Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR DESTRUCTION VAGINAL LESIONS SIMPLE

Professional

Both

$355.00

Service Code	HCPCS 57061
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$2,929.42
Rate for Payer: Aetna Commercial	$131.70
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: BCBS Trust/PPO	$2,929.42
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Mclaren Medicaid	$74.55
Rate for Payer: Meridian Medicaid	$78.28
Rate for Payer: Priority Health Choice Medicaid	$74.55
Rate for Payer: Priority Health Cigna Priority Health	$248.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.76
Rate for Payer: Priority Health Narrow Network	$164.76
Rate for Payer: Priority Health SBD	$164.76

PR DETERMINATION REFRACTIVE STATE

Professional

Both

$94.00

Service Code	HCPCS 92015
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$1,164.90
Rate for Payer: Aetna Commercial	$21.33
Rate for Payer: BCBS Complete	$12.31
Rate for Payer: BCBS Trust/PPO	$1,164.90
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Mclaren Medicaid	$11.72
Rate for Payer: Meridian Medicaid	$12.31
Rate for Payer: Priority Health Choice Medicaid	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$65.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.08
Rate for Payer: Priority Health Narrow Network	$22.08
Rate for Payer: Priority Health SBD	$22.08

PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM

Professional

Both

$26.00

Service Code	HCPCS 96110
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$974.19
Rate for Payer: Aetna Commercial	$10.35
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$974.19
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.37
Rate for Payer: Priority Health Narrow Network	$14.37
Rate for Payer: Priority Health SBD	$14.37

PR DEVELOPMENTAL TESTING W/INTERP & REPORT

Professional

Both

$237.00

Service Code	HCPCS 96111
Min. Negotiated Rate	$94.80
Max. Negotiated Rate	$165.90
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: Cash Price	$189.60
Rate for Payer: Priority Health Cigna Priority Health	$165.90

PR DEXAMETHASONE SODIUM PHOS

Professional

Both

$10.00

Service Code	HCPCS J1100
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$0.12
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00

PR DIABETES PREVENTION PROGRAM

Professional

Both

$130.00

Service Code	HCPCS 00268
Hospital Revenue Code	990
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$91.00
Rate for Payer: BCBS Complete	$52.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Priority Health Cigna Priority Health	$91.00

PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM

Professional

Both

$32.00

Service Code	HCPCS 0403T
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$131.11
Rate for Payer: Aetna Commercial	$32.06
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$131.11
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40

PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX

Professional

Both

$1,269.00

Service Code	HCPCS 29805
Min. Negotiated Rate	$303.74
Max. Negotiated Rate	$888.30
Rate for Payer: Aetna Commercial	$626.78
Rate for Payer: BCBS Complete	$318.93
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Mclaren Medicaid	$303.74
Rate for Payer: Meridian Medicaid	$318.93
Rate for Payer: Priority Health Choice Medicaid	$303.74
Rate for Payer: Priority Health Cigna Priority Health	$888.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$723.59
Rate for Payer: Priority Health Narrow Network	$723.59
Rate for Payer: Priority Health SBD	$723.59

PR DIAGNOSTIC BONE MARROW ASPIRATIONS

Professional

Both

$350.00

Service Code	HCPCS 38220
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$437.96
Rate for Payer: Aetna Commercial	$85.82
Rate for Payer: BCBS Complete	$44.51
Rate for Payer: BCBS Trust/PPO	$437.96
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Mclaren Medicaid	$42.39
Rate for Payer: Meridian Medicaid	$44.51
Rate for Payer: Priority Health Choice Medicaid	$42.39
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.86
Rate for Payer: Priority Health Narrow Network	$144.86
Rate for Payer: Priority Health SBD	$144.86

PR DIAGNOSTIC BONE MARROW BIOPSIES

Professional

Both

$360.00

Service Code	HCPCS 38221
Min. Negotiated Rate	$44.30
Max. Negotiated Rate	$400.45
Rate for Payer: Aetna Commercial	$85.90
Rate for Payer: BCBS Complete	$46.52
Rate for Payer: BCBS Trust/PPO	$400.45
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Mclaren Medicaid	$44.30
Rate for Payer: Meridian Medicaid	$46.52
Rate for Payer: Priority Health Choice Medicaid	$44.30
Rate for Payer: Priority Health Cigna Priority Health	$252.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$149.95
Rate for Payer: Priority Health Narrow Network	$149.95
Rate for Payer: Priority Health SBD	$149.95

PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Professional

Both

$380.00

Service Code	HCPCS 38222
Min. Negotiated Rate	$47.29
Max. Negotiated Rate	$367.17
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: BCBS Complete	$49.65
Rate for Payer: BCBS Trust/PPO	$367.17
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Mclaren Medicaid	$47.29
Rate for Payer: Meridian Medicaid	$49.65
Rate for Payer: Priority Health Choice Medicaid	$47.29
Rate for Payer: Priority Health Cigna Priority Health	$266.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$161.53
Rate for Payer: Priority Health Narrow Network	$161.53
Rate for Payer: Priority Health SBD	$161.53

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE

Professional

Both

$555.00

Service Code	HCPCS 62270
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$874.34
Rate for Payer: Aetna Commercial	$79.39
Rate for Payer: BCBS Complete	$42.49
Rate for Payer: BCBS Trust/PPO	$874.34
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Mclaren Medicaid	$40.47
Rate for Payer: Meridian Medicaid	$42.49
Rate for Payer: Priority Health Choice Medicaid	$40.47
Rate for Payer: Priority Health Cigna Priority Health	$388.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$105.32
Rate for Payer: Priority Health Narrow Network	$105.32
Rate for Payer: Priority Health SBD	$105.32

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT

Professional

Both

$174.00

Service Code	HCPCS 62328
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$1,578.56
Rate for Payer: Aetna Commercial	$114.31
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCBS Trust/PPO	$1,578.56
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Mclaren Medicaid	$53.68
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health	$121.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.38
Rate for Payer: Priority Health Narrow Network	$144.38
Rate for Payer: Priority Health SBD	$144.38

PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

Professional

Both

$1,512.00

Service Code	HCPCS 36909
Min. Negotiated Rate	$124.61
Max. Negotiated Rate	$1,517.28
Rate for Payer: Aetna Commercial	$270.76
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: BCBS Trust/PPO	$1,517.28
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Mclaren Medicaid	$124.61
Rate for Payer: Meridian Medicaid	$130.84
Rate for Payer: Priority Health Choice Medicaid	$124.61
Rate for Payer: Priority Health Cigna Priority Health	$1,058.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$311.73
Rate for Payer: Priority Health Narrow Network	$311.73
Rate for Payer: Priority Health SBD	$311.73

PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL

Professional

Both

$205.00

Service Code	HCPCS 90945
Min. Negotiated Rate	$54.10
Max. Negotiated Rate	$370.34
Rate for Payer: Aetna Commercial	$94.34
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: BCBS Trust/PPO	$370.34
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Mclaren Medicaid	$54.10
Rate for Payer: Meridian Medicaid	$56.80
Rate for Payer: Priority Health Choice Medicaid	$54.10
Rate for Payer: Priority Health Cigna Priority Health	$143.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.19
Rate for Payer: Priority Health Narrow Network	$113.19
Rate for Payer: Priority Health SBD	$113.19

PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS

Professional

Both

$325.00

Service Code	HCPCS 90947
Min. Negotiated Rate	$77.11
Max. Negotiated Rate	$319.62
Rate for Payer: Aetna Commercial	$136.62
Rate for Payer: BCBS Complete	$80.97
Rate for Payer: BCBS Trust/PPO	$319.62
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Mclaren Medicaid	$77.11
Rate for Payer: Meridian Medicaid	$80.97
Rate for Payer: Priority Health Choice Medicaid	$77.11
Rate for Payer: Priority Health Cigna Priority Health	$227.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.14
Rate for Payer: Priority Health Narrow Network	$162.14
Rate for Payer: Priority Health SBD	$162.14

PR DIAPHRAGM

Professional

Both

$70.00

Service Code	HCPCS A4266
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$32.28
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$49.00

PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS

Professional

Both

$223.00

Service Code	HCPCS 57170
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$2,039.77
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: BCBS Complete	$31.53
Rate for Payer: BCBS Trust/PPO	$2,039.77
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cash Price	$178.40
Rate for Payer: Mclaren Medicaid	$30.03
Rate for Payer: Meridian Medicaid	$31.53
Rate for Payer: Priority Health Choice Medicaid	$30.03
Rate for Payer: Priority Health Cigna Priority Health	$156.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.70
Rate for Payer: Priority Health Narrow Network	$67.70
Rate for Payer: Priority Health SBD	$67.70

PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM

Professional

Both

$763.00

Service Code	HCPCS 95957
Min. Negotiated Rate	$133.39
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$270.69
Rate for Payer: BCBS Complete	$305.20
Rate for Payer: BCBS Trust/PPO	$346.56
Rate for Payer: Cash Price	$610.40
Rate for Payer: Cash Price	$610.40
Rate for Payer: Priority Health Cigna Priority Health	$534.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$133.39
Rate for Payer: Priority Health Narrow Network	$133.39
Rate for Payer: Priority Health SBD	$369.19

PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL

Professional

Both

$352.00

Service Code	HCPCS 45905
Min. Negotiated Rate	$109.48
Max. Negotiated Rate	$585.88
Rate for Payer: Aetna Commercial	$224.91
Rate for Payer: BCBS Complete	$114.95
Rate for Payer: BCBS Trust/PPO	$585.88
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Mclaren Medicaid	$109.48
Rate for Payer: Meridian Medicaid	$114.95
Rate for Payer: Priority Health Choice Medicaid	$109.48
Rate for Payer: Priority Health Cigna Priority Health	$246.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$299.86
Rate for Payer: Priority Health Narrow Network	$299.86
Rate for Payer: Priority Health SBD	$299.86

PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION

Professional

Both

$223.00

Service Code	HCPCS 42660
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$1,102.03
Rate for Payer: Aetna Commercial	$114.17
Rate for Payer: BCBS Complete	$58.15
Rate for Payer: BCBS Trust/PPO	$1,102.03
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cash Price	$178.40
Rate for Payer: Mclaren Medicaid	$55.38
Rate for Payer: Meridian Medicaid	$58.15
Rate for Payer: Priority Health Choice Medicaid	$55.38
Rate for Payer: Priority Health Cigna Priority Health	$156.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.81
Rate for Payer: Priority Health Narrow Network	$155.81
Rate for Payer: Priority Health SBD	$155.81

PR DILATE ESOPHAGUS,BALLOON RETROGRADE

Professional

Both

$812.00

Service Code	HCPCS 43456
Min. Negotiated Rate	$324.80
Max. Negotiated Rate	$568.40
Rate for Payer: BCBS Complete	$324.80
Rate for Payer: Cash Price	$649.60
Rate for Payer: Priority Health Cigna Priority Health	$568.40

PR DILATE ESOPH,BALLN,>30MM ACHALASIA

Professional

Both

$1,009.00

Service Code	HCPCS 43458
Min. Negotiated Rate	$403.60
Max. Negotiated Rate	$706.30
Rate for Payer: BCBS Complete	$403.60
Rate for Payer: Cash Price	$807.20
Rate for Payer: Priority Health Cigna Priority Health	$706.30

PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI

Professional

Both

$141.00

Service Code	HCPCS 53660
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$927.17
Rate for Payer: Aetna Commercial	$53.15
Rate for Payer: BCBS Complete	$27.73
Rate for Payer: BCBS Trust/PPO	$927.17
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Mclaren Medicaid	$26.41
Rate for Payer: Meridian Medicaid	$27.73
Rate for Payer: Priority Health Choice Medicaid	$26.41
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.46
Rate for Payer: Priority Health Narrow Network	$66.46
Rate for Payer: Priority Health SBD	$66.46

PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ

Professional

Both

$142.00

Service Code	HCPCS 53661
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$2,149.12
Rate for Payer: Aetna Commercial	$51.53
Rate for Payer: BCBS Complete	$26.84
Rate for Payer: BCBS Trust/PPO	$2,149.12
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Mclaren Medicaid	$25.56
Rate for Payer: Meridian Medicaid	$26.84
Rate for Payer: Priority Health Choice Medicaid	$25.56
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.84
Rate for Payer: Priority Health Narrow Network	$64.84
Rate for Payer: Priority Health SBD	$64.84

Know your out-of-pocket cost for care.

All Charges