Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC

Professional

Both

$5,580.00

Service Code	HCPCS 63077
Min. Negotiated Rate	$145.28
Max. Negotiated Rate	$3,906.00
Rate for Payer: Aetna Commercial	$1,935.47
Rate for Payer: BCBS Complete	$982.04
Rate for Payer: BCBS Trust/PPO	$145.28
Rate for Payer: Cash Price	$4,464.00
Rate for Payer: Cash Price	$4,464.00
Rate for Payer: Mclaren Medicaid	$935.28
Rate for Payer: Meridian Medicaid	$982.04
Rate for Payer: Priority Health Choice Medicaid	$935.28
Rate for Payer: Priority Health Cigna Priority Health	$3,906.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,598.39
Rate for Payer: Priority Health Narrow Network	$2,598.39
Rate for Payer: Priority Health SBD	$2,598.39

PR DISEASE MANAGEMENT PROGRAM

Professional

Both

$450.00

Service Code	HCPCS S0315
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: BCBS Trust/PPO	$111.47
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Priority Health Cigna Priority Health	$315.00

PR DISEASE MGMT PER DIEM

Professional

Both

$150.00

Service Code	HCPCS S0317
Min. Negotiated Rate	$58.11
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$175.00
Rate for Payer: Aetna Commercial	$175.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$58.11
Rate for Payer: BCBS Trust/PPO	$58.11
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00

PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX

Professional

Both

$223.00

Service Code	HCPCS 42975
Min. Negotiated Rate	$61.98
Max. Negotiated Rate	$284.23
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: BCBS Complete	$65.08
Rate for Payer: BCBS Trust/PPO	$284.23
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cash Price	$178.40
Rate for Payer: Mclaren Medicaid	$61.98
Rate for Payer: Meridian Medicaid	$65.08
Rate for Payer: Priority Health Choice Medicaid	$61.98
Rate for Payer: Priority Health Cigna Priority Health	$156.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$168.16
Rate for Payer: Priority Health Narrow Network	$168.16
Rate for Payer: Priority Health SBD	$168.16

PR DISPENSING FEE BINAURAL

Professional

Both

$475.00

Service Code	HCPCS V5160
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$289.59
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Priority Health Cigna Priority Health	$332.50

PR DISPENSING FEE, MONAURAL

Professional

Both

$275.00

Service Code	HCPCS V5241
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50

PR DISP FEE CONTRALATERAL BINAU

Professional

Both

$475.00

Service Code	HCPCS V5240
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$248.26
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Priority Health Cigna Priority Health	$332.50

PR DISP FEE CONTRALATERAL MONAU

Professional

Both

$275.00

Service Code	HCPCS V5200
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$239.68
Rate for Payer: Aetna Commercial	$239.68
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50

PR DISSECTION DEEP JUGULAR NODE

Facility

$920.00

Service Code	CPT 38542
Hospital Charge Code	38542
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$828.00
Rate for Payer: Aetna Commercial	$782.00
Rate for Payer: Aetna New Business (MI Preferred)	$598.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cofinity Commercial	$644.00
Rate for Payer: Cofinity Commercial	$791.20
Rate for Payer: Healthscope Commercial	$828.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$782.00
Rate for Payer: PHP Commercial	$782.00
Rate for Payer: Priority Health Cigna Priority Health	$644.00
Rate for Payer: Priority Health SBD	$579.60

PR DISSECTION DEEP JUGULAR NODE

Professional

Both

$920.00

Service Code	HCPCS 38542
Min. Negotiated Rate	$336.75
Max. Negotiated Rate	$1,136.49
Rate for Payer: Aetna Commercial	$636.69
Rate for Payer: BCBS Complete	$353.59
Rate for Payer: BCBS Trust/PPO	$975.24
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Mclaren Medicaid	$336.75
Rate for Payer: Meridian Medicaid	$353.59
Rate for Payer: Priority Health Choice Medicaid	$336.75
Rate for Payer: Priority Health Cigna Priority Health	$644.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,136.49
Rate for Payer: Priority Health Narrow Network	$1,136.49
Rate for Payer: Priority Health SBD	$1,136.49

PR DISSECTION DEEP JUGULAR NODE

Facility

$920.00

Service Code	CPT 38542
Hospital Charge Code	38542
Min. Negotiated Rate	$517.69
Max. Negotiated Rate	$15,754.72
Rate for Payer: Aetna Commercial	$782.00
Rate for Payer: Aetna Medicare	$5,339.45
Rate for Payer: Aetna New Business (MI Preferred)	$598.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,417.61
Rate for Payer: Amish Plain Church Group Commercial	$6,417.61
Rate for Payer: BCBS Complete	$2,949.02
Rate for Payer: BCBS MAPPO	$5,134.09
Rate for Payer: BCBS Trust/PPO	$2,064.84
Rate for Payer: BCN Medicare Advantage	$5,134.09
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cofinity Commercial	$791.20
Rate for Payer: Cofinity Commercial	$644.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,134.09
Rate for Payer: Healthscope Commercial	$828.00
Rate for Payer: Mclaren Medicaid	$2,808.35
Rate for Payer: Mclaren Medicare	$5,134.09
Rate for Payer: Meridian Medicaid	$2,949.02
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,390.79
Rate for Payer: MI Amish Medical Board Commercial	$5,904.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$782.00
Rate for Payer: PACE Medicare	$4,877.39
Rate for Payer: PACE SWMI	$5,134.09
Rate for Payer: PHP Commercial	$782.00
Rate for Payer: PHP Medicare Advantage	$5,134.09
Rate for Payer: Priority Health Choice Medicaid	$2,808.35
Rate for Payer: Priority Health Cigna Priority Health	$644.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,754.72
Rate for Payer: Priority Health Medicare	$5,134.09
Rate for Payer: Priority Health Narrow Network	$12,603.78
Rate for Payer: Priority Health SBD	$579.60
Rate for Payer: Railroad Medicare Medicare	$5,134.09
Rate for Payer: UHC All Payor (Choice/PPO)	$569.46
Rate for Payer: UHC Dual Complete DSNP	$5,134.09
Rate for Payer: UHC Exchange	$517.69
Rate for Payer: UHC Medicare Advantage	$5,288.11
Rate for Payer: VA VA	$5,134.09

PR DISSECTION DEEP JUGULAR NODE

Professional

Both

$920.00

Service Code	HCPCS 38542
Hospital Charge Code	38542
Min. Negotiated Rate	$336.75
Max. Negotiated Rate	$1,136.49
Rate for Payer: Aetna Commercial	$636.69
Rate for Payer: BCBS Complete	$353.59
Rate for Payer: BCBS Trust/PPO	$975.24
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Mclaren Medicaid	$336.75
Rate for Payer: Meridian Medicaid	$353.59
Rate for Payer: Priority Health Choice Medicaid	$336.75
Rate for Payer: Priority Health Cigna Priority Health	$644.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,136.49
Rate for Payer: Priority Health Narrow Network	$1,136.49
Rate for Payer: Priority Health SBD	$1,136.49

PR DIS SITE TELE SVCS RHC/FQHC

Professional

Both

$184.00

Service Code	HCPCS G2025
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$1,080.37
Rate for Payer: Aetna Commercial	$95.30
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: BCBS Trust/PPO	$1,080.37
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Priority Health Cigna Priority Health	$128.80

PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD

Professional

Both

$84.00

Service Code	HCPCS 92587
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$1,890.26
Rate for Payer: Aetna Commercial	$24.41
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: BCBS Trust/PPO	$1,890.26
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.39
Rate for Payer: Priority Health Narrow Network	$5.39
Rate for Payer: Priority Health SBD	$29.20

PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL

Professional

Both

$68.00

Service Code	HCPCS 92588
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$1,499.32
Rate for Payer: Aetna Commercial	$37.21
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: BCBS Trust/PPO	$1,499.32
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.18
Rate for Payer: Priority Health Narrow Network	$7.18
Rate for Payer: Priority Health SBD	$45.37

PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR

Professional

Both

$2,389.00

Service Code	HCPCS 43130
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$1,672.30
Rate for Payer: Aetna Commercial	$1,052.07
Rate for Payer: BCBS Complete	$534.74
Rate for Payer: BCBS Trust/PPO	$85.32
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Mclaren Medicaid	$509.28
Rate for Payer: Meridian Medicaid	$534.74
Rate for Payer: Priority Health Choice Medicaid	$509.28
Rate for Payer: Priority Health Cigna Priority Health	$1,672.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,396.43
Rate for Payer: Priority Health Narrow Network	$1,396.43
Rate for Payer: Priority Health SBD	$1,396.43

PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR

Professional

Both

$3,105.00

Service Code	HCPCS 43135
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$2,546.50
Rate for Payer: Aetna Commercial	$1,977.64
Rate for Payer: BCBS Complete	$972.88
Rate for Payer: BCBS Trust/PPO	$77.66
Rate for Payer: Cash Price	$2,484.00
Rate for Payer: Cash Price	$2,484.00
Rate for Payer: Mclaren Medicaid	$926.55
Rate for Payer: Meridian Medicaid	$972.88
Rate for Payer: Priority Health Choice Medicaid	$926.55
Rate for Payer: Priority Health Cigna Priority Health	$2,173.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,546.50
Rate for Payer: Priority Health Narrow Network	$2,546.50
Rate for Payer: Priority Health SBD	$2,546.50

PR DIVISION ABERRANT VESSEL VASCULAR RING

Professional

Both

$4,150.00

Service Code	HCPCS 33802
Min. Negotiated Rate	$686.71
Max. Negotiated Rate	$2,905.00
Rate for Payer: Aetna Commercial	$1,453.89
Rate for Payer: BCBS Complete	$721.05
Rate for Payer: BCBS Trust/PPO	$1,485.05
Rate for Payer: Cash Price	$3,320.00
Rate for Payer: Cash Price	$3,320.00
Rate for Payer: Mclaren Medicaid	$686.71
Rate for Payer: Meridian Medicaid	$721.05
Rate for Payer: Priority Health Choice Medicaid	$686.71
Rate for Payer: Priority Health Cigna Priority Health	$2,905.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,702.80
Rate for Payer: Priority Health Narrow Network	$1,702.80
Rate for Payer: Priority Health SBD	$1,702.80

PR DIVISION PLANTAR FASCIA & MUSCLE SPX

Professional

Both

$1,285.00

Service Code	HCPCS 28250
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$3,050.93
Rate for Payer: Aetna Commercial	$533.29
Rate for Payer: BCBS Complete	$279.56
Rate for Payer: BCBS Trust/PPO	$3,050.93
Rate for Payer: Cash Price	$1,028.00
Rate for Payer: Cash Price	$1,028.00
Rate for Payer: Mclaren Medicaid	$266.25
Rate for Payer: Meridian Medicaid	$279.56
Rate for Payer: Priority Health Choice Medicaid	$266.25
Rate for Payer: Priority Health Cigna Priority Health	$899.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$627.58
Rate for Payer: Priority Health Narrow Network	$627.58
Rate for Payer: Priority Health SBD	$627.58

PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB

Professional

Both

$1,097.00

Service Code	HCPCS 21705
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$804.78
Rate for Payer: Aetna Commercial	$719.58
Rate for Payer: BCBS Complete	$354.49
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$877.60
Rate for Payer: Cash Price	$877.60
Rate for Payer: Mclaren Medicaid	$337.61
Rate for Payer: Meridian Medicaid	$354.49
Rate for Payer: Priority Health Choice Medicaid	$337.61
Rate for Payer: Priority Health Cigna Priority Health	$767.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$804.78
Rate for Payer: Priority Health Narrow Network	$804.78
Rate for Payer: Priority Health SBD	$804.78

PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB

Professional

Both

$1,519.00

Service Code	HCPCS 21700
Min. Negotiated Rate	$226.42
Max. Negotiated Rate	$1,117.06
Rate for Payer: Aetna Commercial	$478.91
Rate for Payer: BCBS Complete	$237.74
Rate for Payer: BCBS Trust/PPO	$1,117.06
Rate for Payer: Cash Price	$1,215.20
Rate for Payer: Cash Price	$1,215.20
Rate for Payer: Mclaren Medicaid	$226.42
Rate for Payer: Meridian Medicaid	$237.74
Rate for Payer: Priority Health Choice Medicaid	$226.42
Rate for Payer: Priority Health Cigna Priority Health	$1,063.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$539.25
Rate for Payer: Priority Health Narrow Network	$539.25
Rate for Payer: Priority Health SBD	$539.25

PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL

Professional

Both

$1,648.00

Service Code	HCPCS 34710
Min. Negotiated Rate	$496.29
Max. Negotiated Rate	$1,852.75
Rate for Payer: Aetna Commercial	$1,070.75
Rate for Payer: BCBS Complete	$521.10
Rate for Payer: BCBS Trust/PPO	$1,852.75
Rate for Payer: Cash Price	$1,318.40
Rate for Payer: Cash Price	$1,318.40
Rate for Payer: Mclaren Medicaid	$496.29
Rate for Payer: Meridian Medicaid	$521.10
Rate for Payer: Priority Health Choice Medicaid	$496.29
Rate for Payer: Priority Health Cigna Priority Health	$1,153.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,233.60
Rate for Payer: Priority Health Narrow Network	$1,233.60
Rate for Payer: Priority Health SBD	$1,233.60

PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL

Professional

Both

$617.00

Service Code	HCPCS 34711
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$1,060.83
Rate for Payer: Aetna Commercial	$402.19
Rate for Payer: BCBS Complete	$191.89
Rate for Payer: BCBS Trust/PPO	$1,060.83
Rate for Payer: Cash Price	$493.60
Rate for Payer: Cash Price	$493.60
Rate for Payer: Mclaren Medicaid	$182.75
Rate for Payer: Meridian Medicaid	$191.89
Rate for Payer: Priority Health Choice Medicaid	$182.75
Rate for Payer: Priority Health Cigna Priority Health	$431.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$455.35
Rate for Payer: Priority Health Narrow Network	$455.35
Rate for Payer: Priority Health SBD	$455.35

PR DOG EAR REVISION

Professional

Both

$1,809.00

Service Code	HCPCS 00565
Hospital Revenue Code	990
Min. Negotiated Rate	$723.60
Max. Negotiated Rate	$1,266.30
Rate for Payer: BCBS Complete	$723.60
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Priority Health Cigna Priority Health	$1,266.30

PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN

Professional

Both

$90.00

Service Code	HCPCS 99324
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$63.00
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$63.00

Know your out-of-pocket cost for care.

All Charges