Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NEG PRES WND THRPY DSG SET MED

Facility

$143.06

Hospital Charge Code	27200139
Hospital Revenue Code	272
Min. Negotiated Rate	$90.13
Max. Negotiated Rate	$128.75
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna New Business (MI Preferred)	$92.99
Rate for Payer: Cash Price	$114.45
Rate for Payer: Cofinity Commercial	$100.14
Rate for Payer: Cofinity Commercial	$123.03
Rate for Payer: Healthscope Commercial	$128.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$121.60
Rate for Payer: PHP Commercial	$121.60
Rate for Payer: Priority Health Cigna Priority Health	$100.14
Rate for Payer: Priority Health SBD	$90.13

HC NEG PRES WND THRPY DSG SET SIL

Facility

$267.14

Hospital Charge Code	27200140
Hospital Revenue Code	272
Min. Negotiated Rate	$106.86
Max. Negotiated Rate	$240.43
Rate for Payer: Aetna Commercial	$227.07
Rate for Payer: Aetna New Business (MI Preferred)	$173.64
Rate for Payer: BCBS Complete	$106.86
Rate for Payer: Cash Price	$213.71
Rate for Payer: Cofinity Commercial	$187.00
Rate for Payer: Cofinity Commercial	$229.74
Rate for Payer: Healthscope Commercial	$240.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$227.07
Rate for Payer: PHP Commercial	$227.07
Rate for Payer: Priority Health Cigna Priority Health	$187.00
Rate for Payer: Priority Health SBD	$168.30

HC NEG PRES WND THRPY DSG SET SIL

Facility

$267.14

Hospital Charge Code	27200140
Hospital Revenue Code	272
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$240.43
Rate for Payer: Aetna Commercial	$227.07
Rate for Payer: Aetna New Business (MI Preferred)	$173.64
Rate for Payer: Cash Price	$213.71
Rate for Payer: Cofinity Commercial	$187.00
Rate for Payer: Cofinity Commercial	$229.74
Rate for Payer: Healthscope Commercial	$240.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$227.07
Rate for Payer: PHP Commercial	$227.07
Rate for Payer: Priority Health Cigna Priority Health	$187.00
Rate for Payer: Priority Health SBD	$168.30

HC NEG PRES WND THRPY DSG SET SMA

Facility

$113.72

Hospital Charge Code	27200141
Hospital Revenue Code	272
Min. Negotiated Rate	$45.49
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: BCBS Complete	$45.49
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$79.60
Rate for Payer: Priority Health SBD	$71.64

HC NEG PRES WND THRPY DSG SET SMA

Facility

$113.72

Hospital Charge Code	27200141
Hospital Revenue Code	272
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$79.60
Rate for Payer: Priority Health SBD	$71.64

HC NEG PRES WOUND TX SET MED

Facility

$78.42

Hospital Charge Code	27200127
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$70.58
Rate for Payer: Aetna Commercial	$66.66
Rate for Payer: Aetna New Business (MI Preferred)	$50.97
Rate for Payer: Cash Price	$62.74
Rate for Payer: Cofinity Commercial	$54.89
Rate for Payer: Cofinity Commercial	$67.44
Rate for Payer: Healthscope Commercial	$70.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.66
Rate for Payer: PHP Commercial	$66.66
Rate for Payer: Priority Health Cigna Priority Health	$54.89
Rate for Payer: Priority Health SBD	$49.40

HC NEG PRES WOUND TX SET MED

Facility

$78.42

Hospital Charge Code	27200127
Hospital Revenue Code	272
Min. Negotiated Rate	$31.37
Max. Negotiated Rate	$70.58
Rate for Payer: Aetna Commercial	$66.66
Rate for Payer: Aetna New Business (MI Preferred)	$50.97
Rate for Payer: BCBS Complete	$31.37
Rate for Payer: Cash Price	$62.74
Rate for Payer: Cofinity Commercial	$54.89
Rate for Payer: Cofinity Commercial	$67.44
Rate for Payer: Healthscope Commercial	$70.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.66
Rate for Payer: PHP Commercial	$66.66
Rate for Payer: Priority Health Cigna Priority Health	$54.89
Rate for Payer: Priority Health SBD	$49.40

HC NEG PRES WOUND TX SET SMALL

Facility

$113.72

Hospital Charge Code	27200128
Hospital Revenue Code	272
Min. Negotiated Rate	$45.49
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: BCBS Complete	$45.49
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$79.60
Rate for Payer: Priority Health SBD	$71.64

HC NEG PRES WOUND TX SET SMALL

Facility

$113.72

Hospital Charge Code	27200128
Hospital Revenue Code	272
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$79.60
Rate for Payer: Priority Health SBD	$71.64

HC NEG PRES Y CONNECTOR

Facility

$7.71

Hospital Charge Code	27000174
Hospital Revenue Code	270
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$6.94
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna New Business (MI Preferred)	$5.01
Rate for Payer: Cash Price	$6.17
Rate for Payer: Cofinity Commercial	$5.40
Rate for Payer: Cofinity Commercial	$6.63
Rate for Payer: Healthscope Commercial	$6.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.55
Rate for Payer: PHP Commercial	$6.55
Rate for Payer: Priority Health Cigna Priority Health	$5.40
Rate for Payer: Priority Health SBD	$4.86

HC NEG PRES Y CONNECTOR

Facility

$7.71

Hospital Charge Code	27000174
Hospital Revenue Code	270
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$6.94
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna New Business (MI Preferred)	$5.01
Rate for Payer: BCBS Complete	$3.08
Rate for Payer: Cash Price	$6.17
Rate for Payer: Cofinity Commercial	$5.40
Rate for Payer: Cofinity Commercial	$6.63
Rate for Payer: Healthscope Commercial	$6.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.55
Rate for Payer: PHP Commercial	$6.55
Rate for Payer: Priority Health Cigna Priority Health	$5.40
Rate for Payer: Priority Health SBD	$4.86

HC NEISSERIA GONORRHOEAE AMP DNA

Facility

$66.30

Service Code	CPT 87591
Hospital Charge Code	30600163
Hospital Revenue Code	306
Min. Negotiated Rate	$41.77
Max. Negotiated Rate	$59.67
Rate for Payer: Aetna Commercial	$56.36
Rate for Payer: Aetna New Business (MI Preferred)	$43.10
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Cofinity Commercial	$46.41
Rate for Payer: Healthscope Commercial	$59.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.36
Rate for Payer: PHP Commercial	$56.36
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$41.77

HC NEISSERIA GONORRHOEAE AMP DNA

Facility

$66.30

Service Code	CPT 87591
Hospital Charge Code	30600163
Hospital Revenue Code	306
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$59.67
Rate for Payer: Aetna Commercial	$56.36
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$43.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCBS Trust/PPO	$27.48
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cofinity Commercial	$46.41
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$59.67
Rate for Payer: Mclaren Medicaid	$19.19
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36.84
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.36
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$56.36
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$19.19
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$41.77
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$42.11
Rate for Payer: UHC Core	$59.65
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Exchange	$35.09
Rate for Payer: UHC Medicare Advantage	$36.14
Rate for Payer: VA VA	$35.09

HC NEISSERIA MENINGITITIS

Facility

$51.00

Service Code	CPT 87798
Hospital Charge Code	30600275
Hospital Revenue Code	306
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health SBD	$32.13

HC NEISSERIA MENINGITITIS

Facility

$51.00

Service Code	CPT 87798
Hospital Charge Code	30600275
Hospital Revenue Code	306
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$59.65
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCBS Trust/PPO	$27.48
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Mclaren Medicaid	$19.19
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36.84
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.35
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$19.19
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$32.13
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$42.11
Rate for Payer: UHC Core	$59.65
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Exchange	$35.09
Rate for Payer: UHC Medicare Advantage	$36.14
Rate for Payer: VA VA	$35.09

HC NEONATAL VENT INIT DAY

Facility

$1,538.29

Service Code	CPT 94002
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$82.90
Max. Negotiated Rate	$1,384.46
Rate for Payer: Aetna Commercial	$1,307.55
Rate for Payer: Aetna Medicare	$579.90
Rate for Payer: Aetna New Business (MI Preferred)	$999.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$697.00
Rate for Payer: Amish Plain Church Group Commercial	$697.00
Rate for Payer: BCBS Complete	$320.29
Rate for Payer: BCBS MAPPO	$557.60
Rate for Payer: BCBS Trust/PPO	$82.90
Rate for Payer: BCN Medicare Advantage	$557.60
Rate for Payer: Cash Price	$1,230.63
Rate for Payer: Cash Price	$1,230.63
Rate for Payer: Cofinity Commercial	$1,322.93
Rate for Payer: Cofinity Commercial	$1,076.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$557.60
Rate for Payer: Healthscope Commercial	$1,384.46
Rate for Payer: Mclaren Medicaid	$305.01
Rate for Payer: Mclaren Medicare	$557.60
Rate for Payer: Meridian Medicaid	$320.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$585.48
Rate for Payer: MI Amish Medical Board Commercial	$641.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,307.55
Rate for Payer: PACE Medicare	$529.72
Rate for Payer: PACE SWMI	$557.60
Rate for Payer: PHP Commercial	$1,307.55
Rate for Payer: PHP Medicare Advantage	$557.60
Rate for Payer: Priority Health Choice Medicaid	$305.01
Rate for Payer: Priority Health Cigna Priority Health	$1,076.80
Rate for Payer: Priority Health Medicare	$557.60
Rate for Payer: Priority Health SBD	$969.12
Rate for Payer: Railroad Medicare Medicare	$557.60
Rate for Payer: UHC All Payor (Choice/PPO)	$97.25
Rate for Payer: UHC Dual Complete DSNP	$557.60
Rate for Payer: UHC Exchange	$88.41
Rate for Payer: UHC Medicare Advantage	$574.33
Rate for Payer: VA VA	$557.60

HC NEONATAL VENT INIT DAY

Facility

$1,538.29

Service Code	CPT 94002
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$969.12
Max. Negotiated Rate	$1,384.46
Rate for Payer: Aetna Commercial	$1,307.55
Rate for Payer: Aetna New Business (MI Preferred)	$999.89
Rate for Payer: Cash Price	$1,230.63
Rate for Payer: Cofinity Commercial	$1,076.80
Rate for Payer: Cofinity Commercial	$1,322.93
Rate for Payer: Healthscope Commercial	$1,384.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,307.55
Rate for Payer: PHP Commercial	$1,307.55
Rate for Payer: Priority Health Cigna Priority Health	$1,076.80
Rate for Payer: Priority Health SBD	$969.12

HC NEONATAL VENT SUB DAY

Facility

$1,173.97

Service Code	CPT 94003
Hospital Charge Code	41000038
Hospital Revenue Code	410
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$1,056.57
Rate for Payer: Aetna Commercial	$997.87
Rate for Payer: Aetna Medicare	$579.90
Rate for Payer: Aetna New Business (MI Preferred)	$763.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$697.00
Rate for Payer: Amish Plain Church Group Commercial	$697.00
Rate for Payer: BCBS Complete	$320.29
Rate for Payer: BCBS MAPPO	$557.60
Rate for Payer: BCBS Trust/PPO	$62.94
Rate for Payer: BCN Medicare Advantage	$557.60
Rate for Payer: Cash Price	$939.18
Rate for Payer: Cash Price	$939.18
Rate for Payer: Cofinity Commercial	$821.78
Rate for Payer: Cofinity Commercial	$1,009.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$557.60
Rate for Payer: Healthscope Commercial	$1,056.57
Rate for Payer: Mclaren Medicaid	$305.01
Rate for Payer: Mclaren Medicare	$557.60
Rate for Payer: Meridian Medicaid	$320.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$585.48
Rate for Payer: MI Amish Medical Board Commercial	$641.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$997.87
Rate for Payer: PACE Medicare	$529.72
Rate for Payer: PACE SWMI	$557.60
Rate for Payer: PHP Commercial	$997.87
Rate for Payer: PHP Medicare Advantage	$557.60
Rate for Payer: Priority Health Choice Medicaid	$305.01
Rate for Payer: Priority Health Cigna Priority Health	$821.78
Rate for Payer: Priority Health Medicare	$557.60
Rate for Payer: Priority Health SBD	$739.60
Rate for Payer: Railroad Medicare Medicare	$557.60
Rate for Payer: UHC All Payor (Choice/PPO)	$68.43
Rate for Payer: UHC Dual Complete DSNP	$557.60
Rate for Payer: UHC Exchange	$62.21
Rate for Payer: UHC Medicare Advantage	$574.33
Rate for Payer: VA VA	$557.60

HC NEONATAL VENT SUB DAY

Facility

$1,173.97

Service Code	CPT 94003
Hospital Charge Code	41000038
Hospital Revenue Code	410
Min. Negotiated Rate	$739.60
Max. Negotiated Rate	$1,056.57
Rate for Payer: Aetna Commercial	$997.87
Rate for Payer: Aetna New Business (MI Preferred)	$763.08
Rate for Payer: Cash Price	$939.18
Rate for Payer: Cofinity Commercial	$1,009.61
Rate for Payer: Cofinity Commercial	$821.78
Rate for Payer: Healthscope Commercial	$1,056.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$997.87
Rate for Payer: PHP Commercial	$997.87
Rate for Payer: Priority Health Cigna Priority Health	$821.78
Rate for Payer: Priority Health SBD	$739.60

HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS

Facility

$1,180.78

Service Code	CPT 50431
Hospital Charge Code	36100503
Hospital Revenue Code	361
Min. Negotiated Rate	$743.89
Max. Negotiated Rate	$1,062.70
Rate for Payer: Aetna Commercial	$1,003.66
Rate for Payer: Aetna New Business (MI Preferred)	$767.51
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cofinity Commercial	$1,015.47
Rate for Payer: Cofinity Commercial	$826.55
Rate for Payer: Healthscope Commercial	$1,062.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,003.66
Rate for Payer: PHP Commercial	$1,003.66
Rate for Payer: Priority Health Cigna Priority Health	$826.55
Rate for Payer: Priority Health SBD	$743.89

HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS

Facility

$1,180.78

Service Code	CPT 50431
Hospital Charge Code	36100503
Hospital Revenue Code	361
Min. Negotiated Rate	$63.85
Max. Negotiated Rate	$1,791.30
Rate for Payer: Aetna Commercial	$1,003.66
Rate for Payer: Aetna Medicare	$632.14
Rate for Payer: Aetna New Business (MI Preferred)	$767.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$759.79
Rate for Payer: Amish Plain Church Group Commercial	$759.79
Rate for Payer: BCBS Complete	$349.14
Rate for Payer: BCBS MAPPO	$607.83
Rate for Payer: BCBS Trust/PPO	$652.92
Rate for Payer: BCN Medicare Advantage	$607.83
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cofinity Commercial	$1,015.47
Rate for Payer: Cofinity Commercial	$826.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$607.83
Rate for Payer: Healthscope Commercial	$1,062.70
Rate for Payer: Mclaren Medicaid	$332.48
Rate for Payer: Mclaren Medicare	$607.83
Rate for Payer: Meridian Medicaid	$349.14
Rate for Payer: Meridian Wellcare - Medicare Advantage	$638.22
Rate for Payer: MI Amish Medical Board Commercial	$699.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,003.66
Rate for Payer: PACE Medicare	$577.44
Rate for Payer: PACE SWMI	$607.83
Rate for Payer: PHP Commercial	$1,003.66
Rate for Payer: PHP Medicare Advantage	$607.83
Rate for Payer: Priority Health Choice Medicaid	$332.48
Rate for Payer: Priority Health Cigna Priority Health	$826.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,791.30
Rate for Payer: Priority Health Medicare	$607.83
Rate for Payer: Priority Health Narrow Network	$1,433.04
Rate for Payer: Priority Health SBD	$743.89
Rate for Payer: Railroad Medicare Medicare	$607.83
Rate for Payer: UHC All Payor (Choice/PPO)	$70.24
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$607.83
Rate for Payer: UHC Exchange	$63.85
Rate for Payer: UHC Medicare Advantage	$626.06
Rate for Payer: VA VA	$607.83

HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS

Facility

$1,180.78

Service Code	CPT 50430
Hospital Charge Code	36100502
Hospital Revenue Code	361
Min. Negotiated Rate	$147.35
Max. Negotiated Rate	$1,791.30
Rate for Payer: Aetna Commercial	$1,003.66
Rate for Payer: Aetna Medicare	$632.14
Rate for Payer: Aetna New Business (MI Preferred)	$767.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$759.79
Rate for Payer: Amish Plain Church Group Commercial	$759.79
Rate for Payer: BCBS Complete	$349.14
Rate for Payer: BCBS MAPPO	$607.83
Rate for Payer: BCBS Trust/PPO	$477.73
Rate for Payer: BCN Medicare Advantage	$607.83
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cofinity Commercial	$826.55
Rate for Payer: Cofinity Commercial	$1,015.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$607.83
Rate for Payer: Healthscope Commercial	$1,062.70
Rate for Payer: Mclaren Medicaid	$332.48
Rate for Payer: Mclaren Medicare	$607.83
Rate for Payer: Meridian Medicaid	$349.14
Rate for Payer: Meridian Wellcare - Medicare Advantage	$638.22
Rate for Payer: MI Amish Medical Board Commercial	$699.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,003.66
Rate for Payer: PACE Medicare	$577.44
Rate for Payer: PACE SWMI	$607.83
Rate for Payer: PHP Commercial	$1,003.66
Rate for Payer: PHP Medicare Advantage	$607.83
Rate for Payer: Priority Health Choice Medicaid	$332.48
Rate for Payer: Priority Health Cigna Priority Health	$826.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,791.30
Rate for Payer: Priority Health Medicare	$607.83
Rate for Payer: Priority Health Narrow Network	$1,433.04
Rate for Payer: Priority Health SBD	$743.89
Rate for Payer: Railroad Medicare Medicare	$607.83
Rate for Payer: UHC All Payor (Choice/PPO)	$162.08
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$607.83
Rate for Payer: UHC Exchange	$147.35
Rate for Payer: UHC Medicare Advantage	$626.06
Rate for Payer: VA VA	$607.83

HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS

Facility

$1,180.78

Service Code	CPT 50430
Hospital Charge Code	36100502
Hospital Revenue Code	361
Min. Negotiated Rate	$743.89
Max. Negotiated Rate	$1,062.70
Rate for Payer: Aetna Commercial	$1,003.66
Rate for Payer: Aetna New Business (MI Preferred)	$767.51
Rate for Payer: Cash Price	$944.62
Rate for Payer: Cofinity Commercial	$1,015.47
Rate for Payer: Cofinity Commercial	$826.55
Rate for Payer: Healthscope Commercial	$1,062.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,003.66
Rate for Payer: PHP Commercial	$1,003.66
Rate for Payer: Priority Health Cigna Priority Health	$826.55
Rate for Payer: Priority Health SBD	$743.89

HC NERVE ROOT BLOCK INTERCOSTAL MULT REG

Facility

$1,462.17

Service Code	CPT 64421
Hospital Charge Code	36100404
Hospital Revenue Code	361
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$1,463.00
Rate for Payer: Aetna Commercial	$1,242.84
Rate for Payer: Aetna Medicare	$843.47
Rate for Payer: Aetna New Business (MI Preferred)	$950.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,013.79
Rate for Payer: Amish Plain Church Group Commercial	$1,013.79
Rate for Payer: BCBS Complete	$465.86
Rate for Payer: BCBS MAPPO	$811.03
Rate for Payer: BCBS Trust/PPO	$489.75
Rate for Payer: BCN Medicare Advantage	$811.03
Rate for Payer: Cash Price	$1,169.74
Rate for Payer: Cash Price	$1,169.74
Rate for Payer: Cofinity Commercial	$1,023.52
Rate for Payer: Cofinity Commercial	$1,257.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$811.03
Rate for Payer: Healthscope Commercial	$1,315.95
Rate for Payer: Mclaren Medicaid	$443.63
Rate for Payer: Mclaren Medicare	$811.03
Rate for Payer: Meridian Medicaid	$465.86
Rate for Payer: Meridian Wellcare - Medicare Advantage	$851.58
Rate for Payer: MI Amish Medical Board Commercial	$932.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,242.84
Rate for Payer: PACE Medicare	$770.48
Rate for Payer: PACE SWMI	$811.03
Rate for Payer: PHP Commercial	$1,242.84
Rate for Payer: PHP Medicare Advantage	$811.03
Rate for Payer: Priority Health Choice Medicaid	$443.63
Rate for Payer: Priority Health Cigna Priority Health	$1,023.52
Rate for Payer: Priority Health Medicare	$811.03
Rate for Payer: Priority Health SBD	$921.17
Rate for Payer: Railroad Medicare Medicare	$811.03
Rate for Payer: UHC All Payor (Choice/PPO)	$26.65
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$811.03
Rate for Payer: UHC Exchange	$24.23
Rate for Payer: UHC Medicare Advantage	$835.36
Rate for Payer: VA VA	$811.03

HC NERVE ROOT BLOCK INTERCOSTAL MULT REG

Facility

$1,462.17

Service Code	CPT 64421
Hospital Charge Code	36100404
Hospital Revenue Code	361
Min. Negotiated Rate	$921.17
Max. Negotiated Rate	$1,315.95
Rate for Payer: Aetna Commercial	$1,242.84
Rate for Payer: Aetna New Business (MI Preferred)	$950.41
Rate for Payer: Cash Price	$1,169.74
Rate for Payer: Cofinity Commercial	$1,023.52
Rate for Payer: Cofinity Commercial	$1,257.47
Rate for Payer: Healthscope Commercial	$1,315.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,242.84
Rate for Payer: PHP Commercial	$1,242.84
Rate for Payer: Priority Health Cigna Priority Health	$1,023.52
Rate for Payer: Priority Health SBD	$921.17

Know your out-of-pocket cost for care.

All Charges