Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST

Professional

Both

$46.00

Service Code	HCPCS 96523
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$1,469.20
Rate for Payer: Aetna Commercial	$33.19
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$1,469.20
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.13
Rate for Payer: Priority Health Narrow Network	$34.13
Rate for Payer: Priority Health SBD	$34.13

PR IRRIGATION CORPORA CAVERNOSA PRIAPISM

Professional

Both

$439.00

Service Code	HCPCS 54220
Min. Negotiated Rate	$85.63
Max. Negotiated Rate	$460.68
Rate for Payer: Aetna Commercial	$171.63
Rate for Payer: BCBS Complete	$89.91
Rate for Payer: BCBS Trust/PPO	$460.68
Rate for Payer: Cash Price	$351.20
Rate for Payer: Cash Price	$351.20
Rate for Payer: Mclaren Medicaid	$85.63
Rate for Payer: Meridian Medicaid	$89.91
Rate for Payer: Priority Health Choice Medicaid	$85.63
Rate for Payer: Priority Health Cigna Priority Health	$307.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.91
Rate for Payer: Priority Health Narrow Network	$212.91
Rate for Payer: Priority Health SBD	$212.91

PR IRRIGATION TRAY

Professional

Both

$10.00

Service Code	HCPCS A4320
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00

PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE

Professional

Both

$118.00

Service Code	HCPCS 57150
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$2,018.63
Rate for Payer: Aetna Commercial	$31.87
Rate for Payer: BCBS Complete	$47.20
Rate for Payer: BCBS Trust/PPO	$2,018.63
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.45
Rate for Payer: Priority Health Narrow Network	$36.45
Rate for Payer: Priority Health SBD	$36.45

PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL

Professional

Both

$350.00

Service Code	HCPCS 93571
Min. Negotiated Rate	$99.77
Max. Negotiated Rate	$640.30
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: BCBS Complete	$78.40
Rate for Payer: BCBS Complete	$140.00
Rate for Payer: BCBS Trust/PPO	$640.30
Rate for Payer: BCBS Trust/PPO	$640.30
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$156.80
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health Cigna Priority Health	$137.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.77
Rate for Payer: Priority Health Narrow Network	$99.77
Rate for Payer: Priority Health Narrow Network	$99.77
Rate for Payer: Priority Health SBD	$285.14
Rate for Payer: Priority Health SBD	$285.14

PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL

Professional

Both

$275.00

Service Code	HCPCS 93572
Min. Negotiated Rate	$72.35
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$145.84
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: BCBS Trust/PPO	$78.72
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.35
Rate for Payer: Priority Health Narrow Network	$72.35
Rate for Payer: Priority Health SBD	$154.15

PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR

Professional

Both

$29.00

Service Code	HCPCS 96361
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$22.72
Rate for Payer: Aetna Commercial	$14.58
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCBS Trust/PPO	$22.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$20.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.07
Rate for Payer: Priority Health Narrow Network	$17.07
Rate for Payer: Priority Health SBD	$17.07

PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR

Professional

Both

$107.00

Service Code	HCPCS 96360
Min. Negotiated Rate	$37.67
Max. Negotiated Rate	$190.72
Rate for Payer: Aetna Commercial	$37.67
Rate for Payer: BCBS Complete	$42.80
Rate for Payer: BCBS Trust/PPO	$190.72
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Priority Health Cigna Priority Health	$74.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.57
Rate for Payer: Priority Health Narrow Network	$43.57
Rate for Payer: Priority Health SBD	$43.57

PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR

Professional

Both

$129.00

Service Code	HCPCS 96365
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$75.96
Rate for Payer: BCBS Complete	$51.60
Rate for Payer: BCBS Trust/PPO	$168.00
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Priority Health Cigna Priority Health	$90.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$85.78
Rate for Payer: Priority Health Narrow Network	$85.78
Rate for Payer: Priority Health SBD	$85.78

PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR

Professional

Both

$37.00

Service Code	HCPCS 96366
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$1,006.94
Rate for Payer: Aetna Commercial	$23.44
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: BCBS Trust/PPO	$1,006.94
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.40
Rate for Payer: Priority Health Narrow Network	$27.40
Rate for Payer: Priority Health SBD	$27.40

PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR

Professional

Both

$57.00

Service Code	HCPCS 96367
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$1,165.43
Rate for Payer: Aetna Commercial	$33.47
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: BCBS Trust/PPO	$1,165.43
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.62
Rate for Payer: Priority Health Narrow Network	$38.62
Rate for Payer: Priority Health SBD	$38.62

PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT

Professional

Both

$225.00

Service Code	HCPCS 15860
Min. Negotiated Rate	$67.31
Max. Negotiated Rate	$10,615.31
Rate for Payer: Aetna Commercial	$116.64
Rate for Payer: BCBS Complete	$70.68
Rate for Payer: BCBS Trust/PPO	$10,615.31
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Mclaren Medicaid	$67.31
Rate for Payer: Meridian Medicaid	$70.68
Rate for Payer: Priority Health Choice Medicaid	$67.31
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.88
Rate for Payer: Priority Health Narrow Network	$129.88
Rate for Payer: Priority Health SBD	$129.88

PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS

Professional

Both

$39.00

Service Code	HCPCS 96368
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$1,117.88
Rate for Payer: Aetna Commercial	$22.34
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS Trust/PPO	$1,117.88
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.49
Rate for Payer: Priority Health Narrow Network	$26.49
Rate for Payer: Priority Health SBD	$26.49

PR IV ULTRASOUND,FIRST VESSEL

Professional

Both

$300.00

Service Code	HCPCS 37250
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$210.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00

PR KETOROLAC TROMETHAMINE INJ

Professional

Both

$10.00

Service Code	HCPCS J1885
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$0.50
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$0.11
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$7.00

PR KO IMMOB CANVAS LONG PRE OTS

Professional

Both

$80.00

Service Code	HCPCS L1830
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$42.62
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00

PR KYBELLA

Professional

Both

$600.00

Service Code	HCPCS 00086
Hospital Revenue Code	990
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

PR Kyleena, 19.5 mg

Professional

Both

$1,443.00

Service Code	HCPCS J7296
Min. Negotiated Rate	$1,010.10
Max. Negotiated Rate	$1,156.78
Rate for Payer: Aetna Commercial	$1,101.70
Rate for Payer: BCBS Complete	$1,156.78
Rate for Payer: BCBS Trust/PPO	$1,118.44
Rate for Payer: Cash Price	$1,154.40
Rate for Payer: Cash Price	$1,154.40
Rate for Payer: Mclaren Medicaid	$1,101.70
Rate for Payer: Meridian Medicaid	$1,156.78
Rate for Payer: Priority Health Choice Medicaid	$1,101.70
Rate for Payer: Priority Health Cigna Priority Health	$1,010.10

PR KYLEENA, 19.5 MG

Professional

Both

$860.00

Service Code	HCPCS Q9984
Min. Negotiated Rate	$344.00
Max. Negotiated Rate	$602.00
Rate for Payer: BCBS Complete	$344.00
Rate for Payer: Cash Price	$688.00
Rate for Payer: Priority Health Cigna Priority Health	$602.00

PR KYPHECTOMY SINGLE OR TWO SEGMENTS

Professional

Both

$12,673.00

Service Code	HCPCS 22818
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$8,871.10
Rate for Payer: Aetna Commercial	$2,890.03
Rate for Payer: BCBS Complete	$1,440.53
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$10,138.40
Rate for Payer: Cash Price	$10,138.40
Rate for Payer: Mclaren Medicaid	$1,371.93
Rate for Payer: Meridian Medicaid	$1,440.53
Rate for Payer: Priority Health Choice Medicaid	$1,371.93
Rate for Payer: Priority Health Cigna Priority Health	$8,871.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,271.22
Rate for Payer: Priority Health Narrow Network	$3,271.22
Rate for Payer: Priority Health SBD	$3,271.22

PR LABYRINTHOTOMY TRANSCANAL

Professional

Both

$400.00

Service Code	HCPCS 69801
Min. Negotiated Rate	$79.45
Max. Negotiated Rate	$2,908.82
Rate for Payer: Aetna Commercial	$139.33
Rate for Payer: BCBS Complete	$83.42
Rate for Payer: BCBS Trust/PPO	$2,908.82
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Mclaren Medicaid	$79.45
Rate for Payer: Meridian Medicaid	$83.42
Rate for Payer: Priority Health Choice Medicaid	$79.45
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$174.91
Rate for Payer: Priority Health Narrow Network	$174.91
Rate for Payer: Priority Health SBD	$174.91

PR LAIV3 VACCINE LIVE FOR INTRANASAL USE

Professional

Both

$31.00

Service Code	HCPCS 90660
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$21.70
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70

PR LAIV4 VACCINE FOR INTRANASAL USE

Professional

Both

$31.00

Service Code	HCPCS 90672
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$27.79
Rate for Payer: Aetna Commercial	$27.79
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$27.54
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70

PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL

Professional

Both

$8,098.00

Service Code	HCPCS 63285
Min. Negotiated Rate	$381.43
Max. Negotiated Rate	$5,668.60
Rate for Payer: Aetna Commercial	$3,380.35
Rate for Payer: BCBS Complete	$1,778.24
Rate for Payer: BCBS Trust/PPO	$381.43
Rate for Payer: Cash Price	$6,478.40
Rate for Payer: Cash Price	$6,478.40
Rate for Payer: Mclaren Medicaid	$1,693.56
Rate for Payer: Meridian Medicaid	$1,778.24
Rate for Payer: Priority Health Choice Medicaid	$1,693.56
Rate for Payer: Priority Health Cigna Priority Health	$5,668.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,464.11
Rate for Payer: Priority Health Narrow Network	$4,464.11
Rate for Payer: Priority Health SBD	$4,464.11

PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC

Professional

Both

$8,116.00

Service Code	HCPCS 63286
Min. Negotiated Rate	$172.75
Max. Negotiated Rate	$5,681.20
Rate for Payer: Aetna Commercial	$3,337.98
Rate for Payer: BCBS Complete	$1,749.16
Rate for Payer: BCBS Trust/PPO	$172.75
Rate for Payer: Cash Price	$6,492.80
Rate for Payer: Cash Price	$6,492.80
Rate for Payer: Mclaren Medicaid	$1,665.87
Rate for Payer: Meridian Medicaid	$1,749.16
Rate for Payer: Priority Health Choice Medicaid	$1,665.87
Rate for Payer: Priority Health Cigna Priority Health	$5,681.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,419.93
Rate for Payer: Priority Health Narrow Network	$4,419.93
Rate for Payer: Priority Health SBD	$4,419.93

Know your out-of-pocket cost for care.

All Charges