Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Facility

$492.00

Service Code	CPT 64405
Hospital Charge Code	64405
Hospital Revenue Code	361
Min. Negotiated Rate	$309.96
Max. Negotiated Rate	$442.80
Rate for Payer: Aetna Commercial	$418.20
Rate for Payer: Aetna New Business (MI Preferred)	$319.80
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cofinity Commercial	$344.40
Rate for Payer: Cofinity Commercial	$423.12
Rate for Payer: Healthscope Commercial	$442.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$418.20
Rate for Payer: PHP Commercial	$418.20
Rate for Payer: Priority Health Cigna Priority Health	$344.40
Rate for Payer: Priority Health SBD	$309.96

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Professional

Both

$492.00

Service Code	HCPCS 64405
Hospital Charge Code	64405
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$344.40
Rate for Payer: Aetna Commercial	$69.32
Rate for Payer: BCBS Complete	$35.33
Rate for Payer: BCBS Trust/PPO	$262.57
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cash Price	$393.60
Rate for Payer: Mclaren Medicaid	$33.65
Rate for Payer: Meridian Medicaid	$35.33
Rate for Payer: Priority Health Choice Medicaid	$33.65
Rate for Payer: Priority Health Cigna Priority Health	$344.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$88.89
Rate for Payer: Priority Health Narrow Network	$88.89
Rate for Payer: Priority Health SBD	$88.89

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Professional

Both

$492.00

Service Code	HCPCS 64405
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$344.40
Rate for Payer: Aetna Commercial	$69.32
Rate for Payer: BCBS Complete	$35.33
Rate for Payer: BCBS Trust/PPO	$262.57
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cash Price	$393.60
Rate for Payer: Mclaren Medicaid	$33.65
Rate for Payer: Meridian Medicaid	$35.33
Rate for Payer: Priority Health Choice Medicaid	$33.65
Rate for Payer: Priority Health Cigna Priority Health	$344.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$88.89
Rate for Payer: Priority Health Narrow Network	$88.89
Rate for Payer: Priority Health SBD	$88.89

PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES

Professional

Both

$656.00

Service Code	HCPCS 64425
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$1,001.13
Rate for Payer: Aetna Commercial	$71.32
Rate for Payer: BCBS Complete	$36.24
Rate for Payer: BCBS Trust/PPO	$1,001.13
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cash Price	$524.80
Rate for Payer: Mclaren Medicaid	$34.51
Rate for Payer: Meridian Medicaid	$36.24
Rate for Payer: Priority Health Choice Medicaid	$34.51
Rate for Payer: Priority Health Cigna Priority Health	$459.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.73
Rate for Payer: Priority Health Narrow Network	$91.73
Rate for Payer: Priority Health SBD	$91.73

PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL

Professional

Both

$1,202.00

Service Code	HCPCS 64421
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$841.40
Rate for Payer: Aetna Commercial	$32.34
Rate for Payer: BCBS Complete	$16.55
Rate for Payer: BCBS Trust/PPO	$368.75
Rate for Payer: Cash Price	$961.60
Rate for Payer: Cash Price	$961.60
Rate for Payer: Mclaren Medicaid	$15.76
Rate for Payer: Meridian Medicaid	$16.55
Rate for Payer: Priority Health Choice Medicaid	$15.76
Rate for Payer: Priority Health Cigna Priority Health	$841.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.77
Rate for Payer: Priority Health Narrow Network	$40.77
Rate for Payer: Priority Health SBD	$40.77

PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL

Professional

Both

$215.00

Service Code	HCPCS 64420
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$551.55
Rate for Payer: Aetna Commercial	$76.19
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCBS Trust/PPO	$551.55
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cash Price	$172.00
Rate for Payer: Mclaren Medicaid	$36.85
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health	$150.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.95
Rate for Payer: Priority Health Narrow Network	$97.95
Rate for Payer: Priority Health SBD	$97.95

PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG

Professional

Both

$406.00

Service Code	HCPCS 64451
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$580.60
Rate for Payer: Aetna Commercial	$101.64
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCBS Trust/PPO	$580.60
Rate for Payer: Cash Price	$324.80
Rate for Payer: Cash Price	$324.80
Rate for Payer: Mclaren Medicaid	$51.76
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health	$284.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$136.46
Rate for Payer: Priority Health Narrow Network	$136.46
Rate for Payer: Priority Health SBD	$136.46

PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH

Facility

$254.00

Service Code	CPT 64450
Hospital Charge Code	64450
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$769.16
Rate for Payer: Aetna Commercial	$215.90
Rate for Payer: Aetna Medicare	$639.94
Rate for Payer: Aetna New Business (MI Preferred)	$165.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$769.16
Rate for Payer: Amish Plain Church Group Commercial	$769.16
Rate for Payer: BCBS Complete	$353.45
Rate for Payer: BCBS MAPPO	$615.33
Rate for Payer: BCBS Trust/PPO	$402.78
Rate for Payer: BCN Medicare Advantage	$615.33
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cofinity Commercial	$177.80
Rate for Payer: Cofinity Commercial	$218.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$615.33
Rate for Payer: Healthscope Commercial	$228.60
Rate for Payer: Mclaren Medicaid	$336.59
Rate for Payer: Mclaren Medicare	$615.33
Rate for Payer: Meridian Medicaid	$353.45
Rate for Payer: Meridian Wellcare - Medicare Advantage	$646.10
Rate for Payer: MI Amish Medical Board Commercial	$707.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.90
Rate for Payer: PACE Medicare	$584.56
Rate for Payer: PACE SWMI	$615.33
Rate for Payer: PHP Commercial	$215.90
Rate for Payer: PHP Medicare Advantage	$615.33
Rate for Payer: Priority Health Choice Medicaid	$336.59
Rate for Payer: Priority Health Cigna Priority Health	$177.80
Rate for Payer: Priority Health Medicare	$615.33
Rate for Payer: Priority Health SBD	$160.02
Rate for Payer: Railroad Medicare Medicare	$615.33
Rate for Payer: UHC All Payor (Choice/PPO)	$45.02
Rate for Payer: UHC Dual Complete DSNP	$615.33
Rate for Payer: UHC Exchange	$40.93
Rate for Payer: UHC Medicare Advantage	$633.79
Rate for Payer: VA VA	$615.33

PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH

Facility

$254.00

Service Code	CPT 64450
Hospital Charge Code	64450
Min. Negotiated Rate	$160.02
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna Commercial	$215.90
Rate for Payer: Aetna New Business (MI Preferred)	$165.10
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cofinity Commercial	$218.44
Rate for Payer: Cofinity Commercial	$177.80
Rate for Payer: Healthscope Commercial	$228.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.90
Rate for Payer: PHP Commercial	$215.90
Rate for Payer: Priority Health Cigna Priority Health	$177.80
Rate for Payer: Priority Health SBD	$160.02

PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH

Professional

Both

$254.00

Service Code	HCPCS 64450
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$661.43
Rate for Payer: Aetna Commercial	$54.55
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$661.43
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cash Price	$203.20
Rate for Payer: Mclaren Medicaid	$26.63
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$177.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.21
Rate for Payer: Priority Health Narrow Network	$70.21
Rate for Payer: Priority Health SBD	$70.21

PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH

Professional

Both

$254.00

Service Code	HCPCS 64450
Hospital Charge Code	64450
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$661.43
Rate for Payer: Aetna Commercial	$54.55
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$661.43
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cash Price	$203.20
Rate for Payer: Mclaren Medicaid	$26.63
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$177.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.21
Rate for Payer: Priority Health Narrow Network	$70.21
Rate for Payer: Priority Health SBD	$70.21

PR INJECTION AA&/STRD PARACERVICAL NERVE

Professional

Both

$285.00

Service Code	HCPCS 64435
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$1,878.11
Rate for Payer: Aetna Commercial	$56.32
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCBS Trust/PPO	$1,878.11
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Mclaren Medicaid	$27.90
Rate for Payer: Meridian Medicaid	$29.30
Rate for Payer: Priority Health Choice Medicaid	$27.90
Rate for Payer: Priority Health Cigna Priority Health	$199.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$73.04
Rate for Payer: Priority Health Narrow Network	$73.04
Rate for Payer: Priority Health SBD	$73.04

PR INJECTION AA&/STRD PUDENDAL NERVE

Professional

Both

$250.00

Service Code	HCPCS 64430
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$1,676.82
Rate for Payer: Aetna Commercial	$70.97
Rate for Payer: BCBS Complete	$36.46
Rate for Payer: BCBS Trust/PPO	$1,676.82
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Mclaren Medicaid	$34.72
Rate for Payer: Meridian Medicaid	$36.46
Rate for Payer: Priority Health Choice Medicaid	$34.72
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.73
Rate for Payer: Priority Health Narrow Network	$91.73
Rate for Payer: Priority Health SBD	$91.73

PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN

Professional

Both

$266.00

Service Code	HCPCS 64445
Min. Negotiated Rate	$45.58
Max. Negotiated Rate	$1,332.90
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: BCBS Complete	$47.86
Rate for Payer: BCBS Trust/PPO	$1,332.90
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Mclaren Medicaid	$45.58
Rate for Payer: Meridian Medicaid	$47.86
Rate for Payer: Priority Health Choice Medicaid	$45.58
Rate for Payer: Priority Health Cigna Priority Health	$186.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$122.88
Rate for Payer: Priority Health Narrow Network	$122.88
Rate for Payer: Priority Health SBD	$122.88

PR INJECTION AA&/STRD SUPRASCAPULAR NERVE

Professional

Both

$177.00

Service Code	HCPCS 64418
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$359.77
Rate for Payer: Aetna Commercial	$74.30
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCBS Trust/PPO	$359.77
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Mclaren Medicaid	$35.15
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Cigna Priority Health	$123.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$93.42
Rate for Payer: Priority Health Narrow Network	$93.42
Rate for Payer: Priority Health SBD	$93.42

PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH

Professional

Both

$256.00

Service Code	HCPCS 64400
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$285.28
Rate for Payer: Aetna Commercial	$64.36
Rate for Payer: BCBS Complete	$34.67
Rate for Payer: BCBS Trust/PPO	$285.28
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cash Price	$204.80
Rate for Payer: Mclaren Medicaid	$33.02
Rate for Payer: Meridian Medicaid	$34.67
Rate for Payer: Priority Health Choice Medicaid	$33.02
Rate for Payer: Priority Health Cigna Priority Health	$179.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.93
Rate for Payer: Priority Health Narrow Network	$84.93
Rate for Payer: Priority Health SBD	$84.93

PR INJECTION AA&/STRD VAGUS NERVE

Professional

Both

$165.00

Service Code	HCPCS 64408
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$416.83
Rate for Payer: Aetna Commercial	$56.23
Rate for Payer: BCBS Complete	$29.97
Rate for Payer: BCBS Trust/PPO	$416.83
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Mclaren Medicaid	$28.54
Rate for Payer: Meridian Medicaid	$29.97
Rate for Payer: Priority Health Choice Medicaid	$28.54
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.88
Rate for Payer: Priority Health Narrow Network	$75.88
Rate for Payer: Priority Health SBD	$75.88

PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX

Professional

Both

$301.00

Service Code	HCPCS 49400
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$2,526.86
Rate for Payer: Aetna Commercial	$122.24
Rate for Payer: BCBS Complete	$59.04
Rate for Payer: BCBS Trust/PPO	$2,526.86
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Mclaren Medicaid	$56.23
Rate for Payer: Meridian Medicaid	$59.04
Rate for Payer: Priority Health Choice Medicaid	$56.23
Rate for Payer: Priority Health Cigna Priority Health	$210.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.81
Rate for Payer: Priority Health Narrow Network	$155.81
Rate for Payer: Priority Health SBD	$155.81

PR INJECTION ANES AGENT SPHENOPALATINE GANGLION

Professional

Both

$175.00

Service Code	HCPCS 64505
Min. Negotiated Rate	$67.52
Max. Negotiated Rate	$195.47
Rate for Payer: Aetna Commercial	$128.32
Rate for Payer: BCBS Complete	$70.90
Rate for Payer: BCBS Trust/PPO	$195.47
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Mclaren Medicaid	$67.52
Rate for Payer: Meridian Medicaid	$70.90
Rate for Payer: Priority Health Choice Medicaid	$67.52
Rate for Payer: Priority Health Cigna Priority Health	$122.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$176.10
Rate for Payer: Priority Health Narrow Network	$176.10
Rate for Payer: Priority Health SBD	$176.10

PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC

Professional

Both

$350.00

Service Code	HCPCS 64520
Min. Negotiated Rate	$54.10
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: BCBS Trust/PPO	$224.53
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Mclaren Medicaid	$54.10
Rate for Payer: Meridian Medicaid	$56.80
Rate for Payer: Priority Health Choice Medicaid	$54.10
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.99
Rate for Payer: Priority Health Narrow Network	$140.99
Rate for Payer: Priority Health SBD	$140.99

PR INJECTION, BUPIVICAINE HYDRO

Professional

Both

$10.00

Service Code	HCPCS S0020
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00

PR INJECTION ENZYME PALMAR FASCIAL CORD

Professional

Both

$163.00

Service Code	HCPCS 20527
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$114.10
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: BCBS Complete	$44.06
Rate for Payer: BCBS Trust/PPO	$52.64
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Mclaren Medicaid	$41.96
Rate for Payer: Meridian Medicaid	$44.06
Rate for Payer: Priority Health Choice Medicaid	$41.96
Rate for Payer: Priority Health Cigna Priority Health	$114.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.09
Rate for Payer: Priority Health Narrow Network	$100.09
Rate for Payer: Priority Health SBD	$100.09

PR INJECTION EPIDURAL BLOOD/CLOT PATCH

Professional

Both

$462.00

Service Code	HCPCS 62273
Min. Negotiated Rate	$71.78
Max. Negotiated Rate	$645.05
Rate for Payer: Aetna Commercial	$145.25
Rate for Payer: BCBS Complete	$75.37
Rate for Payer: BCBS Trust/PPO	$645.05
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cash Price	$369.60
Rate for Payer: Mclaren Medicaid	$71.78
Rate for Payer: Meridian Medicaid	$75.37
Rate for Payer: Priority Health Choice Medicaid	$71.78
Rate for Payer: Priority Health Cigna Priority Health	$323.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.11
Rate for Payer: Priority Health Narrow Network	$189.11
Rate for Payer: Priority Health SBD	$189.11

PR INJECTION INTRALESIONAL >7 LESIONS

Professional

Both

$120.00

Service Code	HCPCS 11901
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$185.19
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: BCBS Complete	$30.20
Rate for Payer: BCBS Trust/PPO	$185.19
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Mclaren Medicaid	$28.76
Rate for Payer: Meridian Medicaid	$30.20
Rate for Payer: Priority Health Choice Medicaid	$28.76
Rate for Payer: Priority Health Cigna Priority Health	$84.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.49
Rate for Payer: Priority Health Narrow Network	$55.49
Rate for Payer: Priority Health SBD	$55.49

PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS

Professional

Both

$90.00

Service Code	HCPCS 11900
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$206.51
Rate for Payer: Aetna Commercial	$32.33
Rate for Payer: BCBS Complete	$19.91
Rate for Payer: BCBS Trust/PPO	$206.51
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Mclaren Medicaid	$18.96
Rate for Payer: Meridian Medicaid	$19.91
Rate for Payer: Priority Health Choice Medicaid	$18.96
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.58
Rate for Payer: Priority Health Narrow Network	$36.58
Rate for Payer: Priority Health SBD	$36.58

Know your out-of-pocket cost for care.

All Charges