Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$61.20
Max. Negotiated Rate	$171.16
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: BCBS Trust/PPO	$126.26
Rate for Payer: BCN Commercial	$126.26
Rate for Payer: Cash Price	$122.40
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
Rate for Payer: UHC All Payor (Choice/PPO)	$171.16

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 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	$4.44
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	$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 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 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	$0.03
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: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$833.14
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	$0.03
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: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,031.31
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	$0.03
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: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,242.67
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 24

Facility

$2,448.00

Service Code	HCPCS C1725
Hospital Charge Code	27200024
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
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: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,958.40
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

HC BALLOON CATH TRANSLUMINAL LVL 4

Facility

$421.04

Service Code	HCPCS C1725
Hospital Charge Code	27200053
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$378.94
Rate for Payer: Aetna Commercial	$357.88
Rate for Payer: Aetna Medicare	$210.52
Rate for Payer: Aetna New Business (MI Preferred)	$273.68
Rate for Payer: BCBS Complete	$168.42
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$336.83
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

HC BALLOON CATH TRANSLUMINAL LVL 5

Facility

$588.11

Service Code	HCPCS C1725
Hospital Charge Code	27200078
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$529.30
Rate for Payer: Aetna Commercial	$499.89
Rate for Payer: Aetna Medicare	$294.06
Rate for Payer: Aetna New Business (MI Preferred)	$382.27
Rate for Payer: BCBS Complete	$235.24
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$470.49
Rate for Payer: Cash Price	$470.49
Rate for Payer: Cofinity Commercial	$411.68
Rate for Payer: Cofinity Commercial	$505.77
Rate for Payer: Cofinity Medicare Advantage	$411.68
Rate for Payer: Encore Health Key Benefits Commercial	$470.49
Rate for Payer: Healthscope Commercial	$529.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.89
Rate for Payer: PHP Commercial	$499.89
Rate for Payer: Priority Health Cigna Priority Health	$382.27
Rate for Payer: Priority Health SBD	$370.51

HC BALLOON CATH TRANSLUMINAL LVL 5

Facility

$588.11

Service Code	HCPCS C1725
Hospital Charge Code	27200078
Hospital Revenue Code	272
Min. Negotiated Rate	$370.51
Max. Negotiated Rate	$529.30
Rate for Payer: Aetna Commercial	$499.89
Rate for Payer: Aetna New Business (MI Preferred)	$382.27
Rate for Payer: Cash Price	$470.49
Rate for Payer: Cofinity Commercial	$411.68
Rate for Payer: Cofinity Commercial	$505.77
Rate for Payer: Cofinity Medicare Advantage	$411.68
Rate for Payer: Encore Health Key Benefits Commercial	$470.49
Rate for Payer: Healthscope Commercial	$529.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.89
Rate for Payer: PHP Commercial	$499.89
Rate for Payer: Priority Health Cigna Priority Health	$382.27
Rate for Payer: Priority Health SBD	$370.51

HC BALLOON CATH TRANSLUMINAL LVL 6

Facility

$691.56

Service Code	HCPCS C1725
Hospital Charge Code	27200016
Hospital Revenue Code	272
Min. Negotiated Rate	$435.68
Max. Negotiated Rate	$622.40
Rate for Payer: Aetna Commercial	$587.83
Rate for Payer: Aetna New Business (MI Preferred)	$449.51
Rate for Payer: Cash Price	$553.25
Rate for Payer: Cofinity Commercial	$484.09
Rate for Payer: Cofinity Commercial	$594.74
Rate for Payer: Cofinity Medicare Advantage	$484.09
Rate for Payer: Encore Health Key Benefits Commercial	$553.25
Rate for Payer: Healthscope Commercial	$622.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$587.83
Rate for Payer: PHP Commercial	$587.83
Rate for Payer: Priority Health Cigna Priority Health	$449.51
Rate for Payer: Priority Health SBD	$435.68

HC BALLOON CATH TRANSLUMINAL LVL 6

Facility

$691.56

Service Code	HCPCS C1725
Hospital Charge Code	27200016
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$622.40
Rate for Payer: Aetna Commercial	$587.83
Rate for Payer: Aetna Medicare	$345.78
Rate for Payer: Aetna New Business (MI Preferred)	$449.51
Rate for Payer: BCBS Complete	$276.62
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$553.25
Rate for Payer: Cash Price	$553.25
Rate for Payer: Cofinity Commercial	$484.09
Rate for Payer: Cofinity Commercial	$594.74
Rate for Payer: Cofinity Medicare Advantage	$484.09
Rate for Payer: Encore Health Key Benefits Commercial	$553.25
Rate for Payer: Healthscope Commercial	$622.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$587.83
Rate for Payer: PHP Commercial	$587.83
Rate for Payer: Priority Health Cigna Priority Health	$449.51
Rate for Payer: Priority Health SBD	$435.68

HC BALLOON CATH TRANSLUMINAL LVL 69

Facility

$6,937.70

Service Code	HCPCS C1725
Hospital Charge Code	27200064
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$6,243.93
Rate for Payer: Aetna Commercial	$5,897.04
Rate for Payer: Aetna Medicare	$3,468.85
Rate for Payer: Aetna New Business (MI Preferred)	$4,509.50
Rate for Payer: BCBS Complete	$2,775.08
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$5,550.16
Rate for Payer: Cash Price	$5,550.16
Rate for Payer: Cofinity Commercial	$4,856.39
Rate for Payer: Cofinity Commercial	$5,966.42
Rate for Payer: Cofinity Medicare Advantage	$4,856.39
Rate for Payer: Encore Health Key Benefits Commercial	$5,550.16
Rate for Payer: Healthscope Commercial	$6,243.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,897.04
Rate for Payer: PHP Commercial	$5,897.04
Rate for Payer: Priority Health Cigna Priority Health	$4,509.50
Rate for Payer: Priority Health SBD	$4,370.75

HC BALLOON CATH TRANSLUMINAL LVL 69

Facility

$6,937.70

Service Code	HCPCS C1725
Hospital Charge Code	27200064
Hospital Revenue Code	272
Min. Negotiated Rate	$4,370.75
Max. Negotiated Rate	$6,243.93
Rate for Payer: Aetna Commercial	$5,897.04
Rate for Payer: Aetna New Business (MI Preferred)	$4,509.50
Rate for Payer: Cash Price	$5,550.16
Rate for Payer: Cofinity Commercial	$4,856.39
Rate for Payer: Cofinity Commercial	$5,966.42
Rate for Payer: Cofinity Medicare Advantage	$4,856.39
Rate for Payer: Encore Health Key Benefits Commercial	$5,550.16
Rate for Payer: Healthscope Commercial	$6,243.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,897.04
Rate for Payer: PHP Commercial	$5,897.04
Rate for Payer: Priority Health Cigna Priority Health	$4,509.50
Rate for Payer: Priority Health SBD	$4,370.75

HC BALLOON CATH TRANSLUMINAL LVL 7

Facility

$734.40

Service Code	HCPCS C1725
Hospital Charge Code	27200044
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$660.96
Rate for Payer: Aetna Commercial	$624.24
Rate for Payer: Aetna Medicare	$367.20
Rate for Payer: Aetna New Business (MI Preferred)	$477.36
Rate for Payer: BCBS Complete	$293.76
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$587.52
Rate for Payer: Cash Price	$587.52
Rate for Payer: Cofinity Commercial	$514.08
Rate for Payer: Cofinity Commercial	$631.58
Rate for Payer: Cofinity Medicare Advantage	$514.08
Rate for Payer: Encore Health Key Benefits Commercial	$587.52
Rate for Payer: Healthscope Commercial	$660.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$624.24
Rate for Payer: PHP Commercial	$624.24
Rate for Payer: Priority Health Cigna Priority Health	$477.36
Rate for Payer: Priority Health SBD	$462.67

HC BALLOON CATH TRANSLUMINAL LVL 7

Facility

$734.40

Service Code	HCPCS C1725
Hospital Charge Code	27200044
Hospital Revenue Code	272
Min. Negotiated Rate	$462.67
Max. Negotiated Rate	$660.96
Rate for Payer: Aetna Commercial	$624.24
Rate for Payer: Aetna New Business (MI Preferred)	$477.36
Rate for Payer: Cash Price	$587.52
Rate for Payer: Cofinity Commercial	$514.08
Rate for Payer: Cofinity Commercial	$631.58
Rate for Payer: Cofinity Medicare Advantage	$514.08
Rate for Payer: Encore Health Key Benefits Commercial	$587.52
Rate for Payer: Healthscope Commercial	$660.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$624.24
Rate for Payer: PHP Commercial	$624.24
Rate for Payer: Priority Health Cigna Priority Health	$477.36
Rate for Payer: Priority Health SBD	$462.67

Know your out-of-pocket cost for care.

All Charges