Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC EP AFTER DRUGS

Facility

$7,278.36

Service Code	CPT 93623
Hospital Charge Code	48100039
Hospital Revenue Code	481
Min. Negotiated Rate	$4,585.37
Max. Negotiated Rate	$6,550.52
Rate for Payer: Aetna Commercial	$6,186.61
Rate for Payer: Aetna New Business (MI Preferred)	$4,730.93
Rate for Payer: Cash Price	$5,822.69
Rate for Payer: Cofinity Commercial	$5,094.85
Rate for Payer: Cofinity Commercial	$6,259.39
Rate for Payer: Healthscope Commercial	$6,550.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,186.61
Rate for Payer: PHP Commercial	$6,186.61
Rate for Payer: Priority Health Cigna Priority Health	$5,094.85
Rate for Payer: Priority Health SBD	$4,585.37

HC EP EVAL OF SQ ICD

Facility

$3,277.26

Service Code	CPT 93644
Hospital Charge Code	48000027
Hospital Revenue Code	480
Min. Negotiated Rate	$2,064.67
Max. Negotiated Rate	$2,949.53
Rate for Payer: Aetna Commercial	$2,785.67
Rate for Payer: Aetna New Business (MI Preferred)	$2,130.22
Rate for Payer: Cash Price	$2,621.81
Rate for Payer: Cofinity Commercial	$2,294.08
Rate for Payer: Cofinity Commercial	$2,818.44
Rate for Payer: Healthscope Commercial	$2,949.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,785.67
Rate for Payer: PHP Commercial	$2,785.67
Rate for Payer: Priority Health Cigna Priority Health	$2,294.08
Rate for Payer: Priority Health SBD	$2,064.67

HC EP EVAL OF SQ ICD

Facility

$3,277.26

Service Code	CPT 93644
Hospital Charge Code	48000027
Hospital Revenue Code	480
Min. Negotiated Rate	$186.31
Max. Negotiated Rate	$2,949.53
Rate for Payer: Aetna Commercial	$2,785.67
Rate for Payer: Aetna New Business (MI Preferred)	$2,130.22
Rate for Payer: BCBS Complete	$1,310.90
Rate for Payer: Cash Price	$2,621.81
Rate for Payer: Cash Price	$2,621.81
Rate for Payer: Cofinity Commercial	$2,818.44
Rate for Payer: Cofinity Commercial	$2,294.08
Rate for Payer: Healthscope Commercial	$2,949.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,785.67
Rate for Payer: PHP Commercial	$2,785.67
Rate for Payer: Priority Health Cigna Priority Health	$2,294.08
Rate for Payer: Priority Health SBD	$2,064.67
Rate for Payer: UHC All Payor (Choice/PPO)	$204.94
Rate for Payer: UHC Exchange	$186.31

HC EP EVALUATION OF GEN/LEADS

Facility

$2,341.80

Service Code	CPT 93641
Hospital Charge Code	48100042
Hospital Revenue Code	481
Min. Negotiated Rate	$1,475.33
Max. Negotiated Rate	$2,107.62
Rate for Payer: Aetna Commercial	$1,990.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,522.17
Rate for Payer: Cash Price	$1,873.44
Rate for Payer: Cofinity Commercial	$1,639.26
Rate for Payer: Cofinity Commercial	$2,013.95
Rate for Payer: Healthscope Commercial	$2,107.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,990.53
Rate for Payer: PHP Commercial	$1,990.53
Rate for Payer: Priority Health Cigna Priority Health	$1,639.26
Rate for Payer: Priority Health SBD	$1,475.33

HC EP EVALUATION OF GEN/LEADS

Facility

$2,341.80

Service Code	CPT 93641
Hospital Charge Code	48100042
Hospital Revenue Code	481
Min. Negotiated Rate	$878.00
Max. Negotiated Rate	$2,107.62
Rate for Payer: Aetna Commercial	$1,990.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,522.17
Rate for Payer: BCBS Complete	$936.72
Rate for Payer: BCBS Trust/PPO	$1,235.74
Rate for Payer: Cash Price	$1,873.44
Rate for Payer: Cash Price	$1,873.44
Rate for Payer: Cofinity Commercial	$1,639.26
Rate for Payer: Cofinity Commercial	$2,013.95
Rate for Payer: Healthscope Commercial	$2,107.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,990.53
Rate for Payer: PHP Commercial	$1,990.53
Rate for Payer: Priority Health Cigna Priority Health	$1,639.26
Rate for Payer: Priority Health SBD	$1,475.33
Rate for Payer: UHC Core	$878.00

HC EP EVALUATION OF LEADS

Facility

$2,146.53

Service Code	CPT 93640
Hospital Charge Code	48100041
Hospital Revenue Code	481
Min. Negotiated Rate	$858.61
Max. Negotiated Rate	$1,931.88
Rate for Payer: Aetna Commercial	$1,824.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,395.24
Rate for Payer: BCBS Complete	$858.61
Rate for Payer: BCBS Trust/PPO	$1,188.14
Rate for Payer: Cash Price	$1,717.22
Rate for Payer: Cash Price	$1,717.22
Rate for Payer: Cofinity Commercial	$1,502.57
Rate for Payer: Cofinity Commercial	$1,846.02
Rate for Payer: Healthscope Commercial	$1,931.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,824.55
Rate for Payer: PHP Commercial	$1,824.55
Rate for Payer: Priority Health Cigna Priority Health	$1,502.57
Rate for Payer: Priority Health SBD	$1,352.31
Rate for Payer: UHC Core	$878.00

HC EP EVALUATION OF LEADS

Facility

$2,146.53

Service Code	CPT 93640
Hospital Charge Code	48100041
Hospital Revenue Code	481
Min. Negotiated Rate	$1,352.31
Max. Negotiated Rate	$1,931.88
Rate for Payer: Aetna Commercial	$1,824.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,395.24
Rate for Payer: Cash Price	$1,717.22
Rate for Payer: Cofinity Commercial	$1,502.57
Rate for Payer: Cofinity Commercial	$1,846.02
Rate for Payer: Healthscope Commercial	$1,931.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,824.55
Rate for Payer: PHP Commercial	$1,824.55
Rate for Payer: Priority Health Cigna Priority Health	$1,502.57
Rate for Payer: Priority Health SBD	$1,352.31

HC EPIDURAL PREP (OB)

Facility

$633.42

Hospital Charge Code	37000003
Hospital Revenue Code	370
Min. Negotiated Rate	$399.05
Max. Negotiated Rate	$570.08
Rate for Payer: Aetna Commercial	$538.41
Rate for Payer: Aetna New Business (MI Preferred)	$411.72
Rate for Payer: Cash Price	$506.74
Rate for Payer: Cofinity Commercial	$443.39
Rate for Payer: Cofinity Commercial	$544.74
Rate for Payer: Healthscope Commercial	$570.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$538.41
Rate for Payer: PHP Commercial	$538.41
Rate for Payer: Priority Health Cigna Priority Health	$443.39
Rate for Payer: Priority Health SBD	$399.05

HC EPIDURAL PREP (OB)

Facility

$633.42

Hospital Charge Code	37000003
Hospital Revenue Code	370
Min. Negotiated Rate	$253.37
Max. Negotiated Rate	$570.08
Rate for Payer: Aetna Commercial	$538.41
Rate for Payer: Aetna New Business (MI Preferred)	$411.72
Rate for Payer: BCBS Complete	$253.37
Rate for Payer: Cash Price	$506.74
Rate for Payer: Cofinity Commercial	$443.39
Rate for Payer: Cofinity Commercial	$544.74
Rate for Payer: Healthscope Commercial	$570.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$538.41
Rate for Payer: PHP Commercial	$538.41
Rate for Payer: Priority Health Cigna Priority Health	$443.39
Rate for Payer: Priority Health SBD	$399.05

HC EPIFIX (14 MM DISC) PER SQ CM

Facility

$478.89

Service Code	HCPCS Q4186
Hospital Charge Code	63600135
Hospital Revenue Code	636
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$431.00
Rate for Payer: Aetna Commercial	$407.06
Rate for Payer: Aetna New Business (MI Preferred)	$311.28
Rate for Payer: Cash Price	$383.11
Rate for Payer: Cofinity Commercial	$335.22
Rate for Payer: Cofinity Commercial	$411.85
Rate for Payer: Healthscope Commercial	$431.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$407.06
Rate for Payer: PHP Commercial	$407.06
Rate for Payer: Priority Health Cigna Priority Health	$335.22
Rate for Payer: Priority Health SBD	$301.70

HC EPIFIX (14 MM DISC) PER SQ CM

Facility

$478.89

Service Code	HCPCS Q4186
Hospital Charge Code	63600135
Hospital Revenue Code	636
Min. Negotiated Rate	$191.56
Max. Negotiated Rate	$431.00
Rate for Payer: Aetna Commercial	$407.06
Rate for Payer: Aetna New Business (MI Preferred)	$311.28
Rate for Payer: BCBS Complete	$191.56
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$383.11
Rate for Payer: Cash Price	$383.11
Rate for Payer: Cofinity Commercial	$411.85
Rate for Payer: Cofinity Commercial	$335.22
Rate for Payer: Healthscope Commercial	$431.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$407.06
Rate for Payer: PHP Commercial	$407.06
Rate for Payer: Priority Health Cigna Priority Health	$335.22
Rate for Payer: Priority Health SBD	$301.70

HC EPIFIX (18 MM DISC) PER SQ CM

Facility

$695.64

Service Code	HCPCS Q4186
Hospital Charge Code	63600136
Hospital Revenue Code	636
Min. Negotiated Rate	$278.26
Max. Negotiated Rate	$626.08
Rate for Payer: Aetna Commercial	$591.29
Rate for Payer: Aetna New Business (MI Preferred)	$452.17
Rate for Payer: BCBS Complete	$278.26
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$556.51
Rate for Payer: Cash Price	$556.51
Rate for Payer: Cofinity Commercial	$598.25
Rate for Payer: Cofinity Commercial	$486.95
Rate for Payer: Healthscope Commercial	$626.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$591.29
Rate for Payer: PHP Commercial	$591.29
Rate for Payer: Priority Health Cigna Priority Health	$486.95
Rate for Payer: Priority Health SBD	$438.25

HC EPIFIX (18 MM DISC) PER SQ CM

Facility

$695.64

Service Code	HCPCS Q4186
Hospital Charge Code	63600136
Hospital Revenue Code	636
Min. Negotiated Rate	$438.25
Max. Negotiated Rate	$626.08
Rate for Payer: Aetna Commercial	$591.29
Rate for Payer: Aetna New Business (MI Preferred)	$452.17
Rate for Payer: Cash Price	$556.51
Rate for Payer: Cofinity Commercial	$486.95
Rate for Payer: Cofinity Commercial	$598.25
Rate for Payer: Healthscope Commercial	$626.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$591.29
Rate for Payer: PHP Commercial	$591.29
Rate for Payer: Priority Health Cigna Priority Health	$486.95
Rate for Payer: Priority Health SBD	$438.25

HC EPIFIX 2X2 PER SQ CM

Facility

$678.30

Service Code	HCPCS Q4186
Hospital Charge Code	63600130
Hospital Revenue Code	636
Min. Negotiated Rate	$427.33
Max. Negotiated Rate	$610.47
Rate for Payer: Aetna Commercial	$576.56
Rate for Payer: Aetna New Business (MI Preferred)	$440.90
Rate for Payer: Cash Price	$542.64
Rate for Payer: Cofinity Commercial	$474.81
Rate for Payer: Cofinity Commercial	$583.34
Rate for Payer: Healthscope Commercial	$610.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$576.56
Rate for Payer: PHP Commercial	$576.56
Rate for Payer: Priority Health Cigna Priority Health	$474.81
Rate for Payer: Priority Health SBD	$427.33

HC EPIFIX 2X2 PER SQ CM

Facility

$678.30

Service Code	HCPCS Q4186
Hospital Charge Code	63600130
Hospital Revenue Code	636
Min. Negotiated Rate	$271.32
Max. Negotiated Rate	$610.47
Rate for Payer: Aetna Commercial	$576.56
Rate for Payer: Aetna New Business (MI Preferred)	$440.90
Rate for Payer: BCBS Complete	$271.32
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$542.64
Rate for Payer: Cash Price	$542.64
Rate for Payer: Cofinity Commercial	$583.34
Rate for Payer: Cofinity Commercial	$474.81
Rate for Payer: Healthscope Commercial	$610.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$576.56
Rate for Payer: PHP Commercial	$576.56
Rate for Payer: Priority Health Cigna Priority Health	$474.81
Rate for Payer: Priority Health SBD	$427.33

HC EPIFIX 2X3 PER SQ CM

Facility

$486.20

Service Code	HCPCS Q4186
Hospital Charge Code	63600131
Hospital Revenue Code	636
Min. Negotiated Rate	$194.48
Max. Negotiated Rate	$437.58
Rate for Payer: Aetna Commercial	$413.27
Rate for Payer: Aetna New Business (MI Preferred)	$316.03
Rate for Payer: BCBS Complete	$194.48
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$388.96
Rate for Payer: Cash Price	$388.96
Rate for Payer: Cofinity Commercial	$418.13
Rate for Payer: Cofinity Commercial	$340.34
Rate for Payer: Healthscope Commercial	$437.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$413.27
Rate for Payer: PHP Commercial	$413.27
Rate for Payer: Priority Health Cigna Priority Health	$340.34
Rate for Payer: Priority Health SBD	$306.31

HC EPIFIX 2X3 PER SQ CM

Facility

$486.20

Service Code	HCPCS Q4186
Hospital Charge Code	63600131
Hospital Revenue Code	636
Min. Negotiated Rate	$306.31
Max. Negotiated Rate	$437.58
Rate for Payer: Aetna Commercial	$413.27
Rate for Payer: Aetna New Business (MI Preferred)	$316.03
Rate for Payer: Cash Price	$388.96
Rate for Payer: Cofinity Commercial	$340.34
Rate for Payer: Cofinity Commercial	$418.13
Rate for Payer: Healthscope Commercial	$437.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$413.27
Rate for Payer: PHP Commercial	$413.27
Rate for Payer: Priority Health Cigna Priority Health	$340.34
Rate for Payer: Priority Health SBD	$306.31

HC EPIFIX 2X4 PER SQ CM

Facility

$430.32

Service Code	HCPCS Q4186
Hospital Charge Code	63600132
Hospital Revenue Code	636
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$387.29
Rate for Payer: Aetna Commercial	$365.77
Rate for Payer: Aetna New Business (MI Preferred)	$279.71
Rate for Payer: Cash Price	$344.26
Rate for Payer: Cofinity Commercial	$301.22
Rate for Payer: Cofinity Commercial	$370.08
Rate for Payer: Healthscope Commercial	$387.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$365.77
Rate for Payer: PHP Commercial	$365.77
Rate for Payer: Priority Health Cigna Priority Health	$301.22
Rate for Payer: Priority Health SBD	$271.10

HC EPIFIX 2X4 PER SQ CM

Facility

$430.32

Service Code	HCPCS Q4186
Hospital Charge Code	63600132
Hospital Revenue Code	636
Min. Negotiated Rate	$172.13
Max. Negotiated Rate	$387.29
Rate for Payer: Aetna Commercial	$365.77
Rate for Payer: Aetna New Business (MI Preferred)	$279.71
Rate for Payer: BCBS Complete	$172.13
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$344.26
Rate for Payer: Cash Price	$344.26
Rate for Payer: Cofinity Commercial	$370.08
Rate for Payer: Cofinity Commercial	$301.22
Rate for Payer: Healthscope Commercial	$387.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$365.77
Rate for Payer: PHP Commercial	$365.77
Rate for Payer: Priority Health Cigna Priority Health	$301.22
Rate for Payer: Priority Health SBD	$271.10

HC EPIFIX 3X4 PER SQ CM

Facility

$404.43

Service Code	HCPCS Q4186
Hospital Charge Code	63600133
Hospital Revenue Code	636
Min. Negotiated Rate	$161.77
Max. Negotiated Rate	$363.99
Rate for Payer: Aetna Commercial	$343.77
Rate for Payer: Aetna New Business (MI Preferred)	$262.88
Rate for Payer: BCBS Complete	$161.77
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$323.54
Rate for Payer: Cash Price	$323.54
Rate for Payer: Cofinity Commercial	$347.81
Rate for Payer: Cofinity Commercial	$283.10
Rate for Payer: Healthscope Commercial	$363.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.77
Rate for Payer: PHP Commercial	$343.77
Rate for Payer: Priority Health Cigna Priority Health	$283.10
Rate for Payer: Priority Health SBD	$254.79

HC EPIFIX 3X4 PER SQ CM

Facility

$404.43

Service Code	HCPCS Q4186
Hospital Charge Code	63600133
Hospital Revenue Code	636
Min. Negotiated Rate	$254.79
Max. Negotiated Rate	$363.99
Rate for Payer: Aetna Commercial	$343.77
Rate for Payer: Aetna New Business (MI Preferred)	$262.88
Rate for Payer: Cash Price	$323.54
Rate for Payer: Cofinity Commercial	$283.10
Rate for Payer: Cofinity Commercial	$347.81
Rate for Payer: Healthscope Commercial	$363.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.77
Rate for Payer: PHP Commercial	$343.77
Rate for Payer: Priority Health Cigna Priority Health	$283.10
Rate for Payer: Priority Health SBD	$254.79

HC EPIFIX 4 X 4.5 PER SQ CM

Facility

$207.64

Service Code	HCPCS Q4186
Hospital Charge Code	63600227
Hospital Revenue Code	636
Min. Negotiated Rate	$130.81
Max. Negotiated Rate	$186.88
Rate for Payer: Aetna Commercial	$176.49
Rate for Payer: Aetna New Business (MI Preferred)	$134.97
Rate for Payer: Cash Price	$166.11
Rate for Payer: Cofinity Commercial	$145.35
Rate for Payer: Cofinity Commercial	$178.57
Rate for Payer: Healthscope Commercial	$186.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$176.49
Rate for Payer: PHP Commercial	$176.49
Rate for Payer: Priority Health Cigna Priority Health	$145.35
Rate for Payer: Priority Health SBD	$130.81

HC EPIFIX 4 X 4.5 PER SQ CM

Facility

$207.64

Service Code	HCPCS Q4186
Hospital Charge Code	63600227
Hospital Revenue Code	636
Min. Negotiated Rate	$83.06
Max. Negotiated Rate	$281.38
Rate for Payer: Aetna Commercial	$176.49
Rate for Payer: Aetna New Business (MI Preferred)	$134.97
Rate for Payer: BCBS Complete	$83.06
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$166.11
Rate for Payer: Cash Price	$166.11
Rate for Payer: Cofinity Commercial	$178.57
Rate for Payer: Cofinity Commercial	$145.35
Rate for Payer: Healthscope Commercial	$186.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$176.49
Rate for Payer: PHP Commercial	$176.49
Rate for Payer: Priority Health Cigna Priority Health	$145.35
Rate for Payer: Priority Health SBD	$130.81

HC EPIFIX 4X4 PER SQ CM

Facility

$389.01

Service Code	HCPCS Q4186
Hospital Charge Code	63600134
Hospital Revenue Code	636
Min. Negotiated Rate	$155.60
Max. Negotiated Rate	$350.11
Rate for Payer: Aetna Commercial	$330.66
Rate for Payer: Aetna New Business (MI Preferred)	$252.86
Rate for Payer: BCBS Complete	$155.60
Rate for Payer: BCBS Trust/PPO	$281.38
Rate for Payer: Cash Price	$311.21
Rate for Payer: Cash Price	$311.21
Rate for Payer: Cofinity Commercial	$334.55
Rate for Payer: Cofinity Commercial	$272.31
Rate for Payer: Healthscope Commercial	$350.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$330.66
Rate for Payer: PHP Commercial	$330.66
Rate for Payer: Priority Health Cigna Priority Health	$272.31
Rate for Payer: Priority Health SBD	$245.08

HC EPIFIX 4X4 PER SQ CM

Facility

$389.01

Service Code	HCPCS Q4186
Hospital Charge Code	63600134
Hospital Revenue Code	636
Min. Negotiated Rate	$245.08
Max. Negotiated Rate	$350.11
Rate for Payer: Aetna Commercial	$330.66
Rate for Payer: Aetna New Business (MI Preferred)	$252.86
Rate for Payer: Cash Price	$311.21
Rate for Payer: Cofinity Commercial	$272.31
Rate for Payer: Cofinity Commercial	$334.55
Rate for Payer: Healthscope Commercial	$350.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$330.66
Rate for Payer: PHP Commercial	$330.66
Rate for Payer: Priority Health Cigna Priority Health	$272.31
Rate for Payer: Priority Health SBD	$245.08

Know your out-of-pocket cost for care.

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