Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR IMM ADMN SARSCOV2 3MCG/0.2ML TRIS-SUCROSE 1ST

Professional

Both

$40.00

Service Code	HCPCS 0081A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$570.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$570.00
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 IMM ADMN SARSCOV2 3MCG/0.2ML TRIS-SUCROSE 2ND

Professional

Both

$40.00

Service Code	HCPCS 0082A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.95
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$28.95
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 IMM ADMN SARSCOV2 3MCG/0.2ML TRIS-SUCROSE 3RD

Professional

Both

$40.00

Service Code	HCPCS 0083A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$570.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$570.00
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 IMM ADMN SARSCOV2 50 MCG/0.25 ML BOOSTER DOSE

Professional

Both

$40.00

Service Code	HCPCS 0064A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$80.25
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$80.25
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 IMM ADMN SARSCOV2 AD26 5X1010 VP/0.5 ML 1 DOSE

Professional

Both

$40.00

Service Code	HCPCS 0031A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$712.50
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$712.50
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 IMM ADMN SARSCOV2 AD26 5X1010 VP/0.5 ML BST DOSE

Professional

Both

$40.00

Service Code	HCPCS 0034A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.95
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$28.95
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 IMM ADMN SARSCOV2 BIVALENT 10 MCG/0.2 ML 1ST

Professional

Both

$40.00

Service Code	HCPCS 0151A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR IMM ADMN SARSCOV2 BIVALENT 10 MCG/0.2 ML ADDL

Professional

Both

$40.00

Service Code	HCPCS 0164A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$3,002.09
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$3,002.09
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 IMM ADMN SARSCOV2 BIVALENT 10 MCG/0.2 ML ADDL

Professional

Both

$40.00

Service Code	HCPCS 0154A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$480.55
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$480.55
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 IMM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML ADDL

Professional

Both

$40.00

Service Code	HCPCS 0144A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$68.75
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$68.75
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 IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML 1 DOSE

Professional

Both

$40.00

Service Code	HCPCS 0121A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML ADDL

Professional

Both

$40.00

Service Code	HCPCS 0124A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$122.97
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$122.97
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 IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 1ST

Professional

Both

$40.00

Service Code	HCPCS 0171A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 2ND

Professional

Both

$40.00

Service Code	HCPCS 0172A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 3RD

Professional

Both

$40.00

Service Code	HCPCS 0173A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$2,756.25
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$2,756.25
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 IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML ADDL

Professional

Both

$40.00

Service Code	HCPCS 0174A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$570.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$570.00
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 IMM ADMN SARSCOV2 BIVALENT 50 MCG/0.5 ML ADDL

Professional

Both

$40.00

Service Code	HCPCS 0134A
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$1,882.66
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$1,882.66
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 IMM ADMN SARSCOV2 VACCINE SINGLE DOSE

Professional

Both

$83.04

Service Code	HCPCS 90480
Min. Negotiated Rate	$33.22
Max. Negotiated Rate	$58.13
Rate for Payer: Aetna Commercial	$40.00
Rate for Payer: BCBS Complete	$33.22
Rate for Payer: Cash Price	$66.43
Rate for Payer: Cash Price	$66.43
Rate for Payer: Priority Health Cigna Priority Health	$58.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.98
Rate for Payer: Priority Health Narrow Network	$39.98
Rate for Payer: Priority Health SBD	$39.98

PR IMMUNIZE COUNS < 21YR 5-15 M

Professional

Both

$30.00

Service Code	HCPCS G0312
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

PR IMMUNIZE COUNS < 21YR 6-30 M

Professional

Both

$45.00

Service Code	HCPCS G0313
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$31.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$31.50

PR IMMUNIZE COUNSEL 16-30 MINS

Professional

Both

$45.00

Service Code	HCPCS G0311
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$31.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$31.50

PR IMMUNIZE COUNSEL 5-15 MIN

Professional

Both

$30.00

Service Code	HCPCS G0310
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

PR IMPLANTATION NERVE END BONE/MUSCLE

Professional

Both

$1,817.00

Service Code	HCPCS 64787
Min. Negotiated Rate	$136.83
Max. Negotiated Rate	$1,271.90
Rate for Payer: Aetna Commercial	$310.40
Rate for Payer: BCBS Complete	$155.21
Rate for Payer: BCBS Trust/PPO	$136.83
Rate for Payer: Cash Price	$1,453.60
Rate for Payer: Cash Price	$1,453.60
Rate for Payer: Mclaren Medicaid	$147.82
Rate for Payer: Meridian Medicaid	$155.21
Rate for Payer: Priority Health Choice Medicaid	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$1,271.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$395.79
Rate for Payer: Priority Health Narrow Network	$395.79
Rate for Payer: Priority Health SBD	$395.79

PR IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER

Professional

Both

$618.00

Service Code	HCPCS 33282
Min. Negotiated Rate	$247.20
Max. Negotiated Rate	$432.60
Rate for Payer: BCBS Complete	$247.20
Rate for Payer: Cash Price	$494.40
Rate for Payer: Priority Health Cigna Priority Health	$432.60

PR IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE

Professional

Both

$990.00

Service Code	HCPCS 49568
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$693.00
Rate for Payer: BCBS Complete	$396.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Priority Health Cigna Priority Health	$693.00

Know your out-of-pocket cost for care.

All Charges