Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC MECONIUM DRUG SCRN MULTI DRUGS.

Facility

$102.00

Service Code	CPT 80307
Hospital Charge Code	30100653
Hospital Revenue Code	301
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$95.77
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$66.30
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	$35.69
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCBS Trust/PPO	$48.67
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$71.40
Rate for Payer: Cofinity Commercial	$87.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Mclaren Medicaid	$33.99
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Medicaid	$35.69
Rate for Payer: Meridian Wellcare - Medicare Advantage	$65.25
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$86.70
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$86.70
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$33.99
Rate for Payer: Priority Health Cigna Priority Health	$71.40
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health SBD	$64.26
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$74.57
Rate for Payer: UHC Core	$95.77
Rate for Payer: UHC Dual Complete DSNP	$62.14
Rate for Payer: UHC Exchange	$62.14
Rate for Payer: UHC Medicare Advantage	$64.00
Rate for Payer: VA VA	$62.14

HC MECONIUM OPIATES CONFIRMATION

Facility

$115.00

Service Code	CPT 80361
Hospital Charge Code	30100577
Hospital Revenue Code	301
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45
Rate for Payer: UHC Core	$41.98

HC MECONIUM OPIATES CONFIRMATION

Facility

$115.00

Service Code	CPT 80361
Hospital Charge Code	30100577
Hospital Revenue Code	301
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45

HC MECONIUM OXYCODONE CONFIRMATION

Facility

$115.00

Service Code	CPT 80365
Hospital Charge Code	30000104
Hospital Revenue Code	300
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45
Rate for Payer: UHC Core	$31.91

HC MECONIUM OXYCODONE CONFIRMATION

Facility

$115.00

Service Code	CPT 80365
Hospital Charge Code	30000104
Hospital Revenue Code	300
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45

HC MECONIUM THC CONFIRMATION

Facility

$115.00

Service Code	CPT 80349
Hospital Charge Code	30100567
Hospital Revenue Code	301
Min. Negotiated Rate	$29.32
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45
Rate for Payer: UHC Core	$29.32

HC MECONIUM THC CONFIRMATION

Facility

$115.00

Service Code	CPT 80349
Hospital Charge Code	30100567
Hospital Revenue Code	301
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45

HC MECONIUM TRAMADOL CONFIRMATION

Facility

$115.00

Service Code	CPT 80373
Hospital Charge Code	30000101
Hospital Revenue Code	300
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45
Rate for Payer: UHC Core	$25.87

HC MECONIUM TRAMADOL CONFIRMATION

Facility

$115.00

Service Code	CPT 80373
Hospital Charge Code	30000101
Hospital Revenue Code	300
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna New Business (MI Preferred)	$74.75
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cofinity Commercial	$80.50
Rate for Payer: Cofinity Commercial	$98.90
Rate for Payer: Healthscope Commercial	$103.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.75
Rate for Payer: PHP Commercial	$97.75
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health SBD	$72.45

HC MEDICAL NUTRITION TX EACH 15"

Facility

$63.86

Service Code	HCPCS G0270
Hospital Charge Code	94200008
Hospital Revenue Code	942
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$75.23
Rate for Payer: Aetna Commercial	$54.28
Rate for Payer: Aetna New Business (MI Preferred)	$41.51
Rate for Payer: BCBS Complete	$25.54
Rate for Payer: BCBS Trust/PPO	$75.23
Rate for Payer: Cash Price	$51.09
Rate for Payer: Cash Price	$51.09
Rate for Payer: Cofinity Commercial	$54.92
Rate for Payer: Cofinity Commercial	$44.70
Rate for Payer: Healthscope Commercial	$57.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.28
Rate for Payer: PHP Commercial	$54.28
Rate for Payer: Priority Health Cigna Priority Health	$44.70
Rate for Payer: Priority Health SBD	$40.23
Rate for Payer: UHC All Payor (Choice/PPO)	$29.17
Rate for Payer: UHC Exchange	$26.52

HC MEDICAL NUTRITION TX EACH 15"

Facility

$63.86

Service Code	HCPCS G0270
Hospital Charge Code	94200008
Hospital Revenue Code	942
Min. Negotiated Rate	$40.23
Max. Negotiated Rate	$57.47
Rate for Payer: Aetna Commercial	$54.28
Rate for Payer: Aetna New Business (MI Preferred)	$41.51
Rate for Payer: Cash Price	$51.09
Rate for Payer: Cofinity Commercial	$44.70
Rate for Payer: Cofinity Commercial	$54.92
Rate for Payer: Healthscope Commercial	$57.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.28
Rate for Payer: PHP Commercial	$54.28
Rate for Payer: Priority Health Cigna Priority Health	$44.70
Rate for Payer: Priority Health SBD	$40.23

HC MED PHYSIC DOS EVAL RAD EXPS

Facility

$258.81

Service Code	CPT 76145
Hospital Charge Code	32000333
Hospital Revenue Code	320
Min. Negotiated Rate	$163.05
Max. Negotiated Rate	$232.93
Rate for Payer: Aetna Commercial	$219.99
Rate for Payer: Aetna New Business (MI Preferred)	$168.23
Rate for Payer: Cash Price	$207.05
Rate for Payer: Cofinity Commercial	$181.17
Rate for Payer: Cofinity Commercial	$222.58
Rate for Payer: Healthscope Commercial	$232.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.99
Rate for Payer: PHP Commercial	$219.99
Rate for Payer: Priority Health Cigna Priority Health	$181.17
Rate for Payer: Priority Health SBD	$163.05

HC MED PHYSIC DOS EVAL RAD EXPS

Facility

$258.81

Service Code	CPT 76145
Hospital Charge Code	32000333
Hospital Revenue Code	320
Min. Negotiated Rate	$163.05
Max. Negotiated Rate	$1,505.86
Rate for Payer: Aetna Commercial	$219.99
Rate for Payer: Aetna Medicare	$495.99
Rate for Payer: Aetna New Business (MI Preferred)	$168.23
Rate for Payer: Allen County Amish Medical Aid Commercial	$596.14
Rate for Payer: Amish Plain Church Group Commercial	$596.14
Rate for Payer: BCBS Complete	$273.94
Rate for Payer: BCBS MAPPO	$476.91
Rate for Payer: BCBS Trust/PPO	$1,505.86
Rate for Payer: BCN Medicare Advantage	$476.91
Rate for Payer: Cash Price	$207.05
Rate for Payer: Cash Price	$207.05
Rate for Payer: Cofinity Commercial	$222.58
Rate for Payer: Cofinity Commercial	$181.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$476.91
Rate for Payer: Healthscope Commercial	$232.93
Rate for Payer: Mclaren Medicaid	$260.87
Rate for Payer: Mclaren Medicare	$476.91
Rate for Payer: Meridian Medicaid	$273.94
Rate for Payer: Meridian Wellcare - Medicare Advantage	$500.76
Rate for Payer: MI Amish Medical Board Commercial	$548.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.99
Rate for Payer: PACE Medicare	$453.06
Rate for Payer: PACE SWMI	$476.91
Rate for Payer: PHP Commercial	$219.99
Rate for Payer: PHP Medicare Advantage	$476.91
Rate for Payer: Priority Health Choice Medicaid	$260.87
Rate for Payer: Priority Health Cigna Priority Health	$181.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,054.39
Rate for Payer: Priority Health Medicare	$476.91
Rate for Payer: Priority Health Narrow Network	$843.51
Rate for Payer: Priority Health SBD	$163.05
Rate for Payer: Railroad Medicare Medicare	$476.91
Rate for Payer: UHC All Payor (Choice/PPO)	$979.70
Rate for Payer: UHC Dual Complete DSNP	$476.91
Rate for Payer: UHC Exchange	$890.64
Rate for Payer: UHC Medicare Advantage	$491.22
Rate for Payer: VA VA	$476.91

HC MED SURG ROOM & BOARD

Facility

$3,291.02

Hospital Charge Code	11000001
Hospital Revenue Code	110
Min. Negotiated Rate	$2,073.34
Max. Negotiated Rate	$2,961.92
Rate for Payer: Aetna Commercial	$2,797.37
Rate for Payer: Aetna New Business (MI Preferred)	$2,139.16
Rate for Payer: Cash Price	$2,632.82
Rate for Payer: Cofinity Commercial	$2,303.71
Rate for Payer: Cofinity Commercial	$2,830.28
Rate for Payer: Healthscope Commercial	$2,961.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,797.37
Rate for Payer: PHP Commercial	$2,797.37
Rate for Payer: Priority Health Cigna Priority Health	$2,303.71
Rate for Payer: Priority Health SBD	$2,073.34

HC MED SURVEILLANCE SH

Facility

$48.00

Service Code	HCPCS G0435
Hospital Charge Code	30200415
Hospital Revenue Code	302
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna New Business (MI Preferred)	$31.20
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cofinity Commercial	$33.60
Rate for Payer: Cofinity Commercial	$41.28
Rate for Payer: Healthscope Commercial	$43.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.80
Rate for Payer: PHP Commercial	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health SBD	$30.24

HC MED SURVEILLANCE SH

Facility

$48.00

Service Code	HCPCS G0435
Hospital Charge Code	30200415
Hospital Revenue Code	302
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Medicare	$12.46
Rate for Payer: Aetna New Business (MI Preferred)	$31.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$14.98
Rate for Payer: Amish Plain Church Group Commercial	$14.98
Rate for Payer: BCBS Complete	$6.88
Rate for Payer: BCBS MAPPO	$11.98
Rate for Payer: BCBS Trust/PPO	$9.39
Rate for Payer: BCN Medicare Advantage	$11.98
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cofinity Commercial	$33.60
Rate for Payer: Cofinity Commercial	$41.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.98
Rate for Payer: Healthscope Commercial	$43.20
Rate for Payer: Mclaren Medicaid	$6.55
Rate for Payer: Mclaren Medicare	$11.98
Rate for Payer: Meridian Medicaid	$6.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.58
Rate for Payer: MI Amish Medical Board Commercial	$13.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.80
Rate for Payer: PACE Medicare	$11.38
Rate for Payer: PACE SWMI	$11.98
Rate for Payer: PHP Commercial	$40.80
Rate for Payer: PHP Medicare Advantage	$11.98
Rate for Payer: Priority Health Choice Medicaid	$6.55
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health Medicare	$11.98
Rate for Payer: Priority Health SBD	$30.24
Rate for Payer: Railroad Medicare Medicare	$11.98
Rate for Payer: UHC All Payor (Choice/PPO)	$14.38
Rate for Payer: UHC Core	$20.39
Rate for Payer: UHC Dual Complete DSNP	$11.98
Rate for Payer: UHC Exchange	$11.98
Rate for Payer: UHC Medicare Advantage	$12.34
Rate for Payer: VA VA	$11.98

HC MEDTRONIC CRT ICD

Facility

$29,376.00

Service Code	HCPCS C1882
Hospital Charge Code	27500006
Hospital Revenue Code	275
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$26,438.40
Rate for Payer: Aetna Commercial	$24,969.60
Rate for Payer: Aetna New Business (MI Preferred)	$19,094.40
Rate for Payer: BCBS Complete	$11,750.40
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$23,500.80
Rate for Payer: Cash Price	$23,500.80
Rate for Payer: Cofinity Commercial	$25,263.36
Rate for Payer: Cofinity Commercial	$20,563.20
Rate for Payer: Healthscope Commercial	$26,438.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24,969.60
Rate for Payer: PHP Commercial	$24,969.60
Rate for Payer: Priority Health Cigna Priority Health	$20,563.20
Rate for Payer: Priority Health SBD	$18,506.88

HC MEDTRONIC CRT ICD

Facility

$29,376.00

Service Code	HCPCS C1882
Hospital Charge Code	27500006
Hospital Revenue Code	275
Min. Negotiated Rate	$18,506.88
Max. Negotiated Rate	$26,438.40
Rate for Payer: Aetna Commercial	$24,969.60
Rate for Payer: Aetna New Business (MI Preferred)	$19,094.40
Rate for Payer: Cash Price	$23,500.80
Rate for Payer: Cofinity Commercial	$20,563.20
Rate for Payer: Cofinity Commercial	$25,263.36
Rate for Payer: Healthscope Commercial	$26,438.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24,969.60
Rate for Payer: PHP Commercial	$24,969.60
Rate for Payer: Priority Health Cigna Priority Health	$20,563.20
Rate for Payer: Priority Health SBD	$18,506.88

HC MEDTRONIC CRT LEAD

Facility

$6,085.82

Service Code	HCPCS C1900
Hospital Charge Code	27800018
Hospital Revenue Code	278
Min. Negotiated Rate	$3,834.07
Max. Negotiated Rate	$5,477.24
Rate for Payer: Aetna Commercial	$5,172.95
Rate for Payer: Aetna New Business (MI Preferred)	$3,955.78
Rate for Payer: Cash Price	$4,868.66
Rate for Payer: Cofinity Commercial	$4,260.07
Rate for Payer: Cofinity Commercial	$5,233.81
Rate for Payer: Healthscope Commercial	$5,477.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,172.95
Rate for Payer: PHP Commercial	$5,172.95
Rate for Payer: Priority Health Cigna Priority Health	$4,260.07
Rate for Payer: Priority Health SBD	$3,834.07

HC MEDTRONIC CRT LEAD

Facility

$6,085.82

Service Code	HCPCS C1900
Hospital Charge Code	27800018
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5,477.24
Rate for Payer: Aetna Commercial	$5,172.95
Rate for Payer: Aetna New Business (MI Preferred)	$3,955.78
Rate for Payer: BCBS Complete	$2,434.33
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$4,868.66
Rate for Payer: Cash Price	$4,868.66
Rate for Payer: Cofinity Commercial	$5,233.81
Rate for Payer: Cofinity Commercial	$4,260.07
Rate for Payer: Healthscope Commercial	$5,477.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,172.95
Rate for Payer: PHP Commercial	$5,172.95
Rate for Payer: Priority Health Cigna Priority Health	$4,260.07
Rate for Payer: Priority Health SBD	$3,834.07

HC MEDTRONIC DUAL PACEMAKER

Facility

$8,670.00

Service Code	HCPCS C1785
Hospital Charge Code	27500007
Hospital Revenue Code	275
Min. Negotiated Rate	$5,462.10
Max. Negotiated Rate	$7,803.00
Rate for Payer: Aetna Commercial	$7,369.50
Rate for Payer: Aetna New Business (MI Preferred)	$5,635.50
Rate for Payer: Cash Price	$6,936.00
Rate for Payer: Cofinity Commercial	$6,069.00
Rate for Payer: Cofinity Commercial	$7,456.20
Rate for Payer: Healthscope Commercial	$7,803.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,369.50
Rate for Payer: PHP Commercial	$7,369.50
Rate for Payer: Priority Health Cigna Priority Health	$6,069.00
Rate for Payer: Priority Health SBD	$5,462.10

HC MEDTRONIC DUAL PACEMAKER

Facility

$8,670.00

Service Code	HCPCS C1785
Hospital Charge Code	27500007
Hospital Revenue Code	275
Min. Negotiated Rate	$3,468.00
Max. Negotiated Rate	$7,803.00
Rate for Payer: Aetna Commercial	$7,369.50
Rate for Payer: Aetna New Business (MI Preferred)	$5,635.50
Rate for Payer: BCBS Complete	$3,468.00
Rate for Payer: Cash Price	$6,936.00
Rate for Payer: Cofinity Commercial	$6,069.00
Rate for Payer: Cofinity Commercial	$7,456.20
Rate for Payer: Healthscope Commercial	$7,803.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,369.50
Rate for Payer: PHP Commercial	$7,369.50
Rate for Payer: Priority Health Cigna Priority Health	$6,069.00
Rate for Payer: Priority Health SBD	$5,462.10

HC MEDTRONIC ICD DUAL

Facility

$25,806.00

Service Code	HCPCS C1721
Hospital Charge Code	27800019
Hospital Revenue Code	278
Min. Negotiated Rate	$10,322.40
Max. Negotiated Rate	$23,225.40
Rate for Payer: Aetna Commercial	$21,935.10
Rate for Payer: Aetna New Business (MI Preferred)	$16,773.90
Rate for Payer: BCBS Complete	$10,322.40
Rate for Payer: Cash Price	$20,644.80
Rate for Payer: Cofinity Commercial	$18,064.20
Rate for Payer: Cofinity Commercial	$22,193.16
Rate for Payer: Healthscope Commercial	$23,225.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21,935.10
Rate for Payer: PHP Commercial	$21,935.10
Rate for Payer: Priority Health Cigna Priority Health	$18,064.20
Rate for Payer: Priority Health SBD	$16,257.78

HC MEDTRONIC ICD DUAL

Facility

$25,806.00

Service Code	HCPCS C1721
Hospital Charge Code	27800019
Hospital Revenue Code	278
Min. Negotiated Rate	$16,257.78
Max. Negotiated Rate	$23,225.40
Rate for Payer: Aetna Commercial	$21,935.10
Rate for Payer: Aetna New Business (MI Preferred)	$16,773.90
Rate for Payer: Cash Price	$20,644.80
Rate for Payer: Cofinity Commercial	$18,064.20
Rate for Payer: Cofinity Commercial	$22,193.16
Rate for Payer: Healthscope Commercial	$23,225.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21,935.10
Rate for Payer: PHP Commercial	$21,935.10
Rate for Payer: Priority Health Cigna Priority Health	$18,064.20
Rate for Payer: Priority Health SBD	$16,257.78

HC MEDTRONIC ICD SINGLE

Facility

$23,358.00

Service Code	HCPCS C1722
Hospital Charge Code	27800020
Hospital Revenue Code	278
Min. Negotiated Rate	$9,343.20
Max. Negotiated Rate	$21,022.20
Rate for Payer: Aetna Commercial	$19,854.30
Rate for Payer: Aetna New Business (MI Preferred)	$15,182.70
Rate for Payer: BCBS Complete	$9,343.20
Rate for Payer: Cash Price	$18,686.40
Rate for Payer: Cofinity Commercial	$20,087.88
Rate for Payer: Cofinity Commercial	$16,350.60
Rate for Payer: Healthscope Commercial	$21,022.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19,854.30
Rate for Payer: PHP Commercial	$19,854.30
Rate for Payer: Priority Health Cigna Priority Health	$16,350.60
Rate for Payer: Priority Health SBD	$14,715.54

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All Charges