Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT

Professional

Both

$1,944.00

Service Code	HCPCS 26540
Min. Negotiated Rate	$400.45
Max. Negotiated Rate	$1,360.80
Rate for Payer: Aetna Commercial	$924.08
Rate for Payer: BCBS Complete	$475.92
Rate for Payer: BCBS Trust/PPO	$400.45
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Mclaren Medicaid	$453.26
Rate for Payer: Meridian Medicaid	$475.92
Rate for Payer: Priority Health Choice Medicaid	$453.26
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,088.71
Rate for Payer: Priority Health Narrow Network	$1,088.71
Rate for Payer: Priority Health SBD	$1,088.71

PR RPR COMPONENT INFLATABLE PENILE PROSTHESIS

Professional

Both

$1,475.00

Service Code	HCPCS 54408
Min. Negotiated Rate	$503.96
Max. Negotiated Rate	$2,176.77
Rate for Payer: Aetna Commercial	$1,014.50
Rate for Payer: BCBS Complete	$529.16
Rate for Payer: BCBS Trust/PPO	$2,176.77
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Mclaren Medicaid	$503.96
Rate for Payer: Meridian Medicaid	$529.16
Rate for Payer: Priority Health Choice Medicaid	$503.96
Rate for Payer: Priority Health Cigna Priority Health	$1,032.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,261.74
Rate for Payer: Priority Health Narrow Network	$1,261.74
Rate for Payer: Priority Health SBD	$1,261.74

PR RPR CONGENITAL AV FISTULA EXTREMITIES

Professional

Both

$4,140.00

Service Code	HCPCS 35184
Min. Negotiated Rate	$602.79
Max. Negotiated Rate	$2,898.00
Rate for Payer: Aetna Commercial	$1,296.30
Rate for Payer: BCBS Complete	$632.93
Rate for Payer: BCBS Trust/PPO	$669.36
Rate for Payer: Cash Price	$3,312.00
Rate for Payer: Cash Price	$3,312.00
Rate for Payer: Mclaren Medicaid	$602.79
Rate for Payer: Meridian Medicaid	$632.93
Rate for Payer: Priority Health Choice Medicaid	$602.79
Rate for Payer: Priority Health Cigna Priority Health	$2,898.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,498.52
Rate for Payer: Priority Health Narrow Network	$1,498.52
Rate for Payer: Priority Health SBD	$1,498.52

PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS

Professional

Both

$5,695.00

Service Code	HCPCS 33500
Min. Negotiated Rate	$426.34
Max. Negotiated Rate	$3,986.50
Rate for Payer: Aetna Commercial	$2,094.69
Rate for Payer: BCBS Complete	$1,024.99
Rate for Payer: BCBS Trust/PPO	$426.34
Rate for Payer: Cash Price	$4,556.00
Rate for Payer: Cash Price	$4,556.00
Rate for Payer: Mclaren Medicaid	$976.18
Rate for Payer: Meridian Medicaid	$1,024.99
Rate for Payer: Priority Health Choice Medicaid	$976.18
Rate for Payer: Priority Health Cigna Priority Health	$3,986.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,433.71
Rate for Payer: Priority Health Narrow Network	$2,433.71
Rate for Payer: Priority Health SBD	$2,433.71

PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT

Professional

Both

$835.00

Service Code	HCPCS 36576
Min. Negotiated Rate	$115.66
Max. Negotiated Rate	$1,186.03
Rate for Payer: Aetna Commercial	$245.57
Rate for Payer: BCBS Complete	$121.44
Rate for Payer: BCBS Trust/PPO	$1,186.03
Rate for Payer: Cash Price	$668.00
Rate for Payer: Cash Price	$668.00
Rate for Payer: Mclaren Medicaid	$115.66
Rate for Payer: Meridian Medicaid	$121.44
Rate for Payer: Priority Health Choice Medicaid	$115.66
Rate for Payer: Priority Health Cigna Priority Health	$584.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$288.32
Rate for Payer: Priority Health Narrow Network	$288.32
Rate for Payer: Priority Health SBD	$288.32

PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT

Professional

Both

$5,875.00

Service Code	HCPCS 39540
Min. Negotiated Rate	$552.74
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$887.30
Rate for Payer: BCBS Complete	$580.38
Rate for Payer: BCBS Trust/PPO	$676.75
Rate for Payer: Cash Price	$4,700.00
Rate for Payer: Cash Price	$4,700.00
Rate for Payer: Mclaren Medicaid	$552.74
Rate for Payer: Meridian Medicaid	$580.38
Rate for Payer: Priority Health Choice Medicaid	$552.74
Rate for Payer: Priority Health Cigna Priority Health	$4,112.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,368.73
Rate for Payer: Priority Health Narrow Network	$1,368.73
Rate for Payer: Priority Health SBD	$1,368.73

PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC

Professional

Both

$1,678.00

Service Code	HCPCS 39541
Min. Negotiated Rate	$509.28
Max. Negotiated Rate	$1,476.72
Rate for Payer: Aetna Commercial	$964.34
Rate for Payer: BCBS Complete	$623.53
Rate for Payer: BCBS Trust/PPO	$509.28
Rate for Payer: Cash Price	$1,342.40
Rate for Payer: Cash Price	$1,342.40
Rate for Payer: Mclaren Medicaid	$593.84
Rate for Payer: Meridian Medicaid	$623.53
Rate for Payer: Priority Health Choice Medicaid	$593.84
Rate for Payer: Priority Health Cigna Priority Health	$1,174.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,476.72
Rate for Payer: Priority Health Narrow Network	$1,476.72
Rate for Payer: Priority Health SBD	$1,476.72

PR RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY

Professional

Both

$1,275.00

Service Code	HCPCS 27675
Min. Negotiated Rate	$221.89
Max. Negotiated Rate	$892.50
Rate for Payer: Aetna Commercial	$654.05
Rate for Payer: BCBS Complete	$336.60
Rate for Payer: BCBS Trust/PPO	$221.89
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Mclaren Medicaid	$320.57
Rate for Payer: Meridian Medicaid	$336.60
Rate for Payer: Priority Health Choice Medicaid	$320.57
Rate for Payer: Priority Health Cigna Priority Health	$892.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$762.90
Rate for Payer: Priority Health Narrow Network	$762.90
Rate for Payer: Priority Health SBD	$762.90

PR RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM

Professional

Both

$1,890.04

Service Code	HCPCS 63707
Min. Negotiated Rate	$608.97
Max. Negotiated Rate	$1,608.08
Rate for Payer: Aetna Commercial	$1,204.37
Rate for Payer: BCBS Complete	$639.42
Rate for Payer: BCBS Trust/PPO	$1,181.28
Rate for Payer: Cash Price	$1,512.03
Rate for Payer: Cash Price	$1,512.03
Rate for Payer: Mclaren Medicaid	$608.97
Rate for Payer: Meridian Medicaid	$639.42
Rate for Payer: Priority Health Choice Medicaid	$608.97
Rate for Payer: Priority Health Cigna Priority Health	$1,323.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,608.08
Rate for Payer: Priority Health Narrow Network	$1,608.08
Rate for Payer: Priority Health SBD	$1,608.08

PR RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM

Professional

Both

$5,910.00

Service Code	HCPCS 63709
Min. Negotiated Rate	$722.07
Max. Negotiated Rate	$4,137.00
Rate for Payer: Aetna Commercial	$1,435.43
Rate for Payer: BCBS Complete	$758.17
Rate for Payer: BCBS Trust/PPO	$1,064.00
Rate for Payer: Cash Price	$4,728.00
Rate for Payer: Cash Price	$4,728.00
Rate for Payer: Mclaren Medicaid	$722.07
Rate for Payer: Meridian Medicaid	$758.17
Rate for Payer: Priority Health Choice Medicaid	$722.07
Rate for Payer: Priority Health Cigna Priority Health	$4,137.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,904.22
Rate for Payer: Priority Health Narrow Network	$1,904.22
Rate for Payer: Priority Health SBD	$1,904.22

PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY

Professional

Both

$5,729.00

Service Code	HCPCS 62120
Min. Negotiated Rate	$1,110.49
Max. Negotiated Rate	$4,010.30
Rate for Payer: Aetna Commercial	$2,715.90
Rate for Payer: BCBS Complete	$1,413.69
Rate for Payer: BCBS Trust/PPO	$1,110.49
Rate for Payer: Cash Price	$4,583.20
Rate for Payer: Cash Price	$4,583.20
Rate for Payer: Mclaren Medicaid	$1,346.37
Rate for Payer: Meridian Medicaid	$1,413.69
Rate for Payer: Priority Health Choice Medicaid	$1,346.37
Rate for Payer: Priority Health Cigna Priority Health	$4,010.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,559.85
Rate for Payer: Priority Health Narrow Network	$3,559.85
Rate for Payer: Priority Health SBD	$3,559.85

PR RPR EPIGASTRIC HERNIA INCARCERATED

Professional

Both

$1,459.00

Service Code	HCPCS 49572
Min. Negotiated Rate	$583.60
Max. Negotiated Rate	$1,021.30
Rate for Payer: BCBS Complete	$583.60
Rate for Payer: Cash Price	$1,167.20
Rate for Payer: Priority Health Cigna Priority Health	$1,021.30

PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX

Professional

Both

$1,148.00

Service Code	HCPCS 49570
Min. Negotiated Rate	$459.20
Max. Negotiated Rate	$803.60
Rate for Payer: BCBS Complete	$459.20
Rate for Payer: Cash Price	$918.40
Rate for Payer: Priority Health Cigna Priority Health	$803.60

PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH

Professional

Both

$595.00

Service Code	HCPCS 27664
Min. Negotiated Rate	$235.15
Max. Negotiated Rate	$1,815.77
Rate for Payer: Aetna Commercial	$480.09
Rate for Payer: BCBS Complete	$246.91
Rate for Payer: BCBS Trust/PPO	$1,815.77
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Mclaren Medicaid	$235.15
Rate for Payer: Meridian Medicaid	$246.91
Rate for Payer: Priority Health Choice Medicaid	$235.15
Rate for Payer: Priority Health Cigna Priority Health	$416.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$559.15
Rate for Payer: Priority Health Narrow Network	$559.15
Rate for Payer: Priority Health SBD	$559.15

PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH

Professional

Both

$842.00

Service Code	HCPCS 27665
Min. Negotiated Rate	$275.20
Max. Negotiated Rate	$1,815.77
Rate for Payer: Aetna Commercial	$558.66
Rate for Payer: BCBS Complete	$288.96
Rate for Payer: BCBS Trust/PPO	$1,815.77
Rate for Payer: Cash Price	$673.60
Rate for Payer: Cash Price	$673.60
Rate for Payer: Mclaren Medicaid	$275.20
Rate for Payer: Meridian Medicaid	$288.96
Rate for Payer: Priority Health Choice Medicaid	$275.20
Rate for Payer: Priority Health Cigna Priority Health	$589.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$646.99
Rate for Payer: Priority Health Narrow Network	$646.99
Rate for Payer: Priority Health SBD	$646.99

PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH

Professional

Both

$1,067.00

Service Code	HCPCS 27659
Min. Negotiated Rate	$305.66
Max. Negotiated Rate	$1,861.44
Rate for Payer: Aetna Commercial	$625.38
Rate for Payer: BCBS Complete	$320.94
Rate for Payer: BCBS Trust/PPO	$1,861.44
Rate for Payer: Cash Price	$853.60
Rate for Payer: Cash Price	$853.60
Rate for Payer: Mclaren Medicaid	$305.66
Rate for Payer: Meridian Medicaid	$320.94
Rate for Payer: Priority Health Choice Medicaid	$305.66
Rate for Payer: Priority Health Cigna Priority Health	$746.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$720.53
Rate for Payer: Priority Health Narrow Network	$720.53
Rate for Payer: Priority Health SBD	$720.53

PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR

Professional

Both

$5,448.00

Service Code	HCPCS 46740
Min. Negotiated Rate	$93.51
Max. Negotiated Rate	$3,813.60
Rate for Payer: Aetna Commercial	$2,917.67
Rate for Payer: BCBS Complete	$1,457.98
Rate for Payer: BCBS Trust/PPO	$93.51
Rate for Payer: Cash Price	$4,358.40
Rate for Payer: Cash Price	$4,358.40
Rate for Payer: Mclaren Medicaid	$1,388.55
Rate for Payer: Meridian Medicaid	$1,457.98
Rate for Payer: Priority Health Choice Medicaid	$1,388.55
Rate for Payer: Priority Health Cigna Priority Health	$3,813.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,811.24
Rate for Payer: Priority Health Narrow Network	$3,811.24
Rate for Payer: Priority Health SBD	$3,811.24

PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL

Professional

Both

$5,046.00

Service Code	HCPCS 46742
Min. Negotiated Rate	$477.58
Max. Negotiated Rate	$4,399.21
Rate for Payer: Aetna Commercial	$3,377.01
Rate for Payer: BCBS Complete	$1,682.52
Rate for Payer: BCBS Trust/PPO	$477.58
Rate for Payer: Cash Price	$4,036.80
Rate for Payer: Cash Price	$4,036.80
Rate for Payer: Mclaren Medicaid	$1,602.40
Rate for Payer: Meridian Medicaid	$1,682.52
Rate for Payer: Priority Health Choice Medicaid	$1,602.40
Rate for Payer: Priority Health Cigna Priority Health	$3,532.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,399.21
Rate for Payer: Priority Health Narrow Network	$4,399.21
Rate for Payer: Priority Health SBD	$4,399.21

PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR

Professional

Both

$3,803.00

Service Code	HCPCS 46730
Min. Negotiated Rate	$105.13
Max. Negotiated Rate	$3,495.49
Rate for Payer: Aetna Commercial	$2,672.39
Rate for Payer: BCBS Complete	$1,336.98
Rate for Payer: BCBS Trust/PPO	$105.13
Rate for Payer: Cash Price	$3,042.40
Rate for Payer: Cash Price	$3,042.40
Rate for Payer: Mclaren Medicaid	$1,273.31
Rate for Payer: Meridian Medicaid	$1,336.98
Rate for Payer: Priority Health Choice Medicaid	$1,273.31
Rate for Payer: Priority Health Cigna Priority Health	$2,662.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,495.49
Rate for Payer: Priority Health Narrow Network	$3,495.49
Rate for Payer: Priority Health SBD	$3,495.49

PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE

Professional

Both

$1,946.00

Service Code	HCPCS 54340
Min. Negotiated Rate	$364.02
Max. Negotiated Rate	$2,917.27
Rate for Payer: Aetna Commercial	$730.32
Rate for Payer: BCBS Complete	$382.22
Rate for Payer: BCBS Trust/PPO	$2,917.27
Rate for Payer: Cash Price	$1,556.80
Rate for Payer: Cash Price	$1,556.80
Rate for Payer: Mclaren Medicaid	$364.02
Rate for Payer: Meridian Medicaid	$382.22
Rate for Payer: Priority Health Choice Medicaid	$364.02
Rate for Payer: Priority Health Cigna Priority Health	$1,362.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$909.96
Rate for Payer: Priority Health Narrow Network	$909.96
Rate for Payer: Priority Health SBD	$909.96

PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR

Professional

Both

$7,400.00

Service Code	HCPCS 33660
Min. Negotiated Rate	$1,101.42
Max. Negotiated Rate	$5,180.00
Rate for Payer: Aetna Commercial	$2,358.28
Rate for Payer: BCBS Complete	$1,156.49
Rate for Payer: BCBS Trust/PPO	$1,131.09
Rate for Payer: Cash Price	$5,920.00
Rate for Payer: Cash Price	$5,920.00
Rate for Payer: Mclaren Medicaid	$1,101.42
Rate for Payer: Meridian Medicaid	$1,156.49
Rate for Payer: Priority Health Choice Medicaid	$1,101.42
Rate for Payer: Priority Health Cigna Priority Health	$5,180.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,739.05
Rate for Payer: Priority Health Narrow Network	$2,739.05
Rate for Payer: Priority Health SBD	$2,739.05

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$1,604.00

Service Code	HCPCS 49525
Hospital Charge Code	49525
Min. Negotiated Rate	$369.34
Max. Negotiated Rate	$1,122.80
Rate for Payer: Aetna Commercial	$773.33
Rate for Payer: BCBS Complete	$387.81
Rate for Payer: BCBS Trust/PPO	$515.62
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Mclaren Medicaid	$369.34
Rate for Payer: Meridian Medicaid	$387.81
Rate for Payer: Priority Health Choice Medicaid	$369.34
Rate for Payer: Priority Health Cigna Priority Health	$1,122.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,013.67
Rate for Payer: Priority Health Narrow Network	$1,013.67
Rate for Payer: Priority Health SBD	$1,013.67

PR RPR INGUN HERNIA SLIDING ANY AGE

Facility

$1,604.00

Service Code	CPT 49525
Hospital Charge Code	49525
Hospital Revenue Code	960
Min. Negotiated Rate	$1,010.52
Max. Negotiated Rate	$1,443.60
Rate for Payer: Aetna Commercial	$1,363.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,042.60
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Cofinity Commercial	$1,122.80
Rate for Payer: Cofinity Commercial	$1,379.44
Rate for Payer: Healthscope Commercial	$1,443.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,363.40
Rate for Payer: PHP Commercial	$1,363.40
Rate for Payer: Priority Health Cigna Priority Health	$1,122.80
Rate for Payer: Priority Health SBD	$1,010.52

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$1,604.00

Service Code	HCPCS 49525
Min. Negotiated Rate	$369.34
Max. Negotiated Rate	$1,122.80
Rate for Payer: Aetna Commercial	$773.33
Rate for Payer: BCBS Complete	$387.81
Rate for Payer: BCBS Trust/PPO	$515.62
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Mclaren Medicaid	$369.34
Rate for Payer: Meridian Medicaid	$387.81
Rate for Payer: Priority Health Choice Medicaid	$369.34
Rate for Payer: Priority Health Cigna Priority Health	$1,122.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,013.67
Rate for Payer: Priority Health Narrow Network	$1,013.67
Rate for Payer: Priority Health SBD	$1,013.67

PR RPR INGUN HERNIA SLIDING ANY AGE

Facility

$1,604.00

Service Code	CPT 49525
Hospital Charge Code	49525
Hospital Revenue Code	960
Min. Negotiated Rate	$567.78
Max. Negotiated Rate	$3,847.99
Rate for Payer: Aetna Commercial	$1,363.40
Rate for Payer: Aetna Medicare	$3,201.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,042.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,847.99
Rate for Payer: Amish Plain Church Group Commercial	$3,847.99
Rate for Payer: BCBS Complete	$1,768.23
Rate for Payer: BCBS MAPPO	$3,078.39
Rate for Payer: BCBS Trust/PPO	$1,472.51
Rate for Payer: BCN Medicare Advantage	$3,078.39
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Cash Price	$1,283.20
Rate for Payer: Cofinity Commercial	$1,122.80
Rate for Payer: Cofinity Commercial	$1,379.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,078.39
Rate for Payer: Healthscope Commercial	$1,443.60
Rate for Payer: Mclaren Medicaid	$1,683.88
Rate for Payer: Mclaren Medicare	$3,078.39
Rate for Payer: Meridian Medicaid	$1,768.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,232.31
Rate for Payer: MI Amish Medical Board Commercial	$3,540.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,363.40
Rate for Payer: PACE Medicare	$2,924.47
Rate for Payer: PACE SWMI	$3,078.39
Rate for Payer: PHP Commercial	$1,363.40
Rate for Payer: PHP Medicare Advantage	$3,078.39
Rate for Payer: Priority Health Choice Medicaid	$1,683.88
Rate for Payer: Priority Health Cigna Priority Health	$1,122.80
Rate for Payer: Priority Health Medicare	$3,078.39
Rate for Payer: Priority Health SBD	$1,010.52
Rate for Payer: Railroad Medicare Medicare	$3,078.39
Rate for Payer: UHC All Payor (Choice/PPO)	$624.56
Rate for Payer: UHC Dual Complete DSNP	$3,078.39
Rate for Payer: UHC Exchange	$567.78
Rate for Payer: UHC Medicare Advantage	$3,170.74
Rate for Payer: VA VA	$3,078.39

Know your out-of-pocket cost for care.

All Charges