Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR INJECTION THERAPEUTIC CARPAL TUNNEL

Professional

Both

$153.00

Service Code	HCPCS 20526
Min. Negotiated Rate	$36.21
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna Commercial	$76.12
Rate for Payer: BCBS Complete	$38.02
Rate for Payer: BCBS Trust/PPO	$106.97
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Mclaren Medicaid	$36.21
Rate for Payer: Meridian Medicaid	$38.02
Rate for Payer: Priority Health Choice Medicaid	$36.21
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.81
Rate for Payer: Priority Health Narrow Network	$86.81
Rate for Payer: Priority Health SBD	$86.81

PR INJECTION THRU KIDNEY TUBE FOR XRAY

Professional

Both

$234.00

Service Code	HCPCS 50394
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$163.80
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: Cash Price	$187.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80

PR INJECTION TURBINATE THERAPEUTIC

Professional

Both

$213.00

Service Code	HCPCS 30200
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$504.53
Rate for Payer: Aetna Commercial	$73.33
Rate for Payer: BCBS Complete	$40.26
Rate for Payer: BCBS Trust/PPO	$504.53
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$170.40
Rate for Payer: Mclaren Medicaid	$38.34
Rate for Payer: Meridian Medicaid	$40.26
Rate for Payer: Priority Health Choice Medicaid	$38.34
Rate for Payer: Priority Health Cigna Priority Health	$149.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.42
Rate for Payer: Priority Health Narrow Network	$82.42
Rate for Payer: Priority Health SBD	$82.42

PR INJECTION WRIST ARTHROGRAPHY

Professional

Both

$280.00

Service Code	HCPCS 25246
Min. Negotiated Rate	$46.01
Max. Negotiated Rate	$2,365.73
Rate for Payer: Aetna Commercial	$99.22
Rate for Payer: BCBS Complete	$48.31
Rate for Payer: BCBS Trust/PPO	$2,365.73
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Mclaren Medicaid	$46.01
Rate for Payer: Meridian Medicaid	$48.31
Rate for Payer: Priority Health Choice Medicaid	$46.01
Rate for Payer: Priority Health Cigna Priority Health	$196.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$109.79
Rate for Payer: Priority Health Narrow Network	$109.79
Rate for Payer: Priority Health SBD	$109.79

PR INJECT NERV BLCK,CERV PLEXUS

Professional

Both

$250.00

Service Code	HCPCS 64413
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00

PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA

Professional

Both

$633.00

Service Code	HCPCS 27096
Min. Negotiated Rate	$52.61
Max. Negotiated Rate	$638.71
Rate for Payer: Aetna Commercial	$110.93
Rate for Payer: BCBS Complete	$55.24
Rate for Payer: BCBS Trust/PPO	$638.71
Rate for Payer: Cash Price	$506.40
Rate for Payer: Cash Price	$506.40
Rate for Payer: Mclaren Medicaid	$52.61
Rate for Payer: Meridian Medicaid	$55.24
Rate for Payer: Priority Health Choice Medicaid	$52.61
Rate for Payer: Priority Health Cigna Priority Health	$443.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$125.10
Rate for Payer: Priority Health Narrow Network	$125.10
Rate for Payer: Priority Health SBD	$125.10

PR INJECT THRU CHOLANGIO CATHETER

Professional

Both

$275.00

Service Code	HCPCS 47505
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$192.50
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50

PR INJ ENOXAPARIN SODIUM

Professional

Both

$15.00

Service Code	HCPCS J1650
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$0.70
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS Trust/PPO	$0.27
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50

PR INJ FOR SACROILIAC JT ANESTH

Facility

$1,250.10

Service Code	HCPCS G0260
Hospital Charge Code	G0260
Min. Negotiated Rate	$332.37
Max. Negotiated Rate	$1,932.06
Rate for Payer: Aetna Commercial	$1,062.58
Rate for Payer: Aetna Medicare	$639.94
Rate for Payer: Aetna New Business (MI Preferred)	$812.56
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	$332.37
Rate for Payer: BCN Medicare Advantage	$615.33
Rate for Payer: Cash Price	$1,000.08
Rate for Payer: Cash Price	$1,000.08
Rate for Payer: Cofinity Commercial	$1,075.09
Rate for Payer: Cofinity Commercial	$875.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$615.33
Rate for Payer: Healthscope Commercial	$1,125.09
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	$1,062.58
Rate for Payer: PACE Medicare	$584.56
Rate for Payer: PACE SWMI	$615.33
Rate for Payer: PHP Commercial	$1,062.58
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	$875.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,932.06
Rate for Payer: Priority Health Medicare	$615.33
Rate for Payer: Priority Health Narrow Network	$1,545.65
Rate for Payer: Priority Health SBD	$787.56
Rate for Payer: Railroad Medicare Medicare	$615.33
Rate for Payer: UHC Dual Complete DSNP	$615.33
Rate for Payer: UHC Medicare Advantage	$633.79
Rate for Payer: VA VA	$615.33

PR INJ FOR SACROILIAC JT ANESTH

Facility

$1,250.10

Service Code	HCPCS G0260
Hospital Charge Code	G0260
Min. Negotiated Rate	$787.56
Max. Negotiated Rate	$1,125.09
Rate for Payer: Aetna Commercial	$1,062.58
Rate for Payer: Aetna New Business (MI Preferred)	$812.56
Rate for Payer: Cash Price	$1,000.08
Rate for Payer: Cofinity Commercial	$1,075.09
Rate for Payer: Cofinity Commercial	$875.07
Rate for Payer: Healthscope Commercial	$1,125.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,062.58
Rate for Payer: PHP Commercial	$1,062.58
Rate for Payer: Priority Health Cigna Priority Health	$875.07
Rate for Payer: Priority Health SBD	$787.56

PR INJ HEPARIN SODIUM PER 1000U

Professional

Both

$1.00

Service Code	HCPCS J1644
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna Commercial	$0.28
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.70

PR INJ IRON DEXTRAN

Professional

Both

$30.00

Service Code	HCPCS J1750
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$17.84
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$17.65
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

PR INJ PROGESTERONE PER 50 MG

Professional

Both

$5.00

Service Code	HCPCS J2675
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$0.94
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCBS Trust/PPO	$0.58
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50

PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE

Professional

Both

$773.00

Service Code	HCPCS 38792
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$672.53
Rate for Payer: Aetna Commercial	$41.33
Rate for Payer: BCBS Complete	$21.25
Rate for Payer: BCBS Trust/PPO	$672.53
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cash Price	$618.40
Rate for Payer: Mclaren Medicaid	$20.24
Rate for Payer: Meridian Medicaid	$21.25
Rate for Payer: Priority Health Choice Medicaid	$20.24
Rate for Payer: Priority Health Cigna Priority Health	$541.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.53
Rate for Payer: Priority Health Narrow Network	$69.53
Rate for Payer: Priority Health SBD	$69.53

PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE

Facility

$773.00

Service Code	CPT 38792
Hospital Charge Code	38792
Hospital Revenue Code	960
Min. Negotiated Rate	$486.99
Max. Negotiated Rate	$695.70
Rate for Payer: Aetna Commercial	$657.05
Rate for Payer: Aetna New Business (MI Preferred)	$502.45
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cofinity Commercial	$664.78
Rate for Payer: Cofinity Commercial	$541.10
Rate for Payer: Healthscope Commercial	$695.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$657.05
Rate for Payer: PHP Commercial	$657.05
Rate for Payer: Priority Health Cigna Priority Health	$541.10
Rate for Payer: Priority Health SBD	$486.99

PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE

Professional

Both

$773.00

Service Code	HCPCS 38792
Hospital Charge Code	38792
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$672.53
Rate for Payer: Aetna Commercial	$41.33
Rate for Payer: BCBS Complete	$21.25
Rate for Payer: BCBS Trust/PPO	$672.53
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cash Price	$618.40
Rate for Payer: Mclaren Medicaid	$20.24
Rate for Payer: Meridian Medicaid	$21.25
Rate for Payer: Priority Health Choice Medicaid	$20.24
Rate for Payer: Priority Health Cigna Priority Health	$541.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.53
Rate for Payer: Priority Health Narrow Network	$69.53
Rate for Payer: Priority Health SBD	$69.53

PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE

Facility

$773.00

Service Code	CPT 38792
Hospital Charge Code	38792
Hospital Revenue Code	960
Min. Negotiated Rate	$31.11
Max. Negotiated Rate	$695.70
Rate for Payer: Aetna Commercial	$657.05
Rate for Payer: Aetna Medicare	$381.67
Rate for Payer: Aetna New Business (MI Preferred)	$502.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$458.74
Rate for Payer: Amish Plain Church Group Commercial	$458.74
Rate for Payer: BCBS Complete	$210.80
Rate for Payer: BCBS MAPPO	$366.99
Rate for Payer: BCBS Trust/PPO	$81.71
Rate for Payer: BCN Medicare Advantage	$366.99
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cofinity Commercial	$541.10
Rate for Payer: Cofinity Commercial	$664.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$366.99
Rate for Payer: Healthscope Commercial	$695.70
Rate for Payer: Mclaren Medicaid	$200.74
Rate for Payer: Mclaren Medicare	$366.99
Rate for Payer: Meridian Medicaid	$210.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$385.34
Rate for Payer: MI Amish Medical Board Commercial	$422.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$657.05
Rate for Payer: PACE Medicare	$348.64
Rate for Payer: PACE SWMI	$366.99
Rate for Payer: PHP Commercial	$657.05
Rate for Payer: PHP Medicare Advantage	$366.99
Rate for Payer: Priority Health Choice Medicaid	$200.74
Rate for Payer: Priority Health Cigna Priority Health	$541.10
Rate for Payer: Priority Health Medicare	$366.99
Rate for Payer: Priority Health SBD	$486.99
Rate for Payer: Railroad Medicare Medicare	$366.99
Rate for Payer: UHC All Payor (Choice/PPO)	$34.22
Rate for Payer: UHC Dual Complete DSNP	$366.99
Rate for Payer: UHC Exchange	$31.11
Rate for Payer: UHC Medicare Advantage	$378.00
Rate for Payer: VA VA	$366.99

PR INJ, RIMABOTULINUMTOXINB

Professional

Both

$14.00

Service Code	HCPCS J0587
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$13.42
Rate for Payer: Aetna Commercial	$13.42
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$13.27
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.80

PR INJ RISPERDAL CONSTA, 0.5 MG

Professional

Both

$8.00

Service Code	HCPCS J2794
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$12.52
Rate for Payer: Aetna Commercial	$12.52
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCBS Trust/PPO	$12.06
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR INJ. ROMOSOZUMAB-AQQG 1 MG

Professional

Both

$11.00

Service Code	HCPCS J3111
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$10.92
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.70

PR INJ TESTOSTERONE CYPIONATE

Professional

Both

$0.16

Service Code	HCPCS J1071
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: BCBS Complete	$0.06
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.13
Rate for Payer: Priority Health Cigna Priority Health	$0.11

PR INSERT CANNULA PROLONG CP INSUFF

Professional

Both

$1,551.00

Service Code	HCPCS 36822
Min. Negotiated Rate	$620.40
Max. Negotiated Rate	$1,085.70
Rate for Payer: BCBS Complete	$620.40
Rate for Payer: Cash Price	$1,240.80
Rate for Payer: Priority Health Cigna Priority Health	$1,085.70

PR INSERT GASTROSTOMY TUBE PERCUTANEOUS

Professional

Both

$375.00

Service Code	HCPCS 49440
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$583.24
Rate for Payer: Aetna Commercial	$270.42
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCBS Trust/PPO	$583.24
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Mclaren Medicaid	$126.31
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$349.85
Rate for Payer: Priority Health Narrow Network	$349.85
Rate for Payer: Priority Health SBD	$349.85

PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY

Professional

Both

$1,680.00

Service Code	HCPCS 19340
Min. Negotiated Rate	$487.13
Max. Negotiated Rate	$1,176.00
Rate for Payer: Aetna Commercial	$818.17
Rate for Payer: BCBS Complete	$511.49
Rate for Payer: BCBS Trust/PPO	$562.50
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Mclaren Medicaid	$487.13
Rate for Payer: Meridian Medicaid	$511.49
Rate for Payer: Priority Health Choice Medicaid	$487.13
Rate for Payer: Priority Health Cigna Priority Health	$1,176.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$935.52
Rate for Payer: Priority Health Narrow Network	$935.52
Rate for Payer: Priority Health SBD	$935.52

PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE

Professional

Both

$155.00

Service Code	HCPCS 59200
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$108.50
Rate for Payer: Aetna Commercial	$49.05
Rate for Payer: BCBS Complete	$62.00
Rate for Payer: BCBS Trust/PPO	$90.87
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Priority Health Cigna Priority Health	$108.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.33
Rate for Payer: Priority Health Narrow Network	$62.33
Rate for Payer: Priority Health SBD	$62.33

Know your out-of-pocket cost for care.

All Charges