Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB

Professional

Both

$202.00

Service Code	HCPCS 93289
Min. Negotiated Rate	$51.07
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$92.99
Rate for Payer: BCBS Complete	$80.80
Rate for Payer: BCBS Trust/PPO	$120.45
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$161.60
Rate for Payer: Priority Health Cigna Priority Health	$141.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.07
Rate for Payer: Priority Health Narrow Network	$51.07
Rate for Payer: Priority Health SBD	$103.08

PR INTERTHORACOSCAPULAR AMPUTATION

Professional

Both

$5,872.00

Service Code	HCPCS 23900
Min. Negotiated Rate	$354.88
Max. Negotiated Rate	$4,110.40
Rate for Payer: Aetna Commercial	$1,852.71
Rate for Payer: BCBS Complete	$932.40
Rate for Payer: BCBS Trust/PPO	$354.88
Rate for Payer: Cash Price	$4,697.60
Rate for Payer: Cash Price	$4,697.60
Rate for Payer: Mclaren Medicaid	$888.00
Rate for Payer: Meridian Medicaid	$932.40
Rate for Payer: Priority Health Choice Medicaid	$888.00
Rate for Payer: Priority Health Cigna Priority Health	$4,110.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,115.63
Rate for Payer: Priority Health Narrow Network	$2,115.63
Rate for Payer: Priority Health SBD	$2,115.63

PR INTESTINAL PLICATION SEPARATE PROCEDURE

Professional

Both

$2,909.00

Service Code	HCPCS 44680
Min. Negotiated Rate	$305.89
Max. Negotiated Rate	$2,036.30
Rate for Payer: Aetna Commercial	$1,457.86
Rate for Payer: BCBS Complete	$722.61
Rate for Payer: BCBS Trust/PPO	$305.89
Rate for Payer: Cash Price	$2,327.20
Rate for Payer: Cash Price	$2,327.20
Rate for Payer: Mclaren Medicaid	$688.20
Rate for Payer: Meridian Medicaid	$722.61
Rate for Payer: Priority Health Choice Medicaid	$688.20
Rate for Payer: Priority Health Cigna Priority Health	$2,036.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,892.10
Rate for Payer: Priority Health Narrow Network	$1,892.10
Rate for Payer: Priority Health SBD	$1,892.10

PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN

Professional

Both

$480.00

Service Code	HCPCS 46946
Min. Negotiated Rate	$244.52
Max. Negotiated Rate	$1,392.60
Rate for Payer: Aetna Commercial	$507.35
Rate for Payer: BCBS Complete	$256.75
Rate for Payer: BCBS Trust/PPO	$1,392.60
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cash Price	$384.00
Rate for Payer: Mclaren Medicaid	$244.52
Rate for Payer: Meridian Medicaid	$256.75
Rate for Payer: Priority Health Choice Medicaid	$244.52
Rate for Payer: Priority Health Cigna Priority Health	$336.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$672.05
Rate for Payer: Priority Health Narrow Network	$672.05
Rate for Payer: Priority Health SBD	$672.05

PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN

Professional

Both

$452.00

Service Code	HCPCS 46945
Min. Negotiated Rate	$218.96
Max. Negotiated Rate	$1,245.20
Rate for Payer: Aetna Commercial	$449.56
Rate for Payer: BCBS Complete	$229.91
Rate for Payer: BCBS Trust/PPO	$1,245.20
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cash Price	$361.60
Rate for Payer: Mclaren Medicaid	$218.96
Rate for Payer: Meridian Medicaid	$229.91
Rate for Payer: Priority Health Choice Medicaid	$218.96
Rate for Payer: Priority Health Cigna Priority Health	$316.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$599.14
Rate for Payer: Priority Health Narrow Network	$599.14
Rate for Payer: Priority Health SBD	$599.14

PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I

Professional

Both

$287.00

Service Code	HCPCS 93662
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$200.90
Rate for Payer: Aetna Commercial	$195.64
Rate for Payer: Aetna Commercial	$195.64
Rate for Payer: BCBS Complete	$114.80
Rate for Payer: BCBS Complete	$219.20
Rate for Payer: BCBS Trust/PPO	$68.15
Rate for Payer: BCBS Trust/PPO	$68.15
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$438.40
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$438.40
Rate for Payer: Priority Health Cigna Priority Health	$383.60
Rate for Payer: Priority Health Cigna Priority Health	$200.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.05
Rate for Payer: Priority Health Narrow Network	$34.05
Rate for Payer: Priority Health Narrow Network	$34.05
Rate for Payer: Priority Health SBD	$136.19
Rate for Payer: Priority Health SBD	$136.19

PR INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING

Professional

Both

$1,177.00

Service Code	HCPCS 93613
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$1,339.77
Rate for Payer: Aetna Commercial	$397.73
Rate for Payer: BCBS Complete	$190.55
Rate for Payer: BCBS Trust/PPO	$1,339.77
Rate for Payer: Cash Price	$941.60
Rate for Payer: Cash Price	$941.60
Rate for Payer: Mclaren Medicaid	$181.48
Rate for Payer: Meridian Medicaid	$190.55
Rate for Payer: Priority Health Choice Medicaid	$181.48
Rate for Payer: Priority Health Cigna Priority Health	$823.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.96
Rate for Payer: Priority Health Narrow Network	$113.96
Rate for Payer: Priority Health SBD	$406.67

PR INTRACRANIAL ARVEN MALFRMJ DURAL CMPL

Professional

Both

$9,031.00

Service Code	HCPCS 61692
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$6,321.70
Rate for Payer: Aetna Commercial	$4,717.73
Rate for Payer: BCBS Complete	$2,471.33
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: Cash Price	$7,224.80
Rate for Payer: Cash Price	$7,224.80
Rate for Payer: Mclaren Medicaid	$2,353.65
Rate for Payer: Meridian Medicaid	$2,471.33
Rate for Payer: Priority Health Choice Medicaid	$2,353.65
Rate for Payer: Priority Health Cigna Priority Health	$6,321.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,211.48
Rate for Payer: Priority Health Narrow Network	$6,211.48
Rate for Payer: Priority Health SBD	$6,211.48

PR INTRACRANIAL ARVEN MALFRMJ DURAL SMPL

Professional

Both

$7,667.00

Service Code	HCPCS 61690
Min. Negotiated Rate	$331.77
Max. Negotiated Rate	$5,366.90
Rate for Payer: Aetna Commercial	$2,817.87
Rate for Payer: BCBS Complete	$1,485.71
Rate for Payer: BCBS Trust/PPO	$331.77
Rate for Payer: Cash Price	$6,133.60
Rate for Payer: Cash Price	$6,133.60
Rate for Payer: Mclaren Medicaid	$1,414.96
Rate for Payer: Meridian Medicaid	$1,485.71
Rate for Payer: Priority Health Choice Medicaid	$1,414.96
Rate for Payer: Priority Health Cigna Priority Health	$5,366.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,725.19
Rate for Payer: Priority Health Narrow Network	$3,725.19
Rate for Payer: Priority Health SBD	$3,725.19

PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL

Professional

Both

$11,885.00

Service Code	HCPCS 61686
Min. Negotiated Rate	$191.24
Max. Negotiated Rate	$8,319.50
Rate for Payer: Aetna Commercial	$5,806.18
Rate for Payer: BCBS Complete	$3,038.95
Rate for Payer: BCBS Trust/PPO	$191.24
Rate for Payer: Cash Price	$9,508.00
Rate for Payer: Cash Price	$9,508.00
Rate for Payer: Mclaren Medicaid	$2,894.24
Rate for Payer: Meridian Medicaid	$3,038.95
Rate for Payer: Priority Health Choice Medicaid	$2,894.24
Rate for Payer: Priority Health Cigna Priority Health	$8,319.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,639.49
Rate for Payer: Priority Health Narrow Network	$7,639.49
Rate for Payer: Priority Health SBD	$7,639.49

PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL

Professional

Both

$5,870.00

Service Code	HCPCS 61684
Min. Negotiated Rate	$195.47
Max. Negotiated Rate	$4,848.57
Rate for Payer: Aetna Commercial	$3,673.33
Rate for Payer: BCBS Complete	$1,930.32
Rate for Payer: BCBS Trust/PPO	$195.47
Rate for Payer: Cash Price	$4,696.00
Rate for Payer: Cash Price	$4,696.00
Rate for Payer: Mclaren Medicaid	$1,838.40
Rate for Payer: Meridian Medicaid	$1,930.32
Rate for Payer: Priority Health Choice Medicaid	$1,838.40
Rate for Payer: Priority Health Cigna Priority Health	$4,109.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,848.57
Rate for Payer: Priority Health Narrow Network	$4,848.57
Rate for Payer: Priority Health SBD	$4,848.57

PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL

Professional

Both

$8,741.22

Service Code	HCPCS 61682
Min. Negotiated Rate	$275.77
Max. Negotiated Rate	$7,065.90
Rate for Payer: Aetna Commercial	$5,378.16
Rate for Payer: BCBS Complete	$2,822.24
Rate for Payer: BCBS Trust/PPO	$275.77
Rate for Payer: Cash Price	$6,992.98
Rate for Payer: Cash Price	$6,992.98
Rate for Payer: Mclaren Medicaid	$2,687.85
Rate for Payer: Meridian Medicaid	$2,822.24
Rate for Payer: Priority Health Choice Medicaid	$2,687.85
Rate for Payer: Priority Health Cigna Priority Health	$6,118.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,065.90
Rate for Payer: Priority Health Narrow Network	$7,065.90
Rate for Payer: Priority Health SBD	$7,065.90

PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL

Professional

Both

$4,661.04

Service Code	HCPCS 61680
Min. Negotiated Rate	$373.51
Max. Negotiated Rate	$3,815.78
Rate for Payer: Aetna Commercial	$2,931.17
Rate for Payer: BCBS Complete	$1,544.97
Rate for Payer: BCBS Trust/PPO	$373.51
Rate for Payer: Cash Price	$3,728.83
Rate for Payer: Cash Price	$3,728.83
Rate for Payer: Mclaren Medicaid	$1,471.40
Rate for Payer: Meridian Medicaid	$1,544.97
Rate for Payer: Priority Health Choice Medicaid	$1,471.40
Rate for Payer: Priority Health Cigna Priority Health	$3,262.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,815.78
Rate for Payer: Priority Health Narrow Network	$3,815.78
Rate for Payer: Priority Health SBD	$3,815.78

PR INTRAFRACTION TRACK MOTION

Professional

Both

$173.00

Service Code	HCPCS G6017
Min. Negotiated Rate	$69.20
Max. Negotiated Rate	$1,256.83
Rate for Payer: Aetna Commercial	$94.22
Rate for Payer: BCBS Complete	$69.20
Rate for Payer: BCBS Trust/PPO	$1,256.83
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Priority Health Cigna Priority Health	$121.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$126.50
Rate for Payer: Priority Health Narrow Network	$126.50
Rate for Payer: Priority Health SBD	$126.50

PR INTRAOPERATIVE COLONIC LAVAGE

Professional

Both

$404.00

Service Code	HCPCS 44701
Min. Negotiated Rate	$107.14
Max. Negotiated Rate	$295.16
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: BCBS Complete	$112.50
Rate for Payer: BCBS Trust/PPO	$226.64
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Mclaren Medicaid	$107.14
Rate for Payer: Meridian Medicaid	$112.50
Rate for Payer: Priority Health Choice Medicaid	$107.14
Rate for Payer: Priority Health Cigna Priority Health	$282.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$295.16
Rate for Payer: Priority Health Narrow Network	$295.16
Rate for Payer: Priority Health SBD	$295.16

PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION

Professional

Both

$299.00

Service Code	HCPCS 38900
Hospital Charge Code	38900
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$438.49
Rate for Payer: Aetna Commercial	$172.38
Rate for Payer: BCBS Complete	$91.48
Rate for Payer: BCBS Trust/PPO	$438.49
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Mclaren Medicaid	$87.12
Rate for Payer: Meridian Medicaid	$91.48
Rate for Payer: Priority Health Choice Medicaid	$87.12
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$294.08
Rate for Payer: Priority Health Narrow Network	$294.08
Rate for Payer: Priority Health SBD	$294.08

PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION

Professional

Both

$299.00

Service Code	HCPCS 38900
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$438.49
Rate for Payer: Aetna Commercial	$172.38
Rate for Payer: BCBS Complete	$91.48
Rate for Payer: BCBS Trust/PPO	$438.49
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Mclaren Medicaid	$87.12
Rate for Payer: Meridian Medicaid	$91.48
Rate for Payer: Priority Health Choice Medicaid	$87.12
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$294.08
Rate for Payer: Priority Health Narrow Network	$294.08
Rate for Payer: Priority Health SBD	$294.08

PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION

Facility

$299.00

Service Code	CPT 38900
Hospital Charge Code	38900
Min. Negotiated Rate	$188.37
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna Commercial	$254.15
Rate for Payer: Aetna New Business (MI Preferred)	$194.35
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cofinity Commercial	$209.30
Rate for Payer: Cofinity Commercial	$257.14
Rate for Payer: Healthscope Commercial	$269.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$254.15
Rate for Payer: PHP Commercial	$254.15
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health SBD	$188.37

PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION

Facility

$299.00

Service Code	CPT 38900
Hospital Charge Code	38900
Min. Negotiated Rate	$119.60
Max. Negotiated Rate	$282.38
Rate for Payer: Aetna Commercial	$254.15
Rate for Payer: Aetna New Business (MI Preferred)	$194.35
Rate for Payer: BCBS Complete	$119.60
Rate for Payer: BCBS Trust/PPO	$282.38
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cofinity Commercial	$209.30
Rate for Payer: Cofinity Commercial	$257.14
Rate for Payer: Healthscope Commercial	$269.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$254.15
Rate for Payer: PHP Commercial	$254.15
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health SBD	$188.37
Rate for Payer: UHC All Payor (Choice/PPO)	$147.31
Rate for Payer: UHC Exchange	$133.92

PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE

Professional

Both

$670.00

Service Code	HCPCS 41009
Min. Negotiated Rate	$183.18
Max. Negotiated Rate	$1,140.60
Rate for Payer: Aetna Commercial	$371.20
Rate for Payer: BCBS Complete	$192.34
Rate for Payer: BCBS Trust/PPO	$1,140.60
Rate for Payer: Cash Price	$536.00
Rate for Payer: Cash Price	$536.00
Rate for Payer: Mclaren Medicaid	$183.18
Rate for Payer: Meridian Medicaid	$192.34
Rate for Payer: Priority Health Choice Medicaid	$183.18
Rate for Payer: Priority Health Cigna Priority Health	$469.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$499.77
Rate for Payer: Priority Health Narrow Network	$499.77
Rate for Payer: Priority Health SBD	$499.77

PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD

Professional

Both

$589.00

Service Code	HCPCS 41006
Min. Negotiated Rate	$148.04
Max. Negotiated Rate	$931.39
Rate for Payer: Aetna Commercial	$301.56
Rate for Payer: BCBS Complete	$155.44
Rate for Payer: BCBS Trust/PPO	$931.39
Rate for Payer: Cash Price	$471.20
Rate for Payer: Cash Price	$471.20
Rate for Payer: Mclaren Medicaid	$148.04
Rate for Payer: Meridian Medicaid	$155.44
Rate for Payer: Priority Health Choice Medicaid	$148.04
Rate for Payer: Priority Health Cigna Priority Health	$412.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$405.11
Rate for Payer: Priority Health Narrow Network	$405.11
Rate for Payer: Priority Health SBD	$405.11

PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC

Professional

Both

$384.00

Service Code	HCPCS 41005
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$795.62
Rate for Payer: Aetna Commercial	$144.95
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: BCBS Trust/PPO	$795.62
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cash Price	$307.20
Rate for Payer: Mclaren Medicaid	$74.55
Rate for Payer: Meridian Medicaid	$78.28
Rate for Payer: Priority Health Choice Medicaid	$74.55
Rate for Payer: Priority Health Cigna Priority Health	$268.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$211.09
Rate for Payer: Priority Health Narrow Network	$211.09
Rate for Payer: Priority Health SBD	$211.09

PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE

Professional

Both

$693.00

Service Code	HCPCS 41008
Min. Negotiated Rate	$165.50
Max. Negotiated Rate	$1,030.71
Rate for Payer: Aetna Commercial	$338.86
Rate for Payer: BCBS Complete	$173.78
Rate for Payer: BCBS Trust/PPO	$1,030.71
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Mclaren Medicaid	$165.50
Rate for Payer: Meridian Medicaid	$173.78
Rate for Payer: Priority Health Choice Medicaid	$165.50
Rate for Payer: Priority Health Cigna Priority Health	$485.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.97
Rate for Payer: Priority Health Narrow Network	$450.97
Rate for Payer: Priority Health SBD	$450.97

PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP

Professional

Both

$110.00

Service Code	HCPCS 94610
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$1,160.68
Rate for Payer: Aetna Commercial	$61.24
Rate for Payer: BCBS Complete	$37.35
Rate for Payer: BCBS Trust/PPO	$1,160.68
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Mclaren Medicaid	$35.57
Rate for Payer: Meridian Medicaid	$37.35
Rate for Payer: Priority Health Choice Medicaid	$35.57
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.55
Rate for Payer: Priority Health Narrow Network	$74.55
Rate for Payer: Priority Health SBD	$74.55

PR INTRAUT COPPER CONTRACEPTIVE

Professional

Both

$1,326.00

Service Code	HCPCS J7300
Min. Negotiated Rate	$928.20
Max. Negotiated Rate	$1,139.25
Rate for Payer: Aetna Commercial	$1,085.00
Rate for Payer: BCBS Complete	$1,139.25
Rate for Payer: BCBS Trust/PPO	$1,100.19
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Mclaren Medicaid	$1,085.00
Rate for Payer: Meridian Medicaid	$1,139.25
Rate for Payer: Priority Health Choice Medicaid	$1,085.00
Rate for Payer: Priority Health Cigna Priority Health	$928.20

Know your out-of-pocket cost for care.

All Charges