Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BACITRACIN 4 OZ

Facility

$30.37

Hospital Charge Code	27100007
Hospital Revenue Code	271
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$27.33
Rate for Payer: Aetna Commercial	$25.81
Rate for Payer: Aetna New Business (MI Preferred)	$19.74
Rate for Payer: BCBS Complete	$12.15
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cofinity Commercial	$21.26
Rate for Payer: Cofinity Commercial	$26.12
Rate for Payer: Healthscope Commercial	$27.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.81
Rate for Payer: PHP Commercial	$25.81
Rate for Payer: Priority Health Cigna Priority Health	$21.26
Rate for Payer: Priority Health SBD	$19.13

HC BACK SCREEN

Facility

$51.00

Hospital Charge Code	42000047
Hospital Revenue Code	420
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health SBD	$32.13
Rate for Payer: UHC Core	$37.74

HC BACK SCREEN

Facility

$51.00

Hospital Charge Code	42000047
Hospital Revenue Code	420
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health SBD	$32.13

HC BACK SCREEN, VBISD

Facility

$68.34

Hospital Charge Code	43000014
Hospital Revenue Code	430
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$61.51
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna New Business (MI Preferred)	$44.42
Rate for Payer: BCBS Complete	$27.34
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cofinity Commercial	$47.84
Rate for Payer: Cofinity Commercial	$58.77
Rate for Payer: Healthscope Commercial	$61.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.09
Rate for Payer: PHP Commercial	$58.09
Rate for Payer: Priority Health Cigna Priority Health	$47.84
Rate for Payer: Priority Health SBD	$43.05
Rate for Payer: UHC Core	$50.57

HC BACK SCREEN, VBISD

Facility

$68.34

Hospital Charge Code	43000014
Hospital Revenue Code	430
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$61.51
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna New Business (MI Preferred)	$44.42
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cofinity Commercial	$47.84
Rate for Payer: Cofinity Commercial	$58.77
Rate for Payer: Healthscope Commercial	$61.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.09
Rate for Payer: PHP Commercial	$58.09
Rate for Payer: Priority Health Cigna Priority Health	$47.84
Rate for Payer: Priority Health SBD	$43.05

HC BACTERIAL VAGINOSIS PANEL

Facility

$150.00

Service Code	CPT 0352U
Hospital Charge Code	30600337
Hospital Revenue Code	306
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC BACTERIAL VAGINOSIS PANEL

Facility

$150.00

Service Code	CPT 0352U
Hospital Charge Code	30600337
Hospital Revenue Code	306
Min. Negotiated Rate	$78.02
Max. Negotiated Rate	$178.29
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare	$148.34
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$178.29
Rate for Payer: Amish Plain Church Group Commercial	$178.29
Rate for Payer: BCBS Complete	$81.93
Rate for Payer: BCBS MAPPO	$142.63
Rate for Payer: BCN Medicare Advantage	$142.63
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$142.63
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Mclaren Medicaid	$78.02
Rate for Payer: Mclaren Medicare	$142.63
Rate for Payer: Meridian Medicaid	$81.93
Rate for Payer: Meridian Wellcare - Medicare Advantage	$149.76
Rate for Payer: MI Amish Medical Board Commercial	$164.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PACE Medicare	$135.50
Rate for Payer: PACE SWMI	$142.63
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: PHP Medicare Advantage	$142.63
Rate for Payer: Priority Health Choice Medicaid	$78.02
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health Medicare	$142.63
Rate for Payer: Priority Health SBD	$94.50
Rate for Payer: Railroad Medicare Medicare	$142.63
Rate for Payer: UHC All Payor (Choice/PPO)	$171.16
Rate for Payer: UHC Core	$171.16
Rate for Payer: UHC Dual Complete DSNP	$142.63
Rate for Payer: UHC Exchange	$142.63
Rate for Payer: UHC Medicare Advantage	$146.91
Rate for Payer: VA VA	$142.63

HC BAG BLOOD TRANSFER

Facility

$8.70

Hospital Charge Code	27000161
Hospital Revenue Code	270
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$7.83
Rate for Payer: Aetna Commercial	$7.40
Rate for Payer: Aetna New Business (MI Preferred)	$5.66
Rate for Payer: BCBS Complete	$3.48
Rate for Payer: Cash Price	$6.96
Rate for Payer: Cofinity Commercial	$6.09
Rate for Payer: Cofinity Commercial	$7.48
Rate for Payer: Healthscope Commercial	$7.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.40
Rate for Payer: PHP Commercial	$7.40
Rate for Payer: Priority Health Cigna Priority Health	$6.09
Rate for Payer: Priority Health SBD	$5.48

HC BAG BLOOD TRANSFER

Facility

$8.70

Hospital Charge Code	27000161
Hospital Revenue Code	270
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$7.83
Rate for Payer: Aetna Commercial	$7.40
Rate for Payer: Aetna New Business (MI Preferred)	$5.66
Rate for Payer: Cash Price	$6.96
Rate for Payer: Cofinity Commercial	$6.09
Rate for Payer: Cofinity Commercial	$7.48
Rate for Payer: Healthscope Commercial	$7.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.40
Rate for Payer: PHP Commercial	$7.40
Rate for Payer: Priority Health Cigna Priority Health	$6.09
Rate for Payer: Priority Health SBD	$5.48

HC BAG WASTE

Facility

$63.00

Hospital Charge Code	27000670
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna Commercial	$53.55
Rate for Payer: Aetna New Business (MI Preferred)	$40.95
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cofinity Commercial	$44.10
Rate for Payer: Cofinity Commercial	$54.18
Rate for Payer: Healthscope Commercial	$56.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.55
Rate for Payer: PHP Commercial	$53.55
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health SBD	$39.69

HC BAG WASTE

Facility

$63.00

Hospital Charge Code	27000670
Hospital Revenue Code	270
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna Commercial	$53.55
Rate for Payer: Aetna New Business (MI Preferred)	$40.95
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cofinity Commercial	$44.10
Rate for Payer: Cofinity Commercial	$54.18
Rate for Payer: Healthscope Commercial	$56.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.55
Rate for Payer: PHP Commercial	$53.55
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health SBD	$39.69

HC BALLOON DILITATION URETER

Facility

$733.86

Service Code	CPT 50706
Hospital Charge Code	36100512
Hospital Revenue Code	361
Min. Negotiated Rate	$171.91
Max. Negotiated Rate	$2,557.00
Rate for Payer: Aetna Commercial	$623.78
Rate for Payer: Aetna New Business (MI Preferred)	$477.01
Rate for Payer: BCBS Complete	$293.54
Rate for Payer: BCBS Trust/PPO	$2,557.00
Rate for Payer: Cash Price	$587.09
Rate for Payer: Cash Price	$587.09
Rate for Payer: Cofinity Commercial	$631.12
Rate for Payer: Cofinity Commercial	$513.70
Rate for Payer: Healthscope Commercial	$660.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$623.78
Rate for Payer: PHP Commercial	$623.78
Rate for Payer: Priority Health Cigna Priority Health	$513.70
Rate for Payer: Priority Health SBD	$462.33
Rate for Payer: UHC All Payor (Choice/PPO)	$189.10
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$171.91

HC BALLOON DILITATION URETER

Facility

$733.86

Service Code	CPT 50706
Hospital Charge Code	36100512
Hospital Revenue Code	361
Min. Negotiated Rate	$462.33
Max. Negotiated Rate	$660.47
Rate for Payer: Aetna Commercial	$623.78
Rate for Payer: Aetna New Business (MI Preferred)	$477.01
Rate for Payer: Cash Price	$587.09
Rate for Payer: Cofinity Commercial	$631.12
Rate for Payer: Cofinity Commercial	$513.70
Rate for Payer: Healthscope Commercial	$660.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$623.78
Rate for Payer: PHP Commercial	$623.78
Rate for Payer: Priority Health Cigna Priority Health	$513.70
Rate for Payer: Priority Health SBD	$462.33

HC BALLOON PUMP SETUP

Facility

$1,887.28

Hospital Charge Code	27000090
Hospital Revenue Code	270
Min. Negotiated Rate	$1,188.99
Max. Negotiated Rate	$1,698.55
Rate for Payer: Aetna Commercial	$1,604.19
Rate for Payer: Aetna New Business (MI Preferred)	$1,226.73
Rate for Payer: Cash Price	$1,509.82
Rate for Payer: Cofinity Commercial	$1,321.10
Rate for Payer: Cofinity Commercial	$1,623.06
Rate for Payer: Healthscope Commercial	$1,698.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,604.19
Rate for Payer: PHP Commercial	$1,604.19
Rate for Payer: Priority Health Cigna Priority Health	$1,321.10
Rate for Payer: Priority Health SBD	$1,188.99

HC BALLOON PUMP SETUP

Facility

$1,887.28

Hospital Charge Code	27000090
Hospital Revenue Code	270
Min. Negotiated Rate	$754.91
Max. Negotiated Rate	$1,698.55
Rate for Payer: Aetna Commercial	$1,604.19
Rate for Payer: Aetna New Business (MI Preferred)	$1,226.73
Rate for Payer: BCBS Complete	$754.91
Rate for Payer: Cash Price	$1,509.82
Rate for Payer: Cofinity Commercial	$1,321.10
Rate for Payer: Cofinity Commercial	$1,623.06
Rate for Payer: Healthscope Commercial	$1,698.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,604.19
Rate for Payer: PHP Commercial	$1,604.19
Rate for Payer: Priority Health Cigna Priority Health	$1,321.10
Rate for Payer: Priority Health SBD	$1,188.99

HC BALLOONS CATH TRANSLUMINAL LVL 1

Facility

$80.85

Service Code	HCPCS C1725
Hospital Charge Code	27200262
Hospital Revenue Code	272
Min. Negotiated Rate	$50.94
Max. Negotiated Rate	$72.76
Rate for Payer: Aetna Commercial	$68.72
Rate for Payer: Aetna New Business (MI Preferred)	$52.55
Rate for Payer: Cash Price	$64.68
Rate for Payer: Cofinity Commercial	$56.60
Rate for Payer: Cofinity Commercial	$69.53
Rate for Payer: Healthscope Commercial	$72.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.72
Rate for Payer: PHP Commercial	$68.72
Rate for Payer: Priority Health Cigna Priority Health	$56.60
Rate for Payer: Priority Health SBD	$50.94

HC BALLOONS CATH TRANSLUMINAL LVL 1

Facility

$80.85

Service Code	HCPCS C1725
Hospital Charge Code	27200262
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$72.76
Rate for Payer: Aetna Commercial	$68.72
Rate for Payer: Aetna New Business (MI Preferred)	$52.55
Rate for Payer: BCBS Complete	$32.34
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$64.68
Rate for Payer: Cash Price	$64.68
Rate for Payer: Cofinity Commercial	$56.60
Rate for Payer: Cofinity Commercial	$69.53
Rate for Payer: Healthscope Commercial	$72.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.72
Rate for Payer: PHP Commercial	$68.72
Rate for Payer: Priority Health Cigna Priority Health	$56.60
Rate for Payer: Priority Health SBD	$50.94

HC BALLOONS CATH TRANSLUMINAL LVL 2

Facility

$244.19

Service Code	HCPCS C1725
Hospital Charge Code	27200263
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$219.77
Rate for Payer: Aetna Commercial	$207.56
Rate for Payer: Aetna New Business (MI Preferred)	$158.72
Rate for Payer: BCBS Complete	$97.68
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$195.35
Rate for Payer: Cash Price	$195.35
Rate for Payer: Cofinity Commercial	$170.93
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Healthscope Commercial	$219.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.56
Rate for Payer: PHP Commercial	$207.56
Rate for Payer: Priority Health Cigna Priority Health	$170.93
Rate for Payer: Priority Health SBD	$153.84

HC BALLOONS CATH TRANSLUMINAL LVL 2

Facility

$244.19

Service Code	HCPCS C1725
Hospital Charge Code	27200263
Hospital Revenue Code	272
Min. Negotiated Rate	$153.84
Max. Negotiated Rate	$219.77
Rate for Payer: Aetna Commercial	$207.56
Rate for Payer: Aetna New Business (MI Preferred)	$158.72
Rate for Payer: Cash Price	$195.35
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Commercial	$170.93
Rate for Payer: Healthscope Commercial	$219.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.56
Rate for Payer: PHP Commercial	$207.56
Rate for Payer: Priority Health Cigna Priority Health	$170.93
Rate for Payer: Priority Health SBD	$153.84

HC BALLOONS CATH TRANSLUMINAL LVL 3

Facility

$412.78

Service Code	HCPCS C1725
Hospital Charge Code	27200053
Hospital Revenue Code	272
Min. Negotiated Rate	$260.05
Max. Negotiated Rate	$371.50
Rate for Payer: Aetna Commercial	$350.86
Rate for Payer: Aetna New Business (MI Preferred)	$268.31
Rate for Payer: Cash Price	$330.22
Rate for Payer: Cofinity Commercial	$288.95
Rate for Payer: Cofinity Commercial	$354.99
Rate for Payer: Healthscope Commercial	$371.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.86
Rate for Payer: PHP Commercial	$350.86
Rate for Payer: Priority Health Cigna Priority Health	$288.95
Rate for Payer: Priority Health SBD	$260.05

HC BALLOONS CATH TRANSLUMINAL LVL 3

Facility

$412.78

Service Code	HCPCS C1725
Hospital Charge Code	27200053
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$371.50
Rate for Payer: Aetna Commercial	$350.86
Rate for Payer: Aetna New Business (MI Preferred)	$268.31
Rate for Payer: BCBS Complete	$165.11
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$330.22
Rate for Payer: Cash Price	$330.22
Rate for Payer: Cofinity Commercial	$288.95
Rate for Payer: Cofinity Commercial	$354.99
Rate for Payer: Healthscope Commercial	$371.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.86
Rate for Payer: PHP Commercial	$350.86
Rate for Payer: Priority Health Cigna Priority Health	$288.95
Rate for Payer: Priority Health SBD	$260.05

HC BALLOONS CATH TRANSLUMINAL LVL 4

Facility

$576.58

Service Code	HCPCS C1725
Hospital Charge Code	27200078
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$518.92
Rate for Payer: Aetna Commercial	$490.09
Rate for Payer: Aetna New Business (MI Preferred)	$374.78
Rate for Payer: BCBS Complete	$230.63
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$461.26
Rate for Payer: Cash Price	$461.26
Rate for Payer: Cofinity Commercial	$403.61
Rate for Payer: Cofinity Commercial	$495.86
Rate for Payer: Healthscope Commercial	$518.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$490.09
Rate for Payer: PHP Commercial	$490.09
Rate for Payer: Priority Health Cigna Priority Health	$403.61
Rate for Payer: Priority Health SBD	$363.25

HC BALLOONS CATH TRANSLUMINAL LVL 4

Facility

$576.58

Service Code	HCPCS C1725
Hospital Charge Code	27200078
Hospital Revenue Code	272
Min. Negotiated Rate	$363.25
Max. Negotiated Rate	$518.92
Rate for Payer: Aetna Commercial	$490.09
Rate for Payer: Aetna New Business (MI Preferred)	$374.78
Rate for Payer: Cash Price	$461.26
Rate for Payer: Cofinity Commercial	$403.61
Rate for Payer: Cofinity Commercial	$495.86
Rate for Payer: Healthscope Commercial	$518.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$490.09
Rate for Payer: PHP Commercial	$490.09
Rate for Payer: Priority Health Cigna Priority Health	$403.61
Rate for Payer: Priority Health SBD	$363.25

HC BALLOONS CATH TRANSLUMINAL LVL 5

Facility

$678.00

Service Code	HCPCS C1725
Hospital Charge Code	27200016
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$610.20
Rate for Payer: Aetna Commercial	$576.30
Rate for Payer: Aetna New Business (MI Preferred)	$440.70
Rate for Payer: BCBS Complete	$271.20
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cofinity Commercial	$474.60
Rate for Payer: Cofinity Commercial	$583.08
Rate for Payer: Healthscope Commercial	$610.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$576.30
Rate for Payer: PHP Commercial	$576.30
Rate for Payer: Priority Health Cigna Priority Health	$474.60
Rate for Payer: Priority Health SBD	$427.14

HC BALLOONS CATH TRANSLUMINAL LVL 5

Facility

$678.00

Service Code	HCPCS C1725
Hospital Charge Code	27200016
Hospital Revenue Code	272
Min. Negotiated Rate	$427.14
Max. Negotiated Rate	$610.20
Rate for Payer: Aetna Commercial	$576.30
Rate for Payer: Aetna New Business (MI Preferred)	$440.70
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cofinity Commercial	$474.60
Rate for Payer: Cofinity Commercial	$583.08
Rate for Payer: Healthscope Commercial	$610.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$576.30
Rate for Payer: PHP Commercial	$576.30
Rate for Payer: Priority Health Cigna Priority Health	$474.60
Rate for Payer: Priority Health SBD	$427.14

Know your out-of-pocket cost for care.

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