Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP

Facility

$389.05

Service Code	NDC 60432-608-16
Hospital Charge Code	6620
Hospital Revenue Code	637
Min. Negotiated Rate	$245.10
Max. Negotiated Rate	$350.14
Rate for Payer: Aetna Commercial	$330.69
Rate for Payer: Aetna New Business (MI Preferred)	$252.88
Rate for Payer: Cash Price	$311.24
Rate for Payer: Cofinity Commercial	$334.58
Rate for Payer: Cofinity Commercial	$272.34
Rate for Payer: Healthscope Commercial	$350.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$330.69
Rate for Payer: PHP Commercial	$330.69
Rate for Payer: Priority Health Cigna Priority Health	$272.34
Rate for Payer: Priority Health SBD	$245.10

PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP

Facility

$766.97

Service Code	NDC 60432-604-16
Hospital Charge Code	11145
Hospital Revenue Code	637
Min. Negotiated Rate	$483.19
Max. Negotiated Rate	$690.27
Rate for Payer: Aetna Commercial	$651.92
Rate for Payer: Aetna New Business (MI Preferred)	$498.53
Rate for Payer: Cash Price	$613.58
Rate for Payer: Cofinity Commercial	$536.88
Rate for Payer: Cofinity Commercial	$659.59
Rate for Payer: Healthscope Commercial	$690.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$651.92
Rate for Payer: PHP Commercial	$651.92
Rate for Payer: Priority Health Cigna Priority Health	$536.88
Rate for Payer: Priority Health SBD	$483.19

PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX

Professional

Both

$2,085.00

Service Code	HCPCS 49255
Min. Negotiated Rate	$508.64
Max. Negotiated Rate	$1,459.50
Rate for Payer: Aetna Commercial	$1,060.40
Rate for Payer: BCBS Complete	$534.07
Rate for Payer: BCBS Trust/PPO	$1,221.96
Rate for Payer: Cash Price	$1,668.00
Rate for Payer: Cash Price	$1,668.00
Rate for Payer: Mclaren Medicaid	$508.64
Rate for Payer: Meridian Medicaid	$534.07
Rate for Payer: Priority Health Choice Medicaid	$508.64
Rate for Payer: Priority Health Cigna Priority Health	$1,459.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,392.91
Rate for Payer: Priority Health Narrow Network	$1,392.91
Rate for Payer: Priority Health SBD	$1,392.91

PR ONDANSETRON HCL INJECTION

Professional

Both

$30.00

Service Code	HCPCS J2405
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$0.10
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$0.05
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR

Professional

Both

$2,000.00

Service Code	HCPCS 00527
Hospital Revenue Code	990
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,400.00
Rate for Payer: BCBS Complete	$800.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Priority Health Cigna Priority Health	$1,400.00

PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES

Professional

Both

$35.00

Service Code	HCPCS 99422
Min. Negotiated Rate	$21.61
Max. Negotiated Rate	$1,260.52
Rate for Payer: Aetna Commercial	$25.74
Rate for Payer: BCBS Complete	$22.69
Rate for Payer: BCBS Trust/PPO	$1,260.52
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Mclaren Medicaid	$21.61
Rate for Payer: Meridian Medicaid	$22.69
Rate for Payer: Priority Health Choice Medicaid	$21.61
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.11
Rate for Payer: Priority Health Narrow Network	$26.11
Rate for Payer: Priority Health SBD	$26.11

PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES

Professional

Both

$35.00

Service Code	HCPCS 99423
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$873.28
Rate for Payer: Aetna Commercial	$40.51
Rate for Payer: BCBS Complete	$36.31
Rate for Payer: BCBS Trust/PPO	$873.28
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Mclaren Medicaid	$34.58
Rate for Payer: Meridian Medicaid	$36.31
Rate for Payer: Priority Health Choice Medicaid	$34.58
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.42
Rate for Payer: Priority Health Narrow Network	$41.42
Rate for Payer: Priority Health SBD	$41.42

PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES

Professional

Both

$35.00

Service Code	HCPCS 99421
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$1,630.70
Rate for Payer: Aetna Commercial	$12.71
Rate for Payer: BCBS Complete	$11.50
Rate for Payer: BCBS Trust/PPO	$1,630.70
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Mclaren Medicaid	$10.95
Rate for Payer: Meridian Medicaid	$11.50
Rate for Payer: Priority Health Choice Medicaid	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.23
Rate for Payer: Priority Health Narrow Network	$13.23
Rate for Payer: Priority Health SBD	$13.23

PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI

Professional

Both

$2,764.00

Service Code	HCPCS 58940
Min. Negotiated Rate	$144.75
Max. Negotiated Rate	$1,934.80
Rate for Payer: Aetna Commercial	$655.82
Rate for Payer: BCBS Complete	$375.73
Rate for Payer: BCBS Trust/PPO	$144.75
Rate for Payer: Cash Price	$2,211.20
Rate for Payer: Cash Price	$2,211.20
Rate for Payer: Mclaren Medicaid	$357.84
Rate for Payer: Meridian Medicaid	$375.73
Rate for Payer: Priority Health Choice Medicaid	$357.84
Rate for Payer: Priority Health Cigna Priority Health	$1,934.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$792.51
Rate for Payer: Priority Health Narrow Network	$792.51
Rate for Payer: Priority Health SBD	$792.51

PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY

Professional

Both

$2,261.00

Service Code	HCPCS 58943
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$1,660.29
Rate for Payer: Aetna Commercial	$1,398.24
Rate for Payer: BCBS Complete	$810.28
Rate for Payer: BCBS Trust/PPO	$132.60
Rate for Payer: Cash Price	$1,808.80
Rate for Payer: Cash Price	$1,808.80
Rate for Payer: Mclaren Medicaid	$771.70
Rate for Payer: Meridian Medicaid	$810.28
Rate for Payer: Priority Health Choice Medicaid	$771.70
Rate for Payer: Priority Health Cigna Priority Health	$1,582.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,660.29
Rate for Payer: Priority Health Narrow Network	$1,660.29
Rate for Payer: Priority Health SBD	$1,660.29

PROPAFENONE 150 MG TABLET

Facility

$2.92

Service Code	NDC 60687-537-11
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.84

PROPAFENONE 150 MG TABLET

Facility

$291.36

Service Code	NDC 60687-537-01
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$183.56
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$203.95
Rate for Payer: Priority Health SBD	$183.56

PROPAFENONE 150 MG TABLET

Facility

$241.30

Service Code	NDC 53489-551-01
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$152.02
Max. Negotiated Rate	$217.17
Rate for Payer: Aetna Commercial	$205.10
Rate for Payer: Aetna New Business (MI Preferred)	$156.84
Rate for Payer: Cash Price	$193.04
Rate for Payer: Cofinity Commercial	$168.91
Rate for Payer: Cofinity Commercial	$207.52
Rate for Payer: Healthscope Commercial	$217.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$205.10
Rate for Payer: PHP Commercial	$205.10
Rate for Payer: Priority Health Cigna Priority Health	$168.91
Rate for Payer: Priority Health SBD	$152.02

PROPAFENONE 150 MG TABLET

Facility

$348.48

Service Code	NDC 60687-709-01
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$219.54
Max. Negotiated Rate	$313.63
Rate for Payer: Aetna Commercial	$296.21
Rate for Payer: Aetna New Business (MI Preferred)	$226.51
Rate for Payer: Cash Price	$278.78
Rate for Payer: Cofinity Commercial	$243.94
Rate for Payer: Cofinity Commercial	$299.69
Rate for Payer: Healthscope Commercial	$313.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$296.21
Rate for Payer: PHP Commercial	$296.21
Rate for Payer: Priority Health Cigna Priority Health	$243.94
Rate for Payer: Priority Health SBD	$219.54

PROPAFENONE 150 MG TABLET

Facility

$343.10

Service Code	NDC 59651-256-01
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$216.15
Max. Negotiated Rate	$308.79
Rate for Payer: Aetna Commercial	$291.64
Rate for Payer: Aetna New Business (MI Preferred)	$223.02
Rate for Payer: Cash Price	$274.48
Rate for Payer: Cofinity Commercial	$240.17
Rate for Payer: Cofinity Commercial	$295.07
Rate for Payer: Healthscope Commercial	$308.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$291.64
Rate for Payer: PHP Commercial	$291.64
Rate for Payer: Priority Health Cigna Priority Health	$240.17
Rate for Payer: Priority Health SBD	$216.15

PROPAFENONE 150 MG TABLET

Facility

$3.49

Service Code	NDC 60687-709-11
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.14
Rate for Payer: Aetna Commercial	$2.97
Rate for Payer: Aetna New Business (MI Preferred)	$2.27
Rate for Payer: Cash Price	$2.79
Rate for Payer: Cofinity Commercial	$2.44
Rate for Payer: Cofinity Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.97
Rate for Payer: PHP Commercial	$2.97
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.20

PROPAFENONE 150 MG TABLET

Facility

$340.10

Service Code	NDC 0591-0582-01
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$214.26
Max. Negotiated Rate	$306.09
Rate for Payer: Aetna Commercial	$289.08
Rate for Payer: Aetna New Business (MI Preferred)	$221.06
Rate for Payer: Cash Price	$272.08
Rate for Payer: Cofinity Commercial	$238.07
Rate for Payer: Cofinity Commercial	$292.49
Rate for Payer: Healthscope Commercial	$306.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$289.08
Rate for Payer: PHP Commercial	$289.08
Rate for Payer: Priority Health Cigna Priority Health	$238.07
Rate for Payer: Priority Health SBD	$214.26

PROPARACAINE 0.5 % EYE DROPS

Facility

$96.50

Service Code	NDC 61314-016-01
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$60.80
Max. Negotiated Rate	$86.85
Rate for Payer: Aetna Commercial	$82.02
Rate for Payer: Aetna New Business (MI Preferred)	$62.72
Rate for Payer: Cash Price	$77.20
Rate for Payer: Cofinity Commercial	$67.55
Rate for Payer: Cofinity Commercial	$82.99
Rate for Payer: Healthscope Commercial	$86.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$82.02
Rate for Payer: PHP Commercial	$82.02
Rate for Payer: Priority Health Cigna Priority Health	$67.55
Rate for Payer: Priority Health SBD	$60.80

PROPARACAINE 0.5 % EYE DROPS

Facility

$113.72

Service Code	NDC 17478-263-12
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$79.60
Rate for Payer: Priority Health SBD	$71.64

PROPARACAINE 0.5 % EYE DROPS

Facility

$116.71

Service Code	NDC 24208-730-06
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$73.53
Max. Negotiated Rate	$105.04
Rate for Payer: Aetna Commercial	$99.20
Rate for Payer: Aetna New Business (MI Preferred)	$75.86
Rate for Payer: Cash Price	$93.37
Rate for Payer: Cofinity Commercial	$100.37
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Healthscope Commercial	$105.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.20
Rate for Payer: PHP Commercial	$99.20
Rate for Payer: Priority Health Cigna Priority Health	$81.70
Rate for Payer: Priority Health SBD	$73.53

PR OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND

Professional

Both

$2,477.00

Service Code	HCPCS 50250
Min. Negotiated Rate	$770.63
Max. Negotiated Rate	$4,748.36
Rate for Payer: Aetna Commercial	$1,561.74
Rate for Payer: BCBS Complete	$809.16
Rate for Payer: BCBS Trust/PPO	$4,748.36
Rate for Payer: Cash Price	$1,981.60
Rate for Payer: Cash Price	$1,981.60
Rate for Payer: Mclaren Medicaid	$770.63
Rate for Payer: Meridian Medicaid	$809.16
Rate for Payer: Priority Health Choice Medicaid	$770.63
Rate for Payer: Priority Health Cigna Priority Health	$1,733.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,933.39
Rate for Payer: Priority Health Narrow Network	$1,933.39
Rate for Payer: Priority Health SBD	$1,933.39

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Professional

Both

$883.00

Service Code	HCPCS 38531
Min. Negotiated Rate	$287.98
Max. Negotiated Rate	$970.62
Rate for Payer: Aetna Commercial	$551.41
Rate for Payer: BCBS Complete	$302.38
Rate for Payer: BCBS Trust/PPO	$662.49
Rate for Payer: Cash Price	$706.40
Rate for Payer: Cash Price	$706.40
Rate for Payer: Mclaren Medicaid	$287.98
Rate for Payer: Meridian Medicaid	$302.38
Rate for Payer: Priority Health Choice Medicaid	$287.98
Rate for Payer: Priority Health Cigna Priority Health	$618.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$970.62
Rate for Payer: Priority Health Narrow Network	$970.62
Rate for Payer: Priority Health SBD	$970.62

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Facility

$883.00

Service Code	CPT 38531
Hospital Charge Code	38531
Min. Negotiated Rate	$442.70
Max. Negotiated Rate	$4,239.58
Rate for Payer: Aetna Commercial	$750.55
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Aetna New Business (MI Preferred)	$573.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$1,669.27
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Cash Price	$706.40
Rate for Payer: Cash Price	$706.40
Rate for Payer: Cofinity Commercial	$759.38
Rate for Payer: Cofinity Commercial	$618.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Healthscope Commercial	$794.70
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$750.55
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Commercial	$750.55
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health Cigna Priority Health	$618.10
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health SBD	$556.29
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$486.97
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$442.70
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Facility

$883.00

Service Code	CPT 38531
Hospital Charge Code	38531
Min. Negotiated Rate	$556.29
Max. Negotiated Rate	$794.70
Rate for Payer: Aetna Commercial	$750.55
Rate for Payer: Aetna New Business (MI Preferred)	$573.95
Rate for Payer: Cash Price	$706.40
Rate for Payer: Cofinity Commercial	$618.10
Rate for Payer: Cofinity Commercial	$759.38
Rate for Payer: Healthscope Commercial	$794.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$750.55
Rate for Payer: PHP Commercial	$750.55
Rate for Payer: Priority Health Cigna Priority Health	$618.10
Rate for Payer: Priority Health SBD	$556.29

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Professional

Both

$883.00

Service Code	HCPCS 38531
Hospital Charge Code	38531
Min. Negotiated Rate	$287.98
Max. Negotiated Rate	$970.62
Rate for Payer: Aetna Commercial	$551.41
Rate for Payer: BCBS Complete	$302.38
Rate for Payer: BCBS Trust/PPO	$662.49
Rate for Payer: Cash Price	$706.40
Rate for Payer: Cash Price	$706.40
Rate for Payer: Mclaren Medicaid	$287.98
Rate for Payer: Meridian Medicaid	$302.38
Rate for Payer: Priority Health Choice Medicaid	$287.98
Rate for Payer: Priority Health Cigna Priority Health	$618.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$970.62
Rate for Payer: Priority Health Narrow Network	$970.62
Rate for Payer: Priority Health SBD	$970.62

Know your out-of-pocket cost for care.

All Charges