Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ACB GARMENT MEASURE VISIT

Facility

$372.74

Service Code	CPT 99211
Hospital Charge Code	51000048
Hospital Revenue Code	761
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$335.47
Rate for Payer: Aetna Commercial	$316.83
Rate for Payer: Aetna Medicare	$186.37
Rate for Payer: Aetna New Business (MI Preferred)	$242.28
Rate for Payer: BCBS Complete	$149.10
Rate for Payer: Cash Price	$298.19
Rate for Payer: Cofinity Commercial	$260.92
Rate for Payer: Cofinity Commercial	$320.56
Rate for Payer: Cofinity Medicare Advantage	$260.92
Rate for Payer: Encore Health Key Benefits Commercial	$298.19
Rate for Payer: Healthscope Commercial	$335.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.83
Rate for Payer: PHP Commercial	$316.83
Rate for Payer: Priority Health Cigna Priority Health	$242.28
Rate for Payer: Priority Health SBD	$234.83

HC ACB GARMENT MEASURE VISIT

Facility

$372.74

Service Code	CPT 99211
Hospital Charge Code	51000048
Hospital Revenue Code	761
Min. Negotiated Rate	$234.83
Max. Negotiated Rate	$335.47
Rate for Payer: Aetna Commercial	$316.83
Rate for Payer: Aetna New Business (MI Preferred)	$242.28
Rate for Payer: Cash Price	$298.19
Rate for Payer: Cofinity Commercial	$260.92
Rate for Payer: Cofinity Commercial	$320.56
Rate for Payer: Cofinity Medicare Advantage	$260.92
Rate for Payer: Encore Health Key Benefits Commercial	$298.19
Rate for Payer: Healthscope Commercial	$335.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.83
Rate for Payer: PHP Commercial	$316.83
Rate for Payer: Priority Health Cigna Priority Health	$242.28
Rate for Payer: Priority Health SBD	$234.83

HC ACB NEW PATIENT VISIT

Facility

$165.16

Service Code	HCPCS 99211
Hospital Charge Code	51000100
Hospital Revenue Code	510
Min. Negotiated Rate	$104.05
Max. Negotiated Rate	$148.64
Rate for Payer: Aetna Commercial	$140.39
Rate for Payer: Aetna New Business (MI Preferred)	$107.35
Rate for Payer: Cash Price	$132.13
Rate for Payer: Cofinity Commercial	$115.61
Rate for Payer: Cofinity Commercial	$142.04
Rate for Payer: Cofinity Medicare Advantage	$115.61
Rate for Payer: Encore Health Key Benefits Commercial	$132.13
Rate for Payer: Healthscope Commercial	$148.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.39
Rate for Payer: PHP Commercial	$140.39
Rate for Payer: Priority Health Cigna Priority Health	$107.35
Rate for Payer: Priority Health SBD	$104.05

HC ACB NEW PATIENT VISIT

Facility

$165.16

Service Code	HCPCS 99211
Hospital Charge Code	51000100
Hospital Revenue Code	510
Min. Negotiated Rate	$66.06
Max. Negotiated Rate	$148.64
Rate for Payer: Aetna Commercial	$140.39
Rate for Payer: Aetna Medicare	$82.58
Rate for Payer: Aetna New Business (MI Preferred)	$107.35
Rate for Payer: BCBS Complete	$66.06
Rate for Payer: Cash Price	$132.13
Rate for Payer: Cofinity Commercial	$115.61
Rate for Payer: Cofinity Commercial	$142.04
Rate for Payer: Cofinity Medicare Advantage	$115.61
Rate for Payer: Encore Health Key Benefits Commercial	$132.13
Rate for Payer: Healthscope Commercial	$148.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.39
Rate for Payer: PHP Commercial	$140.39
Rate for Payer: Priority Health Cigna Priority Health	$107.35
Rate for Payer: Priority Health SBD	$104.05

HC ACB NEW PT LEVEL 2

Facility

$494.43

Service Code	CPT 99202
Hospital Charge Code	51000101
Hospital Revenue Code	510
Min. Negotiated Rate	$197.77
Max. Negotiated Rate	$444.99
Rate for Payer: Aetna Commercial	$420.27
Rate for Payer: Aetna Medicare	$247.22
Rate for Payer: Aetna New Business (MI Preferred)	$321.38
Rate for Payer: BCBS Complete	$197.77
Rate for Payer: Cash Price	$395.54
Rate for Payer: Cofinity Commercial	$346.10
Rate for Payer: Cofinity Commercial	$425.21
Rate for Payer: Cofinity Medicare Advantage	$346.10
Rate for Payer: Encore Health Key Benefits Commercial	$395.54
Rate for Payer: Healthscope Commercial	$444.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.27
Rate for Payer: PHP Commercial	$420.27
Rate for Payer: Priority Health Cigna Priority Health	$321.38
Rate for Payer: Priority Health SBD	$311.49

HC ACB NEW PT LEVEL 2

Facility

$494.43

Service Code	CPT 99202
Hospital Charge Code	51000101
Hospital Revenue Code	510
Min. Negotiated Rate	$311.49
Max. Negotiated Rate	$444.99
Rate for Payer: Aetna Commercial	$420.27
Rate for Payer: Aetna New Business (MI Preferred)	$321.38
Rate for Payer: Cash Price	$395.54
Rate for Payer: Cofinity Commercial	$346.10
Rate for Payer: Cofinity Commercial	$425.21
Rate for Payer: Cofinity Medicare Advantage	$346.10
Rate for Payer: Encore Health Key Benefits Commercial	$395.54
Rate for Payer: Healthscope Commercial	$444.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.27
Rate for Payer: PHP Commercial	$420.27
Rate for Payer: Priority Health Cigna Priority Health	$321.38
Rate for Payer: Priority Health SBD	$311.49

HC ACB NEW PT LEVEL 3

Facility

$688.85

Service Code	CPT 99203
Hospital Charge Code	51000102
Hospital Revenue Code	510
Min. Negotiated Rate	$433.98
Max. Negotiated Rate	$619.97
Rate for Payer: Aetna Commercial	$585.52
Rate for Payer: Aetna New Business (MI Preferred)	$447.75
Rate for Payer: Cash Price	$551.08
Rate for Payer: Cofinity Commercial	$482.19
Rate for Payer: Cofinity Commercial	$592.41
Rate for Payer: Cofinity Medicare Advantage	$482.19
Rate for Payer: Encore Health Key Benefits Commercial	$551.08
Rate for Payer: Healthscope Commercial	$619.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.52
Rate for Payer: PHP Commercial	$585.52
Rate for Payer: Priority Health Cigna Priority Health	$447.75
Rate for Payer: Priority Health SBD	$433.98

HC ACB NEW PT LEVEL 3

Facility

$688.85

Service Code	CPT 99203
Hospital Charge Code	51000102
Hospital Revenue Code	510
Min. Negotiated Rate	$275.54
Max. Negotiated Rate	$619.97
Rate for Payer: Aetna Commercial	$585.52
Rate for Payer: Aetna Medicare	$344.43
Rate for Payer: Aetna New Business (MI Preferred)	$447.75
Rate for Payer: BCBS Complete	$275.54
Rate for Payer: Cash Price	$551.08
Rate for Payer: Cofinity Commercial	$482.19
Rate for Payer: Cofinity Commercial	$592.41
Rate for Payer: Cofinity Medicare Advantage	$482.19
Rate for Payer: Encore Health Key Benefits Commercial	$551.08
Rate for Payer: Healthscope Commercial	$619.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.52
Rate for Payer: PHP Commercial	$585.52
Rate for Payer: Priority Health Cigna Priority Health	$447.75
Rate for Payer: Priority Health SBD	$433.98

HC ACB NEW PT LEVEL 4

Facility

$874.52

Service Code	CPT 99204
Hospital Charge Code	51000103
Hospital Revenue Code	510
Min. Negotiated Rate	$349.81
Max. Negotiated Rate	$787.07
Rate for Payer: Aetna Commercial	$743.34
Rate for Payer: Aetna Medicare	$437.26
Rate for Payer: Aetna New Business (MI Preferred)	$568.44
Rate for Payer: BCBS Complete	$349.81
Rate for Payer: Cash Price	$699.62
Rate for Payer: Cofinity Commercial	$612.16
Rate for Payer: Cofinity Commercial	$752.09
Rate for Payer: Cofinity Medicare Advantage	$612.16
Rate for Payer: Encore Health Key Benefits Commercial	$699.62
Rate for Payer: Healthscope Commercial	$787.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$743.34
Rate for Payer: PHP Commercial	$743.34
Rate for Payer: Priority Health Cigna Priority Health	$568.44
Rate for Payer: Priority Health SBD	$550.95

HC ACB NEW PT LEVEL 4

Facility

$874.52

Service Code	CPT 99204
Hospital Charge Code	51000103
Hospital Revenue Code	510
Min. Negotiated Rate	$550.95
Max. Negotiated Rate	$787.07
Rate for Payer: Aetna Commercial	$743.34
Rate for Payer: Aetna New Business (MI Preferred)	$568.44
Rate for Payer: Cash Price	$699.62
Rate for Payer: Cofinity Commercial	$612.16
Rate for Payer: Cofinity Commercial	$752.09
Rate for Payer: Cofinity Medicare Advantage	$612.16
Rate for Payer: Encore Health Key Benefits Commercial	$699.62
Rate for Payer: Healthscope Commercial	$787.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$743.34
Rate for Payer: PHP Commercial	$743.34
Rate for Payer: Priority Health Cigna Priority Health	$568.44
Rate for Payer: Priority Health SBD	$550.95

HC ACB NEW PT LEVEL 5

Facility

$1,042.88

Service Code	CPT 99205
Hospital Charge Code	51000104
Hospital Revenue Code	510
Min. Negotiated Rate	$417.15
Max. Negotiated Rate	$938.59
Rate for Payer: Aetna Commercial	$886.45
Rate for Payer: Aetna Medicare	$521.44
Rate for Payer: Aetna New Business (MI Preferred)	$677.87
Rate for Payer: BCBS Complete	$417.15
Rate for Payer: Cash Price	$834.30
Rate for Payer: Cofinity Commercial	$730.02
Rate for Payer: Cofinity Commercial	$896.88
Rate for Payer: Cofinity Medicare Advantage	$730.02
Rate for Payer: Encore Health Key Benefits Commercial	$834.30
Rate for Payer: Healthscope Commercial	$938.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$886.45
Rate for Payer: PHP Commercial	$886.45
Rate for Payer: Priority Health Cigna Priority Health	$677.87
Rate for Payer: Priority Health SBD	$657.01

HC ACB NEW PT LEVEL 5

Facility

$1,042.88

Service Code	CPT 99205
Hospital Charge Code	51000104
Hospital Revenue Code	510
Min. Negotiated Rate	$657.01
Max. Negotiated Rate	$938.59
Rate for Payer: Aetna Commercial	$886.45
Rate for Payer: Aetna New Business (MI Preferred)	$677.87
Rate for Payer: Cash Price	$834.30
Rate for Payer: Cofinity Commercial	$730.02
Rate for Payer: Cofinity Commercial	$896.88
Rate for Payer: Cofinity Medicare Advantage	$730.02
Rate for Payer: Encore Health Key Benefits Commercial	$834.30
Rate for Payer: Healthscope Commercial	$938.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$886.45
Rate for Payer: PHP Commercial	$886.45
Rate for Payer: Priority Health Cigna Priority Health	$677.87
Rate for Payer: Priority Health SBD	$657.01

HC ACCESS AORTA

Facility

$3,920.31

Service Code	CPT 36200
Hospital Charge Code	36100105
Hospital Revenue Code	361
Min. Negotiated Rate	$1,568.12
Max. Negotiated Rate	$3,528.28
Rate for Payer: Aetna Commercial	$3,332.26
Rate for Payer: Aetna Medicare	$1,960.15
Rate for Payer: Aetna New Business (MI Preferred)	$2,548.20
Rate for Payer: BCBS Complete	$1,568.12
Rate for Payer: Cash Price	$3,136.25
Rate for Payer: Cofinity Commercial	$2,744.22
Rate for Payer: Cofinity Commercial	$3,371.47
Rate for Payer: Cofinity Medicare Advantage	$2,744.22
Rate for Payer: Encore Health Key Benefits Commercial	$3,136.25
Rate for Payer: Healthscope Commercial	$3,528.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,332.26
Rate for Payer: PHP Commercial	$3,332.26
Rate for Payer: Priority Health Cigna Priority Health	$2,548.20
Rate for Payer: Priority Health SBD	$2,469.80

HC ACCESS AORTA

Facility

$3,920.31

Service Code	CPT 36200
Hospital Charge Code	36100105
Hospital Revenue Code	361
Min. Negotiated Rate	$2,469.80
Max. Negotiated Rate	$3,528.28
Rate for Payer: Aetna Commercial	$3,332.26
Rate for Payer: Aetna New Business (MI Preferred)	$2,548.20
Rate for Payer: Cash Price	$3,136.25
Rate for Payer: Cofinity Commercial	$2,744.22
Rate for Payer: Cofinity Commercial	$3,371.47
Rate for Payer: Cofinity Medicare Advantage	$2,744.22
Rate for Payer: Encore Health Key Benefits Commercial	$3,136.25
Rate for Payer: Healthscope Commercial	$3,528.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,332.26
Rate for Payer: PHP Commercial	$3,332.26
Rate for Payer: Priority Health Cigna Priority Health	$2,548.20
Rate for Payer: Priority Health SBD	$2,469.80

HC ACCESS EXTREMITY ARTERY

Facility

$500.92

Service Code	CPT 36140
Hospital Charge Code	36100102
Hospital Revenue Code	761
Min. Negotiated Rate	$200.37
Max. Negotiated Rate	$450.83
Rate for Payer: Aetna Commercial	$425.78
Rate for Payer: Aetna Medicare	$250.46
Rate for Payer: Aetna New Business (MI Preferred)	$325.60
Rate for Payer: BCBS Complete	$200.37
Rate for Payer: Cash Price	$400.74
Rate for Payer: Cofinity Commercial	$350.64
Rate for Payer: Cofinity Commercial	$430.79
Rate for Payer: Cofinity Medicare Advantage	$350.64
Rate for Payer: Encore Health Key Benefits Commercial	$400.74
Rate for Payer: Healthscope Commercial	$450.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$425.78
Rate for Payer: PHP Commercial	$425.78
Rate for Payer: Priority Health Cigna Priority Health	$325.60
Rate for Payer: Priority Health SBD	$315.58

HC ACCESS EXTREMITY ARTERY

Facility

$500.92

Service Code	CPT 36140
Hospital Charge Code	36100102
Hospital Revenue Code	761
Min. Negotiated Rate	$315.58
Max. Negotiated Rate	$450.83
Rate for Payer: Aetna Commercial	$425.78
Rate for Payer: Aetna New Business (MI Preferred)	$325.60
Rate for Payer: Cash Price	$400.74
Rate for Payer: Cofinity Commercial	$350.64
Rate for Payer: Cofinity Commercial	$430.79
Rate for Payer: Cofinity Medicare Advantage	$350.64
Rate for Payer: Encore Health Key Benefits Commercial	$400.74
Rate for Payer: Healthscope Commercial	$450.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$425.78
Rate for Payer: PHP Commercial	$425.78
Rate for Payer: Priority Health Cigna Priority Health	$325.60
Rate for Payer: Priority Health SBD	$315.58

HC ACCESS MAIN PULMONARY

Facility

$427.58

Service Code	CPT 36013
Hospital Charge Code	36100099
Hospital Revenue Code	361
Min. Negotiated Rate	$171.03
Max. Negotiated Rate	$384.82
Rate for Payer: Aetna Commercial	$363.44
Rate for Payer: Aetna Medicare	$213.79
Rate for Payer: Aetna New Business (MI Preferred)	$277.93
Rate for Payer: BCBS Complete	$171.03
Rate for Payer: Cash Price	$342.06
Rate for Payer: Cofinity Commercial	$299.31
Rate for Payer: Cofinity Commercial	$367.72
Rate for Payer: Cofinity Medicare Advantage	$299.31
Rate for Payer: Encore Health Key Benefits Commercial	$342.06
Rate for Payer: Healthscope Commercial	$384.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.44
Rate for Payer: PHP Commercial	$363.44
Rate for Payer: Priority Health Cigna Priority Health	$277.93
Rate for Payer: Priority Health SBD	$269.38

HC ACCESS MAIN PULMONARY

Facility

$427.58

Service Code	CPT 36013
Hospital Charge Code	36100099
Hospital Revenue Code	361
Min. Negotiated Rate	$269.38
Max. Negotiated Rate	$384.82
Rate for Payer: Aetna Commercial	$363.44
Rate for Payer: Aetna New Business (MI Preferred)	$277.93
Rate for Payer: Cash Price	$342.06
Rate for Payer: Cofinity Commercial	$299.31
Rate for Payer: Cofinity Commercial	$367.72
Rate for Payer: Cofinity Medicare Advantage	$299.31
Rate for Payer: Encore Health Key Benefits Commercial	$342.06
Rate for Payer: Healthscope Commercial	$384.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.44
Rate for Payer: PHP Commercial	$363.44
Rate for Payer: Priority Health Cigna Priority Health	$277.93
Rate for Payer: Priority Health SBD	$269.38

HC ACCESS VEIN

Facility

$388.71

Service Code	CPT 36000
Hospital Charge Code	36100093
Hospital Revenue Code	361
Min. Negotiated Rate	$244.89
Max. Negotiated Rate	$349.84
Rate for Payer: Aetna Commercial	$330.40
Rate for Payer: Aetna New Business (MI Preferred)	$252.66
Rate for Payer: Cash Price	$310.97
Rate for Payer: Cofinity Commercial	$272.10
Rate for Payer: Cofinity Commercial	$334.29
Rate for Payer: Cofinity Medicare Advantage	$272.10
Rate for Payer: Encore Health Key Benefits Commercial	$310.97
Rate for Payer: Healthscope Commercial	$349.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.40
Rate for Payer: PHP Commercial	$330.40
Rate for Payer: Priority Health Cigna Priority Health	$252.66
Rate for Payer: Priority Health SBD	$244.89

HC ACCESS VEIN

Facility

$388.71

Service Code	CPT 36000
Hospital Charge Code	36100093
Hospital Revenue Code	361
Min. Negotiated Rate	$155.48
Max. Negotiated Rate	$349.84
Rate for Payer: Aetna Commercial	$330.40
Rate for Payer: Aetna Medicare	$194.35
Rate for Payer: Aetna New Business (MI Preferred)	$252.66
Rate for Payer: BCBS Complete	$155.48
Rate for Payer: Cash Price	$310.97
Rate for Payer: Cofinity Commercial	$272.10
Rate for Payer: Cofinity Commercial	$334.29
Rate for Payer: Cofinity Medicare Advantage	$272.10
Rate for Payer: Encore Health Key Benefits Commercial	$310.97
Rate for Payer: Healthscope Commercial	$349.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.40
Rate for Payer: PHP Commercial	$330.40
Rate for Payer: Priority Health Cigna Priority Health	$252.66
Rate for Payer: Priority Health SBD	$244.89

HC ACCESS VEIN ORGAN BLOOD SAMPLING

Facility

$1,069.35

Service Code	CPT 36500
Hospital Charge Code	36100118
Hospital Revenue Code	361
Min. Negotiated Rate	$427.74
Max. Negotiated Rate	$962.41
Rate for Payer: Aetna Commercial	$908.95
Rate for Payer: Aetna Medicare	$534.67
Rate for Payer: Aetna New Business (MI Preferred)	$695.08
Rate for Payer: BCBS Complete	$427.74
Rate for Payer: Cash Price	$855.48
Rate for Payer: Cofinity Commercial	$748.54
Rate for Payer: Cofinity Commercial	$919.64
Rate for Payer: Cofinity Medicare Advantage	$748.54
Rate for Payer: Encore Health Key Benefits Commercial	$855.48
Rate for Payer: Healthscope Commercial	$962.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$908.95
Rate for Payer: PHP Commercial	$908.95
Rate for Payer: Priority Health Cigna Priority Health	$695.08
Rate for Payer: Priority Health SBD	$673.69

HC ACCESS VEIN ORGAN BLOOD SAMPLING

Facility

$1,069.35

Service Code	CPT 36500
Hospital Charge Code	36100118
Hospital Revenue Code	361
Min. Negotiated Rate	$673.69
Max. Negotiated Rate	$962.41
Rate for Payer: Aetna Commercial	$908.95
Rate for Payer: Aetna New Business (MI Preferred)	$695.08
Rate for Payer: Cash Price	$855.48
Rate for Payer: Cofinity Commercial	$748.54
Rate for Payer: Cofinity Commercial	$919.64
Rate for Payer: Cofinity Medicare Advantage	$748.54
Rate for Payer: Encore Health Key Benefits Commercial	$855.48
Rate for Payer: Healthscope Commercial	$962.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$908.95
Rate for Payer: PHP Commercial	$908.95
Rate for Payer: Priority Health Cigna Priority Health	$695.08
Rate for Payer: Priority Health SBD	$673.69

HC ACCESS VENA CAVA

Facility

$3,128.58

Service Code	CPT 36010
Hospital Charge Code	36100096
Hospital Revenue Code	361
Min. Negotiated Rate	$1,971.01
Max. Negotiated Rate	$2,815.72
Rate for Payer: Aetna Commercial	$2,659.29
Rate for Payer: Aetna New Business (MI Preferred)	$2,033.58
Rate for Payer: Cash Price	$2,502.86
Rate for Payer: Cofinity Commercial	$2,190.01
Rate for Payer: Cofinity Commercial	$2,690.58
Rate for Payer: Cofinity Medicare Advantage	$2,190.01
Rate for Payer: Encore Health Key Benefits Commercial	$2,502.86
Rate for Payer: Healthscope Commercial	$2,815.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,659.29
Rate for Payer: PHP Commercial	$2,659.29
Rate for Payer: Priority Health Cigna Priority Health	$2,033.58
Rate for Payer: Priority Health SBD	$1,971.01

HC ACCESS VENA CAVA

Facility

$3,128.58

Service Code	CPT 36010
Hospital Charge Code	36100096
Hospital Revenue Code	361
Min. Negotiated Rate	$1,251.43
Max. Negotiated Rate	$2,815.72
Rate for Payer: Aetna Commercial	$2,659.29
Rate for Payer: Aetna Medicare	$1,564.29
Rate for Payer: Aetna New Business (MI Preferred)	$2,033.58
Rate for Payer: BCBS Complete	$1,251.43
Rate for Payer: Cash Price	$2,502.86
Rate for Payer: Cofinity Commercial	$2,190.01
Rate for Payer: Cofinity Commercial	$2,690.58
Rate for Payer: Cofinity Medicare Advantage	$2,190.01
Rate for Payer: Encore Health Key Benefits Commercial	$2,502.86
Rate for Payer: Healthscope Commercial	$2,815.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,659.29
Rate for Payer: PHP Commercial	$2,659.29
Rate for Payer: Priority Health Cigna Priority Health	$2,033.58
Rate for Payer: Priority Health SBD	$1,971.01

HC ACCESS WINDOW

Facility

$38.93

Hospital Charge Code	27000624
Hospital Revenue Code	270
Min. Negotiated Rate	$24.53
Max. Negotiated Rate	$35.04
Rate for Payer: Aetna Commercial	$33.09
Rate for Payer: Aetna New Business (MI Preferred)	$25.30
Rate for Payer: Cash Price	$31.14
Rate for Payer: Cofinity Commercial	$27.25
Rate for Payer: Cofinity Commercial	$33.48
Rate for Payer: Cofinity Medicare Advantage	$27.25
Rate for Payer: Encore Health Key Benefits Commercial	$31.14
Rate for Payer: Healthscope Commercial	$35.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.09
Rate for Payer: PHP Commercial	$33.09
Rate for Payer: Priority Health Cigna Priority Health	$25.30
Rate for Payer: Priority Health SBD	$24.53

Know your out-of-pocket cost for care.

All Charges