Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM

Facility

$158.65

Service Code	CPT 17262
Hospital Charge Code	76100127
Hospital Revenue Code	761
Min. Negotiated Rate	$86.65
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$134.85
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$103.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$86.65
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$126.92
Rate for Payer: Cash Price	$126.92
Rate for Payer: Cofinity Commercial	$136.44
Rate for Payer: Cofinity Commercial	$111.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$142.78
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$134.85
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$134.85
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$111.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$99.95
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$119.22
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$108.38
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM

Facility

$158.65

Service Code	CPT 17262
Hospital Charge Code	76100127
Hospital Revenue Code	761
Min. Negotiated Rate	$99.95
Max. Negotiated Rate	$142.78
Rate for Payer: Aetna Commercial	$134.85
Rate for Payer: Aetna New Business (MI Preferred)	$103.12
Rate for Payer: Cash Price	$126.92
Rate for Payer: Cofinity Commercial	$111.06
Rate for Payer: Cofinity Commercial	$136.44
Rate for Payer: Healthscope Commercial	$142.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$134.85
Rate for Payer: PHP Commercial	$134.85
Rate for Payer: Priority Health Cigna Priority Health	$111.06
Rate for Payer: Priority Health SBD	$99.95

HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM

Facility

$522.00

Service Code	CPT 17263
Hospital Charge Code	76100372
Hospital Revenue Code	761
Min. Negotiated Rate	$328.86
Max. Negotiated Rate	$469.80
Rate for Payer: Aetna Commercial	$443.70
Rate for Payer: Aetna New Business (MI Preferred)	$339.30
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cofinity Commercial	$365.40
Rate for Payer: Cofinity Commercial	$448.92
Rate for Payer: Healthscope Commercial	$469.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$443.70
Rate for Payer: PHP Commercial	$443.70
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health SBD	$328.86

HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM

Facility

$522.00

Service Code	CPT 17263
Hospital Charge Code	76100372
Hospital Revenue Code	761
Min. Negotiated Rate	$79.71
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$443.70
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$339.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$79.71
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cofinity Commercial	$448.92
Rate for Payer: Cofinity Commercial	$365.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$469.80
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$443.70
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$443.70
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$328.86
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$131.82
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$119.84
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV

Facility

$400.86

Service Code	CPT 64632
Hospital Charge Code	36100608
Hospital Revenue Code	361
Min. Negotiated Rate	$252.54
Max. Negotiated Rate	$360.77
Rate for Payer: Aetna Commercial	$340.73
Rate for Payer: Aetna New Business (MI Preferred)	$260.56
Rate for Payer: Cash Price	$320.69
Rate for Payer: Cofinity Commercial	$280.60
Rate for Payer: Cofinity Commercial	$344.74
Rate for Payer: Healthscope Commercial	$360.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.73
Rate for Payer: PHP Commercial	$340.73
Rate for Payer: Priority Health Cigna Priority Health	$280.60
Rate for Payer: Priority Health SBD	$252.54

HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV

Facility

$400.86

Service Code	CPT 64632
Hospital Charge Code	36100608
Hospital Revenue Code	361
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$340.73
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$260.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.42
Rate for Payer: Amish Plain Church Group Commercial	$329.42
Rate for Payer: BCBS Complete	$151.38
Rate for Payer: BCBS MAPPO	$263.54
Rate for Payer: BCBS Trust/PPO	$29.64
Rate for Payer: BCN Medicare Advantage	$263.54
Rate for Payer: Cash Price	$320.69
Rate for Payer: Cash Price	$320.69
Rate for Payer: Cofinity Commercial	$280.60
Rate for Payer: Cofinity Commercial	$344.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$360.77
Rate for Payer: Mclaren Medicaid	$144.16
Rate for Payer: Mclaren Medicare	$263.54
Rate for Payer: Meridian Medicaid	$151.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.72
Rate for Payer: MI Amish Medical Board Commercial	$303.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.73
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$340.73
Rate for Payer: PHP Medicare Advantage	$263.54
Rate for Payer: Priority Health Choice Medicaid	$144.16
Rate for Payer: Priority Health Cigna Priority Health	$280.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$813.49
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health Narrow Network	$650.79
Rate for Payer: Priority Health SBD	$252.54
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$72.40
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$65.82
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS

Facility

$276.07

Service Code	CPT 17004
Hospital Charge Code	76100122
Hospital Revenue Code	761
Min. Negotiated Rate	$173.92
Max. Negotiated Rate	$248.46
Rate for Payer: Aetna Commercial	$234.66
Rate for Payer: Aetna New Business (MI Preferred)	$179.45
Rate for Payer: Cash Price	$220.86
Rate for Payer: Cofinity Commercial	$193.25
Rate for Payer: Cofinity Commercial	$237.42
Rate for Payer: Healthscope Commercial	$248.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$234.66
Rate for Payer: PHP Commercial	$234.66
Rate for Payer: Priority Health Cigna Priority Health	$193.25
Rate for Payer: Priority Health SBD	$173.92

HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS

Facility

$276.07

Service Code	CPT 17004
Hospital Charge Code	76100122
Hospital Revenue Code	761
Min. Negotiated Rate	$91.09
Max. Negotiated Rate	$1,118.65
Rate for Payer: Aetna Commercial	$234.66
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$179.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$91.09
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$220.86
Rate for Payer: Cash Price	$220.86
Rate for Payer: Cofinity Commercial	$237.42
Rate for Payer: Cofinity Commercial	$193.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$248.46
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$234.66
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$234.66
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$193.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,118.65
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$894.92
Rate for Payer: Priority Health SBD	$173.92
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$106.26
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$96.60
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION

Facility

$173.07

Service Code	CPT 17000
Hospital Charge Code	76100120
Hospital Revenue Code	761
Min. Negotiated Rate	$54.36
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$147.11
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$112.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$71.26
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$138.46
Rate for Payer: Cash Price	$138.46
Rate for Payer: Cofinity Commercial	$148.84
Rate for Payer: Cofinity Commercial	$121.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$155.76
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.11
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$147.11
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$121.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$109.03
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$59.80
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$54.36
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION

Facility

$173.07

Service Code	CPT 17000
Hospital Charge Code	76100120
Hospital Revenue Code	761
Min. Negotiated Rate	$109.03
Max. Negotiated Rate	$155.76
Rate for Payer: Aetna Commercial	$147.11
Rate for Payer: Aetna New Business (MI Preferred)	$112.50
Rate for Payer: Cash Price	$138.46
Rate for Payer: Cofinity Commercial	$121.15
Rate for Payer: Cofinity Commercial	$148.84
Rate for Payer: Healthscope Commercial	$155.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.11
Rate for Payer: PHP Commercial	$147.11
Rate for Payer: Priority Health Cigna Priority Health	$121.15
Rate for Payer: Priority Health SBD	$109.03

HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH

Facility

$34.78

Service Code	CPT 17003
Hospital Charge Code	76100121
Hospital Revenue Code	761
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$31.30
Rate for Payer: Aetna Commercial	$29.56
Rate for Payer: Aetna New Business (MI Preferred)	$22.61
Rate for Payer: Cash Price	$27.82
Rate for Payer: Cofinity Commercial	$24.35
Rate for Payer: Cofinity Commercial	$29.91
Rate for Payer: Healthscope Commercial	$31.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.56
Rate for Payer: PHP Commercial	$29.56
Rate for Payer: Priority Health Cigna Priority Health	$24.35
Rate for Payer: Priority Health SBD	$21.91

HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH

Facility

$34.78

Service Code	CPT 17003
Hospital Charge Code	76100121
Hospital Revenue Code	761
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$31.30
Rate for Payer: Aetna Commercial	$29.56
Rate for Payer: Aetna New Business (MI Preferred)	$22.61
Rate for Payer: BCBS Complete	$13.91
Rate for Payer: BCBS Trust/PPO	$11.27
Rate for Payer: Cash Price	$27.82
Rate for Payer: Cash Price	$27.82
Rate for Payer: Cofinity Commercial	$24.35
Rate for Payer: Cofinity Commercial	$29.91
Rate for Payer: Healthscope Commercial	$31.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.56
Rate for Payer: PHP Commercial	$29.56
Rate for Payer: Priority Health Cigna Priority Health	$24.35
Rate for Payer: Priority Health SBD	$21.91
Rate for Payer: UHC All Payor (Choice/PPO)	$2.16
Rate for Payer: UHC Exchange	$1.96

HC DESTRUCT VAGINAL LESION(S) SIMPLE

Facility

$3,822.09

Service Code	CPT 57061
Hospital Charge Code	36100583
Hospital Revenue Code	761
Min. Negotiated Rate	$46.33
Max. Negotiated Rate	$3,477.26
Rate for Payer: Aetna Commercial	$3,248.78
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$2,484.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$46.33
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$3,057.67
Rate for Payer: Cash Price	$3,057.67
Rate for Payer: Cofinity Commercial	$2,675.46
Rate for Payer: Cofinity Commercial	$3,287.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$3,439.88
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,248.78
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$3,248.78
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$2,675.46
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$2,407.92
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$126.06
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$114.60
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

HC DESTRUCT VAGINAL LESION(S) SIMPLE

Facility

$3,822.09

Service Code	CPT 57061
Hospital Charge Code	36100583
Hospital Revenue Code	761
Min. Negotiated Rate	$2,407.92
Max. Negotiated Rate	$3,439.88
Rate for Payer: Aetna Commercial	$3,248.78
Rate for Payer: Aetna New Business (MI Preferred)	$2,484.36
Rate for Payer: Cash Price	$3,057.67
Rate for Payer: Cofinity Commercial	$2,675.46
Rate for Payer: Cofinity Commercial	$3,287.00
Rate for Payer: Healthscope Commercial	$3,439.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,248.78
Rate for Payer: PHP Commercial	$3,248.78
Rate for Payer: Priority Health Cigna Priority Health	$2,675.46
Rate for Payer: Priority Health SBD	$2,407.92

HC DES VESSEL/BRANCH

Facility

$24,183.90

Service Code	CPT C9600
Hospital Charge Code	48100075
Hospital Revenue Code	481
Min. Negotiated Rate	$5,354.45
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Commercial	$20,556.32
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Aetna New Business (MI Preferred)	$15,719.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$8,479.25
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cofinity Commercial	$20,798.15
Rate for Payer: Cofinity Commercial	$16,928.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Healthscope Commercial	$21,765.51
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20,556.32
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Commercial	$20,556.32
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health Cigna Priority Health	$16,928.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Priority Health SBD	$15,235.86
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$27,444.72
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$18,707.28
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

HC DES VESSEL/BRANCH

Facility

$24,183.90

Service Code	CPT C9600
Hospital Charge Code	48100075
Hospital Revenue Code	481
Min. Negotiated Rate	$15,235.86
Max. Negotiated Rate	$21,765.51
Rate for Payer: Aetna Commercial	$20,556.32
Rate for Payer: Aetna New Business (MI Preferred)	$15,719.54
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cofinity Commercial	$16,928.73
Rate for Payer: Cofinity Commercial	$20,798.15
Rate for Payer: Healthscope Commercial	$21,765.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20,556.32
Rate for Payer: PHP Commercial	$20,556.32
Rate for Payer: Priority Health Cigna Priority Health	$16,928.73
Rate for Payer: Priority Health SBD	$15,235.86

HC DEVELOPMENTAL TESTING

Facility

$371.75

Service Code	CPT 96110
Hospital Charge Code	51000057
Hospital Revenue Code	761
Min. Negotiated Rate	$234.20
Max. Negotiated Rate	$334.58
Rate for Payer: Aetna Commercial	$315.99
Rate for Payer: Aetna New Business (MI Preferred)	$241.64
Rate for Payer: Cash Price	$297.40
Rate for Payer: Cofinity Commercial	$260.22
Rate for Payer: Cofinity Commercial	$319.70
Rate for Payer: Healthscope Commercial	$334.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$315.99
Rate for Payer: PHP Commercial	$315.99
Rate for Payer: Priority Health Cigna Priority Health	$260.22
Rate for Payer: Priority Health SBD	$234.20

HC DEVELOPMENTAL TESTING

Facility

$371.75

Service Code	CPT 96110
Hospital Charge Code	51000057
Hospital Revenue Code	761
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$334.58
Rate for Payer: Aetna Commercial	$315.99
Rate for Payer: Aetna New Business (MI Preferred)	$241.64
Rate for Payer: BCBS Complete	$148.70
Rate for Payer: BCBS Trust/PPO	$10.71
Rate for Payer: Cash Price	$297.40
Rate for Payer: Cash Price	$297.40
Rate for Payer: Cofinity Commercial	$260.22
Rate for Payer: Cofinity Commercial	$319.70
Rate for Payer: Healthscope Commercial	$334.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$315.99
Rate for Payer: PHP Commercial	$315.99
Rate for Payer: Priority Health Cigna Priority Health	$260.22
Rate for Payer: Priority Health SBD	$234.20
Rate for Payer: UHC All Payor (Choice/PPO)	$12.61
Rate for Payer: UHC Exchange	$11.46

HC DEVICE NOT RETURNED ACTIWATCH

Professional

Both

$949.00

Service Code	HCPCS 00615
Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$664.30
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: Cash Price	$759.20
Rate for Payer: Priority Health Cigna Priority Health	$664.30

HC DEVICE NOT RETURNED ACTIWATCH

Facility

$949.00

Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$597.87
Max. Negotiated Rate	$854.10
Rate for Payer: Aetna Commercial	$806.65
Rate for Payer: Aetna New Business (MI Preferred)	$616.85
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cofinity Commercial	$664.30
Rate for Payer: Cofinity Commercial	$816.14
Rate for Payer: Healthscope Commercial	$854.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$806.65
Rate for Payer: PHP Commercial	$806.65
Rate for Payer: Priority Health Cigna Priority Health	$664.30
Rate for Payer: Priority Health SBD	$597.87

HC DEVICE NOT RETURNED ACTIWATCH

Facility

$949.00

Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$854.10
Rate for Payer: Aetna Commercial	$806.65
Rate for Payer: Aetna New Business (MI Preferred)	$616.85
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cofinity Commercial	$664.30
Rate for Payer: Cofinity Commercial	$816.14
Rate for Payer: Healthscope Commercial	$854.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$806.65
Rate for Payer: PHP Commercial	$806.65
Rate for Payer: Priority Health Cigna Priority Health	$664.30
Rate for Payer: Priority Health SBD	$597.87

HC DEVICE NOT RETURNED ACTIWATCH

Professional

Both

$949.00

Service Code	HCPCS 00615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$664.30
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: Cash Price	$759.20
Rate for Payer: Priority Health Cigna Priority Health	$664.30

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Facility

$310.00

Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna Commercial	$263.50
Rate for Payer: Aetna New Business (MI Preferred)	$201.50
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cofinity Commercial	$217.00
Rate for Payer: Cofinity Commercial	$266.60
Rate for Payer: Healthscope Commercial	$279.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.50
Rate for Payer: PHP Commercial	$263.50
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health SBD	$195.30

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Professional

Both

$310.00

Service Code	HCPCS 00616
Hospital Revenue Code	270
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$217.00
Rate for Payer: BCBS Complete	$124.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Priority Health Cigna Priority Health	$217.00

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Professional

Both

$310.00

Service Code	HCPCS 00616
Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$217.00
Rate for Payer: BCBS Complete	$124.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Priority Health Cigna Priority Health	$217.00

Know your out-of-pocket cost for care.

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