Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR DERMAGRAFT

Professional

Both

$50.00

Service Code	HCPCS Q4106
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$281.06
Rate for Payer: Aetna Commercial	$46.29
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$281.06
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00

PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100

Professional

Both

$1,555.00

Service Code	HCPCS 15135
Min. Negotiated Rate	$116.11
Max. Negotiated Rate	$1,088.50
Rate for Payer: Aetna Commercial	$810.88
Rate for Payer: BCBS Complete	$508.36
Rate for Payer: BCBS Trust/PPO	$116.11
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Mclaren Medicaid	$484.15
Rate for Payer: Meridian Medicaid	$508.36
Rate for Payer: Priority Health Choice Medicaid	$484.15
Rate for Payer: Priority Health Cigna Priority Health	$1,088.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$931.41
Rate for Payer: Priority Health Narrow Network	$931.41
Rate for Payer: Priority Health SBD	$931.41

PR DERMAL FILLER JUVEDERM ULTRA

Professional

Both

$675.00

Service Code	HCPCS 00087
Hospital Revenue Code	990
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$270.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS

Professional

Both

$400.00

Service Code	HCPCS 00089
Hospital Revenue Code	990
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS >1

Professional

Both

$675.00

Service Code	HCPCS 00090
Hospital Revenue Code	990
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$270.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50

PR DERMAL FILLER JUVEDERM VOLLURE

Professional

Both

$700.00

Service Code	HCPCS 00118
Hospital Revenue Code	990
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$490.00
Rate for Payer: BCBS Complete	$280.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Priority Health Cigna Priority Health	$490.00

PR DERMAL FILLER JUVEDERM VOLUMA

Professional

Both

$800.00

Service Code	HCPCS 00091
Hospital Revenue Code	990
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$560.00
Rate for Payer: BCBS Complete	$320.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Priority Health Cigna Priority Health	$560.00

PR DERMAL FILLER RESTYLANE 1/2 UNIT

Professional

Both

$400.00

Service Code	HCPCS 00252
Hospital Revenue Code	990
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00

PR DERMAL FILLER RESTYLANE 1 UNIT

Professional

Both

$650.00

Service Code	HCPCS 00253
Hospital Revenue Code	990
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$455.00
Rate for Payer: BCBS Complete	$260.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Priority Health Cigna Priority Health	$455.00

PR DERMAL FILLER RESTYLANE DEFYNE

Professional

Both

$700.00

Service Code	HCPCS 00360
Hospital Revenue Code	990
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$490.00
Rate for Payer: BCBS Complete	$280.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Priority Health Cigna Priority Health	$490.00

PR DERMAL FILLER RESTYLANE LYFT

Professional

Both

$650.00

Service Code	HCPCS 00359
Hospital Revenue Code	990
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$455.00
Rate for Payer: BCBS Complete	$260.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Priority Health Cigna Priority Health	$455.00

PR DERMAL FILLER RESTYLANE REFYNE

Professional

Both

$700.00

Service Code	HCPCS 00361
Hospital Revenue Code	990
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$490.00
Rate for Payer: BCBS Complete	$280.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Priority Health Cigna Priority Health	$490.00

PR DERMAL FILLER VOLBELLA

Professional

Both

$400.00

Service Code	HCPCS 00092
Hospital Revenue Code	990
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00

PR DERMAL FILLER VOLBELLA >1

Professional

Both

$700.00

Service Code	HCPCS 00120
Hospital Revenue Code	990
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$490.00
Rate for Payer: BCBS Complete	$280.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Priority Health Cigna Priority Health	$490.00

PR DESTROY NERVE,CERV SPINAL MUSCLES

Professional

Both

$354.00

Service Code	HCPCS 64613
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$247.80
Rate for Payer: BCBS Complete	$141.60
Rate for Payer: Cash Price	$283.20
Rate for Payer: Priority Health Cigna Priority Health	$247.80

PR DESTRUCTION BENIGN LESIONS 15/>

Professional

Both

$213.00

Service Code	HCPCS 17111
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$85.72
Rate for Payer: BCBS Complete	$56.13
Rate for Payer: BCBS Trust/PPO	$562.50
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$170.40
Rate for Payer: Mclaren Medicaid	$53.46
Rate for Payer: Meridian Medicaid	$56.13
Rate for Payer: Priority Health Choice Medicaid	$53.46
Rate for Payer: Priority Health Cigna Priority Health	$149.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.70
Rate for Payer: Priority Health Narrow Network	$100.70
Rate for Payer: Priority Health SBD	$100.70

PR DESTRUCTION BENIGN LESIONS UP TO 14

Facility

$179.00

Service Code	CPT 17110
Hospital Charge Code	17110
Hospital Revenue Code	521
Min. Negotiated Rate	$58.19
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$152.15
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$116.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$58.19
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cofinity Commercial	$125.30
Rate for Payer: Cofinity Commercial	$153.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$161.10
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$152.15
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$152.15
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$125.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$112.77
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$74.56
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$67.78
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

PR DESTRUCTION BENIGN LESIONS UP TO 14

Facility

$179.00

Service Code	CPT 17110
Hospital Charge Code	17110
Hospital Revenue Code	521
Min. Negotiated Rate	$112.77
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna Commercial	$152.15
Rate for Payer: Aetna New Business (MI Preferred)	$116.35
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cofinity Commercial	$125.30
Rate for Payer: Cofinity Commercial	$153.94
Rate for Payer: Healthscope Commercial	$161.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$152.15
Rate for Payer: PHP Commercial	$152.15
Rate for Payer: Priority Health Cigna Priority Health	$125.30
Rate for Payer: Priority Health SBD	$112.77

PR DESTRUCTION BENIGN LESIONS UP TO 14

Professional

Both

$179.00

Service Code	HCPCS 17110
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$4,160.00
Rate for Payer: Aetna Commercial	$69.33
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCBS Trust/PPO	$4,160.00
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Mclaren Medicaid	$44.09
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health	$125.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.20
Rate for Payer: Priority Health Narrow Network	$82.20
Rate for Payer: Priority Health SBD	$82.20

PR DESTRUCTION BENIGN LESIONS UP TO 14

Professional

Both

$179.00

Service Code	HCPCS 17110
Hospital Charge Code	17110
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$4,160.00
Rate for Payer: Aetna Commercial	$69.33
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCBS Trust/PPO	$4,160.00
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Mclaren Medicaid	$44.09
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health	$125.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.20
Rate for Payer: Priority Health Narrow Network	$82.20
Rate for Payer: Priority Health SBD	$82.20

PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM

Professional

Both

$618.00

Service Code	HCPCS 17106
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$947.65
Rate for Payer: Aetna Commercial	$291.61
Rate for Payer: BCBS Complete	$185.85
Rate for Payer: BCBS Trust/PPO	$947.65
Rate for Payer: Cash Price	$494.40
Rate for Payer: Cash Price	$494.40
Rate for Payer: Mclaren Medicaid	$177.00
Rate for Payer: Meridian Medicaid	$185.85
Rate for Payer: Priority Health Choice Medicaid	$177.00
Rate for Payer: Priority Health Cigna Priority Health	$432.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$337.46
Rate for Payer: Priority Health Narrow Network	$337.46
Rate for Payer: Priority Health SBD	$337.46

PR DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY

Professional

Both

$331.00

Service Code	HCPCS 46930
Min. Negotiated Rate	$97.55
Max. Negotiated Rate	$1,115.77
Rate for Payer: Aetna Commercial	$200.96
Rate for Payer: BCBS Complete	$102.43
Rate for Payer: BCBS Trust/PPO	$1,115.77
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Mclaren Medicaid	$97.55
Rate for Payer: Meridian Medicaid	$102.43
Rate for Payer: Priority Health Choice Medicaid	$97.55
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$266.94
Rate for Payer: Priority Health Narrow Network	$266.94
Rate for Payer: Priority Health SBD	$266.94

PR DESTRUCTION LESION LID MARGIN </ 1 CM

Professional

Both

$477.00

Service Code	HCPCS 67850
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$347.09
Rate for Payer: Aetna Commercial	$169.96
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$347.09
Rate for Payer: Cash Price	$381.60
Rate for Payer: Cash Price	$381.60
Rate for Payer: Mclaren Medicaid	$83.28
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$333.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$227.73
Rate for Payer: Priority Health Narrow Network	$227.73
Rate for Payer: Priority Health SBD	$227.73

PR DESTRUCTION LESIONS VULVA EXTENSIVE

Professional

Both

$569.00

Service Code	HCPCS 56515
Min. Negotiated Rate	$136.96
Max. Negotiated Rate	$2,047.16
Rate for Payer: Aetna Commercial	$249.32
Rate for Payer: BCBS Complete	$143.81
Rate for Payer: BCBS Trust/PPO	$2,047.16
Rate for Payer: Cash Price	$455.20
Rate for Payer: Cash Price	$455.20
Rate for Payer: Mclaren Medicaid	$136.96
Rate for Payer: Meridian Medicaid	$143.81
Rate for Payer: Priority Health Choice Medicaid	$136.96
Rate for Payer: Priority Health Cigna Priority Health	$398.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$302.99
Rate for Payer: Priority Health Narrow Network	$302.99
Rate for Payer: Priority Health SBD	$302.99

PR DESTRUCTION LESIONS VULVA SIMPLE

Professional

Both

$376.00

Service Code	HCPCS 56501
Min. Negotiated Rate	$86.27
Max. Negotiated Rate	$1,962.11
Rate for Payer: Aetna Commercial	$152.26
Rate for Payer: BCBS Complete	$90.58
Rate for Payer: BCBS Trust/PPO	$1,962.11
Rate for Payer: Cash Price	$300.80
Rate for Payer: Cash Price	$300.80
Rate for Payer: Mclaren Medicaid	$86.27
Rate for Payer: Meridian Medicaid	$90.58
Rate for Payer: Priority Health Choice Medicaid	$86.27
Rate for Payer: Priority Health Cigna Priority Health	$263.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$190.80
Rate for Payer: Priority Health Narrow Network	$190.80
Rate for Payer: Priority Health SBD	$190.80

Know your out-of-pocket cost for care.

All Charges