Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY

Professional

Both

$1,099.00

Service Code	HCPCS 52276
Min. Negotiated Rate	$165.93
Max. Negotiated Rate	$2,759.84
Rate for Payer: Aetna Commercial	$338.51
Rate for Payer: BCBS Complete	$174.23
Rate for Payer: BCBS Trust/PPO	$2,759.84
Rate for Payer: Cash Price	$879.20
Rate for Payer: Cash Price	$879.20
Rate for Payer: Mclaren Medicaid	$165.93
Rate for Payer: Meridian Medicaid	$174.23
Rate for Payer: Priority Health Choice Medicaid	$165.93
Rate for Payer: Priority Health Cigna Priority Health	$769.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$416.62
Rate for Payer: Priority Health Narrow Network	$416.62
Rate for Payer: Priority Health SBD	$416.62

PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE

Professional

Both

$702.00

Service Code	HCPCS 52270
Min. Negotiated Rate	$114.17
Max. Negotiated Rate	$4,237.49
Rate for Payer: Aetna Commercial	$233.02
Rate for Payer: BCBS Complete	$119.88
Rate for Payer: BCBS Trust/PPO	$4,237.49
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Mclaren Medicaid	$114.17
Rate for Payer: Meridian Medicaid	$119.88
Rate for Payer: Priority Health Choice Medicaid	$114.17
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.39
Rate for Payer: Priority Health Narrow Network	$286.39
Rate for Payer: Priority Health SBD	$286.39

PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE

Professional

Both

$958.00

Service Code	HCPCS 52275
Min. Negotiated Rate	$155.92
Max. Negotiated Rate	$5,563.53
Rate for Payer: Aetna Commercial	$317.31
Rate for Payer: BCBS Complete	$163.72
Rate for Payer: BCBS Trust/PPO	$5,563.53
Rate for Payer: Cash Price	$766.40
Rate for Payer: Cash Price	$766.40
Rate for Payer: Mclaren Medicaid	$155.92
Rate for Payer: Meridian Medicaid	$163.72
Rate for Payer: Priority Health Choice Medicaid	$155.92
Rate for Payer: Priority Health Cigna Priority Health	$670.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$391.21
Rate for Payer: Priority Health Narrow Network	$391.21
Rate for Payer: Priority Health SBD	$391.21

PR CYSTOURETHROSCOPY WITH BIOPSY

Professional

Both

$733.00

Service Code	HCPCS 52204
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$1,981.65
Rate for Payer: Aetna Commercial	$180.40
Rate for Payer: BCBS Complete	$93.71
Rate for Payer: BCBS Trust/PPO	$1,981.65
Rate for Payer: Cash Price	$586.40
Rate for Payer: Cash Price	$586.40
Rate for Payer: Mclaren Medicaid	$89.25
Rate for Payer: Meridian Medicaid	$93.71
Rate for Payer: Priority Health Choice Medicaid	$89.25
Rate for Payer: Priority Health Cigna Priority Health	$513.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$222.63
Rate for Payer: Priority Health Narrow Network	$222.63
Rate for Payer: Priority Health SBD	$222.63

PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS

Professional

Both

$1,398.00

Service Code	HCPCS 52320
Min. Negotiated Rate	$154.43
Max. Negotiated Rate	$978.60
Rate for Payer: Aetna Commercial	$315.24
Rate for Payer: BCBS Complete	$162.15
Rate for Payer: BCBS Trust/PPO	$454.34
Rate for Payer: Cash Price	$1,118.40
Rate for Payer: Cash Price	$1,118.40
Rate for Payer: Mclaren Medicaid	$154.43
Rate for Payer: Meridian Medicaid	$162.15
Rate for Payer: Priority Health Choice Medicaid	$154.43
Rate for Payer: Priority Health Cigna Priority Health	$978.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$387.98
Rate for Payer: Priority Health Narrow Network	$387.98
Rate for Payer: Priority Health SBD	$387.98

PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE

Professional

Both

$408.00

Service Code	HCPCS 52283
Min. Negotiated Rate	$126.74
Max. Negotiated Rate	$606.49
Rate for Payer: Aetna Commercial	$258.19
Rate for Payer: BCBS Complete	$133.08
Rate for Payer: BCBS Trust/PPO	$606.49
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Mclaren Medicaid	$126.74
Rate for Payer: Meridian Medicaid	$133.08
Rate for Payer: Priority Health Choice Medicaid	$126.74
Rate for Payer: Priority Health Cigna Priority Health	$285.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$317.74
Rate for Payer: Priority Health Narrow Network	$317.74
Rate for Payer: Priority Health SBD	$317.74

PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI

Professional

Both

$465.00

Service Code	HCPCS 52290
Min. Negotiated Rate	$152.93
Max. Negotiated Rate	$1,479.24
Rate for Payer: Aetna Commercial	$311.87
Rate for Payer: BCBS Complete	$160.58
Rate for Payer: BCBS Trust/PPO	$1,479.24
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cash Price	$372.00
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	$325.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$384.74
Rate for Payer: Priority Health Narrow Network	$384.74
Rate for Payer: Priority Health SBD	$384.74

PR CYSTO W/COMPLEX REMOVAL STONE & STENT

Professional

Both

$793.00

Service Code	HCPCS 52315
Min. Negotiated Rate	$172.32
Max. Negotiated Rate	$1,188.68
Rate for Payer: Aetna Commercial	$351.84
Rate for Payer: BCBS Complete	$180.94
Rate for Payer: BCBS Trust/PPO	$1,188.68
Rate for Payer: Cash Price	$634.40
Rate for Payer: Cash Price	$634.40
Rate for Payer: Mclaren Medicaid	$172.32
Rate for Payer: Meridian Medicaid	$180.94
Rate for Payer: Priority Health Choice Medicaid	$172.32
Rate for Payer: Priority Health Cigna Priority Health	$555.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$433.90
Rate for Payer: Priority Health Narrow Network	$433.90
Rate for Payer: Priority Health SBD	$433.90

PR CYSTO W/DESTRUCTION OF LESIONS

Professional

Both

$2,770.00

Service Code	HCPCS 52214
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$2,177.12
Rate for Payer: Aetna Commercial	$227.00
Rate for Payer: BCBS Complete	$115.18
Rate for Payer: BCBS Trust/PPO	$2,177.12
Rate for Payer: Cash Price	$2,216.00
Rate for Payer: Cash Price	$2,216.00
Rate for Payer: Mclaren Medicaid	$109.70
Rate for Payer: Meridian Medicaid	$115.18
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health	$1,939.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$276.66
Rate for Payer: Priority Health Narrow Network	$276.66
Rate for Payer: Priority Health SBD	$276.66

PR CYSTO W/INSERT URETERAL STENT

Professional

Both

$850.00

Service Code	HCPCS 52332
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$2,268.52
Rate for Payer: Aetna Commercial	$198.36
Rate for Payer: BCBS Complete	$102.88
Rate for Payer: BCBS Trust/PPO	$2,268.52
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Mclaren Medicaid	$97.98
Rate for Payer: Meridian Medicaid	$102.88
Rate for Payer: Priority Health Choice Medicaid	$97.98
Rate for Payer: Priority Health Cigna Priority Health	$595.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$245.87
Rate for Payer: Priority Health Narrow Network	$245.87
Rate for Payer: Priority Health SBD	$245.87

PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS

Professional

Both

$755.00

Service Code	HCPCS 52001
Min. Negotiated Rate	$180.41
Max. Negotiated Rate	$1,930.41
Rate for Payer: Aetna Commercial	$367.75
Rate for Payer: BCBS Complete	$189.43
Rate for Payer: BCBS Trust/PPO	$1,930.41
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cash Price	$604.00
Rate for Payer: Mclaren Medicaid	$180.41
Rate for Payer: Meridian Medicaid	$189.43
Rate for Payer: Priority Health Choice Medicaid	$180.41
Rate for Payer: Priority Health Cigna Priority Health	$528.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$452.81
Rate for Payer: Priority Health Narrow Network	$452.81
Rate for Payer: Priority Health SBD	$452.81

PR CYSTO W/REMOVAL OF LESIONS MINOR

Professional

Both

$2,280.00

Service Code	HCPCS 52224
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$2,846.48
Rate for Payer: Aetna Commercial	$261.58
Rate for Payer: BCBS Complete	$133.30
Rate for Payer: BCBS Trust/PPO	$2,846.48
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Mclaren Medicaid	$126.95
Rate for Payer: Meridian Medicaid	$133.30
Rate for Payer: Priority Health Choice Medicaid	$126.95
Rate for Payer: Priority Health Cigna Priority Health	$1,596.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$320.43
Rate for Payer: Priority Health Narrow Network	$320.43
Rate for Payer: Priority Health SBD	$320.43

PR CYSTO W/REMOVAL OF TUMORS SMALL

Professional

Both

$1,056.00

Service Code	HCPCS 52234
Min. Negotiated Rate	$154.43
Max. Negotiated Rate	$5,244.96
Rate for Payer: Aetna Commercial	$314.10
Rate for Payer: BCBS Complete	$162.15
Rate for Payer: BCBS Trust/PPO	$5,244.96
Rate for Payer: Cash Price	$844.80
Rate for Payer: Cash Price	$844.80
Rate for Payer: Mclaren Medicaid	$154.43
Rate for Payer: Meridian Medicaid	$162.15
Rate for Payer: Priority Health Choice Medicaid	$154.43
Rate for Payer: Priority Health Cigna Priority Health	$739.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$387.98
Rate for Payer: Priority Health Narrow Network	$387.98
Rate for Payer: Priority Health SBD	$387.98

PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI

Professional

Both

$539.00

Service Code	HCPCS 52300
Min. Negotiated Rate	$175.73
Max. Negotiated Rate	$1,512.52
Rate for Payer: Aetna Commercial	$358.89
Rate for Payer: BCBS Complete	$184.52
Rate for Payer: BCBS Trust/PPO	$1,512.52
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Mclaren Medicaid	$175.73
Rate for Payer: Meridian Medicaid	$184.52
Rate for Payer: Priority Health Choice Medicaid	$175.73
Rate for Payer: Priority Health Cigna Priority Health	$377.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$442.56
Rate for Payer: Priority Health Narrow Network	$442.56
Rate for Payer: Priority Health SBD	$442.56

PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI

Professional

Both

$571.22

Service Code	HCPCS 52301
Min. Negotiated Rate	$182.12
Max. Negotiated Rate	$1,202.94
Rate for Payer: Aetna Commercial	$371.30
Rate for Payer: BCBS Complete	$191.23
Rate for Payer: BCBS Trust/PPO	$1,202.94
Rate for Payer: Cash Price	$456.98
Rate for Payer: Cash Price	$456.98
Rate for Payer: Mclaren Medicaid	$182.12
Rate for Payer: Meridian Medicaid	$191.23
Rate for Payer: Priority Health Choice Medicaid	$182.12
Rate for Payer: Priority Health Cigna Priority Health	$399.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$457.15
Rate for Payer: Priority Health Narrow Network	$457.15
Rate for Payer: Priority Health SBD	$457.15

PR CYSTO W/SIMPLE REMOVAL STONE & STENT

Professional

Both

$578.00

Service Code	HCPCS 52310
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$904.45
Rate for Payer: Aetna Commercial	$193.36
Rate for Payer: BCBS Complete	$100.19
Rate for Payer: BCBS Trust/PPO	$904.45
Rate for Payer: Cash Price	$462.40
Rate for Payer: Cash Price	$462.40
Rate for Payer: Mclaren Medicaid	$95.42
Rate for Payer: Meridian Medicaid	$100.19
Rate for Payer: Priority Health Choice Medicaid	$95.42
Rate for Payer: Priority Health Cigna Priority Health	$404.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$239.38
Rate for Payer: Priority Health Narrow Network	$239.38
Rate for Payer: Priority Health SBD	$239.38

PR CYSTO W/SUBURTRIC NJX IMPLT MATRL

Professional

Both

$1,287.00

Service Code	HCPCS 52327
Min. Negotiated Rate	$162.31
Max. Negotiated Rate	$2,129.58
Rate for Payer: Aetna Commercial	$338.60
Rate for Payer: BCBS Complete	$170.43
Rate for Payer: BCBS Trust/PPO	$2,129.58
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Mclaren Medicaid	$162.31
Rate for Payer: Meridian Medicaid	$170.43
Rate for Payer: Priority Health Choice Medicaid	$162.31
Rate for Payer: Priority Health Cigna Priority Health	$900.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$408.51
Rate for Payer: Priority Health Narrow Network	$408.51
Rate for Payer: Priority Health SBD	$408.51

PR CYSTO W/TX INTRA-RENAL STRICTURE

Professional

Both

$664.00

Service Code	HCPCS 52343
Min. Negotiated Rate	$215.77
Max. Negotiated Rate	$2,659.46
Rate for Payer: Aetna Commercial	$439.49
Rate for Payer: BCBS Complete	$226.56
Rate for Payer: BCBS Trust/PPO	$2,659.46
Rate for Payer: Cash Price	$531.20
Rate for Payer: Cash Price	$531.20
Rate for Payer: Mclaren Medicaid	$215.77
Rate for Payer: Meridian Medicaid	$226.56
Rate for Payer: Priority Health Choice Medicaid	$215.77
Rate for Payer: Priority Health Cigna Priority Health	$464.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$542.52
Rate for Payer: Priority Health Narrow Network	$542.52
Rate for Payer: Priority Health SBD	$542.52

PR CYSTO W/TX URETERAL STRICTURE

Professional

Both

$1,507.00

Service Code	HCPCS 52341
Min. Negotiated Rate	$178.49
Max. Negotiated Rate	$2,160.75
Rate for Payer: Aetna Commercial	$363.22
Rate for Payer: BCBS Complete	$187.41
Rate for Payer: BCBS Trust/PPO	$2,160.75
Rate for Payer: Cash Price	$1,205.60
Rate for Payer: Cash Price	$1,205.60
Rate for Payer: Mclaren Medicaid	$178.49
Rate for Payer: Meridian Medicaid	$187.41
Rate for Payer: Priority Health Choice Medicaid	$178.49
Rate for Payer: Priority Health Cigna Priority Health	$1,054.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$448.49
Rate for Payer: Priority Health Narrow Network	$448.49
Rate for Payer: Priority Health SBD	$448.49

PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE

Professional

Both

$1,678.00

Service Code	HCPCS 52342
Min. Negotiated Rate	$194.26
Max. Negotiated Rate	$1,174.60
Rate for Payer: Aetna Commercial	$395.15
Rate for Payer: BCBS Complete	$203.97
Rate for Payer: BCBS Trust/PPO	$440.60
Rate for Payer: Cash Price	$1,342.40
Rate for Payer: Cash Price	$1,342.40
Rate for Payer: Mclaren Medicaid	$194.26
Rate for Payer: Meridian Medicaid	$203.97
Rate for Payer: Priority Health Choice Medicaid	$194.26
Rate for Payer: Priority Health Cigna Priority Health	$1,174.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$486.86
Rate for Payer: Priority Health Narrow Network	$486.86
Rate for Payer: Priority Health SBD	$486.86

PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY

Professional

Both

$808.00

Service Code	HCPCS 52353
Min. Negotiated Rate	$245.80
Max. Negotiated Rate	$7,607.52
Rate for Payer: Aetna Commercial	$501.54
Rate for Payer: BCBS Complete	$258.09
Rate for Payer: BCBS Trust/PPO	$7,607.52
Rate for Payer: Cash Price	$646.40
Rate for Payer: Cash Price	$646.40
Rate for Payer: Mclaren Medicaid	$245.80
Rate for Payer: Meridian Medicaid	$258.09
Rate for Payer: Priority Health Choice Medicaid	$245.80
Rate for Payer: Priority Health Cigna Priority Health	$565.60
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 CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES

Professional

Both

$2,941.00

Service Code	HCPCS 52352
Min. Negotiated Rate	$222.16
Max. Negotiated Rate	$2,058.70
Rate for Payer: Aetna Commercial	$452.78
Rate for Payer: BCBS Complete	$233.27
Rate for Payer: BCBS Trust/PPO	$677.97
Rate for Payer: Cash Price	$2,352.80
Rate for Payer: Cash Price	$2,352.80
Rate for Payer: Mclaren Medicaid	$222.16
Rate for Payer: Meridian Medicaid	$233.27
Rate for Payer: Priority Health Choice Medicaid	$222.16
Rate for Payer: Priority Health Cigna Priority Health	$2,058.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$558.18
Rate for Payer: Priority Health Narrow Network	$558.18
Rate for Payer: Priority Health SBD	$558.18

PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX

Professional

Both

$596.00

Service Code	HCPCS 52351
Min. Negotiated Rate	$190.21
Max. Negotiated Rate	$476.60
Rate for Payer: Aetna Commercial	$386.83
Rate for Payer: BCBS Complete	$199.72
Rate for Payer: BCBS Trust/PPO	$393.43
Rate for Payer: Cash Price	$476.80
Rate for Payer: Cash Price	$476.80
Rate for Payer: Mclaren Medicaid	$190.21
Rate for Payer: Meridian Medicaid	$199.72
Rate for Payer: Priority Health Choice Medicaid	$190.21
Rate for Payer: Priority Health Cigna Priority Health	$417.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$476.60
Rate for Payer: Priority Health Narrow Network	$476.60
Rate for Payer: Priority Health SBD	$476.60

PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE

Professional

Both

$867.00

Service Code	HCPCS 52346
Min. Negotiated Rate	$279.88
Max. Negotiated Rate	$2,753.98
Rate for Payer: Aetna Commercial	$571.60
Rate for Payer: BCBS Complete	$293.87
Rate for Payer: BCBS Trust/PPO	$2,753.98
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$279.88
Rate for Payer: Meridian Medicaid	$293.87
Rate for Payer: Priority Health Choice Medicaid	$279.88
Rate for Payer: Priority Health Cigna Priority Health	$606.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$702.46
Rate for Payer: Priority Health Narrow Network	$702.46
Rate for Payer: Priority Health SBD	$702.46

PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE

Professional

Both

$783.00

Service Code	HCPCS 52344
Min. Negotiated Rate	$231.96
Max. Negotiated Rate	$3,736.67
Rate for Payer: Aetna Commercial	$471.86
Rate for Payer: BCBS Complete	$243.56
Rate for Payer: BCBS Trust/PPO	$3,736.67
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$626.40
Rate for Payer: Mclaren Medicaid	$231.96
Rate for Payer: Meridian Medicaid	$243.56
Rate for Payer: Priority Health Choice Medicaid	$231.96
Rate for Payer: Priority Health Cigna Priority Health	$548.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$580.89
Rate for Payer: Priority Health Narrow Network	$580.89
Rate for Payer: Priority Health SBD	$580.89

Know your out-of-pocket cost for care.

All Charges