Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Professional

Both

$906.00

Service Code	HCPCS 46040
Min. Negotiated Rate	$274.77
Max. Negotiated Rate	$1,260.52
Rate for Payer: Aetna Commercial	$564.66
Rate for Payer: BCBS Complete	$288.51
Rate for Payer: BCBS Trust/PPO	$1,260.52
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Mclaren Medicaid	$274.77
Rate for Payer: Meridian Medicaid	$288.51
Rate for Payer: Priority Health Choice Medicaid	$274.77
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$751.43
Rate for Payer: Priority Health Narrow Network	$751.43
Rate for Payer: Priority Health SBD	$751.43

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Facility

$906.00

Service Code	CPT 46040
Hospital Charge Code	46040
Hospital Revenue Code	960
Min. Negotiated Rate	$570.78
Max. Negotiated Rate	$815.40
Rate for Payer: Aetna Commercial	$770.10
Rate for Payer: Aetna New Business (MI Preferred)	$588.90
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cofinity Commercial	$634.20
Rate for Payer: Cofinity Commercial	$779.16
Rate for Payer: Healthscope Commercial	$815.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$770.10
Rate for Payer: PHP Commercial	$770.10
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health SBD	$570.78

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Facility

$906.00

Service Code	CPT 46040
Hospital Charge Code	46040
Hospital Revenue Code	960
Min. Negotiated Rate	$422.40
Max. Negotiated Rate	$1,312.52
Rate for Payer: Aetna Commercial	$770.10
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Aetna New Business (MI Preferred)	$588.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$1,162.01
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cofinity Commercial	$779.16
Rate for Payer: Cofinity Commercial	$634.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Healthscope Commercial	$815.40
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$770.10
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Commercial	$770.10
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health SBD	$570.78
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$464.64
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$422.40
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Professional

Both

$906.00

Service Code	HCPCS 46040
Hospital Charge Code	46040
Min. Negotiated Rate	$274.77
Max. Negotiated Rate	$1,260.52
Rate for Payer: Aetna Commercial	$564.66
Rate for Payer: BCBS Complete	$288.51
Rate for Payer: BCBS Trust/PPO	$1,260.52
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Mclaren Medicaid	$274.77
Rate for Payer: Meridian Medicaid	$288.51
Rate for Payer: Priority Health Choice Medicaid	$274.77
Rate for Payer: Priority Health Cigna Priority Health	$634.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$751.43
Rate for Payer: Priority Health Narrow Network	$751.43
Rate for Payer: Priority Health SBD	$751.43

PR I&D OF BARTHOLINS GLAND ABSCESS

Professional

Both

$378.00

Service Code	HCPCS 56420
Min. Negotiated Rate	$71.36
Max. Negotiated Rate	$264.60
Rate for Payer: Aetna Commercial	$128.52
Rate for Payer: BCBS Complete	$74.93
Rate for Payer: BCBS Trust/PPO	$244.07
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Mclaren Medicaid	$71.36
Rate for Payer: Meridian Medicaid	$74.93
Rate for Payer: Priority Health Choice Medicaid	$71.36
Rate for Payer: Priority Health Cigna Priority Health	$264.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$158.59
Rate for Payer: Priority Health Narrow Network	$158.59
Rate for Payer: Priority Health SBD	$158.59

PR I&D PELVIS/HIP JOINT AREA INFECTED BURSA

Professional

Both

$1,220.00

Service Code	HCPCS 26991
Min. Negotiated Rate	$342.08
Max. Negotiated Rate	$854.00
Rate for Payer: Aetna Commercial	$701.42
Rate for Payer: BCBS Complete	$359.18
Rate for Payer: BCBS Trust/PPO	$758.11
Rate for Payer: Cash Price	$976.00
Rate for Payer: Cash Price	$976.00
Rate for Payer: Mclaren Medicaid	$342.08
Rate for Payer: Meridian Medicaid	$359.18
Rate for Payer: Priority Health Choice Medicaid	$342.08
Rate for Payer: Priority Health Cigna Priority Health	$854.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$813.46
Rate for Payer: Priority Health Narrow Network	$813.46
Rate for Payer: Priority Health SBD	$813.46

PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

Professional

Both

$1,483.00

Service Code	HCPCS 26990
Min. Negotiated Rate	$433.21
Max. Negotiated Rate	$1,049.90
Rate for Payer: Aetna Commercial	$895.50
Rate for Payer: BCBS Complete	$462.50
Rate for Payer: BCBS Trust/PPO	$433.21
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Mclaren Medicaid	$440.48
Rate for Payer: Meridian Medicaid	$462.50
Rate for Payer: Priority Health Choice Medicaid	$440.48
Rate for Payer: Priority Health Cigna Priority Health	$1,038.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,049.90
Rate for Payer: Priority Health Narrow Network	$1,049.90
Rate for Payer: Priority Health SBD	$1,049.90

PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

Facility

$1,483.00

Service Code	CPT 26990
Hospital Charge Code	26990
Min. Negotiated Rate	$934.29
Max. Negotiated Rate	$1,334.70
Rate for Payer: Aetna Commercial	$1,260.55
Rate for Payer: Aetna New Business (MI Preferred)	$963.95
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cofinity Commercial	$1,038.10
Rate for Payer: Cofinity Commercial	$1,275.38
Rate for Payer: Healthscope Commercial	$1,334.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,260.55
Rate for Payer: PHP Commercial	$1,260.55
Rate for Payer: Priority Health Cigna Priority Health	$1,038.10
Rate for Payer: Priority Health SBD	$934.29

PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

Professional

Both

$1,483.00

Service Code	HCPCS 26990
Hospital Charge Code	26990
Min. Negotiated Rate	$433.21
Max. Negotiated Rate	$1,049.90
Rate for Payer: Aetna Commercial	$895.50
Rate for Payer: BCBS Complete	$462.50
Rate for Payer: BCBS Trust/PPO	$433.21
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Mclaren Medicaid	$440.48
Rate for Payer: Meridian Medicaid	$462.50
Rate for Payer: Priority Health Choice Medicaid	$440.48
Rate for Payer: Priority Health Cigna Priority Health	$1,038.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,049.90
Rate for Payer: Priority Health Narrow Network	$1,049.90
Rate for Payer: Priority Health SBD	$1,049.90

PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

Facility

$1,483.00

Service Code	CPT 26990
Hospital Charge Code	26990
Min. Negotiated Rate	$677.15
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,260.55
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$963.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,234.36
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cofinity Commercial	$1,275.38
Rate for Payer: Cofinity Commercial	$1,038.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$1,334.70
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,260.55
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,260.55
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,038.10
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$934.29
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$744.86
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$677.15
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR I&D PENIS DEEP

Professional

Both

$751.00

Service Code	HCPCS 54015
Min. Negotiated Rate	$194.26
Max. Negotiated Rate	$2,212.52
Rate for Payer: Aetna Commercial	$391.78
Rate for Payer: BCBS Complete	$203.97
Rate for Payer: BCBS Trust/PPO	$2,212.52
Rate for Payer: Cash Price	$600.80
Rate for Payer: Cash Price	$600.80
Rate for Payer: Mclaren Medicaid	$194.26
Rate for Payer: Meridian Medicaid	$203.97
Rate for Payer: Priority Health Choice Medicaid	$194.26
Rate for Payer: Priority Health Cigna Priority Health	$525.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$486.31
Rate for Payer: Priority Health Narrow Network	$486.31
Rate for Payer: Priority Health SBD	$486.31

PR I&D PERIANAL ABSCESS SUPERFICIAL

Professional

Both

$441.00

Service Code	HCPCS 46050
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$1,360.90
Rate for Payer: Aetna Commercial	$132.59
Rate for Payer: BCBS Complete	$68.66
Rate for Payer: BCBS Trust/PPO	$1,360.90
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$352.80
Rate for Payer: Mclaren Medicaid	$65.39
Rate for Payer: Meridian Medicaid	$68.66
Rate for Payer: Priority Health Choice Medicaid	$65.39
Rate for Payer: Priority Health Cigna Priority Health	$308.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.75
Rate for Payer: Priority Health Narrow Network	$178.75
Rate for Payer: Priority Health SBD	$178.75

PR I&D SHOULDER DEEP ABSCESS/HEMATOMA

Professional

Both

$702.00

Service Code	HCPCS 23030
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna Commercial	$338.61
Rate for Payer: BCBS Complete	$172.88
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Mclaren Medicaid	$164.65
Rate for Payer: Meridian Medicaid	$172.88
Rate for Payer: Priority Health Choice Medicaid	$164.65
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$390.65
Rate for Payer: Priority Health Narrow Network	$390.65
Rate for Payer: Priority Health SBD	$390.65

PR I&D SHOULDER INFECTED BURSA

Professional

Both

$706.00

Service Code	HCPCS 23031
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$494.20
Rate for Payer: Aetna Commercial	$287.48
Rate for Payer: BCBS Complete	$151.41
Rate for Payer: BCBS Trust/PPO	$18.68
Rate for Payer: Cash Price	$564.80
Rate for Payer: Cash Price	$564.80
Rate for Payer: Mclaren Medicaid	$144.20
Rate for Payer: Meridian Medicaid	$151.41
Rate for Payer: Priority Health Choice Medicaid	$144.20
Rate for Payer: Priority Health Cigna Priority Health	$494.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$341.63
Rate for Payer: Priority Health Narrow Network	$341.63
Rate for Payer: Priority Health SBD	$341.63

PR I&D SOFT TISSUE ABSCESS SUBFASCIAL

Professional

Both

$505.00

Service Code	HCPCS 20005
Min. Negotiated Rate	$202.00
Max. Negotiated Rate	$353.50
Rate for Payer: BCBS Complete	$202.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Priority Health Cigna Priority Health	$353.50

PR I&D SUBMUCOSAL ABSCESS RECTUM

Professional

Both

$517.00

Service Code	HCPCS 45005
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$2,676.37
Rate for Payer: Aetna Commercial	$217.12
Rate for Payer: BCBS Complete	$111.82
Rate for Payer: BCBS Trust/PPO	$2,676.37
Rate for Payer: Cash Price	$413.60
Rate for Payer: Cash Price	$413.60
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	$361.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$294.57
Rate for Payer: Priority Health Narrow Network	$294.57
Rate for Payer: Priority Health SBD	$294.57

PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA

Professional

Both

$608.00

Service Code	HCPCS 23930
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$425.60
Rate for Payer: Aetna Commercial	$288.31
Rate for Payer: BCBS Complete	$146.04
Rate for Payer: BCBS Trust/PPO	$18.25
Rate for Payer: Cash Price	$486.40
Rate for Payer: Cash Price	$486.40
Rate for Payer: Mclaren Medicaid	$139.09
Rate for Payer: Meridian Medicaid	$146.04
Rate for Payer: Priority Health Choice Medicaid	$139.09
Rate for Payer: Priority Health Cigna Priority Health	$425.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$330.90
Rate for Payer: Priority Health Narrow Network	$330.90
Rate for Payer: Priority Health SBD	$330.90

PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL

Professional

Both

$516.00

Service Code	HCPCS 57023
Min. Negotiated Rate	$205.97
Max. Negotiated Rate	$2,321.35
Rate for Payer: Aetna Commercial	$380.17
Rate for Payer: BCBS Complete	$216.27
Rate for Payer: BCBS Trust/PPO	$2,321.35
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Mclaren Medicaid	$205.97
Rate for Payer: Meridian Medicaid	$216.27
Rate for Payer: Priority Health Choice Medicaid	$205.97
Rate for Payer: Priority Health Cigna Priority Health	$361.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$454.97
Rate for Payer: Priority Health Narrow Network	$454.97
Rate for Payer: Priority Health SBD	$454.97

PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM

Professional

Both

$449.00

Service Code	HCPCS 57022
Min. Negotiated Rate	$116.72
Max. Negotiated Rate	$3,001.80
Rate for Payer: Aetna Commercial	$214.36
Rate for Payer: BCBS Complete	$122.56
Rate for Payer: BCBS Trust/PPO	$3,001.80
Rate for Payer: Cash Price	$359.20
Rate for Payer: Cash Price	$359.20
Rate for Payer: Mclaren Medicaid	$116.72
Rate for Payer: Meridian Medicaid	$122.56
Rate for Payer: Priority Health Choice Medicaid	$116.72
Rate for Payer: Priority Health Cigna Priority Health	$314.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$258.48
Rate for Payer: Priority Health Narrow Network	$258.48
Rate for Payer: Priority Health SBD	$258.48

PR I&D VULVA/PERINEAL ABSCESS

Professional

Both

$273.00

Service Code	HCPCS 56405
Min. Negotiated Rate	$82.01
Max. Negotiated Rate	$1,505.13
Rate for Payer: Aetna Commercial	$146.26
Rate for Payer: BCBS Complete	$86.11
Rate for Payer: BCBS Trust/PPO	$1,505.13
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Mclaren Medicaid	$82.01
Rate for Payer: Meridian Medicaid	$86.11
Rate for Payer: Priority Health Choice Medicaid	$82.01
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.32
Rate for Payer: Priority Health Narrow Network	$181.32
Rate for Payer: Priority Health SBD	$181.32

PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE

Professional

Both

$20.00

Service Code	HCPCS 90657
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$9.50
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 IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE

Professional

Both

$20.00

Service Code	HCPCS 90658
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$16.32
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 IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE

Professional

Both

$24.00

Service Code	HCPCS 90656
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$17.69
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: BCBS Trust/PPO	$17.00
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 IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE

Professional

Both

$23.00

Service Code	HCPCS 90655
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$16.30
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10

PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90686
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.65
Rate for Payer: Aetna Commercial	$22.35
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$22.65
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50

Know your out-of-pocket cost for care.

All Charges