Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED

Facility

$2,051.00

Service Code	CPT 49521
Hospital Charge Code	49521
Hospital Revenue Code	960
Min. Negotiated Rate	$707.93
Max. Negotiated Rate	$8,414.74
Rate for Payer: Aetna Commercial	$1,743.35
Rate for Payer: Aetna Medicare	$7,001.06
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,414.74
Rate for Payer: Amish Plain Church Group Commercial	$8,414.74
Rate for Payer: BCBS Complete	$3,866.74
Rate for Payer: BCBS MAPPO	$6,731.79
Rate for Payer: BCBS Trust/PPO	$1,472.51
Rate for Payer: BCN Medicare Advantage	$6,731.79
Rate for Payer: Cash Price	$1,640.80
Rate for Payer: Cash Price	$1,640.80
Rate for Payer: Cofinity Commercial	$1,763.86
Rate for Payer: Cofinity Commercial	$1,435.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,731.79
Rate for Payer: Healthscope Commercial	$1,845.90
Rate for Payer: Mclaren Medicaid	$3,682.29
Rate for Payer: Mclaren Medicare	$6,731.79
Rate for Payer: Meridian Medicaid	$3,866.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,068.38
Rate for Payer: MI Amish Medical Board Commercial	$7,741.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,743.35
Rate for Payer: PACE Medicare	$6,395.20
Rate for Payer: PACE SWMI	$6,731.79
Rate for Payer: PHP Commercial	$1,743.35
Rate for Payer: PHP Medicare Advantage	$6,731.79
Rate for Payer: Priority Health Choice Medicaid	$3,682.29
Rate for Payer: Priority Health Cigna Priority Health	$1,435.70
Rate for Payer: Priority Health Medicare	$6,731.79
Rate for Payer: Priority Health SBD	$1,292.13
Rate for Payer: Railroad Medicare Medicare	$6,731.79
Rate for Payer: UHC All Payor (Choice/PPO)	$778.72
Rate for Payer: UHC Dual Complete DSNP	$6,731.79
Rate for Payer: UHC Exchange	$707.93
Rate for Payer: UHC Medicare Advantage	$6,933.74
Rate for Payer: VA VA	$6,731.79

PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED

Professional

Both

$2,051.00

Service Code	HCPCS 49521
Min. Negotiated Rate	$134.72
Max. Negotiated Rate	$1,435.70
Rate for Payer: Aetna Commercial	$967.53
Rate for Payer: BCBS Complete	$483.54
Rate for Payer: BCBS Trust/PPO	$134.72
Rate for Payer: Cash Price	$1,640.80
Rate for Payer: Cash Price	$1,640.80
Rate for Payer: Mclaren Medicaid	$460.51
Rate for Payer: Meridian Medicaid	$483.54
Rate for Payer: Priority Health Choice Medicaid	$460.51
Rate for Payer: Priority Health Cigna Priority Health	$1,435.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,264.13
Rate for Payer: Priority Health Narrow Network	$1,264.13
Rate for Payer: Priority Health SBD	$1,264.13

PR RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT

Professional

Both

$4,381.00

Service Code	HCPCS 38115
Min. Negotiated Rate	$710.04
Max. Negotiated Rate	$3,066.70
Rate for Payer: Aetna Commercial	$1,592.12
Rate for Payer: BCBS Complete	$865.30
Rate for Payer: BCBS Trust/PPO	$710.04
Rate for Payer: Cash Price	$3,504.80
Rate for Payer: Cash Price	$3,504.80
Rate for Payer: Mclaren Medicaid	$824.10
Rate for Payer: Meridian Medicaid	$865.30
Rate for Payer: Priority Health Choice Medicaid	$824.10
Rate for Payer: Priority Health Cigna Priority Health	$3,066.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,790.15
Rate for Payer: Priority Health Narrow Network	$2,790.15
Rate for Payer: Priority Health SBD	$2,790.15

PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE

Professional

Both

$1,932.00

Service Code	HCPCS 49600
Min. Negotiated Rate	$472.43
Max. Negotiated Rate	$2,035.01
Rate for Payer: Aetna Commercial	$991.65
Rate for Payer: BCBS Complete	$496.05
Rate for Payer: BCBS Trust/PPO	$2,035.01
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Mclaren Medicaid	$472.43
Rate for Payer: Meridian Medicaid	$496.05
Rate for Payer: Priority Health Choice Medicaid	$472.43
Rate for Payer: Priority Health Cigna Priority Health	$1,352.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,296.48
Rate for Payer: Priority Health Narrow Network	$1,296.48
Rate for Payer: Priority Health SBD	$1,296.48

PR RPR SPIGELIAN HERNIA

Professional

Both

$1,594.00

Service Code	HCPCS 49590
Min. Negotiated Rate	$637.60
Max. Negotiated Rate	$1,115.80
Rate for Payer: BCBS Complete	$637.60
Rate for Payer: Cash Price	$1,275.20
Rate for Payer: Priority Health Cigna Priority Health	$1,115.80

PR RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL

Professional

Both

$7,731.00

Service Code	HCPCS 38780
Min. Negotiated Rate	$672.02
Max. Negotiated Rate	$5,411.70
Rate for Payer: Aetna Commercial	$1,285.27
Rate for Payer: BCBS Complete	$705.62
Rate for Payer: BCBS Trust/PPO	$957.28
Rate for Payer: Cash Price	$6,184.80
Rate for Payer: Cash Price	$6,184.80
Rate for Payer: Mclaren Medicaid	$672.02
Rate for Payer: Meridian Medicaid	$705.62
Rate for Payer: Priority Health Choice Medicaid	$672.02
Rate for Payer: Priority Health Cigna Priority Health	$5,411.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,243.29
Rate for Payer: Priority Health Narrow Network	$2,243.29
Rate for Payer: Priority Health SBD	$2,243.29

PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON

Professional

Both

$1,228.00

Service Code	HCPCS 28200
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$1,084.07
Rate for Payer: Aetna Commercial	$428.78
Rate for Payer: BCBS Complete	$221.63
Rate for Payer: BCBS Trust/PPO	$1,084.07
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cash Price	$982.40
Rate for Payer: Mclaren Medicaid	$211.08
Rate for Payer: Meridian Medicaid	$221.63
Rate for Payer: Priority Health Choice Medicaid	$211.08
Rate for Payer: Priority Health Cigna Priority Health	$859.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$498.91
Rate for Payer: Priority Health Narrow Network	$498.91
Rate for Payer: Priority Health SBD	$498.91

PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS

Professional

Both

$1,229.00

Service Code	HCPCS 25263
Min. Negotiated Rate	$413.22
Max. Negotiated Rate	$3,601.42
Rate for Payer: Aetna Commercial	$843.92
Rate for Payer: BCBS Complete	$433.88
Rate for Payer: BCBS Trust/PPO	$3,601.42
Rate for Payer: Cash Price	$983.20
Rate for Payer: Cash Price	$983.20
Rate for Payer: Mclaren Medicaid	$413.22
Rate for Payer: Meridian Medicaid	$433.88
Rate for Payer: Priority Health Choice Medicaid	$413.22
Rate for Payer: Priority Health Cigna Priority Health	$860.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$980.44
Rate for Payer: Priority Health Narrow Network	$980.44
Rate for Payer: Priority Health SBD	$980.44

PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU

Professional

Both

$1,668.00

Service Code	HCPCS 25260
Min. Negotiated Rate	$413.22
Max. Negotiated Rate	$1,459.69
Rate for Payer: Aetna Commercial	$841.29
Rate for Payer: BCBS Complete	$433.88
Rate for Payer: BCBS Trust/PPO	$1,459.69
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Mclaren Medicaid	$413.22
Rate for Payer: Meridian Medicaid	$433.88
Rate for Payer: Priority Health Choice Medicaid	$413.22
Rate for Payer: Priority Health Cigna Priority Health	$1,167.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$982.49
Rate for Payer: Priority Health Narrow Network	$982.49
Rate for Payer: Priority Health SBD	$982.49

PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN

Professional

Both

$1,390.00

Service Code	HCPCS 25270
Min. Negotiated Rate	$322.91
Max. Negotiated Rate	$3,579.76
Rate for Payer: Aetna Commercial	$656.88
Rate for Payer: BCBS Complete	$339.06
Rate for Payer: BCBS Trust/PPO	$3,579.76
Rate for Payer: Cash Price	$1,112.00
Rate for Payer: Cash Price	$1,112.00
Rate for Payer: Mclaren Medicaid	$322.91
Rate for Payer: Meridian Medicaid	$339.06
Rate for Payer: Priority Health Choice Medicaid	$322.91
Rate for Payer: Priority Health Cigna Priority Health	$973.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$765.98
Rate for Payer: Priority Health Narrow Network	$765.98
Rate for Payer: Priority Health SBD	$765.98

PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU

Professional

Both

$1,589.00

Service Code	HCPCS 25272
Min. Negotiated Rate	$365.30
Max. Negotiated Rate	$3,566.55
Rate for Payer: Aetna Commercial	$747.23
Rate for Payer: BCBS Complete	$383.56
Rate for Payer: BCBS Trust/PPO	$3,566.55
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Mclaren Medicaid	$365.30
Rate for Payer: Meridian Medicaid	$383.56
Rate for Payer: Priority Health Choice Medicaid	$365.30
Rate for Payer: Priority Health Cigna Priority Health	$1,112.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$866.58
Rate for Payer: Priority Health Narrow Network	$866.58
Rate for Payer: Priority Health SBD	$866.58

PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT

Professional

Both

$1,985.00

Service Code	HCPCS 25275
Min. Negotiated Rate	$436.86
Max. Negotiated Rate	$1,389.50
Rate for Payer: Aetna Commercial	$894.15
Rate for Payer: BCBS Complete	$458.70
Rate for Payer: BCBS Trust/PPO	$1,102.56
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Mclaren Medicaid	$436.86
Rate for Payer: Meridian Medicaid	$458.70
Rate for Payer: Priority Health Choice Medicaid	$436.86
Rate for Payer: Priority Health Cigna Priority Health	$1,389.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,037.64
Rate for Payer: Priority Health Narrow Network	$1,037.64
Rate for Payer: Priority Health SBD	$1,037.64

PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON

Professional

Both

$928.00

Service Code	HCPCS 28210
Min. Negotiated Rate	$273.49
Max. Negotiated Rate	$912.90
Rate for Payer: Aetna Commercial	$564.04
Rate for Payer: BCBS Complete	$287.16
Rate for Payer: BCBS Trust/PPO	$912.90
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cash Price	$742.40
Rate for Payer: Mclaren Medicaid	$273.49
Rate for Payer: Meridian Medicaid	$287.16
Rate for Payer: Priority Health Choice Medicaid	$273.49
Rate for Payer: Priority Health Cigna Priority Health	$649.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$649.04
Rate for Payer: Priority Health Narrow Network	$649.04
Rate for Payer: Priority Health SBD	$649.04

PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS

Professional

Both

$8,520.00

Service Code	HCPCS 33877
Min. Negotiated Rate	$2,114.78
Max. Negotiated Rate	$5,964.00
Rate for Payer: Aetna Commercial	$4,855.61
Rate for Payer: BCBS Complete	$2,362.42
Rate for Payer: BCBS Trust/PPO	$2,114.78
Rate for Payer: Cash Price	$6,816.00
Rate for Payer: Cash Price	$6,816.00
Rate for Payer: Mclaren Medicaid	$2,249.92
Rate for Payer: Meridian Medicaid	$2,362.42
Rate for Payer: Priority Health Choice Medicaid	$2,249.92
Rate for Payer: Priority Health Cigna Priority Health	$5,964.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,602.04
Rate for Payer: Priority Health Narrow Network	$5,602.04
Rate for Payer: Priority Health SBD	$5,602.04

PR RPR/TRAUMATIC AV FISTULA EXTREMITIES

Professional

Both

$1,511.00

Service Code	HCPCS 35190
Min. Negotiated Rate	$474.78
Max. Negotiated Rate	$1,192.11
Rate for Payer: Aetna Commercial	$1,022.68
Rate for Payer: BCBS Complete	$498.52
Rate for Payer: BCBS Trust/PPO	$706.87
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Mclaren Medicaid	$474.78
Rate for Payer: Meridian Medicaid	$498.52
Rate for Payer: Priority Health Choice Medicaid	$474.78
Rate for Payer: Priority Health Cigna Priority Health	$1,057.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,192.11
Rate for Payer: Priority Health Narrow Network	$1,192.11
Rate for Payer: Priority Health SBD	$1,192.11

PR RPR/TRAUMATIC AV FISTULA HEAD & NECK

Professional

Both

$4,157.00

Service Code	HCPCS 35188
Min. Negotiated Rate	$833.26
Max. Negotiated Rate	$2,909.90
Rate for Payer: Aetna Commercial	$1,718.98
Rate for Payer: BCBS Complete	$874.92
Rate for Payer: BCBS Trust/PPO	$933.51
Rate for Payer: Cash Price	$3,325.60
Rate for Payer: Cash Price	$3,325.60
Rate for Payer: Mclaren Medicaid	$833.26
Rate for Payer: Meridian Medicaid	$874.92
Rate for Payer: Priority Health Choice Medicaid	$833.26
Rate for Payer: Priority Health Cigna Priority Health	$2,909.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,060.80
Rate for Payer: Priority Health Narrow Network	$2,060.80
Rate for Payer: Priority Health SBD	$2,060.80

PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE

Professional

Both

$618.00

Service Code	HCPCS 55060
Min. Negotiated Rate	$243.67
Max. Negotiated Rate	$1,220.90
Rate for Payer: Aetna Commercial	$486.63
Rate for Payer: BCBS Complete	$255.85
Rate for Payer: BCBS Trust/PPO	$1,220.90
Rate for Payer: Cash Price	$494.40
Rate for Payer: Cash Price	$494.40
Rate for Payer: Mclaren Medicaid	$243.67
Rate for Payer: Meridian Medicaid	$255.85
Rate for Payer: Priority Health Choice Medicaid	$243.67
Rate for Payer: Priority Health Cigna Priority Health	$432.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$609.53
Rate for Payer: Priority Health Narrow Network	$609.53
Rate for Payer: Priority Health SBD	$609.53

PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP

Professional

Both

$439.00

Service Code	HCPCS 36575
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$1,177.58
Rate for Payer: Aetna Commercial	$46.01
Rate for Payer: BCBS Complete	$21.91
Rate for Payer: BCBS Trust/PPO	$1,177.58
Rate for Payer: Cash Price	$351.20
Rate for Payer: Cash Price	$351.20
Rate for Payer: Mclaren Medicaid	$20.87
Rate for Payer: Meridian Medicaid	$21.91
Rate for Payer: Priority Health Choice Medicaid	$20.87
Rate for Payer: Priority Health Cigna Priority Health	$307.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$52.13
Rate for Payer: Priority Health Narrow Network	$52.13
Rate for Payer: Priority Health SBD	$52.13

PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED

Professional

Both

$1,434.00

Service Code	HCPCS 49582
Min. Negotiated Rate	$573.60
Max. Negotiated Rate	$1,003.80
Rate for Payer: BCBS Complete	$573.60
Rate for Payer: Cash Price	$1,147.20
Rate for Payer: Priority Health Cigna Priority Health	$1,003.80

PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE

Professional

Both

$1,243.00

Service Code	HCPCS 49580
Min. Negotiated Rate	$497.20
Max. Negotiated Rate	$870.10
Rate for Payer: BCBS Complete	$497.20
Rate for Payer: Cash Price	$994.40
Rate for Payer: Priority Health Cigna Priority Health	$870.10

PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED

Professional

Both

$1,652.00

Service Code	HCPCS 49587
Min. Negotiated Rate	$660.80
Max. Negotiated Rate	$1,156.40
Rate for Payer: BCBS Complete	$660.80
Rate for Payer: Cash Price	$1,321.60
Rate for Payer: Priority Health Cigna Priority Health	$1,156.40

PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE

Professional

Both

$1,434.00

Service Code	HCPCS 49585
Min. Negotiated Rate	$573.60
Max. Negotiated Rate	$1,003.80
Rate for Payer: BCBS Complete	$573.60
Rate for Payer: Cash Price	$1,147.20
Rate for Payer: Priority Health Cigna Priority Health	$1,003.80

PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC

Professional

Both

$7,883.00

Service Code	HCPCS 33414
Min. Negotiated Rate	$509.28
Max. Negotiated Rate	$5,518.10
Rate for Payer: Aetna Commercial	$2,886.79
Rate for Payer: BCBS Complete	$1,413.69
Rate for Payer: BCBS Trust/PPO	$509.28
Rate for Payer: Cash Price	$6,306.40
Rate for Payer: Cash Price	$6,306.40
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	$5,518.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,348.67
Rate for Payer: Priority Health Narrow Network	$3,348.67
Rate for Payer: Priority Health SBD	$3,348.67

PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER

Professional

Both

$2,768.00

Service Code	HCPCS 26428
Min. Negotiated Rate	$98.26
Max. Negotiated Rate	$1,937.60
Rate for Payer: Aetna Commercial	$1,057.07
Rate for Payer: BCBS Complete	$541.68
Rate for Payer: BCBS Trust/PPO	$98.26
Rate for Payer: Cash Price	$2,214.40
Rate for Payer: Cash Price	$2,214.40
Rate for Payer: Mclaren Medicaid	$515.89
Rate for Payer: Meridian Medicaid	$541.68
Rate for Payer: Priority Health Choice Medicaid	$515.89
Rate for Payer: Priority Health Cigna Priority Health	$1,937.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,239.34
Rate for Payer: Priority Health Narrow Network	$1,239.34
Rate for Payer: Priority Health SBD	$1,239.34

PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR

Professional

Both

$1,944.00

Service Code	HCPCS 26426
Min. Negotiated Rate	$195.47
Max. Negotiated Rate	$1,360.80
Rate for Payer: Aetna Commercial	$669.62
Rate for Payer: BCBS Complete	$345.54
Rate for Payer: BCBS Trust/PPO	$195.47
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Mclaren Medicaid	$329.09
Rate for Payer: Meridian Medicaid	$345.54
Rate for Payer: Priority Health Choice Medicaid	$329.09
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$780.79
Rate for Payer: Priority Health Narrow Network	$780.79
Rate for Payer: Priority Health SBD	$780.79

Know your out-of-pocket cost for care.

All Charges