Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT

Professional

Both

$116.00

Service Code	HCPCS 92230
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$1,393.66
Rate for Payer: Aetna Commercial	$36.07
Rate for Payer: BCBS Complete	$22.82
Rate for Payer: BCBS Trust/PPO	$1,393.66
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Mclaren Medicaid	$21.73
Rate for Payer: Meridian Medicaid	$22.82
Rate for Payer: Priority Health Choice Medicaid	$21.73
Rate for Payer: Priority Health Cigna Priority Health	$81.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.94
Rate for Payer: Priority Health Narrow Network	$40.94
Rate for Payer: Priority Health SBD	$40.94

PR FLUPHENAZINE DECANOATE 25 MG

Professional

Both

$24.00

Service Code	HCPCS J2680
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$16.80
Rate for Payer: Aetna Commercial	$9.42
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: BCBS Trust/PPO	$5.22
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Priority Health Cigna Priority Health	$16.80

PR FLUVIRIN VACC, 3 YRS & >, IM

Professional

Both

$20.00

Service Code	HCPCS Q2037
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$18.62
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR FLUZONE VACC, 3 YRS & >, IM

Professional

Both

$25.00

Service Code	HCPCS Q2038
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$12.68
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50

PR FOLLOW-UP/REASSESSMENT

Professional

Both

$300.00

Service Code	HCPCS S0316
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$20.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Trust/PPO	$53.36
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00

PR FO NONTORSION JOINT CF

Professional

Both

$203.00

Service Code	HCPCS L3935
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$142.10
Rate for Payer: Aetna Commercial	$121.09
Rate for Payer: BCBS Complete	$81.20
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Priority Health Cigna Priority Health	$142.10

PR FOOT ARCH SUPP LONGITUD/META

Professional

Both

$40.00

Service Code	HCPCS L3060
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$44.42
Rate for Payer: Aetna Commercial	$44.42
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR FOOT PLAS HEEL STABI PRE OTS

Professional

Both

$49.00

Service Code	HCPCS L3170
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$34.30
Rate for Payer: Aetna Commercial	$30.64
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Priority Health Cigna Priority Health	$34.30

PR FO PIP DIP JNT/SPRNG PRE OTS

Professional

Both

$61.00

Service Code	HCPCS L3925
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$42.70
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70

PR FOREARM/ARM CUFFS FREE MOTIO

Professional

Both

$625.00

Service Code	HCPCS L3720
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$374.53
Rate for Payer: BCBS Complete	$250.00
Rate for Payer: Cash Price	$500.00
Rate for Payer: Cash Price	$500.00
Rate for Payer: Priority Health Cigna Priority Health	$437.50

PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE

Professional

Both

$2,215.00

Service Code	HCPCS 15731
Min. Negotiated Rate	$637.30
Max. Negotiated Rate	$1,550.50
Rate for Payer: Aetna Commercial	$1,071.45
Rate for Payer: BCBS Complete	$669.16
Rate for Payer: BCBS Trust/PPO	$852.18
Rate for Payer: Cash Price	$1,772.00
Rate for Payer: Cash Price	$1,772.00
Rate for Payer: Mclaren Medicaid	$637.30
Rate for Payer: Meridian Medicaid	$669.16
Rate for Payer: Priority Health Choice Medicaid	$637.30
Rate for Payer: Priority Health Cigna Priority Health	$1,550.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,223.66
Rate for Payer: Priority Health Narrow Network	$1,223.66
Rate for Payer: Priority Health SBD	$1,223.66

PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING

Professional

Both

$150.00

Service Code	HCPCS 54450
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$1,562.18
Rate for Payer: Aetna Commercial	$73.96
Rate for Payer: BCBS Complete	$37.80
Rate for Payer: BCBS Trust/PPO	$1,562.18
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Mclaren Medicaid	$36.00
Rate for Payer: Meridian Medicaid	$37.80
Rate for Payer: Priority Health Choice Medicaid	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$90.78
Rate for Payer: Priority Health Narrow Network	$90.78
Rate for Payer: Priority Health SBD	$90.78

PR FO W/O JOINTS CF

Professional

Both

$196.00

Service Code	HCPCS L3933
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$137.20
Rate for Payer: Aetna Commercial	$116.96
Rate for Payer: BCBS Complete	$78.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Priority Health Cigna Priority Health	$137.20

PR FRAC FL FACE

Professional

Both

$400.00

Service Code	HCPCS 00100
Hospital Revenue Code	990
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$280.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00

PR FRAC NECK

Professional

Both

$150.00

Service Code	HCPCS 00102
Hospital Revenue Code	990
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$105.00
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00

PR FRAC SCARS PER INCH

Professional

Both

$50.00

Service Code	HCPCS 00104
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00

PR FRAC THGH/ABD/BACK

Professional

Both

$450.00

Service Code	HCPCS 00103
Hospital Revenue Code	990
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$315.00
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Priority Health Cigna Priority Health	$315.00

PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC

Professional

Both

$522.00

Service Code	HCPCS 30930
Min. Negotiated Rate	$76.47
Max. Negotiated Rate	$790.87
Rate for Payer: Aetna Commercial	$147.55
Rate for Payer: BCBS Complete	$80.29
Rate for Payer: BCBS Trust/PPO	$790.87
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Mclaren Medicaid	$76.47
Rate for Payer: Meridian Medicaid	$80.29
Rate for Payer: Priority Health Choice Medicaid	$76.47
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.38
Rate for Payer: Priority Health Narrow Network	$164.38
Rate for Payer: Priority Health SBD	$164.38

PR FRAC UP/LOW FACE

Professional

Both

$250.00

Service Code	HCPCS 00101
Hospital Revenue Code	990
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00

PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY

Professional

Both

$558.00

Service Code	HCPCS 41520
Min. Negotiated Rate	$162.09
Max. Negotiated Rate	$653.51
Rate for Payer: Aetna Commercial	$326.38
Rate for Payer: BCBS Complete	$170.19
Rate for Payer: BCBS Trust/PPO	$653.51
Rate for Payer: Cash Price	$446.40
Rate for Payer: Cash Price	$446.40
Rate for Payer: Mclaren Medicaid	$162.09
Rate for Payer: Meridian Medicaid	$170.19
Rate for Payer: Priority Health Choice Medicaid	$162.09
Rate for Payer: Priority Health Cigna Priority Health	$390.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$445.10
Rate for Payer: Priority Health Narrow Network	$445.10
Rate for Payer: Priority Health SBD	$445.10

PR FRENULOTOMY PENIS

Professional

Both

$809.00

Service Code	HCPCS 54164
Min. Negotiated Rate	$125.03
Max. Negotiated Rate	$1,012.75
Rate for Payer: Aetna Commercial	$244.64
Rate for Payer: BCBS Complete	$131.28
Rate for Payer: BCBS Trust/PPO	$1,012.75
Rate for Payer: Cash Price	$647.20
Rate for Payer: Cash Price	$647.20
Rate for Payer: Mclaren Medicaid	$125.03
Rate for Payer: Meridian Medicaid	$131.28
Rate for Payer: Priority Health Choice Medicaid	$125.03
Rate for Payer: Priority Health Cigna Priority Health	$566.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$310.70
Rate for Payer: Priority Health Narrow Network	$310.70
Rate for Payer: Priority Health SBD	$310.70

PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK

Professional

Both

$1,474.00

Service Code	HCPCS 15570
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$1,031.80
Rate for Payer: Aetna Commercial	$788.69
Rate for Payer: BCBS Complete	$489.79
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Mclaren Medicaid	$466.47
Rate for Payer: Meridian Medicaid	$489.79
Rate for Payer: Priority Health Choice Medicaid	$466.47
Rate for Payer: Priority Health Cigna Priority Health	$1,031.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$897.30
Rate for Payer: Priority Health Narrow Network	$897.30
Rate for Payer: Priority Health SBD	$897.30

PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL

Professional

Both

$1,591.00

Service Code	HCPCS 15576
Min. Negotiated Rate	$413.65
Max. Negotiated Rate	$4,106.40
Rate for Payer: Aetna Commercial	$703.16
Rate for Payer: BCBS Complete	$434.33
Rate for Payer: BCBS Trust/PPO	$4,106.40
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Mclaren Medicaid	$413.65
Rate for Payer: Meridian Medicaid	$434.33
Rate for Payer: Priority Health Choice Medicaid	$413.65
Rate for Payer: Priority Health Cigna Priority Health	$1,113.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$793.30
Rate for Payer: Priority Health Narrow Network	$793.30
Rate for Payer: Priority Health SBD	$793.30

PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS

Professional

Both

$1,535.00

Service Code	HCPCS 15572
Min. Negotiated Rate	$471.80
Max. Negotiated Rate	$6,341.25
Rate for Payer: Aetna Commercial	$789.01
Rate for Payer: BCBS Complete	$495.39
Rate for Payer: BCBS Trust/PPO	$6,341.25
Rate for Payer: Cash Price	$1,228.00
Rate for Payer: Cash Price	$1,228.00
Rate for Payer: Mclaren Medicaid	$471.80
Rate for Payer: Meridian Medicaid	$495.39
Rate for Payer: Priority Health Choice Medicaid	$471.80
Rate for Payer: Priority Health Cigna Priority Health	$1,074.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$903.87
Rate for Payer: Priority Health Narrow Network	$903.87
Rate for Payer: Priority Health SBD	$903.87

PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F

Professional

Both

$1,880.00

Service Code	HCPCS 15574
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$1,316.00
Rate for Payer: Aetna Commercial	$791.76
Rate for Payer: BCBS Complete	$497.18
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$1,504.00
Rate for Payer: Cash Price	$1,504.00
Rate for Payer: Mclaren Medicaid	$473.50
Rate for Payer: Meridian Medicaid	$497.18
Rate for Payer: Priority Health Choice Medicaid	$473.50
Rate for Payer: Priority Health Cigna Priority Health	$1,316.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$901.00
Rate for Payer: Priority Health Narrow Network	$901.00
Rate for Payer: Priority Health SBD	$901.00

Know your out-of-pocket cost for care.

All Charges