Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL

Professional

Both

$375.00

Service Code	HCPCS 62367
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$310.64
Rate for Payer: Aetna Commercial	$31.85
Rate for Payer: BCBS Complete	$16.55
Rate for Payer: BCBS Trust/PPO	$310.64
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Mclaren Medicaid	$15.76
Rate for Payer: Meridian Medicaid	$16.55
Rate for Payer: Priority Health Choice Medicaid	$15.76
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.34
Rate for Payer: Priority Health Narrow Network	$41.34
Rate for Payer: Priority Health SBD	$41.34

PR ELECTROACOUS EVAL HEARING AID BINAURAL

Professional

Both

$77.00

Service Code	HCPCS 92595
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$338.64
Rate for Payer: Aetna Commercial	$49.30
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: BCBS Trust/PPO	$338.64
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$53.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.54
Rate for Payer: Priority Health Narrow Network	$61.54
Rate for Payer: Priority Health SBD	$61.54

PR ELECTROACOUS EVAL HEARING AID MONAURAL

Professional

Both

$26.00

Service Code	HCPCS 92594
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$231.15
Rate for Payer: Aetna Commercial	$22.43
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$231.15
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	$28.75
Rate for Payer: Priority Health Narrow Network	$28.75
Rate for Payer: Priority Health SBD	$28.75

PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY

Professional

Both

$197.00

Service Code	HCPCS 95824
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$262.57
Rate for Payer: Aetna Commercial	$106.88
Rate for Payer: BCBS Complete	$78.80
Rate for Payer: BCBS Trust/PPO	$262.57
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.20
Rate for Payer: Priority Health Narrow Network	$51.20
Rate for Payer: Priority Health SBD	$131.15

PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN

Professional

Both

$738.00

Service Code	HCPCS 95812
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$1,286.41
Rate for Payer: Aetna Commercial	$364.65
Rate for Payer: BCBS Complete	$295.20
Rate for Payer: BCBS Trust/PPO	$1,286.41
Rate for Payer: Cash Price	$590.40
Rate for Payer: Cash Price	$590.40
Rate for Payer: Priority Health Cigna Priority Health	$516.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health SBD	$463.52

PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY

Professional

Both

$360.00

Service Code	HCPCS 95822
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$614.41
Rate for Payer: Aetna Commercial	$435.49
Rate for Payer: BCBS Complete	$144.00
Rate for Payer: BCBS Trust/PPO	$614.41
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: Priority Health Cigna Priority Health	$252.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.55
Rate for Payer: Priority Health Narrow Network	$74.55
Rate for Payer: Priority Health SBD	$558.29

PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP

Professional

Both

$202.00

Service Code	HCPCS 95819
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$596.01
Rate for Payer: Aetna Commercial	$477.15
Rate for Payer: Aetna Commercial	$477.15
Rate for Payer: BCBS Complete	$80.80
Rate for Payer: BCBS Complete	$311.20
Rate for Payer: BCBS Trust/PPO	$150.04
Rate for Payer: BCBS Trust/PPO	$150.04
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$161.60
Rate for Payer: Priority Health Cigna Priority Health	$544.60
Rate for Payer: Priority Health Cigna Priority Health	$141.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health SBD	$596.01
Rate for Payer: Priority Health SBD	$596.01

PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY

Professional

Both

$678.00

Service Code	HCPCS 95816
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$513.82
Rate for Payer: Aetna Commercial	$398.47
Rate for Payer: Aetna Commercial	$398.47
Rate for Payer: BCBS Complete	$110.40
Rate for Payer: BCBS Complete	$271.20
Rate for Payer: BCBS Trust/PPO	$231.92
Rate for Payer: BCBS Trust/PPO	$231.92
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$542.40
Rate for Payer: Priority Health Cigna Priority Health	$193.20
Rate for Payer: Priority Health Cigna Priority Health	$474.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health Narrow Network	$74.10
Rate for Payer: Priority Health SBD	$513.82
Rate for Payer: Priority Health SBD	$513.82

PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS

Professional

Both

$276.00

Service Code	HCPCS 91132
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$600.05
Rate for Payer: Aetna Commercial	$438.73
Rate for Payer: BCBS Complete	$110.40
Rate for Payer: BCBS Trust/PPO	$538.87
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Priority Health Cigna Priority Health	$193.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.58
Rate for Payer: Priority Health Narrow Network	$34.58
Rate for Payer: Priority Health SBD	$600.05

PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM

Professional

Both

$560.00

Service Code	HCPCS 93724
Min. Negotiated Rate	$65.72
Max. Negotiated Rate	$396.26
Rate for Payer: Aetna Commercial	$311.50
Rate for Payer: BCBS Complete	$224.00
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: Cash Price	$448.00
Rate for Payer: Cash Price	$448.00
Rate for Payer: Priority Health Cigna Priority Health	$392.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.72
Rate for Payer: Priority Health Narrow Network	$65.72
Rate for Payer: Priority Health SBD	$396.26

PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL

Professional

Both

$4,063.00

Service Code	HCPCS 62000
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,844.10
Rate for Payer: Aetna Commercial	$1,335.49
Rate for Payer: BCBS Complete	$708.75
Rate for Payer: BCBS Trust/PPO	$1,847.99
Rate for Payer: Cash Price	$3,250.40
Rate for Payer: Cash Price	$3,250.40
Rate for Payer: Mclaren Medicaid	$675.00
Rate for Payer: Meridian Medicaid	$708.75
Rate for Payer: Priority Health Choice Medicaid	$675.00
Rate for Payer: Priority Health Cigna Priority Health	$2,844.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,776.81
Rate for Payer: Priority Health Narrow Network	$1,776.81
Rate for Payer: Priority Health SBD	$1,776.81

PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL

Professional

Both

$5,136.00

Service Code	HCPCS 62005
Min. Negotiated Rate	$829.00
Max. Negotiated Rate	$3,595.20
Rate for Payer: Aetna Commercial	$1,642.59
Rate for Payer: BCBS Complete	$870.45
Rate for Payer: BCBS Trust/PPO	$1,278.49
Rate for Payer: Cash Price	$4,108.80
Rate for Payer: Cash Price	$4,108.80
Rate for Payer: Mclaren Medicaid	$829.00
Rate for Payer: Meridian Medicaid	$870.45
Rate for Payer: Priority Health Choice Medicaid	$829.00
Rate for Payer: Priority Health Cigna Priority Health	$3,595.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,182.22
Rate for Payer: Priority Health Narrow Network	$2,182.22
Rate for Payer: Priority Health SBD	$2,182.22

PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN

Professional

Both

$6,743.00

Service Code	HCPCS 62010
Min. Negotiated Rate	$1,000.46
Max. Negotiated Rate	$4,720.10
Rate for Payer: Aetna Commercial	$1,985.02
Rate for Payer: BCBS Complete	$1,050.48
Rate for Payer: BCBS Trust/PPO	$2,117.43
Rate for Payer: Cash Price	$5,394.40
Rate for Payer: Cash Price	$5,394.40
Rate for Payer: Mclaren Medicaid	$1,000.46
Rate for Payer: Meridian Medicaid	$1,050.48
Rate for Payer: Priority Health Choice Medicaid	$1,000.46
Rate for Payer: Priority Health Cigna Priority Health	$4,720.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,634.64
Rate for Payer: Priority Health Narrow Network	$2,634.64
Rate for Payer: Priority Health SBD	$2,634.64

PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN

Professional

Both

$142.00

Service Code	HCPCS 99318
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$99.40
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: Cash Price	$113.60
Rate for Payer: Priority Health Cigna Priority Health	$99.40

PREMATURITY WITH MAJOR PROBLEMS

Facility

$62,506.32

Service Code	MS-DRG 791
Min. Negotiated Rate	$827.00
Max. Negotiated Rate	$62,506.32
Rate for Payer: Aetna Medicare	$31,203.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$37,504.40
Rate for Payer: Amish Plain Church Group Commercial	$37,504.40
Rate for Payer: BCBS MAPPO	$30,003.52
Rate for Payer: BCBS Trust/PPO	$10,878.49
Rate for Payer: BCN Medicare Advantage	$30,003.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$30,003.52
Rate for Payer: Mclaren Medicare	$30,003.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$31,503.70
Rate for Payer: MI Amish Medical Board Commercial	$34,504.05
Rate for Payer: PACE Medicare	$28,503.34
Rate for Payer: PACE SWMI	$30,003.52
Rate for Payer: PHP Medicare Advantage	$30,003.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58,801.67
Rate for Payer: Priority Health Medicare	$30,003.52
Rate for Payer: Priority Health Narrow Network	$47,041.34
Rate for Payer: Railroad Medicare Medicare	$30,003.52
Rate for Payer: UHC All Payor (Choice/PPO)	$62,506.32
Rate for Payer: UHC Core	$827.00
Rate for Payer: UHC Dual Complete DSNP	$30,003.52
Rate for Payer: UHC Medicare Advantage	$30,903.63
Rate for Payer: VA VA	$30,003.52

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$37,715.52

Service Code	MS-DRG 792
Min. Negotiated Rate	$678.00
Max. Negotiated Rate	$37,715.52
Rate for Payer: Aetna Medicare	$19,031.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,873.95
Rate for Payer: Amish Plain Church Group Commercial	$22,873.95
Rate for Payer: BCBS MAPPO	$18,299.16
Rate for Payer: BCBS Trust/PPO	$5,691.77
Rate for Payer: BCN Medicare Advantage	$18,299.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,299.16
Rate for Payer: Mclaren Medicare	$18,299.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19,214.12
Rate for Payer: MI Amish Medical Board Commercial	$21,044.03
Rate for Payer: PACE Medicare	$17,384.20
Rate for Payer: PACE SWMI	$18,299.16
Rate for Payer: PHP Medicare Advantage	$18,299.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35,480.18
Rate for Payer: Priority Health Medicare	$18,299.16
Rate for Payer: Priority Health Narrow Network	$28,384.14
Rate for Payer: Railroad Medicare Medicare	$18,299.16
Rate for Payer: UHC All Payor (Choice/PPO)	$37,715.52
Rate for Payer: UHC Core	$678.00
Rate for Payer: UHC Dual Complete DSNP	$18,299.16
Rate for Payer: UHC Medicare Advantage	$18,848.13
Rate for Payer: VA VA	$18,299.16

PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART

Professional

Both

$2,291.00

Service Code	HCPCS 34101
Min. Negotiated Rate	$372.75
Max. Negotiated Rate	$1,746.03
Rate for Payer: Aetna Commercial	$800.84
Rate for Payer: BCBS Complete	$391.39
Rate for Payer: BCBS Trust/PPO	$1,746.03
Rate for Payer: Cash Price	$1,832.80
Rate for Payer: Cash Price	$1,832.80
Rate for Payer: Mclaren Medicaid	$372.75
Rate for Payer: Meridian Medicaid	$391.39
Rate for Payer: Priority Health Choice Medicaid	$372.75
Rate for Payer: Priority Health Cigna Priority Health	$1,603.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$930.40
Rate for Payer: Priority Health Narrow Network	$930.40
Rate for Payer: Priority Health SBD	$930.40

PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART

Professional

Both

$1,994.00

Service Code	HCPCS 34001
Min. Negotiated Rate	$571.48
Max. Negotiated Rate	$1,434.86
Rate for Payer: Aetna Commercial	$1,229.89
Rate for Payer: BCBS Complete	$600.05
Rate for Payer: BCBS Trust/PPO	$1,434.86
Rate for Payer: Cash Price	$1,595.20
Rate for Payer: Cash Price	$1,595.20
Rate for Payer: Mclaren Medicaid	$571.48
Rate for Payer: Meridian Medicaid	$600.05
Rate for Payer: Priority Health Choice Medicaid	$571.48
Rate for Payer: Priority Health Cigna Priority Health	$1,395.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,420.86
Rate for Payer: Priority Health Narrow Network	$1,420.86
Rate for Payer: Priority Health SBD	$1,420.86

PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART

Professional

Both

$1,956.00

Service Code	HCPCS 34201
Min. Negotiated Rate	$637.51
Max. Negotiated Rate	$2,634.63
Rate for Payer: Aetna Commercial	$1,375.38
Rate for Payer: BCBS Complete	$669.39
Rate for Payer: BCBS Trust/PPO	$2,634.63
Rate for Payer: Cash Price	$1,564.80
Rate for Payer: Cash Price	$1,564.80
Rate for Payer: Mclaren Medicaid	$637.51
Rate for Payer: Meridian Medicaid	$669.39
Rate for Payer: Priority Health Choice Medicaid	$637.51
Rate for Payer: Priority Health Cigna Priority Health	$1,369.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,586.84
Rate for Payer: Priority Health Narrow Network	$1,586.84
Rate for Payer: Priority Health SBD	$1,586.84

PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY

Professional

Both

$1,971.00

Service Code	HCPCS 34051
Min. Negotiated Rate	$624.09
Max. Negotiated Rate	$2,053.50
Rate for Payer: Aetna Commercial	$1,330.19
Rate for Payer: BCBS Complete	$655.29
Rate for Payer: BCBS Trust/PPO	$2,053.50
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Mclaren Medicaid	$624.09
Rate for Payer: Meridian Medicaid	$655.29
Rate for Payer: Priority Health Choice Medicaid	$624.09
Rate for Payer: Priority Health Cigna Priority Health	$1,379.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,553.86
Rate for Payer: Priority Health Narrow Network	$1,553.86
Rate for Payer: Priority Health SBD	$1,553.86

PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC

Professional

Both

$1,938.00

Service Code	HCPCS 34203
Min. Negotiated Rate	$592.35
Max. Negotiated Rate	$3,301.73
Rate for Payer: Aetna Commercial	$1,273.42
Rate for Payer: BCBS Complete	$621.97
Rate for Payer: BCBS Trust/PPO	$3,301.73
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Mclaren Medicaid	$592.35
Rate for Payer: Meridian Medicaid	$621.97
Rate for Payer: Priority Health Choice Medicaid	$592.35
Rate for Payer: Priority Health Cigna Priority Health	$1,356.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,473.00
Rate for Payer: Priority Health Narrow Network	$1,473.00
Rate for Payer: Priority Health SBD	$1,473.00

PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART

Professional

Both

$2,676.00

Service Code	HCPCS 34151
Min. Negotiated Rate	$868.40
Max. Negotiated Rate	$2,233.15
Rate for Payer: Aetna Commercial	$1,868.74
Rate for Payer: BCBS Complete	$911.82
Rate for Payer: BCBS Trust/PPO	$2,233.15
Rate for Payer: Cash Price	$2,140.80
Rate for Payer: Cash Price	$2,140.80
Rate for Payer: Mclaren Medicaid	$868.40
Rate for Payer: Meridian Medicaid	$911.82
Rate for Payer: Priority Health Choice Medicaid	$868.40
Rate for Payer: Priority Health Cigna Priority Health	$1,873.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,164.00
Rate for Payer: Priority Health Narrow Network	$2,164.00
Rate for Payer: Priority Health SBD	$2,164.00

PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC

Professional

Both

$1,233.34

Service Code	HCPCS 34111
Min. Negotiated Rate	$372.32
Max. Negotiated Rate	$1,789.88
Rate for Payer: Aetna Commercial	$804.67
Rate for Payer: BCBS Complete	$390.94
Rate for Payer: BCBS Trust/PPO	$1,789.88
Rate for Payer: Cash Price	$986.67
Rate for Payer: Cash Price	$986.67
Rate for Payer: Mclaren Medicaid	$372.32
Rate for Payer: Meridian Medicaid	$390.94
Rate for Payer: Priority Health Choice Medicaid	$372.32
Rate for Payer: Priority Health Cigna Priority Health	$863.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$933.58
Rate for Payer: Priority Health Narrow Network	$933.58
Rate for Payer: Priority Health SBD	$933.58

PR EMERGENCY DEPARTMENT VISIT HIGH MDM

Professional

Both

$364.00

Service Code	HCPCS 99285
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$932.45
Rate for Payer: Aetna Commercial	$179.88
Rate for Payer: BCBS Complete	$116.30
Rate for Payer: BCBS Trust/PPO	$932.45
Rate for Payer: Cash Price	$291.20
Rate for Payer: Cash Price	$291.20
Rate for Payer: Mclaren Medicaid	$110.76
Rate for Payer: Meridian Medicaid	$116.30
Rate for Payer: Priority Health Choice Medicaid	$110.76
Rate for Payer: Priority Health Cigna Priority Health	$254.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.90
Rate for Payer: Priority Health Narrow Network	$284.90
Rate for Payer: Priority Health SBD	$284.90

PR EMERGENCY DEPARTMENT VISIT LOW MDM

Professional

Both

$170.00

Service Code	HCPCS 99283
Min. Negotiated Rate	$44.94
Max. Negotiated Rate	$119.00
Rate for Payer: Aetna Commercial	$72.50
Rate for Payer: BCBS Complete	$47.19
Rate for Payer: BCBS Trust/PPO	$75.14
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Mclaren Medicaid	$44.94
Rate for Payer: Meridian Medicaid	$47.19
Rate for Payer: Priority Health Choice Medicaid	$44.94
Rate for Payer: Priority Health Cigna Priority Health	$119.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$108.57
Rate for Payer: Priority Health Narrow Network	$108.57
Rate for Payer: Priority Health SBD	$108.57

Know your out-of-pocket cost for care.

All Charges