Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

HC INTRAUTERINE COPPER CONTRACEPTIVE

Facility

$1,765.44

Service Code	HCPCS J7300
Hospital Charge Code	63600119
Hospital Revenue Code	636
Min. Negotiated Rate	$706.18
Max. Negotiated Rate	$1,588.90
Rate for Payer: Aetna Commercial	$1,500.62
Rate for Payer: Aetna Medicare	$882.72
Rate for Payer: Aetna New Business (MI Preferred)	$1,147.54
Rate for Payer: BCBS Complete	$706.18
Rate for Payer: Cash Price	$1,412.35
Rate for Payer: Cofinity Commercial	$1,235.81
Rate for Payer: Cofinity Commercial	$1,518.28
Rate for Payer: Cofinity Medicare Advantage	$1,235.81
Rate for Payer: Encore Health Key Benefits Commercial	$1,412.35
Rate for Payer: Healthscope Commercial	$1,588.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,500.62
Rate for Payer: PHP Commercial	$1,500.62
Rate for Payer: Priority Health Cigna Priority Health	$1,147.54
Rate for Payer: Priority Health SBD	$1,112.23

HC INTRAUTERINE COPPER CONTRACEPTIVE

Facility

$1,765.44

Service Code	HCPCS J7300
Hospital Charge Code	63600119
Hospital Revenue Code	636
Min. Negotiated Rate	$1,112.23
Max. Negotiated Rate	$1,588.90
Rate for Payer: Aetna Commercial	$1,500.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,147.54
Rate for Payer: Cash Price	$1,412.35
Rate for Payer: Cofinity Commercial	$1,235.81
Rate for Payer: Cofinity Commercial	$1,518.28
Rate for Payer: Cofinity Medicare Advantage	$1,235.81
Rate for Payer: Encore Health Key Benefits Commercial	$1,412.35
Rate for Payer: Healthscope Commercial	$1,588.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,500.62
Rate for Payer: PHP Commercial	$1,500.62
Rate for Payer: Priority Health Cigna Priority Health	$1,147.54
Rate for Payer: Priority Health SBD	$1,112.23

HC INTRAVENTRICULAR PACING

Facility

$3,767.24

Service Code	CPT 93612
Hospital Charge Code	48100034
Hospital Revenue Code	481
Min. Negotiated Rate	$2,373.36
Max. Negotiated Rate	$3,390.52
Rate for Payer: Aetna Commercial	$3,202.15
Rate for Payer: Aetna New Business (MI Preferred)	$2,448.71
Rate for Payer: Cash Price	$3,013.79
Rate for Payer: Cofinity Commercial	$2,637.07
Rate for Payer: Cofinity Commercial	$3,239.83
Rate for Payer: Cofinity Medicare Advantage	$2,637.07
Rate for Payer: Encore Health Key Benefits Commercial	$3,013.79
Rate for Payer: Healthscope Commercial	$3,390.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,202.15
Rate for Payer: PHP Commercial	$3,202.15
Rate for Payer: Priority Health Cigna Priority Health	$2,448.71
Rate for Payer: Priority Health SBD	$2,373.36

HC INTRAVENTRICULAR PACING

Facility

$3,767.24

Service Code	CPT 93612
Hospital Charge Code	48100034
Hospital Revenue Code	481
Min. Negotiated Rate	$2,373.36
Max. Negotiated Rate	$20,831.72
Rate for Payer: Aetna Commercial	$3,202.15
Rate for Payer: Aetna Medicare	$7,696.54
Rate for Payer: Aetna New Business (MI Preferred)	$2,448.71
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	$3,013.79
Rate for Payer: Cash Price	$3,013.79
Rate for Payer: Cofinity Commercial	$3,239.83
Rate for Payer: Cofinity Commercial	$2,637.07
Rate for Payer: Cofinity Medicare Advantage	$2,637.07
Rate for Payer: Encore Health Key Benefits Commercial	$3,013.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,400.52
Rate for Payer: Healthscope Commercial	$3,390.52
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	$3,202.15
Rate for Payer: PACE Medicare	$7,030.49
Rate for Payer: PACE SWMI	$7,400.52
Rate for Payer: PHP Commercial	$3,202.15
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	$2,448.71
Rate for Payer: Priority Health Medicare	$7,400.52
Rate for Payer: Priority Health SBD	$2,373.36
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 INTRINSIC FACTOR ANTIBODIES

Facility

$48.96

Service Code	CPT 86340
Hospital Charge Code	30200200
Hospital Revenue Code	302
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$44.06
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare	$15.68
Rate for Payer: Aetna New Business (MI Preferred)	$31.82
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.85
Rate for Payer: Amish Plain Church Group Commercial	$18.85
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: BCBS MAPPO	$15.08
Rate for Payer: BCN Medicare Advantage	$15.08
Rate for Payer: Cash Price	$39.17
Rate for Payer: Cash Price	$39.17
Rate for Payer: Cofinity Commercial	$42.11
Rate for Payer: Cofinity Commercial	$34.27
Rate for Payer: Cofinity Medicare Advantage	$34.27
Rate for Payer: Encore Health Key Benefits Commercial	$39.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.08
Rate for Payer: Healthscope Commercial	$44.06
Rate for Payer: Mclaren Medicaid	$8.08
Rate for Payer: Mclaren Medicare	$15.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.83
Rate for Payer: Meridian Medicaid	$8.49
Rate for Payer: MI Amish Medical Board Commercial	$17.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.62
Rate for Payer: PACE Medicare	$14.33
Rate for Payer: PACE SWMI	$15.08
Rate for Payer: PHP Commercial	$41.62
Rate for Payer: PHP Medicare Advantage	$15.08
Rate for Payer: Priority Health Choice Medicaid	$8.08
Rate for Payer: Priority Health Cigna Priority Health	$31.82
Rate for Payer: Priority Health Medicare	$15.08
Rate for Payer: Priority Health SBD	$30.84
Rate for Payer: Railroad Medicare Medicare	$15.08
Rate for Payer: UHC All Payor (Choice/PPO)	$42.45
Rate for Payer: UHC Dual Complete DSNP	$15.08
Rate for Payer: UHC Medicare Advantage	$15.08
Rate for Payer: UHCCP Medicaid	$8.49
Rate for Payer: VA VA	$15.08

HC INTRINSIC FACTOR ANTIBODIES

Facility

$48.96

Service Code	CPT 86340
Hospital Charge Code	30200200
Hospital Revenue Code	302
Min. Negotiated Rate	$30.84
Max. Negotiated Rate	$44.06
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna New Business (MI Preferred)	$31.82
Rate for Payer: Cash Price	$39.17
Rate for Payer: Cofinity Commercial	$34.27
Rate for Payer: Cofinity Commercial	$42.11
Rate for Payer: Cofinity Medicare Advantage	$34.27
Rate for Payer: Encore Health Key Benefits Commercial	$39.17
Rate for Payer: Healthscope Commercial	$44.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.62
Rate for Payer: PHP Commercial	$41.62
Rate for Payer: Priority Health Cigna Priority Health	$31.82
Rate for Payer: Priority Health SBD	$30.84

HC INTRO AORTA TRANSLUMBAR

Facility

$3,745.44

Service Code	CPT 36160
Hospital Charge Code	36100621
Hospital Revenue Code	361
Min. Negotiated Rate	$2,359.63
Max. Negotiated Rate	$3,370.90
Rate for Payer: Aetna Commercial	$3,183.62
Rate for Payer: Aetna New Business (MI Preferred)	$2,434.54
Rate for Payer: Cash Price	$2,996.35
Rate for Payer: Cofinity Commercial	$2,621.81
Rate for Payer: Cofinity Commercial	$3,221.08
Rate for Payer: Cofinity Medicare Advantage	$2,621.81
Rate for Payer: Encore Health Key Benefits Commercial	$2,996.35
Rate for Payer: Healthscope Commercial	$3,370.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,183.62
Rate for Payer: PHP Commercial	$3,183.62
Rate for Payer: Priority Health Cigna Priority Health	$2,434.54
Rate for Payer: Priority Health SBD	$2,359.63

HC INTRO AORTA TRANSLUMBAR

Facility

$3,745.44

Service Code	CPT 36160
Hospital Charge Code	36100621
Hospital Revenue Code	361
Min. Negotiated Rate	$1,498.18
Max. Negotiated Rate	$3,370.90
Rate for Payer: Aetna Commercial	$3,183.62
Rate for Payer: Aetna Medicare	$1,872.72
Rate for Payer: Aetna New Business (MI Preferred)	$2,434.54
Rate for Payer: BCBS Complete	$1,498.18
Rate for Payer: Cash Price	$2,996.35
Rate for Payer: Cofinity Commercial	$2,621.81
Rate for Payer: Cofinity Commercial	$3,221.08
Rate for Payer: Cofinity Medicare Advantage	$2,621.81
Rate for Payer: Encore Health Key Benefits Commercial	$2,996.35
Rate for Payer: Healthscope Commercial	$3,370.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,183.62
Rate for Payer: PHP Commercial	$3,183.62
Rate for Payer: Priority Health Cigna Priority Health	$2,434.54
Rate for Payer: Priority Health SBD	$2,359.63

HC INTRODUCER

Facility

$299.58

Service Code	HCPCS C1894
Hospital Charge Code	27200049
Hospital Revenue Code	272
Min. Negotiated Rate	$188.74
Max. Negotiated Rate	$269.62
Rate for Payer: Aetna Commercial	$254.64
Rate for Payer: Aetna New Business (MI Preferred)	$194.73
Rate for Payer: Cash Price	$239.66
Rate for Payer: Cofinity Commercial	$209.71
Rate for Payer: Cofinity Commercial	$257.64
Rate for Payer: Cofinity Medicare Advantage	$209.71
Rate for Payer: Encore Health Key Benefits Commercial	$239.66
Rate for Payer: Healthscope Commercial	$269.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.64
Rate for Payer: PHP Commercial	$254.64
Rate for Payer: Priority Health Cigna Priority Health	$194.73
Rate for Payer: Priority Health SBD	$188.74

HC INTRODUCER

Facility

$299.58

Service Code	HCPCS C1894
Hospital Charge Code	27200049
Hospital Revenue Code	272
Min. Negotiated Rate	$119.83
Max. Negotiated Rate	$269.62
Rate for Payer: Aetna Commercial	$254.64
Rate for Payer: Aetna Medicare	$149.79
Rate for Payer: Aetna New Business (MI Preferred)	$194.73
Rate for Payer: BCBS Complete	$119.83
Rate for Payer: Cash Price	$239.66
Rate for Payer: Cofinity Commercial	$209.71
Rate for Payer: Cofinity Commercial	$257.64
Rate for Payer: Cofinity Medicare Advantage	$209.71
Rate for Payer: Encore Health Key Benefits Commercial	$239.66
Rate for Payer: Healthscope Commercial	$269.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.64
Rate for Payer: PHP Commercial	$254.64
Rate for Payer: Priority Health Cigna Priority Health	$194.73
Rate for Payer: Priority Health SBD	$188.74

HC INTRODUCER LONG

Facility

$254.93

Service Code	HCPCS C1894
Hospital Charge Code	27200050
Hospital Revenue Code	272
Min. Negotiated Rate	$101.97
Max. Negotiated Rate	$229.44
Rate for Payer: Aetna Commercial	$216.69
Rate for Payer: Aetna Medicare	$127.47
Rate for Payer: Aetna New Business (MI Preferred)	$165.70
Rate for Payer: BCBS Complete	$101.97
Rate for Payer: Cash Price	$203.94
Rate for Payer: Cofinity Commercial	$178.45
Rate for Payer: Cofinity Commercial	$219.24
Rate for Payer: Cofinity Medicare Advantage	$178.45
Rate for Payer: Encore Health Key Benefits Commercial	$203.94
Rate for Payer: Healthscope Commercial	$229.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.69
Rate for Payer: PHP Commercial	$216.69
Rate for Payer: Priority Health Cigna Priority Health	$165.70
Rate for Payer: Priority Health SBD	$160.61

HC INTRODUCER LONG

Facility

$254.93

Service Code	HCPCS C1894
Hospital Charge Code	27200050
Hospital Revenue Code	272
Min. Negotiated Rate	$160.61
Max. Negotiated Rate	$229.44
Rate for Payer: Aetna Commercial	$216.69
Rate for Payer: Aetna New Business (MI Preferred)	$165.70
Rate for Payer: Cash Price	$203.94
Rate for Payer: Cofinity Commercial	$178.45
Rate for Payer: Cofinity Commercial	$219.24
Rate for Payer: Cofinity Medicare Advantage	$178.45
Rate for Payer: Encore Health Key Benefits Commercial	$203.94
Rate for Payer: Healthscope Commercial	$229.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.69
Rate for Payer: PHP Commercial	$216.69
Rate for Payer: Priority Health Cigna Priority Health	$165.70
Rate for Payer: Priority Health SBD	$160.61

HC INTRODUCER REGULAR

Facility

$94.68

Service Code	HCPCS C1893
Hospital Charge Code	27200051
Hospital Revenue Code	272
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$85.21
Rate for Payer: Aetna Commercial	$80.48
Rate for Payer: Aetna New Business (MI Preferred)	$61.54
Rate for Payer: Cash Price	$75.74
Rate for Payer: Cofinity Commercial	$66.28
Rate for Payer: Cofinity Commercial	$81.42
Rate for Payer: Cofinity Medicare Advantage	$66.28
Rate for Payer: Encore Health Key Benefits Commercial	$75.74
Rate for Payer: Healthscope Commercial	$85.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.48
Rate for Payer: PHP Commercial	$80.48
Rate for Payer: Priority Health Cigna Priority Health	$61.54
Rate for Payer: Priority Health SBD	$59.65

HC INTRODUCER REGULAR

Facility

$94.68

Service Code	HCPCS C1893
Hospital Charge Code	27200051
Hospital Revenue Code	272
Min. Negotiated Rate	$37.87
Max. Negotiated Rate	$85.21
Rate for Payer: Aetna Commercial	$80.48
Rate for Payer: Aetna Medicare	$47.34
Rate for Payer: Aetna New Business (MI Preferred)	$61.54
Rate for Payer: BCBS Complete	$37.87
Rate for Payer: Cash Price	$75.74
Rate for Payer: Cofinity Commercial	$66.28
Rate for Payer: Cofinity Commercial	$81.42
Rate for Payer: Cofinity Medicare Advantage	$66.28
Rate for Payer: Encore Health Key Benefits Commercial	$75.74
Rate for Payer: Healthscope Commercial	$85.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.48
Rate for Payer: PHP Commercial	$80.48
Rate for Payer: Priority Health Cigna Priority Health	$61.54
Rate for Payer: Priority Health SBD	$59.65

HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY

Facility

$3,457.60

Service Code	CPT 50553
Hospital Charge Code	36100246
Hospital Revenue Code	361
Min. Negotiated Rate	$2,178.29
Max. Negotiated Rate	$3,111.84
Rate for Payer: Aetna Commercial	$2,938.96
Rate for Payer: Aetna New Business (MI Preferred)	$2,247.44
Rate for Payer: Cash Price	$2,766.08
Rate for Payer: Cofinity Commercial	$2,420.32
Rate for Payer: Cofinity Commercial	$2,973.54
Rate for Payer: Cofinity Medicare Advantage	$2,420.32
Rate for Payer: Encore Health Key Benefits Commercial	$2,766.08
Rate for Payer: Healthscope Commercial	$3,111.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,938.96
Rate for Payer: PHP Commercial	$2,938.96
Rate for Payer: Priority Health Cigna Priority Health	$2,247.44
Rate for Payer: Priority Health SBD	$2,178.29

HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY

Facility

$3,457.60

Service Code	CPT 50553
Hospital Charge Code	36100246
Hospital Revenue Code	361
Min. Negotiated Rate	$2,178.29
Max. Negotiated Rate	$13,956.13
Rate for Payer: Aetna Commercial	$2,938.96
Rate for Payer: Aetna Medicare	$5,156.27
Rate for Payer: Aetna New Business (MI Preferred)	$2,247.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,197.44
Rate for Payer: Amish Plain Church Group Commercial	$6,197.44
Rate for Payer: BCBS Complete	$2,790.33
Rate for Payer: BCBS MAPPO	$4,957.95
Rate for Payer: BCN Medicare Advantage	$4,957.95
Rate for Payer: Cash Price	$2,766.08
Rate for Payer: Cash Price	$2,766.08
Rate for Payer: Cofinity Commercial	$2,973.54
Rate for Payer: Cofinity Commercial	$2,420.32
Rate for Payer: Cofinity Medicare Advantage	$2,420.32
Rate for Payer: Encore Health Key Benefits Commercial	$2,766.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,957.95
Rate for Payer: Healthscope Commercial	$3,111.84
Rate for Payer: Mclaren Medicaid	$2,657.46
Rate for Payer: Mclaren Medicare	$4,957.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,205.85
Rate for Payer: Meridian Medicaid	$2,790.33
Rate for Payer: MI Amish Medical Board Commercial	$5,701.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,938.96
Rate for Payer: PACE Medicare	$4,710.05
Rate for Payer: PACE SWMI	$4,957.95
Rate for Payer: PHP Commercial	$2,938.96
Rate for Payer: PHP Medicare Advantage	$4,957.95
Rate for Payer: Priority Health Choice Medicaid	$2,657.46
Rate for Payer: Priority Health Cigna Priority Health	$2,247.44
Rate for Payer: Priority Health Medicare	$4,957.95
Rate for Payer: Priority Health SBD	$2,178.29
Rate for Payer: Railroad Medicare Medicare	$4,957.95
Rate for Payer: UHC All Payor (Choice/PPO)	$13,956.13
Rate for Payer: UHC Dual Complete DSNP	$4,957.95
Rate for Payer: UHC Medicare Advantage	$4,957.95
Rate for Payer: UHCCP Medicaid	$2,791.33
Rate for Payer: VA VA	$4,957.95

HC INTRO SHEATH NON GUIDE LVL 1

Facility

$41.77

Service Code	HCPCS C1894
Hospital Charge Code	27200276
Hospital Revenue Code	272
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$37.59
Rate for Payer: Aetna Commercial	$35.50
Rate for Payer: Aetna Medicare	$20.89
Rate for Payer: Aetna New Business (MI Preferred)	$27.15
Rate for Payer: BCBS Complete	$16.71
Rate for Payer: Cash Price	$33.42
Rate for Payer: Cofinity Commercial	$29.24
Rate for Payer: Cofinity Commercial	$35.92
Rate for Payer: Cofinity Medicare Advantage	$29.24
Rate for Payer: Encore Health Key Benefits Commercial	$33.42
Rate for Payer: Healthscope Commercial	$37.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.50
Rate for Payer: PHP Commercial	$35.50
Rate for Payer: Priority Health Cigna Priority Health	$27.15
Rate for Payer: Priority Health SBD	$26.32

HC INTRO SHEATH NON GUIDE LVL 1

Facility

$41.77

Service Code	HCPCS C1894
Hospital Charge Code	27200276
Hospital Revenue Code	272
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$37.59
Rate for Payer: Aetna Commercial	$35.50
Rate for Payer: Aetna New Business (MI Preferred)	$27.15
Rate for Payer: Cash Price	$33.42
Rate for Payer: Cofinity Commercial	$29.24
Rate for Payer: Cofinity Commercial	$35.92
Rate for Payer: Cofinity Medicare Advantage	$29.24
Rate for Payer: Encore Health Key Benefits Commercial	$33.42
Rate for Payer: Healthscope Commercial	$37.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.50
Rate for Payer: PHP Commercial	$35.50
Rate for Payer: Priority Health Cigna Priority Health	$27.15
Rate for Payer: Priority Health SBD	$26.32

HC INTRO SHEATH NON GUIDE LVL 11

Facility

$1,195.00

Service Code	HCPCS C1894
Hospital Charge Code	27200322
Hospital Revenue Code	272
Min. Negotiated Rate	$478.00
Max. Negotiated Rate	$1,075.50
Rate for Payer: Aetna Commercial	$1,015.75
Rate for Payer: Aetna Medicare	$597.50
Rate for Payer: Aetna New Business (MI Preferred)	$776.75
Rate for Payer: BCBS Complete	$478.00
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cofinity Commercial	$1,027.70
Rate for Payer: Cofinity Commercial	$836.50
Rate for Payer: Cofinity Medicare Advantage	$836.50
Rate for Payer: Encore Health Key Benefits Commercial	$956.00
Rate for Payer: Healthscope Commercial	$1,075.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,015.75
Rate for Payer: PHP Commercial	$1,015.75
Rate for Payer: Priority Health Cigna Priority Health	$776.75
Rate for Payer: Priority Health SBD	$752.85

HC INTRO SHEATH NON GUIDE LVL 11

Facility

$1,195.00

Service Code	HCPCS C1894
Hospital Charge Code	27200322
Hospital Revenue Code	272
Min. Negotiated Rate	$752.85
Max. Negotiated Rate	$1,075.50
Rate for Payer: Aetna Commercial	$1,015.75
Rate for Payer: Aetna New Business (MI Preferred)	$776.75
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cofinity Commercial	$1,027.70
Rate for Payer: Cofinity Commercial	$836.50
Rate for Payer: Cofinity Medicare Advantage	$836.50
Rate for Payer: Encore Health Key Benefits Commercial	$956.00
Rate for Payer: Healthscope Commercial	$1,075.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,015.75
Rate for Payer: PHP Commercial	$1,015.75
Rate for Payer: Priority Health Cigna Priority Health	$776.75
Rate for Payer: Priority Health SBD	$752.85

HC INTRO SHEATH NON GUIDE LVL 2

Facility

$162.30

Service Code	HCPCS C1894
Hospital Charge Code	27200020
Hospital Revenue Code	272
Min. Negotiated Rate	$64.92
Max. Negotiated Rate	$146.07
Rate for Payer: Aetna Commercial	$137.96
Rate for Payer: Aetna Medicare	$81.15
Rate for Payer: Aetna New Business (MI Preferred)	$105.50
Rate for Payer: BCBS Complete	$64.92
Rate for Payer: Cash Price	$129.84
Rate for Payer: Cofinity Commercial	$113.61
Rate for Payer: Cofinity Commercial	$139.58
Rate for Payer: Cofinity Medicare Advantage	$113.61
Rate for Payer: Encore Health Key Benefits Commercial	$129.84
Rate for Payer: Healthscope Commercial	$146.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.96
Rate for Payer: PHP Commercial	$137.96
Rate for Payer: Priority Health Cigna Priority Health	$105.50
Rate for Payer: Priority Health SBD	$102.25

HC INTRO SHEATH NON GUIDE LVL 2

Facility

$162.30

Service Code	HCPCS C1894
Hospital Charge Code	27200020
Hospital Revenue Code	272
Min. Negotiated Rate	$102.25
Max. Negotiated Rate	$146.07
Rate for Payer: Aetna Commercial	$137.96
Rate for Payer: Aetna New Business (MI Preferred)	$105.50
Rate for Payer: Cash Price	$129.84
Rate for Payer: Cofinity Commercial	$113.61
Rate for Payer: Cofinity Commercial	$139.58
Rate for Payer: Cofinity Medicare Advantage	$113.61
Rate for Payer: Encore Health Key Benefits Commercial	$129.84
Rate for Payer: Healthscope Commercial	$146.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.96
Rate for Payer: PHP Commercial	$137.96
Rate for Payer: Priority Health Cigna Priority Health	$105.50
Rate for Payer: Priority Health SBD	$102.25

HC INTRO SHEATH NON GUIDE LVL 3

Facility

$337.50

Service Code	HCPCS C1894
Hospital Charge Code	27200042
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 INTRO SHEATH NON GUIDE LVL 3

Facility

$337.50

Service Code	HCPCS C1894
Hospital Charge Code	27200042
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

Know your out-of-pocket cost for care.

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