Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90685
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.05
Rate for Payer: Aetna Commercial	$19.36
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$22.05
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 IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90687
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$10.44
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$10.78
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 IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE

Professional

Both

$25.00

Service Code	HCPCS 90688
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$21.56
Rate for Payer: Aetna Commercial	$20.88
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$21.56
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 IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM

Professional

Both

$68.00

Service Code	HCPCS 90662
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$73.40
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: BCBS Trust/PPO	$73.62
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Priority Health Cigna Priority Health	$47.60

PR ILEOSCOPY STOMA W/BALLOON DILATION

Professional

Both

$230.00

Service Code	HCPCS 44381
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$282.11
Rate for Payer: Aetna Commercial	$110.61
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCBS Trust/PPO	$282.11
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Mclaren Medicaid	$53.68
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health	$161.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.00
Rate for Payer: Priority Health Narrow Network	$147.00
Rate for Payer: Priority Health SBD	$147.00

PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE

Professional

Both

$919.00

Service Code	HCPCS 44382
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$643.30
Rate for Payer: Aetna Commercial	$97.19
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS Trust/PPO	$226.11
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cash Price	$735.20
Rate for Payer: Mclaren Medicaid	$46.86
Rate for Payer: Meridian Medicaid	$49.20
Rate for Payer: Priority Health Choice Medicaid	$46.86
Rate for Payer: Priority Health Cigna Priority Health	$643.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$128.76
Rate for Payer: Priority Health Narrow Network	$128.76
Rate for Payer: Priority Health SBD	$128.76

PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT

Professional

Both

$235.00

Service Code	HCPCS 44384
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$402.56
Rate for Payer: Aetna Commercial	$205.72
Rate for Payer: BCBS Complete	$100.64
Rate for Payer: BCBS Trust/PPO	$402.56
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Mclaren Medicaid	$95.85
Rate for Payer: Meridian Medicaid	$100.64
Rate for Payer: Priority Health Choice Medicaid	$95.85
Rate for Payer: Priority Health Cigna Priority Health	$164.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$267.53
Rate for Payer: Priority Health Narrow Network	$267.53
Rate for Payer: Priority Health SBD	$267.53

PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD

Professional

Both

$822.00

Service Code	HCPCS 44380
Min. Negotiated Rate	$36.42
Max. Negotiated Rate	$575.40
Rate for Payer: Aetna Commercial	$74.35
Rate for Payer: BCBS Complete	$38.24
Rate for Payer: BCBS Trust/PPO	$247.77
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cash Price	$657.60
Rate for Payer: Mclaren Medicaid	$36.42
Rate for Payer: Meridian Medicaid	$38.24
Rate for Payer: Priority Health Choice Medicaid	$36.42
Rate for Payer: Priority Health Cigna Priority Health	$575.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.78
Rate for Payer: Priority Health Narrow Network	$98.78
Rate for Payer: Priority Health SBD	$98.78

PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT

Professional

Both

$1,066.00

Service Code	HCPCS 44383
Min. Negotiated Rate	$426.40
Max. Negotiated Rate	$746.20
Rate for Payer: BCBS Complete	$426.40
Rate for Payer: Cash Price	$852.80
Rate for Payer: Priority Health Cigna Priority Health	$746.20

PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE

Professional

Both

$2,504.00

Service Code	HCPCS 44310
Min. Negotiated Rate	$81.93
Max. Negotiated Rate	$1,819.78
Rate for Payer: Aetna Commercial	$1,396.74
Rate for Payer: BCBS Complete	$695.55
Rate for Payer: BCBS Trust/PPO	$81.93
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Cash Price	$2,003.20
Rate for Payer: Mclaren Medicaid	$662.43
Rate for Payer: Meridian Medicaid	$695.55
Rate for Payer: Priority Health Choice Medicaid	$662.43
Rate for Payer: Priority Health Cigna Priority Health	$1,752.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,819.78
Rate for Payer: Priority Health Narrow Network	$1,819.78
Rate for Payer: Priority Health SBD	$1,819.78

PR ILIAC ART ANGIO,CARDIAC CATH

Professional

Both

$35.00

Service Code	HCPCS G0278
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$152.15
Rate for Payer: Aetna Commercial	$17.94
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$152.15
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.48
Rate for Payer: Priority Health Narrow Network	$20.48
Rate for Payer: Priority Health SBD	$20.48

PR IM ADM INTRANSL/ORAL 1 VACCINE

Professional

Both

$32.00

Service Code	HCPCS 90473
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$611.77
Rate for Payer: Aetna Commercial	$5.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$611.77
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.75
Rate for Payer: Priority Health Narrow Network	$26.75
Rate for Payer: Priority Health SBD	$26.75

PR IM ADM INTRANSL/ORAL EA VACCINE

Professional

Both

$23.00

Service Code	HCPCS 90474
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$652.45
Rate for Payer: Aetna Commercial	$5.00
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$652.45
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
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	$15.72

PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE

Professional

Both

$32.00

Service Code	HCPCS 90471
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$593.28
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$593.28
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.75
Rate for Payer: Priority Health Narrow Network	$26.75
Rate for Payer: Priority Health SBD	$26.75

PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE

Professional

Both

$23.00

Service Code	HCPCS 90472
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$1,006.41
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$1,006.41
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.31
Rate for Payer: Priority Health Narrow Network	$19.31
Rate for Payer: Priority Health SBD	$19.31

PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX

Professional

Both

$35.00

Service Code	HCPCS 90460
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$519.85
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$519.85
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.75
Rate for Payer: Priority Health Narrow Network	$26.75
Rate for Payer: Priority Health SBD	$26.75

PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT

Professional

Both

$23.00

Service Code	HCPCS 90461
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$544.68
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$544.68
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.48
Rate for Payer: Priority Health Narrow Network	$13.48
Rate for Payer: Priority Health SBD	$13.48

PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE

Professional

Both

$739.00

Service Code	HCPCS 10030
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$148.19
Rate for Payer: BCBS Complete	$88.79
Rate for Payer: BCBS Trust/PPO	$2,625.00
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Mclaren Medicaid	$84.56
Rate for Payer: Meridian Medicaid	$88.79
Rate for Payer: Priority Health Choice Medicaid	$84.56
Rate for Payer: Priority Health Cigna Priority Health	$517.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$163.59
Rate for Payer: Priority Health Narrow Network	$163.59
Rate for Payer: Priority Health SBD	$163.59

PRIMAQUINE 26.3 MG TABLET

Facility

$597.12

Service Code	NDC 76385-102-01
Hospital Charge Code	6541
Hospital Revenue Code	637
Min. Negotiated Rate	$376.19
Max. Negotiated Rate	$537.41
Rate for Payer: Aetna Commercial	$507.55
Rate for Payer: Aetna New Business (MI Preferred)	$388.13
Rate for Payer: Cash Price	$477.70
Rate for Payer: Cofinity Commercial	$417.98
Rate for Payer: Cofinity Commercial	$513.52
Rate for Payer: Healthscope Commercial	$537.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$507.55
Rate for Payer: PHP Commercial	$507.55
Rate for Payer: Priority Health Cigna Priority Health	$417.98
Rate for Payer: Priority Health SBD	$376.19

PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, NON-INTRACRANIAL, ARTERIAL OR ARTERIAL BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); INITIAL VESSEL

Facility

$31,275.01

Service Code	CPT 37184
Hospital Revenue Code	360
Min. Negotiated Rate	$410.94
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Medicare	$16,226.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,503.28
Rate for Payer: Amish Plain Church Group Commercial	$19,503.28
Rate for Payer: BCBS Complete	$8,962.14
Rate for Payer: BCBS MAPPO	$15,602.62
Rate for Payer: BCBS Trust/PPO	$2,559.98
Rate for Payer: BCN Medicare Advantage	$15,602.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,602.62
Rate for Payer: Mclaren Medicaid	$8,534.63
Rate for Payer: Mclaren Medicare	$15,602.62
Rate for Payer: Meridian Medicaid	$8,962.14
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16,382.75
Rate for Payer: MI Amish Medical Board Commercial	$17,943.01
Rate for Payer: PACE Medicare	$14,822.49
Rate for Payer: PACE SWMI	$15,602.62
Rate for Payer: PHP Medicare Advantage	$15,602.62
Rate for Payer: Priority Health Choice Medicaid	$8,534.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$15,602.62
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Railroad Medicare Medicare	$15,602.62
Rate for Payer: UHC All Payor (Choice/PPO)	$452.03
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$15,602.62
Rate for Payer: UHC Exchange	$410.94
Rate for Payer: UHC Medicare Advantage	$16,070.70
Rate for Payer: VA VA	$15,602.62

PR IMBRICATION DIAPHRAGM EVENTRATION

Professional

Both

$5,313.00

Service Code	HCPCS 39545
Min. Negotiated Rate	$568.07
Max. Negotiated Rate	$3,719.10
Rate for Payer: Aetna Commercial	$914.62
Rate for Payer: BCBS Complete	$596.47
Rate for Payer: BCBS Trust/PPO	$671.47
Rate for Payer: Cash Price	$4,250.40
Rate for Payer: Cash Price	$4,250.40
Rate for Payer: Mclaren Medicaid	$568.07
Rate for Payer: Meridian Medicaid	$596.47
Rate for Payer: Priority Health Choice Medicaid	$568.07
Rate for Payer: Priority Health Cigna Priority Health	$3,719.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,410.75
Rate for Payer: Priority Health Narrow Network	$1,410.75
Rate for Payer: Priority Health SBD	$1,410.75

PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

Professional

Both

$400.00

Service Code	HCPCS 49406
Min. Negotiated Rate	$120.77
Max. Negotiated Rate	$2,515.24
Rate for Payer: Aetna Commercial	$260.75
Rate for Payer: BCBS Complete	$126.81
Rate for Payer: BCBS Trust/PPO	$2,515.24
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Mclaren Medicaid	$120.77
Rate for Payer: Meridian Medicaid	$126.81
Rate for Payer: Priority Health Choice Medicaid	$120.77
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$333.97
Rate for Payer: Priority Health Narrow Network	$333.97
Rate for Payer: Priority Health SBD	$333.97

PRIMIDONE 250 MG TABLET

Facility

$313.92

Service Code	NDC 68084-203-01
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$197.77
Max. Negotiated Rate	$282.53
Rate for Payer: Aetna Commercial	$266.83
Rate for Payer: Aetna New Business (MI Preferred)	$204.05
Rate for Payer: Cash Price	$251.14
Rate for Payer: Cofinity Commercial	$219.74
Rate for Payer: Cofinity Commercial	$269.97
Rate for Payer: Healthscope Commercial	$282.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$266.83
Rate for Payer: PHP Commercial	$266.83
Rate for Payer: Priority Health Cigna Priority Health	$219.74
Rate for Payer: Priority Health SBD	$197.77

PRIMIDONE 250 MG TABLET

Facility

$218.98

Service Code	NDC 50268-687-15
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$137.96
Max. Negotiated Rate	$197.08
Rate for Payer: Aetna Commercial	$186.13
Rate for Payer: Aetna New Business (MI Preferred)	$142.34
Rate for Payer: Cash Price	$175.18
Rate for Payer: Cofinity Commercial	$153.29
Rate for Payer: Cofinity Commercial	$188.32
Rate for Payer: Healthscope Commercial	$197.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$186.13
Rate for Payer: PHP Commercial	$186.13
Rate for Payer: Priority Health Cigna Priority Health	$153.29
Rate for Payer: Priority Health SBD	$137.96

PRIMIDONE 250 MG TABLET

Facility

$210.90

Service Code	NDC 53746-545-01
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$132.87
Max. Negotiated Rate	$189.81
Rate for Payer: Aetna Commercial	$179.26
Rate for Payer: Aetna New Business (MI Preferred)	$137.08
Rate for Payer: Cash Price	$168.72
Rate for Payer: Cofinity Commercial	$147.63
Rate for Payer: Cofinity Commercial	$181.37
Rate for Payer: Healthscope Commercial	$189.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$179.26
Rate for Payer: PHP Commercial	$179.26
Rate for Payer: Priority Health Cigna Priority Health	$147.63
Rate for Payer: Priority Health SBD	$132.87

Know your out-of-pocket cost for care.

All Charges