Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM

Facility

$309.75

Service Code	CPT 12052
Hospital Charge Code	76100119
Hospital Revenue Code	761
Min. Negotiated Rate	$195.14
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$263.29
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$201.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$247.80
Rate for Payer: Cash Price	$247.80
Rate for Payer: Cofinity Commercial	$266.38
Rate for Payer: Cofinity Commercial	$216.82
Rate for Payer: Cofinity Medicare Advantage	$216.82
Rate for Payer: Encore Health Key Benefits Commercial	$247.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$278.77
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.29
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$263.29
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$201.34
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$195.14
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM

Facility

$309.75

Service Code	CPT 12052
Hospital Charge Code	76100119
Hospital Revenue Code	761
Min. Negotiated Rate	$195.14
Max. Negotiated Rate	$278.77
Rate for Payer: Aetna Commercial	$263.29
Rate for Payer: Aetna New Business (MI Preferred)	$201.34
Rate for Payer: Cash Price	$247.80
Rate for Payer: Cofinity Commercial	$216.82
Rate for Payer: Cofinity Commercial	$266.38
Rate for Payer: Cofinity Medicare Advantage	$216.82
Rate for Payer: Encore Health Key Benefits Commercial	$247.80
Rate for Payer: Healthscope Commercial	$278.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.29
Rate for Payer: PHP Commercial	$263.29
Rate for Payer: Priority Health Cigna Priority Health	$201.34
Rate for Payer: Priority Health SBD	$195.14

HC INTMD RPR WND FACE/MM 5.1-7.5 CM

Facility

$899.53

Service Code	CPT 12053
Hospital Charge Code	76100315
Hospital Revenue Code	761
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$764.60
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$584.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$719.62
Rate for Payer: Cash Price	$719.62
Rate for Payer: Cofinity Commercial	$773.60
Rate for Payer: Cofinity Commercial	$629.67
Rate for Payer: Cofinity Medicare Advantage	$629.67
Rate for Payer: Encore Health Key Benefits Commercial	$719.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$809.58
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$764.60
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$764.60
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$584.69
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$566.70
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HC INTMD RPR WND FACE/MM 5.1-7.5 CM

Facility

$899.53

Service Code	CPT 12053
Hospital Charge Code	76100315
Hospital Revenue Code	761
Min. Negotiated Rate	$566.70
Max. Negotiated Rate	$809.58
Rate for Payer: Aetna Commercial	$764.60
Rate for Payer: Aetna New Business (MI Preferred)	$584.69
Rate for Payer: Cash Price	$719.62
Rate for Payer: Cofinity Commercial	$629.67
Rate for Payer: Cofinity Commercial	$773.60
Rate for Payer: Cofinity Medicare Advantage	$629.67
Rate for Payer: Encore Health Key Benefits Commercial	$719.62
Rate for Payer: Healthscope Commercial	$809.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$764.60
Rate for Payer: PHP Commercial	$764.60
Rate for Payer: Priority Health Cigna Priority Health	$584.69
Rate for Payer: Priority Health SBD	$566.70

HC INTRA AORTIC BALLOON INSERTION

Facility

$2,205.80

Service Code	CPT 33967
Hospital Charge Code	36100083
Hospital Revenue Code	361
Min. Negotiated Rate	$1,389.65
Max. Negotiated Rate	$1,985.22
Rate for Payer: Aetna Commercial	$1,874.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,433.77
Rate for Payer: Cash Price	$1,764.64
Rate for Payer: Cofinity Commercial	$1,544.06
Rate for Payer: Cofinity Commercial	$1,896.99
Rate for Payer: Cofinity Medicare Advantage	$1,544.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,764.64
Rate for Payer: Healthscope Commercial	$1,985.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,874.93
Rate for Payer: PHP Commercial	$1,874.93
Rate for Payer: Priority Health Cigna Priority Health	$1,433.77
Rate for Payer: Priority Health SBD	$1,389.65

HC INTRA AORTIC BALLOON INSERTION

Facility

$2,205.80

Service Code	CPT 33967
Hospital Charge Code	36100083
Hospital Revenue Code	361
Min. Negotiated Rate	$882.32
Max. Negotiated Rate	$1,985.22
Rate for Payer: Aetna Commercial	$1,874.93
Rate for Payer: Aetna Medicare	$1,102.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,433.77
Rate for Payer: BCBS Complete	$882.32
Rate for Payer: Cash Price	$1,764.64
Rate for Payer: Cofinity Commercial	$1,544.06
Rate for Payer: Cofinity Commercial	$1,896.99
Rate for Payer: Cofinity Medicare Advantage	$1,544.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,764.64
Rate for Payer: Healthscope Commercial	$1,985.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,874.93
Rate for Payer: PHP Commercial	$1,874.93
Rate for Payer: Priority Health Cigna Priority Health	$1,433.77
Rate for Payer: Priority Health SBD	$1,389.65

HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS

Facility

$1,340.24

Service Code	CPT 33968
Hospital Charge Code	48100104
Hospital Revenue Code	481
Min. Negotiated Rate	$844.35
Max. Negotiated Rate	$1,206.22
Rate for Payer: Aetna Commercial	$1,139.20
Rate for Payer: Aetna New Business (MI Preferred)	$871.16
Rate for Payer: Cash Price	$1,072.19
Rate for Payer: Cofinity Commercial	$1,152.61
Rate for Payer: Cofinity Commercial	$938.17
Rate for Payer: Cofinity Medicare Advantage	$938.17
Rate for Payer: Encore Health Key Benefits Commercial	$1,072.19
Rate for Payer: Healthscope Commercial	$1,206.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,139.20
Rate for Payer: PHP Commercial	$1,139.20
Rate for Payer: Priority Health Cigna Priority Health	$871.16
Rate for Payer: Priority Health SBD	$844.35

HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS

Facility

$1,340.24

Service Code	CPT 33968
Hospital Charge Code	48100104
Hospital Revenue Code	481
Min. Negotiated Rate	$536.10
Max. Negotiated Rate	$1,206.22
Rate for Payer: Aetna Commercial	$1,139.20
Rate for Payer: Aetna Medicare	$670.12
Rate for Payer: Aetna New Business (MI Preferred)	$871.16
Rate for Payer: BCBS Complete	$536.10
Rate for Payer: Cash Price	$1,072.19
Rate for Payer: Cofinity Commercial	$1,152.61
Rate for Payer: Cofinity Commercial	$938.17
Rate for Payer: Cofinity Medicare Advantage	$938.17
Rate for Payer: Encore Health Key Benefits Commercial	$1,072.19
Rate for Payer: Healthscope Commercial	$1,206.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,139.20
Rate for Payer: PHP Commercial	$1,139.20
Rate for Payer: Priority Health Cigna Priority Health	$871.16
Rate for Payer: Priority Health SBD	$844.35

HC INTRA ART ADMIN RP PARTICULATE

Facility

$1,073.12

Service Code	CPT 79445
Hospital Charge Code	34200001
Hospital Revenue Code	342
Min. Negotiated Rate	$676.07
Max. Negotiated Rate	$965.81
Rate for Payer: Aetna Commercial	$912.15
Rate for Payer: Aetna New Business (MI Preferred)	$697.53
Rate for Payer: Cash Price	$858.50
Rate for Payer: Cofinity Commercial	$751.18
Rate for Payer: Cofinity Commercial	$922.88
Rate for Payer: Cofinity Medicare Advantage	$751.18
Rate for Payer: Encore Health Key Benefits Commercial	$858.50
Rate for Payer: Healthscope Commercial	$965.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$912.15
Rate for Payer: PHP Commercial	$912.15
Rate for Payer: Priority Health Cigna Priority Health	$697.53
Rate for Payer: Priority Health SBD	$676.07

HC INTRA ART ADMIN RP PARTICULATE

Facility

$1,073.12

Service Code	CPT 79445
Hospital Charge Code	34200001
Hospital Revenue Code	342
Min. Negotiated Rate	$117.16
Max. Negotiated Rate	$965.81
Rate for Payer: Aetna Commercial	$912.15
Rate for Payer: Aetna Medicare	$227.33
Rate for Payer: Aetna New Business (MI Preferred)	$697.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$273.24
Rate for Payer: Amish Plain Church Group Commercial	$273.24
Rate for Payer: BCBS Complete	$123.02
Rate for Payer: BCBS MAPPO	$218.59
Rate for Payer: BCN Medicare Advantage	$218.59
Rate for Payer: Cash Price	$858.50
Rate for Payer: Cash Price	$858.50
Rate for Payer: Cofinity Commercial	$751.18
Rate for Payer: Cofinity Commercial	$922.88
Rate for Payer: Cofinity Medicare Advantage	$751.18
Rate for Payer: Encore Health Key Benefits Commercial	$858.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$218.59
Rate for Payer: Healthscope Commercial	$965.81
Rate for Payer: Mclaren Medicaid	$117.16
Rate for Payer: Mclaren Medicare	$218.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$229.52
Rate for Payer: Meridian Medicaid	$123.02
Rate for Payer: MI Amish Medical Board Commercial	$251.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$912.15
Rate for Payer: PACE Medicare	$207.66
Rate for Payer: PACE SWMI	$218.59
Rate for Payer: PHP Commercial	$912.15
Rate for Payer: PHP Medicare Advantage	$218.59
Rate for Payer: Priority Health Choice Medicaid	$117.16
Rate for Payer: Priority Health Cigna Priority Health	$697.53
Rate for Payer: Priority Health Medicare	$218.59
Rate for Payer: Priority Health SBD	$676.07
Rate for Payer: Railroad Medicare Medicare	$218.59
Rate for Payer: UHC All Payor (Choice/PPO)	$615.31
Rate for Payer: UHC Core	$794.11
Rate for Payer: UHC Dual Complete DSNP	$218.59
Rate for Payer: UHC Exchange	$794.11
Rate for Payer: UHC Medicare Advantage	$218.59
Rate for Payer: UHCCP Medicaid	$123.07
Rate for Payer: VA VA	$218.59

HC INTRA ATRIAL PACING

Facility

$3,148.49

Service Code	CPT 93610
Hospital Charge Code	48100033
Hospital Revenue Code	481
Min. Negotiated Rate	$1,983.55
Max. Negotiated Rate	$2,833.64
Rate for Payer: Aetna Commercial	$2,676.22
Rate for Payer: Aetna New Business (MI Preferred)	$2,046.52
Rate for Payer: Cash Price	$2,518.79
Rate for Payer: Cofinity Commercial	$2,203.94
Rate for Payer: Cofinity Commercial	$2,707.70
Rate for Payer: Cofinity Medicare Advantage	$2,203.94
Rate for Payer: Encore Health Key Benefits Commercial	$2,518.79
Rate for Payer: Healthscope Commercial	$2,833.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,676.22
Rate for Payer: PHP Commercial	$2,676.22
Rate for Payer: Priority Health Cigna Priority Health	$2,046.52
Rate for Payer: Priority Health SBD	$1,983.55

HC INTRA ATRIAL PACING

Facility

$3,148.49

Service Code	CPT 93610
Hospital Charge Code	48100033
Hospital Revenue Code	481
Min. Negotiated Rate	$1,983.55
Max. Negotiated Rate	$20,831.72
Rate for Payer: Aetna Commercial	$2,676.22
Rate for Payer: Aetna Medicare	$7,696.54
Rate for Payer: Aetna New Business (MI Preferred)	$2,046.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,250.65
Rate for Payer: Amish Plain Church Group Commercial	$9,250.65
Rate for Payer: BCBS Complete	$4,165.01
Rate for Payer: BCBS MAPPO	$7,400.52
Rate for Payer: BCN Medicare Advantage	$7,400.52
Rate for Payer: Cash Price	$2,518.79
Rate for Payer: Cash Price	$2,518.79
Rate for Payer: Cofinity Commercial	$2,203.94
Rate for Payer: Cofinity Commercial	$2,707.70
Rate for Payer: Cofinity Medicare Advantage	$2,203.94
Rate for Payer: Encore Health Key Benefits Commercial	$2,518.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,400.52
Rate for Payer: Healthscope Commercial	$2,833.64
Rate for Payer: Mclaren Medicaid	$3,966.68
Rate for Payer: Mclaren Medicare	$7,400.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,770.55
Rate for Payer: Meridian Medicaid	$4,165.01
Rate for Payer: MI Amish Medical Board Commercial	$8,510.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,676.22
Rate for Payer: PACE Medicare	$7,030.49
Rate for Payer: PACE SWMI	$7,400.52
Rate for Payer: PHP Commercial	$2,676.22
Rate for Payer: PHP Medicare Advantage	$7,400.52
Rate for Payer: Priority Health Choice Medicaid	$3,966.68
Rate for Payer: Priority Health Cigna Priority Health	$2,046.52
Rate for Payer: Priority Health Medicare	$7,400.52
Rate for Payer: Priority Health SBD	$1,983.55
Rate for Payer: Railroad Medicare Medicare	$7,400.52
Rate for Payer: UHC All Payor (Choice/PPO)	$20,831.72
Rate for Payer: UHC Dual Complete DSNP	$7,400.52
Rate for Payer: UHC Medicare Advantage	$7,400.52
Rate for Payer: UHCCP Medicaid	$4,166.49
Rate for Payer: VA VA	$7,400.52

HC INTRA ATRIAL RECORDING

Facility

$3,037.97

Service Code	CPT 93602
Hospital Charge Code	48100030
Hospital Revenue Code	481
Min. Negotiated Rate	$1,913.92
Max. Negotiated Rate	$20,831.72
Rate for Payer: Aetna Commercial	$2,582.27
Rate for Payer: Aetna Medicare	$7,696.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,974.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,250.65
Rate for Payer: Amish Plain Church Group Commercial	$9,250.65
Rate for Payer: BCBS Complete	$4,165.01
Rate for Payer: BCBS MAPPO	$7,400.52
Rate for Payer: BCN Medicare Advantage	$7,400.52
Rate for Payer: Cash Price	$2,430.38
Rate for Payer: Cash Price	$2,430.38
Rate for Payer: Cofinity Commercial	$2,612.65
Rate for Payer: Cofinity Commercial	$2,126.58
Rate for Payer: Cofinity Medicare Advantage	$2,126.58
Rate for Payer: Encore Health Key Benefits Commercial	$2,430.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,400.52
Rate for Payer: Healthscope Commercial	$2,734.17
Rate for Payer: Mclaren Medicaid	$3,966.68
Rate for Payer: Mclaren Medicare	$7,400.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,770.55
Rate for Payer: Meridian Medicaid	$4,165.01
Rate for Payer: MI Amish Medical Board Commercial	$8,510.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,582.27
Rate for Payer: PACE Medicare	$7,030.49
Rate for Payer: PACE SWMI	$7,400.52
Rate for Payer: PHP Commercial	$2,582.27
Rate for Payer: PHP Medicare Advantage	$7,400.52
Rate for Payer: Priority Health Choice Medicaid	$3,966.68
Rate for Payer: Priority Health Cigna Priority Health	$1,974.68
Rate for Payer: Priority Health Medicare	$7,400.52
Rate for Payer: Priority Health SBD	$1,913.92
Rate for Payer: Railroad Medicare Medicare	$7,400.52
Rate for Payer: UHC All Payor (Choice/PPO)	$20,831.72
Rate for Payer: UHC Dual Complete DSNP	$7,400.52
Rate for Payer: UHC Medicare Advantage	$7,400.52
Rate for Payer: UHCCP Medicaid	$4,166.49
Rate for Payer: VA VA	$7,400.52

HC INTRA ATRIAL RECORDING

Facility

$3,037.97

Service Code	CPT 93602
Hospital Charge Code	48100030
Hospital Revenue Code	481
Min. Negotiated Rate	$1,913.92
Max. Negotiated Rate	$2,734.17
Rate for Payer: Aetna Commercial	$2,582.27
Rate for Payer: Aetna New Business (MI Preferred)	$1,974.68
Rate for Payer: Cash Price	$2,430.38
Rate for Payer: Cofinity Commercial	$2,126.58
Rate for Payer: Cofinity Commercial	$2,612.65
Rate for Payer: Cofinity Medicare Advantage	$2,126.58
Rate for Payer: Encore Health Key Benefits Commercial	$2,430.38
Rate for Payer: Healthscope Commercial	$2,734.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,582.27
Rate for Payer: PHP Commercial	$2,582.27
Rate for Payer: Priority Health Cigna Priority Health	$1,974.68
Rate for Payer: Priority Health SBD	$1,913.92

HC INTRACARDIAC ECHOCARDIOGRAPHY

Facility

$5,511.38

Service Code	CPT 93662
Hospital Charge Code	48100047
Hospital Revenue Code	481
Min. Negotiated Rate	$3,472.17
Max. Negotiated Rate	$4,960.24
Rate for Payer: Aetna Commercial	$4,684.67
Rate for Payer: Aetna New Business (MI Preferred)	$3,582.40
Rate for Payer: Cash Price	$4,409.10
Rate for Payer: Cofinity Commercial	$3,857.97
Rate for Payer: Cofinity Commercial	$4,739.79
Rate for Payer: Cofinity Medicare Advantage	$3,857.97
Rate for Payer: Encore Health Key Benefits Commercial	$4,409.10
Rate for Payer: Healthscope Commercial	$4,960.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,684.67
Rate for Payer: PHP Commercial	$4,684.67
Rate for Payer: Priority Health Cigna Priority Health	$3,582.40
Rate for Payer: Priority Health SBD	$3,472.17

HC INTRACARDIAC ECHOCARDIOGRAPHY

Facility

$5,511.38

Service Code	CPT 93662
Hospital Charge Code	48100047
Hospital Revenue Code	481
Min. Negotiated Rate	$2,204.55
Max. Negotiated Rate	$4,960.24
Rate for Payer: Aetna Commercial	$4,684.67
Rate for Payer: Aetna Medicare	$2,755.69
Rate for Payer: Aetna New Business (MI Preferred)	$3,582.40
Rate for Payer: BCBS Complete	$2,204.55
Rate for Payer: Cash Price	$4,409.10
Rate for Payer: Cofinity Commercial	$3,857.97
Rate for Payer: Cofinity Commercial	$4,739.79
Rate for Payer: Cofinity Medicare Advantage	$3,857.97
Rate for Payer: Encore Health Key Benefits Commercial	$4,409.10
Rate for Payer: Healthscope Commercial	$4,960.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,684.67
Rate for Payer: PHP Commercial	$4,684.67
Rate for Payer: Priority Health Cigna Priority Health	$3,582.40
Rate for Payer: Priority Health SBD	$3,472.17

HC INTRACARDIAC ELECTROCARDIOGRAPHY CATH LVL 55

Facility

$5,500.00

Service Code	HCPCS C1759
Hospital Charge Code	27200379
Hospital Revenue Code	272
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$4,675.00
Rate for Payer: Aetna Medicare	$2,750.00
Rate for Payer: Aetna New Business (MI Preferred)	$3,575.00
Rate for Payer: BCBS Complete	$2,200.00
Rate for Payer: Cash Price	$4,400.00
Rate for Payer: Cofinity Commercial	$3,850.00
Rate for Payer: Cofinity Commercial	$4,730.00
Rate for Payer: Cofinity Medicare Advantage	$3,850.00
Rate for Payer: Encore Health Key Benefits Commercial	$4,400.00
Rate for Payer: Healthscope Commercial	$4,950.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,675.00
Rate for Payer: PHP Commercial	$4,675.00
Rate for Payer: Priority Health Cigna Priority Health	$3,575.00
Rate for Payer: Priority Health SBD	$3,465.00

HC INTRACARDIAC ELECTROCARDIOGRAPHY CATH LVL 55

Facility

$5,500.00

Service Code	HCPCS C1759
Hospital Charge Code	27200379
Hospital Revenue Code	272
Min. Negotiated Rate	$3,465.00
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$4,675.00
Rate for Payer: Aetna New Business (MI Preferred)	$3,575.00
Rate for Payer: Cash Price	$4,400.00
Rate for Payer: Cofinity Commercial	$3,850.00
Rate for Payer: Cofinity Commercial	$4,730.00
Rate for Payer: Cofinity Medicare Advantage	$3,850.00
Rate for Payer: Encore Health Key Benefits Commercial	$4,400.00
Rate for Payer: Healthscope Commercial	$4,950.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,675.00
Rate for Payer: PHP Commercial	$4,675.00
Rate for Payer: Priority Health Cigna Priority Health	$3,575.00
Rate for Payer: Priority Health SBD	$3,465.00

HC INTRACAV APPL - I

Facility

$573.26

Service Code	CPT 77762
Hospital Charge Code	33300028
Hospital Revenue Code	333
Min. Negotiated Rate	$361.15
Max. Negotiated Rate	$515.93
Rate for Payer: Aetna Commercial	$487.27
Rate for Payer: Aetna New Business (MI Preferred)	$372.62
Rate for Payer: Cash Price	$458.61
Rate for Payer: Cofinity Commercial	$401.28
Rate for Payer: Cofinity Commercial	$493.00
Rate for Payer: Cofinity Medicare Advantage	$401.28
Rate for Payer: Encore Health Key Benefits Commercial	$458.61
Rate for Payer: Healthscope Commercial	$515.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$487.27
Rate for Payer: PHP Commercial	$487.27
Rate for Payer: Priority Health Cigna Priority Health	$372.62
Rate for Payer: Priority Health SBD	$361.15

HC INTRACAV APPL - I

Facility

$573.26

Service Code	CPT 77762
Hospital Charge Code	33300028
Hospital Revenue Code	333
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$1,588.08
Rate for Payer: Aetna Commercial	$487.27
Rate for Payer: Aetna Medicare	$586.74
Rate for Payer: Aetna New Business (MI Preferred)	$372.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$705.21
Rate for Payer: Amish Plain Church Group Commercial	$705.21
Rate for Payer: BCBS Complete	$317.51
Rate for Payer: BCBS MAPPO	$564.17
Rate for Payer: BCN Medicare Advantage	$564.17
Rate for Payer: Cash Price	$458.61
Rate for Payer: Cash Price	$458.61
Rate for Payer: Cofinity Commercial	$493.00
Rate for Payer: Cofinity Commercial	$401.28
Rate for Payer: Cofinity Medicare Advantage	$401.28
Rate for Payer: Encore Health Key Benefits Commercial	$458.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$564.17
Rate for Payer: Healthscope Commercial	$515.93
Rate for Payer: Mclaren Medicaid	$302.40
Rate for Payer: Mclaren Medicare	$564.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$592.38
Rate for Payer: Meridian Medicaid	$317.51
Rate for Payer: MI Amish Medical Board Commercial	$648.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$487.27
Rate for Payer: PACE Medicare	$535.96
Rate for Payer: PACE SWMI	$564.17
Rate for Payer: PHP Commercial	$487.27
Rate for Payer: PHP Medicare Advantage	$564.17
Rate for Payer: Priority Health Choice Medicaid	$302.40
Rate for Payer: Priority Health Cigna Priority Health	$372.62
Rate for Payer: Priority Health Medicare	$564.17
Rate for Payer: Priority Health SBD	$361.15
Rate for Payer: Railroad Medicare Medicare	$564.17
Rate for Payer: UHC All Payor (Choice/PPO)	$1,588.08
Rate for Payer: UHC Core	$424.21
Rate for Payer: UHC Dual Complete DSNP	$564.17
Rate for Payer: UHC Exchange	$424.21
Rate for Payer: UHC Medicare Advantage	$564.17
Rate for Payer: UHCCP Medicaid	$317.63
Rate for Payer: VA VA	$564.17

HC INTRACAV APPL - S

Facility

$436.97

Service Code	CPT 77761
Hospital Charge Code	33300027
Hospital Revenue Code	333
Min. Negotiated Rate	$275.29
Max. Negotiated Rate	$1,588.08
Rate for Payer: Aetna Commercial	$371.42
Rate for Payer: Aetna Medicare	$586.74
Rate for Payer: Aetna New Business (MI Preferred)	$284.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$705.21
Rate for Payer: Amish Plain Church Group Commercial	$705.21
Rate for Payer: BCBS Complete	$317.51
Rate for Payer: BCBS MAPPO	$564.17
Rate for Payer: BCN Medicare Advantage	$564.17
Rate for Payer: Cash Price	$349.58
Rate for Payer: Cash Price	$349.58
Rate for Payer: Cofinity Commercial	$375.79
Rate for Payer: Cofinity Commercial	$305.88
Rate for Payer: Cofinity Medicare Advantage	$305.88
Rate for Payer: Encore Health Key Benefits Commercial	$349.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$564.17
Rate for Payer: Healthscope Commercial	$393.27
Rate for Payer: Mclaren Medicaid	$302.40
Rate for Payer: Mclaren Medicare	$564.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$592.38
Rate for Payer: Meridian Medicaid	$317.51
Rate for Payer: MI Amish Medical Board Commercial	$648.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.42
Rate for Payer: PACE Medicare	$535.96
Rate for Payer: PACE SWMI	$564.17
Rate for Payer: PHP Commercial	$371.42
Rate for Payer: PHP Medicare Advantage	$564.17
Rate for Payer: Priority Health Choice Medicaid	$302.40
Rate for Payer: Priority Health Cigna Priority Health	$284.03
Rate for Payer: Priority Health Medicare	$564.17
Rate for Payer: Priority Health SBD	$275.29
Rate for Payer: Railroad Medicare Medicare	$564.17
Rate for Payer: UHC All Payor (Choice/PPO)	$1,588.08
Rate for Payer: UHC Core	$323.36
Rate for Payer: UHC Dual Complete DSNP	$564.17
Rate for Payer: UHC Exchange	$323.36
Rate for Payer: UHC Medicare Advantage	$564.17
Rate for Payer: UHCCP Medicaid	$317.63
Rate for Payer: VA VA	$564.17

HC INTRACAV APPL - S

Facility

$436.97

Service Code	CPT 77761
Hospital Charge Code	33300027
Hospital Revenue Code	333
Min. Negotiated Rate	$275.29
Max. Negotiated Rate	$393.27
Rate for Payer: Aetna Commercial	$371.42
Rate for Payer: Aetna New Business (MI Preferred)	$284.03
Rate for Payer: Cash Price	$349.58
Rate for Payer: Cofinity Commercial	$305.88
Rate for Payer: Cofinity Commercial	$375.79
Rate for Payer: Cofinity Medicare Advantage	$305.88
Rate for Payer: Encore Health Key Benefits Commercial	$349.58
Rate for Payer: Healthscope Commercial	$393.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.42
Rate for Payer: PHP Commercial	$371.42
Rate for Payer: Priority Health Cigna Priority Health	$284.03
Rate for Payer: Priority Health SBD	$275.29

HC INTRAOSSEOUS NEEDLE PLACEMENT

Facility

$484.89

Service Code	CPT 36680
Hospital Charge Code	45000080
Hospital Revenue Code	450
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$1,095.50
Rate for Payer: Aetna Commercial	$412.16
Rate for Payer: Aetna Medicare	$404.75
Rate for Payer: Aetna New Business (MI Preferred)	$315.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$486.48
Rate for Payer: Amish Plain Church Group Commercial	$486.48
Rate for Payer: BCBS Complete	$219.03
Rate for Payer: BCBS MAPPO	$389.18
Rate for Payer: BCN Medicare Advantage	$389.18
Rate for Payer: Cash Price	$387.91
Rate for Payer: Cash Price	$387.91
Rate for Payer: Cofinity Commercial	$417.01
Rate for Payer: Cofinity Commercial	$339.42
Rate for Payer: Cofinity Medicare Advantage	$339.42
Rate for Payer: Encore Health Key Benefits Commercial	$387.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.18
Rate for Payer: Healthscope Commercial	$436.40
Rate for Payer: Mclaren Medicaid	$208.60
Rate for Payer: Mclaren Medicare	$389.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$408.64
Rate for Payer: Meridian Medicaid	$219.03
Rate for Payer: MI Amish Medical Board Commercial	$447.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$412.16
Rate for Payer: PACE Medicare	$369.72
Rate for Payer: PACE SWMI	$389.18
Rate for Payer: PHP Commercial	$412.16
Rate for Payer: PHP Medicare Advantage	$389.18
Rate for Payer: Priority Health Choice Medicaid	$208.60
Rate for Payer: Priority Health Cigna Priority Health	$315.18
Rate for Payer: Priority Health Medicare	$389.18
Rate for Payer: Priority Health SBD	$305.48
Rate for Payer: Railroad Medicare Medicare	$389.18
Rate for Payer: UHC All Payor (Choice/PPO)	$1,095.50
Rate for Payer: UHC Dual Complete DSNP	$389.18
Rate for Payer: UHC Medicare Advantage	$389.18
Rate for Payer: UHCCP Medicaid	$219.11
Rate for Payer: VA VA	$389.18

HC INTRAOSSEOUS NEEDLE PLACEMENT

Facility

$484.89

Service Code	CPT 36680
Hospital Charge Code	45000080
Hospital Revenue Code	450
Min. Negotiated Rate	$305.48
Max. Negotiated Rate	$436.40
Rate for Payer: Aetna Commercial	$412.16
Rate for Payer: Aetna New Business (MI Preferred)	$315.18
Rate for Payer: Cash Price	$387.91
Rate for Payer: Cofinity Commercial	$339.42
Rate for Payer: Cofinity Commercial	$417.01
Rate for Payer: Cofinity Medicare Advantage	$339.42
Rate for Payer: Encore Health Key Benefits Commercial	$387.91
Rate for Payer: Healthscope Commercial	$436.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$412.16
Rate for Payer: PHP Commercial	$412.16
Rate for Payer: Priority Health Cigna Priority Health	$315.18
Rate for Payer: Priority Health SBD	$305.48

HC INTRASPINAL CATHETER

Facility

$292.74

Service Code	HCPCS C1755
Hospital Charge Code	27200248
Hospital Revenue Code	272
Min. Negotiated Rate	$117.10
Max. Negotiated Rate	$263.47
Rate for Payer: Aetna Commercial	$248.83
Rate for Payer: Aetna Medicare	$146.37
Rate for Payer: Aetna New Business (MI Preferred)	$190.28
Rate for Payer: BCBS Complete	$117.10
Rate for Payer: Cash Price	$234.19
Rate for Payer: Cofinity Commercial	$204.92
Rate for Payer: Cofinity Commercial	$251.76
Rate for Payer: Cofinity Medicare Advantage	$204.92
Rate for Payer: Encore Health Key Benefits Commercial	$234.19
Rate for Payer: Healthscope Commercial	$263.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$248.83
Rate for Payer: PHP Commercial	$248.83
Rate for Payer: Priority Health Cigna Priority Health	$190.28
Rate for Payer: Priority Health SBD	$184.43

Know your out-of-pocket cost for care.

All Charges