Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$1,246.37
Max. Negotiated Rate	$1,780.53
Rate for Payer: Aetna Commercial	$1,681.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,285.94
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,384.86
Rate for Payer: Cofinity Commercial	$1,701.40
Rate for Payer: Cofinity Medicare Advantage	$1,384.86
Rate for Payer: Encore Health Key Benefits Commercial	$1,582.70
Rate for Payer: Healthscope Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,681.61
Rate for Payer: PHP Commercial	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,285.94
Rate for Payer: Priority Health SBD	$1,246.37

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$791.35
Max. Negotiated Rate	$1,780.53
Rate for Payer: Aetna Commercial	$1,681.61
Rate for Payer: Aetna Medicare	$989.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,285.94
Rate for Payer: BCBS Complete	$791.35
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,384.86
Rate for Payer: Cofinity Commercial	$1,701.40
Rate for Payer: Cofinity Medicare Advantage	$1,384.86
Rate for Payer: Encore Health Key Benefits Commercial	$1,582.70
Rate for Payer: Healthscope Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,681.61
Rate for Payer: PHP Commercial	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,285.94
Rate for Payer: Priority Health SBD	$1,246.37

HC GUIDING CATHETER LVL 2

Facility

$285.99

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$180.17
Max. Negotiated Rate	$257.39
Rate for Payer: Aetna Commercial	$243.09
Rate for Payer: Aetna New Business (MI Preferred)	$185.89
Rate for Payer: Cash Price	$228.79
Rate for Payer: Cofinity Commercial	$200.19
Rate for Payer: Cofinity Commercial	$245.95
Rate for Payer: Cofinity Medicare Advantage	$200.19
Rate for Payer: Encore Health Key Benefits Commercial	$228.79
Rate for Payer: Healthscope Commercial	$257.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.09
Rate for Payer: PHP Commercial	$243.09
Rate for Payer: Priority Health Cigna Priority Health	$185.89
Rate for Payer: Priority Health SBD	$180.17

HC GUIDING CATHETER LVL 2

Facility

$285.99

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$257.39
Rate for Payer: Aetna Commercial	$243.09
Rate for Payer: Aetna Medicare	$143.00
Rate for Payer: Aetna New Business (MI Preferred)	$185.89
Rate for Payer: BCBS Complete	$114.40
Rate for Payer: Cash Price	$228.79
Rate for Payer: Cofinity Commercial	$200.19
Rate for Payer: Cofinity Commercial	$245.95
Rate for Payer: Cofinity Medicare Advantage	$200.19
Rate for Payer: Encore Health Key Benefits Commercial	$228.79
Rate for Payer: Healthscope Commercial	$257.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.09
Rate for Payer: PHP Commercial	$243.09
Rate for Payer: Priority Health Cigna Priority Health	$185.89
Rate for Payer: Priority Health SBD	$180.17

HC GUIDING CATHETER LVL 24

Facility

$2,477.72

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$991.09
Max. Negotiated Rate	$2,229.95
Rate for Payer: Aetna Commercial	$2,106.06
Rate for Payer: Aetna Medicare	$1,238.86
Rate for Payer: Aetna New Business (MI Preferred)	$1,610.52
Rate for Payer: BCBS Complete	$991.09
Rate for Payer: Cash Price	$1,982.18
Rate for Payer: Cofinity Commercial	$1,734.40
Rate for Payer: Cofinity Commercial	$2,130.84
Rate for Payer: Cofinity Medicare Advantage	$1,734.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,982.18
Rate for Payer: Healthscope Commercial	$2,229.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,106.06
Rate for Payer: PHP Commercial	$2,106.06
Rate for Payer: Priority Health Cigna Priority Health	$1,610.52
Rate for Payer: Priority Health SBD	$1,560.96

HC GUIDING CATHETER LVL 24

Facility

$2,477.72

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$1,560.96
Max. Negotiated Rate	$2,229.95
Rate for Payer: Aetna Commercial	$2,106.06
Rate for Payer: Aetna New Business (MI Preferred)	$1,610.52
Rate for Payer: Cash Price	$1,982.18
Rate for Payer: Cofinity Commercial	$1,734.40
Rate for Payer: Cofinity Commercial	$2,130.84
Rate for Payer: Cofinity Medicare Advantage	$1,734.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,982.18
Rate for Payer: Healthscope Commercial	$2,229.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,106.06
Rate for Payer: PHP Commercial	$2,106.06
Rate for Payer: Priority Health Cigna Priority Health	$1,610.52
Rate for Payer: Priority Health SBD	$1,560.96

HC GUIDING CATHETER LVL 3

Facility

$337.50

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$303.75
Rate for Payer: Aetna Commercial	$286.88
Rate for Payer: Aetna Medicare	$168.75
Rate for Payer: Aetna New Business (MI Preferred)	$219.38
Rate for Payer: BCBS Complete	$135.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cofinity Commercial	$236.25
Rate for Payer: Cofinity Commercial	$290.25
Rate for Payer: Cofinity Medicare Advantage	$236.25
Rate for Payer: Encore Health Key Benefits Commercial	$270.00
Rate for Payer: Healthscope Commercial	$303.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.88
Rate for Payer: PHP Commercial	$286.88
Rate for Payer: Priority Health Cigna Priority Health	$219.38
Rate for Payer: Priority Health SBD	$212.62

HC GUIDING CATHETER LVL 3

Facility

$337.50

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$212.62
Max. Negotiated Rate	$303.75
Rate for Payer: Aetna Commercial	$286.88
Rate for Payer: Aetna New Business (MI Preferred)	$219.38
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cofinity Commercial	$236.25
Rate for Payer: Cofinity Commercial	$290.25
Rate for Payer: Cofinity Medicare Advantage	$236.25
Rate for Payer: Encore Health Key Benefits Commercial	$270.00
Rate for Payer: Healthscope Commercial	$303.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.88
Rate for Payer: PHP Commercial	$286.88
Rate for Payer: Priority Health Cigna Priority Health	$219.38
Rate for Payer: Priority Health SBD	$212.62

HC GUIDING CATHETER LVL 35

Facility

$3,592.55

Service Code	HCPCS C1887
Hospital Charge Code	27800061
Hospital Revenue Code	278
Min. Negotiated Rate	$1,437.02
Max. Negotiated Rate	$3,233.30
Rate for Payer: Aetna Commercial	$3,053.67
Rate for Payer: Aetna Medicare	$1,796.28
Rate for Payer: Aetna New Business (MI Preferred)	$2,335.16
Rate for Payer: BCBS Complete	$1,437.02
Rate for Payer: Cash Price	$2,874.04
Rate for Payer: Cofinity Commercial	$2,514.78
Rate for Payer: Cofinity Commercial	$3,089.59
Rate for Payer: Cofinity Medicare Advantage	$2,514.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,874.04
Rate for Payer: Healthscope Commercial	$3,233.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,053.67
Rate for Payer: PHP Commercial	$3,053.67
Rate for Payer: Priority Health Cigna Priority Health	$2,335.16
Rate for Payer: Priority Health SBD	$2,263.31

HC GUIDING CATHETER LVL 35

Facility

$3,592.55

Service Code	HCPCS C1887
Hospital Charge Code	27800061
Hospital Revenue Code	278
Min. Negotiated Rate	$2,263.31
Max. Negotiated Rate	$3,233.30
Rate for Payer: Aetna Commercial	$3,053.67
Rate for Payer: Aetna New Business (MI Preferred)	$2,335.16
Rate for Payer: Cash Price	$2,874.04
Rate for Payer: Cofinity Commercial	$2,514.78
Rate for Payer: Cofinity Commercial	$3,089.59
Rate for Payer: Cofinity Medicare Advantage	$2,514.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,874.04
Rate for Payer: Healthscope Commercial	$3,233.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,053.67
Rate for Payer: PHP Commercial	$3,053.67
Rate for Payer: Priority Health Cigna Priority Health	$2,335.16
Rate for Payer: Priority Health SBD	$2,263.31

HC GUIDING CATHETER LVL 4

Facility

$490.52

Service Code	HCPCS C1887
Hospital Charge Code	27200272
Hospital Revenue Code	272
Min. Negotiated Rate	$196.21
Max. Negotiated Rate	$441.47
Rate for Payer: Aetna Commercial	$416.94
Rate for Payer: Aetna Medicare	$245.26
Rate for Payer: Aetna New Business (MI Preferred)	$318.84
Rate for Payer: BCBS Complete	$196.21
Rate for Payer: Cash Price	$392.42
Rate for Payer: Cofinity Commercial	$343.36
Rate for Payer: Cofinity Commercial	$421.85
Rate for Payer: Cofinity Medicare Advantage	$343.36
Rate for Payer: Encore Health Key Benefits Commercial	$392.42
Rate for Payer: Healthscope Commercial	$441.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$416.94
Rate for Payer: PHP Commercial	$416.94
Rate for Payer: Priority Health Cigna Priority Health	$318.84
Rate for Payer: Priority Health SBD	$309.03

HC GUIDING CATHETER LVL 4

Facility

$490.52

Service Code	HCPCS C1887
Hospital Charge Code	27200272
Hospital Revenue Code	272
Min. Negotiated Rate	$309.03
Max. Negotiated Rate	$441.47
Rate for Payer: Aetna Commercial	$416.94
Rate for Payer: Aetna New Business (MI Preferred)	$318.84
Rate for Payer: Cash Price	$392.42
Rate for Payer: Cofinity Commercial	$343.36
Rate for Payer: Cofinity Commercial	$421.85
Rate for Payer: Cofinity Medicare Advantage	$343.36
Rate for Payer: Encore Health Key Benefits Commercial	$392.42
Rate for Payer: Healthscope Commercial	$441.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$416.94
Rate for Payer: PHP Commercial	$416.94
Rate for Payer: Priority Health Cigna Priority Health	$318.84
Rate for Payer: Priority Health SBD	$309.03

HC GUIDING CATHETER LVL 42

Facility

$4,295.53

Hospital Charge Code	27200130
Hospital Revenue Code	272
Min. Negotiated Rate	$1,718.21
Max. Negotiated Rate	$3,865.98
Rate for Payer: Aetna Commercial	$3,651.20
Rate for Payer: Aetna Medicare	$2,147.76
Rate for Payer: Aetna New Business (MI Preferred)	$2,792.09
Rate for Payer: BCBS Complete	$1,718.21
Rate for Payer: Cash Price	$3,436.42
Rate for Payer: Cofinity Commercial	$3,006.87
Rate for Payer: Cofinity Commercial	$3,694.16
Rate for Payer: Cofinity Medicare Advantage	$3,006.87
Rate for Payer: Encore Health Key Benefits Commercial	$3,436.42
Rate for Payer: Healthscope Commercial	$3,865.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,651.20
Rate for Payer: PHP Commercial	$3,651.20
Rate for Payer: Priority Health Cigna Priority Health	$2,792.09
Rate for Payer: Priority Health SBD	$2,706.18

HC GUIDING CATHETER LVL 42

Facility

$4,295.53

Hospital Charge Code	27200130
Hospital Revenue Code	272
Min. Negotiated Rate	$2,706.18
Max. Negotiated Rate	$3,865.98
Rate for Payer: Aetna Commercial	$3,651.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,792.09
Rate for Payer: Cash Price	$3,436.42
Rate for Payer: Cofinity Commercial	$3,006.87
Rate for Payer: Cofinity Commercial	$3,694.16
Rate for Payer: Cofinity Medicare Advantage	$3,006.87
Rate for Payer: Encore Health Key Benefits Commercial	$3,436.42
Rate for Payer: Healthscope Commercial	$3,865.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,651.20
Rate for Payer: PHP Commercial	$3,651.20
Rate for Payer: Priority Health Cigna Priority Health	$2,792.09
Rate for Payer: Priority Health SBD	$2,706.18

HC GUIDING CATHETER LVL 57

Facility

$5,712.15

Service Code	HCPCS C1887
Hospital Charge Code	27200095
Hospital Revenue Code	272
Min. Negotiated Rate	$2,284.86
Max. Negotiated Rate	$5,140.94
Rate for Payer: Aetna Commercial	$4,855.33
Rate for Payer: Aetna Medicare	$2,856.07
Rate for Payer: Aetna New Business (MI Preferred)	$3,712.90
Rate for Payer: BCBS Complete	$2,284.86
Rate for Payer: Cash Price	$4,569.72
Rate for Payer: Cofinity Commercial	$3,998.51
Rate for Payer: Cofinity Commercial	$4,912.45
Rate for Payer: Cofinity Medicare Advantage	$3,998.51
Rate for Payer: Encore Health Key Benefits Commercial	$4,569.72
Rate for Payer: Healthscope Commercial	$5,140.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,855.33
Rate for Payer: PHP Commercial	$4,855.33
Rate for Payer: Priority Health Cigna Priority Health	$3,712.90
Rate for Payer: Priority Health SBD	$3,598.65

HC GUIDING CATHETER LVL 57

Facility

$5,712.15

Service Code	HCPCS C1887
Hospital Charge Code	27200095
Hospital Revenue Code	272
Min. Negotiated Rate	$3,598.65
Max. Negotiated Rate	$5,140.94
Rate for Payer: Aetna Commercial	$4,855.33
Rate for Payer: Aetna New Business (MI Preferred)	$3,712.90
Rate for Payer: Cash Price	$4,569.72
Rate for Payer: Cofinity Commercial	$3,998.51
Rate for Payer: Cofinity Commercial	$4,912.45
Rate for Payer: Cofinity Medicare Advantage	$3,998.51
Rate for Payer: Encore Health Key Benefits Commercial	$4,569.72
Rate for Payer: Healthscope Commercial	$5,140.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,855.33
Rate for Payer: PHP Commercial	$4,855.33
Rate for Payer: Priority Health Cigna Priority Health	$3,712.90
Rate for Payer: Priority Health SBD	$3,598.65

HC GUIDING CATHETER LVL 6

Facility

$662.80

Service Code	HCPCS C1887
Hospital Charge Code	27800151
Hospital Revenue Code	278
Min. Negotiated Rate	$265.12
Max. Negotiated Rate	$596.52
Rate for Payer: Aetna Commercial	$563.38
Rate for Payer: Aetna Medicare	$331.40
Rate for Payer: Aetna New Business (MI Preferred)	$430.82
Rate for Payer: BCBS Complete	$265.12
Rate for Payer: Cash Price	$530.24
Rate for Payer: Cofinity Commercial	$463.96
Rate for Payer: Cofinity Commercial	$570.01
Rate for Payer: Cofinity Medicare Advantage	$463.96
Rate for Payer: Encore Health Key Benefits Commercial	$530.24
Rate for Payer: Healthscope Commercial	$596.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$563.38
Rate for Payer: PHP Commercial	$563.38
Rate for Payer: Priority Health Cigna Priority Health	$430.82
Rate for Payer: Priority Health SBD	$417.56

HC GUIDING CATHETER LVL 6

Facility

$662.80

Service Code	HCPCS C1887
Hospital Charge Code	27800151
Hospital Revenue Code	278
Min. Negotiated Rate	$417.56
Max. Negotiated Rate	$596.52
Rate for Payer: Aetna Commercial	$563.38
Rate for Payer: Aetna New Business (MI Preferred)	$430.82
Rate for Payer: Cash Price	$530.24
Rate for Payer: Cofinity Commercial	$463.96
Rate for Payer: Cofinity Commercial	$570.01
Rate for Payer: Cofinity Medicare Advantage	$463.96
Rate for Payer: Encore Health Key Benefits Commercial	$530.24
Rate for Payer: Healthscope Commercial	$596.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$563.38
Rate for Payer: PHP Commercial	$563.38
Rate for Payer: Priority Health Cigna Priority Health	$430.82
Rate for Payer: Priority Health SBD	$417.56

HC HAEMOPHILUS INFLUENZAE

Facility

$52.02

Service Code	CPT 87798
Hospital Charge Code	30600269
Hospital Revenue Code	306
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$98.77
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
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	$19.75
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Mclaren Medicaid	$18.81
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.84
Rate for Payer: Meridian Medicaid	$19.75
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$18.81
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$32.77
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$98.77
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Medicare Advantage	$35.09
Rate for Payer: UHCCP Medicaid	$19.76
Rate for Payer: VA VA	$35.09

HC HAEMOPHILUS INFLUENZAE

Facility

$52.02

Service Code	CPT 87798
Hospital Charge Code	30600269
Hospital Revenue Code	306
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM

Facility

$33.29

Service Code	CPT 90648
Hospital Charge Code	63600069
Hospital Revenue Code	636
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$29.96
Rate for Payer: Aetna Commercial	$28.30
Rate for Payer: Aetna Medicare	$16.64
Rate for Payer: Aetna New Business (MI Preferred)	$21.64
Rate for Payer: BCBS Complete	$13.32
Rate for Payer: Cash Price	$26.63
Rate for Payer: Cofinity Commercial	$23.30
Rate for Payer: Cofinity Commercial	$28.63
Rate for Payer: Cofinity Medicare Advantage	$23.30
Rate for Payer: Encore Health Key Benefits Commercial	$26.63
Rate for Payer: Healthscope Commercial	$29.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.30
Rate for Payer: PHP Commercial	$28.30
Rate for Payer: Priority Health Cigna Priority Health	$21.64
Rate for Payer: Priority Health SBD	$20.97

HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM

Facility

$33.29

Service Code	CPT 90648
Hospital Charge Code	63600069
Hospital Revenue Code	636
Min. Negotiated Rate	$20.97
Max. Negotiated Rate	$29.96
Rate for Payer: Aetna Commercial	$28.30
Rate for Payer: Aetna New Business (MI Preferred)	$21.64
Rate for Payer: Cash Price	$26.63
Rate for Payer: Cofinity Commercial	$23.30
Rate for Payer: Cofinity Commercial	$28.63
Rate for Payer: Cofinity Medicare Advantage	$23.30
Rate for Payer: Encore Health Key Benefits Commercial	$26.63
Rate for Payer: Healthscope Commercial	$29.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.30
Rate for Payer: PHP Commercial	$28.30
Rate for Payer: Priority Health Cigna Priority Health	$21.64
Rate for Payer: Priority Health SBD	$20.97

HC HAI ESTABLISHED PATIENT LEVEL I

Facility

$148.19

Service Code	CPT 99211
Hospital Charge Code	51000014
Hospital Revenue Code	510
Min. Negotiated Rate	$93.36
Max. Negotiated Rate	$133.37
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna New Business (MI Preferred)	$96.32
Rate for Payer: Cash Price	$118.55
Rate for Payer: Cofinity Commercial	$103.73
Rate for Payer: Cofinity Commercial	$127.44
Rate for Payer: Cofinity Medicare Advantage	$103.73
Rate for Payer: Encore Health Key Benefits Commercial	$118.55
Rate for Payer: Healthscope Commercial	$133.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.96
Rate for Payer: PHP Commercial	$125.96
Rate for Payer: Priority Health Cigna Priority Health	$96.32
Rate for Payer: Priority Health SBD	$93.36

HC HAI ESTABLISHED PATIENT LEVEL I

Facility

$148.19

Service Code	CPT 99211
Hospital Charge Code	51000014
Hospital Revenue Code	510
Min. Negotiated Rate	$59.28
Max. Negotiated Rate	$133.37
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna Medicare	$74.09
Rate for Payer: Aetna New Business (MI Preferred)	$96.32
Rate for Payer: BCBS Complete	$59.28
Rate for Payer: Cash Price	$118.55
Rate for Payer: Cofinity Commercial	$103.73
Rate for Payer: Cofinity Commercial	$127.44
Rate for Payer: Cofinity Medicare Advantage	$103.73
Rate for Payer: Encore Health Key Benefits Commercial	$118.55
Rate for Payer: Healthscope Commercial	$133.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.96
Rate for Payer: PHP Commercial	$125.96
Rate for Payer: Priority Health Cigna Priority Health	$96.32
Rate for Payer: Priority Health SBD	$93.36

HC HAI PICC FLUSH

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000060
Hospital Revenue Code	761
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna Medicare	$67.36
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: BCBS Complete	$53.88
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Cofinity Medicare Advantage	$94.30
Rate for Payer: Encore Health Key Benefits Commercial	$107.77
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$87.56
Rate for Payer: Priority Health SBD	$84.87

Know your out-of-pocket cost for care.

All Charges