Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC IR FIBRIN STRIPPING OF VAD

Facility

$628.94

Service Code	CPT 75901
Hospital Charge Code	32000275
Hospital Revenue Code	320
Min. Negotiated Rate	$251.58
Max. Negotiated Rate	$566.05
Rate for Payer: Aetna Commercial	$534.60
Rate for Payer: Aetna Medicare	$314.47
Rate for Payer: Aetna New Business (MI Preferred)	$408.81
Rate for Payer: BCBS Complete	$251.58
Rate for Payer: Cash Price	$503.15
Rate for Payer: Cofinity Commercial	$440.26
Rate for Payer: Cofinity Commercial	$540.89
Rate for Payer: Cofinity Medicare Advantage	$440.26
Rate for Payer: Encore Health Key Benefits Commercial	$503.15
Rate for Payer: Healthscope Commercial	$566.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$534.60
Rate for Payer: PHP Commercial	$534.60
Rate for Payer: Priority Health Cigna Priority Health	$408.81
Rate for Payer: Priority Health SBD	$396.23
Rate for Payer: UHC Core	$465.42
Rate for Payer: UHC Exchange	$465.42

HC IR FLUORO GUIDE CVA

Facility

$306.43

Service Code	CPT 77001
Hospital Charge Code	32000245
Hospital Revenue Code	320
Min. Negotiated Rate	$122.57
Max. Negotiated Rate	$275.79
Rate for Payer: Aetna Commercial	$260.47
Rate for Payer: Aetna Medicare	$153.22
Rate for Payer: Aetna New Business (MI Preferred)	$199.18
Rate for Payer: BCBS Complete	$122.57
Rate for Payer: Cash Price	$245.14
Rate for Payer: Cofinity Commercial	$214.50
Rate for Payer: Cofinity Commercial	$263.53
Rate for Payer: Cofinity Medicare Advantage	$214.50
Rate for Payer: Encore Health Key Benefits Commercial	$245.14
Rate for Payer: Healthscope Commercial	$275.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.47
Rate for Payer: PHP Commercial	$260.47
Rate for Payer: Priority Health Cigna Priority Health	$199.18
Rate for Payer: Priority Health SBD	$193.05
Rate for Payer: UHC Core	$226.76
Rate for Payer: UHC Exchange	$226.76

HC IR FLUORO GUIDE CVA

Facility

$306.43

Service Code	CPT 77001
Hospital Charge Code	32000245
Hospital Revenue Code	320
Min. Negotiated Rate	$193.05
Max. Negotiated Rate	$275.79
Rate for Payer: Aetna Commercial	$260.47
Rate for Payer: Aetna New Business (MI Preferred)	$199.18
Rate for Payer: Cash Price	$245.14
Rate for Payer: Cofinity Commercial	$214.50
Rate for Payer: Cofinity Commercial	$263.53
Rate for Payer: Cofinity Medicare Advantage	$214.50
Rate for Payer: Encore Health Key Benefits Commercial	$245.14
Rate for Payer: Healthscope Commercial	$275.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.47
Rate for Payer: PHP Commercial	$260.47
Rate for Payer: Priority Health Cigna Priority Health	$199.18
Rate for Payer: Priority Health SBD	$193.05

HC IR FLUOROSCOPIC GUIDE SPINE

Facility

$561.59

Service Code	CPT 77003
Hospital Charge Code	32000247
Hospital Revenue Code	320
Min. Negotiated Rate	$353.80
Max. Negotiated Rate	$505.43
Rate for Payer: Aetna Commercial	$477.35
Rate for Payer: Aetna New Business (MI Preferred)	$365.03
Rate for Payer: Cash Price	$449.27
Rate for Payer: Cofinity Commercial	$393.11
Rate for Payer: Cofinity Commercial	$482.97
Rate for Payer: Cofinity Medicare Advantage	$393.11
Rate for Payer: Encore Health Key Benefits Commercial	$449.27
Rate for Payer: Healthscope Commercial	$505.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.35
Rate for Payer: PHP Commercial	$477.35
Rate for Payer: Priority Health Cigna Priority Health	$365.03
Rate for Payer: Priority Health SBD	$353.80

HC IR FLUOROSCOPIC GUIDE SPINE

Facility

$561.59

Service Code	CPT 77003
Hospital Charge Code	32000247
Hospital Revenue Code	320
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$505.43
Rate for Payer: Aetna Commercial	$477.35
Rate for Payer: Aetna Medicare	$280.80
Rate for Payer: Aetna New Business (MI Preferred)	$365.03
Rate for Payer: BCBS Complete	$224.64
Rate for Payer: Cash Price	$449.27
Rate for Payer: Cofinity Commercial	$393.11
Rate for Payer: Cofinity Commercial	$482.97
Rate for Payer: Cofinity Medicare Advantage	$393.11
Rate for Payer: Encore Health Key Benefits Commercial	$449.27
Rate for Payer: Healthscope Commercial	$505.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.35
Rate for Payer: PHP Commercial	$477.35
Rate for Payer: Priority Health Cigna Priority Health	$365.03
Rate for Payer: Priority Health SBD	$353.80
Rate for Payer: UHC Core	$415.58
Rate for Payer: UHC Exchange	$415.58

HC IR FLUORO UP TO 1 HOUR DR TIME

Facility

$561.59

Service Code	CPT 76000
Hospital Charge Code	32000231
Hospital Revenue Code	320
Min. Negotiated Rate	$126.36
Max. Negotiated Rate	$663.58
Rate for Payer: Aetna Commercial	$477.35
Rate for Payer: Aetna Medicare	$245.17
Rate for Payer: Aetna New Business (MI Preferred)	$365.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$294.68
Rate for Payer: Amish Plain Church Group Commercial	$294.68
Rate for Payer: BCBS Complete	$132.67
Rate for Payer: BCBS MAPPO	$235.74
Rate for Payer: BCN Medicare Advantage	$235.74
Rate for Payer: Cash Price	$449.27
Rate for Payer: Cash Price	$449.27
Rate for Payer: Cofinity Commercial	$482.97
Rate for Payer: Cofinity Commercial	$393.11
Rate for Payer: Cofinity Medicare Advantage	$393.11
Rate for Payer: Encore Health Key Benefits Commercial	$449.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$235.74
Rate for Payer: Healthscope Commercial	$505.43
Rate for Payer: Mclaren Medicaid	$126.36
Rate for Payer: Mclaren Medicare	$235.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$247.53
Rate for Payer: Meridian Medicaid	$132.67
Rate for Payer: MI Amish Medical Board Commercial	$271.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.35
Rate for Payer: PACE Medicare	$223.95
Rate for Payer: PACE SWMI	$235.74
Rate for Payer: PHP Commercial	$477.35
Rate for Payer: PHP Medicare Advantage	$235.74
Rate for Payer: Priority Health Choice Medicaid	$126.36
Rate for Payer: Priority Health Cigna Priority Health	$365.03
Rate for Payer: Priority Health Medicare	$235.74
Rate for Payer: Priority Health SBD	$353.80
Rate for Payer: Railroad Medicare Medicare	$235.74
Rate for Payer: UHC All Payor (Choice/PPO)	$663.58
Rate for Payer: UHC Core	$415.58
Rate for Payer: UHC Dual Complete DSNP	$235.74
Rate for Payer: UHC Exchange	$415.58
Rate for Payer: UHC Medicare Advantage	$235.74
Rate for Payer: UHCCP Medicaid	$132.72
Rate for Payer: VA VA	$235.74

HC IR FLUORO UP TO 1 HOUR DR TIME

Facility

$561.59

Service Code	CPT 76000
Hospital Charge Code	32000231
Hospital Revenue Code	320
Min. Negotiated Rate	$353.80
Max. Negotiated Rate	$505.43
Rate for Payer: Aetna Commercial	$477.35
Rate for Payer: Aetna New Business (MI Preferred)	$365.03
Rate for Payer: Cash Price	$449.27
Rate for Payer: Cofinity Commercial	$393.11
Rate for Payer: Cofinity Commercial	$482.97
Rate for Payer: Cofinity Medicare Advantage	$393.11
Rate for Payer: Encore Health Key Benefits Commercial	$449.27
Rate for Payer: Healthscope Commercial	$505.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.35
Rate for Payer: PHP Commercial	$477.35
Rate for Payer: Priority Health Cigna Priority Health	$365.03
Rate for Payer: Priority Health SBD	$353.80

HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ

Facility

$975.38

Service Code	CPT 64454
Hospital Charge Code	36100581
Hospital Revenue Code	761
Min. Negotiated Rate	$614.49
Max. Negotiated Rate	$877.84
Rate for Payer: Aetna Commercial	$829.07
Rate for Payer: Aetna New Business (MI Preferred)	$634.00
Rate for Payer: Cash Price	$780.30
Rate for Payer: Cofinity Commercial	$682.77
Rate for Payer: Cofinity Commercial	$838.83
Rate for Payer: Cofinity Medicare Advantage	$682.77
Rate for Payer: Encore Health Key Benefits Commercial	$780.30
Rate for Payer: Healthscope Commercial	$877.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$829.07
Rate for Payer: PHP Commercial	$829.07
Rate for Payer: Priority Health Cigna Priority Health	$634.00
Rate for Payer: Priority Health SBD	$614.49

HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ

Facility

$975.38

Service Code	CPT 64454
Hospital Charge Code	36100581
Hospital Revenue Code	761
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Commercial	$829.07
Rate for Payer: Aetna Medicare	$702.42
Rate for Payer: Aetna New Business (MI Preferred)	$634.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$844.25
Rate for Payer: Amish Plain Church Group Commercial	$844.25
Rate for Payer: BCBS Complete	$380.12
Rate for Payer: BCBS MAPPO	$675.40
Rate for Payer: BCN Medicare Advantage	$675.40
Rate for Payer: Cash Price	$780.30
Rate for Payer: Cash Price	$780.30
Rate for Payer: Cofinity Commercial	$838.83
Rate for Payer: Cofinity Commercial	$682.77
Rate for Payer: Cofinity Medicare Advantage	$682.77
Rate for Payer: Encore Health Key Benefits Commercial	$780.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$675.40
Rate for Payer: Healthscope Commercial	$877.84
Rate for Payer: Mclaren Medicaid	$362.01
Rate for Payer: Mclaren Medicare	$675.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$709.17
Rate for Payer: Meridian Medicaid	$380.12
Rate for Payer: MI Amish Medical Board Commercial	$776.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$829.07
Rate for Payer: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Commercial	$829.07
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Cigna Priority Health	$634.00
Rate for Payer: Priority Health Medicare	$675.40
Rate for Payer: Priority Health SBD	$614.49
Rate for Payer: Railroad Medicare Medicare	$675.40
Rate for Payer: UHC All Payor (Choice/PPO)	$1,901.18
Rate for Payer: UHC Dual Complete DSNP	$675.40
Rate for Payer: UHC Medicare Advantage	$675.40
Rate for Payer: UHCCP Medicaid	$380.25
Rate for Payer: VA VA	$675.40

HC IR GI BILI DUCT DIL W WO STENT

Facility

$1,506.90

Service Code	CPT 74363
Hospital Charge Code	32000157
Hospital Revenue Code	320
Min. Negotiated Rate	$949.35
Max. Negotiated Rate	$1,356.21
Rate for Payer: Aetna Commercial	$1,280.87
Rate for Payer: Aetna New Business (MI Preferred)	$979.49
Rate for Payer: Cash Price	$1,205.52
Rate for Payer: Cofinity Commercial	$1,054.83
Rate for Payer: Cofinity Commercial	$1,295.93
Rate for Payer: Cofinity Medicare Advantage	$1,054.83
Rate for Payer: Encore Health Key Benefits Commercial	$1,205.52
Rate for Payer: Healthscope Commercial	$1,356.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,280.87
Rate for Payer: PHP Commercial	$1,280.87
Rate for Payer: Priority Health Cigna Priority Health	$979.49
Rate for Payer: Priority Health SBD	$949.35

HC IR GI BILI DUCT DIL W WO STENT

Facility

$1,506.90

Service Code	CPT 74363
Hospital Charge Code	32000157
Hospital Revenue Code	320
Min. Negotiated Rate	$602.76
Max. Negotiated Rate	$1,356.21
Rate for Payer: Aetna Commercial	$1,280.87
Rate for Payer: Aetna Medicare	$753.45
Rate for Payer: Aetna New Business (MI Preferred)	$979.49
Rate for Payer: BCBS Complete	$602.76
Rate for Payer: Cash Price	$1,205.52
Rate for Payer: Cofinity Commercial	$1,054.83
Rate for Payer: Cofinity Commercial	$1,295.93
Rate for Payer: Cofinity Medicare Advantage	$1,054.83
Rate for Payer: Encore Health Key Benefits Commercial	$1,205.52
Rate for Payer: Healthscope Commercial	$1,356.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,280.87
Rate for Payer: PHP Commercial	$1,280.87
Rate for Payer: Priority Health Cigna Priority Health	$979.49
Rate for Payer: Priority Health SBD	$949.35
Rate for Payer: UHC Core	$1,115.11
Rate for Payer: UHC Exchange	$1,115.11

HC IR GI INJ PREV PLACE GI TUBE FL

Facility

$2,205.59

Service Code	CPT 44799
Hospital Charge Code	36100194
Hospital Revenue Code	361
Min. Negotiated Rate	$1,389.52
Max. Negotiated Rate	$1,985.03
Rate for Payer: Aetna Commercial	$1,874.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,433.63
Rate for Payer: Cash Price	$1,764.47
Rate for Payer: Cofinity Commercial	$1,543.91
Rate for Payer: Cofinity Commercial	$1,896.81
Rate for Payer: Cofinity Medicare Advantage	$1,543.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,764.47
Rate for Payer: Healthscope Commercial	$1,985.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,874.75
Rate for Payer: PHP Commercial	$1,874.75
Rate for Payer: Priority Health Cigna Priority Health	$1,433.63
Rate for Payer: Priority Health SBD	$1,389.52

HC IR GI INJ PREV PLACE GI TUBE FL

Facility

$2,205.59

Service Code	CPT 44799
Hospital Charge Code	36100194
Hospital Revenue Code	361
Min. Negotiated Rate	$490.11
Max. Negotiated Rate	$2,573.89
Rate for Payer: Aetna Commercial	$1,874.75
Rate for Payer: Aetna Medicare	$950.96
Rate for Payer: Aetna New Business (MI Preferred)	$1,433.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,142.97
Rate for Payer: Amish Plain Church Group Commercial	$1,142.97
Rate for Payer: BCBS Complete	$514.61
Rate for Payer: BCBS MAPPO	$914.38
Rate for Payer: BCN Medicare Advantage	$914.38
Rate for Payer: Cash Price	$1,764.47
Rate for Payer: Cash Price	$1,764.47
Rate for Payer: Cofinity Commercial	$1,896.81
Rate for Payer: Cofinity Commercial	$1,543.91
Rate for Payer: Cofinity Medicare Advantage	$1,543.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,764.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$914.38
Rate for Payer: Healthscope Commercial	$1,985.03
Rate for Payer: Mclaren Medicaid	$490.11
Rate for Payer: Mclaren Medicare	$914.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$960.10
Rate for Payer: Meridian Medicaid	$514.61
Rate for Payer: MI Amish Medical Board Commercial	$1,051.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,874.75
Rate for Payer: PACE Medicare	$868.66
Rate for Payer: PACE SWMI	$914.38
Rate for Payer: PHP Commercial	$1,874.75
Rate for Payer: PHP Medicare Advantage	$914.38
Rate for Payer: Priority Health Choice Medicaid	$490.11
Rate for Payer: Priority Health Cigna Priority Health	$1,433.63
Rate for Payer: Priority Health Medicare	$914.38
Rate for Payer: Priority Health SBD	$1,389.52
Rate for Payer: Railroad Medicare Medicare	$914.38
Rate for Payer: UHC All Payor (Choice/PPO)	$2,573.89
Rate for Payer: UHC Dual Complete DSNP	$914.38
Rate for Payer: UHC Medicare Advantage	$914.38
Rate for Payer: UHCCP Medicaid	$514.80
Rate for Payer: VA VA	$914.38

HC IR GI LONG TUBE PLACEMENT GUIDANCE

Facility

$340.34

Service Code	CPT 74340
Hospital Charge Code	32000156
Hospital Revenue Code	320
Min. Negotiated Rate	$214.41
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Commercial	$289.29
Rate for Payer: Aetna New Business (MI Preferred)	$221.22
Rate for Payer: Cash Price	$272.27
Rate for Payer: Cofinity Commercial	$238.24
Rate for Payer: Cofinity Commercial	$292.69
Rate for Payer: Cofinity Medicare Advantage	$238.24
Rate for Payer: Encore Health Key Benefits Commercial	$272.27
Rate for Payer: Healthscope Commercial	$306.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.29
Rate for Payer: PHP Commercial	$289.29
Rate for Payer: Priority Health Cigna Priority Health	$221.22
Rate for Payer: Priority Health SBD	$214.41

HC IR GI LONG TUBE PLACEMENT GUIDANCE

Facility

$340.34

Service Code	CPT 74340
Hospital Charge Code	32000156
Hospital Revenue Code	320
Min. Negotiated Rate	$136.14
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Commercial	$289.29
Rate for Payer: Aetna Medicare	$170.17
Rate for Payer: Aetna New Business (MI Preferred)	$221.22
Rate for Payer: BCBS Complete	$136.14
Rate for Payer: Cash Price	$272.27
Rate for Payer: Cofinity Commercial	$238.24
Rate for Payer: Cofinity Commercial	$292.69
Rate for Payer: Cofinity Medicare Advantage	$238.24
Rate for Payer: Encore Health Key Benefits Commercial	$272.27
Rate for Payer: Healthscope Commercial	$306.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.29
Rate for Payer: PHP Commercial	$289.29
Rate for Payer: Priority Health Cigna Priority Health	$221.22
Rate for Payer: Priority Health SBD	$214.41
Rate for Payer: UHC Core	$251.85
Rate for Payer: UHC Exchange	$251.85

HC IR GUIDE FNA DIAGNOSTIC ASPIRA

Facility

$261.34

Service Code	CPT 76942
Hospital Charge Code	40200057
Hospital Revenue Code	402
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$235.21
Rate for Payer: Aetna Commercial	$222.14
Rate for Payer: Aetna New Business (MI Preferred)	$169.87
Rate for Payer: Cash Price	$209.07
Rate for Payer: Cofinity Commercial	$182.94
Rate for Payer: Cofinity Commercial	$224.75
Rate for Payer: Cofinity Medicare Advantage	$182.94
Rate for Payer: Encore Health Key Benefits Commercial	$209.07
Rate for Payer: Healthscope Commercial	$235.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.14
Rate for Payer: PHP Commercial	$222.14
Rate for Payer: Priority Health Cigna Priority Health	$169.87
Rate for Payer: Priority Health SBD	$164.64

HC IR GUIDE FNA DIAGNOSTIC ASPIRA

Facility

$261.34

Service Code	CPT 76942
Hospital Charge Code	40200057
Hospital Revenue Code	402
Min. Negotiated Rate	$104.54
Max. Negotiated Rate	$235.21
Rate for Payer: Aetna Commercial	$222.14
Rate for Payer: Aetna Medicare	$130.67
Rate for Payer: Aetna New Business (MI Preferred)	$169.87
Rate for Payer: BCBS Complete	$104.54
Rate for Payer: Cash Price	$209.07
Rate for Payer: Cofinity Commercial	$182.94
Rate for Payer: Cofinity Commercial	$224.75
Rate for Payer: Cofinity Medicare Advantage	$182.94
Rate for Payer: Encore Health Key Benefits Commercial	$209.07
Rate for Payer: Healthscope Commercial	$235.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.14
Rate for Payer: PHP Commercial	$222.14
Rate for Payer: Priority Health Cigna Priority Health	$169.87
Rate for Payer: Priority Health SBD	$164.64
Rate for Payer: UHC Core	$193.39
Rate for Payer: UHC Exchange	$193.39

HC IR GUIDE VISCERAL TISSUE AB

Facility

$388.71

Service Code	CPT 76940
Hospital Charge Code	32000244
Hospital Revenue Code	320
Min. Negotiated Rate	$155.48
Max. Negotiated Rate	$349.84
Rate for Payer: Aetna Commercial	$330.40
Rate for Payer: Aetna Medicare	$194.35
Rate for Payer: Aetna New Business (MI Preferred)	$252.66
Rate for Payer: BCBS Complete	$155.48
Rate for Payer: Cash Price	$310.97
Rate for Payer: Cofinity Commercial	$272.10
Rate for Payer: Cofinity Commercial	$334.29
Rate for Payer: Cofinity Medicare Advantage	$272.10
Rate for Payer: Encore Health Key Benefits Commercial	$310.97
Rate for Payer: Healthscope Commercial	$349.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.40
Rate for Payer: PHP Commercial	$330.40
Rate for Payer: Priority Health Cigna Priority Health	$252.66
Rate for Payer: Priority Health SBD	$244.89
Rate for Payer: UHC Core	$287.65
Rate for Payer: UHC Exchange	$287.65

HC IR GUIDE VISCERAL TISSUE AB

Facility

$388.71

Service Code	CPT 76940
Hospital Charge Code	32000244
Hospital Revenue Code	320
Min. Negotiated Rate	$244.89
Max. Negotiated Rate	$349.84
Rate for Payer: Aetna Commercial	$330.40
Rate for Payer: Aetna New Business (MI Preferred)	$252.66
Rate for Payer: Cash Price	$310.97
Rate for Payer: Cofinity Commercial	$272.10
Rate for Payer: Cofinity Commercial	$334.29
Rate for Payer: Cofinity Medicare Advantage	$272.10
Rate for Payer: Encore Health Key Benefits Commercial	$310.97
Rate for Payer: Healthscope Commercial	$349.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.40
Rate for Payer: PHP Commercial	$330.40
Rate for Payer: Priority Health Cigna Priority Health	$252.66
Rate for Payer: Priority Health SBD	$244.89

HC IR GUIDEWIRE

Facility

$44.74

Hospital Charge Code	27200306
Hospital Revenue Code	272
Min. Negotiated Rate	$28.19
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$38.03
Rate for Payer: Aetna New Business (MI Preferred)	$29.08
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cofinity Commercial	$31.32
Rate for Payer: Cofinity Commercial	$38.48
Rate for Payer: Cofinity Medicare Advantage	$31.32
Rate for Payer: Encore Health Key Benefits Commercial	$35.79
Rate for Payer: Healthscope Commercial	$40.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.03
Rate for Payer: PHP Commercial	$38.03
Rate for Payer: Priority Health Cigna Priority Health	$29.08
Rate for Payer: Priority Health SBD	$28.19

HC IR GUIDEWIRE

Facility

$44.74

Hospital Charge Code	27200306
Hospital Revenue Code	272
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$38.03
Rate for Payer: Aetna Medicare	$22.37
Rate for Payer: Aetna New Business (MI Preferred)	$29.08
Rate for Payer: BCBS Complete	$17.90
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cofinity Commercial	$31.32
Rate for Payer: Cofinity Commercial	$38.48
Rate for Payer: Cofinity Medicare Advantage	$31.32
Rate for Payer: Encore Health Key Benefits Commercial	$35.79
Rate for Payer: Healthscope Commercial	$40.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.03
Rate for Payer: PHP Commercial	$38.03
Rate for Payer: Priority Health Cigna Priority Health	$29.08
Rate for Payer: Priority Health SBD	$28.19

HC IR GU NEPHROSTOGRAM BILAT

Facility

$486.00

Service Code	CPT 74425
Hospital Charge Code	32000162
Hospital Revenue Code	320
Min. Negotiated Rate	$186.69
Max. Negotiated Rate	$980.43
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Aetna Medicare	$362.23
Rate for Payer: Aetna New Business (MI Preferred)	$315.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$435.38
Rate for Payer: Amish Plain Church Group Commercial	$435.38
Rate for Payer: BCBS Complete	$196.02
Rate for Payer: BCBS MAPPO	$348.30
Rate for Payer: BCN Medicare Advantage	$348.30
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cofinity Commercial	$417.96
Rate for Payer: Cofinity Commercial	$340.20
Rate for Payer: Cofinity Medicare Advantage	$340.20
Rate for Payer: Encore Health Key Benefits Commercial	$388.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$348.30
Rate for Payer: Healthscope Commercial	$437.40
Rate for Payer: Mclaren Medicaid	$186.69
Rate for Payer: Mclaren Medicare	$348.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$365.71
Rate for Payer: Meridian Medicaid	$196.02
Rate for Payer: MI Amish Medical Board Commercial	$400.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$413.10
Rate for Payer: PACE Medicare	$330.88
Rate for Payer: PACE SWMI	$348.30
Rate for Payer: PHP Commercial	$413.10
Rate for Payer: PHP Medicare Advantage	$348.30
Rate for Payer: Priority Health Choice Medicaid	$186.69
Rate for Payer: Priority Health Cigna Priority Health	$315.90
Rate for Payer: Priority Health Medicare	$348.30
Rate for Payer: Priority Health SBD	$306.18
Rate for Payer: Railroad Medicare Medicare	$348.30
Rate for Payer: UHC All Payor (Choice/PPO)	$980.43
Rate for Payer: UHC Core	$359.64
Rate for Payer: UHC Dual Complete DSNP	$348.30
Rate for Payer: UHC Exchange	$359.64
Rate for Payer: UHC Medicare Advantage	$348.30
Rate for Payer: UHCCP Medicaid	$196.09
Rate for Payer: VA VA	$348.30

HC IR GU NEPHROSTOGRAM BILAT

Facility

$486.00

Service Code	CPT 74425
Hospital Charge Code	32000162
Hospital Revenue Code	320
Min. Negotiated Rate	$306.18
Max. Negotiated Rate	$437.40
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Aetna New Business (MI Preferred)	$315.90
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cofinity Commercial	$340.20
Rate for Payer: Cofinity Commercial	$417.96
Rate for Payer: Cofinity Medicare Advantage	$340.20
Rate for Payer: Encore Health Key Benefits Commercial	$388.80
Rate for Payer: Healthscope Commercial	$437.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$413.10
Rate for Payer: PHP Commercial	$413.10
Rate for Payer: Priority Health Cigna Priority Health	$315.90
Rate for Payer: Priority Health SBD	$306.18

HC IR GU RENAL CYST STUDY

Facility

$825.69

Service Code	CPT 74470
Hospital Charge Code	32000167
Hospital Revenue Code	320
Min. Negotiated Rate	$286.63
Max. Negotiated Rate	$1,505.27
Rate for Payer: Aetna Commercial	$701.84
Rate for Payer: Aetna Medicare	$556.14
Rate for Payer: Aetna New Business (MI Preferred)	$536.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$668.44
Rate for Payer: Amish Plain Church Group Commercial	$668.44
Rate for Payer: BCBS Complete	$300.96
Rate for Payer: BCBS MAPPO	$534.75
Rate for Payer: BCN Medicare Advantage	$534.75
Rate for Payer: Cash Price	$660.55
Rate for Payer: Cash Price	$660.55
Rate for Payer: Cofinity Commercial	$710.09
Rate for Payer: Cofinity Commercial	$577.98
Rate for Payer: Cofinity Medicare Advantage	$577.98
Rate for Payer: Encore Health Key Benefits Commercial	$660.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$534.75
Rate for Payer: Healthscope Commercial	$743.12
Rate for Payer: Mclaren Medicaid	$286.63
Rate for Payer: Mclaren Medicare	$534.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$561.49
Rate for Payer: Meridian Medicaid	$300.96
Rate for Payer: MI Amish Medical Board Commercial	$614.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$701.84
Rate for Payer: PACE Medicare	$508.01
Rate for Payer: PACE SWMI	$534.75
Rate for Payer: PHP Commercial	$701.84
Rate for Payer: PHP Medicare Advantage	$534.75
Rate for Payer: Priority Health Choice Medicaid	$286.63
Rate for Payer: Priority Health Cigna Priority Health	$536.70
Rate for Payer: Priority Health Medicare	$534.75
Rate for Payer: Priority Health SBD	$520.18
Rate for Payer: Railroad Medicare Medicare	$534.75
Rate for Payer: UHC All Payor (Choice/PPO)	$1,505.27
Rate for Payer: UHC Core	$611.01
Rate for Payer: UHC Dual Complete DSNP	$534.75
Rate for Payer: UHC Exchange	$611.01
Rate for Payer: UHC Medicare Advantage	$534.75
Rate for Payer: UHCCP Medicaid	$301.06
Rate for Payer: VA VA	$534.75

HC IR GU RENAL CYST STUDY

Facility

$825.69

Service Code	CPT 74470
Hospital Charge Code	32000167
Hospital Revenue Code	320
Min. Negotiated Rate	$520.18
Max. Negotiated Rate	$743.12
Rate for Payer: Aetna Commercial	$701.84
Rate for Payer: Aetna New Business (MI Preferred)	$536.70
Rate for Payer: Cash Price	$660.55
Rate for Payer: Cofinity Commercial	$577.98
Rate for Payer: Cofinity Commercial	$710.09
Rate for Payer: Cofinity Medicare Advantage	$577.98
Rate for Payer: Encore Health Key Benefits Commercial	$660.55
Rate for Payer: Healthscope Commercial	$743.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$701.84
Rate for Payer: PHP Commercial	$701.84
Rate for Payer: Priority Health Cigna Priority Health	$536.70
Rate for Payer: Priority Health SBD	$520.18

Know your out-of-pocket cost for care.

All Charges