Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL

Facility

$3,119.16

Service Code	CPT 47533
Hospital Charge Code	36100490
Hospital Revenue Code	361
Min. Negotiated Rate	$250.17
Max. Negotiated Rate	$5,427.00
Rate for Payer: Aetna Commercial	$2,651.29
Rate for Payer: Aetna Medicare	$3,201.53
Rate for Payer: Aetna New Business (MI Preferred)	$2,027.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,847.99
Rate for Payer: Amish Plain Church Group Commercial	$3,847.99
Rate for Payer: BCBS Complete	$1,768.23
Rate for Payer: BCBS MAPPO	$3,078.39
Rate for Payer: BCBS Trust/PPO	$2,108.16
Rate for Payer: BCN Medicare Advantage	$3,078.39
Rate for Payer: Cash Price	$2,495.33
Rate for Payer: Cash Price	$2,495.33
Rate for Payer: Cofinity Commercial	$2,183.41
Rate for Payer: Cofinity Commercial	$2,682.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,078.39
Rate for Payer: Healthscope Commercial	$2,807.24
Rate for Payer: Mclaren Medicaid	$1,683.88
Rate for Payer: Mclaren Medicare	$3,078.39
Rate for Payer: Meridian Medicaid	$1,768.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,232.31
Rate for Payer: MI Amish Medical Board Commercial	$3,540.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,651.29
Rate for Payer: PACE Medicare	$2,924.47
Rate for Payer: PACE SWMI	$3,078.39
Rate for Payer: PHP Commercial	$2,651.29
Rate for Payer: PHP Medicare Advantage	$3,078.39
Rate for Payer: Priority Health Choice Medicaid	$1,683.88
Rate for Payer: Priority Health Cigna Priority Health	$2,183.41
Rate for Payer: Priority Health Medicare	$3,078.39
Rate for Payer: Priority Health SBD	$1,965.07
Rate for Payer: Railroad Medicare Medicare	$3,078.39
Rate for Payer: UHC All Payor (Choice/PPO)	$275.19
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,078.39
Rate for Payer: UHC Exchange	$250.17
Rate for Payer: UHC Medicare Advantage	$3,170.74
Rate for Payer: VA VA	$3,078.39

HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE

Facility

$1,142.85

Service Code	CPT 19282
Hospital Charge Code	36100415
Hospital Revenue Code	361
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,028.56
Rate for Payer: Aetna Commercial	$971.42
Rate for Payer: Aetna New Business (MI Preferred)	$742.85
Rate for Payer: Cash Price	$914.28
Rate for Payer: Cofinity Commercial	$982.85
Rate for Payer: Cofinity Commercial	$800.00
Rate for Payer: Healthscope Commercial	$1,028.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$971.42
Rate for Payer: PHP Commercial	$971.42
Rate for Payer: Priority Health Cigna Priority Health	$800.00
Rate for Payer: Priority Health SBD	$720.00

HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE

Facility

$1,142.85

Service Code	CPT 19282
Hospital Charge Code	36100415
Hospital Revenue Code	361
Min. Negotiated Rate	$47.48
Max. Negotiated Rate	$1,028.56
Rate for Payer: Aetna Commercial	$971.42
Rate for Payer: Aetna New Business (MI Preferred)	$742.85
Rate for Payer: BCBS Complete	$457.14
Rate for Payer: BCBS Trust/PPO	$458.45
Rate for Payer: BCCCP Commercial	$176.03
Rate for Payer: Cash Price	$914.28
Rate for Payer: Cash Price	$914.28
Rate for Payer: Cofinity Commercial	$982.85
Rate for Payer: Cofinity Commercial	$800.00
Rate for Payer: Healthscope Commercial	$1,028.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$971.42
Rate for Payer: PHP Commercial	$971.42
Rate for Payer: Priority Health Cigna Priority Health	$800.00
Rate for Payer: Priority Health SBD	$720.00
Rate for Payer: UHC All Payor (Choice/PPO)	$52.23
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$47.48

HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE

Facility

$1,721.55

Service Code	CPT 19288
Hospital Charge Code	36100421
Hospital Revenue Code	361
Min. Negotiated Rate	$1,084.58
Max. Negotiated Rate	$1,549.40
Rate for Payer: Aetna Commercial	$1,463.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,119.01
Rate for Payer: Cash Price	$1,377.24
Rate for Payer: Cofinity Commercial	$1,205.08
Rate for Payer: Cofinity Commercial	$1,480.53
Rate for Payer: Healthscope Commercial	$1,549.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,463.32
Rate for Payer: PHP Commercial	$1,463.32
Rate for Payer: Priority Health Cigna Priority Health	$1,205.08
Rate for Payer: Priority Health SBD	$1,084.58

HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE

Facility

$1,721.55

Service Code	CPT 19288
Hospital Charge Code	36100421
Hospital Revenue Code	361
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,549.40
Rate for Payer: Aetna Commercial	$1,463.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,119.01
Rate for Payer: BCBS Complete	$688.62
Rate for Payer: BCBS Trust/PPO	$1,390.73
Rate for Payer: BCCCP Commercial	$506.78
Rate for Payer: Cash Price	$1,377.24
Rate for Payer: Cash Price	$1,377.24
Rate for Payer: Cofinity Commercial	$1,480.53
Rate for Payer: Cofinity Commercial	$1,205.08
Rate for Payer: Healthscope Commercial	$1,549.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,463.32
Rate for Payer: PHP Commercial	$1,463.32
Rate for Payer: Priority Health Cigna Priority Health	$1,205.08
Rate for Payer: Priority Health SBD	$1,084.58
Rate for Payer: UHC All Payor (Choice/PPO)	$66.28
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$60.25

HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE

Facility

$2,065.76

Service Code	CPT 19284
Hospital Charge Code	36100417
Hospital Revenue Code	361
Min. Negotiated Rate	$1,301.43
Max. Negotiated Rate	$1,859.18
Rate for Payer: Aetna Commercial	$1,755.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,342.74
Rate for Payer: Cash Price	$1,652.61
Rate for Payer: Cofinity Commercial	$1,446.03
Rate for Payer: Cofinity Commercial	$1,776.55
Rate for Payer: Healthscope Commercial	$1,859.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,755.90
Rate for Payer: PHP Commercial	$1,755.90
Rate for Payer: Priority Health Cigna Priority Health	$1,446.03
Rate for Payer: Priority Health SBD	$1,301.43

HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE

Facility

$2,065.76

Service Code	CPT 19284
Hospital Charge Code	36100417
Hospital Revenue Code	361
Min. Negotiated Rate	$47.81
Max. Negotiated Rate	$1,859.18
Rate for Payer: Aetna Commercial	$1,755.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,342.74
Rate for Payer: BCBS Complete	$826.30
Rate for Payer: BCBS Trust/PPO	$407.72
Rate for Payer: BCCCP Commercial	$197.10
Rate for Payer: Cash Price	$1,652.61
Rate for Payer: Cash Price	$1,652.61
Rate for Payer: Cofinity Commercial	$1,776.55
Rate for Payer: Cofinity Commercial	$1,446.03
Rate for Payer: Healthscope Commercial	$1,859.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,755.90
Rate for Payer: PHP Commercial	$1,755.90
Rate for Payer: Priority Health Cigna Priority Health	$1,446.03
Rate for Payer: Priority Health SBD	$1,301.43
Rate for Payer: UHC All Payor (Choice/PPO)	$52.59
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$47.81

HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE

Facility

$2,861.45

Service Code	CPT 19286
Hospital Charge Code	36100419
Hospital Revenue Code	361
Min. Negotiated Rate	$1,802.71
Max. Negotiated Rate	$2,575.30
Rate for Payer: Aetna Commercial	$2,432.23
Rate for Payer: Aetna New Business (MI Preferred)	$1,859.94
Rate for Payer: Cash Price	$2,289.16
Rate for Payer: Cofinity Commercial	$2,003.02
Rate for Payer: Cofinity Commercial	$2,460.85
Rate for Payer: Healthscope Commercial	$2,575.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,432.23
Rate for Payer: PHP Commercial	$2,432.23
Rate for Payer: Priority Health Cigna Priority Health	$2,003.02
Rate for Payer: Priority Health SBD	$1,802.71

HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE

Facility

$2,861.45

Service Code	CPT 19286
Hospital Charge Code	36100419
Hospital Revenue Code	361
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$2,575.30
Rate for Payer: Aetna Commercial	$2,432.23
Rate for Payer: Aetna New Business (MI Preferred)	$1,859.94
Rate for Payer: BCBS Complete	$1,144.58
Rate for Payer: BCBS Trust/PPO	$815.20
Rate for Payer: BCCCP Commercial	$312.47
Rate for Payer: Cash Price	$2,289.16
Rate for Payer: Cash Price	$2,289.16
Rate for Payer: Cofinity Commercial	$2,003.02
Rate for Payer: Cofinity Commercial	$2,460.85
Rate for Payer: Healthscope Commercial	$2,575.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,432.23
Rate for Payer: PHP Commercial	$2,432.23
Rate for Payer: Priority Health Cigna Priority Health	$2,003.02
Rate for Payer: Priority Health SBD	$1,802.71
Rate for Payer: UHC All Payor (Choice/PPO)	$44.66
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$40.60

HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE

Facility

$1,420.38

Service Code	CPT 19281
Hospital Charge Code	36100414
Hospital Revenue Code	361
Min. Negotiated Rate	$894.84
Max. Negotiated Rate	$1,278.34
Rate for Payer: Aetna Commercial	$1,207.32
Rate for Payer: Aetna New Business (MI Preferred)	$923.25
Rate for Payer: Cash Price	$1,136.30
Rate for Payer: Cofinity Commercial	$994.27
Rate for Payer: Cofinity Commercial	$1,221.53
Rate for Payer: Healthscope Commercial	$1,278.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,207.32
Rate for Payer: PHP Commercial	$1,207.32
Rate for Payer: Priority Health Cigna Priority Health	$994.27
Rate for Payer: Priority Health SBD	$894.84

HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE

Facility

$1,420.38

Service Code	CPT 19281
Hospital Charge Code	36100414
Hospital Revenue Code	361
Min. Negotiated Rate	$94.63
Max. Negotiated Rate	$4,496.47
Rate for Payer: Aetna Commercial	$1,207.32
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$923.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$400.79
Rate for Payer: BCCCP Commercial	$248.73
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$1,136.30
Rate for Payer: Cash Price	$1,136.30
Rate for Payer: Cofinity Commercial	$994.27
Rate for Payer: Cofinity Commercial	$1,221.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$1,278.34
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,207.32
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$1,207.32
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$994.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,496.47
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,597.18
Rate for Payer: Priority Health SBD	$894.84
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$104.09
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$94.63
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE

Facility

$1,660.51

Service Code	CPT 19287
Hospital Charge Code	36100420
Hospital Revenue Code	361
Min. Negotiated Rate	$1,046.12
Max. Negotiated Rate	$1,494.46
Rate for Payer: Aetna Commercial	$1,411.43
Rate for Payer: Aetna New Business (MI Preferred)	$1,079.33
Rate for Payer: Cash Price	$1,328.41
Rate for Payer: Cofinity Commercial	$1,162.36
Rate for Payer: Cofinity Commercial	$1,428.04
Rate for Payer: Healthscope Commercial	$1,494.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,411.43
Rate for Payer: PHP Commercial	$1,411.43
Rate for Payer: Priority Health Cigna Priority Health	$1,162.36
Rate for Payer: Priority Health SBD	$1,046.12

HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE

Facility

$1,660.51

Service Code	CPT 19287
Hospital Charge Code	36100420
Hospital Revenue Code	361
Min. Negotiated Rate	$120.83
Max. Negotiated Rate	$1,945.97
Rate for Payer: Aetna Commercial	$1,411.43
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$1,079.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$280.63
Rate for Payer: BCCCP Commercial	$656.55
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$1,328.41
Rate for Payer: Cash Price	$1,328.41
Rate for Payer: Cofinity Commercial	$1,162.36
Rate for Payer: Cofinity Commercial	$1,428.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$1,494.46
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,411.43
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$1,411.43
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health Cigna Priority Health	$1,162.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,945.97
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,556.78
Rate for Payer: Priority Health SBD	$1,046.12
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$132.91
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$120.83
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE

Facility

$2,343.35

Service Code	CPT 19283
Hospital Charge Code	36100416
Hospital Revenue Code	361
Min. Negotiated Rate	$95.61
Max. Negotiated Rate	$2,109.02
Rate for Payer: Aetna Commercial	$1,991.85
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$280.63
Rate for Payer: BCCCP Commercial	$268.69
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$1,874.68
Rate for Payer: Cash Price	$1,874.68
Rate for Payer: Cofinity Commercial	$1,640.34
Rate for Payer: Cofinity Commercial	$2,015.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$2,109.02
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,991.85
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$1,991.85
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health Cigna Priority Health	$1,640.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,945.97
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,556.78
Rate for Payer: Priority Health SBD	$1,476.31
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$105.17
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$95.61
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE

Facility

$2,343.35

Service Code	CPT 19283
Hospital Charge Code	36100416
Hospital Revenue Code	361
Min. Negotiated Rate	$1,476.31
Max. Negotiated Rate	$2,109.02
Rate for Payer: Aetna Commercial	$1,991.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.18
Rate for Payer: Cash Price	$1,874.68
Rate for Payer: Cofinity Commercial	$1,640.34
Rate for Payer: Cofinity Commercial	$2,015.28
Rate for Payer: Healthscope Commercial	$2,109.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,991.85
Rate for Payer: PHP Commercial	$1,991.85
Rate for Payer: Priority Health Cigna Priority Health	$1,640.34
Rate for Payer: Priority Health SBD	$1,476.31

HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE

Facility

$1,924.49

Service Code	CPT 19285
Hospital Charge Code	36100418
Hospital Revenue Code	361
Min. Negotiated Rate	$1,212.43
Max. Negotiated Rate	$1,732.04
Rate for Payer: Aetna Commercial	$1,635.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,250.92
Rate for Payer: Cash Price	$1,539.59
Rate for Payer: Cofinity Commercial	$1,347.14
Rate for Payer: Cofinity Commercial	$1,655.06
Rate for Payer: Healthscope Commercial	$1,732.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,635.82
Rate for Payer: PHP Commercial	$1,635.82
Rate for Payer: Priority Health Cigna Priority Health	$1,347.14
Rate for Payer: Priority Health SBD	$1,212.43

HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE

Facility

$1,924.49

Service Code	CPT 19285
Hospital Charge Code	36100418
Hospital Revenue Code	361
Min. Negotiated Rate	$80.88
Max. Negotiated Rate	$1,945.97
Rate for Payer: Aetna Commercial	$1,635.82
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$1,250.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$536.98
Rate for Payer: BCCCP Commercial	$382.11
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$1,539.59
Rate for Payer: Cash Price	$1,539.59
Rate for Payer: Cofinity Commercial	$1,347.14
Rate for Payer: Cofinity Commercial	$1,655.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$1,732.04
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,635.82
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$1,635.82
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health Cigna Priority Health	$1,347.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,945.97
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,556.78
Rate for Payer: Priority Health SBD	$1,212.43
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$88.97
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$80.88
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER

Facility

$7,123.41

Service Code	CPT 36215
Hospital Charge Code	36100106
Hospital Revenue Code	361
Min. Negotiated Rate	$4,487.75
Max. Negotiated Rate	$6,411.07
Rate for Payer: Aetna Commercial	$6,054.90
Rate for Payer: Aetna New Business (MI Preferred)	$4,630.22
Rate for Payer: Cash Price	$5,698.73
Rate for Payer: Cofinity Commercial	$6,126.13
Rate for Payer: Cofinity Commercial	$4,986.39
Rate for Payer: Healthscope Commercial	$6,411.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,054.90
Rate for Payer: PHP Commercial	$6,054.90
Rate for Payer: Priority Health Cigna Priority Health	$4,986.39
Rate for Payer: Priority Health SBD	$4,487.75

HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER

Facility

$7,123.41

Service Code	CPT 36215
Hospital Charge Code	36100106
Hospital Revenue Code	361
Min. Negotiated Rate	$203.34
Max. Negotiated Rate	$6,411.07
Rate for Payer: Aetna Commercial	$6,054.90
Rate for Payer: Aetna New Business (MI Preferred)	$4,630.22
Rate for Payer: BCBS Complete	$2,849.36
Rate for Payer: BCBS Trust/PPO	$2,242.09
Rate for Payer: Cash Price	$5,698.73
Rate for Payer: Cash Price	$5,698.73
Rate for Payer: Cofinity Commercial	$6,126.13
Rate for Payer: Cofinity Commercial	$4,986.39
Rate for Payer: Healthscope Commercial	$6,411.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,054.90
Rate for Payer: PHP Commercial	$6,054.90
Rate for Payer: Priority Health Cigna Priority Health	$4,986.39
Rate for Payer: Priority Health SBD	$4,487.75
Rate for Payer: UHC All Payor (Choice/PPO)	$223.67
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$203.34

HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER

Facility

$1,000.00

Service Code	CPT 36216
Hospital Charge Code	36100107
Hospital Revenue Code	361
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$850.00
Rate for Payer: Aetna New Business (MI Preferred)	$650.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cofinity Commercial	$700.00
Rate for Payer: Cofinity Commercial	$860.00
Rate for Payer: Healthscope Commercial	$900.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$850.00
Rate for Payer: PHP Commercial	$850.00
Rate for Payer: Priority Health Cigna Priority Health	$700.00
Rate for Payer: Priority Health SBD	$630.00

HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER

Facility

$1,000.00

Service Code	CPT 36216
Hospital Charge Code	36100107
Hospital Revenue Code	361
Min. Negotiated Rate	$260.97
Max. Negotiated Rate	$2,318.12
Rate for Payer: Aetna Commercial	$850.00
Rate for Payer: Aetna New Business (MI Preferred)	$650.00
Rate for Payer: BCBS Complete	$400.00
Rate for Payer: BCBS Trust/PPO	$2,318.12
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cofinity Commercial	$700.00
Rate for Payer: Cofinity Commercial	$860.00
Rate for Payer: Healthscope Commercial	$900.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$850.00
Rate for Payer: PHP Commercial	$850.00
Rate for Payer: Priority Health Cigna Priority Health	$700.00
Rate for Payer: Priority Health SBD	$630.00
Rate for Payer: UHC All Payor (Choice/PPO)	$287.07
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$260.97

HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER

Facility

$828.96

Service Code	CPT 36217
Hospital Charge Code	36100108
Hospital Revenue Code	361
Min. Negotiated Rate	$320.24
Max. Negotiated Rate	$3,794.07
Rate for Payer: Aetna Commercial	$704.62
Rate for Payer: Aetna New Business (MI Preferred)	$538.82
Rate for Payer: BCBS Complete	$331.58
Rate for Payer: BCBS Trust/PPO	$3,794.07
Rate for Payer: Cash Price	$663.17
Rate for Payer: Cash Price	$663.17
Rate for Payer: Cofinity Commercial	$580.27
Rate for Payer: Cofinity Commercial	$712.91
Rate for Payer: Healthscope Commercial	$746.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$704.62
Rate for Payer: PHP Commercial	$704.62
Rate for Payer: Priority Health Cigna Priority Health	$580.27
Rate for Payer: Priority Health SBD	$522.24
Rate for Payer: UHC All Payor (Choice/PPO)	$352.26
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$320.24

HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER

Facility

$828.96

Service Code	CPT 36217
Hospital Charge Code	36100108
Hospital Revenue Code	361
Min. Negotiated Rate	$522.24
Max. Negotiated Rate	$746.06
Rate for Payer: Aetna Commercial	$704.62
Rate for Payer: Aetna New Business (MI Preferred)	$538.82
Rate for Payer: Cash Price	$663.17
Rate for Payer: Cofinity Commercial	$580.27
Rate for Payer: Cofinity Commercial	$712.91
Rate for Payer: Healthscope Commercial	$746.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$704.62
Rate for Payer: PHP Commercial	$704.62
Rate for Payer: Priority Health Cigna Priority Health	$580.27
Rate for Payer: Priority Health SBD	$522.24

HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER

Facility

$1,100.84

Service Code	CPT 36218
Hospital Charge Code	36100109
Hospital Revenue Code	361
Min. Negotiated Rate	$693.53
Max. Negotiated Rate	$990.76
Rate for Payer: Aetna Commercial	$935.71
Rate for Payer: Aetna New Business (MI Preferred)	$715.55
Rate for Payer: Cash Price	$880.67
Rate for Payer: Cofinity Commercial	$946.72
Rate for Payer: Cofinity Commercial	$770.59
Rate for Payer: Healthscope Commercial	$990.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$935.71
Rate for Payer: PHP Commercial	$935.71
Rate for Payer: Priority Health Cigna Priority Health	$770.59
Rate for Payer: Priority Health SBD	$693.53

HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER

Facility

$1,100.84

Service Code	CPT 36218
Hospital Charge Code	36100109
Hospital Revenue Code	361
Min. Negotiated Rate	$50.43
Max. Negotiated Rate	$990.76
Rate for Payer: Aetna Commercial	$935.71
Rate for Payer: Aetna New Business (MI Preferred)	$715.55
Rate for Payer: BCBS Complete	$440.34
Rate for Payer: BCBS Trust/PPO	$371.09
Rate for Payer: Cash Price	$880.67
Rate for Payer: Cash Price	$880.67
Rate for Payer: Cofinity Commercial	$946.72
Rate for Payer: Cofinity Commercial	$770.59
Rate for Payer: Healthscope Commercial	$990.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$935.71
Rate for Payer: PHP Commercial	$935.71
Rate for Payer: Priority Health Cigna Priority Health	$770.59
Rate for Payer: Priority Health SBD	$693.53
Rate for Payer: UHC All Payor (Choice/PPO)	$55.47
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$50.43

Know your out-of-pocket cost for care.

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