Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC GROUP THERAPEUTIC PROCEDURES

Facility

$109.35

Service Code	CPT 97150
Hospital Charge Code	42000027
Hospital Revenue Code	420
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$92.95
Rate for Payer: Aetna Medicare	$54.67
Rate for Payer: Aetna New Business (MI Preferred)	$71.08
Rate for Payer: BCBS Complete	$43.74
Rate for Payer: BCBS Trust/PPO	$16.45
Rate for Payer: BCN Commercial	$16.45
Rate for Payer: Cash Price	$87.48
Rate for Payer: Cash Price	$87.48
Rate for Payer: Cash Price	$87.48
Rate for Payer: Cofinity Advantage	$76.55
Rate for Payer: Cofinity Commercial	$94.04
Rate for Payer: Encore Health Key Benefits Commercial	$87.48
Rate for Payer: Healthscope Commercial	$98.42
Rate for Payer: MI Amish Medical Board Commercial	$87.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.95
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$82.01
Rate for Payer: PHP Commercial	$92.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$18.00
Rate for Payer: Priority Health SBD	$68.89
Rate for Payer: Priority Health Tiered Network	$14.40
Rate for Payer: UHC All Payor (Choice/PPO)	$71.08
Rate for Payer: UHC Core	$56.97
Rate for Payer: UHC Exchange	$42.97

HC GROWTH HORMONE HGH

Facility

$67.63

Service Code	CPT 83003
Hospital Charge Code	30100752
Hospital Revenue Code	301
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$60.87
Rate for Payer: Aetna Commercial	$57.49
Rate for Payer: Aetna Medicare	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$43.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$20.84
Rate for Payer: Amish Plain Church Group Commercial	$20.84
Rate for Payer: BCBS Complete	$9.16
Rate for Payer: BCBS MAPPO	$16.67
Rate for Payer: BCBS Trust/PPO	$17.77
Rate for Payer: BCN Commercial	$17.77
Rate for Payer: BCN Medicare Advantage	$16.67
Rate for Payer: Cash Price	$54.10
Rate for Payer: Cash Price	$54.10
Rate for Payer: Cofinity Advantage	$47.34
Rate for Payer: Cofinity Commercial	$58.16
Rate for Payer: Encore Health Key Benefits Commercial	$54.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$16.67
Rate for Payer: Healthscope Commercial	$60.87
Rate for Payer: Mclaren Medicaid	$8.72
Rate for Payer: Mclaren Medicare	$16.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17.50
Rate for Payer: Meridian Medicaid	$17.50
Rate for Payer: MI Amish Medical Board Commercial	$19.17
Rate for Payer: Molina Medicare/Medicaid	$18.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.49
Rate for Payer: Nomi Health Commercial	$25.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$50.72
Rate for Payer: PACE Medicare	$15.84
Rate for Payer: PACE SWMI	$16.67
Rate for Payer: PHP Commercial	$57.49
Rate for Payer: PHP Medicare Advantage	$16.67
Rate for Payer: Priority Health Choice Medicaid	$8.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$16.67
Rate for Payer: Priority Health Medicare	$16.67
Rate for Payer: Priority Health SBD	$42.61
Rate for Payer: Priority Health Tiered Network	$13.34
Rate for Payer: Railroad Medicare Medicare	$16.67
Rate for Payer: UHC All Payor (Choice/PPO)	$25.01
Rate for Payer: UHC Core	$25.01
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16.67
Rate for Payer: UHC Exchange	$25.01
Rate for Payer: UHC Medicaid	$8.72
Rate for Payer: UHCCP Medicaid	$8.72
Rate for Payer: VA VA	$16.67

HC GROWTH HORMONE HGH

Facility

$67.63

Service Code	CPT 83003
Hospital Charge Code	30100752
Hospital Revenue Code	301
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$60.87
Rate for Payer: Aetna Commercial	$57.49
Rate for Payer: Aetna New Business (MI Preferred)	$43.96
Rate for Payer: Cash Price	$54.10
Rate for Payer: Cofinity Advantage	$47.34
Rate for Payer: Cofinity Commercial	$58.16
Rate for Payer: Encore Health Key Benefits Commercial	$54.10
Rate for Payer: Healthscope Commercial	$60.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$50.72
Rate for Payer: PHP Commercial	$57.49
Rate for Payer: Priority Health SBD	$42.61

HC GROWTH HORMONE STIMULATION TEST

Facility

$689.79

Service Code	CPT 96365
Hospital Charge Code	76100362
Hospital Revenue Code	761
Min. Negotiated Rate	$110.84
Max. Negotiated Rate	$685.39
Rate for Payer: Aetna Commercial	$586.32
Rate for Payer: Aetna Medicare	$220.42
Rate for Payer: Aetna New Business (MI Preferred)	$448.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$264.93
Rate for Payer: Amish Plain Church Group Commercial	$264.93
Rate for Payer: BCBS Complete	$116.40
Rate for Payer: BCBS MAPPO	$211.94
Rate for Payer: BCBS Trust/PPO	$234.77
Rate for Payer: BCN Commercial	$234.77
Rate for Payer: BCN Medicare Advantage	$211.94
Rate for Payer: Cash Price	$551.83
Rate for Payer: Cash Price	$551.83
Rate for Payer: Cofinity Advantage	$482.85
Rate for Payer: Cofinity Commercial	$593.22
Rate for Payer: Encore Health Key Benefits Commercial	$551.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$211.94
Rate for Payer: Healthscope Commercial	$620.81
Rate for Payer: Mclaren Medicaid	$110.84
Rate for Payer: Mclaren Medicare	$211.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$222.54
Rate for Payer: Meridian Medicaid	$222.54
Rate for Payer: MI Amish Medical Board Commercial	$243.73
Rate for Payer: Molina Medicare/Medicaid	$233.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$586.32
Rate for Payer: Nomi Health Commercial	$635.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$517.34
Rate for Payer: PACE Medicare	$201.34
Rate for Payer: PACE SWMI	$211.94
Rate for Payer: PHP Commercial	$586.32
Rate for Payer: PHP Medicare Advantage	$211.94
Rate for Payer: Priority Health Choice Medicaid	$110.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$685.39
Rate for Payer: Priority Health Medicare	$211.94
Rate for Payer: Priority Health SBD	$434.57
Rate for Payer: Priority Health Tiered Network	$548.31
Rate for Payer: Railroad Medicare Medicare	$211.94
Rate for Payer: UHC All Payor (Choice/PPO)	$448.36
Rate for Payer: UHC Core	$359.38
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$211.94
Rate for Payer: UHC Exchange	$271.09
Rate for Payer: UHC Medicaid	$110.84
Rate for Payer: UHCCP Medicaid	$110.84
Rate for Payer: VA VA	$211.94

HC GROWTH HORMONE STIMULATION TEST

Facility

$689.79

Service Code	CPT 96365
Hospital Charge Code	76100362
Hospital Revenue Code	761
Min. Negotiated Rate	$434.57
Max. Negotiated Rate	$620.81
Rate for Payer: Aetna Commercial	$586.32
Rate for Payer: Aetna New Business (MI Preferred)	$448.36
Rate for Payer: Cash Price	$551.83
Rate for Payer: Cofinity Advantage	$482.85
Rate for Payer: Cofinity Commercial	$593.22
Rate for Payer: Encore Health Key Benefits Commercial	$551.83
Rate for Payer: Healthscope Commercial	$620.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$586.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$517.34
Rate for Payer: PHP Commercial	$586.32
Rate for Payer: Priority Health SBD	$434.57

HC GSU OBSERVATION PER HOUR

Facility

$160.00

Service Code	HCPCS G0378
Hospital Charge Code	76200011
Hospital Revenue Code	762
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80

HC GSU OBSERVATION PER HOUR

Facility

$160.00

Service Code	HCPCS G0378
Hospital Charge Code	76200011
Hospital Revenue Code	762
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$1,608.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: BCBS Trust/PPO	$112.58
Rate for Payer: BCN Commercial	$112.58
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: MI Amish Medical Board Commercial	$128.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80
Rate for Payer: UHC Medicaid	$1,608.00
Rate for Payer: UHCCP Medicaid	$810.00

HC G TUBE REPLACEMENT

Facility

$588.03

Hospital Charge Code	36000046
Hospital Revenue Code	360
Min. Negotiated Rate	$235.21
Max. Negotiated Rate	$529.23
Rate for Payer: Aetna Commercial	$499.83
Rate for Payer: Aetna Medicare	$294.01
Rate for Payer: Aetna New Business (MI Preferred)	$382.22
Rate for Payer: BCBS Complete	$235.21
Rate for Payer: Cash Price	$470.42
Rate for Payer: Cofinity Advantage	$411.62
Rate for Payer: Cofinity Commercial	$505.71
Rate for Payer: Encore Health Key Benefits Commercial	$470.42
Rate for Payer: Healthscope Commercial	$529.23
Rate for Payer: MI Amish Medical Board Commercial	$470.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$441.02
Rate for Payer: PHP Commercial	$499.83
Rate for Payer: Priority Health SBD	$370.46

HC G TUBE REPLACEMENT

Facility

$588.03

Hospital Charge Code	36000046
Hospital Revenue Code	360
Min. Negotiated Rate	$370.46
Max. Negotiated Rate	$529.23
Rate for Payer: Aetna Commercial	$499.83
Rate for Payer: Aetna New Business (MI Preferred)	$382.22
Rate for Payer: Cash Price	$470.42
Rate for Payer: Cofinity Advantage	$411.62
Rate for Payer: Cofinity Commercial	$505.71
Rate for Payer: Encore Health Key Benefits Commercial	$470.42
Rate for Payer: Healthscope Commercial	$529.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$441.02
Rate for Payer: PHP Commercial	$499.83
Rate for Payer: Priority Health SBD	$370.46

HC GUIDANT CAROTID STENT

Facility

$5,937.84

Hospital Charge Code	27800044
Hospital Revenue Code	278
Min. Negotiated Rate	$2,333.57
Max. Negotiated Rate	$5,344.06
Rate for Payer: Aetna Commercial	$5,047.16
Rate for Payer: Aetna Medicare	$2,968.92
Rate for Payer: Aetna New Business (MI Preferred)	$3,859.60
Rate for Payer: BCBS Complete	$2,375.14
Rate for Payer: Cash Price	$4,750.27
Rate for Payer: Cofinity Advantage	$4,156.49
Rate for Payer: Cofinity Commercial	$5,106.54
Rate for Payer: Encore Health Key Benefits Commercial	$4,750.27
Rate for Payer: Healthscope Commercial	$5,344.06
Rate for Payer: MI Amish Medical Board Commercial	$4,750.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,047.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,453.38
Rate for Payer: PHP Commercial	$5,047.16
Rate for Payer: Priority Health SBD	$3,740.84
Rate for Payer: UHC All Payor (Choice/PPO)	$3,859.60
Rate for Payer: UHC Core	$3,093.61
Rate for Payer: UHC Exchange	$2,333.57

HC GUIDANT CAROTID STENT

Facility

$5,937.84

Hospital Charge Code	27800044
Hospital Revenue Code	278
Min. Negotiated Rate	$3,740.84
Max. Negotiated Rate	$5,344.06
Rate for Payer: Aetna Commercial	$5,047.16
Rate for Payer: Aetna New Business (MI Preferred)	$3,859.60
Rate for Payer: Cash Price	$4,750.27
Rate for Payer: Cofinity Advantage	$4,156.49
Rate for Payer: Cofinity Commercial	$5,106.54
Rate for Payer: Encore Health Key Benefits Commercial	$4,750.27
Rate for Payer: Healthscope Commercial	$5,344.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,047.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,453.38
Rate for Payer: PHP Commercial	$5,047.16
Rate for Payer: Priority Health SBD	$3,740.84

HC GUIDANT CRT LEAD

Facility

$10,560.06

Service Code	HCPCS C1900
Hospital Charge Code	27800013
Hospital Revenue Code	278
Min. Negotiated Rate	$6,652.84
Max. Negotiated Rate	$9,504.05
Rate for Payer: Aetna Commercial	$8,976.05
Rate for Payer: Aetna New Business (MI Preferred)	$6,864.04
Rate for Payer: Cash Price	$8,448.05
Rate for Payer: Cofinity Advantage	$7,392.04
Rate for Payer: Cofinity Commercial	$9,081.65
Rate for Payer: Encore Health Key Benefits Commercial	$8,448.05
Rate for Payer: Healthscope Commercial	$9,504.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,976.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,920.05
Rate for Payer: PHP Commercial	$8,976.05
Rate for Payer: Priority Health SBD	$6,652.84

HC GUIDANT CRT LEAD

Facility

$10,560.06

Service Code	HCPCS C1900
Hospital Charge Code	27800013
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$9,504.05
Rate for Payer: Aetna Commercial	$8,976.05
Rate for Payer: Aetna Medicare	$5,280.03
Rate for Payer: Aetna New Business (MI Preferred)	$6,864.04
Rate for Payer: BCBS Complete	$4,224.02
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$8,448.05
Rate for Payer: Cash Price	$8,448.05
Rate for Payer: Cofinity Advantage	$7,392.04
Rate for Payer: Cofinity Commercial	$9,081.65
Rate for Payer: Encore Health Key Benefits Commercial	$8,448.05
Rate for Payer: Healthscope Commercial	$9,504.05
Rate for Payer: MI Amish Medical Board Commercial	$8,448.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,976.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,920.05
Rate for Payer: PHP Commercial	$8,976.05
Rate for Payer: Priority Health SBD	$6,652.84
Rate for Payer: UHC All Payor (Choice/PPO)	$6,864.04
Rate for Payer: UHC Core	$5,501.79
Rate for Payer: UHC Exchange	$4,150.10

HC GUIDANT TACHY (ICD) LEAD

Facility

$13,517.92

Service Code	HCPCS C1895
Hospital Charge Code	27800014
Hospital Revenue Code	278
Min. Negotiated Rate	$8,516.29
Max. Negotiated Rate	$12,166.13
Rate for Payer: Aetna Commercial	$11,490.23
Rate for Payer: Aetna New Business (MI Preferred)	$8,786.65
Rate for Payer: Cash Price	$10,814.34
Rate for Payer: Cofinity Advantage	$9,462.54
Rate for Payer: Cofinity Commercial	$11,625.41
Rate for Payer: Encore Health Key Benefits Commercial	$10,814.34
Rate for Payer: Healthscope Commercial	$12,166.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11,490.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$10,138.44
Rate for Payer: PHP Commercial	$11,490.23
Rate for Payer: Priority Health SBD	$8,516.29

HC GUIDANT TACHY (ICD) LEAD

Facility

$13,517.92

Service Code	HCPCS C1895
Hospital Charge Code	27800014
Hospital Revenue Code	278
Min. Negotiated Rate	$5,312.54
Max. Negotiated Rate	$12,166.13
Rate for Payer: Aetna Commercial	$11,490.23
Rate for Payer: Aetna Medicare	$6,758.96
Rate for Payer: Aetna New Business (MI Preferred)	$8,786.65
Rate for Payer: BCBS Complete	$5,407.17
Rate for Payer: Cash Price	$10,814.34
Rate for Payer: Cofinity Advantage	$9,462.54
Rate for Payer: Cofinity Commercial	$11,625.41
Rate for Payer: Encore Health Key Benefits Commercial	$10,814.34
Rate for Payer: Healthscope Commercial	$12,166.13
Rate for Payer: MI Amish Medical Board Commercial	$10,814.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11,490.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$10,138.44
Rate for Payer: PHP Commercial	$11,490.23
Rate for Payer: Priority Health SBD	$8,516.29
Rate for Payer: UHC All Payor (Choice/PPO)	$8,786.65
Rate for Payer: UHC Core	$7,042.84
Rate for Payer: UHC Exchange	$5,312.54

HC GUIDED DRAIN CATH PLACEMENT

Facility

$545.27

Service Code	CPT 75989
Hospital Charge Code	32000229
Hospital Revenue Code	320
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$490.74
Rate for Payer: Aetna Commercial	$463.48
Rate for Payer: Aetna Medicare	$272.63
Rate for Payer: Aetna New Business (MI Preferred)	$354.43
Rate for Payer: BCBS Complete	$218.11
Rate for Payer: BCBS Trust/PPO	$127.20
Rate for Payer: BCN Commercial	$127.20
Rate for Payer: Cash Price	$436.22
Rate for Payer: Cash Price	$436.22
Rate for Payer: Cofinity Advantage	$381.69
Rate for Payer: Cofinity Commercial	$468.93
Rate for Payer: Encore Health Key Benefits Commercial	$436.22
Rate for Payer: Healthscope Commercial	$490.74
Rate for Payer: MI Amish Medical Board Commercial	$436.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$463.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$408.95
Rate for Payer: PHP Commercial	$463.48
Rate for Payer: Priority Health SBD	$343.52
Rate for Payer: UHC All Payor (Choice/PPO)	$354.43
Rate for Payer: UHC Core	$284.09
Rate for Payer: UHC Exchange	$214.29

HC GUIDED DRAIN CATH PLACEMENT

Facility

$545.27

Service Code	CPT 75989
Hospital Charge Code	32000229
Hospital Revenue Code	320
Min. Negotiated Rate	$343.52
Max. Negotiated Rate	$490.74
Rate for Payer: Aetna Commercial	$463.48
Rate for Payer: Aetna New Business (MI Preferred)	$354.43
Rate for Payer: Cash Price	$436.22
Rate for Payer: Cofinity Advantage	$381.69
Rate for Payer: Cofinity Commercial	$468.93
Rate for Payer: Encore Health Key Benefits Commercial	$436.22
Rate for Payer: Healthscope Commercial	$490.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$463.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$408.95
Rate for Payer: PHP Commercial	$463.48
Rate for Payer: Priority Health SBD	$343.52

HC GUIDELINER CATHETER

Facility

$1,787.98

Hospital Charge Code	27200126
Hospital Revenue Code	272
Min. Negotiated Rate	$1,126.43
Max. Negotiated Rate	$1,609.18
Rate for Payer: Aetna Commercial	$1,519.78
Rate for Payer: Aetna New Business (MI Preferred)	$1,162.19
Rate for Payer: Cash Price	$1,430.38
Rate for Payer: Cofinity Advantage	$1,251.59
Rate for Payer: Cofinity Commercial	$1,537.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,430.38
Rate for Payer: Healthscope Commercial	$1,609.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,519.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,340.98
Rate for Payer: PHP Commercial	$1,519.78
Rate for Payer: Priority Health SBD	$1,126.43

HC GUIDELINER CATHETER

Facility

$1,787.98

Hospital Charge Code	27200126
Hospital Revenue Code	272
Min. Negotiated Rate	$702.68
Max. Negotiated Rate	$1,609.18
Rate for Payer: Aetna Commercial	$1,519.78
Rate for Payer: Aetna Medicare	$893.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,162.19
Rate for Payer: BCBS Complete	$715.19
Rate for Payer: Cash Price	$1,430.38
Rate for Payer: Cofinity Advantage	$1,251.59
Rate for Payer: Cofinity Commercial	$1,537.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,430.38
Rate for Payer: Healthscope Commercial	$1,609.18
Rate for Payer: MI Amish Medical Board Commercial	$1,430.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,519.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,340.98
Rate for Payer: PHP Commercial	$1,519.78
Rate for Payer: Priority Health SBD	$1,126.43
Rate for Payer: UHC All Payor (Choice/PPO)	$1,162.19
Rate for Payer: UHC Core	$931.54
Rate for Payer: UHC Exchange	$702.68

HC GUIDEWIRE

Facility

$50.37

Service Code	HCPCS C1769
Hospital Charge Code	27200045
Hospital Revenue Code	272
Min. Negotiated Rate	$31.73
Max. Negotiated Rate	$45.33
Rate for Payer: Aetna Commercial	$42.81
Rate for Payer: Aetna New Business (MI Preferred)	$32.74
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cofinity Advantage	$35.26
Rate for Payer: Cofinity Commercial	$43.32
Rate for Payer: Encore Health Key Benefits Commercial	$40.30
Rate for Payer: Healthscope Commercial	$45.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.78
Rate for Payer: PHP Commercial	$42.81
Rate for Payer: Priority Health SBD	$31.73

HC GUIDEWIRE

Facility

$50.37

Service Code	HCPCS C1769
Hospital Charge Code	27200045
Hospital Revenue Code	272
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$45.33
Rate for Payer: Aetna Commercial	$42.81
Rate for Payer: Aetna Medicare	$25.18
Rate for Payer: Aetna New Business (MI Preferred)	$32.74
Rate for Payer: BCBS Complete	$20.15
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cofinity Advantage	$35.26
Rate for Payer: Cofinity Commercial	$43.32
Rate for Payer: Encore Health Key Benefits Commercial	$40.30
Rate for Payer: Healthscope Commercial	$45.33
Rate for Payer: MI Amish Medical Board Commercial	$40.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.78
Rate for Payer: PHP Commercial	$42.81
Rate for Payer: Priority Health SBD	$31.73
Rate for Payer: UHC All Payor (Choice/PPO)	$32.74
Rate for Payer: UHC Core	$26.24
Rate for Payer: UHC Exchange	$19.80

HC GUIDE WIRE DILATATION

Facility

$1,372.36

Hospital Charge Code	36000050
Hospital Revenue Code	360
Min. Negotiated Rate	$548.94
Max. Negotiated Rate	$1,235.12
Rate for Payer: Aetna Commercial	$1,166.51
Rate for Payer: Aetna Medicare	$686.18
Rate for Payer: Aetna New Business (MI Preferred)	$892.03
Rate for Payer: BCBS Complete	$548.94
Rate for Payer: Cash Price	$1,097.89
Rate for Payer: Cofinity Advantage	$960.65
Rate for Payer: Cofinity Commercial	$1,180.23
Rate for Payer: Encore Health Key Benefits Commercial	$1,097.89
Rate for Payer: Healthscope Commercial	$1,235.12
Rate for Payer: MI Amish Medical Board Commercial	$1,097.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,166.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,029.27
Rate for Payer: PHP Commercial	$1,166.51
Rate for Payer: Priority Health SBD	$864.59

HC GUIDE WIRE DILATATION

Facility

$1,372.36

Hospital Charge Code	36000050
Hospital Revenue Code	360
Min. Negotiated Rate	$864.59
Max. Negotiated Rate	$1,235.12
Rate for Payer: Aetna Commercial	$1,166.51
Rate for Payer: Aetna New Business (MI Preferred)	$892.03
Rate for Payer: Cash Price	$1,097.89
Rate for Payer: Cofinity Advantage	$960.65
Rate for Payer: Cofinity Commercial	$1,180.23
Rate for Payer: Encore Health Key Benefits Commercial	$1,097.89
Rate for Payer: Healthscope Commercial	$1,235.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,166.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,029.27
Rate for Payer: PHP Commercial	$1,166.51
Rate for Payer: Priority Health SBD	$864.59

HC GUIDEWIRE GLIDEWIRE LVL 1

Facility

$79.56

Service Code	HCPCS C1769
Hospital Charge Code	27200273
Hospital Revenue Code	272
Min. Negotiated Rate	$50.12
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Advantage	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.67
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health SBD	$50.12

HC GUIDEWIRE GLIDEWIRE LVL 1

Facility

$79.56

Service Code	HCPCS C1769
Hospital Charge Code	27200273
Hospital Revenue Code	272
Min. Negotiated Rate	$31.27
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna Medicare	$39.78
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: BCBS Complete	$31.82
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Advantage	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: MI Amish Medical Board Commercial	$63.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.67
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health SBD	$50.12
Rate for Payer: UHC All Payor (Choice/PPO)	$51.71
Rate for Payer: UHC Core	$41.45
Rate for Payer: UHC Exchange	$31.27

Know your out-of-pocket cost for care.

All Charges