Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC EXC TUMOR SOFT TISSUE THIGH/KNEE, SQ 3CM OR >

Facility

$3,547.91

Service Code	CPT 27337
Hospital Charge Code	76100249
Hospital Revenue Code	761
Min. Negotiated Rate	$2,235.18
Max. Negotiated Rate	$3,193.12
Rate for Payer: Aetna Commercial	$3,015.72
Rate for Payer: Aetna New Business (MI Preferred)	$2,306.14
Rate for Payer: Cash Price	$2,838.33
Rate for Payer: Cofinity Commercial	$2,483.54
Rate for Payer: Cofinity Commercial	$3,051.20
Rate for Payer: Healthscope Commercial	$3,193.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,015.72
Rate for Payer: PHP Commercial	$3,015.72
Rate for Payer: Priority Health Cigna Priority Health	$2,483.54
Rate for Payer: Priority Health SBD	$2,235.18

HC EXC TUMOR SOFT TISSUE THIGH/KNEE, SQ 3CM OR >

Facility

$3,547.91

Service Code	CPT 27337
Hospital Charge Code	76100249
Hospital Revenue Code	761
Min. Negotiated Rate	$417.16
Max. Negotiated Rate	$7,382.58
Rate for Payer: Aetna Commercial	$3,015.72
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Aetna New Business (MI Preferred)	$2,306.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$1,360.17
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Cash Price	$2,838.33
Rate for Payer: Cash Price	$2,838.33
Rate for Payer: Cofinity Commercial	$2,483.54
Rate for Payer: Cofinity Commercial	$3,051.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Healthscope Commercial	$3,193.12
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,015.72
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Commercial	$3,015.72
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health Cigna Priority Health	$2,483.54
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,382.58
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health Narrow Network	$5,906.06
Rate for Payer: Priority Health SBD	$2,235.18
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$458.88
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$417.16
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>

Facility

$3,951.97

Service Code	CPT 24071
Hospital Charge Code	76100324
Hospital Revenue Code	761
Min. Negotiated Rate	$2,489.74
Max. Negotiated Rate	$3,556.77
Rate for Payer: Aetna Commercial	$3,359.17
Rate for Payer: Aetna New Business (MI Preferred)	$2,568.78
Rate for Payer: Cash Price	$3,161.58
Rate for Payer: Cofinity Commercial	$2,766.38
Rate for Payer: Cofinity Commercial	$3,398.69
Rate for Payer: Healthscope Commercial	$3,556.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,359.17
Rate for Payer: PHP Commercial	$3,359.17
Rate for Payer: Priority Health Cigna Priority Health	$2,766.38
Rate for Payer: Priority Health SBD	$2,489.74

HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>

Facility

$3,951.97

Service Code	CPT 24071
Hospital Charge Code	76100324
Hospital Revenue Code	761
Min. Negotiated Rate	$403.41
Max. Negotiated Rate	$3,556.77
Rate for Payer: Aetna Commercial	$3,359.17
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Aetna New Business (MI Preferred)	$2,568.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$1,331.20
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Cash Price	$3,161.58
Rate for Payer: Cash Price	$3,161.58
Rate for Payer: Cofinity Commercial	$2,766.38
Rate for Payer: Cofinity Commercial	$3,398.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Healthscope Commercial	$3,556.77
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,359.17
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Commercial	$3,359.17
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health Cigna Priority Health	$2,766.38
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health SBD	$2,489.74
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$443.75
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$403.41
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM

Facility

$2,870.28

Service Code	CPT 24075
Hospital Charge Code	76100310
Hospital Revenue Code	761
Min. Negotiated Rate	$329.08
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$2,439.74
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,865.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$746.15
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$2,296.22
Rate for Payer: Cash Price	$2,296.22
Rate for Payer: Cofinity Commercial	$2,468.44
Rate for Payer: Cofinity Commercial	$2,009.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$2,583.25
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,439.74
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$2,439.74
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$2,009.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Priority Health SBD	$1,808.28
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$361.99
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$329.08
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM

Facility

$2,870.28

Service Code	CPT 24075
Hospital Charge Code	76100310
Hospital Revenue Code	761
Min. Negotiated Rate	$1,808.28
Max. Negotiated Rate	$2,583.25
Rate for Payer: Aetna Commercial	$2,439.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,865.68
Rate for Payer: Cash Price	$2,296.22
Rate for Payer: Cofinity Commercial	$2,468.44
Rate for Payer: Cofinity Commercial	$2,009.20
Rate for Payer: Healthscope Commercial	$2,583.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,439.74
Rate for Payer: PHP Commercial	$2,439.74
Rate for Payer: Priority Health Cigna Priority Health	$2,009.20
Rate for Payer: Priority Health SBD	$1,808.28

HC EXERCISE CHALLENGE

Facility

$1,000.24

Service Code	CPT 93464
Hospital Charge Code	48100108
Hospital Revenue Code	481
Min. Negotiated Rate	$630.15
Max. Negotiated Rate	$900.22
Rate for Payer: Aetna Commercial	$850.20
Rate for Payer: Aetna New Business (MI Preferred)	$650.16
Rate for Payer: Cash Price	$800.19
Rate for Payer: Cofinity Commercial	$700.17
Rate for Payer: Cofinity Commercial	$860.21
Rate for Payer: Healthscope Commercial	$900.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$850.20
Rate for Payer: PHP Commercial	$850.20
Rate for Payer: Priority Health Cigna Priority Health	$700.17
Rate for Payer: Priority Health SBD	$630.15

HC EXERCISE CHALLENGE

Facility

$1,000.24

Service Code	CPT 93464
Hospital Charge Code	48100108
Hospital Revenue Code	481
Min. Negotiated Rate	$213.82
Max. Negotiated Rate	$900.22
Rate for Payer: Aetna Commercial	$850.20
Rate for Payer: Aetna New Business (MI Preferred)	$650.16
Rate for Payer: BCBS Complete	$400.10
Rate for Payer: BCBS Trust/PPO	$607.90
Rate for Payer: Cash Price	$800.19
Rate for Payer: Cash Price	$800.19
Rate for Payer: Cofinity Commercial	$700.17
Rate for Payer: Cofinity Commercial	$860.21
Rate for Payer: Healthscope Commercial	$900.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$850.20
Rate for Payer: PHP Commercial	$850.20
Rate for Payer: Priority Health Cigna Priority Health	$700.17
Rate for Payer: Priority Health SBD	$630.15
Rate for Payer: UHC All Payor (Choice/PPO)	$235.20
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$213.82

HC EXERCISE TEST FOR BRONCHOSPASM W/EKG

Facility

$336.86

Service Code	CPT 94617
Hospital Charge Code	46000033
Hospital Revenue Code	460
Min. Negotiated Rate	$212.22
Max. Negotiated Rate	$303.17
Rate for Payer: Aetna Commercial	$286.33
Rate for Payer: Aetna New Business (MI Preferred)	$218.96
Rate for Payer: Cash Price	$269.49
Rate for Payer: Cofinity Commercial	$235.80
Rate for Payer: Cofinity Commercial	$289.70
Rate for Payer: Healthscope Commercial	$303.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$286.33
Rate for Payer: PHP Commercial	$286.33
Rate for Payer: Priority Health Cigna Priority Health	$235.80
Rate for Payer: Priority Health SBD	$212.22

HC EXERCISE TEST FOR BRONCHOSPASM W/EKG

Facility

$336.86

Service Code	CPT 94617
Hospital Charge Code	46000033
Hospital Revenue Code	460
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$351.10
Rate for Payer: Aetna Commercial	$286.33
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$218.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$256.37
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$269.49
Rate for Payer: Cash Price	$269.49
Rate for Payer: Cofinity Commercial	$235.80
Rate for Payer: Cofinity Commercial	$289.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$303.17
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$286.33
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$286.33
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health Cigna Priority Health	$235.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Priority Health SBD	$212.22
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$96.17
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$87.43
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC EXERCISE TEST FOR BRONCHOSPASM WO ECG

Facility

$133.58

Service Code	CPT 94619
Hospital Charge Code	46000032
Hospital Revenue Code	460
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$113.54
Rate for Payer: Aetna Medicare	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$86.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$68.04
Rate for Payer: Amish Plain Church Group Commercial	$68.04
Rate for Payer: BCBS Complete	$31.26
Rate for Payer: BCBS MAPPO	$54.43
Rate for Payer: BCBS Trust/PPO	$248.67
Rate for Payer: BCN Medicare Advantage	$54.43
Rate for Payer: Cash Price	$106.86
Rate for Payer: Cash Price	$106.86
Rate for Payer: Cofinity Commercial	$93.51
Rate for Payer: Cofinity Commercial	$114.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$54.43
Rate for Payer: Healthscope Commercial	$120.22
Rate for Payer: Mclaren Medicaid	$29.77
Rate for Payer: Mclaren Medicare	$54.43
Rate for Payer: Meridian Medicaid	$31.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$57.15
Rate for Payer: MI Amish Medical Board Commercial	$62.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.54
Rate for Payer: PACE Medicare	$51.71
Rate for Payer: PACE SWMI	$54.43
Rate for Payer: PHP Commercial	$113.54
Rate for Payer: PHP Medicare Advantage	$54.43
Rate for Payer: Priority Health Choice Medicaid	$29.77
Rate for Payer: Priority Health Cigna Priority Health	$93.51
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.33
Rate for Payer: Priority Health Medicare	$54.43
Rate for Payer: Priority Health Narrow Network	$138.66
Rate for Payer: Priority Health SBD	$84.16
Rate for Payer: Railroad Medicare Medicare	$54.43
Rate for Payer: UHC All Payor (Choice/PPO)	$70.24
Rate for Payer: UHC Dual Complete DSNP	$54.43
Rate for Payer: UHC Exchange	$63.85
Rate for Payer: UHC Medicare Advantage	$56.06
Rate for Payer: VA VA	$54.43

HC EXERCISE TEST FOR BRONCHOSPASM WO ECG

Facility

$133.58

Service Code	CPT 94619
Hospital Charge Code	46000032
Hospital Revenue Code	460
Min. Negotiated Rate	$84.16
Max. Negotiated Rate	$120.22
Rate for Payer: Aetna Commercial	$113.54
Rate for Payer: Aetna New Business (MI Preferred)	$86.83
Rate for Payer: Cash Price	$106.86
Rate for Payer: Cofinity Commercial	$114.88
Rate for Payer: Cofinity Commercial	$93.51
Rate for Payer: Healthscope Commercial	$120.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.54
Rate for Payer: PHP Commercial	$113.54
Rate for Payer: Priority Health Cigna Priority Health	$93.51
Rate for Payer: Priority Health SBD	$84.16

HC EXPLORE WOUND EXTREMITY

Facility

$1,904.25

Service Code	CPT 20103
Hospital Charge Code	45000007
Hospital Revenue Code	761
Min. Negotiated Rate	$1,199.68
Max. Negotiated Rate	$1,713.82
Rate for Payer: Aetna Commercial	$1,618.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,237.76
Rate for Payer: Cash Price	$1,523.40
Rate for Payer: Cofinity Commercial	$1,637.66
Rate for Payer: Cofinity Commercial	$1,332.98
Rate for Payer: Healthscope Commercial	$1,713.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,618.61
Rate for Payer: PHP Commercial	$1,618.61
Rate for Payer: Priority Health Cigna Priority Health	$1,332.98
Rate for Payer: Priority Health SBD	$1,199.68

HC EXPLORE WOUND EXTREMITY

Facility

$1,904.25

Service Code	CPT 20103
Hospital Charge Code	45000007
Hospital Revenue Code	761
Min. Negotiated Rate	$339.88
Max. Negotiated Rate	$4,496.47
Rate for Payer: Aetna Commercial	$1,618.61
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,237.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$445.56
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$1,523.40
Rate for Payer: Cash Price	$1,523.40
Rate for Payer: Cofinity Commercial	$1,637.66
Rate for Payer: Cofinity Commercial	$1,332.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$1,713.82
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,618.61
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$1,618.61
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$1,332.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,496.47
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,597.18
Rate for Payer: Priority Health SBD	$1,199.68
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$373.87
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$339.88
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

HC EXTENDED RECOVERY 0-6 HRS

Facility

$1,726.39

Hospital Charge Code	71000005
Hospital Revenue Code	710
Min. Negotiated Rate	$690.56
Max. Negotiated Rate	$1,553.75
Rate for Payer: Aetna Commercial	$1,467.43
Rate for Payer: Aetna New Business (MI Preferred)	$1,122.15
Rate for Payer: BCBS Complete	$690.56
Rate for Payer: Cash Price	$1,381.11
Rate for Payer: Cofinity Commercial	$1,208.47
Rate for Payer: Cofinity Commercial	$1,484.70
Rate for Payer: Healthscope Commercial	$1,553.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,467.43
Rate for Payer: PHP Commercial	$1,467.43
Rate for Payer: Priority Health Cigna Priority Health	$1,208.47
Rate for Payer: Priority Health SBD	$1,087.63

HC EXTENDED RECOVERY 0-6 HRS

Facility

$1,726.39

Hospital Charge Code	71000005
Hospital Revenue Code	710
Min. Negotiated Rate	$1,087.63
Max. Negotiated Rate	$1,553.75
Rate for Payer: Aetna Commercial	$1,467.43
Rate for Payer: Aetna New Business (MI Preferred)	$1,122.15
Rate for Payer: Cash Price	$1,381.11
Rate for Payer: Cofinity Commercial	$1,208.47
Rate for Payer: Cofinity Commercial	$1,484.70
Rate for Payer: Healthscope Commercial	$1,553.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,467.43
Rate for Payer: PHP Commercial	$1,467.43
Rate for Payer: Priority Health Cigna Priority Health	$1,208.47
Rate for Payer: Priority Health SBD	$1,087.63

HC EXTENDED RECOVERY 12-18 HRS

Facility

$2,018.44

Hospital Charge Code	71000006
Hospital Revenue Code	710
Min. Negotiated Rate	$1,271.62
Max. Negotiated Rate	$1,816.60
Rate for Payer: Aetna Commercial	$1,715.67
Rate for Payer: Aetna New Business (MI Preferred)	$1,311.99
Rate for Payer: Cash Price	$1,614.75
Rate for Payer: Cofinity Commercial	$1,412.91
Rate for Payer: Cofinity Commercial	$1,735.86
Rate for Payer: Healthscope Commercial	$1,816.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,715.67
Rate for Payer: PHP Commercial	$1,715.67
Rate for Payer: Priority Health Cigna Priority Health	$1,412.91
Rate for Payer: Priority Health SBD	$1,271.62

HC EXTENDED RECOVERY 12-18 HRS

Facility

$2,018.44

Hospital Charge Code	71000006
Hospital Revenue Code	710
Min. Negotiated Rate	$807.38
Max. Negotiated Rate	$1,816.60
Rate for Payer: Aetna Commercial	$1,715.67
Rate for Payer: Aetna New Business (MI Preferred)	$1,311.99
Rate for Payer: BCBS Complete	$807.38
Rate for Payer: Cash Price	$1,614.75
Rate for Payer: Cofinity Commercial	$1,412.91
Rate for Payer: Cofinity Commercial	$1,735.86
Rate for Payer: Healthscope Commercial	$1,816.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,715.67
Rate for Payer: PHP Commercial	$1,715.67
Rate for Payer: Priority Health Cigna Priority Health	$1,412.91
Rate for Payer: Priority Health SBD	$1,271.62

HC EXTENDED RECOVERY 18-24 HRS

Facility

$2,206.16

Hospital Charge Code	71000007
Hospital Revenue Code	710
Min. Negotiated Rate	$1,389.88
Max. Negotiated Rate	$1,985.54
Rate for Payer: Aetna Commercial	$1,875.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,434.00
Rate for Payer: Cash Price	$1,764.93
Rate for Payer: Cofinity Commercial	$1,544.31
Rate for Payer: Cofinity Commercial	$1,897.30
Rate for Payer: Healthscope Commercial	$1,985.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,875.24
Rate for Payer: PHP Commercial	$1,875.24
Rate for Payer: Priority Health Cigna Priority Health	$1,544.31
Rate for Payer: Priority Health SBD	$1,389.88

HC EXTENDED RECOVERY 18-24 HRS

Facility

$2,206.16

Hospital Charge Code	71000007
Hospital Revenue Code	710
Min. Negotiated Rate	$882.46
Max. Negotiated Rate	$1,985.54
Rate for Payer: Aetna Commercial	$1,875.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,434.00
Rate for Payer: BCBS Complete	$882.46
Rate for Payer: Cash Price	$1,764.93
Rate for Payer: Cofinity Commercial	$1,544.31
Rate for Payer: Cofinity Commercial	$1,897.30
Rate for Payer: Healthscope Commercial	$1,985.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,875.24
Rate for Payer: PHP Commercial	$1,875.24
Rate for Payer: Priority Health Cigna Priority Health	$1,544.31
Rate for Payer: Priority Health SBD	$1,389.88

HC EXTENDED RECOVERY 6-12 HRS

Facility

$1,888.04

Hospital Charge Code	71000008
Hospital Revenue Code	710
Min. Negotiated Rate	$1,189.47
Max. Negotiated Rate	$1,699.24
Rate for Payer: Aetna Commercial	$1,604.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,227.23
Rate for Payer: Cash Price	$1,510.43
Rate for Payer: Cofinity Commercial	$1,321.63
Rate for Payer: Cofinity Commercial	$1,623.71
Rate for Payer: Healthscope Commercial	$1,699.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,604.83
Rate for Payer: PHP Commercial	$1,604.83
Rate for Payer: Priority Health Cigna Priority Health	$1,321.63
Rate for Payer: Priority Health SBD	$1,189.47

HC EXTENDED RECOVERY 6-12 HRS

Facility

$1,888.04

Hospital Charge Code	71000008
Hospital Revenue Code	710
Min. Negotiated Rate	$755.22
Max. Negotiated Rate	$1,699.24
Rate for Payer: Aetna Commercial	$1,604.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,227.23
Rate for Payer: BCBS Complete	$755.22
Rate for Payer: Cash Price	$1,510.43
Rate for Payer: Cofinity Commercial	$1,321.63
Rate for Payer: Cofinity Commercial	$1,623.71
Rate for Payer: Healthscope Commercial	$1,699.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,604.83
Rate for Payer: PHP Commercial	$1,604.83
Rate for Payer: Priority Health Cigna Priority Health	$1,321.63
Rate for Payer: Priority Health SBD	$1,189.47

HC EXTENSION KIT

Facility

$1,992.14

Service Code	HCPCS C1883
Hospital Charge Code	27800052
Hospital Revenue Code	278
Min. Negotiated Rate	$796.86
Max. Negotiated Rate	$1,792.93
Rate for Payer: Aetna Commercial	$1,693.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,294.89
Rate for Payer: BCBS Complete	$796.86
Rate for Payer: Cash Price	$1,593.71
Rate for Payer: Cofinity Commercial	$1,394.50
Rate for Payer: Cofinity Commercial	$1,713.24
Rate for Payer: Healthscope Commercial	$1,792.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,693.32
Rate for Payer: PHP Commercial	$1,693.32
Rate for Payer: Priority Health Cigna Priority Health	$1,394.50
Rate for Payer: Priority Health SBD	$1,255.05

HC EXTENSION KIT

Facility

$1,992.14

Service Code	HCPCS C1883
Hospital Charge Code	27800052
Hospital Revenue Code	278
Min. Negotiated Rate	$1,255.05
Max. Negotiated Rate	$1,792.93
Rate for Payer: Aetna Commercial	$1,693.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,294.89
Rate for Payer: Cash Price	$1,593.71
Rate for Payer: Cofinity Commercial	$1,394.50
Rate for Payer: Cofinity Commercial	$1,713.24
Rate for Payer: Healthscope Commercial	$1,792.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,693.32
Rate for Payer: PHP Commercial	$1,693.32
Rate for Payer: Priority Health Cigna Priority Health	$1,394.50
Rate for Payer: Priority Health SBD	$1,255.05

HC EXTENSION ST JUDE

Facility

$2,324.18

Service Code	HCPCS C1883
Hospital Charge Code	27800053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.23
Max. Negotiated Rate	$2,091.76
Rate for Payer: Aetna Commercial	$1,975.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,510.72
Rate for Payer: Cash Price	$1,859.34
Rate for Payer: Cofinity Commercial	$1,626.93
Rate for Payer: Cofinity Commercial	$1,998.79
Rate for Payer: Healthscope Commercial	$2,091.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,975.55
Rate for Payer: PHP Commercial	$1,975.55
Rate for Payer: Priority Health Cigna Priority Health	$1,626.93
Rate for Payer: Priority Health SBD	$1,464.23

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