Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH SHOULDER SNG NRV

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100595
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,085.35
Rate for Payer: Amish Plain Church Group Commercial	$1,085.35
Rate for Payer: BCBS Complete	$488.67
Rate for Payer: BCBS MAPPO	$868.28
Rate for Payer: BCN Medicare Advantage	$868.28
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Mclaren Medicaid	$465.40
Rate for Payer: Mclaren Medicare	$868.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$911.69
Rate for Payer: Meridian Medicaid	$488.67
Rate for Payer: MI Amish Medical Board Commercial	$998.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$798.39
Rate for Payer: Railroad Medicare Medicare	$868.28
Rate for Payer: UHC All Payor (Choice/PPO)	$2,444.12
Rate for Payer: UHC Dual Complete DSNP	$868.28
Rate for Payer: UHC Medicare Advantage	$868.28
Rate for Payer: UHCCP Medicaid	$488.84
Rate for Payer: VA VA	$868.28

HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH SHOULDER SNG NRV

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100595
Hospital Revenue Code	361
Min. Negotiated Rate	$798.39
Max. Negotiated Rate	$1,140.56
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health SBD	$798.39

HC ABLATION AV NODE

Facility

$8,558.71

Service Code	CPT 93650
Hospital Charge Code	48100044
Hospital Revenue Code	481
Min. Negotiated Rate	$3,966.68
Max. Negotiated Rate	$20,831.72
Rate for Payer: Aetna Commercial	$7,274.90
Rate for Payer: Aetna Medicare	$7,696.54
Rate for Payer: Aetna New Business (MI Preferred)	$5,563.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,250.65
Rate for Payer: Amish Plain Church Group Commercial	$9,250.65
Rate for Payer: BCBS Complete	$4,165.01
Rate for Payer: BCBS MAPPO	$7,400.52
Rate for Payer: BCN Medicare Advantage	$7,400.52
Rate for Payer: Cash Price	$6,846.97
Rate for Payer: Cash Price	$6,846.97
Rate for Payer: Cofinity Commercial	$7,360.49
Rate for Payer: Cofinity Commercial	$5,991.10
Rate for Payer: Cofinity Medicare Advantage	$5,991.10
Rate for Payer: Encore Health Key Benefits Commercial	$6,846.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,400.52
Rate for Payer: Healthscope Commercial	$7,702.84
Rate for Payer: Mclaren Medicaid	$3,966.68
Rate for Payer: Mclaren Medicare	$7,400.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,770.55
Rate for Payer: Meridian Medicaid	$4,165.01
Rate for Payer: MI Amish Medical Board Commercial	$8,510.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,274.90
Rate for Payer: PACE Medicare	$7,030.49
Rate for Payer: PACE SWMI	$7,400.52
Rate for Payer: PHP Commercial	$7,274.90
Rate for Payer: PHP Medicare Advantage	$7,400.52
Rate for Payer: Priority Health Choice Medicaid	$3,966.68
Rate for Payer: Priority Health Cigna Priority Health	$5,563.16
Rate for Payer: Priority Health Medicare	$7,400.52
Rate for Payer: Priority Health SBD	$5,391.99
Rate for Payer: Railroad Medicare Medicare	$7,400.52
Rate for Payer: UHC All Payor (Choice/PPO)	$20,831.72
Rate for Payer: UHC Dual Complete DSNP	$7,400.52
Rate for Payer: UHC Medicare Advantage	$7,400.52
Rate for Payer: UHCCP Medicaid	$4,166.49
Rate for Payer: VA VA	$7,400.52

HC ABLATION AV NODE

Facility

$8,558.71

Service Code	CPT 93650
Hospital Charge Code	48100044
Hospital Revenue Code	481
Min. Negotiated Rate	$5,391.99
Max. Negotiated Rate	$7,702.84
Rate for Payer: Aetna Commercial	$7,274.90
Rate for Payer: Aetna New Business (MI Preferred)	$5,563.16
Rate for Payer: Cash Price	$6,846.97
Rate for Payer: Cofinity Commercial	$5,991.10
Rate for Payer: Cofinity Commercial	$7,360.49
Rate for Payer: Cofinity Medicare Advantage	$5,991.10
Rate for Payer: Encore Health Key Benefits Commercial	$6,846.97
Rate for Payer: Healthscope Commercial	$7,702.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,274.90
Rate for Payer: PHP Commercial	$7,274.90
Rate for Payer: Priority Health Cigna Priority Health	$5,563.16
Rate for Payer: Priority Health SBD	$5,391.99

HC ABLATION BONE

Facility

$6,775.93

Service Code	CPT 20982
Hospital Charge Code	36100480
Hospital Revenue Code	361
Min. Negotiated Rate	$4,268.84
Max. Negotiated Rate	$6,098.34
Rate for Payer: Aetna Commercial	$5,759.54
Rate for Payer: Aetna New Business (MI Preferred)	$4,404.35
Rate for Payer: Cash Price	$5,420.74
Rate for Payer: Cofinity Commercial	$4,743.15
Rate for Payer: Cofinity Commercial	$5,827.30
Rate for Payer: Cofinity Medicare Advantage	$4,743.15
Rate for Payer: Encore Health Key Benefits Commercial	$5,420.74
Rate for Payer: Healthscope Commercial	$6,098.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,759.54
Rate for Payer: PHP Commercial	$5,759.54
Rate for Payer: Priority Health Cigna Priority Health	$4,404.35
Rate for Payer: Priority Health SBD	$4,268.84

HC ABLATION BONE

Facility

$6,775.93

Service Code	CPT 20982
Hospital Charge Code	36100480
Hospital Revenue Code	361
Min. Negotiated Rate	$4,268.84
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Commercial	$5,759.54
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Aetna New Business (MI Preferred)	$4,404.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Cash Price	$5,420.74
Rate for Payer: Cash Price	$5,420.74
Rate for Payer: Cofinity Commercial	$5,827.30
Rate for Payer: Cofinity Commercial	$4,743.15
Rate for Payer: Cofinity Medicare Advantage	$4,743.15
Rate for Payer: Encore Health Key Benefits Commercial	$5,420.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Healthscope Commercial	$6,098.34
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,759.54
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Commercial	$5,759.54
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Cigna Priority Health	$4,404.35
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Priority Health SBD	$4,268.84
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T EA ADDL JOINT

Facility

$1,092.42

Service Code	CPT 64634
Hospital Charge Code	36100591
Hospital Revenue Code	361
Min. Negotiated Rate	$688.22
Max. Negotiated Rate	$983.18
Rate for Payer: Aetna Commercial	$928.56
Rate for Payer: Aetna New Business (MI Preferred)	$710.07
Rate for Payer: Cash Price	$873.94
Rate for Payer: Cofinity Commercial	$764.69
Rate for Payer: Cofinity Commercial	$939.48
Rate for Payer: Cofinity Medicare Advantage	$764.69
Rate for Payer: Encore Health Key Benefits Commercial	$873.94
Rate for Payer: Healthscope Commercial	$983.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$928.56
Rate for Payer: PHP Commercial	$928.56
Rate for Payer: Priority Health Cigna Priority Health	$710.07
Rate for Payer: Priority Health SBD	$688.22

HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T EA ADDL JOINT

Facility

$1,092.42

Service Code	CPT 64634
Hospital Charge Code	36100591
Hospital Revenue Code	361
Min. Negotiated Rate	$436.97
Max. Negotiated Rate	$983.18
Rate for Payer: Aetna Commercial	$928.56
Rate for Payer: Aetna Medicare	$546.21
Rate for Payer: Aetna New Business (MI Preferred)	$710.07
Rate for Payer: BCBS Complete	$436.97
Rate for Payer: Cash Price	$873.94
Rate for Payer: Cofinity Commercial	$764.69
Rate for Payer: Cofinity Commercial	$939.48
Rate for Payer: Cofinity Medicare Advantage	$764.69
Rate for Payer: Encore Health Key Benefits Commercial	$873.94
Rate for Payer: Healthscope Commercial	$983.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$928.56
Rate for Payer: PHP Commercial	$928.56
Rate for Payer: Priority Health Cigna Priority Health	$710.07
Rate for Payer: Priority Health SBD	$688.22

HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T SNG LVL

Facility

$2,683.22

Service Code	CPT 64633
Hospital Charge Code	36100590
Hospital Revenue Code	361
Min. Negotiated Rate	$1,690.43
Max. Negotiated Rate	$2,414.90
Rate for Payer: Aetna Commercial	$2,280.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,744.09
Rate for Payer: Cash Price	$2,146.58
Rate for Payer: Cofinity Commercial	$1,878.25
Rate for Payer: Cofinity Commercial	$2,307.57
Rate for Payer: Cofinity Medicare Advantage	$1,878.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,146.58
Rate for Payer: Healthscope Commercial	$2,414.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,280.74
Rate for Payer: PHP Commercial	$2,280.74
Rate for Payer: Priority Health Cigna Priority Health	$1,744.09
Rate for Payer: Priority Health SBD	$1,690.43

HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T SNG LVL

Facility

$2,683.22

Service Code	CPT 64633
Hospital Charge Code	36100590
Hospital Revenue Code	361
Min. Negotiated Rate	$1,020.81
Max. Negotiated Rate	$5,360.98
Rate for Payer: Aetna Commercial	$2,280.74
Rate for Payer: Aetna Medicare	$1,980.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,744.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,380.62
Rate for Payer: Amish Plain Church Group Commercial	$2,380.62
Rate for Payer: BCBS Complete	$1,071.85
Rate for Payer: BCBS MAPPO	$1,904.50
Rate for Payer: BCN Medicare Advantage	$1,904.50
Rate for Payer: Cash Price	$2,146.58
Rate for Payer: Cash Price	$2,146.58
Rate for Payer: Cofinity Commercial	$2,307.57
Rate for Payer: Cofinity Commercial	$1,878.25
Rate for Payer: Cofinity Medicare Advantage	$1,878.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,146.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,904.50
Rate for Payer: Healthscope Commercial	$2,414.90
Rate for Payer: Mclaren Medicaid	$1,020.81
Rate for Payer: Mclaren Medicare	$1,904.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,999.72
Rate for Payer: Meridian Medicaid	$1,071.85
Rate for Payer: MI Amish Medical Board Commercial	$2,190.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,280.74
Rate for Payer: PACE Medicare	$1,809.28
Rate for Payer: PACE SWMI	$1,904.50
Rate for Payer: PHP Commercial	$2,280.74
Rate for Payer: PHP Medicare Advantage	$1,904.50
Rate for Payer: Priority Health Choice Medicaid	$1,020.81
Rate for Payer: Priority Health Cigna Priority Health	$1,744.09
Rate for Payer: Priority Health Medicare	$1,904.50
Rate for Payer: Priority Health SBD	$1,690.43
Rate for Payer: Railroad Medicare Medicare	$1,904.50
Rate for Payer: UHC All Payor (Choice/PPO)	$5,360.98
Rate for Payer: UHC Dual Complete DSNP	$1,904.50
Rate for Payer: UHC Medicare Advantage	$1,904.50
Rate for Payer: UHCCP Medicaid	$1,072.23
Rate for Payer: VA VA	$1,904.50

HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S EA ADDL JOINT

Facility

$1,092.42

Service Code	CPT 64636
Hospital Charge Code	36100593
Hospital Revenue Code	361
Min. Negotiated Rate	$436.97
Max. Negotiated Rate	$983.18
Rate for Payer: Aetna Commercial	$928.56
Rate for Payer: Aetna Medicare	$546.21
Rate for Payer: Aetna New Business (MI Preferred)	$710.07
Rate for Payer: BCBS Complete	$436.97
Rate for Payer: Cash Price	$873.94
Rate for Payer: Cofinity Commercial	$764.69
Rate for Payer: Cofinity Commercial	$939.48
Rate for Payer: Cofinity Medicare Advantage	$764.69
Rate for Payer: Encore Health Key Benefits Commercial	$873.94
Rate for Payer: Healthscope Commercial	$983.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$928.56
Rate for Payer: PHP Commercial	$928.56
Rate for Payer: Priority Health Cigna Priority Health	$710.07
Rate for Payer: Priority Health SBD	$688.22

HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S EA ADDL JOINT

Facility

$1,092.42

Service Code	CPT 64636
Hospital Charge Code	36100593
Hospital Revenue Code	361
Min. Negotiated Rate	$688.22
Max. Negotiated Rate	$983.18
Rate for Payer: Aetna Commercial	$928.56
Rate for Payer: Aetna New Business (MI Preferred)	$710.07
Rate for Payer: Cash Price	$873.94
Rate for Payer: Cofinity Commercial	$764.69
Rate for Payer: Cofinity Commercial	$939.48
Rate for Payer: Cofinity Medicare Advantage	$764.69
Rate for Payer: Encore Health Key Benefits Commercial	$873.94
Rate for Payer: Healthscope Commercial	$983.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$928.56
Rate for Payer: PHP Commercial	$928.56
Rate for Payer: Priority Health Cigna Priority Health	$710.07
Rate for Payer: Priority Health SBD	$688.22

HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S SNG LVL

Facility

$2,683.22

Service Code	CPT 64635
Hospital Charge Code	36100592
Hospital Revenue Code	361
Min. Negotiated Rate	$1,020.81
Max. Negotiated Rate	$5,360.98
Rate for Payer: Aetna Commercial	$2,280.74
Rate for Payer: Aetna Medicare	$1,980.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,744.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,380.62
Rate for Payer: Amish Plain Church Group Commercial	$2,380.62
Rate for Payer: BCBS Complete	$1,071.85
Rate for Payer: BCBS MAPPO	$1,904.50
Rate for Payer: BCN Medicare Advantage	$1,904.50
Rate for Payer: Cash Price	$2,146.58
Rate for Payer: Cash Price	$2,146.58
Rate for Payer: Cofinity Commercial	$1,878.25
Rate for Payer: Cofinity Commercial	$2,307.57
Rate for Payer: Cofinity Medicare Advantage	$1,878.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,146.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,904.50
Rate for Payer: Healthscope Commercial	$2,414.90
Rate for Payer: Mclaren Medicaid	$1,020.81
Rate for Payer: Mclaren Medicare	$1,904.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,999.72
Rate for Payer: Meridian Medicaid	$1,071.85
Rate for Payer: MI Amish Medical Board Commercial	$2,190.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,280.74
Rate for Payer: PACE Medicare	$1,809.28
Rate for Payer: PACE SWMI	$1,904.50
Rate for Payer: PHP Commercial	$2,280.74
Rate for Payer: PHP Medicare Advantage	$1,904.50
Rate for Payer: Priority Health Choice Medicaid	$1,020.81
Rate for Payer: Priority Health Cigna Priority Health	$1,744.09
Rate for Payer: Priority Health Medicare	$1,904.50
Rate for Payer: Priority Health SBD	$1,690.43
Rate for Payer: Railroad Medicare Medicare	$1,904.50
Rate for Payer: UHC All Payor (Choice/PPO)	$5,360.98
Rate for Payer: UHC Dual Complete DSNP	$1,904.50
Rate for Payer: UHC Medicare Advantage	$1,904.50
Rate for Payer: UHCCP Medicaid	$1,072.23
Rate for Payer: VA VA	$1,904.50

HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S SNG LVL

Facility

$2,683.22

Service Code	CPT 64635
Hospital Charge Code	36100592
Hospital Revenue Code	361
Min. Negotiated Rate	$1,690.43
Max. Negotiated Rate	$2,414.90
Rate for Payer: Aetna Commercial	$2,280.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,744.09
Rate for Payer: Cash Price	$2,146.58
Rate for Payer: Cofinity Commercial	$1,878.25
Rate for Payer: Cofinity Commercial	$2,307.57
Rate for Payer: Cofinity Medicare Advantage	$1,878.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,146.58
Rate for Payer: Healthscope Commercial	$2,414.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,280.74
Rate for Payer: PHP Commercial	$2,280.74
Rate for Payer: Priority Health Cigna Priority Health	$1,744.09
Rate for Payer: Priority Health SBD	$1,690.43

HC ABLATION CATHETER

Facility

$4,346.76

Service Code	HCPCS C1733
Hospital Charge Code	27200008
Hospital Revenue Code	272
Min. Negotiated Rate	$2,738.46
Max. Negotiated Rate	$3,912.08
Rate for Payer: Aetna Commercial	$3,694.75
Rate for Payer: Aetna New Business (MI Preferred)	$2,825.39
Rate for Payer: Cash Price	$3,477.41
Rate for Payer: Cofinity Commercial	$3,042.73
Rate for Payer: Cofinity Commercial	$3,738.21
Rate for Payer: Cofinity Medicare Advantage	$3,042.73
Rate for Payer: Encore Health Key Benefits Commercial	$3,477.41
Rate for Payer: Healthscope Commercial	$3,912.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,694.75
Rate for Payer: PHP Commercial	$3,694.75
Rate for Payer: Priority Health Cigna Priority Health	$2,825.39
Rate for Payer: Priority Health SBD	$2,738.46

HC ABLATION CATHETER

Facility

$4,346.76

Service Code	HCPCS C1733
Hospital Charge Code	27200008
Hospital Revenue Code	272
Min. Negotiated Rate	$1,738.70
Max. Negotiated Rate	$3,912.08
Rate for Payer: Aetna Commercial	$3,694.75
Rate for Payer: Aetna Medicare	$2,173.38
Rate for Payer: Aetna New Business (MI Preferred)	$2,825.39
Rate for Payer: BCBS Complete	$1,738.70
Rate for Payer: Cash Price	$3,477.41
Rate for Payer: Cofinity Commercial	$3,042.73
Rate for Payer: Cofinity Commercial	$3,738.21
Rate for Payer: Cofinity Medicare Advantage	$3,042.73
Rate for Payer: Encore Health Key Benefits Commercial	$3,477.41
Rate for Payer: Healthscope Commercial	$3,912.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,694.75
Rate for Payer: PHP Commercial	$3,694.75
Rate for Payer: Priority Health Cigna Priority Health	$2,825.39
Rate for Payer: Priority Health SBD	$2,738.46

HC ABLATION CATHETER (8/10 MM TIP

Facility

$5,912.22

Service Code	HCPCS C1733
Hospital Charge Code	27200009
Hospital Revenue Code	272
Min. Negotiated Rate	$2,364.89
Max. Negotiated Rate	$5,321.00
Rate for Payer: Aetna Commercial	$5,025.39
Rate for Payer: Aetna Medicare	$2,956.11
Rate for Payer: Aetna New Business (MI Preferred)	$3,842.94
Rate for Payer: BCBS Complete	$2,364.89
Rate for Payer: Cash Price	$4,729.78
Rate for Payer: Cofinity Commercial	$4,138.55
Rate for Payer: Cofinity Commercial	$5,084.51
Rate for Payer: Cofinity Medicare Advantage	$4,138.55
Rate for Payer: Encore Health Key Benefits Commercial	$4,729.78
Rate for Payer: Healthscope Commercial	$5,321.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,025.39
Rate for Payer: PHP Commercial	$5,025.39
Rate for Payer: Priority Health Cigna Priority Health	$3,842.94
Rate for Payer: Priority Health SBD	$3,724.70

HC ABLATION CATHETER (8/10 MM TIP

Facility

$5,912.22

Service Code	HCPCS C1733
Hospital Charge Code	27200009
Hospital Revenue Code	272
Min. Negotiated Rate	$3,724.70
Max. Negotiated Rate	$5,321.00
Rate for Payer: Aetna Commercial	$5,025.39
Rate for Payer: Aetna New Business (MI Preferred)	$3,842.94
Rate for Payer: Cash Price	$4,729.78
Rate for Payer: Cofinity Commercial	$4,138.55
Rate for Payer: Cofinity Commercial	$5,084.51
Rate for Payer: Cofinity Medicare Advantage	$4,138.55
Rate for Payer: Encore Health Key Benefits Commercial	$4,729.78
Rate for Payer: Healthscope Commercial	$5,321.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,025.39
Rate for Payer: PHP Commercial	$5,025.39
Rate for Payer: Priority Health Cigna Priority Health	$3,842.94
Rate for Payer: Priority Health SBD	$3,724.70

HC ABLATION CATH EXTRAVASC TISSUE

Facility

$7,222.46

Service Code	HCPCS C1886
Hospital Charge Code	27000645
Hospital Revenue Code	272
Min. Negotiated Rate	$2,888.98
Max. Negotiated Rate	$6,500.21
Rate for Payer: Aetna Commercial	$6,139.09
Rate for Payer: Aetna Medicare	$3,611.23
Rate for Payer: Aetna New Business (MI Preferred)	$4,694.60
Rate for Payer: BCBS Complete	$2,888.98
Rate for Payer: Cash Price	$5,777.97
Rate for Payer: Cofinity Commercial	$5,055.72
Rate for Payer: Cofinity Commercial	$6,211.32
Rate for Payer: Cofinity Medicare Advantage	$5,055.72
Rate for Payer: Encore Health Key Benefits Commercial	$5,777.97
Rate for Payer: Healthscope Commercial	$6,500.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,139.09
Rate for Payer: PHP Commercial	$6,139.09
Rate for Payer: Priority Health Cigna Priority Health	$4,694.60
Rate for Payer: Priority Health SBD	$4,550.15

HC ABLATION CATH EXTRAVASC TISSUE

Facility

$7,222.46

Service Code	HCPCS C1886
Hospital Charge Code	27000645
Hospital Revenue Code	272
Min. Negotiated Rate	$4,550.15
Max. Negotiated Rate	$6,500.21
Rate for Payer: Aetna Commercial	$6,139.09
Rate for Payer: Aetna New Business (MI Preferred)	$4,694.60
Rate for Payer: Cash Price	$5,777.97
Rate for Payer: Cofinity Commercial	$5,055.72
Rate for Payer: Cofinity Commercial	$6,211.32
Rate for Payer: Cofinity Medicare Advantage	$5,055.72
Rate for Payer: Encore Health Key Benefits Commercial	$5,777.97
Rate for Payer: Healthscope Commercial	$6,500.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,139.09
Rate for Payer: PHP Commercial	$6,139.09
Rate for Payer: Priority Health Cigna Priority Health	$4,694.60
Rate for Payer: Priority Health SBD	$4,550.15

HC ABLATION CATH NON-CARD ENDOVASC IMPLANT LVL 12

Facility

$1,275.00

Service Code	HCPCS C1888
Hospital Charge Code	27200324
Hospital Revenue Code	272
Min. Negotiated Rate	$803.25
Max. Negotiated Rate	$1,147.50
Rate for Payer: Aetna Commercial	$1,083.75
Rate for Payer: Aetna New Business (MI Preferred)	$828.75
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cofinity Commercial	$1,096.50
Rate for Payer: Cofinity Commercial	$892.50
Rate for Payer: Cofinity Medicare Advantage	$892.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,020.00
Rate for Payer: Healthscope Commercial	$1,147.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,083.75
Rate for Payer: PHP Commercial	$1,083.75
Rate for Payer: Priority Health Cigna Priority Health	$828.75
Rate for Payer: Priority Health SBD	$803.25

HC ABLATION CATH NON-CARD ENDOVASC IMPLANT LVL 12

Facility

$1,275.00

Service Code	HCPCS C1888
Hospital Charge Code	27200324
Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$1,147.50
Rate for Payer: Aetna Commercial	$1,083.75
Rate for Payer: Aetna Medicare	$637.50
Rate for Payer: Aetna New Business (MI Preferred)	$828.75
Rate for Payer: BCBS Complete	$510.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cofinity Commercial	$1,096.50
Rate for Payer: Cofinity Commercial	$892.50
Rate for Payer: Cofinity Medicare Advantage	$892.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,020.00
Rate for Payer: Healthscope Commercial	$1,147.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,083.75
Rate for Payer: PHP Commercial	$1,083.75
Rate for Payer: Priority Health Cigna Priority Health	$828.75
Rate for Payer: Priority Health SBD	$803.25

HC ABLATION CATH NON CARD ENDOVASC IMPLANT LVL 15

Facility

$1,593.75

Service Code	CPT C1888
Hospital Charge Code	27200358
Hospital Revenue Code	272
Min. Negotiated Rate	$1,004.06
Max. Negotiated Rate	$1,434.38
Rate for Payer: Aetna Commercial	$1,354.69
Rate for Payer: Aetna New Business (MI Preferred)	$1,035.94
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cofinity Commercial	$1,115.62
Rate for Payer: Cofinity Commercial	$1,370.62
Rate for Payer: Cofinity Medicare Advantage	$1,115.62
Rate for Payer: Encore Health Key Benefits Commercial	$1,275.00
Rate for Payer: Healthscope Commercial	$1,434.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,354.69
Rate for Payer: PHP Commercial	$1,354.69
Rate for Payer: Priority Health Cigna Priority Health	$1,035.94
Rate for Payer: Priority Health SBD	$1,004.06

HC ABLATION CATH NON CARD ENDOVASC IMPLANT LVL 15

Facility

$1,593.75

Service Code	CPT C1888
Hospital Charge Code	27200358
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,434.38
Rate for Payer: Aetna Commercial	$1,354.69
Rate for Payer: Aetna Medicare	$796.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,035.94
Rate for Payer: BCBS Complete	$637.50
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cofinity Commercial	$1,115.62
Rate for Payer: Cofinity Commercial	$1,370.62
Rate for Payer: Cofinity Medicare Advantage	$1,115.62
Rate for Payer: Encore Health Key Benefits Commercial	$1,275.00
Rate for Payer: Healthscope Commercial	$1,434.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,354.69
Rate for Payer: PHP Commercial	$1,354.69
Rate for Payer: Priority Health Cigna Priority Health	$1,035.94
Rate for Payer: Priority Health SBD	$1,004.06

HC ABLATION RF LUNG

Facility

$6,017.36

Service Code	CPT 32998
Hospital Charge Code	36100055
Hospital Revenue Code	361
Min. Negotiated Rate	$3,790.94
Max. Negotiated Rate	$5,415.62
Rate for Payer: Aetna Commercial	$5,114.76
Rate for Payer: Aetna New Business (MI Preferred)	$3,911.28
Rate for Payer: Cash Price	$4,813.89
Rate for Payer: Cofinity Commercial	$4,212.15
Rate for Payer: Cofinity Commercial	$5,174.93
Rate for Payer: Cofinity Medicare Advantage	$4,212.15
Rate for Payer: Encore Health Key Benefits Commercial	$4,813.89
Rate for Payer: Healthscope Commercial	$5,415.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,114.76
Rate for Payer: PHP Commercial	$5,114.76
Rate for Payer: Priority Health Cigna Priority Health	$3,911.28
Rate for Payer: Priority Health SBD	$3,790.94

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