Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC AVULSION OF NAIL PLATE

Facility

$319.94

Service Code	CPT 11730
Hospital Charge Code	76100045
Hospital Revenue Code	761
Min. Negotiated Rate	$201.56
Max. Negotiated Rate	$287.95
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna New Business (MI Preferred)	$207.96
Rate for Payer: Cash Price	$255.95
Rate for Payer: Cofinity Commercial	$223.96
Rate for Payer: Cofinity Commercial	$275.15
Rate for Payer: Cofinity Medicare Advantage	$223.96
Rate for Payer: Encore Health Key Benefits Commercial	$255.95
Rate for Payer: Healthscope Commercial	$287.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$271.95
Rate for Payer: PHP Commercial	$271.95
Rate for Payer: Priority Health Cigna Priority Health	$207.96
Rate for Payer: Priority Health SBD	$201.56

HC AVULSION OF NAIL PLATE

Facility

$319.94

Service Code	CPT 11730
Hospital Charge Code	76100045
Hospital Revenue Code	761
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Aetna New Business (MI Preferred)	$207.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Cash Price	$255.95
Rate for Payer: Cash Price	$255.95
Rate for Payer: Cofinity Commercial	$275.15
Rate for Payer: Cofinity Commercial	$223.96
Rate for Payer: Cofinity Medicare Advantage	$223.96
Rate for Payer: Encore Health Key Benefits Commercial	$255.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Healthscope Commercial	$287.95
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$271.95
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Commercial	$271.95
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$207.96
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Priority Health SBD	$201.56
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

HC BACITRACIN 1 OZ

Facility

$8.13

Hospital Charge Code	27100006
Hospital Revenue Code	271
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$7.32
Rate for Payer: Aetna Commercial	$6.91
Rate for Payer: Aetna New Business (MI Preferred)	$5.28
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cofinity Commercial	$5.69
Rate for Payer: Cofinity Commercial	$6.99
Rate for Payer: Cofinity Medicare Advantage	$5.69
Rate for Payer: Encore Health Key Benefits Commercial	$6.50
Rate for Payer: Healthscope Commercial	$7.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.91
Rate for Payer: PHP Commercial	$6.91
Rate for Payer: Priority Health Cigna Priority Health	$5.28
Rate for Payer: Priority Health SBD	$5.12

HC BACITRACIN 1 OZ

Facility

$8.13

Hospital Charge Code	27100006
Hospital Revenue Code	271
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$7.32
Rate for Payer: Aetna Commercial	$6.91
Rate for Payer: Aetna Medicare	$4.07
Rate for Payer: Aetna New Business (MI Preferred)	$5.28
Rate for Payer: BCBS Complete	$3.25
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cofinity Commercial	$5.69
Rate for Payer: Cofinity Commercial	$6.99
Rate for Payer: Cofinity Medicare Advantage	$5.69
Rate for Payer: Encore Health Key Benefits Commercial	$6.50
Rate for Payer: Healthscope Commercial	$7.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.91
Rate for Payer: PHP Commercial	$6.91
Rate for Payer: Priority Health Cigna Priority Health	$5.28
Rate for Payer: Priority Health SBD	$5.12

HC BACITRACIN 4 OZ

Facility

$30.98

Hospital Charge Code	27100007
Hospital Revenue Code	271
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$27.88
Rate for Payer: Aetna Commercial	$26.33
Rate for Payer: Aetna Medicare	$15.49
Rate for Payer: Aetna New Business (MI Preferred)	$20.14
Rate for Payer: BCBS Complete	$12.39
Rate for Payer: Cash Price	$24.78
Rate for Payer: Cofinity Commercial	$21.69
Rate for Payer: Cofinity Commercial	$26.64
Rate for Payer: Cofinity Medicare Advantage	$21.69
Rate for Payer: Encore Health Key Benefits Commercial	$24.78
Rate for Payer: Healthscope Commercial	$27.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.33
Rate for Payer: PHP Commercial	$26.33
Rate for Payer: Priority Health Cigna Priority Health	$20.14
Rate for Payer: Priority Health SBD	$19.52

HC BACITRACIN 4 OZ

Facility

$30.98

Hospital Charge Code	27100007
Hospital Revenue Code	271
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$27.88
Rate for Payer: Aetna Commercial	$26.33
Rate for Payer: Aetna New Business (MI Preferred)	$20.14
Rate for Payer: Cash Price	$24.78
Rate for Payer: Cofinity Commercial	$21.69
Rate for Payer: Cofinity Commercial	$26.64
Rate for Payer: Cofinity Medicare Advantage	$21.69
Rate for Payer: Encore Health Key Benefits Commercial	$24.78
Rate for Payer: Healthscope Commercial	$27.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.33
Rate for Payer: PHP Commercial	$26.33
Rate for Payer: Priority Health Cigna Priority Health	$20.14
Rate for Payer: Priority Health SBD	$19.52

HC BACK SCREEN

Facility

$52.02

Hospital Charge Code	42000047
Hospital Revenue Code	420
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC BACK SCREEN

Facility

$52.02

Hospital Charge Code	42000047
Hospital Revenue Code	420
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna Medicare	$26.01
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: BCBS Complete	$20.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77
Rate for Payer: UHC Core	$38.49
Rate for Payer: UHC Exchange	$38.49

HC BACK SCREEN, VBISD

Facility

$68.34

Hospital Charge Code	43000014
Hospital Revenue Code	430
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$61.51
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna New Business (MI Preferred)	$44.42
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cofinity Commercial	$47.84
Rate for Payer: Cofinity Commercial	$58.77
Rate for Payer: Cofinity Medicare Advantage	$47.84
Rate for Payer: Encore Health Key Benefits Commercial	$54.67
Rate for Payer: Healthscope Commercial	$61.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.09
Rate for Payer: PHP Commercial	$58.09
Rate for Payer: Priority Health Cigna Priority Health	$44.42
Rate for Payer: Priority Health SBD	$43.05

HC BACK SCREEN, VBISD

Facility

$68.34

Hospital Charge Code	43000014
Hospital Revenue Code	430
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare	$34.17
Rate for Payer: Aetna New Business (MI Preferred)	$44.42
Rate for Payer: BCBS Complete	$27.34
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cofinity Commercial	$58.77
Rate for Payer: Cofinity Commercial	$47.84
Rate for Payer: Cofinity Medicare Advantage	$47.84
Rate for Payer: Encore Health Key Benefits Commercial	$54.67
Rate for Payer: Healthscope Commercial	$61.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.09
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$58.09
Rate for Payer: Priority Health Cigna Priority Health	$44.42
Rate for Payer: Priority Health SBD	$43.05
Rate for Payer: UHC Core	$50.57
Rate for Payer: UHC Exchange	$50.57

HC BACTERIAL VAGINOSIS PANEL

Facility

$153.00

Service Code	CPT 0352U
Hospital Charge Code	30600337
Hospital Revenue Code	306
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC BACTERIAL VAGINOSIS PANEL

Facility

$153.00

Service Code	CPT 0352U
Hospital Charge Code	30600337
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC BAG BLOOD TRANSFER

Facility

$8.87

Hospital Charge Code	27000161
Hospital Revenue Code	270
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$7.98
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare	$4.43
Rate for Payer: Aetna New Business (MI Preferred)	$5.77
Rate for Payer: BCBS Complete	$3.55
Rate for Payer: Cash Price	$7.10
Rate for Payer: Cofinity Commercial	$6.21
Rate for Payer: Cofinity Commercial	$7.63
Rate for Payer: Cofinity Medicare Advantage	$6.21
Rate for Payer: Encore Health Key Benefits Commercial	$7.10
Rate for Payer: Healthscope Commercial	$7.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.54
Rate for Payer: PHP Commercial	$7.54
Rate for Payer: Priority Health Cigna Priority Health	$5.77
Rate for Payer: Priority Health SBD	$5.59

HC BAG BLOOD TRANSFER

Facility

$8.87

Hospital Charge Code	27000161
Hospital Revenue Code	270
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$7.98
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna New Business (MI Preferred)	$5.77
Rate for Payer: Cash Price	$7.10
Rate for Payer: Cofinity Commercial	$6.21
Rate for Payer: Cofinity Commercial	$7.63
Rate for Payer: Cofinity Medicare Advantage	$6.21
Rate for Payer: Encore Health Key Benefits Commercial	$7.10
Rate for Payer: Healthscope Commercial	$7.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.54
Rate for Payer: PHP Commercial	$7.54
Rate for Payer: Priority Health Cigna Priority Health	$5.77
Rate for Payer: Priority Health SBD	$5.59

HC BAG WASTE

Facility

$64.26

Hospital Charge Code	27000670
Hospital Revenue Code	270
Min. Negotiated Rate	$40.48
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Commercial	$54.62
Rate for Payer: Aetna New Business (MI Preferred)	$41.77
Rate for Payer: Cash Price	$51.41
Rate for Payer: Cofinity Commercial	$44.98
Rate for Payer: Cofinity Commercial	$55.26
Rate for Payer: Cofinity Medicare Advantage	$44.98
Rate for Payer: Encore Health Key Benefits Commercial	$51.41
Rate for Payer: Healthscope Commercial	$57.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.62
Rate for Payer: PHP Commercial	$54.62
Rate for Payer: Priority Health Cigna Priority Health	$41.77
Rate for Payer: Priority Health SBD	$40.48

HC BAG WASTE

Facility

$64.26

Hospital Charge Code	27000670
Hospital Revenue Code	270
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Commercial	$54.62
Rate for Payer: Aetna Medicare	$32.13
Rate for Payer: Aetna New Business (MI Preferred)	$41.77
Rate for Payer: BCBS Complete	$25.70
Rate for Payer: Cash Price	$51.41
Rate for Payer: Cofinity Commercial	$44.98
Rate for Payer: Cofinity Commercial	$55.26
Rate for Payer: Cofinity Medicare Advantage	$44.98
Rate for Payer: Encore Health Key Benefits Commercial	$51.41
Rate for Payer: Healthscope Commercial	$57.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.62
Rate for Payer: PHP Commercial	$54.62
Rate for Payer: Priority Health Cigna Priority Health	$41.77
Rate for Payer: Priority Health SBD	$40.48

HC BALLOON CATH TRANSLUMINAL LVL 10

Facility

$1,041.42

Service Code	HCPCS C1725
Hospital Charge Code	27200066
Hospital Revenue Code	272
Min. Negotiated Rate	$656.09
Max. Negotiated Rate	$937.28
Rate for Payer: Aetna Commercial	$885.21
Rate for Payer: Aetna New Business (MI Preferred)	$676.92
Rate for Payer: Cash Price	$833.14
Rate for Payer: Cofinity Commercial	$728.99
Rate for Payer: Cofinity Commercial	$895.62
Rate for Payer: Cofinity Medicare Advantage	$728.99
Rate for Payer: Encore Health Key Benefits Commercial	$833.14
Rate for Payer: Healthscope Commercial	$937.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$885.21
Rate for Payer: PHP Commercial	$885.21
Rate for Payer: Priority Health Cigna Priority Health	$676.92
Rate for Payer: Priority Health SBD	$656.09

HC BALLOON CATH TRANSLUMINAL LVL 10

Facility

$1,041.42

Service Code	HCPCS C1725
Hospital Charge Code	27200066
Hospital Revenue Code	272
Min. Negotiated Rate	$416.57
Max. Negotiated Rate	$937.28
Rate for Payer: Aetna Commercial	$885.21
Rate for Payer: Aetna Medicare	$520.71
Rate for Payer: Aetna New Business (MI Preferred)	$676.92
Rate for Payer: BCBS Complete	$416.57
Rate for Payer: Cash Price	$833.14
Rate for Payer: Cofinity Commercial	$728.99
Rate for Payer: Cofinity Commercial	$895.62
Rate for Payer: Cofinity Medicare Advantage	$728.99
Rate for Payer: Encore Health Key Benefits Commercial	$833.14
Rate for Payer: Healthscope Commercial	$937.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$885.21
Rate for Payer: PHP Commercial	$885.21
Rate for Payer: Priority Health Cigna Priority Health	$676.92
Rate for Payer: Priority Health SBD	$656.09

HC BALLOON CATH TRANSLUMINAL LVL 12

Facility

$1,289.14

Service Code	HCPCS C1725
Hospital Charge Code	27200001
Hospital Revenue Code	272
Min. Negotiated Rate	$812.16
Max. Negotiated Rate	$1,160.23
Rate for Payer: Aetna Commercial	$1,095.77
Rate for Payer: Aetna New Business (MI Preferred)	$837.94
Rate for Payer: Cash Price	$1,031.31
Rate for Payer: Cofinity Commercial	$1,108.66
Rate for Payer: Cofinity Commercial	$902.40
Rate for Payer: Cofinity Medicare Advantage	$902.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,031.31
Rate for Payer: Healthscope Commercial	$1,160.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,095.77
Rate for Payer: PHP Commercial	$1,095.77
Rate for Payer: Priority Health Cigna Priority Health	$837.94
Rate for Payer: Priority Health SBD	$812.16

HC BALLOON CATH TRANSLUMINAL LVL 12

Facility

$1,289.14

Service Code	HCPCS C1725
Hospital Charge Code	27200001
Hospital Revenue Code	272
Min. Negotiated Rate	$515.66
Max. Negotiated Rate	$1,160.23
Rate for Payer: Aetna Commercial	$1,095.77
Rate for Payer: Aetna Medicare	$644.57
Rate for Payer: Aetna New Business (MI Preferred)	$837.94
Rate for Payer: BCBS Complete	$515.66
Rate for Payer: Cash Price	$1,031.31
Rate for Payer: Cofinity Commercial	$1,108.66
Rate for Payer: Cofinity Commercial	$902.40
Rate for Payer: Cofinity Medicare Advantage	$902.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,031.31
Rate for Payer: Healthscope Commercial	$1,160.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,095.77
Rate for Payer: PHP Commercial	$1,095.77
Rate for Payer: Priority Health Cigna Priority Health	$837.94
Rate for Payer: Priority Health SBD	$812.16

HC BALLOON CATH TRANSLUMINAL LVL 15

Facility

$1,553.34

Service Code	HCPCS C1725
Hospital Charge Code	27200083
Hospital Revenue Code	272
Min. Negotiated Rate	$978.60
Max. Negotiated Rate	$1,398.01
Rate for Payer: Aetna Commercial	$1,320.34
Rate for Payer: Aetna New Business (MI Preferred)	$1,009.67
Rate for Payer: Cash Price	$1,242.67
Rate for Payer: Cofinity Commercial	$1,087.34
Rate for Payer: Cofinity Commercial	$1,335.87
Rate for Payer: Cofinity Medicare Advantage	$1,087.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,242.67
Rate for Payer: Healthscope Commercial	$1,398.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,320.34
Rate for Payer: PHP Commercial	$1,320.34
Rate for Payer: Priority Health Cigna Priority Health	$1,009.67
Rate for Payer: Priority Health SBD	$978.60

HC BALLOON CATH TRANSLUMINAL LVL 15

Facility

$1,553.34

Service Code	HCPCS C1725
Hospital Charge Code	27200083
Hospital Revenue Code	272
Min. Negotiated Rate	$621.34
Max. Negotiated Rate	$1,398.01
Rate for Payer: Aetna Commercial	$1,320.34
Rate for Payer: Aetna Medicare	$776.67
Rate for Payer: Aetna New Business (MI Preferred)	$1,009.67
Rate for Payer: BCBS Complete	$621.34
Rate for Payer: Cash Price	$1,242.67
Rate for Payer: Cofinity Commercial	$1,087.34
Rate for Payer: Cofinity Commercial	$1,335.87
Rate for Payer: Cofinity Medicare Advantage	$1,087.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,242.67
Rate for Payer: Healthscope Commercial	$1,398.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,320.34
Rate for Payer: PHP Commercial	$1,320.34
Rate for Payer: Priority Health Cigna Priority Health	$1,009.67
Rate for Payer: Priority Health SBD	$978.60

HC BALLOON CATH TRANSLUMINAL LVL 24

Facility

$2,448.00

Service Code	HCPCS C1725
Hospital Charge Code	27200024
Hospital Revenue Code	272
Min. Negotiated Rate	$979.20
Max. Negotiated Rate	$2,203.20
Rate for Payer: Aetna Commercial	$2,080.80
Rate for Payer: Aetna Medicare	$1,224.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,591.20
Rate for Payer: BCBS Complete	$979.20
Rate for Payer: Cash Price	$1,958.40
Rate for Payer: Cofinity Commercial	$1,713.60
Rate for Payer: Cofinity Commercial	$2,105.28
Rate for Payer: Cofinity Medicare Advantage	$1,713.60
Rate for Payer: Encore Health Key Benefits Commercial	$1,958.40
Rate for Payer: Healthscope Commercial	$2,203.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,080.80
Rate for Payer: PHP Commercial	$2,080.80
Rate for Payer: Priority Health Cigna Priority Health	$1,591.20
Rate for Payer: Priority Health SBD	$1,542.24

HC BALLOON CATH TRANSLUMINAL LVL 24

Facility

$2,448.00

Service Code	HCPCS C1725
Hospital Charge Code	27200024
Hospital Revenue Code	272
Min. Negotiated Rate	$1,542.24
Max. Negotiated Rate	$2,203.20
Rate for Payer: Aetna Commercial	$2,080.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,591.20
Rate for Payer: Cash Price	$1,958.40
Rate for Payer: Cofinity Commercial	$1,713.60
Rate for Payer: Cofinity Commercial	$2,105.28
Rate for Payer: Cofinity Medicare Advantage	$1,713.60
Rate for Payer: Encore Health Key Benefits Commercial	$1,958.40
Rate for Payer: Healthscope Commercial	$2,203.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,080.80
Rate for Payer: PHP Commercial	$2,080.80
Rate for Payer: Priority Health Cigna Priority Health	$1,591.20
Rate for Payer: Priority Health SBD	$1,542.24

HC BALLOON CATH TRANSLUMINAL LVL 4

Facility

$421.04

Service Code	HCPCS C1725
Hospital Charge Code	27200053
Hospital Revenue Code	272
Min. Negotiated Rate	$265.26
Max. Negotiated Rate	$378.94
Rate for Payer: Aetna Commercial	$357.88
Rate for Payer: Aetna New Business (MI Preferred)	$273.68
Rate for Payer: Cash Price	$336.83
Rate for Payer: Cofinity Commercial	$294.73
Rate for Payer: Cofinity Commercial	$362.09
Rate for Payer: Cofinity Medicare Advantage	$294.73
Rate for Payer: Encore Health Key Benefits Commercial	$336.83
Rate for Payer: Healthscope Commercial	$378.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.88
Rate for Payer: PHP Commercial	$357.88
Rate for Payer: Priority Health Cigna Priority Health	$273.68
Rate for Payer: Priority Health SBD	$265.26

Know your out-of-pocket cost for care.

All Charges