Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL

Professional

Both

$743.00

Service Code	HCPCS 62311
Min. Negotiated Rate	$297.20
Max. Negotiated Rate	$520.10
Rate for Payer: BCBS Complete	$297.20
Rate for Payer: Cash Price	$594.40
Rate for Payer: Priority Health Cigna Priority Health	$520.10

PR NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC

Professional

Both

$661.00

Service Code	HCPCS 62310
Min. Negotiated Rate	$264.40
Max. Negotiated Rate	$462.70
Rate for Payer: BCBS Complete	$264.40
Rate for Payer: Cash Price	$528.80
Rate for Payer: Priority Health Cigna Priority Health	$462.70

PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

Professional

Both

$331.00

Service Code	HCPCS 62321
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,592.30
Rate for Payer: Aetna Commercial	$138.22
Rate for Payer: BCBS Complete	$71.57
Rate for Payer: BCBS Trust/PPO	$1,592.30
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Mclaren Medicaid	$68.16
Rate for Payer: Meridian Medicaid	$71.57
Rate for Payer: Priority Health Choice Medicaid	$68.16
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.35
Rate for Payer: Priority Health Narrow Network	$178.35
Rate for Payer: Priority Health SBD	$178.35

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

Facility

$302.00

Service Code	CPT 62323
Hospital Charge Code	62323
Min. Negotiated Rate	$190.26
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna Commercial	$256.70
Rate for Payer: Aetna New Business (MI Preferred)	$196.30
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cofinity Commercial	$211.40
Rate for Payer: Cofinity Commercial	$259.72
Rate for Payer: Healthscope Commercial	$271.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$256.70
Rate for Payer: PHP Commercial	$256.70
Rate for Payer: Priority Health Cigna Priority Health	$211.40
Rate for Payer: Priority Health SBD	$190.26

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

Facility

$302.00

Service Code	CPT 62323
Hospital Charge Code	62323
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$1,932.06
Rate for Payer: Aetna Commercial	$256.70
Rate for Payer: Aetna Medicare	$639.94
Rate for Payer: Aetna New Business (MI Preferred)	$196.30
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	$550.13
Rate for Payer: BCN Medicare Advantage	$615.33
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cofinity Commercial	$259.72
Rate for Payer: Cofinity Commercial	$211.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$615.33
Rate for Payer: Healthscope Commercial	$271.80
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	$256.70
Rate for Payer: PACE Medicare	$584.56
Rate for Payer: PACE SWMI	$615.33
Rate for Payer: PHP Commercial	$256.70
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	$211.40
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	$190.26
Rate for Payer: Railroad Medicare Medicare	$615.33
Rate for Payer: UHC All Payor (Choice/PPO)	$106.61
Rate for Payer: UHC Dual Complete DSNP	$615.33
Rate for Payer: UHC Exchange	$96.92
Rate for Payer: UHC Medicare Advantage	$633.79
Rate for Payer: VA VA	$615.33

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

Professional

Both

$302.00

Service Code	HCPCS 62323
Hospital Charge Code	62323
Min. Negotiated Rate	$63.05
Max. Negotiated Rate	$1,879.69
Rate for Payer: Aetna Commercial	$127.22
Rate for Payer: BCBS Complete	$66.20
Rate for Payer: BCBS Trust/PPO	$1,879.69
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cash Price	$241.60
Rate for Payer: Mclaren Medicaid	$63.05
Rate for Payer: Meridian Medicaid	$66.20
Rate for Payer: Priority Health Choice Medicaid	$63.05
Rate for Payer: Priority Health Cigna Priority Health	$211.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.34
Rate for Payer: Priority Health Narrow Network	$165.34
Rate for Payer: Priority Health SBD	$165.34

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

Professional

Both

$302.00

Service Code	HCPCS 62323
Min. Negotiated Rate	$63.05
Max. Negotiated Rate	$1,879.69
Rate for Payer: Aetna Commercial	$127.22
Rate for Payer: BCBS Complete	$66.20
Rate for Payer: BCBS Trust/PPO	$1,879.69
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cash Price	$241.60
Rate for Payer: Mclaren Medicaid	$63.05
Rate for Payer: Meridian Medicaid	$66.20
Rate for Payer: Priority Health Choice Medicaid	$63.05
Rate for Payer: Priority Health Cigna Priority Health	$211.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.34
Rate for Payer: Priority Health Narrow Network	$165.34
Rate for Payer: Priority Health SBD	$165.34

PR NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL

Professional

Both

$855.00

Service Code	HCPCS 62319
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$598.50
Rate for Payer: BCBS Complete	$342.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Priority Health Cigna Priority Health	$598.50

PR NJX PEYRONIE W/SURG EXPOS PLAQUE

Professional

Both

$1,070.00

Service Code	HCPCS 54205
Min. Negotiated Rate	$340.59
Max. Negotiated Rate	$850.52
Rate for Payer: Aetna Commercial	$681.56
Rate for Payer: BCBS Complete	$357.62
Rate for Payer: BCBS Trust/PPO	$414.72
Rate for Payer: Cash Price	$856.00
Rate for Payer: Cash Price	$856.00
Rate for Payer: Mclaren Medicaid	$340.59
Rate for Payer: Meridian Medicaid	$357.62
Rate for Payer: Priority Health Choice Medicaid	$340.59
Rate for Payer: Priority Health Cigna Priority Health	$749.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$850.52
Rate for Payer: Priority Health Narrow Network	$850.52
Rate for Payer: Priority Health SBD	$850.52

PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION

Professional

Both

$900.00

Service Code	HCPCS 0232T
Hospital Charge Code	0232T
Min. Negotiated Rate	$91.43
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$128.61
Rate for Payer: Aetna Commercial	$128.61
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: BCBS Complete	$360.00
Rate for Payer: BCBS Trust/PPO	$91.43
Rate for Payer: BCBS Trust/PPO	$91.43
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Priority Health Cigna Priority Health	$630.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION

Professional

Both

$900.00

Service Code	HCPCS 0232T
Min. Negotiated Rate	$91.43
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$128.61
Rate for Payer: Aetna Commercial	$128.61
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: BCBS Complete	$360.00
Rate for Payer: BCBS Trust/PPO	$91.43
Rate for Payer: BCBS Trust/PPO	$91.43
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: Priority Health Cigna Priority Health	$630.00

PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION

Facility

$650.00

Service Code	CPT 0232T
Hospital Charge Code	0232T
Min. Negotiated Rate	$193.93
Max. Negotiated Rate	$1,132.15
Rate for Payer: Aetna Commercial	$552.50
Rate for Payer: Aetna Medicare	$368.71
Rate for Payer: Aetna New Business (MI Preferred)	$422.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.16
Rate for Payer: Amish Plain Church Group Commercial	$443.16
Rate for Payer: BCBS Complete	$203.64
Rate for Payer: BCBS MAPPO	$354.53
Rate for Payer: BCN Medicare Advantage	$354.53
Rate for Payer: Cash Price	$520.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Cofinity Commercial	$559.00
Rate for Payer: Cofinity Commercial	$455.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.53
Rate for Payer: Healthscope Commercial	$585.00
Rate for Payer: Mclaren Medicaid	$193.93
Rate for Payer: Mclaren Medicare	$354.53
Rate for Payer: Meridian Medicaid	$203.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.26
Rate for Payer: MI Amish Medical Board Commercial	$407.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$552.50
Rate for Payer: PACE Medicare	$336.80
Rate for Payer: PACE SWMI	$354.53
Rate for Payer: PHP Commercial	$552.50
Rate for Payer: PHP Medicare Advantage	$354.53
Rate for Payer: Priority Health Choice Medicaid	$193.93
Rate for Payer: Priority Health Cigna Priority Health	$455.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,132.15
Rate for Payer: Priority Health Medicare	$354.53
Rate for Payer: Priority Health Narrow Network	$905.72
Rate for Payer: Priority Health SBD	$409.50
Rate for Payer: Railroad Medicare Medicare	$354.53
Rate for Payer: UHC Dual Complete DSNP	$354.53
Rate for Payer: UHC Medicare Advantage	$365.17
Rate for Payer: VA VA	$354.53

PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION

Facility

$650.00

Service Code	CPT 0232T
Hospital Charge Code	0232T
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$552.50
Rate for Payer: Aetna New Business (MI Preferred)	$422.50
Rate for Payer: Cash Price	$520.00
Rate for Payer: Cofinity Commercial	$455.00
Rate for Payer: Cofinity Commercial	$559.00
Rate for Payer: Healthscope Commercial	$585.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$552.50
Rate for Payer: PHP Commercial	$552.50
Rate for Payer: Priority Health Cigna Priority Health	$455.00
Rate for Payer: Priority Health SBD	$409.50

PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

Professional

Both

$203.00

Service Code	HCPCS 50431
Min. Negotiated Rate	$41.54
Max. Negotiated Rate	$2,577.05
Rate for Payer: Aetna Commercial	$82.85
Rate for Payer: BCBS Complete	$43.62
Rate for Payer: BCBS Trust/PPO	$2,577.05
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Mclaren Medicaid	$41.54
Rate for Payer: Meridian Medicaid	$43.62
Rate for Payer: Priority Health Choice Medicaid	$41.54
Rate for Payer: Priority Health Cigna Priority Health	$142.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$104.29
Rate for Payer: Priority Health Narrow Network	$104.29
Rate for Payer: Priority Health SBD	$104.29

PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS

Professional

Both

$235.00

Service Code	HCPCS 50430
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$2,447.09
Rate for Payer: Aetna Commercial	$196.43
Rate for Payer: BCBS Complete	$100.64
Rate for Payer: BCBS Trust/PPO	$2,447.09
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Mclaren Medicaid	$95.85
Rate for Payer: Meridian Medicaid	$100.64
Rate for Payer: Priority Health Choice Medicaid	$95.85
Rate for Payer: Priority Health Cigna Priority Health	$164.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$242.62
Rate for Payer: Priority Health Narrow Network	$242.62
Rate for Payer: Priority Health SBD	$242.62

PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH

Professional

Both

$564.00

Service Code	HCPCS 36005
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$1,201.88
Rate for Payer: Aetna Commercial	$64.54
Rate for Payer: BCBS Complete	$31.09
Rate for Payer: BCBS Trust/PPO	$1,201.88
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cash Price	$451.20
Rate for Payer: Mclaren Medicaid	$29.61
Rate for Payer: Meridian Medicaid	$31.09
Rate for Payer: Priority Health Choice Medicaid	$29.61
Rate for Payer: Priority Health Cigna Priority Health	$394.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00

PR NJX RETROGRADE URETHROCSTOGRAPY

Professional

Both

$703.00

Service Code	HCPCS 51610
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$1,159.09
Rate for Payer: Aetna Commercial	$81.03
Rate for Payer: BCBS Complete	$42.71
Rate for Payer: BCBS Trust/PPO	$1,159.09
Rate for Payer: Cash Price	$562.40
Rate for Payer: Cash Price	$562.40
Rate for Payer: Mclaren Medicaid	$40.68
Rate for Payer: Meridian Medicaid	$42.71
Rate for Payer: Priority Health Choice Medicaid	$40.68
Rate for Payer: Priority Health Cigna Priority Health	$492.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.13
Rate for Payer: Priority Health Narrow Network	$102.13
Rate for Payer: Priority Health SBD	$102.13

PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG

Professional

Both

$209.00

Service Code	HCPCS 50690
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$3,404.37
Rate for Payer: Aetna Commercial	$88.08
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCBS Trust/PPO	$3,404.37
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$167.20
Rate for Payer: Mclaren Medicaid	$44.09
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health	$146.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$111.32
Rate for Payer: Priority Health Narrow Network	$111.32
Rate for Payer: Priority Health SBD	$111.32

PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST

Professional

Both

$230.00

Service Code	HCPCS 54250
Min. Negotiated Rate	$23.23
Max. Negotiated Rate	$1,901.35
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: BCBS Complete	$92.00
Rate for Payer: BCBS Trust/PPO	$1,901.35
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Priority Health Cigna Priority Health	$161.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.23
Rate for Payer: Priority Health Narrow Network	$23.23
Rate for Payer: Priority Health SBD	$195.06

PR NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER

Professional

Both

$47.00

Service Code	HCPCS 94761
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$498.19
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: BCBS Trust/PPO	$498.19
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Priority Health Cigna Priority Health	$32.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.94
Rate for Payer: Priority Health Narrow Network	$4.94
Rate for Payer: Priority Health SBD	$4.94

PR NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR

Professional

Both

$41.00

Service Code	HCPCS 94762
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$235.09
Rate for Payer: Aetna Commercial	$28.15
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$235.09
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$28.70
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 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER

Professional

Both

$44.00

Service Code	HCPCS 94760
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$407.32
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$407.32
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.14
Rate for Payer: Priority Health Narrow Network	$3.14
Rate for Payer: Priority Health SBD	$3.14

PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS

Professional

Both

$309.00

Service Code	HCPCS 93923
Min. Negotiated Rate	$28.75
Max. Negotiated Rate	$415.24
Rate for Payer: Aetna Commercial	$139.53
Rate for Payer: Aetna Commercial	$139.53
Rate for Payer: BCBS Complete	$123.60
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$415.24
Rate for Payer: BCBS Trust/PPO	$415.24
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health Cigna Priority Health	$216.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.75
Rate for Payer: Priority Health Narrow Network	$28.75
Rate for Payer: Priority Health Narrow Network	$28.75
Rate for Payer: Priority Health SBD	$172.47
Rate for Payer: Priority Health SBD	$172.47

PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL

Professional

Both

$26.00

Service Code	HCPCS 93922
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$131.55
Rate for Payer: Aetna Commercial	$90.01
Rate for Payer: Aetna Commercial	$90.01
Rate for Payer: BCBS Complete	$80.40
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: BCBS Trust/PPO	$131.55
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health Cigna Priority Health	$140.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.17
Rate for Payer: Priority Health Narrow Network	$16.17
Rate for Payer: Priority Health Narrow Network	$16.17
Rate for Payer: Priority Health SBD	$110.49
Rate for Payer: Priority Health SBD	$110.49

PR NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN

Professional

Both

$55.00

Service Code	HCPCS 98967
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$1,248.37
Rate for Payer: Aetna Commercial	$27.83
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$1,248.37
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$38.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.20
Rate for Payer: Priority Health Narrow Network	$29.20
Rate for Payer: Priority Health SBD	$29.20

Know your out-of-pocket cost for care.

All Charges