	$302.03
Rate for Payer: Meridian Medicaid	$317.13
Rate for Payer: Priority Health Choice Medicaid	$302.03
Rate for Payer: Priority Health Cigna Priority Health	$712.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$754.35
Rate for Payer: Priority Health Narrow Network	$754.35
Rate for Payer: Priority Health SBD	$754.35

PR CYSTO MANJ W/O RMVL URETERAL STONE

Professional

Both

$1,029.00

Service Code	HCPCS 52330
Min. Negotiated Rate	$165.29
Max. Negotiated Rate	$6,449.49
Rate for Payer: Aetna Commercial	$337.43
Rate for Payer: BCBS Complete	$173.55
Rate for Payer: BCBS Trust/PPO	$6,449.49
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cash Price	$823.20
Rate for Payer: Mclaren Medicaid	$165.29
Rate for Payer: Meridian Medicaid	$173.55
Rate for Payer: Priority Health Choice Medicaid	$165.29
Rate for Payer: Priority Health Cigna Priority Health	$720.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$414.99
Rate for Payer: Priority Health Narrow Network	$414.99
Rate for Payer: Priority Health SBD	$414.99

PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION

Professional

Both

$747.00

Service Code	HCPCS 52354
Min. Negotiated Rate	$261.56
Max. Negotiated Rate	$656.54
Rate for Payer: Aetna Commercial	$534.36
Rate for Payer: BCBS Complete	$274.64
Rate for Payer: BCBS Trust/PPO	$475.77
Rate for Payer: Cash Price	$597.60
Rate for Payer: Cash Price	$597.60
Rate for Payer: Mclaren Medicaid	$261.56
Rate for Payer: Meridian Medicaid	$274.64
Rate for Payer: Priority Health Choice Medicaid	$261.56
Rate for Payer: Priority Health Cigna Priority Health	$522.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$656.54
Rate for Payer: Priority Health Narrow Network	$656.54
Rate for Payer: Priority Health SBD	$656.54

PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR

Professional

Both

$1,424.00

Service Code	HCPCS 52355
Min. Negotiated Rate	$293.09
Max. Negotiated Rate	$7,524.58
Rate for Payer: Aetna Commercial	$598.21
Rate for Payer: BCBS Complete	$307.74
Rate for Payer: BCBS Trust/PPO	$7,524.58
Rate for Payer: Cash Price	$1,139.20
Rate for Payer: Cash Price	$1,139.20
Rate for Payer: Mclaren Medicaid	$293.09
Rate for Payer: Meridian Medicaid	$307.74
Rate for Payer: Priority Health Choice Medicaid	$293.09
Rate for Payer: Priority Health Cigna Priority Health	$996.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$735.42
Rate for Payer: Priority Health Narrow Network	$735.42
Rate for Payer: Priority Health SBD	$735.42

PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED

Professional

Both

$3,134.00

Service Code	HCPCS 51865
Min. Negotiated Rate	$569.78
Max. Negotiated Rate	$2,193.80
Rate for Payer: Aetna Commercial	$1,154.60
Rate for Payer: BCBS Complete	$598.27
Rate for Payer: BCBS Trust/PPO	$1,532.07
Rate for Payer: Cash Price	$2,507.20
Rate for Payer: Cash Price	$2,507.20
Rate for Payer: Mclaren Medicaid	$569.78
Rate for Payer: Meridian Medicaid	$598.27
Rate for Payer: Priority Health Choice Medicaid	$569.78
Rate for Payer: Priority Health Cigna Priority Health	$2,193.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,431.40
Rate for Payer: Priority Health Narrow Network	$1,431.40
Rate for Payer: Priority Health SBD	$1,431.40

PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE

Professional

Both

$2,400.00

Service Code	HCPCS 51860
Min. Negotiated Rate	$475.84
Max. Negotiated Rate	$2,379.46
Rate for Payer: Aetna Commercial	$958.23
Rate for Payer: BCBS Complete	$499.63
Rate for Payer: BCBS Trust/PPO	$2,379.46
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Mclaren Medicaid	$475.84
Rate for Payer: Meridian Medicaid	$499.63
Rate for Payer: Priority Health Choice Medicaid	$475.84
Rate for Payer: Priority Health Cigna Priority Health	$1,680.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,195.26
Rate for Payer: Priority Health Narrow Network	$1,195.26
Rate for Payer: Priority Health SBD	$1,195.26

PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE

Professional

Both

$535.00

Service Code	HCPCS 51040
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$3,051.99
Rate for Payer: Aetna Commercial	$370.57
Rate for Payer: BCBS Complete	$196.81
Rate for Payer: BCBS Trust/PPO	$3,051.99
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cash Price	$428.00
Rate for Payer: Mclaren Medicaid	$187.44
Rate for Payer: Meridian Medicaid	$196.81
Rate for Payer: Priority Health Choice Medicaid	$187.44
Rate for Payer: Priority Health Cigna Priority Health	$374.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$466.88
Rate for Payer: Priority Health Narrow Network	$466.88
Rate for Payer: Priority Health SBD	$466.88

PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL

Professional

Both

$2,402.00

Service Code	HCPCS 51020
Min. Negotiated Rate	$301.61
Max. Negotiated Rate	$3,049.88
Rate for Payer: Aetna Commercial	$601.20
Rate for Payer: BCBS Complete	$316.69
Rate for Payer: BCBS Trust/PPO	$3,049.88
Rate for Payer: Cash Price	$1,921.60
Rate for Payer: Cash Price	$1,921.60
Rate for Payer: Mclaren Medicaid	$301.61
Rate for Payer: Meridian Medicaid	$316.69
Rate for Payer: Priority Health Choice Medicaid	$301.61
Rate for Payer: Priority Health Cigna Priority Health	$1,681.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$752.72
Rate for Payer: Priority Health Narrow Network	$752.72
Rate for Payer: Priority Health SBD	$752.72

PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE

Professional

Both

$1,963.00

Service Code	HCPCS 51525
Min. Negotiated Rate	$544.85
Max. Negotiated Rate	$3,181.95
Rate for Payer: Aetna Commercial	$1,103.89
Rate for Payer: BCBS Complete	$572.09
Rate for Payer: BCBS Trust/PPO	$3,181.95
Rate for Payer: Cash Price	$1,570.40
Rate for Payer: Cash Price	$1,570.40
Rate for Payer: Mclaren Medicaid	$544.85
Rate for Payer: Meridian Medicaid	$572.09
Rate for Payer: Priority Health Choice Medicaid	$544.85
Rate for Payer: Priority Health Cigna Priority Health	$1,374.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,370.35
Rate for Payer: Priority Health Narrow Network	$1,370.35
Rate for Payer: Priority Health SBD	$1,370.35

PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE

Professional

Both

$1,695.00

Service Code	HCPCS 51535
Min. Negotiated Rate	$495.86
Max. Negotiated Rate	$3,177.20
Rate for Payer: Aetna Commercial	$1,001.20
Rate for Payer: BCBS Complete	$520.65
Rate for Payer: BCBS Trust/PPO	$3,177.20
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Mclaren Medicaid	$495.86
Rate for Payer: Meridian Medicaid	$520.65
Rate for Payer: Priority Health Choice Medicaid	$495.86
Rate for Payer: Priority Health Cigna Priority Health	$1,186.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,243.36
Rate for Payer: Priority Health Narrow Network	$1,243.36
Rate for Payer: Priority Health SBD	$1,243.36

PR CYSTOTOMY EXCISION BLADDER TUMOR

Professional

Both

$1,363.00

Service Code	HCPCS 51530
Min. Negotiated Rate	$489.90
Max. Negotiated Rate	$2,404.29
Rate for Payer: Aetna Commercial	$988.36
Rate for Payer: BCBS Complete	$514.40
Rate for Payer: BCBS Trust/PPO	$2,404.29
Rate for Payer: Cash Price	$1,090.40
Rate for Payer: Cash Price	$1,090.40
Rate for Payer: Mclaren Medicaid	$489.90
Rate for Payer: Meridian Medicaid	$514.40
Rate for Payer: Priority Health Choice Medicaid	$489.90
Rate for Payer: Priority Health Cigna Priority Health	$954.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,227.70
Rate for Payer: Priority Health Narrow Network	$1,227.70
Rate for Payer: Priority Health SBD	$1,227.70

PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK

Professional

Both

$1,204.00

Service Code	HCPCS 51520
Min. Negotiated Rate	$380.42
Max. Negotiated Rate	$3,020.82
Rate for Payer: Aetna Commercial	$763.07
Rate for Payer: BCBS Complete	$399.44
Rate for Payer: BCBS Trust/PPO	$3,020.82
Rate for Payer: Cash Price	$963.20
Rate for Payer: Cash Price	$963.20
Rate for Payer: Mclaren Medicaid	$380.42
Rate for Payer: Meridian Medicaid	$399.44
Rate for Payer: Priority Health Choice Medicaid	$380.42
Rate for Payer: Priority Health Cigna Priority Health	$842.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$952.11
Rate for Payer: Priority Health Narrow Network	$952.11
Rate for Payer: Priority Health SBD	$952.11

PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO

Professional

Both

$1,930.00

Service Code	HCPCS 51065
Min. Negotiated Rate	$370.83
Max. Negotiated Rate	$2,864.97
Rate for Payer: Aetna Commercial	$743.33
Rate for Payer: BCBS Complete	$389.37
Rate for Payer: BCBS Trust/PPO	$2,864.97
Rate for Payer: Cash Price	$1,544.00
Rate for Payer: Cash Price	$1,544.00
Rate for Payer: Mclaren Medicaid	$370.83
Rate for Payer: Meridian Medicaid	$389.37
Rate for Payer: Priority Health Choice Medicaid	$370.83
Rate for Payer: Priority Health Cigna Priority Health	$1,351.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$927.79
Rate for Payer: Priority Health Narrow Network	$927.79
Rate for Payer: Priority Health SBD	$927.79

PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX

Professional

Both

$1,012.00

Service Code	HCPCS 51045
Min. Negotiated Rate	$319.07
Max. Negotiated Rate	$3,133.88
Rate for Payer: Aetna Commercial	$645.19
Rate for Payer: BCBS Complete	$335.02
Rate for Payer: BCBS Trust/PPO	$3,133.88
Rate for Payer: Cash Price	$809.60
Rate for Payer: Cash Price	$809.60
Rate for Payer: Mclaren Medicaid	$319.07
Rate for Payer: Meridian Medicaid	$335.02
Rate for Payer: Priority Health Choice Medicaid	$319.07
Rate for Payer: Priority Health Cigna Priority Health	$708.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$805.13
Rate for Payer: Priority Health Narrow Network	$805.13
Rate for Payer: Priority Health SBD	$805.13

PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT

Professional

Both

$831.00

Service Code	HCPCS 52356
Min. Negotiated Rate	$260.71
Max. Negotiated Rate	$654.37
Rate for Payer: Aetna Commercial	$532.71
Rate for Payer: BCBS Complete	$273.75
Rate for Payer: BCBS Trust/PPO	$478.11
Rate for Payer: Cash Price	$664.80
Rate for Payer: Cash Price	$664.80
Rate for Payer: Mclaren Medicaid	$260.71
Rate for Payer: Meridian Medicaid	$273.75
Rate for Payer: Priority Health Choice Medicaid	$260.71
Rate for Payer: Priority Health Cigna Priority Health	$581.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$654.37
Rate for Payer: Priority Health Narrow Network	$654.37
Rate for Payer: Priority Health SBD	$654.37

PR CYSTOURETHROSCOPY

Professional

Both

$461.00

Service Code	HCPCS 52000
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$1,840.07
Rate for Payer: Aetna Commercial	$102.99
Rate for Payer: BCBS Complete	$53.22
Rate for Payer: BCBS Trust/PPO	$1,840.07
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cash Price	$368.80
Rate for Payer: Mclaren Medicaid	$50.69
Rate for Payer: Meridian Medicaid	$53.22
Rate for Payer: Priority Health Choice Medicaid	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$322.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.52
Rate for Payer: Priority Health Narrow Network	$127.52
Rate for Payer: Priority Health SBD	$127.52

PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER

Professional

Both

$691.00

Service Code	HCPCS 52287
Min. Negotiated Rate	$106.29
Max. Negotiated Rate	$1,222.49
Rate for Payer: Aetna Commercial	$217.02
Rate for Payer: BCBS Complete	$111.60
Rate for Payer: BCBS Trust/PPO	$1,222.49
Rate for Payer: Cash Price	$552.80
Rate for Payer: Cash Price	$552.80
Rate for Payer: Mclaren Medicaid	$106.29
Rate for Payer: Meridian Medicaid	$111.60
Rate for Payer: Priority Health Choice Medicaid	$106.29
Rate for Payer: Priority Health Cigna Priority Health	$483.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.02
Rate for Payer: Priority Health Narrow Network	$268.02
Rate for Payer: Priority Health SBD	$268.02

PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT

Professional

Both

$637.00

Service Code	HCPCS 52282
Min. Negotiated Rate	$211.72
Max. Negotiated Rate	$1,714.86
Rate for Payer: Aetna Commercial	$429.33
Rate for Payer: BCBS Complete	$222.31
Rate for Payer: BCBS Trust/PPO	$1,714.86
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cash Price	$509.60
Rate for Payer: Mclaren Medicaid	$211.72
Rate for Payer: Meridian Medicaid	$222.31
Rate for Payer: Priority Health Choice Medicaid	$211.72
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$530.63
Rate for Payer: Priority Health Narrow Network	$530.63
Rate for Payer: Priority Health SBD	$530.63

PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG

Professional

Both

$490.00

Service Code	HCPCS 52250
Min. Negotiated Rate	$150.17
Max. Negotiated Rate	$4,966.55
Rate for Payer: Aetna Commercial	$305.69
Rate for Payer: BCBS Complete	$157.68
Rate for Payer: BCBS Trust/PPO	$4,966.55
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cash Price	$392.00
Rate for Payer: Mclaren Medicaid	$150.17
Rate for Payer: Meridian Medicaid	$157.68
Rate for Payer: Priority Health Choice Medicaid	$150.17
Rate for Payer: Priority Health Cigna Priority Health	$343.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$377.71
Rate for Payer: Priority Health Narrow Network	$377.71
Rate for Payer: Priority Health SBD	$377.71

PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME

Professional

Both

$626.00

Service Code	HCPCS 52285
Min. Negotiated Rate	$123.54
Max. Negotiated Rate	$1,483.99
Rate for Payer: Aetna Commercial	$250.61
Rate for Payer: BCBS Complete	$129.72
Rate for Payer: BCBS Trust/PPO	$1,483.99
Rate for Payer: Cash Price	$500.80
Rate for Payer: Cash Price	$500.80
Rate for Payer: Mclaren Medicaid	$123.54
Rate for Payer: Meridian Medicaid	$129.72
Rate for Payer: Priority Health Choice Medicaid	$123.54
Rate for Payer: Priority Health Cigna Priority Health	$438.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$309.08
Rate for Payer: Priority Health Narrow Network	$309.08
Rate for Payer: Priority Health SBD	$309.08

PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM

Professional

Both

$1,144.00

Service Code	HCPCS 52235
Min. Negotiated Rate	$181.26
Max. Negotiated Rate	$3,767.31
Rate for Payer: Aetna Commercial	$368.99
Rate for Payer: BCBS Complete	$190.32
Rate for Payer: BCBS Trust/PPO	$3,767.31
Rate for Payer: Cash Price	$915.20
Rate for Payer: Cash Price	$915.20
Rate for Payer: Mclaren Medicaid	$181.26
Rate for Payer: Meridian Medicaid	$190.32
Rate for Payer: Priority Health Choice Medicaid	$181.26
Rate for Payer: Priority Health Cigna Priority Health	$800.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$454.98
Rate for Payer: Priority Health Narrow Network	$454.98
Rate for Payer: Priority Health SBD	$454.98

PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE

Professional

Both

$2,199.00

Service Code	HCPCS 52240
Min. Negotiated Rate	$246.02
Max. Negotiated Rate	$4,858.78
Rate for Payer: Aetna Commercial	$501.54
Rate for Payer: BCBS Complete	$258.32
Rate for Payer: BCBS Trust/PPO	$4,858.78
Rate for Payer: Cash Price	$1,759.20
Rate for Payer: Cash Price	$1,759.20
Rate for Payer: Mclaren Medicaid	$246.02
Rate for Payer: Meridian Medicaid	$258.32
Rate for Payer: Priority Health Choice Medicaid	$246.02
Rate for Payer: Priority Health Cigna Priority Health	$1,539.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$617.63
Rate for Payer: Priority Health Narrow Network	$617.63
Rate for Payer: Priority Health SBD	$617.63

PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH

Professional

Both

$387.00

Service Code	HCPCS 52260
Min. Negotiated Rate	$132.49
Max. Negotiated Rate	$1,421.13
Rate for Payer: Aetna Commercial	$269.31
Rate for Payer: BCBS Complete	$139.11
Rate for Payer: BCBS Trust/PPO	$1,421.13
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cash Price	$309.60
Rate for Payer: Mclaren Medicaid	$132.49
Rate for Payer: Meridian Medicaid	$139.11
Rate for Payer: Priority Health Choice Medicaid	$132.49
Rate for Payer: Priority Health Cigna Priority Health	$270.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$333.39
Rate for Payer: Priority Health Narrow Network	$333.39
Rate for Payer: Priority Health SBD	$333.39

PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA

Professional

Both

$625.00

Service Code	HCPCS 52265
Min. Negotiated Rate	$102.45
Max. Negotiated Rate	$5,029.94
Rate for Payer: Aetna Commercial	$208.09
Rate for Payer: BCBS Complete	$107.57
Rate for Payer: BCBS Trust/PPO	$5,029.94
Rate for Payer: Cash Price	$500.00
Rate for Payer: Cash Price	$500.00
Rate for Payer: Mclaren Medicaid	$102.45
Rate for Payer: Meridian Medicaid	$107.57
Rate for Payer: Priority Health Choice Medicaid	$102.45
Rate for Payer: Priority Health Cigna Priority Health	$437.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$257.21
Rate for Payer: Priority Health Narrow Network	$257.21
Rate for Payer: Priority Health SBD	$257.21

Know your out-of-pocket cost for care.

All Charges