Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR

Professional

Both

$697.00

Service Code	HCPCS 41827
Min. Negotiated Rate	$184.88
Max. Negotiated Rate	$529.88
Rate for Payer: Aetna Commercial	$383.32
Rate for Payer: BCBS Complete	$194.12
Rate for Payer: BCBS Trust/PPO	$529.88
Rate for Payer: Cash Price	$557.60
Rate for Payer: Cash Price	$557.60
Rate for Payer: Mclaren Medicaid	$184.88
Rate for Payer: Meridian Medicaid	$194.12
Rate for Payer: Priority Health Choice Medicaid	$184.88
Rate for Payer: Priority Health Cigna Priority Health	$487.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$505.07
Rate for Payer: Priority Health Narrow Network	$505.07
Rate for Payer: Priority Health SBD	$505.07

PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR

Professional

Both

$412.00

Service Code	HCPCS 41825
Min. Negotiated Rate	$78.17
Max. Negotiated Rate	$339.70
Rate for Payer: Aetna Commercial	$156.16
Rate for Payer: BCBS Complete	$82.08
Rate for Payer: BCBS Trust/PPO	$339.70
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$329.60
Rate for Payer: Mclaren Medicaid	$78.17
Rate for Payer: Meridian Medicaid	$82.08
Rate for Payer: Priority Health Choice Medicaid	$78.17
Rate for Payer: Priority Health Cigna Priority Health	$288.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.43
Rate for Payer: Priority Health Narrow Network	$213.43
Rate for Payer: Priority Health SBD	$213.43

PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR

Professional

Both

$362.00

Service Code	HCPCS 40810
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$667.79
Rate for Payer: Aetna Commercial	$159.38
Rate for Payer: BCBS Complete	$82.75
Rate for Payer: BCBS Trust/PPO	$667.79
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cash Price	$289.60
Rate for Payer: Mclaren Medicaid	$78.81
Rate for Payer: Meridian Medicaid	$82.75
Rate for Payer: Priority Health Choice Medicaid	$78.81
Rate for Payer: Priority Health Cigna Priority Health	$253.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$216.96
Rate for Payer: Priority Health Narrow Network	$216.96
Rate for Payer: Priority Health SBD	$216.96

PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP

Professional

Both

$1,944.00

Service Code	HCPCS 40525
Min. Negotiated Rate	$355.28
Max. Negotiated Rate	$1,360.80
Rate for Payer: Aetna Commercial	$731.34
Rate for Payer: BCBS Complete	$373.04
Rate for Payer: BCBS Trust/PPO	$774.49
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Mclaren Medicaid	$355.28
Rate for Payer: Meridian Medicaid	$373.04
Rate for Payer: Priority Health Choice Medicaid	$355.28
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$973.09
Rate for Payer: Priority Health Narrow Network	$973.09
Rate for Payer: Priority Health SBD	$973.09

PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR

Professional

Both

$712.00

Service Code	HCPCS 40510
Min. Negotiated Rate	$225.14
Max. Negotiated Rate	$615.02
Rate for Payer: Aetna Commercial	$459.97
Rate for Payer: BCBS Complete	$236.40
Rate for Payer: BCBS Trust/PPO	$378.26
Rate for Payer: Cash Price	$569.60
Rate for Payer: Cash Price	$569.60
Rate for Payer: Mclaren Medicaid	$225.14
Rate for Payer: Meridian Medicaid	$236.40
Rate for Payer: Priority Health Choice Medicaid	$225.14
Rate for Payer: Priority Health Cigna Priority Health	$498.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$615.02
Rate for Payer: Priority Health Narrow Network	$615.02
Rate for Payer: Priority Health SBD	$615.02

PR EXC LIP V-EXC W/PRIM DIR LINR CLSR

Professional

Both

$1,161.00

Service Code	HCPCS 40520
Min. Negotiated Rate	$230.04
Max. Negotiated Rate	$812.70
Rate for Payer: Aetna Commercial	$468.59
Rate for Payer: BCBS Complete	$241.54
Rate for Payer: BCBS Trust/PPO	$423.17
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Mclaren Medicaid	$230.04
Rate for Payer: Meridian Medicaid	$241.54
Rate for Payer: Priority Health Choice Medicaid	$230.04
Rate for Payer: Priority Health Cigna Priority Health	$812.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$632.08
Rate for Payer: Priority Health Narrow Network	$632.08
Rate for Payer: Priority Health SBD	$632.08

PR EXC LOCAL MALIGNANT TUMOR STOMACH

Professional

Both

$1,807.00

Service Code	HCPCS 43611
Min. Negotiated Rate	$785.76
Max. Negotiated Rate	$2,153.75
Rate for Payer: Aetna Commercial	$1,652.07
Rate for Payer: BCBS Complete	$825.05
Rate for Payer: BCBS Trust/PPO	$787.17
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Mclaren Medicaid	$785.76
Rate for Payer: Meridian Medicaid	$825.05
Rate for Payer: Priority Health Choice Medicaid	$785.76
Rate for Payer: Priority Health Cigna Priority Health	$1,264.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,153.75
Rate for Payer: Priority Health Narrow Network	$2,153.75
Rate for Payer: Priority Health SBD	$2,153.75

PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH

Professional

Both

$3,097.00

Service Code	HCPCS 43610
Min. Negotiated Rate	$625.37
Max. Negotiated Rate	$2,167.90
Rate for Payer: Aetna Commercial	$1,326.15
Rate for Payer: BCBS Complete	$656.64
Rate for Payer: BCBS Trust/PPO	$686.26
Rate for Payer: Cash Price	$2,477.60
Rate for Payer: Cash Price	$2,477.60
Rate for Payer: Mclaren Medicaid	$625.37
Rate for Payer: Meridian Medicaid	$656.64
Rate for Payer: Priority Health Choice Medicaid	$625.37
Rate for Payer: Priority Health Cigna Priority Health	$2,167.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,720.41
Rate for Payer: Priority Health Narrow Network	$1,720.41
Rate for Payer: Priority Health SBD	$1,720.41

PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD

Professional

Both

$286.00

Service Code	HCPCS 33268
Min. Negotiated Rate	$80.73
Max. Negotiated Rate	$1,025.43
Rate for Payer: Aetna Commercial	$175.64
Rate for Payer: BCBS Complete	$84.77
Rate for Payer: BCBS Trust/PPO	$1,025.43
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Mclaren Medicaid	$80.73
Rate for Payer: Meridian Medicaid	$84.77
Rate for Payer: Priority Health Choice Medicaid	$80.73
Rate for Payer: Priority Health Cigna Priority Health	$200.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$203.21
Rate for Payer: Priority Health Narrow Network	$203.21
Rate for Payer: Priority Health SBD	$203.21

PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD

Professional

Both

$2,082.00

Service Code	HCPCS 33267
Min. Negotiated Rate	$656.04
Max. Negotiated Rate	$5,381.79
Rate for Payer: Aetna Commercial	$1,400.04
Rate for Payer: BCBS Complete	$688.84
Rate for Payer: BCBS Trust/PPO	$5,381.79
Rate for Payer: Cash Price	$1,665.60
Rate for Payer: Cash Price	$1,665.60
Rate for Payer: Mclaren Medicaid	$656.04
Rate for Payer: Meridian Medicaid	$688.84
Rate for Payer: Priority Health Choice Medicaid	$656.04
Rate for Payer: Priority Health Cigna Priority Health	$1,457.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,629.91
Rate for Payer: Priority Health Narrow Network	$1,629.91
Rate for Payer: Priority Health SBD	$1,629.91

PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT

Facility

$2,073.00

Service Code	CPT 44800
Hospital Charge Code	44800
Min. Negotiated Rate	$766.87
Max. Negotiated Rate	$1,865.70
Rate for Payer: Aetna Commercial	$1,762.05
Rate for Payer: Aetna New Business (MI Preferred)	$1,347.45
Rate for Payer: BCBS Complete	$829.20
Rate for Payer: BCBS Trust/PPO	$1,559.75
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Cofinity Commercial	$1,782.78
Rate for Payer: Cofinity Commercial	$1,451.10
Rate for Payer: Healthscope Commercial	$1,865.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,762.05
Rate for Payer: PHP Commercial	$1,762.05
Rate for Payer: Priority Health Cigna Priority Health	$1,451.10
Rate for Payer: Priority Health SBD	$1,305.99
Rate for Payer: UHC All Payor (Choice/PPO)	$843.56
Rate for Payer: UHC Exchange	$766.87

PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT

Professional

Both

$2,073.00

Service Code	HCPCS 44800
Hospital Charge Code	44800
Min. Negotiated Rate	$332.30
Max. Negotiated Rate	$1,451.10
Rate for Payer: Aetna Commercial	$1,037.13
Rate for Payer: BCBS Complete	$523.79
Rate for Payer: BCBS Trust/PPO	$332.30
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Mclaren Medicaid	$498.85
Rate for Payer: Meridian Medicaid	$523.79
Rate for Payer: Priority Health Choice Medicaid	$498.85
Rate for Payer: Priority Health Cigna Priority Health	$1,451.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,363.50
Rate for Payer: Priority Health Narrow Network	$1,363.50
Rate for Payer: Priority Health SBD	$1,363.50

PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT

Facility

$2,073.00

Service Code	CPT 44800
Hospital Charge Code	44800
Min. Negotiated Rate	$1,305.99
Max. Negotiated Rate	$1,865.70
Rate for Payer: Aetna Commercial	$1,762.05
Rate for Payer: Aetna New Business (MI Preferred)	$1,347.45
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Cofinity Commercial	$1,451.10
Rate for Payer: Cofinity Commercial	$1,782.78
Rate for Payer: Healthscope Commercial	$1,865.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,762.05
Rate for Payer: PHP Commercial	$1,762.05
Rate for Payer: Priority Health Cigna Priority Health	$1,451.10
Rate for Payer: Priority Health SBD	$1,305.99

PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT

Professional

Both

$2,073.00

Service Code	HCPCS 44800
Min. Negotiated Rate	$332.30
Max. Negotiated Rate	$1,451.10
Rate for Payer: Aetna Commercial	$1,037.13
Rate for Payer: BCBS Complete	$523.79
Rate for Payer: BCBS Trust/PPO	$332.30
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Cash Price	$1,658.40
Rate for Payer: Mclaren Medicaid	$498.85
Rate for Payer: Meridian Medicaid	$523.79
Rate for Payer: Priority Health Choice Medicaid	$498.85
Rate for Payer: Priority Health Cigna Priority Health	$1,451.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,363.50
Rate for Payer: Priority Health Narrow Network	$1,363.50
Rate for Payer: Priority Health SBD	$1,363.50

PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF

Professional

Both

$572.00

Service Code	HCPCS 40818
Min. Negotiated Rate	$170.19
Max. Negotiated Rate	$762.87
Rate for Payer: Aetna Commercial	$357.02
Rate for Payer: BCBS Complete	$178.70
Rate for Payer: BCBS Trust/PPO	$762.87
Rate for Payer: Cash Price	$457.60
Rate for Payer: Cash Price	$457.60
Rate for Payer: Mclaren Medicaid	$170.19
Rate for Payer: Meridian Medicaid	$178.70
Rate for Payer: Priority Health Choice Medicaid	$170.19
Rate for Payer: Priority Health Cigna Priority Health	$400.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$469.79
Rate for Payer: Priority Health Narrow Network	$469.79
Rate for Payer: Priority Health SBD	$469.79

PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV

Professional

Both

$1,868.00

Service Code	HCPCS 64788
Min. Negotiated Rate	$161.13
Max. Negotiated Rate	$1,307.60
Rate for Payer: Aetna Commercial	$515.29
Rate for Payer: BCBS Complete	$278.22
Rate for Payer: BCBS Trust/PPO	$161.13
Rate for Payer: Cash Price	$1,494.40
Rate for Payer: Cash Price	$1,494.40
Rate for Payer: Mclaren Medicaid	$264.97
Rate for Payer: Meridian Medicaid	$278.22
Rate for Payer: Priority Health Choice Medicaid	$264.97
Rate for Payer: Priority Health Cigna Priority Health	$1,307.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$689.67
Rate for Payer: Priority Health Narrow Network	$689.67
Rate for Payer: Priority Health SBD	$689.67

PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV

Professional

Both

$1,964.00

Service Code	HCPCS 64792
Min. Negotiated Rate	$209.74
Max. Negotiated Rate	$1,806.82
Rate for Payer: Aetna Commercial	$1,376.32
Rate for Payer: BCBS Complete	$727.53
Rate for Payer: BCBS Trust/PPO	$209.74
Rate for Payer: Cash Price	$1,571.20
Rate for Payer: Cash Price	$1,571.20
Rate for Payer: Mclaren Medicaid	$692.89
Rate for Payer: Meridian Medicaid	$727.53
Rate for Payer: Priority Health Choice Medicaid	$692.89
Rate for Payer: Priority Health Cigna Priority Health	$1,374.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,806.82
Rate for Payer: Priority Health Narrow Network	$1,806.82
Rate for Payer: Priority Health SBD	$1,806.82

PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV

Professional

Both

$2,334.00

Service Code	HCPCS 64790
Min. Negotiated Rate	$160.07
Max. Negotiated Rate	$1,633.80
Rate for Payer: Aetna Commercial	$1,074.60
Rate for Payer: BCBS Complete	$576.12
Rate for Payer: BCBS Trust/PPO	$160.07
Rate for Payer: Cash Price	$1,867.20
Rate for Payer: Cash Price	$1,867.20
Rate for Payer: Mclaren Medicaid	$548.69
Rate for Payer: Meridian Medicaid	$576.12
Rate for Payer: Priority Health Choice Medicaid	$548.69
Rate for Payer: Priority Health Cigna Priority Health	$1,633.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,441.04
Rate for Payer: Priority Health Narrow Network	$1,441.04
Rate for Payer: Priority Health SBD	$1,441.04

PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE

Professional

Both

$1,194.00

Service Code	HCPCS 64774
Min. Negotiated Rate	$266.26
Max. Negotiated Rate	$835.80
Rate for Payer: Aetna Commercial	$520.46
Rate for Payer: BCBS Complete	$290.97
Rate for Payer: BCBS Trust/PPO	$266.26
Rate for Payer: Cash Price	$955.20
Rate for Payer: Cash Price	$955.20
Rate for Payer: Mclaren Medicaid	$277.11
Rate for Payer: Meridian Medicaid	$290.97
Rate for Payer: Priority Health Choice Medicaid	$277.11
Rate for Payer: Priority Health Cigna Priority Health	$835.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$727.03
Rate for Payer: Priority Health Narrow Network	$727.03
Rate for Payer: Priority Health SBD	$727.03

PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT

Professional

Both

$1,234.00

Service Code	HCPCS 64776
Min. Negotiated Rate	$262.20
Max. Negotiated Rate	$863.80
Rate for Payer: Aetna Commercial	$501.13
Rate for Payer: BCBS Complete	$275.31
Rate for Payer: BCBS Trust/PPO	$302.19
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cash Price	$987.20
Rate for Payer: Mclaren Medicaid	$262.20
Rate for Payer: Meridian Medicaid	$275.31
Rate for Payer: Priority Health Choice Medicaid	$262.20
Rate for Payer: Priority Health Cigna Priority Health	$863.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$677.77
Rate for Payer: Priority Health Narrow Network	$677.77
Rate for Payer: Priority Health SBD	$677.77

PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE

Professional

Both

$1,661.00

Service Code	HCPCS 64782
Min. Negotiated Rate	$293.73
Max. Negotiated Rate	$1,162.70
Rate for Payer: Aetna Commercial	$586.40
Rate for Payer: BCBS Complete	$308.42
Rate for Payer: BCBS Trust/PPO	$306.94
Rate for Payer: Cash Price	$1,328.80
Rate for Payer: Cash Price	$1,328.80
Rate for Payer: Mclaren Medicaid	$293.73
Rate for Payer: Meridian Medicaid	$308.42
Rate for Payer: Priority Health Choice Medicaid	$293.73
Rate for Payer: Priority Health Cigna Priority Health	$1,162.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$772.33
Rate for Payer: Priority Health Narrow Network	$772.33
Rate for Payer: Priority Health SBD	$772.33

PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC

Professional

Both

$2,440.00

Service Code	HCPCS 64784
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$1,708.00
Rate for Payer: Aetna Commercial	$937.29
Rate for Payer: BCBS Complete	$489.57
Rate for Payer: BCBS Trust/PPO	$128.38
Rate for Payer: Cash Price	$1,952.00
Rate for Payer: Cash Price	$1,952.00
Rate for Payer: Mclaren Medicaid	$466.26
Rate for Payer: Meridian Medicaid	$489.57
Rate for Payer: Priority Health Choice Medicaid	$466.26
Rate for Payer: Priority Health Cigna Priority Health	$1,708.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,232.11
Rate for Payer: Priority Health Narrow Network	$1,232.11
Rate for Payer: Priority Health SBD	$1,232.11

PR EXC PRESAC/SACROCOCCYGEAL TUMOR

Professional

Both

$3,922.00

Service Code	HCPCS 49215
Min. Negotiated Rate	$757.05
Max. Negotiated Rate	$3,845.34
Rate for Payer: Aetna Commercial	$2,988.87
Rate for Payer: BCBS Complete	$1,485.71
Rate for Payer: BCBS Trust/PPO	$757.05
Rate for Payer: Cash Price	$3,137.60
Rate for Payer: Cash Price	$3,137.60
Rate for Payer: Mclaren Medicaid	$1,414.96
Rate for Payer: Meridian Medicaid	$1,485.71
Rate for Payer: Priority Health Choice Medicaid	$1,414.96
Rate for Payer: Priority Health Cigna Priority Health	$2,745.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,845.34
Rate for Payer: Priority Health Narrow Network	$3,845.34
Rate for Payer: Priority Health SBD	$3,845.34

PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR

Professional

Both

$1,752.00

Service Code	HCPCS 42415
Min. Negotiated Rate	$284.75
Max. Negotiated Rate	$1,866.23
Rate for Payer: Aetna Commercial	$1,398.85
Rate for Payer: BCBS Complete	$713.44
Rate for Payer: BCBS Trust/PPO	$284.75
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Mclaren Medicaid	$679.47
Rate for Payer: Meridian Medicaid	$713.44
Rate for Payer: Priority Health Choice Medicaid	$679.47
Rate for Payer: Priority Health Cigna Priority Health	$1,226.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,866.23
Rate for Payer: Priority Health Narrow Network	$1,866.23
Rate for Payer: Priority Health SBD	$1,866.23

PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ

Professional

Both

$1,161.00

Service Code	HCPCS 42410
Min. Negotiated Rate	$160.60
Max. Negotiated Rate	$1,114.20
Rate for Payer: Aetna Commercial	$830.54
Rate for Payer: BCBS Complete	$426.06
Rate for Payer: BCBS Trust/PPO	$160.60
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Mclaren Medicaid	$405.77
Rate for Payer: Meridian Medicaid	$426.06
Rate for Payer: Priority Health Choice Medicaid	$405.77
Rate for Payer: Priority Health Cigna Priority Health	$812.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,114.20
Rate for Payer: Priority Health Narrow Network	$1,114.20
Rate for Payer: Priority Health SBD	$1,114.20

Know your out-of-pocket cost for care.

All Charges