Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ANESTH,PELV NERV REMOVAL INTRAPELV

Professional

Both

$4.00

Service Code	HCPCS 01190
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, DIAG

Professional

Both

$5.00

Service Code	HCPCS 01935
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, THER

Professional

Both

$5.00

Service Code	HCPCS 01936
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANESTH,RAD SURG CLAVICLE/SCAPULA

Professional

Both

$6.00

Service Code	HCPCS 00452
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR ANES THRC SPINE & CORD ANT APPR W/O 1 LUNG VENTJ

Professional

Both

$13.00

Service Code	HCPCS 00625
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75

PR ANESTH,SHOULDER SPICA

Professional

Both

$4.00

Service Code	HCPCS 01682
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANESTH,THORACOLUMBAR SYMPATHECTOMY

Professional

Both

$13.00

Service Code	HCPCS 00622
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75

PR ANESTH,UGI ENDOSCOPY

Professional

Both

$5.00

Service Code	HCPCS 00740
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES TRANSURETHRAL PX RESECTION OF BLADDER TUMOR

Professional

Both

$5.00

Service Code	HCPCS 00912
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES TRANSURETHRAL PX W/URETHROCYSTOSCOPY NOS

Professional

Both

$3.00

Service Code	HCPCS 00910
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES TRANSVENOUS INSJ/REPLACEMENT PACING CVDFB

Professional

Both

$7.00

Service Code	HCPCS 00534
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES TRURL PX FRAGMNTJ MNPJ&/RMVL URTRL CALCULUS

Professional

Both

$5.00

Service Code	HCPCS 00918
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES TRURL PX POST-TRURL RESECTION BLEEDING

Professional

Both

$5.00

Service Code	HCPCS 00916
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES URGENT HYSTERECTOMY FOLLOWING DELIVERY

Professional

Both

$8.00

Service Code	HCPCS 01962
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR ANES VAG PX COLPTMY VAGNC COLPRPHY&OPN URTL PX

Professional

Both

$4.00

Service Code	HCPCS 00942
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES VAG PX HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY

Professional

Both

$4.00

Service Code	HCPCS 00952
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES XTRPRTL PX LWR ABD W/UR TRACT ADRENALECTOMY

Professional

Both

$10.00

Service Code	HCPCS 00866
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RAD PRST8ECT

Professional

Both

$7.00

Service Code	HCPCS 00865
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RENAL PX

Professional

Both

$7.00

Service Code	HCPCS 00862
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RENAL TRANSPL

Professional

Both

$10.00

Service Code	HCPCS 00868
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR ANES XTRPRTL PX LWR ABD W/UR TRACT TOT CSTC

Professional

Both

$8.00

Service Code	HCPCS 00864
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR ANES XTRPRTL PX LWR ABD W/UR TRC CYSTOLITHOTOMY

Professional

Both

$5.00

Service Code	HCPCS 00870
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANKLE CONTROL ORTHO PRE OTS

Professional

Both

$98.00

Service Code	HCPCS L4350
Min. Negotiated Rate	$38.78
Max. Negotiated Rate	$219.97
Rate for Payer: Aetna Commercial	$159.33
Rate for Payer: Aetna Medicare	$123.66
Rate for Payer: Aetna New Business (MI Preferred)	$159.33
Rate for Payer: Aetna New Business (MI Preferred)	$171.22
Rate for Payer: BCBS MAPPO	$118.90
Rate for Payer: BCN Commercial	$113.84
Rate for Payer: BCN Medicare Advantage	$118.90
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cofinity Commercial	$171.22
Rate for Payer: Cofinity Commercial	$159.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$118.90
Rate for Payer: Healthscope Commercial	$190.24
Rate for Payer: Healthscope Commercial	$219.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$124.84
Rate for Payer: Molina Medicare/Medicaid	$130.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.96
Rate for Payer: Nomi Health Commercial	$142.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.50
Rate for Payer: PACE SWMI	$118.90
Rate for Payer: PHP Medicare Advantage	$118.90
Rate for Payer: Priority Health Medicare	$118.90
Rate for Payer: Railroad Medicare Medicare	$118.90
Rate for Payer: UHC All Payor (Choice/PPO)	$38.78
Rate for Payer: UHC Core	$38.78
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$118.90
Rate for Payer: UHC Exchange	$38.78

PR ANKLE DISARTICULATION

Professional

Both

$1,376.00

Service Code	HCPCS 27889
Min. Negotiated Rate	$381.06
Max. Negotiated Rate	$1,139.98
Rate for Payer: Aetna Commercial	$794.51
Rate for Payer: Aetna Medicare	$616.64
Rate for Payer: Aetna New Business (MI Preferred)	$794.51
Rate for Payer: Aetna New Business (MI Preferred)	$853.80
Rate for Payer: BCBS Complete	$400.11
Rate for Payer: BCBS MAPPO	$592.92
Rate for Payer: BCN Commercial	$959.11
Rate for Payer: BCN Medicare Advantage	$592.92
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Cofinity Commercial	$853.80
Rate for Payer: Cofinity Commercial	$794.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$592.92
Rate for Payer: Healthscope Commercial	$948.67
Rate for Payer: Healthscope Commercial	$1,096.90
Rate for Payer: Mclaren Medicaid	$381.06
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$622.57
Rate for Payer: Meridian Medicaid	$400.11
Rate for Payer: Molina Medicare/Medicaid	$652.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,133.26
Rate for Payer: Nomi Health Commercial	$711.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,032.00
Rate for Payer: PACE SWMI	$592.92
Rate for Payer: PHP Medicare Advantage	$592.92
Rate for Payer: Priority Health Choice Medicaid	$381.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,025.26
Rate for Payer: Priority Health Medicare	$592.92
Rate for Payer: Priority Health SBD	$1,025.26
Rate for Payer: Priority Health Tiered Network	$1,025.26
Rate for Payer: Railroad Medicare Medicare	$592.92
Rate for Payer: UHC All Payor (Choice/PPO)	$1,139.98
Rate for Payer: UHC Core	$1,139.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$592.92
Rate for Payer: UHC Exchange	$1,139.98
Rate for Payer: UHC Medicaid	$381.06
Rate for Payer: UHCCP Medicaid	$381.06

PR ANN BREAST EXAM

Professional

Both

$21.00

Service Code	HCPCS S0613
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: Aetna New Business (MI Preferred)	$25.00
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCN Commercial	$19.15
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

Know your out-of-pocket cost for care.

All Charges