Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC CONTRAST BATHS EACH 15 MIN

Facility

$103.70

Service Code	CPT 97034
Hospital Charge Code	42000017
Hospital Revenue Code	420
Min. Negotiated Rate	$65.33
Max. Negotiated Rate	$93.33
Rate for Payer: Aetna Commercial	$88.14
Rate for Payer: Aetna New Business (MI Preferred)	$67.40
Rate for Payer: Cash Price	$82.96
Rate for Payer: Cofinity Commercial	$72.59
Rate for Payer: Cofinity Commercial	$89.18
Rate for Payer: Healthscope Commercial	$93.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.14
Rate for Payer: PHP Commercial	$88.14
Rate for Payer: Priority Health Cigna Priority Health	$72.59
Rate for Payer: Priority Health SBD	$65.33

HC CONTRAST BATHS EACH 15 MIN

Facility

$103.70

Service Code	CPT 97034
Hospital Charge Code	42000017
Hospital Revenue Code	420
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$93.33
Rate for Payer: Aetna Commercial	$88.14
Rate for Payer: Aetna New Business (MI Preferred)	$67.40
Rate for Payer: BCBS Complete	$41.48
Rate for Payer: BCBS Trust/PPO	$9.60
Rate for Payer: Cash Price	$82.96
Rate for Payer: Cash Price	$82.96
Rate for Payer: Cofinity Commercial	$89.18
Rate for Payer: Cofinity Commercial	$72.59
Rate for Payer: Healthscope Commercial	$93.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.14
Rate for Payer: PHP Commercial	$88.14
Rate for Payer: Priority Health Cigna Priority Health	$72.59
Rate for Payer: Priority Health SBD	$65.33
Rate for Payer: UHC All Payor (Choice/PPO)	$15.12
Rate for Payer: UHC Exchange	$13.75

HC CONTROL NOSEBLEED ANTERIOR SIMPLE

Facility

$406.51

Service Code	CPT 30901
Hospital Charge Code	45000011
Hospital Revenue Code	761
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$365.86
Rate for Payer: Aetna Commercial	$345.53
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$264.23
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$100.08
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$325.21
Rate for Payer: Cash Price	$325.21
Rate for Payer: Cofinity Commercial	$349.60
Rate for Payer: Cofinity Commercial	$284.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$365.86
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$345.53
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$345.53
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health Cigna Priority Health	$284.56
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Priority Health SBD	$256.10
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$60.87
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$55.34
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC CONTROL NOSEBLEED ANTERIOR SIMPLE

Facility

$406.51

Service Code	CPT 30901
Hospital Charge Code	45000011
Hospital Revenue Code	761
Min. Negotiated Rate	$256.10
Max. Negotiated Rate	$365.86
Rate for Payer: Aetna Commercial	$345.53
Rate for Payer: Aetna New Business (MI Preferred)	$264.23
Rate for Payer: Cash Price	$325.21
Rate for Payer: Cofinity Commercial	$284.56
Rate for Payer: Cofinity Commercial	$349.60
Rate for Payer: Healthscope Commercial	$365.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$345.53
Rate for Payer: PHP Commercial	$345.53
Rate for Payer: Priority Health Cigna Priority Health	$284.56
Rate for Payer: Priority Health SBD	$256.10

HC CONTROL OROPHARYNGEAL HEM SIMPLE

Facility

$738.99

Service Code	CPT 42960
Hospital Charge Code	45000100
Hospital Revenue Code	450
Min. Negotiated Rate	$159.46
Max. Negotiated Rate	$1,408.21
Rate for Payer: Aetna Commercial	$628.14
Rate for Payer: Aetna Medicare	$509.15
Rate for Payer: Aetna New Business (MI Preferred)	$480.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$611.96
Rate for Payer: Amish Plain Church Group Commercial	$611.96
Rate for Payer: BCBS Complete	$281.21
Rate for Payer: BCBS MAPPO	$489.57
Rate for Payer: BCBS Trust/PPO	$285.56
Rate for Payer: BCN Medicare Advantage	$489.57
Rate for Payer: Cash Price	$591.19
Rate for Payer: Cash Price	$591.19
Rate for Payer: Cofinity Commercial	$517.29
Rate for Payer: Cofinity Commercial	$635.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$489.57
Rate for Payer: Healthscope Commercial	$665.09
Rate for Payer: Mclaren Medicaid	$267.79
Rate for Payer: Mclaren Medicare	$489.57
Rate for Payer: Meridian Medicaid	$281.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$514.05
Rate for Payer: MI Amish Medical Board Commercial	$563.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$628.14
Rate for Payer: PACE Medicare	$465.09
Rate for Payer: PACE SWMI	$489.57
Rate for Payer: PHP Commercial	$628.14
Rate for Payer: PHP Medicare Advantage	$489.57
Rate for Payer: Priority Health Choice Medicaid	$267.79
Rate for Payer: Priority Health Cigna Priority Health	$517.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,408.21
Rate for Payer: Priority Health Medicare	$489.57
Rate for Payer: Priority Health Narrow Network	$1,126.56
Rate for Payer: Priority Health SBD	$465.56
Rate for Payer: Railroad Medicare Medicare	$489.57
Rate for Payer: UHC All Payor (Choice/PPO)	$175.41
Rate for Payer: UHC Dual Complete DSNP	$489.57
Rate for Payer: UHC Exchange	$159.46
Rate for Payer: UHC Medicare Advantage	$504.26
Rate for Payer: VA VA	$489.57

HC CONTROL OROPHARYNGEAL HEM SIMPLE

Facility

$738.99

Service Code	CPT 42960
Hospital Charge Code	45000100
Hospital Revenue Code	450
Min. Negotiated Rate	$465.56
Max. Negotiated Rate	$665.09
Rate for Payer: Aetna Commercial	$628.14
Rate for Payer: Aetna New Business (MI Preferred)	$480.34
Rate for Payer: Cash Price	$591.19
Rate for Payer: Cofinity Commercial	$517.29
Rate for Payer: Cofinity Commercial	$635.53
Rate for Payer: Healthscope Commercial	$665.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$628.14
Rate for Payer: PHP Commercial	$628.14
Rate for Payer: Priority Health Cigna Priority Health	$517.29
Rate for Payer: Priority Health SBD	$465.56

HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE

Facility

$1,316.00

Service Code	CPT 42960
Hospital Charge Code	76100478
Hospital Revenue Code	761
Min. Negotiated Rate	$159.46
Max. Negotiated Rate	$1,408.21
Rate for Payer: Aetna Commercial	$1,118.60
Rate for Payer: Aetna Medicare	$509.15
Rate for Payer: Aetna New Business (MI Preferred)	$855.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$611.96
Rate for Payer: Amish Plain Church Group Commercial	$611.96
Rate for Payer: BCBS Complete	$281.21
Rate for Payer: BCBS MAPPO	$489.57
Rate for Payer: BCBS Trust/PPO	$285.56
Rate for Payer: BCN Medicare Advantage	$489.57
Rate for Payer: Cash Price	$1,052.80
Rate for Payer: Cash Price	$1,052.80
Rate for Payer: Cofinity Commercial	$1,131.76
Rate for Payer: Cofinity Commercial	$921.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$489.57
Rate for Payer: Healthscope Commercial	$1,184.40
Rate for Payer: Mclaren Medicaid	$267.79
Rate for Payer: Mclaren Medicare	$489.57
Rate for Payer: Meridian Medicaid	$281.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$514.05
Rate for Payer: MI Amish Medical Board Commercial	$563.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,118.60
Rate for Payer: PACE Medicare	$465.09
Rate for Payer: PACE SWMI	$489.57
Rate for Payer: PHP Commercial	$1,118.60
Rate for Payer: PHP Medicare Advantage	$489.57
Rate for Payer: Priority Health Choice Medicaid	$267.79
Rate for Payer: Priority Health Cigna Priority Health	$921.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,408.21
Rate for Payer: Priority Health Medicare	$489.57
Rate for Payer: Priority Health Narrow Network	$1,126.56
Rate for Payer: Priority Health SBD	$829.08
Rate for Payer: Railroad Medicare Medicare	$489.57
Rate for Payer: UHC All Payor (Choice/PPO)	$175.41
Rate for Payer: UHC Dual Complete DSNP	$489.57
Rate for Payer: UHC Exchange	$159.46
Rate for Payer: UHC Medicare Advantage	$504.26
Rate for Payer: VA VA	$489.57

HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE

Facility

$1,316.00

Service Code	CPT 42960
Hospital Charge Code	76100478
Hospital Revenue Code	761
Min. Negotiated Rate	$829.08
Max. Negotiated Rate	$1,184.40
Rate for Payer: Aetna Commercial	$1,118.60
Rate for Payer: Aetna New Business (MI Preferred)	$855.40
Rate for Payer: Cash Price	$1,052.80
Rate for Payer: Cofinity Commercial	$1,131.76
Rate for Payer: Cofinity Commercial	$921.20
Rate for Payer: Healthscope Commercial	$1,184.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,118.60
Rate for Payer: PHP Commercial	$1,118.60
Rate for Payer: Priority Health Cigna Priority Health	$921.20
Rate for Payer: Priority Health SBD	$829.08

HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL

Facility

$3,610.82

Service Code	CPT 47535
Hospital Charge Code	36100492
Hospital Revenue Code	361
Min. Negotiated Rate	$185.99
Max. Negotiated Rate	$5,427.00
Rate for Payer: Aetna Commercial	$3,069.20
Rate for Payer: Aetna Medicare	$3,201.53
Rate for Payer: Aetna New Business (MI Preferred)	$2,347.03
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	$2,108.16
Rate for Payer: BCN Medicare Advantage	$3,078.39
Rate for Payer: Cash Price	$2,888.66
Rate for Payer: Cash Price	$2,888.66
Rate for Payer: Cofinity Commercial	$3,105.31
Rate for Payer: Cofinity Commercial	$2,527.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,078.39
Rate for Payer: Healthscope Commercial	$3,249.74
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	$3,069.20
Rate for Payer: PACE Medicare	$2,924.47
Rate for Payer: PACE SWMI	$3,078.39
Rate for Payer: PHP Commercial	$3,069.20
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	$2,527.57
Rate for Payer: Priority Health Medicare	$3,078.39
Rate for Payer: Priority Health SBD	$2,274.82
Rate for Payer: Railroad Medicare Medicare	$3,078.39
Rate for Payer: UHC All Payor (Choice/PPO)	$204.59
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,078.39
Rate for Payer: UHC Exchange	$185.99
Rate for Payer: UHC Medicare Advantage	$3,170.74
Rate for Payer: VA VA	$3,078.39

HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL

Facility

$3,610.82

Service Code	CPT 47535
Hospital Charge Code	36100492
Hospital Revenue Code	361
Min. Negotiated Rate	$2,274.82
Max. Negotiated Rate	$3,249.74
Rate for Payer: Aetna Commercial	$3,069.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,347.03
Rate for Payer: Cash Price	$2,888.66
Rate for Payer: Cofinity Commercial	$2,527.57
Rate for Payer: Cofinity Commercial	$3,105.31
Rate for Payer: Healthscope Commercial	$3,249.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,069.20
Rate for Payer: PHP Commercial	$3,069.20
Rate for Payer: Priority Health Cigna Priority Health	$2,527.57
Rate for Payer: Priority Health SBD	$2,274.82

HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH

Facility

$1,180.78

Service Code	CPT 50434
Hospital Charge Code	36100506
Hospital Revenue Code	361
Min. Negotiated Rate	$743.89
Max. Negotiated Rate	$1,062.70
Rate for Payer: Aetna Commercial	$1,003.66
Rate for Payer: Aetna New Business (MI Preferred)	$767.51
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cofinity Commercial	$826.55
Rate for Payer: Cofinity Commercial	$1,015.47
Rate for Payer: Healthscope Commercial	$1,062.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,003.66
Rate for Payer: PHP Commercial	$1,003.66
Rate for Payer: Priority Health Cigna Priority Health	$826.55
Rate for Payer: Priority Health SBD	$743.89

HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH

Facility

$1,180.78

Service Code	CPT 50434
Hospital Charge Code	36100506
Hospital Revenue Code	361
Min. Negotiated Rate	$182.06
Max. Negotiated Rate	$5,575.00
Rate for Payer: Aetna Commercial	$1,003.66
Rate for Payer: Aetna Medicare	$1,884.83
Rate for Payer: Aetna New Business (MI Preferred)	$767.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,265.42
Rate for Payer: Amish Plain Church Group Commercial	$2,265.42
Rate for Payer: BCBS Complete	$1,041.01
Rate for Payer: BCBS MAPPO	$1,812.34
Rate for Payer: BCBS Trust/PPO	$502.23
Rate for Payer: BCN Medicare Advantage	$1,812.34
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cofinity Commercial	$1,015.47
Rate for Payer: Cofinity Commercial	$826.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,812.34
Rate for Payer: Healthscope Commercial	$1,062.70
Rate for Payer: Mclaren Medicaid	$991.35
Rate for Payer: Mclaren Medicare	$1,812.34
Rate for Payer: Meridian Medicaid	$1,041.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,902.96
Rate for Payer: MI Amish Medical Board Commercial	$2,084.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,003.66
Rate for Payer: PACE Medicare	$1,721.72
Rate for Payer: PACE SWMI	$1,812.34
Rate for Payer: PHP Commercial	$1,003.66
Rate for Payer: PHP Medicare Advantage	$1,812.34
Rate for Payer: Priority Health Choice Medicaid	$991.35
Rate for Payer: Priority Health Cigna Priority Health	$826.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,575.00
Rate for Payer: Priority Health Medicare	$1,812.34
Rate for Payer: Priority Health Narrow Network	$4,460.00
Rate for Payer: Priority Health SBD	$743.89
Rate for Payer: Railroad Medicare Medicare	$1,812.34
Rate for Payer: UHC All Payor (Choice/PPO)	$200.27
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$1,812.34
Rate for Payer: UHC Exchange	$182.06
Rate for Payer: UHC Medicare Advantage	$1,866.71
Rate for Payer: VA VA	$1,812.34

HC CONVEX WAFER

Facility

$55.92

Hospital Charge Code	27000049
Hospital Revenue Code	270
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$50.33
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna New Business (MI Preferred)	$36.35
Rate for Payer: Cash Price	$44.74
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Cofinity Commercial	$48.09
Rate for Payer: Healthscope Commercial	$50.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.53
Rate for Payer: PHP Commercial	$47.53
Rate for Payer: Priority Health Cigna Priority Health	$39.14
Rate for Payer: Priority Health SBD	$35.23

HC CONVEX WAFER

Facility

$55.92

Hospital Charge Code	27000049
Hospital Revenue Code	270
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$50.33
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna New Business (MI Preferred)	$36.35
Rate for Payer: BCBS Complete	$22.37
Rate for Payer: Cash Price	$44.74
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Cofinity Commercial	$48.09
Rate for Payer: Healthscope Commercial	$50.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.53
Rate for Payer: PHP Commercial	$47.53
Rate for Payer: Priority Health Cigna Priority Health	$39.14
Rate for Payer: Priority Health SBD	$35.23

HC COOK GUIDEWIRE

Facility

$46.93

Service Code	HCPCS C1769
Hospital Charge Code	27200019
Hospital Revenue Code	272
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$42.24
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.85
Rate for Payer: Cofinity Commercial	$40.36
Rate for Payer: Healthscope Commercial	$42.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.89
Rate for Payer: PHP Commercial	$39.89
Rate for Payer: Priority Health Cigna Priority Health	$32.85
Rate for Payer: Priority Health SBD	$29.57

HC COOK GUIDEWIRE

Facility

$46.93

Service Code	HCPCS C1769
Hospital Charge Code	27200019
Hospital Revenue Code	272
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$42.24
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: BCBS Complete	$18.77
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.85
Rate for Payer: Cofinity Commercial	$40.36
Rate for Payer: Healthscope Commercial	$42.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.89
Rate for Payer: PHP Commercial	$39.89
Rate for Payer: Priority Health Cigna Priority Health	$32.85
Rate for Payer: Priority Health SBD	$29.57

HC COOK PIGTAIL

Facility

$459.14

Hospital Charge Code	27200233
Hospital Revenue Code	272
Min. Negotiated Rate	$183.66
Max. Negotiated Rate	$413.23
Rate for Payer: Aetna Commercial	$390.27
Rate for Payer: Aetna New Business (MI Preferred)	$298.44
Rate for Payer: BCBS Complete	$183.66
Rate for Payer: Cash Price	$367.31
Rate for Payer: Cofinity Commercial	$321.40
Rate for Payer: Cofinity Commercial	$394.86
Rate for Payer: Healthscope Commercial	$413.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$390.27
Rate for Payer: PHP Commercial	$390.27
Rate for Payer: Priority Health Cigna Priority Health	$321.40
Rate for Payer: Priority Health SBD	$289.26

HC COOK PIGTAIL

Facility

$459.14

Hospital Charge Code	27200233
Hospital Revenue Code	272
Min. Negotiated Rate	$289.26
Max. Negotiated Rate	$413.23
Rate for Payer: Aetna Commercial	$390.27
Rate for Payer: Aetna New Business (MI Preferred)	$298.44
Rate for Payer: Cash Price	$367.31
Rate for Payer: Cofinity Commercial	$321.40
Rate for Payer: Cofinity Commercial	$394.86
Rate for Payer: Healthscope Commercial	$413.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$390.27
Rate for Payer: PHP Commercial	$390.27
Rate for Payer: Priority Health Cigna Priority Health	$321.40
Rate for Payer: Priority Health SBD	$289.26

HC COOLIEF RF PROBE

Facility

$1,875.00

Hospital Charge Code	27200355
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,593.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,218.75
Rate for Payer: BCBS Complete	$750.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Cofinity Commercial	$1,312.50
Rate for Payer: Cofinity Commercial	$1,612.50
Rate for Payer: Healthscope Commercial	$1,687.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,593.75
Rate for Payer: PHP Commercial	$1,593.75
Rate for Payer: Priority Health Cigna Priority Health	$1,312.50
Rate for Payer: Priority Health SBD	$1,181.25

HC COOLIEF RF PROBE

Facility

$1,875.00

Hospital Charge Code	27200355
Hospital Revenue Code	272
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,593.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,218.75
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Cofinity Commercial	$1,312.50
Rate for Payer: Cofinity Commercial	$1,612.50
Rate for Payer: Healthscope Commercial	$1,687.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,593.75
Rate for Payer: PHP Commercial	$1,593.75
Rate for Payer: Priority Health Cigna Priority Health	$1,312.50
Rate for Payer: Priority Health SBD	$1,181.25

HC COPPER SERUM

Facility

$44.00

Service Code	CPT 82525
Hospital Charge Code	30100170
Hospital Revenue Code	301
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna New Business (MI Preferred)	$28.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cofinity Commercial	$30.80
Rate for Payer: Cofinity Commercial	$37.84
Rate for Payer: Healthscope Commercial	$39.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.40
Rate for Payer: PHP Commercial	$37.40
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health SBD	$27.72

HC COPPER SERUM

Facility

$44.00

Service Code	CPT 82525
Hospital Charge Code	30100170
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna Medicare	$12.91
Rate for Payer: Aetna New Business (MI Preferred)	$28.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.51
Rate for Payer: Amish Plain Church Group Commercial	$15.51
Rate for Payer: BCBS Complete	$7.13
Rate for Payer: BCBS MAPPO	$12.41
Rate for Payer: BCBS Trust/PPO	$9.72
Rate for Payer: BCN Medicare Advantage	$12.41
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cofinity Commercial	$37.84
Rate for Payer: Cofinity Commercial	$30.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.41
Rate for Payer: Healthscope Commercial	$39.60
Rate for Payer: Mclaren Medicaid	$6.79
Rate for Payer: Mclaren Medicare	$12.41
Rate for Payer: Meridian Medicaid	$7.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13.03
Rate for Payer: MI Amish Medical Board Commercial	$14.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.40
Rate for Payer: PACE Medicare	$11.79
Rate for Payer: PACE SWMI	$12.41
Rate for Payer: PHP Commercial	$37.40
Rate for Payer: PHP Medicare Advantage	$12.41
Rate for Payer: Priority Health Choice Medicaid	$6.79
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health Medicare	$12.41
Rate for Payer: Priority Health SBD	$27.72
Rate for Payer: Railroad Medicare Medicare	$12.41
Rate for Payer: UHC All Payor (Choice/PPO)	$14.89
Rate for Payer: UHC Core	$21.10
Rate for Payer: UHC Dual Complete DSNP	$12.41
Rate for Payer: UHC Exchange	$12.41
Rate for Payer: UHC Medicare Advantage	$12.78
Rate for Payer: VA VA	$12.41

HC COPPER URINE

Facility

$62.00

Service Code	CPT 82525
Hospital Charge Code	30100171
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna Commercial	$52.70
Rate for Payer: Aetna Medicare	$12.91
Rate for Payer: Aetna New Business (MI Preferred)	$40.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.51
Rate for Payer: Amish Plain Church Group Commercial	$15.51
Rate for Payer: BCBS Complete	$7.13
Rate for Payer: BCBS MAPPO	$12.41
Rate for Payer: BCBS Trust/PPO	$9.72
Rate for Payer: BCN Medicare Advantage	$12.41
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Cofinity Commercial	$53.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.41
Rate for Payer: Healthscope Commercial	$55.80
Rate for Payer: Mclaren Medicaid	$6.79
Rate for Payer: Mclaren Medicare	$12.41
Rate for Payer: Meridian Medicaid	$7.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13.03
Rate for Payer: MI Amish Medical Board Commercial	$14.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: PACE Medicare	$11.79
Rate for Payer: PACE SWMI	$12.41
Rate for Payer: PHP Commercial	$52.70
Rate for Payer: PHP Medicare Advantage	$12.41
Rate for Payer: Priority Health Choice Medicaid	$6.79
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health Medicare	$12.41
Rate for Payer: Priority Health SBD	$39.06
Rate for Payer: Railroad Medicare Medicare	$12.41
Rate for Payer: UHC All Payor (Choice/PPO)	$14.89
Rate for Payer: UHC Core	$21.10
Rate for Payer: UHC Dual Complete DSNP	$12.41
Rate for Payer: UHC Exchange	$12.41
Rate for Payer: UHC Medicare Advantage	$12.78
Rate for Payer: VA VA	$12.41

HC COPPER URINE

Facility

$62.00

Service Code	CPT 82525
Hospital Charge Code	30100171
Hospital Revenue Code	301
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna Commercial	$52.70
Rate for Payer: Aetna New Business (MI Preferred)	$40.30
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$53.32
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Healthscope Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: PHP Commercial	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health SBD	$39.06

HC CORDIS CATHETER

Facility

$192.76

Service Code	HCPCS C1751
Hospital Charge Code	27200021
Hospital Revenue Code	272
Min. Negotiated Rate	$121.44
Max. Negotiated Rate	$173.48
Rate for Payer: Aetna Commercial	$163.85
Rate for Payer: Aetna New Business (MI Preferred)	$125.29
Rate for Payer: Cash Price	$154.21
Rate for Payer: Cofinity Commercial	$134.93
Rate for Payer: Cofinity Commercial	$165.77
Rate for Payer: Healthscope Commercial	$173.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$163.85
Rate for Payer: PHP Commercial	$163.85
Rate for Payer: Priority Health Cigna Priority Health	$134.93
Rate for Payer: Priority Health SBD	$121.44

Know your out-of-pocket cost for care.

All Charges