Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR DRAINAGE OF PALMAR BURSA SINGLE BURSA

Professional

Both

$1,336.00

Service Code	HCPCS 26025
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$935.20
Rate for Payer: Aetna Commercial	$560.79
Rate for Payer: BCBS Complete	$287.16
Rate for Payer: BCBS Trust/PPO	$84.90
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Mclaren Medicaid	$273.49
Rate for Payer: Meridian Medicaid	$287.16
Rate for Payer: Priority Health Choice Medicaid	$273.49
Rate for Payer: Priority Health Cigna Priority Health	$935.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$649.55
Rate for Payer: Priority Health Narrow Network	$649.55
Rate for Payer: Priority Health SBD	$649.55

PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN

Professional

Both

$2,205.00

Service Code	HCPCS 49060
Min. Negotiated Rate	$698.85
Max. Negotiated Rate	$1,919.15
Rate for Payer: Aetna Commercial	$1,480.16
Rate for Payer: BCBS Complete	$733.79
Rate for Payer: BCBS Trust/PPO	$798.26
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Mclaren Medicaid	$698.85
Rate for Payer: Meridian Medicaid	$733.79
Rate for Payer: Priority Health Choice Medicaid	$698.85
Rate for Payer: Priority Health Cigna Priority Health	$1,543.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,919.15
Rate for Payer: Priority Health Narrow Network	$1,919.15
Rate for Payer: Priority Health SBD	$1,919.15

PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH

Professional

Both

$1,691.00

Service Code	HCPCS 58822
Min. Negotiated Rate	$280.53
Max. Negotiated Rate	$1,183.70
Rate for Payer: Aetna Commercial	$854.23
Rate for Payer: BCBS Complete	$482.63
Rate for Payer: BCBS Trust/PPO	$280.53
Rate for Payer: Cash Price	$1,352.80
Rate for Payer: Cash Price	$1,352.80
Rate for Payer: Mclaren Medicaid	$459.65
Rate for Payer: Meridian Medicaid	$482.63
Rate for Payer: Priority Health Choice Medicaid	$459.65
Rate for Payer: Priority Health Cigna Priority Health	$1,183.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,017.39
Rate for Payer: Priority Health Narrow Network	$1,017.39
Rate for Payer: Priority Health SBD	$1,017.39

PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN

Professional

Both

$879.00

Service Code	HCPCS 58820
Min. Negotiated Rate	$136.83
Max. Negotiated Rate	$615.30
Rate for Payer: Aetna Commercial	$398.40
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCBS Trust/PPO	$136.83
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Mclaren Medicaid	$219.18
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health	$615.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$484.78
Rate for Payer: Priority Health Narrow Network	$484.78
Rate for Payer: Priority Health SBD	$484.78

PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL

Professional

Both

$1,580.00

Service Code	HCPCS 58805
Min. Negotiated Rate	$275.77
Max. Negotiated Rate	$1,106.00
Rate for Payer: Aetna Commercial	$506.69
Rate for Payer: BCBS Complete	$290.29
Rate for Payer: BCBS Trust/PPO	$275.77
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Mclaren Medicaid	$276.47
Rate for Payer: Meridian Medicaid	$290.29
Rate for Payer: Priority Health Choice Medicaid	$276.47
Rate for Payer: Priority Health Cigna Priority Health	$1,106.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$611.19
Rate for Payer: Priority Health Narrow Network	$611.19
Rate for Payer: Priority Health SBD	$611.19

PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR

Professional

Both

$974.00

Service Code	HCPCS 58800
Min. Negotiated Rate	$203.84
Max. Negotiated Rate	$681.80
Rate for Payer: Aetna Commercial	$373.31
Rate for Payer: BCBS Complete	$214.03
Rate for Payer: BCBS Trust/PPO	$503.47
Rate for Payer: Cash Price	$779.20
Rate for Payer: Cash Price	$779.20
Rate for Payer: Mclaren Medicaid	$203.84
Rate for Payer: Meridian Medicaid	$214.03
Rate for Payer: Priority Health Choice Medicaid	$203.84
Rate for Payer: Priority Health Cigna Priority Health	$681.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.23
Rate for Payer: Priority Health Narrow Network	$450.23
Rate for Payer: Priority Health SBD	$450.23

PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN

Professional

Both

$2,773.00

Service Code	HCPCS 49020
Min. Negotiated Rate	$537.81
Max. Negotiated Rate	$2,791.69
Rate for Payer: Aetna Commercial	$2,149.64
Rate for Payer: BCBS Complete	$1,068.83
Rate for Payer: BCBS Trust/PPO	$537.81
Rate for Payer: Cash Price	$2,218.40
Rate for Payer: Cash Price	$2,218.40
Rate for Payer: Mclaren Medicaid	$1,017.93
Rate for Payer: Meridian Medicaid	$1,068.83
Rate for Payer: Priority Health Choice Medicaid	$1,017.93
Rate for Payer: Priority Health Cigna Priority Health	$1,941.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,791.69
Rate for Payer: Priority Health Narrow Network	$2,791.69
Rate for Payer: Priority Health SBD	$2,791.69

PR DRAINAGE SCROTAL WALL ABSCESS

Professional

Both

$391.00

Service Code	HCPCS 55100
Min. Negotiated Rate	$107.99
Max. Negotiated Rate	$1,199.77
Rate for Payer: Aetna Commercial	$212.60
Rate for Payer: BCBS Complete	$113.39
Rate for Payer: BCBS Trust/PPO	$1,199.77
Rate for Payer: Cash Price	$312.80
Rate for Payer: Cash Price	$312.80
Rate for Payer: Mclaren Medicaid	$107.99
Rate for Payer: Meridian Medicaid	$113.39
Rate for Payer: Priority Health Choice Medicaid	$107.99
Rate for Payer: Priority Health Cigna Priority Health	$273.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.10
Rate for Payer: Priority Health Narrow Network	$269.10
Rate for Payer: Priority Health SBD	$269.10

PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN

Professional

Both

$2,180.00

Service Code	HCPCS 49040
Min. Negotiated Rate	$640.83
Max. Negotiated Rate	$1,763.34
Rate for Payer: Aetna Commercial	$1,356.51
Rate for Payer: BCBS Complete	$673.41
Rate for Payer: BCBS Trust/PPO	$640.83
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Mclaren Medicaid	$641.34
Rate for Payer: Meridian Medicaid	$673.41
Rate for Payer: Priority Health Choice Medicaid	$641.34
Rate for Payer: Priority Health Cigna Priority Health	$1,526.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,763.34
Rate for Payer: Priority Health Narrow Network	$1,763.34
Rate for Payer: Priority Health SBD	$1,763.34

PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH

Professional

Both

$750.00

Service Code	HCPCS 26020
Min. Negotiated Rate	$362.31
Max. Negotiated Rate	$860.45
Rate for Payer: Aetna Commercial	$737.75
Rate for Payer: BCBS Complete	$380.43
Rate for Payer: BCBS Trust/PPO	$663.49
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Mclaren Medicaid	$362.31
Rate for Payer: Meridian Medicaid	$380.43
Rate for Payer: Priority Health Choice Medicaid	$362.31
Rate for Payer: Priority Health Cigna Priority Health	$525.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$860.45
Rate for Payer: Priority Health Narrow Network	$860.45
Rate for Payer: Priority Health SBD	$860.45

PR DRESSING CHANGE UNDER ANESTHESIA

Professional

Both

$167.00

Service Code	HCPCS 15852
Min. Negotiated Rate	$28.33
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$50.88
Rate for Payer: BCBS Complete	$29.75
Rate for Payer: BCBS Trust/PPO	$450.00
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Mclaren Medicaid	$28.33
Rate for Payer: Meridian Medicaid	$29.75
Rate for Payer: Priority Health Choice Medicaid	$28.33
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.32
Rate for Payer: Priority Health Narrow Network	$56.32
Rate for Payer: Priority Health SBD	$56.32

PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS

Professional

Both

$547.00

Service Code	HCPCS 41800
Min. Negotiated Rate	$99.26
Max. Negotiated Rate	$2,059.31
Rate for Payer: Aetna Commercial	$204.22
Rate for Payer: BCBS Complete	$104.22
Rate for Payer: BCBS Trust/PPO	$2,059.31
Rate for Payer: Cash Price	$437.60
Rate for Payer: Cash Price	$437.60
Rate for Payer: Mclaren Medicaid	$99.26
Rate for Payer: Meridian Medicaid	$104.22
Rate for Payer: Priority Health Choice Medicaid	$99.26
Rate for Payer: Priority Health Cigna Priority Health	$382.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$271.65
Rate for Payer: Priority Health Narrow Network	$271.65
Rate for Payer: Priority Health SBD	$271.65

PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP

Professional

Both

$620.00

Service Code	HCPCS 40801
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$1,779.31
Rate for Payer: Aetna Commercial	$262.87
Rate for Payer: BCBS Complete	$133.74
Rate for Payer: BCBS Trust/PPO	$1,779.31
Rate for Payer: Cash Price	$496.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: Mclaren Medicaid	$127.37
Rate for Payer: Meridian Medicaid	$133.74
Rate for Payer: Priority Health Choice Medicaid	$127.37
Rate for Payer: Priority Health Cigna Priority Health	$434.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$346.32
Rate for Payer: Priority Health Narrow Network	$346.32
Rate for Payer: Priority Health SBD	$346.32

PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV

Professional

Both

$1,037.00

Service Code	HCPCS 38305
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$1,074.93
Rate for Payer: Aetna Commercial	$608.51
Rate for Payer: BCBS Complete	$335.48
Rate for Payer: BCBS Trust/PPO	$565.81
Rate for Payer: Cash Price	$829.60
Rate for Payer: Cash Price	$829.60
Rate for Payer: Mclaren Medicaid	$319.50
Rate for Payer: Meridian Medicaid	$335.48
Rate for Payer: Priority Health Choice Medicaid	$319.50
Rate for Payer: Priority Health Cigna Priority Health	$725.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,074.93
Rate for Payer: Priority Health Narrow Network	$1,074.93
Rate for Payer: Priority Health SBD	$1,074.93

PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL

Professional

Both

$446.00

Service Code	HCPCS 38300
Min. Negotiated Rate	$135.47
Max. Negotiated Rate	$604.38
Rate for Payer: Aetna Commercial	$255.68
Rate for Payer: BCBS Complete	$142.24
Rate for Payer: BCBS Trust/PPO	$604.38
Rate for Payer: Cash Price	$356.80
Rate for Payer: Cash Price	$356.80
Rate for Payer: Mclaren Medicaid	$135.47
Rate for Payer: Meridian Medicaid	$142.24
Rate for Payer: Priority Health Choice Medicaid	$135.47
Rate for Payer: Priority Health Cigna Priority Health	$312.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$454.88
Rate for Payer: Priority Health Narrow Network	$454.88
Rate for Payer: Priority Health SBD	$454.88

PR DRG OF SKENE'S GLAND ABSCESS OR CYST

Professional

Both

$603.00

Service Code	HCPCS 53060
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$422.10
Rate for Payer: Aetna Commercial	$213.39
Rate for Payer: BCBS Complete	$111.82
Rate for Payer: BCBS Trust/PPO	$283.70
Rate for Payer: Cash Price	$482.40
Rate for Payer: Cash Price	$482.40
Rate for Payer: Mclaren Medicaid	$106.50
Rate for Payer: Meridian Medicaid	$111.82
Rate for Payer: Priority Health Choice Medicaid	$106.50
Rate for Payer: Priority Health Cigna Priority Health	$422.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.56
Rate for Payer: Priority Health Narrow Network	$268.56
Rate for Payer: Priority Health SBD	$268.56

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE

Professional

Both

$303.00

Service Code	HCPCS 16030
Min. Negotiated Rate	$84.14
Max. Negotiated Rate	$569.29
Rate for Payer: Aetna Commercial	$141.99
Rate for Payer: BCBS Complete	$88.35
Rate for Payer: BCBS Trust/PPO	$569.29
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cash Price	$242.40
Rate for Payer: Mclaren Medicaid	$84.14
Rate for Payer: Meridian Medicaid	$88.35
Rate for Payer: Priority Health Choice Medicaid	$84.14
Rate for Payer: Priority Health Cigna Priority Health	$212.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$160.72
Rate for Payer: Priority Health Narrow Network	$160.72
Rate for Payer: Priority Health SBD	$160.72

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM

Professional

Both

$246.00

Service Code	HCPCS 16025
Min. Negotiated Rate	$71.14
Max. Negotiated Rate	$2,369.57
Rate for Payer: Aetna Commercial	$119.21
Rate for Payer: BCBS Complete	$74.70
Rate for Payer: BCBS Trust/PPO	$2,369.57
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Mclaren Medicaid	$71.14
Rate for Payer: Meridian Medicaid	$74.70
Rate for Payer: Priority Health Choice Medicaid	$71.14
Rate for Payer: Priority Health Cigna Priority Health	$172.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.82
Rate for Payer: Priority Health Narrow Network	$134.82
Rate for Payer: Priority Health SBD	$134.82

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL

Professional

Both

$135.00

Service Code	HCPCS 16020
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$3,995.58
Rate for Payer: Aetna Commercial	$59.06
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCBS Trust/PPO	$3,995.58
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Mclaren Medicaid	$35.78
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.82
Rate for Payer: Priority Health Narrow Network	$67.82
Rate for Payer: Priority Health SBD	$67.82

PR DRUG-ELUTING STENTS, SINGLE

Professional

Both

$2,475.00

Service Code	HCPCS G0290
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,732.50
Rate for Payer: BCBS Complete	$990.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Priority Health Cigna Priority Health	$1,732.50

PR DRUG SCREEN MULTI DRUG CLASS

Professional

Both

$38.00

Service Code	HCPCS G0434
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60

PR DRUG SCREEN MULTIP CLASS

Professional

Both

$61.00

Service Code	HCPCS G0431
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$42.70
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70

PR DRUG SCREEN PANEL 10 WITH BATH SALTS

Professional

Both

$75.00

Service Code	HCPCS 00124
Hospital Revenue Code	960
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$52.50
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50

PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS

Professional

Both

$2,386.00

Service Code	HCPCS 36838
Min. Negotiated Rate	$711.42
Max. Negotiated Rate	$1,774.08
Rate for Payer: Aetna Commercial	$1,535.31
Rate for Payer: BCBS Complete	$746.99
Rate for Payer: BCBS Trust/PPO	$1,197.13
Rate for Payer: Cash Price	$1,908.80
Rate for Payer: Cash Price	$1,908.80
Rate for Payer: Mclaren Medicaid	$711.42
Rate for Payer: Meridian Medicaid	$746.99
Rate for Payer: Priority Health Choice Medicaid	$711.42
Rate for Payer: Priority Health Cigna Priority Health	$1,670.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,774.08
Rate for Payer: Priority Health Narrow Network	$1,774.08
Rate for Payer: Priority Health SBD	$1,774.08

PR DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM

Professional

Both

$802.00

Service Code	HCPCS 17107
Min. Negotiated Rate	$230.25
Max. Negotiated Rate	$3,712.50
Rate for Payer: Aetna Commercial	$379.73
Rate for Payer: BCBS Complete	$241.76
Rate for Payer: BCBS Trust/PPO	$3,712.50
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cash Price	$641.60
Rate for Payer: Mclaren Medicaid	$230.25
Rate for Payer: Meridian Medicaid	$241.76
Rate for Payer: Priority Health Choice Medicaid	$230.25
Rate for Payer: Priority Health Cigna Priority Health	$561.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$437.76
Rate for Payer: Priority Health Narrow Network	$437.76
Rate for Payer: Priority Health SBD	$437.76

Know your out-of-pocket cost for care.

All Charges