Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC LD RECOVERY 6-8 HRS

Facility

$1,188.59

Hospital Charge Code	71000016
Hospital Revenue Code	710
Min. Negotiated Rate	$475.44
Max. Negotiated Rate	$1,069.73
Rate for Payer: Aetna Commercial	$1,010.30
Rate for Payer: Aetna New Business (MI Preferred)	$772.58
Rate for Payer: BCBS Complete	$475.44
Rate for Payer: Cash Price	$950.87
Rate for Payer: Cofinity Commercial	$1,022.19
Rate for Payer: Cofinity Commercial	$832.01
Rate for Payer: Healthscope Commercial	$1,069.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,010.30
Rate for Payer: PHP Commercial	$1,010.30
Rate for Payer: Priority Health Cigna Priority Health	$832.01
Rate for Payer: Priority Health SBD	$748.81

HC LD RECOVERY 6-8 HRS

Facility

$1,188.59

Hospital Charge Code	71000016
Hospital Revenue Code	710
Min. Negotiated Rate	$748.81
Max. Negotiated Rate	$1,069.73
Rate for Payer: Aetna Commercial	$1,010.30
Rate for Payer: Aetna New Business (MI Preferred)	$772.58
Rate for Payer: Cash Price	$950.87
Rate for Payer: Cofinity Commercial	$1,022.19
Rate for Payer: Cofinity Commercial	$832.01
Rate for Payer: Healthscope Commercial	$1,069.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,010.30
Rate for Payer: PHP Commercial	$1,010.30
Rate for Payer: Priority Health Cigna Priority Health	$832.01
Rate for Payer: Priority Health SBD	$748.81

HC LD RECOVERY 8-10 HRS

Facility

$1,427.13

Hospital Charge Code	71000017
Hospital Revenue Code	710
Min. Negotiated Rate	$570.85
Max. Negotiated Rate	$1,284.42
Rate for Payer: Aetna Commercial	$1,213.06
Rate for Payer: Aetna New Business (MI Preferred)	$927.63
Rate for Payer: BCBS Complete	$570.85
Rate for Payer: Cash Price	$1,141.70
Rate for Payer: Cofinity Commercial	$1,227.33
Rate for Payer: Cofinity Commercial	$998.99
Rate for Payer: Healthscope Commercial	$1,284.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,213.06
Rate for Payer: PHP Commercial	$1,213.06
Rate for Payer: Priority Health Cigna Priority Health	$998.99
Rate for Payer: Priority Health SBD	$899.09

HC LD RECOVERY 8-10 HRS

Facility

$1,427.13

Hospital Charge Code	71000017
Hospital Revenue Code	710
Min. Negotiated Rate	$899.09
Max. Negotiated Rate	$1,284.42
Rate for Payer: Aetna Commercial	$1,213.06
Rate for Payer: Aetna New Business (MI Preferred)	$927.63
Rate for Payer: Cash Price	$1,141.70
Rate for Payer: Cofinity Commercial	$1,227.33
Rate for Payer: Cofinity Commercial	$998.99
Rate for Payer: Healthscope Commercial	$1,284.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,213.06
Rate for Payer: PHP Commercial	$1,213.06
Rate for Payer: Priority Health Cigna Priority Health	$998.99
Rate for Payer: Priority Health SBD	$899.09

HC LEAD

Facility

$44.00

Service Code	CPT 83655
Hospital Charge Code	30100275
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna Medicare	$12.59
Rate for Payer: Aetna New Business (MI Preferred)	$28.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.14
Rate for Payer: Amish Plain Church Group Commercial	$15.14
Rate for Payer: BCBS Complete	$6.96
Rate for Payer: BCBS MAPPO	$12.11
Rate for Payer: BCBS Trust/PPO	$9.48
Rate for Payer: BCN Medicare Advantage	$12.11
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cofinity Commercial	$37.84
Rate for Payer: Cofinity Commercial	$30.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.11
Rate for Payer: Healthscope Commercial	$39.60
Rate for Payer: Mclaren Medicaid	$6.62
Rate for Payer: Mclaren Medicare	$12.11
Rate for Payer: Meridian Medicaid	$6.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.72
Rate for Payer: MI Amish Medical Board Commercial	$13.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.40
Rate for Payer: PACE Medicare	$11.50
Rate for Payer: PACE SWMI	$12.11
Rate for Payer: PHP Commercial	$37.40
Rate for Payer: PHP Medicare Advantage	$12.11
Rate for Payer: Priority Health Choice Medicaid	$6.62
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health Medicare	$12.11
Rate for Payer: Priority Health SBD	$27.72
Rate for Payer: Railroad Medicare Medicare	$12.11
Rate for Payer: UHC All Payor (Choice/PPO)	$14.53
Rate for Payer: UHC Core	$20.58
Rate for Payer: UHC Dual Complete DSNP	$12.11
Rate for Payer: UHC Exchange	$12.11
Rate for Payer: UHC Medicare Advantage	$12.47
Rate for Payer: VA VA	$12.11

HC LEAD

Facility

$44.00

Service Code	CPT 83655
Hospital Charge Code	30100275
Hospital Revenue Code	301
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna New Business (MI Preferred)	$28.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cofinity Commercial	$30.80
Rate for Payer: Cofinity Commercial	$37.84
Rate for Payer: Healthscope Commercial	$39.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.40
Rate for Payer: PHP Commercial	$37.40
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health SBD	$27.72

HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL

Facility

$14,450.00

Service Code	HCPCS C1777
Hospital Charge Code	27800088
Hospital Revenue Code	278
Min. Negotiated Rate	$5,780.00
Max. Negotiated Rate	$13,005.00
Rate for Payer: Aetna Commercial	$12,282.50
Rate for Payer: Aetna New Business (MI Preferred)	$9,392.50
Rate for Payer: BCBS Complete	$5,780.00
Rate for Payer: Cash Price	$11,560.00
Rate for Payer: Cofinity Commercial	$10,115.00
Rate for Payer: Cofinity Commercial	$12,427.00
Rate for Payer: Healthscope Commercial	$13,005.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12,282.50
Rate for Payer: PHP Commercial	$12,282.50
Rate for Payer: Priority Health Cigna Priority Health	$10,115.00
Rate for Payer: Priority Health SBD	$9,103.50

HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL

Facility

$14,450.00

Service Code	HCPCS C1777
Hospital Charge Code	27800088
Hospital Revenue Code	278
Min. Negotiated Rate	$9,103.50
Max. Negotiated Rate	$13,005.00
Rate for Payer: Aetna Commercial	$12,282.50
Rate for Payer: Aetna New Business (MI Preferred)	$9,392.50
Rate for Payer: Cash Price	$11,560.00
Rate for Payer: Cofinity Commercial	$10,115.00
Rate for Payer: Cofinity Commercial	$12,427.00
Rate for Payer: Healthscope Commercial	$13,005.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12,282.50
Rate for Payer: PHP Commercial	$12,282.50
Rate for Payer: Priority Health Cigna Priority Health	$10,115.00
Rate for Payer: Priority Health SBD	$9,103.50

HC LEAD NEUROSTIM TEST KIT LEVEL 20

Facility

$2,040.00

Service Code	HCPCS C1897
Hospital Charge Code	27800134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.20
Max. Negotiated Rate	$1,836.00
Rate for Payer: Aetna Commercial	$1,734.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,326.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cofinity Commercial	$1,428.00
Rate for Payer: Cofinity Commercial	$1,754.40
Rate for Payer: Healthscope Commercial	$1,836.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,734.00
Rate for Payer: PHP Commercial	$1,734.00
Rate for Payer: Priority Health Cigna Priority Health	$1,428.00
Rate for Payer: Priority Health SBD	$1,285.20

HC LEAD NEUROSTIM TEST KIT LEVEL 20

Facility

$2,040.00

Service Code	HCPCS C1897
Hospital Charge Code	27800134
Hospital Revenue Code	278
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$1,836.00
Rate for Payer: Aetna Commercial	$1,734.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,326.00
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cofinity Commercial	$1,428.00
Rate for Payer: Cofinity Commercial	$1,754.40
Rate for Payer: Healthscope Commercial	$1,836.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,734.00
Rate for Payer: PHP Commercial	$1,734.00
Rate for Payer: Priority Health Cigna Priority Health	$1,428.00
Rate for Payer: Priority Health SBD	$1,285.20

HC LEAD NEUROSTIMULATOR

Facility

$7,656.00

Service Code	HCPCS C1778
Hospital Charge Code	27800017
Hospital Revenue Code	278
Min. Negotiated Rate	$3,062.40
Max. Negotiated Rate	$6,890.40
Rate for Payer: Aetna Commercial	$6,507.60
Rate for Payer: Aetna New Business (MI Preferred)	$4,976.40
Rate for Payer: BCBS Complete	$3,062.40
Rate for Payer: Cash Price	$6,124.80
Rate for Payer: Cofinity Commercial	$5,359.20
Rate for Payer: Cofinity Commercial	$6,584.16
Rate for Payer: Healthscope Commercial	$6,890.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,507.60
Rate for Payer: PHP Commercial	$6,507.60
Rate for Payer: Priority Health Cigna Priority Health	$5,359.20
Rate for Payer: Priority Health SBD	$4,823.28

HC LEAD NEUROSTIMULATOR

Facility

$7,656.00

Service Code	HCPCS C1778
Hospital Charge Code	27800017
Hospital Revenue Code	278
Min. Negotiated Rate	$4,823.28
Max. Negotiated Rate	$6,890.40
Rate for Payer: Aetna Commercial	$6,507.60
Rate for Payer: Aetna New Business (MI Preferred)	$4,976.40
Rate for Payer: Cash Price	$6,124.80
Rate for Payer: Cofinity Commercial	$5,359.20
Rate for Payer: Cofinity Commercial	$6,584.16
Rate for Payer: Healthscope Commercial	$6,890.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,507.60
Rate for Payer: PHP Commercial	$6,507.60
Rate for Payer: Priority Health Cigna Priority Health	$5,359.20
Rate for Payer: Priority Health SBD	$4,823.28

HC LEAD NOS LVL 1

Facility

$195.00

Service Code	HCPCS C1889
Hospital Charge Code	27800144
Hospital Revenue Code	278
Min. Negotiated Rate	$122.85
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$165.75
Rate for Payer: Aetna New Business (MI Preferred)	$126.75
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cofinity Commercial	$136.50
Rate for Payer: Cofinity Commercial	$167.70
Rate for Payer: Healthscope Commercial	$175.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$165.75
Rate for Payer: PHP Commercial	$165.75
Rate for Payer: Priority Health Cigna Priority Health	$136.50
Rate for Payer: Priority Health SBD	$122.85

HC LEAD NOS LVL 1

Facility

$195.00

Service Code	HCPCS C1889
Hospital Charge Code	27800144
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$165.75
Rate for Payer: Aetna New Business (MI Preferred)	$126.75
Rate for Payer: BCBS Complete	$78.00
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cofinity Commercial	$136.50
Rate for Payer: Cofinity Commercial	$167.70
Rate for Payer: Healthscope Commercial	$175.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$165.75
Rate for Payer: PHP Commercial	$165.75
Rate for Payer: Priority Health Cigna Priority Health	$136.50
Rate for Payer: Priority Health SBD	$122.85

HC LEAD REMOVAL DUAL

Facility

$2,868.17

Service Code	CPT 33235
Hospital Charge Code	36100074
Hospital Revenue Code	361
Min. Negotiated Rate	$614.61
Max. Negotiated Rate	$10,721.72
Rate for Payer: Aetna Commercial	$2,437.94
Rate for Payer: Aetna Medicare	$3,633.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,864.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,367.78
Rate for Payer: Amish Plain Church Group Commercial	$4,367.78
Rate for Payer: BCBS Complete	$2,007.08
Rate for Payer: BCBS MAPPO	$3,494.22
Rate for Payer: BCBS Trust/PPO	$1,400.77
Rate for Payer: BCN Medicare Advantage	$3,494.22
Rate for Payer: Cash Price	$2,294.54
Rate for Payer: Cash Price	$2,294.54
Rate for Payer: Cofinity Commercial	$2,466.63
Rate for Payer: Cofinity Commercial	$2,007.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,494.22
Rate for Payer: Healthscope Commercial	$2,581.35
Rate for Payer: Mclaren Medicaid	$1,911.34
Rate for Payer: Mclaren Medicare	$3,494.22
Rate for Payer: Meridian Medicaid	$2,007.08
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,668.93
Rate for Payer: MI Amish Medical Board Commercial	$4,018.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,437.94
Rate for Payer: PACE Medicare	$3,319.51
Rate for Payer: PACE SWMI	$3,494.22
Rate for Payer: PHP Commercial	$2,437.94
Rate for Payer: PHP Medicare Advantage	$3,494.22
Rate for Payer: Priority Health Choice Medicaid	$1,911.34
Rate for Payer: Priority Health Cigna Priority Health	$2,007.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,721.72
Rate for Payer: Priority Health Medicare	$3,494.22
Rate for Payer: Priority Health Narrow Network	$8,577.38
Rate for Payer: Priority Health SBD	$1,806.95
Rate for Payer: Railroad Medicare Medicare	$3,494.22
Rate for Payer: UHC All Payor (Choice/PPO)	$676.07
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,494.22
Rate for Payer: UHC Exchange	$614.61
Rate for Payer: UHC Medicare Advantage	$3,599.05
Rate for Payer: VA VA	$3,494.22

HC LEAD REMOVAL DUAL

Facility

$2,868.17

Service Code	CPT 33235
Hospital Charge Code	36100074
Hospital Revenue Code	361
Min. Negotiated Rate	$1,806.95
Max. Negotiated Rate	$2,581.35
Rate for Payer: Aetna Commercial	$2,437.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,864.31
Rate for Payer: Cash Price	$2,294.54
Rate for Payer: Cofinity Commercial	$2,007.72
Rate for Payer: Cofinity Commercial	$2,466.63
Rate for Payer: Healthscope Commercial	$2,581.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,437.94
Rate for Payer: PHP Commercial	$2,437.94
Rate for Payer: Priority Health Cigna Priority Health	$2,007.72
Rate for Payer: Priority Health SBD	$1,806.95

HC LEAD REMOVAL SINGLE

Facility

$3,632.23

Service Code	CPT 33234
Hospital Charge Code	36100073
Hospital Revenue Code	361
Min. Negotiated Rate	$467.59
Max. Negotiated Rate	$10,721.72
Rate for Payer: Aetna Commercial	$3,087.40
Rate for Payer: Aetna Medicare	$3,633.99
Rate for Payer: Aetna New Business (MI Preferred)	$2,360.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,367.78
Rate for Payer: Amish Plain Church Group Commercial	$4,367.78
Rate for Payer: BCBS Complete	$2,007.08
Rate for Payer: BCBS MAPPO	$3,494.22
Rate for Payer: BCBS Trust/PPO	$1,200.65
Rate for Payer: BCN Medicare Advantage	$3,494.22
Rate for Payer: Cash Price	$2,905.78
Rate for Payer: Cash Price	$2,905.78
Rate for Payer: Cofinity Commercial	$2,542.56
Rate for Payer: Cofinity Commercial	$3,123.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,494.22
Rate for Payer: Healthscope Commercial	$3,269.01
Rate for Payer: Mclaren Medicaid	$1,911.34
Rate for Payer: Mclaren Medicare	$3,494.22
Rate for Payer: Meridian Medicaid	$2,007.08
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,668.93
Rate for Payer: MI Amish Medical Board Commercial	$4,018.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,087.40
Rate for Payer: PACE Medicare	$3,319.51
Rate for Payer: PACE SWMI	$3,494.22
Rate for Payer: PHP Commercial	$3,087.40
Rate for Payer: PHP Medicare Advantage	$3,494.22
Rate for Payer: Priority Health Choice Medicaid	$1,911.34
Rate for Payer: Priority Health Cigna Priority Health	$2,542.56
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,721.72
Rate for Payer: Priority Health Medicare	$3,494.22
Rate for Payer: Priority Health Narrow Network	$8,577.38
Rate for Payer: Priority Health SBD	$2,288.30
Rate for Payer: Railroad Medicare Medicare	$3,494.22
Rate for Payer: UHC All Payor (Choice/PPO)	$514.35
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,494.22
Rate for Payer: UHC Exchange	$467.59
Rate for Payer: UHC Medicare Advantage	$3,599.05
Rate for Payer: VA VA	$3,494.22

HC LEAD REMOVAL SINGLE

Facility

$3,632.23

Service Code	CPT 33234
Hospital Charge Code	36100073
Hospital Revenue Code	361
Min. Negotiated Rate	$2,288.30
Max. Negotiated Rate	$3,269.01
Rate for Payer: Aetna Commercial	$3,087.40
Rate for Payer: Aetna New Business (MI Preferred)	$2,360.95
Rate for Payer: Cash Price	$2,905.78
Rate for Payer: Cofinity Commercial	$2,542.56
Rate for Payer: Cofinity Commercial	$3,123.72
Rate for Payer: Healthscope Commercial	$3,269.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,087.40
Rate for Payer: PHP Commercial	$3,087.40
Rate for Payer: Priority Health Cigna Priority Health	$2,542.56
Rate for Payer: Priority Health SBD	$2,288.30

HC LECITHIN-SPHINGOMYELIN

Facility

$95.00

Service Code	CPT 83661
Hospital Charge Code	30100634
Hospital Revenue Code	301
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$80.75
Rate for Payer: Aetna New Business (MI Preferred)	$61.75
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cofinity Commercial	$66.50
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Healthscope Commercial	$85.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.75
Rate for Payer: PHP Commercial	$80.75
Rate for Payer: Priority Health Cigna Priority Health	$66.50
Rate for Payer: Priority Health SBD	$59.85

HC LECITHIN-SPHINGOMYELIN

Facility

$95.00

Service Code	CPT 83661
Hospital Charge Code	30100634
Hospital Revenue Code	301
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$80.75
Rate for Payer: Aetna Medicare	$22.87
Rate for Payer: Aetna New Business (MI Preferred)	$61.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$27.49
Rate for Payer: Amish Plain Church Group Commercial	$27.49
Rate for Payer: BCBS Complete	$12.63
Rate for Payer: BCBS MAPPO	$21.99
Rate for Payer: BCBS Trust/PPO	$17.22
Rate for Payer: BCN Medicare Advantage	$21.99
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Cofinity Commercial	$66.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.99
Rate for Payer: Healthscope Commercial	$85.50
Rate for Payer: Mclaren Medicaid	$12.03
Rate for Payer: Mclaren Medicare	$21.99
Rate for Payer: Meridian Medicaid	$12.63
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23.09
Rate for Payer: MI Amish Medical Board Commercial	$25.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.75
Rate for Payer: PACE Medicare	$20.89
Rate for Payer: PACE SWMI	$21.99
Rate for Payer: PHP Commercial	$80.75
Rate for Payer: PHP Medicare Advantage	$21.99
Rate for Payer: Priority Health Choice Medicaid	$12.03
Rate for Payer: Priority Health Cigna Priority Health	$66.50
Rate for Payer: Priority Health Medicare	$21.99
Rate for Payer: Priority Health SBD	$59.85
Rate for Payer: Railroad Medicare Medicare	$21.99
Rate for Payer: UHC All Payor (Choice/PPO)	$26.39
Rate for Payer: UHC Core	$37.37
Rate for Payer: UHC Dual Complete DSNP	$21.99
Rate for Payer: UHC Exchange	$21.99
Rate for Payer: UHC Medicare Advantage	$22.65
Rate for Payer: VA VA	$21.99

HC LEFT ATRIAL APPENDAGE CLOS WITH ENDOCARDIAL IMPLANT

Facility

$28,917.00

Service Code	CPT 33340
Hospital Charge Code	48100112
Hospital Revenue Code	481
Min. Negotiated Rate	$747.88
Max. Negotiated Rate	$26,025.30
Rate for Payer: Aetna Commercial	$24,579.45
Rate for Payer: Aetna New Business (MI Preferred)	$18,796.05
Rate for Payer: BCBS Complete	$11,566.80
Rate for Payer: BCBS Trust/PPO	$1,635.09
Rate for Payer: Cash Price	$23,133.60
Rate for Payer: Cash Price	$23,133.60
Rate for Payer: Cofinity Commercial	$24,868.62
Rate for Payer: Cofinity Commercial	$20,241.90
Rate for Payer: Healthscope Commercial	$26,025.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24,579.45
Rate for Payer: PHP Commercial	$24,579.45
Rate for Payer: Priority Health Cigna Priority Health	$20,241.90
Rate for Payer: Priority Health SBD	$18,217.71
Rate for Payer: UHC All Payor (Choice/PPO)	$822.67
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Exchange	$747.88

HC LEFT ATRIAL APPENDAGE CLOS WITH ENDOCARDIAL IMPLANT

Facility

$28,917.00

Service Code	CPT 33340
Hospital Charge Code	48100112
Hospital Revenue Code	481
Min. Negotiated Rate	$18,217.71
Max. Negotiated Rate	$26,025.30
Rate for Payer: Aetna Commercial	$24,579.45
Rate for Payer: Aetna New Business (MI Preferred)	$18,796.05
Rate for Payer: Cash Price	$23,133.60
Rate for Payer: Cofinity Commercial	$20,241.90
Rate for Payer: Cofinity Commercial	$24,868.62
Rate for Payer: Healthscope Commercial	$26,025.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24,579.45
Rate for Payer: PHP Commercial	$24,579.45
Rate for Payer: Priority Health Cigna Priority Health	$20,241.90
Rate for Payer: Priority Health SBD	$18,217.71

HC LEFT CATH W INTERVENTION

Facility

$9,660.80

Service Code	CPT 93458
Hospital Charge Code	48100049
Hospital Revenue Code	481
Min. Negotiated Rate	$6,086.30
Max. Negotiated Rate	$8,694.72
Rate for Payer: Aetna Commercial	$8,211.68
Rate for Payer: Aetna New Business (MI Preferred)	$6,279.52
Rate for Payer: Cash Price	$7,728.64
Rate for Payer: Cofinity Commercial	$6,762.56
Rate for Payer: Cofinity Commercial	$8,308.29
Rate for Payer: Healthscope Commercial	$8,694.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,211.68
Rate for Payer: PHP Commercial	$8,211.68
Rate for Payer: Priority Health Cigna Priority Health	$6,762.56
Rate for Payer: Priority Health SBD	$6,086.30

HC LEFT CATH W INTERVENTION

Facility

$9,660.80

Service Code	CPT 93458
Hospital Charge Code	48100049
Hospital Revenue Code	481
Min. Negotiated Rate	$1,007.21
Max. Negotiated Rate	$8,694.72
Rate for Payer: Aetna Commercial	$8,211.68
Rate for Payer: Aetna Medicare	$3,015.43
Rate for Payer: Aetna New Business (MI Preferred)	$6,279.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,624.31
Rate for Payer: Amish Plain Church Group Commercial	$3,624.31
Rate for Payer: BCBS Complete	$1,665.44
Rate for Payer: BCBS MAPPO	$2,899.45
Rate for Payer: BCBS Trust/PPO	$3,469.29
Rate for Payer: BCN Medicare Advantage	$2,899.45
Rate for Payer: Cash Price	$7,728.64
Rate for Payer: Cash Price	$7,728.64
Rate for Payer: Cofinity Commercial	$8,308.29
Rate for Payer: Cofinity Commercial	$6,762.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,899.45
Rate for Payer: Healthscope Commercial	$8,694.72
Rate for Payer: Mclaren Medicaid	$1,586.00
Rate for Payer: Mclaren Medicare	$2,899.45
Rate for Payer: Meridian Medicaid	$1,665.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,044.42
Rate for Payer: MI Amish Medical Board Commercial	$3,334.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,211.68
Rate for Payer: PACE Medicare	$2,754.48
Rate for Payer: PACE SWMI	$2,899.45
Rate for Payer: PHP Commercial	$8,211.68
Rate for Payer: PHP Medicare Advantage	$2,899.45
Rate for Payer: Priority Health Choice Medicaid	$1,586.00
Rate for Payer: Priority Health Cigna Priority Health	$6,762.56
Rate for Payer: Priority Health Medicare	$2,899.45
Rate for Payer: Priority Health SBD	$6,086.30
Rate for Payer: Railroad Medicare Medicare	$2,899.45
Rate for Payer: UHC All Payor (Choice/PPO)	$1,107.93
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$2,899.45
Rate for Payer: UHC Exchange	$1,007.21
Rate for Payer: UHC Medicare Advantage	$2,986.43
Rate for Payer: VA VA	$2,899.45

HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER

Facility

$100.00

Service Code	CPT 36415
Hospital Charge Code	30000049
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health SBD	$63.00

Know your out-of-pocket cost for care.

All Charges