Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL

Professional

Both

$2,685.00

Service Code	HCPCS 37230
Min. Negotiated Rate	$429.41
Max. Negotiated Rate	$1,879.50
Rate for Payer: Aetna Commercial	$935.98
Rate for Payer: BCBS Complete	$450.88
Rate for Payer: BCBS Trust/PPO	$709.51
Rate for Payer: Cash Price	$2,148.00
Rate for Payer: Cash Price	$2,148.00
Rate for Payer: Mclaren Medicaid	$429.41
Rate for Payer: Meridian Medicaid	$450.88
Rate for Payer: Priority Health Choice Medicaid	$429.41
Rate for Payer: Priority Health Cigna Priority Health	$1,879.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,071.37
Rate for Payer: Priority Health Narrow Network	$1,071.37
Rate for Payer: Priority Health SBD	$1,071.37

PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL

Professional

Both

$510.00

Service Code	HCPCS 37234
Min. Negotiated Rate	$174.23
Max. Negotiated Rate	$790.87
Rate for Payer: Aetna Commercial	$383.02
Rate for Payer: BCBS Complete	$182.94
Rate for Payer: BCBS Trust/PPO	$790.87
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Mclaren Medicaid	$174.23
Rate for Payer: Meridian Medicaid	$182.94
Rate for Payer: Priority Health Choice Medicaid	$174.23
Rate for Payer: Priority Health Cigna Priority Health	$357.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$434.08
Rate for Payer: Priority Health Narrow Network	$434.08
Rate for Payer: Priority Health SBD	$434.08

PR RHINOPLASTY EXTERNAL

Professional

Both

$3,100.00

Service Code	HCPCS 00536
Hospital Revenue Code	990
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: BCBS Complete	$1,240.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00

PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR

Professional

Both

$2,416.00

Service Code	HCPCS 30420
Min. Negotiated Rate	$782.41
Max. Negotiated Rate	$2,037.40
Rate for Payer: Aetna Commercial	$1,845.15
Rate for Payer: BCBS Complete	$979.59
Rate for Payer: BCBS Trust/PPO	$782.41
Rate for Payer: Cash Price	$1,932.80
Rate for Payer: Cash Price	$1,932.80
Rate for Payer: Mclaren Medicaid	$932.94
Rate for Payer: Meridian Medicaid	$979.59
Rate for Payer: Priority Health Choice Medicaid	$932.94
Rate for Payer: Priority Health Cigna Priority Health	$1,691.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,037.40
Rate for Payer: Priority Health Narrow Network	$2,037.40
Rate for Payer: Priority Health SBD	$2,037.40

PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION

Professional

Both

$1,990.00

Service Code	HCPCS 30435
Min. Negotiated Rate	$859.24
Max. Negotiated Rate	$1,879.03
Rate for Payer: Aetna Commercial	$1,717.52
Rate for Payer: BCBS Complete	$902.20
Rate for Payer: BCBS Trust/PPO	$987.39
Rate for Payer: Cash Price	$1,592.00
Rate for Payer: Cash Price	$1,592.00
Rate for Payer: Mclaren Medicaid	$859.24
Rate for Payer: Meridian Medicaid	$902.20
Rate for Payer: Priority Health Choice Medicaid	$859.24
Rate for Payer: Priority Health Cigna Priority Health	$1,393.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,879.03
Rate for Payer: Priority Health Narrow Network	$1,879.03
Rate for Payer: Priority Health SBD	$1,879.03

PR RHINOPLASTY SECONDARY MAJOR REVISION

Professional

Both

$3,431.00

Service Code	HCPCS 30450
Min. Negotiated Rate	$858.49
Max. Negotiated Rate	$2,448.59
Rate for Payer: Aetna Commercial	$2,252.58
Rate for Payer: BCBS Complete	$1,176.85
Rate for Payer: BCBS Trust/PPO	$858.49
Rate for Payer: Cash Price	$2,744.80
Rate for Payer: Cash Price	$2,744.80
Rate for Payer: Mclaren Medicaid	$1,120.81
Rate for Payer: Meridian Medicaid	$1,176.85
Rate for Payer: Priority Health Choice Medicaid	$1,120.81
Rate for Payer: Priority Health Cigna Priority Health	$2,401.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,448.59
Rate for Payer: Priority Health Narrow Network	$2,448.59
Rate for Payer: Priority Health SBD	$2,448.59

PR RHINP DFRM W/COLUM LNGTH TIP ONLY

Professional

Both

$1,343.00

Service Code	HCPCS 30460
Min. Negotiated Rate	$531.44
Max. Negotiated Rate	$1,158.54
Rate for Payer: Aetna Commercial	$1,069.66
Rate for Payer: BCBS Complete	$558.01
Rate for Payer: BCBS Trust/PPO	$557.88
Rate for Payer: Cash Price	$1,074.40
Rate for Payer: Cash Price	$1,074.40
Rate for Payer: Mclaren Medicaid	$531.44
Rate for Payer: Meridian Medicaid	$558.01
Rate for Payer: Priority Health Choice Medicaid	$531.44
Rate for Payer: Priority Health Cigna Priority Health	$940.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,158.54
Rate for Payer: Priority Health Narrow Network	$1,158.54
Rate for Payer: Priority Health SBD	$1,158.54

PR RHINP PRIM COMPLETE XTRNL PARTS

Professional

Both

$3,024.00

Service Code	HCPCS 30410
Min. Negotiated Rate	$562.64
Max. Negotiated Rate	$2,116.80
Rate for Payer: Aetna Commercial	$1,815.03
Rate for Payer: Aetna Commercial	$1,815.03
Rate for Payer: BCBS Complete	$952.75
Rate for Payer: BCBS Complete	$952.75
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: Cash Price	$2,419.20
Rate for Payer: Cash Price	$2,419.20
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Mclaren Medicaid	$907.38
Rate for Payer: Mclaren Medicaid	$907.38
Rate for Payer: Meridian Medicaid	$952.75
Rate for Payer: Meridian Medicaid	$952.75
Rate for Payer: Priority Health Choice Medicaid	$907.38
Rate for Payer: Priority Health Choice Medicaid	$907.38
Rate for Payer: Priority Health Cigna Priority Health	$2,116.80
Rate for Payer: Priority Health Cigna Priority Health	$2,100.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,983.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,983.22
Rate for Payer: Priority Health Narrow Network	$1,983.22
Rate for Payer: Priority Health Narrow Network	$1,983.22
Rate for Payer: Priority Health SBD	$1,983.22
Rate for Payer: Priority Health SBD	$1,983.22

PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI

Professional

Both

$1,500.00

Service Code	HCPCS 30400
Min. Negotiated Rate	$788.95
Max. Negotiated Rate	$1,845.35
Rate for Payer: Aetna Commercial	$1,572.55
Rate for Payer: BCBS Complete	$828.40
Rate for Payer: BCBS Trust/PPO	$1,845.35
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Mclaren Medicaid	$788.95
Rate for Payer: Meridian Medicaid	$828.40
Rate for Payer: Priority Health Choice Medicaid	$788.95
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,726.23
Rate for Payer: Priority Health Narrow Network	$1,726.23
Rate for Payer: Priority Health SBD	$1,726.23

PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM

Professional

Both

$150.00

Service Code	HCPCS 90384
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$78.10
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$91.88
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00

PR RHO D IMMUNE GLOBULIN INJ

Professional

Both

$150.00

Service Code	HCPCS J2790
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$64.41
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00

PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON

Professional

Both

$27.00

Service Code	HCPCS 93042
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$2,070.41
Rate for Payer: Aetna Commercial	$9.24
Rate for Payer: BCBS Complete	$4.47
Rate for Payer: BCBS Trust/PPO	$2,070.41
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Mclaren Medicaid	$4.26
Rate for Payer: Meridian Medicaid	$4.47
Rate for Payer: Priority Health Choice Medicaid	$4.26
Rate for Payer: Priority Health Cigna Priority Health	$18.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.46
Rate for Payer: Priority Health Narrow Network	$9.46
Rate for Payer: Priority Health SBD	$9.46

PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R

Professional

Both

$16.00

Service Code	HCPCS 93041
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$1,926.71
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: BCBS Trust/PPO	$1,926.71
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.51
Rate for Payer: Priority Health Narrow Network	$8.51
Rate for Payer: Priority Health SBD	$8.51

PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT

Professional

Both

$44.00

Service Code	HCPCS 93040
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$2,312.90
Rate for Payer: Aetna Commercial	$16.57
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$2,312.90
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	$17.97
Rate for Payer: Priority Health Narrow Network	$17.97
Rate for Payer: Priority Health SBD	$17.97

PR RHYTIDECTOMY 3 HOURS

Professional

Both

$4,800.00

Service Code	HCPCS 00539
Hospital Revenue Code	990
Min. Negotiated Rate	$1,920.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: BCBS Complete	$1,920.00
Rate for Payer: Cash Price	$3,840.00
Rate for Payer: Priority Health Cigna Priority Health	$3,360.00

PR RHYTIDECTOMY SMAS FLAP

Professional

Both

$4,800.00

Service Code	HCPCS 15829
Min. Negotiated Rate	$129.77
Max. Negotiated Rate	$3,360.00
Rate for Payer: Aetna Commercial	$2,885.67
Rate for Payer: BCBS Complete	$1,920.00
Rate for Payer: BCBS Trust/PPO	$129.77
Rate for Payer: Cash Price	$3,840.00
Rate for Payer: Cash Price	$3,840.00
Rate for Payer: Priority Health Cigna Priority Health	$3,360.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,276.80
Rate for Payer: Priority Health Narrow Network	$3,276.80
Rate for Payer: Priority Health SBD	$3,276.80

PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT

Professional

Both

$437.00

Service Code	HCPCS 93451
Min. Negotiated Rate	$174.80
Max. Negotiated Rate	$1,711.69
Rate for Payer: Aetna Commercial	$1,160.68
Rate for Payer: BCBS Complete	$174.80
Rate for Payer: BCBS Trust/PPO	$1,711.69
Rate for Payer: Cash Price	$349.60
Rate for Payer: Cash Price	$349.60
Rate for Payer: Priority Health Cigna Priority Health	$305.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.16
Rate for Payer: Priority Health Narrow Network	$180.16
Rate for Payer: Priority Health SBD	$1,229.46

PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART

Professional

Both

$322.00

Service Code	HCPCS 35697
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$1,973.73
Rate for Payer: Aetna Commercial	$199.90
Rate for Payer: BCBS Complete	$95.50
Rate for Payer: BCBS Trust/PPO	$1,973.73
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Mclaren Medicaid	$90.95
Rate for Payer: Meridian Medicaid	$95.50
Rate for Payer: Priority Health Choice Medicaid	$90.95
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$227.15
Rate for Payer: Priority Health Narrow Network	$227.15
Rate for Payer: Priority Health SBD	$227.15

PR RINGERS LACTATE INFUSION

Professional

Both

$30.00

Service Code	HCPCS J7120
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$0.74
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 RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF

Facility

$2,580.00

Service Code	CPT 24342
Hospital Charge Code	24342
Min. Negotiated Rate	$1,625.40
Max. Negotiated Rate	$2,322.00
Rate for Payer: Aetna Commercial	$2,193.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,677.00
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Cofinity Commercial	$1,806.00
Rate for Payer: Cofinity Commercial	$2,218.80
Rate for Payer: Healthscope Commercial	$2,322.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,193.00
Rate for Payer: PHP Commercial	$2,193.00
Rate for Payer: Priority Health Cigna Priority Health	$1,806.00
Rate for Payer: Priority Health SBD	$1,625.40

PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF

Professional

Both

$2,580.00

Service Code	HCPCS 24342
Min. Negotiated Rate	$117.28
Max. Negotiated Rate	$1,806.00
Rate for Payer: Aetna Commercial	$1,036.16
Rate for Payer: BCBS Complete	$525.80
Rate for Payer: BCBS Trust/PPO	$117.28
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Mclaren Medicaid	$500.76
Rate for Payer: Meridian Medicaid	$525.80
Rate for Payer: Priority Health Choice Medicaid	$500.76
Rate for Payer: Priority Health Cigna Priority Health	$1,806.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,191.35
Rate for Payer: Priority Health Narrow Network	$1,191.35
Rate for Payer: Priority Health SBD	$1,191.35

PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF

Professional

Both

$2,580.00

Service Code	HCPCS 24342
Hospital Charge Code	24342
Min. Negotiated Rate	$117.28
Max. Negotiated Rate	$1,806.00
Rate for Payer: Aetna Commercial	$1,036.16
Rate for Payer: BCBS Complete	$525.80
Rate for Payer: BCBS Trust/PPO	$117.28
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Mclaren Medicaid	$500.76
Rate for Payer: Meridian Medicaid	$525.80
Rate for Payer: Priority Health Choice Medicaid	$500.76
Rate for Payer: Priority Health Cigna Priority Health	$1,806.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,191.35
Rate for Payer: Priority Health Narrow Network	$1,191.35
Rate for Payer: Priority Health SBD	$1,191.35

PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF

Facility

$2,580.00

Service Code	CPT 24342
Hospital Charge Code	24342
Min. Negotiated Rate	$769.82
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Commercial	$2,193.00
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,677.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$2,601.57
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Cash Price	$2,064.00
Rate for Payer: Cofinity Commercial	$1,806.00
Rate for Payer: Cofinity Commercial	$2,218.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$2,322.00
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,193.00
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$2,193.00
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$1,806.00
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health SBD	$1,625.40
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$846.80
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$769.82
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM

Professional

Both

$91.47

Service Code	HCPCS 90682
Min. Negotiated Rate	$36.59
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$73.40
Rate for Payer: BCBS Complete	$36.59
Rate for Payer: BCBS Trust/PPO	$73.62
Rate for Payer: Cash Price	$73.18
Rate for Payer: Cash Price	$73.18
Rate for Payer: Priority Health Cigna Priority Health	$64.03

PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I

Professional

Both

$2,862.00

Service Code	HCPCS 93461
Min. Negotiated Rate	$567.45
Max. Negotiated Rate	$2,003.40
Rate for Payer: Aetna Commercial	$1,897.18
Rate for Payer: BCBS Complete	$1,144.80
Rate for Payer: BCBS Trust/PPO	$716.90
Rate for Payer: Cash Price	$2,289.60
Rate for Payer: Cash Price	$2,289.60
Rate for Payer: Priority Health Cigna Priority Health	$2,003.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$567.45
Rate for Payer: Priority Health Narrow Network	$567.45
Rate for Payer: Priority Health SBD	$1,941.12

Know your out-of-pocket cost for care.

All Charges