Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

Professional

Both

$160.00

Service Code	HCPCS 99151
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$726.41
Rate for Payer: Aetna Commercial	$27.86
Rate for Payer: BCBS Complete	$15.88
Rate for Payer: BCBS Trust/PPO	$726.41
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Mclaren Medicaid	$15.12
Rate for Payer: Meridian Medicaid	$15.88
Rate for Payer: Priority Health Choice Medicaid	$15.12
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$54.36
Rate for Payer: Priority Health Narrow Network	$54.36
Rate for Payer: Priority Health SBD	$54.36

PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Professional

Both

$152.00

Service Code	HCPCS 99152
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$552.07
Rate for Payer: Aetna Commercial	$13.74
Rate for Payer: BCBS Complete	$8.05
Rate for Payer: BCBS Trust/PPO	$552.07
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Mclaren Medicaid	$7.67
Rate for Payer: Meridian Medicaid	$8.05
Rate for Payer: Priority Health Choice Medicaid	$7.67
Rate for Payer: Priority Health Cigna Priority Health	$106.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.51
Rate for Payer: Priority Health Narrow Network	$39.51
Rate for Payer: Priority Health SBD	$39.51

PR MONALISA TOUCH, SERIES, UP TO 7 VISITS, LICHEN SCLEROSUS

Professional

Both

$2,100.00

Service Code	HCPCS 00560
Hospital Revenue Code	990
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,470.00
Rate for Payer: BCBS Complete	$840.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Priority Health Cigna Priority Health	$1,470.00

PR MONOVISC INJ PER DOSE

Professional

Both

$923.00

Service Code	HCPCS J7327
Min. Negotiated Rate	$369.20
Max. Negotiated Rate	$735.80
Rate for Payer: Aetna Commercial	$735.80
Rate for Payer: BCBS Complete	$369.20
Rate for Payer: BCBS Trust/PPO	$727.84
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cash Price	$738.40
Rate for Payer: Priority Health Cigna Priority Health	$646.10

PR MORPHINE SULFATE INJECTION

Professional

Both

$8.00

Service Code	HCPCS J2270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCBS Trust/PPO	$0.09
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 MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB

Professional

Both

$135.00

Service Code	HCPCS 95905
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$1,790.41
Rate for Payer: Aetna Commercial	$49.71
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Trust/PPO	$1,790.41
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.59
Rate for Payer: Priority Health Narrow Network	$3.59
Rate for Payer: Priority Health SBD	$46.26

PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE

Professional

Both

$126.00

Service Code	HCPCS 90733
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$125.50
Rate for Payer: Aetna Commercial	$125.50
Rate for Payer: BCBS Complete	$50.40
Rate for Payer: BCBS Trust/PPO	$125.49
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Priority Health Cigna Priority Health	$88.20

PR MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN

Professional

Both

$60.00

Service Code	HCPCS 97157
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$997.43
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$997.43
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.17
Rate for Payer: Priority Health Narrow Network	$47.17
Rate for Payer: Priority Health SBD	$47.17

PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY

Professional

Both

$90.00

Service Code	HCPCS 90849
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$46.80
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$58.11
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.14
Rate for Payer: Priority Health Narrow Network	$38.14
Rate for Payer: Priority Health SBD	$38.14

PR MUSCLE-SKIN FLAP,HEAD/NECK

Professional

Both

$3,183.00

Service Code	HCPCS 15732
Min. Negotiated Rate	$1,273.20
Max. Negotiated Rate	$2,228.10
Rate for Payer: BCBS Complete	$1,273.20
Rate for Payer: Cash Price	$2,546.40
Rate for Payer: Priority Health Cigna Priority Health	$2,228.10

PR MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE

Professional

Both

$1,118.00

Service Code	HCPCS 24301
Min. Negotiated Rate	$114.64
Max. Negotiated Rate	$1,159.18
Rate for Payer: Aetna Commercial	$1,002.27
Rate for Payer: BCBS Complete	$510.37
Rate for Payer: BCBS Trust/PPO	$114.64
Rate for Payer: Cash Price	$894.40
Rate for Payer: Cash Price	$894.40
Rate for Payer: Mclaren Medicaid	$486.07
Rate for Payer: Meridian Medicaid	$510.37
Rate for Payer: Priority Health Choice Medicaid	$486.07
Rate for Payer: Priority Health Cigna Priority Health	$782.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,159.18
Rate for Payer: Priority Health Narrow Network	$1,159.18
Rate for Payer: Priority Health SBD	$1,159.18

PR MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE

Professional

Both

$3,005.00

Service Code	HCPCS 23397
Min. Negotiated Rate	$78.96
Max. Negotiated Rate	$2,103.50
Rate for Payer: Aetna Commercial	$1,512.60
Rate for Payer: BCBS Complete	$770.48
Rate for Payer: BCBS Trust/PPO	$78.96
Rate for Payer: Cash Price	$2,404.00
Rate for Payer: Cash Price	$2,404.00
Rate for Payer: Mclaren Medicaid	$733.79
Rate for Payer: Meridian Medicaid	$770.48
Rate for Payer: Priority Health Choice Medicaid	$733.79
Rate for Payer: Priority Health Cigna Priority Health	$2,103.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,743.36
Rate for Payer: Priority Health Narrow Network	$1,743.36
Rate for Payer: Priority Health SBD	$1,743.36

PR MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE

Professional

Both

$3,347.00

Service Code	HCPCS 23395
Min. Negotiated Rate	$61.98
Max. Negotiated Rate	$2,342.90
Rate for Payer: Aetna Commercial	$1,710.89
Rate for Payer: BCBS Complete	$866.87
Rate for Payer: BCBS Trust/PPO	$61.98
Rate for Payer: Cash Price	$2,677.60
Rate for Payer: Cash Price	$2,677.60
Rate for Payer: Mclaren Medicaid	$825.59
Rate for Payer: Meridian Medicaid	$866.87
Rate for Payer: Priority Health Choice Medicaid	$825.59
Rate for Payer: Priority Health Cigna Priority Health	$2,342.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,959.87
Rate for Payer: Priority Health Narrow Network	$1,959.87
Rate for Payer: Priority Health SBD	$1,959.87

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR

Professional

Both

$2,426.00

Service Code	HCPCS 15738
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$1,698.20
Rate for Payer: Aetna Commercial	$1,391.76
Rate for Payer: BCBS Complete	$849.65
Rate for Payer: BCBS Trust/PPO	$75.69
Rate for Payer: Cash Price	$1,940.80
Rate for Payer: Cash Price	$1,940.80
Rate for Payer: Mclaren Medicaid	$809.19
Rate for Payer: Meridian Medicaid	$849.65
Rate for Payer: Priority Health Choice Medicaid	$809.19
Rate for Payer: Priority Health Cigna Priority Health	$1,698.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,556.61
Rate for Payer: Priority Health Narrow Network	$1,556.61
Rate for Payer: Priority Health SBD	$1,556.61

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK

Professional

Both

$4,510.00

Service Code	HCPCS 15734
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$3,157.00
Rate for Payer: Aetna Commercial	$1,635.70
Rate for Payer: BCBS Complete	$1,006.65
Rate for Payer: BCBS Trust/PPO	$75.69
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Mclaren Medicaid	$958.71
Rate for Payer: Meridian Medicaid	$1,006.65
Rate for Payer: Priority Health Choice Medicaid	$958.71
Rate for Payer: Priority Health Cigna Priority Health	$3,157.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,840.63
Rate for Payer: Priority Health Narrow Network	$1,840.63
Rate for Payer: Priority Health SBD	$1,840.63

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK

Facility

$4,510.00

Service Code	CPT 15734
Hospital Charge Code	15734
Min. Negotiated Rate	$1,370.72
Max. Negotiated Rate	$4,059.00
Rate for Payer: Aetna Commercial	$3,833.50
Rate for Payer: Aetna Medicare	$3,319.93
Rate for Payer: Aetna New Business (MI Preferred)	$2,931.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,990.30
Rate for Payer: Amish Plain Church Group Commercial	$3,990.30
Rate for Payer: BCBS Complete	$1,833.62
Rate for Payer: BCBS MAPPO	$3,192.24
Rate for Payer: BCBS Trust/PPO	$1,370.72
Rate for Payer: BCN Medicare Advantage	$3,192.24
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Cofinity Commercial	$3,878.60
Rate for Payer: Cofinity Commercial	$3,157.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,192.24
Rate for Payer: Healthscope Commercial	$4,059.00
Rate for Payer: Mclaren Medicaid	$1,746.16
Rate for Payer: Mclaren Medicare	$3,192.24
Rate for Payer: Meridian Medicaid	$1,833.62
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,351.85
Rate for Payer: MI Amish Medical Board Commercial	$3,671.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,833.50
Rate for Payer: PACE Medicare	$3,032.63
Rate for Payer: PACE SWMI	$3,192.24
Rate for Payer: PHP Commercial	$3,833.50
Rate for Payer: PHP Medicare Advantage	$3,192.24
Rate for Payer: Priority Health Choice Medicaid	$1,746.16
Rate for Payer: Priority Health Cigna Priority Health	$3,157.00
Rate for Payer: Priority Health Medicare	$3,192.24
Rate for Payer: Priority Health SBD	$2,841.30
Rate for Payer: Railroad Medicare Medicare	$3,192.24
Rate for Payer: UHC All Payor (Choice/PPO)	$1,621.20
Rate for Payer: UHC Dual Complete DSNP	$3,192.24
Rate for Payer: UHC Exchange	$1,473.82
Rate for Payer: UHC Medicare Advantage	$3,288.01
Rate for Payer: VA VA	$3,192.24

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK

Facility

$4,510.00

Service Code	CPT 15734
Hospital Charge Code	15734
Min. Negotiated Rate	$2,841.30
Max. Negotiated Rate	$4,059.00
Rate for Payer: Aetna Commercial	$3,833.50
Rate for Payer: Aetna New Business (MI Preferred)	$2,931.50
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Cofinity Commercial	$3,157.00
Rate for Payer: Cofinity Commercial	$3,878.60
Rate for Payer: Healthscope Commercial	$4,059.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,833.50
Rate for Payer: PHP Commercial	$3,833.50
Rate for Payer: Priority Health Cigna Priority Health	$3,157.00
Rate for Payer: Priority Health SBD	$2,841.30

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK

Professional

Both

$4,510.00

Service Code	HCPCS 15734
Hospital Charge Code	15734
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$3,157.00
Rate for Payer: Aetna Commercial	$1,635.70
Rate for Payer: BCBS Complete	$1,006.65
Rate for Payer: BCBS Trust/PPO	$75.69
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Cash Price	$3,608.00
Rate for Payer: Mclaren Medicaid	$958.71
Rate for Payer: Meridian Medicaid	$1,006.65
Rate for Payer: Priority Health Choice Medicaid	$958.71
Rate for Payer: Priority Health Cigna Priority Health	$3,157.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,840.63
Rate for Payer: Priority Health Narrow Network	$1,840.63
Rate for Payer: Priority Health SBD	$1,840.63

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR

Professional

Both

$2,261.00

Service Code	HCPCS 15736
Min. Negotiated Rate	$778.94
Max. Negotiated Rate	$1,648.76
Rate for Payer: Aetna Commercial	$1,317.66
Rate for Payer: BCBS Complete	$817.89
Rate for Payer: BCBS Trust/PPO	$1,648.76
Rate for Payer: Cash Price	$1,808.80
Rate for Payer: Cash Price	$1,808.80
Rate for Payer: Mclaren Medicaid	$778.94
Rate for Payer: Meridian Medicaid	$817.89
Rate for Payer: Priority Health Choice Medicaid	$778.94
Rate for Payer: Priority Health Cigna Priority Health	$1,582.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,492.48
Rate for Payer: Priority Health Narrow Network	$1,492.48
Rate for Payer: Priority Health SBD	$1,492.48

PR MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL

Professional

Both

$3,100.00

Service Code	HCPCS 15733
Min. Negotiated Rate	$657.11
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,117.11
Rate for Payer: BCBS Complete	$689.97
Rate for Payer: BCBS Trust/PPO	$1,152.77
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Mclaren Medicaid	$657.11
Rate for Payer: Meridian Medicaid	$689.97
Rate for Payer: Priority Health Choice Medicaid	$657.11
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,263.53
Rate for Payer: Priority Health Narrow Network	$1,263.53
Rate for Payer: Priority Health SBD	$1,263.53

PR MYOCARDIAL RESECTION

Professional

Both

$6,145.00

Service Code	HCPCS 33542
Min. Negotiated Rate	$841.58
Max. Negotiated Rate	$4,301.50
Rate for Payer: Aetna Commercial	$3,532.04
Rate for Payer: BCBS Complete	$1,723.00
Rate for Payer: BCBS Trust/PPO	$841.58
Rate for Payer: Cash Price	$4,916.00
Rate for Payer: Cash Price	$4,916.00
Rate for Payer: Mclaren Medicaid	$1,640.95
Rate for Payer: Meridian Medicaid	$1,723.00
Rate for Payer: Priority Health Choice Medicaid	$1,640.95
Rate for Payer: Priority Health Cigna Priority Health	$4,301.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,087.02
Rate for Payer: Priority Health Narrow Network	$4,087.02
Rate for Payer: Priority Health SBD	$4,087.02

PR MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR

Professional

Both

$1,923.00

Service Code	HCPCS 58145
Min. Negotiated Rate	$366.79
Max. Negotiated Rate	$1,346.10
Rate for Payer: Aetna Commercial	$676.97
Rate for Payer: BCBS Complete	$385.13
Rate for Payer: BCBS Trust/PPO	$876.45
Rate for Payer: Cash Price	$1,538.40
Rate for Payer: Cash Price	$1,538.40
Rate for Payer: Mclaren Medicaid	$366.79
Rate for Payer: Meridian Medicaid	$385.13
Rate for Payer: Priority Health Choice Medicaid	$366.79
Rate for Payer: Priority Health Cigna Priority Health	$1,346.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$808.60
Rate for Payer: Priority Health Narrow Network	$808.60
Rate for Payer: Priority Health SBD	$808.60

PR MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR

Professional

Both

$2,974.00

Service Code	HCPCS 58140
Min. Negotiated Rate	$591.71
Max. Negotiated Rate	$2,081.80
Rate for Payer: Aetna Commercial	$1,116.00
Rate for Payer: BCBS Complete	$621.30
Rate for Payer: BCBS Trust/PPO	$737.51
Rate for Payer: Cash Price	$2,379.20
Rate for Payer: Cash Price	$2,379.20
Rate for Payer: Mclaren Medicaid	$591.71
Rate for Payer: Meridian Medicaid	$621.30
Rate for Payer: Priority Health Choice Medicaid	$591.71
Rate for Payer: Priority Health Cigna Priority Health	$2,081.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,327.49
Rate for Payer: Priority Health Narrow Network	$1,327.49
Rate for Payer: Priority Health SBD	$1,327.49

PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA

Professional

Both

$2,172.00

Service Code	HCPCS 58146
Min. Negotiated Rate	$740.18
Max. Negotiated Rate	$2,587.61
Rate for Payer: Aetna Commercial	$1,387.27
Rate for Payer: BCBS Complete	$777.19
Rate for Payer: BCBS Trust/PPO	$2,587.61
Rate for Payer: Cash Price	$1,737.60
Rate for Payer: Cash Price	$1,737.60
Rate for Payer: Mclaren Medicaid	$740.18
Rate for Payer: Meridian Medicaid	$777.19
Rate for Payer: Priority Health Choice Medicaid	$740.18
Rate for Payer: Priority Health Cigna Priority Health	$1,520.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,639.94
Rate for Payer: Priority Health Narrow Network	$1,639.94
Rate for Payer: Priority Health SBD	$1,639.94

PR MYRINGOPLASTY

Professional

Both

$1,144.00

Service Code	HCPCS 69620
Min. Negotiated Rate	$318.86
Max. Negotiated Rate	$1,611.84
Rate for Payer: Aetna Commercial	$551.61
Rate for Payer: BCBS Complete	$334.80
Rate for Payer: BCBS Trust/PPO	$1,611.84
Rate for Payer: Cash Price	$915.20
Rate for Payer: Cash Price	$915.20
Rate for Payer: Mclaren Medicaid	$318.86
Rate for Payer: Meridian Medicaid	$334.80
Rate for Payer: Priority Health Choice Medicaid	$318.86
Rate for Payer: Priority Health Cigna Priority Health	$800.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$703.42
Rate for Payer: Priority Health Narrow Network	$703.42
Rate for Payer: Priority Health SBD	$703.42

Know your out-of-pocket cost for care.

All Charges