Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PACEMAKER DUAL CHAMBER LVL 7

Facility

$7,952.00

Service Code	HCPCS C1785
Hospital Charge Code	27500354
Hospital Revenue Code	275
Min. Negotiated Rate	$5,009.76
Max. Negotiated Rate	$7,156.80
Rate for Payer: Aetna Commercial	$6,759.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,168.80
Rate for Payer: Cash Price	$6,361.60
Rate for Payer: Cofinity Commercial	$5,566.40
Rate for Payer: Cofinity Commercial	$6,838.72
Rate for Payer: Healthscope Commercial	$7,156.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,759.20
Rate for Payer: PHP Commercial	$6,759.20
Rate for Payer: Priority Health Cigna Priority Health	$5,566.40
Rate for Payer: Priority Health SBD	$5,009.76

HC PACEMAKER DUAL CHAMBER LVL 7

Facility

$7,952.00

Service Code	HCPCS C1785
Hospital Charge Code	27500354
Hospital Revenue Code	275
Min. Negotiated Rate	$3,180.80
Max. Negotiated Rate	$7,156.80
Rate for Payer: Aetna Commercial	$6,759.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,168.80
Rate for Payer: BCBS Complete	$3,180.80
Rate for Payer: Cash Price	$6,361.60
Rate for Payer: Cofinity Commercial	$5,566.40
Rate for Payer: Cofinity Commercial	$6,838.72
Rate for Payer: Healthscope Commercial	$7,156.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,759.20
Rate for Payer: PHP Commercial	$6,759.20
Rate for Payer: Priority Health Cigna Priority Health	$5,566.40
Rate for Payer: Priority Health SBD	$5,009.76

HC PACEMAKER DUAL CHAMBER LVL 9

Facility

$9,052.00

Service Code	HCPCS C1785
Hospital Charge Code	27500349
Hospital Revenue Code	275
Min. Negotiated Rate	$5,702.76
Max. Negotiated Rate	$8,146.80
Rate for Payer: Aetna Commercial	$7,694.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,883.80
Rate for Payer: Cash Price	$7,241.60
Rate for Payer: Cofinity Commercial	$6,336.40
Rate for Payer: Cofinity Commercial	$7,784.72
Rate for Payer: Healthscope Commercial	$8,146.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,694.20
Rate for Payer: PHP Commercial	$7,694.20
Rate for Payer: Priority Health Cigna Priority Health	$6,336.40
Rate for Payer: Priority Health SBD	$5,702.76

HC PACEMAKER DUAL CHAMBER LVL 9

Facility

$9,052.00

Service Code	HCPCS C1785
Hospital Charge Code	27500349
Hospital Revenue Code	275
Min. Negotiated Rate	$3,620.80
Max. Negotiated Rate	$8,146.80
Rate for Payer: Aetna Commercial	$7,694.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,883.80
Rate for Payer: BCBS Complete	$3,620.80
Rate for Payer: Cash Price	$7,241.60
Rate for Payer: Cofinity Commercial	$6,336.40
Rate for Payer: Cofinity Commercial	$7,784.72
Rate for Payer: Healthscope Commercial	$8,146.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,694.20
Rate for Payer: PHP Commercial	$7,694.20
Rate for Payer: Priority Health Cigna Priority Health	$6,336.40
Rate for Payer: Priority Health SBD	$5,702.76

HC PACEMAKER IMPLANT, DUAL

Facility

$17,588.23

Service Code	CPT 33208
Hospital Charge Code	36100059
Hospital Revenue Code	361
Min. Negotiated Rate	$11,080.58
Max. Negotiated Rate	$15,829.41
Rate for Payer: Aetna Commercial	$14,950.00
Rate for Payer: Aetna New Business (MI Preferred)	$11,432.35
Rate for Payer: Cash Price	$14,070.58
Rate for Payer: Cofinity Commercial	$12,311.76
Rate for Payer: Cofinity Commercial	$15,125.88
Rate for Payer: Healthscope Commercial	$15,829.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14,950.00
Rate for Payer: PHP Commercial	$14,950.00
Rate for Payer: Priority Health Cigna Priority Health	$12,311.76
Rate for Payer: Priority Health SBD	$11,080.58

HC PACEMAKER IMPLANT, DUAL

Facility

$17,588.23

Service Code	CPT 33208
Hospital Charge Code	36100059
Hospital Revenue Code	361
Min. Negotiated Rate	$499.35
Max. Negotiated Rate	$32,375.08
Rate for Payer: Aetna Commercial	$14,950.00
Rate for Payer: Aetna Medicare	$9,881.50
Rate for Payer: Aetna New Business (MI Preferred)	$11,432.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,876.80
Rate for Payer: Amish Plain Church Group Commercial	$11,876.80
Rate for Payer: BCBS Complete	$5,457.63
Rate for Payer: BCBS MAPPO	$9,501.44
Rate for Payer: BCBS Trust/PPO	$7,647.90
Rate for Payer: BCN Medicare Advantage	$9,501.44
Rate for Payer: Cash Price	$14,070.58
Rate for Payer: Cash Price	$14,070.58
Rate for Payer: Cofinity Commercial	$12,311.76
Rate for Payer: Cofinity Commercial	$15,125.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,501.44
Rate for Payer: Healthscope Commercial	$15,829.41
Rate for Payer: Mclaren Medicaid	$5,197.29
Rate for Payer: Mclaren Medicare	$9,501.44
Rate for Payer: Meridian Medicaid	$5,457.63
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,976.51
Rate for Payer: MI Amish Medical Board Commercial	$10,926.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14,950.00
Rate for Payer: PACE Medicare	$9,026.37
Rate for Payer: PACE SWMI	$9,501.44
Rate for Payer: PHP Commercial	$14,950.00
Rate for Payer: PHP Medicare Advantage	$9,501.44
Rate for Payer: Priority Health Choice Medicaid	$5,197.29
Rate for Payer: Priority Health Cigna Priority Health	$12,311.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32,375.08
Rate for Payer: Priority Health Medicare	$9,501.44
Rate for Payer: Priority Health Narrow Network	$25,900.06
Rate for Payer: Priority Health SBD	$11,080.58
Rate for Payer: Railroad Medicare Medicare	$9,501.44
Rate for Payer: UHC All Payor (Choice/PPO)	$549.28
Rate for Payer: UHC Core	$10,600.00
Rate for Payer: UHC Dual Complete DSNP	$9,501.44
Rate for Payer: UHC Exchange	$499.35
Rate for Payer: UHC Medicare Advantage	$9,786.48
Rate for Payer: VA VA	$9,501.44

HC PACEMAKER LEAD

Facility

$1,911.00

Service Code	HCPCS C1898
Hospital Charge Code	27800024
Hospital Revenue Code	278
Min. Negotiated Rate	$764.40
Max. Negotiated Rate	$1,719.90
Rate for Payer: Aetna Commercial	$1,624.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,242.15
Rate for Payer: BCBS Complete	$764.40
Rate for Payer: Cash Price	$1,528.80
Rate for Payer: Cofinity Commercial	$1,337.70
Rate for Payer: Cofinity Commercial	$1,643.46
Rate for Payer: Healthscope Commercial	$1,719.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,624.35
Rate for Payer: PHP Commercial	$1,624.35
Rate for Payer: Priority Health Cigna Priority Health	$1,337.70
Rate for Payer: Priority Health SBD	$1,203.93

HC PACEMAKER LEAD

Facility

$1,911.00

Service Code	HCPCS C1898
Hospital Charge Code	27800024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.93
Max. Negotiated Rate	$1,719.90
Rate for Payer: Aetna Commercial	$1,624.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,242.15
Rate for Payer: Cash Price	$1,528.80
Rate for Payer: Cofinity Commercial	$1,337.70
Rate for Payer: Cofinity Commercial	$1,643.46
Rate for Payer: Healthscope Commercial	$1,719.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,624.35
Rate for Payer: PHP Commercial	$1,624.35
Rate for Payer: Priority Health Cigna Priority Health	$1,337.70
Rate for Payer: Priority Health SBD	$1,203.93

HC PACEMAKER OTHER SINGLE OR DUAL LVL 11

Facility

$11,889.00

Service Code	HCPCS C2621
Hospital Charge Code	27500348
Hospital Revenue Code	275
Min. Negotiated Rate	$7,490.07
Max. Negotiated Rate	$10,700.10
Rate for Payer: Aetna Commercial	$10,105.65
Rate for Payer: Aetna New Business (MI Preferred)	$7,727.85
Rate for Payer: Cash Price	$9,511.20
Rate for Payer: Cofinity Commercial	$10,224.54
Rate for Payer: Cofinity Commercial	$8,322.30
Rate for Payer: Healthscope Commercial	$10,700.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10,105.65
Rate for Payer: PHP Commercial	$10,105.65
Rate for Payer: Priority Health Cigna Priority Health	$8,322.30
Rate for Payer: Priority Health SBD	$7,490.07

HC PACEMAKER OTHER SINGLE OR DUAL LVL 11

Facility

$11,889.00

Service Code	HCPCS C2621
Hospital Charge Code	27500348
Hospital Revenue Code	275
Min. Negotiated Rate	$4,755.60
Max. Negotiated Rate	$10,700.10
Rate for Payer: Aetna Commercial	$10,105.65
Rate for Payer: Aetna New Business (MI Preferred)	$7,727.85
Rate for Payer: BCBS Complete	$4,755.60
Rate for Payer: Cash Price	$9,511.20
Rate for Payer: Cofinity Commercial	$10,224.54
Rate for Payer: Cofinity Commercial	$8,322.30
Rate for Payer: Healthscope Commercial	$10,700.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10,105.65
Rate for Payer: PHP Commercial	$10,105.65
Rate for Payer: Priority Health Cigna Priority Health	$8,322.30
Rate for Payer: Priority Health SBD	$7,490.07

HC PACEMAKER SINGLE CHAMBER LVL 13

Facility

$13,500.00

Service Code	HCPCS C1786
Hospital Charge Code	27500351
Hospital Revenue Code	275
Min. Negotiated Rate	$5,400.00
Max. Negotiated Rate	$12,150.00
Rate for Payer: Aetna Commercial	$11,475.00
Rate for Payer: Aetna New Business (MI Preferred)	$8,775.00
Rate for Payer: BCBS Complete	$5,400.00
Rate for Payer: Cash Price	$10,800.00
Rate for Payer: Cofinity Commercial	$11,610.00
Rate for Payer: Cofinity Commercial	$9,450.00
Rate for Payer: Healthscope Commercial	$12,150.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,475.00
Rate for Payer: PHP Commercial	$11,475.00
Rate for Payer: Priority Health Cigna Priority Health	$9,450.00
Rate for Payer: Priority Health SBD	$8,505.00

HC PACEMAKER SINGLE CHAMBER LVL 13

Facility

$13,500.00

Service Code	HCPCS C1786
Hospital Charge Code	27500351
Hospital Revenue Code	275
Min. Negotiated Rate	$8,505.00
Max. Negotiated Rate	$12,150.00
Rate for Payer: Aetna Commercial	$11,475.00
Rate for Payer: Aetna New Business (MI Preferred)	$8,775.00
Rate for Payer: Cash Price	$10,800.00
Rate for Payer: Cofinity Commercial	$11,610.00
Rate for Payer: Cofinity Commercial	$9,450.00
Rate for Payer: Healthscope Commercial	$12,150.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,475.00
Rate for Payer: PHP Commercial	$11,475.00
Rate for Payer: Priority Health Cigna Priority Health	$9,450.00
Rate for Payer: Priority Health SBD	$8,505.00

HC PACEMAKER SINGLE CHAMBER LVL 16

Facility

$16,532.50

Service Code	HCPCS C1786
Hospital Charge Code	27500350
Hospital Revenue Code	275
Min. Negotiated Rate	$6,613.00
Max. Negotiated Rate	$14,879.25
Rate for Payer: Aetna Commercial	$14,052.62
Rate for Payer: Aetna New Business (MI Preferred)	$10,746.12
Rate for Payer: BCBS Complete	$6,613.00
Rate for Payer: Cash Price	$13,226.00
Rate for Payer: Cofinity Commercial	$11,572.75
Rate for Payer: Cofinity Commercial	$14,217.95
Rate for Payer: Healthscope Commercial	$14,879.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14,052.62
Rate for Payer: PHP Commercial	$14,052.62
Rate for Payer: Priority Health Cigna Priority Health	$11,572.75
Rate for Payer: Priority Health SBD	$10,415.48

HC PACEMAKER SINGLE CHAMBER LVL 16

Facility

$16,532.50

Service Code	HCPCS C1786
Hospital Charge Code	27500350
Hospital Revenue Code	275
Min. Negotiated Rate	$10,415.48
Max. Negotiated Rate	$14,879.25
Rate for Payer: Aetna Commercial	$14,052.62
Rate for Payer: Aetna New Business (MI Preferred)	$10,746.12
Rate for Payer: Cash Price	$13,226.00
Rate for Payer: Cofinity Commercial	$11,572.75
Rate for Payer: Cofinity Commercial	$14,217.95
Rate for Payer: Healthscope Commercial	$14,879.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14,052.62
Rate for Payer: PHP Commercial	$14,052.62
Rate for Payer: Priority Health Cigna Priority Health	$11,572.75
Rate for Payer: Priority Health SBD	$10,415.48

HC PACEMAKER SINGLE CHAMBER LVL 6

Facility

$6,196.00

Service Code	HCPCS C1786
Hospital Charge Code	27500352
Hospital Revenue Code	275
Min. Negotiated Rate	$2,478.40
Max. Negotiated Rate	$5,576.40
Rate for Payer: Aetna Commercial	$5,266.60
Rate for Payer: Aetna New Business (MI Preferred)	$4,027.40
Rate for Payer: BCBS Complete	$2,478.40
Rate for Payer: Cash Price	$4,956.80
Rate for Payer: Cofinity Commercial	$4,337.20
Rate for Payer: Cofinity Commercial	$5,328.56
Rate for Payer: Healthscope Commercial	$5,576.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,266.60
Rate for Payer: PHP Commercial	$5,266.60
Rate for Payer: Priority Health Cigna Priority Health	$4,337.20
Rate for Payer: Priority Health SBD	$3,903.48

HC PACEMAKER SINGLE CHAMBER LVL 6

Facility

$6,196.00

Service Code	HCPCS C1786
Hospital Charge Code	27500352
Hospital Revenue Code	275
Min. Negotiated Rate	$3,903.48
Max. Negotiated Rate	$5,576.40
Rate for Payer: Aetna Commercial	$5,266.60
Rate for Payer: Aetna New Business (MI Preferred)	$4,027.40
Rate for Payer: Cash Price	$4,956.80
Rate for Payer: Cofinity Commercial	$4,337.20
Rate for Payer: Cofinity Commercial	$5,328.56
Rate for Payer: Healthscope Commercial	$5,576.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,266.60
Rate for Payer: PHP Commercial	$5,266.60
Rate for Payer: Priority Health Cigna Priority Health	$4,337.20
Rate for Payer: Priority Health SBD	$3,903.48

HC PACEMAKER SINGLE CHAMBER LVL 8

Facility

$8,152.00

Service Code	HCPCS C1786
Hospital Charge Code	27500353
Hospital Revenue Code	275
Min. Negotiated Rate	$3,260.80
Max. Negotiated Rate	$7,336.80
Rate for Payer: Aetna Commercial	$6,929.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,298.80
Rate for Payer: BCBS Complete	$3,260.80
Rate for Payer: Cash Price	$6,521.60
Rate for Payer: Cofinity Commercial	$5,706.40
Rate for Payer: Cofinity Commercial	$7,010.72
Rate for Payer: Healthscope Commercial	$7,336.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,929.20
Rate for Payer: PHP Commercial	$6,929.20
Rate for Payer: Priority Health Cigna Priority Health	$5,706.40
Rate for Payer: Priority Health SBD	$5,135.76

HC PACEMAKER SINGLE CHAMBER LVL 8

Facility

$8,152.00

Service Code	HCPCS C1786
Hospital Charge Code	27500353
Hospital Revenue Code	275
Min. Negotiated Rate	$5,135.76
Max. Negotiated Rate	$7,336.80
Rate for Payer: Aetna Commercial	$6,929.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,298.80
Rate for Payer: Cash Price	$6,521.60
Rate for Payer: Cofinity Commercial	$5,706.40
Rate for Payer: Cofinity Commercial	$7,010.72
Rate for Payer: Healthscope Commercial	$7,336.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,929.20
Rate for Payer: PHP Commercial	$6,929.20
Rate for Payer: Priority Health Cigna Priority Health	$5,706.40
Rate for Payer: Priority Health SBD	$5,135.76

HC PACEMAKER TESTING CABLE

Facility

$112.44

Hospital Charge Code	27200143
Hospital Revenue Code	272
Min. Negotiated Rate	$70.84
Max. Negotiated Rate	$101.20
Rate for Payer: Aetna Commercial	$95.57
Rate for Payer: Aetna New Business (MI Preferred)	$73.09
Rate for Payer: Cash Price	$89.95
Rate for Payer: Cofinity Commercial	$78.71
Rate for Payer: Cofinity Commercial	$96.70
Rate for Payer: Healthscope Commercial	$101.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.57
Rate for Payer: PHP Commercial	$95.57
Rate for Payer: Priority Health Cigna Priority Health	$78.71
Rate for Payer: Priority Health SBD	$70.84

HC PACEMAKER TESTING CABLE

Facility

$112.44

Hospital Charge Code	27200143
Hospital Revenue Code	272
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$101.20
Rate for Payer: Aetna Commercial	$95.57
Rate for Payer: Aetna New Business (MI Preferred)	$73.09
Rate for Payer: BCBS Complete	$44.98
Rate for Payer: Cash Price	$89.95
Rate for Payer: Cofinity Commercial	$78.71
Rate for Payer: Cofinity Commercial	$96.70
Rate for Payer: Healthscope Commercial	$101.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.57
Rate for Payer: PHP Commercial	$95.57
Rate for Payer: Priority Health Cigna Priority Health	$78.71
Rate for Payer: Priority Health SBD	$70.84

HC PACER POCKET REVISION

Facility

$2,701.70

Service Code	CPT 33222
Hospital Charge Code	36100067
Hospital Revenue Code	361
Min. Negotiated Rate	$333.34
Max. Negotiated Rate	$5,332.95
Rate for Payer: Aetna Commercial	$2,296.44
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,756.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$781.37
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Cash Price	$2,161.36
Rate for Payer: Cash Price	$2,161.36
Rate for Payer: Cofinity Commercial	$2,323.46
Rate for Payer: Cofinity Commercial	$1,891.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Healthscope Commercial	$2,431.53
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,296.44
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Commercial	$2,296.44
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health Cigna Priority Health	$1,891.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,332.95
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,266.36
Rate for Payer: Priority Health SBD	$1,702.07
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$366.67
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$333.34
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

HC PACER POCKET REVISION

Facility

$2,701.70

Service Code	CPT 33222
Hospital Charge Code	36100067
Hospital Revenue Code	361
Min. Negotiated Rate	$1,702.07
Max. Negotiated Rate	$2,431.53
Rate for Payer: Aetna Commercial	$2,296.44
Rate for Payer: Aetna New Business (MI Preferred)	$1,756.10
Rate for Payer: Cash Price	$2,161.36
Rate for Payer: Cofinity Commercial	$1,891.19
Rate for Payer: Cofinity Commercial	$2,323.46
Rate for Payer: Healthscope Commercial	$2,431.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,296.44
Rate for Payer: PHP Commercial	$2,296.44
Rate for Payer: Priority Health Cigna Priority Health	$1,891.19
Rate for Payer: Priority Health SBD	$1,702.07

HC PACK CCS BRONSON FX XC BASE

Facility

$750.00

Hospital Charge Code	27000682
Hospital Revenue Code	270
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna New Business (MI Preferred)	$487.50
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cofinity Commercial	$525.00
Rate for Payer: Cofinity Commercial	$645.00
Rate for Payer: Healthscope Commercial	$675.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$637.50
Rate for Payer: PHP Commercial	$637.50
Rate for Payer: Priority Health Cigna Priority Health	$525.00
Rate for Payer: Priority Health SBD	$472.50

HC PACK CCS BRONSON FX XC BASE

Facility

$750.00

Hospital Charge Code	27000682
Hospital Revenue Code	270
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna New Business (MI Preferred)	$487.50
Rate for Payer: BCBS Complete	$300.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cofinity Commercial	$525.00
Rate for Payer: Cofinity Commercial	$645.00
Rate for Payer: Healthscope Commercial	$675.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$637.50
Rate for Payer: PHP Commercial	$637.50
Rate for Payer: Priority Health Cigna Priority Health	$525.00
Rate for Payer: Priority Health SBD	$472.50

HC PACKED CELLS DIRECT

Facility

$809.10

Service Code	HCPCS P9016
Hospital Charge Code	39000058
Hospital Revenue Code	390
Min. Negotiated Rate	$509.73
Max. Negotiated Rate	$728.19
Rate for Payer: Aetna Commercial	$687.74
Rate for Payer: Aetna New Business (MI Preferred)	$525.92
Rate for Payer: Cash Price	$647.28
Rate for Payer: Cofinity Commercial	$566.37
Rate for Payer: Cofinity Commercial	$695.83
Rate for Payer: Healthscope Commercial	$728.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$687.74
Rate for Payer: PHP Commercial	$687.74
Rate for Payer: Priority Health Cigna Priority Health	$566.37
Rate for Payer: Priority Health SBD	$509.73

Know your out-of-pocket cost for care.

All Charges