Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BALLOON CATH TRANSLUMINAL LVL 8

Facility

$886.79

Service Code	HCPCS C1725
Hospital Charge Code	27200264
Hospital Revenue Code	272
Min. Negotiated Rate	$558.68
Max. Negotiated Rate	$798.11
Rate for Payer: Aetna Commercial	$753.77
Rate for Payer: Aetna New Business (MI Preferred)	$576.41
Rate for Payer: Cash Price	$709.43
Rate for Payer: Cofinity Commercial	$620.75
Rate for Payer: Cofinity Commercial	$762.64
Rate for Payer: Cofinity Medicare Advantage	$620.75
Rate for Payer: Encore Health Key Benefits Commercial	$709.43
Rate for Payer: Healthscope Commercial	$798.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$753.77
Rate for Payer: PHP Commercial	$753.77
Rate for Payer: Priority Health Cigna Priority Health	$576.41
Rate for Payer: Priority Health SBD	$558.68

HC BALLOON CATH TRANSLUMINAL LVL 8

Facility

$886.79

Service Code	HCPCS C1725
Hospital Charge Code	27200264
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$798.11
Rate for Payer: Aetna Commercial	$753.77
Rate for Payer: Aetna Medicare	$443.40
Rate for Payer: Aetna New Business (MI Preferred)	$576.41
Rate for Payer: BCBS Complete	$354.72
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$709.43
Rate for Payer: Cash Price	$709.43
Rate for Payer: Cofinity Commercial	$620.75
Rate for Payer: Cofinity Commercial	$762.64
Rate for Payer: Cofinity Medicare Advantage	$620.75
Rate for Payer: Encore Health Key Benefits Commercial	$709.43
Rate for Payer: Healthscope Commercial	$798.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$753.77
Rate for Payer: PHP Commercial	$753.77
Rate for Payer: Priority Health Cigna Priority Health	$576.41
Rate for Payer: Priority Health SBD	$558.68

HC BALLOON DILITATION URETER

Facility

$748.54

Service Code	CPT 50706
Hospital Charge Code	36100512
Hospital Revenue Code	361
Min. Negotiated Rate	$188.22
Max. Negotiated Rate	$2,890.55
Rate for Payer: Aetna Commercial	$636.26
Rate for Payer: Aetna Medicare	$374.27
Rate for Payer: Aetna New Business (MI Preferred)	$486.55
Rate for Payer: BCBS Complete	$299.42
Rate for Payer: BCBS Trust/PPO	$2,890.55
Rate for Payer: BCN Commercial	$2,890.55
Rate for Payer: Cash Price	$598.83
Rate for Payer: Cash Price	$598.83
Rate for Payer: Cash Price	$598.83
Rate for Payer: Cofinity Commercial	$523.98
Rate for Payer: Cofinity Commercial	$643.74
Rate for Payer: Cofinity Medicare Advantage	$523.98
Rate for Payer: Encore Health Key Benefits Commercial	$598.83
Rate for Payer: Healthscope Commercial	$673.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$636.26
Rate for Payer: PHP Commercial	$636.26
Rate for Payer: Priority Health Cigna Priority Health	$486.55
Rate for Payer: Priority Health SBD	$471.58
Rate for Payer: UHC All Payor (Choice/PPO)	$188.22
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

HC BALLOON DILITATION URETER

Facility

$748.54

Service Code	CPT 50706
Hospital Charge Code	36100512
Hospital Revenue Code	361
Min. Negotiated Rate	$471.58
Max. Negotiated Rate	$673.69
Rate for Payer: Aetna Commercial	$636.26
Rate for Payer: Aetna New Business (MI Preferred)	$486.55
Rate for Payer: Cash Price	$598.83
Rate for Payer: Cofinity Commercial	$523.98
Rate for Payer: Cofinity Commercial	$643.74
Rate for Payer: Cofinity Medicare Advantage	$523.98
Rate for Payer: Encore Health Key Benefits Commercial	$598.83
Rate for Payer: Healthscope Commercial	$673.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$636.26
Rate for Payer: PHP Commercial	$636.26
Rate for Payer: Priority Health Cigna Priority Health	$486.55
Rate for Payer: Priority Health SBD	$471.58

HC BALLOON PUMP SETUP

Facility

$1,925.03

Hospital Charge Code	27000090
Hospital Revenue Code	270
Min. Negotiated Rate	$1,212.77
Max. Negotiated Rate	$1,732.53
Rate for Payer: Aetna Commercial	$1,636.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,251.27
Rate for Payer: Cash Price	$1,540.02
Rate for Payer: Cofinity Commercial	$1,347.52
Rate for Payer: Cofinity Commercial	$1,655.53
Rate for Payer: Cofinity Medicare Advantage	$1,347.52
Rate for Payer: Encore Health Key Benefits Commercial	$1,540.02
Rate for Payer: Healthscope Commercial	$1,732.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,636.28
Rate for Payer: PHP Commercial	$1,636.28
Rate for Payer: Priority Health Cigna Priority Health	$1,251.27
Rate for Payer: Priority Health SBD	$1,212.77

HC BALLOON PUMP SETUP

Facility

$1,925.03

Hospital Charge Code	27000090
Hospital Revenue Code	270
Min. Negotiated Rate	$770.01
Max. Negotiated Rate	$1,732.53
Rate for Payer: Aetna Commercial	$1,636.28
Rate for Payer: Aetna Medicare	$962.52
Rate for Payer: Aetna New Business (MI Preferred)	$1,251.27
Rate for Payer: BCBS Complete	$770.01
Rate for Payer: Cash Price	$1,540.02
Rate for Payer: Cofinity Commercial	$1,347.52
Rate for Payer: Cofinity Commercial	$1,655.53
Rate for Payer: Cofinity Medicare Advantage	$1,347.52
Rate for Payer: Encore Health Key Benefits Commercial	$1,540.02
Rate for Payer: Healthscope Commercial	$1,732.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,636.28
Rate for Payer: PHP Commercial	$1,636.28
Rate for Payer: Priority Health Cigna Priority Health	$1,251.27
Rate for Payer: Priority Health SBD	$1,212.77

HC BALLOONS CATH TRANSLUMINAL LVL 1

Facility

$82.47

Service Code	HCPCS C1725
Hospital Charge Code	27200262
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$74.22
Rate for Payer: Aetna Commercial	$70.10
Rate for Payer: Aetna Medicare	$41.24
Rate for Payer: Aetna New Business (MI Preferred)	$53.61
Rate for Payer: BCBS Complete	$32.99
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$65.98
Rate for Payer: Cash Price	$65.98
Rate for Payer: Cofinity Commercial	$57.73
Rate for Payer: Cofinity Commercial	$70.92
Rate for Payer: Cofinity Medicare Advantage	$57.73
Rate for Payer: Encore Health Key Benefits Commercial	$65.98
Rate for Payer: Healthscope Commercial	$74.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.10
Rate for Payer: PHP Commercial	$70.10
Rate for Payer: Priority Health Cigna Priority Health	$53.61
Rate for Payer: Priority Health SBD	$51.96

HC BALLOONS CATH TRANSLUMINAL LVL 1

Facility

$82.47

Service Code	HCPCS C1725
Hospital Charge Code	27200262
Hospital Revenue Code	272
Min. Negotiated Rate	$51.96
Max. Negotiated Rate	$74.22
Rate for Payer: Aetna Commercial	$70.10
Rate for Payer: Aetna New Business (MI Preferred)	$53.61
Rate for Payer: Cash Price	$65.98
Rate for Payer: Cofinity Commercial	$57.73
Rate for Payer: Cofinity Commercial	$70.92
Rate for Payer: Cofinity Medicare Advantage	$57.73
Rate for Payer: Encore Health Key Benefits Commercial	$65.98
Rate for Payer: Healthscope Commercial	$74.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.10
Rate for Payer: PHP Commercial	$70.10
Rate for Payer: Priority Health Cigna Priority Health	$53.61
Rate for Payer: Priority Health SBD	$51.96

HC BALLOONS CATH TRANSLUMINAL LVL 2

Facility

$249.07

Service Code	HCPCS C1725
Hospital Charge Code	27200263
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$224.16
Rate for Payer: Aetna Commercial	$211.71
Rate for Payer: Aetna Medicare	$124.54
Rate for Payer: Aetna New Business (MI Preferred)	$161.90
Rate for Payer: BCBS Complete	$99.63
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$199.26
Rate for Payer: Cash Price	$199.26
Rate for Payer: Cofinity Commercial	$174.35
Rate for Payer: Cofinity Commercial	$214.20
Rate for Payer: Cofinity Medicare Advantage	$174.35
Rate for Payer: Encore Health Key Benefits Commercial	$199.26
Rate for Payer: Healthscope Commercial	$224.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.71
Rate for Payer: PHP Commercial	$211.71
Rate for Payer: Priority Health Cigna Priority Health	$161.90
Rate for Payer: Priority Health SBD	$156.91

HC BALLOONS CATH TRANSLUMINAL LVL 2

Facility

$249.07

Service Code	HCPCS C1725
Hospital Charge Code	27200263
Hospital Revenue Code	272
Min. Negotiated Rate	$156.91
Max. Negotiated Rate	$224.16
Rate for Payer: Aetna Commercial	$211.71
Rate for Payer: Aetna New Business (MI Preferred)	$161.90
Rate for Payer: Cash Price	$199.26
Rate for Payer: Cofinity Commercial	$174.35
Rate for Payer: Cofinity Commercial	$214.20
Rate for Payer: Cofinity Medicare Advantage	$174.35
Rate for Payer: Encore Health Key Benefits Commercial	$199.26
Rate for Payer: Healthscope Commercial	$224.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.71
Rate for Payer: PHP Commercial	$211.71
Rate for Payer: Priority Health Cigna Priority Health	$161.90
Rate for Payer: Priority Health SBD	$156.91

HC BALLOON STONE EXTRACTION

Facility

$3,189.23

Hospital Charge Code	36000008
Hospital Revenue Code	360
Min. Negotiated Rate	$2,009.21
Max. Negotiated Rate	$2,870.31
Rate for Payer: Aetna Commercial	$2,710.85
Rate for Payer: Aetna New Business (MI Preferred)	$2,073.00
Rate for Payer: Cash Price	$2,551.38
Rate for Payer: Cofinity Commercial	$2,232.46
Rate for Payer: Cofinity Commercial	$2,742.74
Rate for Payer: Cofinity Medicare Advantage	$2,232.46
Rate for Payer: Encore Health Key Benefits Commercial	$2,551.38
Rate for Payer: Healthscope Commercial	$2,870.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,710.85
Rate for Payer: PHP Commercial	$2,710.85
Rate for Payer: Priority Health Cigna Priority Health	$2,073.00
Rate for Payer: Priority Health SBD	$2,009.21

HC BALLOON STONE EXTRACTION

Facility

$3,189.23

Hospital Charge Code	36000008
Hospital Revenue Code	360
Min. Negotiated Rate	$1,275.69
Max. Negotiated Rate	$2,870.31
Rate for Payer: Aetna Commercial	$2,710.85
Rate for Payer: Aetna Medicare	$1,594.62
Rate for Payer: Aetna New Business (MI Preferred)	$2,073.00
Rate for Payer: BCBS Complete	$1,275.69
Rate for Payer: Cash Price	$2,551.38
Rate for Payer: Cofinity Commercial	$2,232.46
Rate for Payer: Cofinity Commercial	$2,742.74
Rate for Payer: Cofinity Medicare Advantage	$2,232.46
Rate for Payer: Encore Health Key Benefits Commercial	$2,551.38
Rate for Payer: Healthscope Commercial	$2,870.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,710.85
Rate for Payer: PHP Commercial	$2,710.85
Rate for Payer: Priority Health Cigna Priority Health	$2,073.00
Rate for Payer: Priority Health SBD	$2,009.21

HC BANANA IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200073
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$2.94
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.63
Rate for Payer: BCN Commercial	$4.63
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Mclaren Medicaid	$2.80
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.48
Rate for Payer: Meridian Medicaid	$2.94
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: Nomi Health Commercial	$7.83
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.37
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health Narrow Network	$4.30
Rate for Payer: Priority Health SBD	$16.00
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Medicare Advantage	$5.22
Rate for Payer: UHCCP Medicaid	$2.94
Rate for Payer: VA VA	$5.22

HC BANANA IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200073
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health SBD	$16.00

HC BANDAGE SCISSORS

Facility

$13.69

Hospital Charge Code	27000029
Hospital Revenue Code	270
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$12.32
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare	$6.84
Rate for Payer: Aetna New Business (MI Preferred)	$8.90
Rate for Payer: BCBS Complete	$5.48
Rate for Payer: Cash Price	$10.95
Rate for Payer: Cofinity Commercial	$11.77
Rate for Payer: Cofinity Commercial	$9.58
Rate for Payer: Cofinity Medicare Advantage	$9.58
Rate for Payer: Encore Health Key Benefits Commercial	$10.95
Rate for Payer: Healthscope Commercial	$12.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.64
Rate for Payer: PHP Commercial	$11.64
Rate for Payer: Priority Health Cigna Priority Health	$8.90
Rate for Payer: Priority Health SBD	$8.62

HC BANDAGE SCISSORS

Facility

$13.69

Hospital Charge Code	27000029
Hospital Revenue Code	270
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$12.32
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna New Business (MI Preferred)	$8.90
Rate for Payer: Cash Price	$10.95
Rate for Payer: Cofinity Commercial	$11.77
Rate for Payer: Cofinity Commercial	$9.58
Rate for Payer: Cofinity Medicare Advantage	$9.58
Rate for Payer: Encore Health Key Benefits Commercial	$10.95
Rate for Payer: Healthscope Commercial	$12.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.64
Rate for Payer: PHP Commercial	$11.64
Rate for Payer: Priority Health Cigna Priority Health	$8.90
Rate for Payer: Priority Health SBD	$8.62

HC BANDING

Facility

$965.64

Hospital Charge Code	36000009
Hospital Revenue Code	360
Min. Negotiated Rate	$608.35
Max. Negotiated Rate	$869.08
Rate for Payer: Aetna Commercial	$820.79
Rate for Payer: Aetna New Business (MI Preferred)	$627.67
Rate for Payer: Cash Price	$772.51
Rate for Payer: Cofinity Commercial	$675.95
Rate for Payer: Cofinity Commercial	$830.45
Rate for Payer: Cofinity Medicare Advantage	$675.95
Rate for Payer: Encore Health Key Benefits Commercial	$772.51
Rate for Payer: Healthscope Commercial	$869.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$820.79
Rate for Payer: PHP Commercial	$820.79
Rate for Payer: Priority Health Cigna Priority Health	$627.67
Rate for Payer: Priority Health SBD	$608.35

HC BANDING

Facility

$965.64

Hospital Charge Code	36000009
Hospital Revenue Code	360
Min. Negotiated Rate	$386.26
Max. Negotiated Rate	$869.08
Rate for Payer: Aetna Commercial	$820.79
Rate for Payer: Aetna Medicare	$482.82
Rate for Payer: Aetna New Business (MI Preferred)	$627.67
Rate for Payer: BCBS Complete	$386.26
Rate for Payer: Cash Price	$772.51
Rate for Payer: Cofinity Commercial	$675.95
Rate for Payer: Cofinity Commercial	$830.45
Rate for Payer: Cofinity Medicare Advantage	$675.95
Rate for Payer: Encore Health Key Benefits Commercial	$772.51
Rate for Payer: Healthscope Commercial	$869.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$820.79
Rate for Payer: PHP Commercial	$820.79
Rate for Payer: Priority Health Cigna Priority Health	$627.67
Rate for Payer: Priority Health SBD	$608.35

HC BARBITURATE URIN

Facility

$101.66

Service Code	CPT 80307
Hospital Charge Code	30000137
Hospital Revenue Code	300
Min. Negotiated Rate	$64.05
Max. Negotiated Rate	$91.49
Rate for Payer: Aetna Commercial	$86.41
Rate for Payer: Aetna New Business (MI Preferred)	$66.08
Rate for Payer: Cash Price	$81.33
Rate for Payer: Cofinity Commercial	$71.16
Rate for Payer: Cofinity Commercial	$87.43
Rate for Payer: Cofinity Medicare Advantage	$71.16
Rate for Payer: Encore Health Key Benefits Commercial	$81.33
Rate for Payer: Healthscope Commercial	$91.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.41
Rate for Payer: PHP Commercial	$86.41
Rate for Payer: Priority Health Cigna Priority Health	$66.08
Rate for Payer: Priority Health SBD	$64.05

HC BARBITURATE URIN

Facility

$101.66

Service Code	CPT 80307
Hospital Charge Code	30000137
Hospital Revenue Code	300
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$93.21
Rate for Payer: Aetna Commercial	$86.41
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$66.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$77.68
Rate for Payer: Amish Plain Church Group Commercial	$77.68
Rate for Payer: BCBS Complete	$34.97
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCBS Trust/PPO	$55.01
Rate for Payer: BCN Commercial	$55.01
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$81.33
Rate for Payer: Cash Price	$81.33
Rate for Payer: Cofinity Commercial	$87.43
Rate for Payer: Cofinity Commercial	$71.16
Rate for Payer: Cofinity Medicare Advantage	$71.16
Rate for Payer: Encore Health Key Benefits Commercial	$81.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$91.49
Rate for Payer: Mclaren Medicaid	$33.31
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65.25
Rate for Payer: Meridian Medicaid	$34.97
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.41
Rate for Payer: Nomi Health Commercial	$93.21
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$86.41
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$33.31
Rate for Payer: Priority Health Cigna Priority Health	$66.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.14
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health Narrow Network	$49.71
Rate for Payer: Priority Health SBD	$64.05
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$74.57
Rate for Payer: UHC Dual Complete DSNP	$62.14
Rate for Payer: UHC Medicare Advantage	$62.14
Rate for Payer: UHCCP Medicaid	$34.98
Rate for Payer: VA VA	$62.14

HC BARBITURATE URINE CONFIRM

Facility

$63.24

Service Code	CPT 80345
Hospital Charge Code	30100571
Hospital Revenue Code	301
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$122.36
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna Medicare	$31.62
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: BCBS Complete	$25.30
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84
Rate for Payer: UHC Core	$122.36
Rate for Payer: UHC Exchange	$122.36

HC BARBITURATE URINE CONFIRM

Facility

$63.24

Service Code	CPT 80345
Hospital Charge Code	30100571
Hospital Revenue Code	301
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC BARRIER ADHESION

Facility

$589.96

Service Code	HCPCS C1765
Hospital Charge Code	27000463
Hospital Revenue Code	270
Min. Negotiated Rate	$371.67
Max. Negotiated Rate	$530.96
Rate for Payer: Aetna Commercial	$501.47
Rate for Payer: Aetna New Business (MI Preferred)	$383.47
Rate for Payer: Cash Price	$471.97
Rate for Payer: Cofinity Commercial	$412.97
Rate for Payer: Cofinity Commercial	$507.37
Rate for Payer: Cofinity Medicare Advantage	$412.97
Rate for Payer: Encore Health Key Benefits Commercial	$471.97
Rate for Payer: Healthscope Commercial	$530.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$501.47
Rate for Payer: PHP Commercial	$501.47
Rate for Payer: Priority Health Cigna Priority Health	$383.47
Rate for Payer: Priority Health SBD	$371.67

HC BARRIER ADHESION

Facility

$589.96

Service Code	HCPCS C1765
Hospital Charge Code	27000463
Hospital Revenue Code	270
Min. Negotiated Rate	$235.98
Max. Negotiated Rate	$530.96
Rate for Payer: Aetna Commercial	$501.47
Rate for Payer: Aetna Medicare	$294.98
Rate for Payer: Aetna New Business (MI Preferred)	$383.47
Rate for Payer: BCBS Complete	$235.98
Rate for Payer: Cash Price	$471.97
Rate for Payer: Cofinity Commercial	$412.97
Rate for Payer: Cofinity Commercial	$507.37
Rate for Payer: Cofinity Medicare Advantage	$412.97
Rate for Payer: Encore Health Key Benefits Commercial	$471.97
Rate for Payer: Healthscope Commercial	$530.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$501.47
Rate for Payer: PHP Commercial	$501.47
Rate for Payer: Priority Health Cigna Priority Health	$383.47
Rate for Payer: Priority Health SBD	$371.67

HC BARRX 360 EXPRESS CATH BALLOON

Facility

$5,720.86

Hospital Charge Code	27200286
Hospital Revenue Code	272
Min. Negotiated Rate	$3,604.14
Max. Negotiated Rate	$5,148.77
Rate for Payer: Aetna Commercial	$4,862.73
Rate for Payer: Aetna New Business (MI Preferred)	$3,718.56
Rate for Payer: Cash Price	$4,576.69
Rate for Payer: Cofinity Commercial	$4,004.60
Rate for Payer: Cofinity Commercial	$4,919.94
Rate for Payer: Cofinity Medicare Advantage	$4,004.60
Rate for Payer: Encore Health Key Benefits Commercial	$4,576.69
Rate for Payer: Healthscope Commercial	$5,148.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,862.73
Rate for Payer: PHP Commercial	$4,862.73
Rate for Payer: Priority Health Cigna Priority Health	$3,718.56
Rate for Payer: Priority Health SBD	$3,604.14

Know your out-of-pocket cost for care.

All Charges