Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<

Facility

$1,372.00

Service Code	CPT 15240
Hospital Charge Code	15240
Hospital Revenue Code	960
Min. Negotiated Rate	$864.36
Max. Negotiated Rate	$1,234.80
Rate for Payer: Aetna Commercial	$1,166.20
Rate for Payer: Aetna New Business (MI Preferred)	$891.80
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Cofinity Commercial	$1,179.92
Rate for Payer: Cofinity Commercial	$960.40
Rate for Payer: Healthscope Commercial	$1,234.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,166.20
Rate for Payer: PHP Commercial	$1,166.20
Rate for Payer: Priority Health Cigna Priority Health	$960.40
Rate for Payer: Priority Health SBD	$864.36

PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<

Facility

$1,372.00

Service Code	CPT 15240
Hospital Charge Code	15240
Hospital Revenue Code	960
Min. Negotiated Rate	$783.24
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Commercial	$1,166.20
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Aetna New Business (MI Preferred)	$891.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$1,662.20
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Cofinity Commercial	$960.40
Rate for Payer: Cofinity Commercial	$1,179.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Healthscope Commercial	$1,234.80
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,166.20
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Commercial	$1,166.20
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health Cigna Priority Health	$960.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Priority Health SBD	$864.36
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$861.56
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$783.24
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<

Professional

Both

$1,667.00

Service Code	HCPCS 15260
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$1,166.90
Rate for Payer: Aetna Commercial	$898.38
Rate for Payer: BCBS Complete	$566.96
Rate for Payer: BCBS Trust/PPO	$35.25
Rate for Payer: Cash Price	$1,333.60
Rate for Payer: Cash Price	$1,333.60
Rate for Payer: Mclaren Medicaid	$539.96
Rate for Payer: Meridian Medicaid	$566.96
Rate for Payer: Priority Health Choice Medicaid	$539.96
Rate for Payer: Priority Health Cigna Priority Health	$1,166.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,032.12
Rate for Payer: Priority Health Narrow Network	$1,032.12
Rate for Payer: Priority Health SBD	$1,032.12

PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<

Professional

Both

$1,656.00

Service Code	HCPCS 15220
Min. Negotiated Rate	$390.64
Max. Negotiated Rate	$12,622.63
Rate for Payer: Aetna Commercial	$650.11
Rate for Payer: BCBS Complete	$410.17
Rate for Payer: BCBS Trust/PPO	$12,622.63
Rate for Payer: Cash Price	$1,324.80
Rate for Payer: Cash Price	$1,324.80
Rate for Payer: Mclaren Medicaid	$390.64
Rate for Payer: Meridian Medicaid	$410.17
Rate for Payer: Priority Health Choice Medicaid	$390.64
Rate for Payer: Priority Health Cigna Priority Health	$1,159.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$745.62
Rate for Payer: Priority Health Narrow Network	$745.62
Rate for Payer: Priority Health SBD	$745.62

PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<

Professional

Both

$1,343.00

Service Code	HCPCS 15200
Min. Negotiated Rate	$138.90
Max. Negotiated Rate	$940.10
Rate for Payer: Aetna Commercial	$720.22
Rate for Payer: BCBS Complete	$452.90
Rate for Payer: BCBS Trust/PPO	$138.90
Rate for Payer: Cash Price	$1,074.40
Rate for Payer: Cash Price	$1,074.40
Rate for Payer: Mclaren Medicaid	$431.33
Rate for Payer: Meridian Medicaid	$452.90
Rate for Payer: Priority Health Choice Medicaid	$431.33
Rate for Payer: Priority Health Cigna Priority Health	$940.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$823.72
Rate for Payer: Priority Health Narrow Network	$823.72
Rate for Payer: Priority Health SBD	$823.72

PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<

Professional

Both

$1,372.00

Service Code	HCPCS 15240
Min. Negotiated Rate	$509.50
Max. Negotiated Rate	$972.10
Rate for Payer: Aetna Commercial	$845.41
Rate for Payer: BCBS Complete	$534.98
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Mclaren Medicaid	$509.50
Rate for Payer: Meridian Medicaid	$534.98
Rate for Payer: Priority Health Choice Medicaid	$509.50
Rate for Payer: Priority Health Cigna Priority Health	$960.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$972.10
Rate for Payer: Priority Health Narrow Network	$972.10
Rate for Payer: Priority Health SBD	$972.10

PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<

Professional

Both

$278.00

Service Code	HCPCS 15221
Min. Negotiated Rate	$43.67
Max. Negotiated Rate	$194.60
Rate for Payer: Aetna Commercial	$75.94
Rate for Payer: BCBS Complete	$45.85
Rate for Payer: BCBS Trust/PPO	$150.00
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Mclaren Medicaid	$43.67
Rate for Payer: Meridian Medicaid	$45.85
Rate for Payer: Priority Health Choice Medicaid	$43.67
Rate for Payer: Priority Health Cigna Priority Health	$194.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.85
Rate for Payer: Priority Health Narrow Network	$83.85
Rate for Payer: Priority Health SBD	$83.85

PR FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<

Professional

Both

$348.00

Service Code	HCPCS 15241
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$2,189.70
Rate for Payer: Aetna Commercial	$115.10
Rate for Payer: BCBS Complete	$71.12
Rate for Payer: BCBS Trust/PPO	$2,189.70
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Mclaren Medicaid	$67.73
Rate for Payer: Meridian Medicaid	$71.12
Rate for Payer: Priority Health Choice Medicaid	$67.73
Rate for Payer: Priority Health Cigna Priority Health	$243.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$128.25
Rate for Payer: Priority Health Narrow Network	$128.25
Rate for Payer: Priority Health SBD	$128.25

PR FT INSERT UCB BERKELEY SHELL

Professional

Both

$300.00

Service Code	HCPCS L3000
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$189.20
Rate for Payer: BCBS Complete	$120.00
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 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR

Professional

Both

$504.00

Service Code	HCPCS 95961
Min. Negotiated Rate	$173.28
Max. Negotiated Rate	$418.60
Rate for Payer: Aetna Commercial	$340.39
Rate for Payer: BCBS Complete	$201.60
Rate for Payer: BCBS Trust/PPO	$173.28
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Priority Health Cigna Priority Health	$352.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$207.51
Rate for Payer: Priority Health Narrow Network	$207.51
Rate for Payer: Priority Health SBD	$418.60

PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT

Professional

Both

$122.00

Service Code	HCPCS 92250
Min. Negotiated Rate	$19.67
Max. Negotiated Rate	$1,952.60
Rate for Payer: Aetna Commercial	$41.28
Rate for Payer: BCBS Complete	$48.80
Rate for Payer: BCBS Trust/PPO	$1,952.60
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cash Price	$97.60
Rate for Payer: Priority Health Cigna Priority Health	$85.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.67
Rate for Payer: Priority Health Narrow Network	$19.67
Rate for Payer: Priority Health SBD	$44.56

PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY

Professional

Both

$321.00

Service Code	HCPCS 93304
Min. Negotiated Rate	$50.12
Max. Negotiated Rate	$799.32
Rate for Payer: Aetna Commercial	$208.46
Rate for Payer: BCBS Complete	$128.40
Rate for Payer: BCBS Trust/PPO	$799.32
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Priority Health Cigna Priority Health	$224.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.12
Rate for Payer: Priority Health Narrow Network	$50.12
Rate for Payer: Priority Health SBD	$219.89

PR FUROSEMIDE INJECTION

Professional

Both

$4.00

Service Code	HCPCS J1940
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCBS Trust/PPO	$0.13
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

PR GARAMYCIN GENTAMICIN INJ

Professional

Both

$4.00

Service Code	HCPCS J1580
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCBS Trust/PPO	$0.88
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.80

PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V

Professional

Both

$121.00

Service Code	HCPCS 94727
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$251.47
Rate for Payer: Aetna Commercial	$46.53
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Trust/PPO	$251.47
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$84.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.72
Rate for Payer: Priority Health Narrow Network	$15.72
Rate for Payer: Priority Health SBD	$58.38

PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE

Professional

Both

$49.00

Service Code	HCPCS 43753
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$192.83
Rate for Payer: Aetna Commercial	$30.07
Rate for Payer: BCBS Complete	$14.31
Rate for Payer: BCBS Trust/PPO	$192.83
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Mclaren Medicaid	$13.63
Rate for Payer: Meridian Medicaid	$14.31
Rate for Payer: Priority Health Choice Medicaid	$13.63
Rate for Payer: Priority Health Cigna Priority Health	$34.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.63
Rate for Payer: Priority Health Narrow Network	$37.63
Rate for Payer: Priority Health SBD	$37.63

PR GASTROCNEMIUS RECESSION

Professional

Both

$1,488.00

Service Code	HCPCS 27687
Min. Negotiated Rate	$294.15
Max. Negotiated Rate	$2,402.71
Rate for Payer: Aetna Commercial	$603.17
Rate for Payer: BCBS Complete	$308.86
Rate for Payer: BCBS Trust/PPO	$2,402.71
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Mclaren Medicaid	$294.15
Rate for Payer: Meridian Medicaid	$308.86
Rate for Payer: Priority Health Choice Medicaid	$294.15
Rate for Payer: Priority Health Cigna Priority Health	$1,041.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$696.01
Rate for Payer: Priority Health Narrow Network	$696.01
Rate for Payer: Priority Health SBD	$696.01

PR GASTRODUODENOSTOMY

Professional

Both

$2,437.00

Service Code	HCPCS 43810
Min. Negotiated Rate	$486.56
Max. Negotiated Rate	$1,786.85
Rate for Payer: Aetna Commercial	$1,376.05
Rate for Payer: BCBS Complete	$683.48
Rate for Payer: BCBS Trust/PPO	$486.56
Rate for Payer: Cash Price	$1,949.60
Rate for Payer: Cash Price	$1,949.60
Rate for Payer: Mclaren Medicaid	$650.93
Rate for Payer: Meridian Medicaid	$683.48
Rate for Payer: Priority Health Choice Medicaid	$650.93
Rate for Payer: Priority Health Cigna Priority Health	$1,705.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,786.85
Rate for Payer: Priority Health Narrow Network	$1,786.85
Rate for Payer: Priority Health SBD	$1,786.85

PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT

Professional

Both

$336.00

Service Code	HCPCS 91034
Min. Negotiated Rate	$65.58
Max. Negotiated Rate	$1,518.86
Rate for Payer: Aetna Commercial	$211.81
Rate for Payer: Aetna Commercial	$211.81
Rate for Payer: BCBS Complete	$134.40
Rate for Payer: BCBS Complete	$48.80
Rate for Payer: BCBS Trust/PPO	$1,518.86
Rate for Payer: BCBS Trust/PPO	$1,518.86
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cash Price	$268.80
Rate for Payer: Priority Health Cigna Priority Health	$235.20
Rate for Payer: Priority Health Cigna Priority Health	$85.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.58
Rate for Payer: Priority Health Narrow Network	$65.58
Rate for Payer: Priority Health Narrow Network	$65.58
Rate for Payer: Priority Health SBD	$259.16
Rate for Payer: Priority Health SBD	$259.16

PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD

Professional

Both

$95.00

Service Code	HCPCS 91037
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$963.09
Rate for Payer: Aetna Commercial	$185.79
Rate for Payer: Aetna Commercial	$185.79
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: BCBS Trust/PPO	$963.09
Rate for Payer: BCBS Trust/PPO	$963.09
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$76.00
Rate for Payer: Priority Health Cigna Priority Health	$66.50
Rate for Payer: Priority Health Cigna Priority Health	$214.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.23
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.23
Rate for Payer: Priority Health Narrow Network	$64.23
Rate for Payer: Priority Health Narrow Network	$64.23
Rate for Payer: Priority Health SBD	$226.82
Rate for Payer: Priority Health SBD	$226.82

PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD

Professional

Both

$858.00

Service Code	HCPCS 91035
Min. Negotiated Rate	$107.34
Max. Negotiated Rate	$976.30
Rate for Payer: Aetna Commercial	$533.12
Rate for Payer: Aetna Commercial	$533.12
Rate for Payer: BCBS Complete	$66.40
Rate for Payer: BCBS Complete	$343.20
Rate for Payer: BCBS Trust/PPO	$976.30
Rate for Payer: BCBS Trust/PPO	$976.30
Rate for Payer: Cash Price	$686.40
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$686.40
Rate for Payer: Priority Health Cigna Priority Health	$600.60
Rate for Payer: Priority Health Cigna Priority Health	$116.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.34
Rate for Payer: Priority Health Narrow Network	$107.34
Rate for Payer: Priority Health Narrow Network	$107.34
Rate for Payer: Priority Health SBD	$622.52
Rate for Payer: Priority Health SBD	$622.52

PR GASTROJEJUNOSTOMY W/O VAGOTOMY

Professional

Both

$2,570.00

Service Code	HCPCS 43820
Min. Negotiated Rate	$860.09
Max. Negotiated Rate	$2,359.53
Rate for Payer: Aetna Commercial	$1,816.01
Rate for Payer: BCBS Complete	$903.09
Rate for Payer: BCBS Trust/PPO	$1,050.26
Rate for Payer: Cash Price	$2,056.00
Rate for Payer: Cash Price	$2,056.00
Rate for Payer: Mclaren Medicaid	$860.09
Rate for Payer: Meridian Medicaid	$903.09
Rate for Payer: Priority Health Choice Medicaid	$860.09
Rate for Payer: Priority Health Cigna Priority Health	$1,799.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,359.53
Rate for Payer: Priority Health Narrow Network	$2,359.53
Rate for Payer: Priority Health SBD	$2,359.53

PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE

Professional

Both

$2,530.00

Service Code	HCPCS 43825
Min. Negotiated Rate	$669.36
Max. Negotiated Rate	$2,304.27
Rate for Payer: Aetna Commercial	$1,773.70
Rate for Payer: BCBS Complete	$880.96
Rate for Payer: BCBS Trust/PPO	$669.36
Rate for Payer: Cash Price	$2,024.00
Rate for Payer: Cash Price	$2,024.00
Rate for Payer: Mclaren Medicaid	$839.01
Rate for Payer: Meridian Medicaid	$880.96
Rate for Payer: Priority Health Choice Medicaid	$839.01
Rate for Payer: Priority Health Cigna Priority Health	$1,771.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,304.27
Rate for Payer: Priority Health Narrow Network	$2,304.27
Rate for Payer: Priority Health SBD	$2,304.27

PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ

Professional

Both

$2,766.00

Service Code	HCPCS 43840
Min. Negotiated Rate	$75.56
Max. Negotiated Rate	$2,387.17
Rate for Payer: Aetna Commercial	$1,836.77
Rate for Payer: BCBS Complete	$912.49
Rate for Payer: BCBS Trust/PPO	$75.56
Rate for Payer: Cash Price	$2,212.80
Rate for Payer: Cash Price	$2,212.80
Rate for Payer: Mclaren Medicaid	$869.04
Rate for Payer: Meridian Medicaid	$912.49
Rate for Payer: Priority Health Choice Medicaid	$869.04
Rate for Payer: Priority Health Cigna Priority Health	$1,936.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,387.17
Rate for Payer: Priority Health Narrow Network	$2,387.17
Rate for Payer: Priority Health SBD	$2,387.17

PR GASTROSTOMY OPN NEONATAL FEEDING

Professional

Both

$2,090.00

Service Code	HCPCS 43831
Min. Negotiated Rate	$392.99
Max. Negotiated Rate	$1,463.00
Rate for Payer: Aetna Commercial	$817.73
Rate for Payer: BCBS Complete	$412.64
Rate for Payer: BCBS Trust/PPO	$1,286.41
Rate for Payer: Cash Price	$1,672.00
Rate for Payer: Cash Price	$1,672.00
Rate for Payer: Mclaren Medicaid	$392.99
Rate for Payer: Meridian Medicaid	$412.64
Rate for Payer: Priority Health Choice Medicaid	$392.99
Rate for Payer: Priority Health Cigna Priority Health	$1,463.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,077.75
Rate for Payer: Priority Health Narrow Network	$1,077.75
Rate for Payer: Priority Health SBD	$1,077.75

Know your out-of-pocket cost for care.

All Charges