Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC LITHIUM LEVEL

Facility

$54.94

Service Code	CPT 80178
Hospital Charge Code	30100034
Hospital Revenue Code	301
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$49.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna New Business (MI Preferred)	$35.71
Rate for Payer: Cash Price	$43.95
Rate for Payer: Cofinity Commercial	$38.46
Rate for Payer: Cofinity Commercial	$47.25
Rate for Payer: Cofinity Medicare Advantage	$38.46
Rate for Payer: Encore Health Key Benefits Commercial	$43.95
Rate for Payer: Healthscope Commercial	$49.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.70
Rate for Payer: PHP Commercial	$46.70
Rate for Payer: Priority Health Cigna Priority Health	$35.71
Rate for Payer: Priority Health SBD	$34.61

HC LITHIUM LEVEL

Facility

$54.94

Service Code	CPT 80178
Hospital Charge Code	30100034
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$49.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare	$6.87
Rate for Payer: Aetna New Business (MI Preferred)	$35.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$8.26
Rate for Payer: Amish Plain Church Group Commercial	$8.26
Rate for Payer: BCBS Complete	$3.72
Rate for Payer: BCBS MAPPO	$6.61
Rate for Payer: BCBS Trust/PPO	$5.85
Rate for Payer: BCN Commercial	$5.85
Rate for Payer: BCN Medicare Advantage	$6.61
Rate for Payer: Cash Price	$43.95
Rate for Payer: Cash Price	$43.95
Rate for Payer: Cofinity Commercial	$47.25
Rate for Payer: Cofinity Commercial	$38.46
Rate for Payer: Cofinity Medicare Advantage	$38.46
Rate for Payer: Encore Health Key Benefits Commercial	$43.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.61
Rate for Payer: Healthscope Commercial	$49.45
Rate for Payer: Mclaren Medicaid	$3.54
Rate for Payer: Mclaren Medicare	$6.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6.94
Rate for Payer: Meridian Medicaid	$3.72
Rate for Payer: MI Amish Medical Board Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.70
Rate for Payer: Nomi Health Commercial	$9.92
Rate for Payer: PACE Medicare	$6.28
Rate for Payer: PACE SWMI	$6.61
Rate for Payer: PHP Commercial	$46.70
Rate for Payer: PHP Medicare Advantage	$6.61
Rate for Payer: Priority Health Choice Medicaid	$3.54
Rate for Payer: Priority Health Cigna Priority Health	$35.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6.80
Rate for Payer: Priority Health Medicare	$6.61
Rate for Payer: Priority Health Narrow Network	$5.44
Rate for Payer: Priority Health SBD	$34.61
Rate for Payer: Railroad Medicare Medicare	$6.61
Rate for Payer: UHC All Payor (Choice/PPO)	$7.93
Rate for Payer: UHC Dual Complete DSNP	$6.61
Rate for Payer: UHC Medicare Advantage	$6.61
Rate for Payer: UHCCP Medicaid	$3.72
Rate for Payer: VA VA	$6.61

HC LITHOTRIPSY

Facility

$2,852.05

Hospital Charge Code	36000072
Hospital Revenue Code	360
Min. Negotiated Rate	$1,796.79
Max. Negotiated Rate	$2,566.84
Rate for Payer: Aetna Commercial	$2,424.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,853.83
Rate for Payer: Cash Price	$2,281.64
Rate for Payer: Cofinity Commercial	$1,996.44
Rate for Payer: Cofinity Commercial	$2,452.76
Rate for Payer: Cofinity Medicare Advantage	$1,996.44
Rate for Payer: Encore Health Key Benefits Commercial	$2,281.64
Rate for Payer: Healthscope Commercial	$2,566.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,424.24
Rate for Payer: PHP Commercial	$2,424.24
Rate for Payer: Priority Health Cigna Priority Health	$1,853.83
Rate for Payer: Priority Health SBD	$1,796.79

HC LITHOTRIPSY

Facility

$2,852.05

Hospital Charge Code	36000072
Hospital Revenue Code	360
Min. Negotiated Rate	$1,140.82
Max. Negotiated Rate	$2,566.84
Rate for Payer: Aetna Commercial	$2,424.24
Rate for Payer: Aetna Medicare	$1,426.02
Rate for Payer: Aetna New Business (MI Preferred)	$1,853.83
Rate for Payer: BCBS Complete	$1,140.82
Rate for Payer: Cash Price	$2,281.64
Rate for Payer: Cofinity Commercial	$1,996.44
Rate for Payer: Cofinity Commercial	$2,452.76
Rate for Payer: Cofinity Medicare Advantage	$1,996.44
Rate for Payer: Encore Health Key Benefits Commercial	$2,281.64
Rate for Payer: Healthscope Commercial	$2,566.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,424.24
Rate for Payer: PHP Commercial	$2,424.24
Rate for Payer: Priority Health Cigna Priority Health	$1,853.83
Rate for Payer: Priority Health SBD	$1,796.79

HC LIVER BIOPSY

Facility

$1,478.99

Hospital Charge Code	36000073
Hospital Revenue Code	360
Min. Negotiated Rate	$931.76
Max. Negotiated Rate	$1,331.09
Rate for Payer: Aetna Commercial	$1,257.14
Rate for Payer: Aetna New Business (MI Preferred)	$961.34
Rate for Payer: Cash Price	$1,183.19
Rate for Payer: Cofinity Commercial	$1,035.29
Rate for Payer: Cofinity Commercial	$1,271.93
Rate for Payer: Cofinity Medicare Advantage	$1,035.29
Rate for Payer: Encore Health Key Benefits Commercial	$1,183.19
Rate for Payer: Healthscope Commercial	$1,331.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,257.14
Rate for Payer: PHP Commercial	$1,257.14
Rate for Payer: Priority Health Cigna Priority Health	$961.34
Rate for Payer: Priority Health SBD	$931.76

HC LIVER BIOPSY

Facility

$1,478.99

Hospital Charge Code	36000073
Hospital Revenue Code	360
Min. Negotiated Rate	$591.60
Max. Negotiated Rate	$1,331.09
Rate for Payer: Aetna Commercial	$1,257.14
Rate for Payer: Aetna Medicare	$739.50
Rate for Payer: Aetna New Business (MI Preferred)	$961.34
Rate for Payer: BCBS Complete	$591.60
Rate for Payer: Cash Price	$1,183.19
Rate for Payer: Cofinity Commercial	$1,035.29
Rate for Payer: Cofinity Commercial	$1,271.93
Rate for Payer: Cofinity Medicare Advantage	$1,035.29
Rate for Payer: Encore Health Key Benefits Commercial	$1,183.19
Rate for Payer: Healthscope Commercial	$1,331.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,257.14
Rate for Payer: PHP Commercial	$1,257.14
Rate for Payer: Priority Health Cigna Priority Health	$961.34
Rate for Payer: Priority Health SBD	$931.76

HC LIVER KIDNEY MICROSOME ANTIBODY

Facility

$56.60

Service Code	CPT 86376
Hospital Charge Code	30200208
Hospital Revenue Code	302
Min. Negotiated Rate	$35.66
Max. Negotiated Rate	$50.94
Rate for Payer: Aetna Commercial	$48.11
Rate for Payer: Aetna New Business (MI Preferred)	$36.79
Rate for Payer: Cash Price	$45.28
Rate for Payer: Cofinity Commercial	$39.62
Rate for Payer: Cofinity Commercial	$48.68
Rate for Payer: Cofinity Medicare Advantage	$39.62
Rate for Payer: Encore Health Key Benefits Commercial	$45.28
Rate for Payer: Healthscope Commercial	$50.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.11
Rate for Payer: PHP Commercial	$48.11
Rate for Payer: Priority Health Cigna Priority Health	$36.79
Rate for Payer: Priority Health SBD	$35.66

HC LIVER KIDNEY MICROSOME ANTIBODY

Facility

$56.60

Service Code	CPT 86376
Hospital Charge Code	30200208
Hospital Revenue Code	302
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$50.94
Rate for Payer: Aetna Commercial	$48.11
Rate for Payer: Aetna Medicare	$15.13
Rate for Payer: Aetna New Business (MI Preferred)	$36.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.19
Rate for Payer: Amish Plain Church Group Commercial	$18.19
Rate for Payer: BCBS Complete	$8.19
Rate for Payer: BCBS MAPPO	$14.55
Rate for Payer: BCBS Trust/PPO	$12.88
Rate for Payer: BCN Commercial	$12.88
Rate for Payer: BCN Medicare Advantage	$14.55
Rate for Payer: Cash Price	$45.28
Rate for Payer: Cash Price	$45.28
Rate for Payer: Cofinity Commercial	$48.68
Rate for Payer: Cofinity Commercial	$39.62
Rate for Payer: Cofinity Medicare Advantage	$39.62
Rate for Payer: Encore Health Key Benefits Commercial	$45.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.55
Rate for Payer: Healthscope Commercial	$50.94
Rate for Payer: Mclaren Medicaid	$7.80
Rate for Payer: Mclaren Medicare	$14.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.28
Rate for Payer: Meridian Medicaid	$8.19
Rate for Payer: MI Amish Medical Board Commercial	$16.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.11
Rate for Payer: Nomi Health Commercial	$21.82
Rate for Payer: PACE Medicare	$13.82
Rate for Payer: PACE SWMI	$14.55
Rate for Payer: PHP Commercial	$48.11
Rate for Payer: PHP Medicare Advantage	$14.55
Rate for Payer: Priority Health Choice Medicaid	$7.80
Rate for Payer: Priority Health Cigna Priority Health	$36.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.97
Rate for Payer: Priority Health Medicare	$14.55
Rate for Payer: Priority Health Narrow Network	$11.98
Rate for Payer: Priority Health SBD	$35.66
Rate for Payer: Railroad Medicare Medicare	$14.55
Rate for Payer: UHC All Payor (Choice/PPO)	$17.46
Rate for Payer: UHC Dual Complete DSNP	$14.55
Rate for Payer: UHC Medicare Advantage	$14.55
Rate for Payer: UHCCP Medicaid	$8.19
Rate for Payer: VA VA	$14.55

HC LOBSTER IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200045
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health SBD	$16.00

HC LOBSTER IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200045
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$2.94
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.63
Rate for Payer: BCN Commercial	$4.63
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Mclaren Medicaid	$2.80
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.48
Rate for Payer: Meridian Medicaid	$2.94
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: Nomi Health Commercial	$7.83
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.37
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health Narrow Network	$4.30
Rate for Payer: Priority Health SBD	$16.00
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Medicare Advantage	$5.22
Rate for Payer: UHCCP Medicaid	$2.94
Rate for Payer: VA VA	$5.22

HC LOCAL ANES ADDL 15 MIN

Facility

$96.37

Hospital Charge Code	37000009
Hospital Revenue Code	370
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$86.73
Rate for Payer: Aetna Commercial	$81.91
Rate for Payer: Aetna Medicare	$48.18
Rate for Payer: Aetna New Business (MI Preferred)	$62.64
Rate for Payer: BCBS Complete	$38.55
Rate for Payer: Cash Price	$77.10
Rate for Payer: Cofinity Commercial	$67.46
Rate for Payer: Cofinity Commercial	$82.88
Rate for Payer: Cofinity Medicare Advantage	$67.46
Rate for Payer: Encore Health Key Benefits Commercial	$77.10
Rate for Payer: Healthscope Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.91
Rate for Payer: PHP Commercial	$81.91
Rate for Payer: Priority Health Cigna Priority Health	$62.64
Rate for Payer: Priority Health SBD	$60.71

HC LOCAL ANES ADDL 15 MIN

Facility

$96.37

Hospital Charge Code	37000009
Hospital Revenue Code	370
Min. Negotiated Rate	$60.71
Max. Negotiated Rate	$86.73
Rate for Payer: Aetna Commercial	$81.91
Rate for Payer: Aetna New Business (MI Preferred)	$62.64
Rate for Payer: Cash Price	$77.10
Rate for Payer: Cofinity Commercial	$67.46
Rate for Payer: Cofinity Commercial	$82.88
Rate for Payer: Cofinity Medicare Advantage	$67.46
Rate for Payer: Encore Health Key Benefits Commercial	$77.10
Rate for Payer: Healthscope Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.91
Rate for Payer: PHP Commercial	$81.91
Rate for Payer: Priority Health Cigna Priority Health	$62.64
Rate for Payer: Priority Health SBD	$60.71

HC LOCAL ANES INIT 30 MIN

Facility

$349.64

Hospital Charge Code	37000010
Hospital Revenue Code	370
Min. Negotiated Rate	$139.86
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$297.19
Rate for Payer: Aetna Medicare	$174.82
Rate for Payer: Aetna New Business (MI Preferred)	$227.27
Rate for Payer: BCBS Complete	$139.86
Rate for Payer: Cash Price	$279.71
Rate for Payer: Cofinity Commercial	$244.75
Rate for Payer: Cofinity Commercial	$300.69
Rate for Payer: Cofinity Medicare Advantage	$244.75
Rate for Payer: Encore Health Key Benefits Commercial	$279.71
Rate for Payer: Healthscope Commercial	$314.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.19
Rate for Payer: PHP Commercial	$297.19
Rate for Payer: Priority Health Cigna Priority Health	$227.27
Rate for Payer: Priority Health SBD	$220.27

HC LOCAL ANES INIT 30 MIN

Facility

$349.64

Hospital Charge Code	37000010
Hospital Revenue Code	370
Min. Negotiated Rate	$220.27
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$297.19
Rate for Payer: Aetna New Business (MI Preferred)	$227.27
Rate for Payer: Cash Price	$279.71
Rate for Payer: Cofinity Commercial	$244.75
Rate for Payer: Cofinity Commercial	$300.69
Rate for Payer: Cofinity Medicare Advantage	$244.75
Rate for Payer: Encore Health Key Benefits Commercial	$279.71
Rate for Payer: Healthscope Commercial	$314.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.19
Rate for Payer: PHP Commercial	$297.19
Rate for Payer: Priority Health Cigna Priority Health	$227.27
Rate for Payer: Priority Health SBD	$220.27

HC LOCALIZATION CLIP

Facility

$206.83

Service Code	HCPCS A4648
Hospital Charge Code	27800040
Hospital Revenue Code	278
Min. Negotiated Rate	$82.73
Max. Negotiated Rate	$186.15
Rate for Payer: Aetna Commercial	$175.81
Rate for Payer: Aetna Medicare	$103.42
Rate for Payer: Aetna New Business (MI Preferred)	$134.44
Rate for Payer: BCBS Complete	$82.73
Rate for Payer: Cash Price	$165.46
Rate for Payer: Cofinity Commercial	$144.78
Rate for Payer: Cofinity Commercial	$177.87
Rate for Payer: Cofinity Medicare Advantage	$144.78
Rate for Payer: Encore Health Key Benefits Commercial	$165.46
Rate for Payer: Healthscope Commercial	$186.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.81
Rate for Payer: PHP Commercial	$175.81
Rate for Payer: Priority Health Cigna Priority Health	$134.44
Rate for Payer: Priority Health SBD	$130.30

HC LOCALIZATION CLIP

Facility

$206.83

Service Code	HCPCS A4648
Hospital Charge Code	27800040
Hospital Revenue Code	278
Min. Negotiated Rate	$130.30
Max. Negotiated Rate	$186.15
Rate for Payer: Aetna Commercial	$175.81
Rate for Payer: Aetna New Business (MI Preferred)	$134.44
Rate for Payer: Cash Price	$165.46
Rate for Payer: Cofinity Commercial	$144.78
Rate for Payer: Cofinity Commercial	$177.87
Rate for Payer: Cofinity Medicare Advantage	$144.78
Rate for Payer: Encore Health Key Benefits Commercial	$165.46
Rate for Payer: Healthscope Commercial	$186.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.81
Rate for Payer: PHP Commercial	$175.81
Rate for Payer: Priority Health Cigna Priority Health	$134.44
Rate for Payer: Priority Health SBD	$130.30

HC LOCALIZATION DEVICE LEVEL 1

Facility

$146.88

Service Code	HCPCS A4648
Hospital Charge Code	27800350
Hospital Revenue Code	278
Min. Negotiated Rate	$92.53
Max. Negotiated Rate	$132.19
Rate for Payer: Aetna Commercial	$124.85
Rate for Payer: Aetna New Business (MI Preferred)	$95.47
Rate for Payer: Cash Price	$117.50
Rate for Payer: Cofinity Commercial	$102.82
Rate for Payer: Cofinity Commercial	$126.32
Rate for Payer: Cofinity Medicare Advantage	$102.82
Rate for Payer: Encore Health Key Benefits Commercial	$117.50
Rate for Payer: Healthscope Commercial	$132.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.85
Rate for Payer: PHP Commercial	$124.85
Rate for Payer: Priority Health Cigna Priority Health	$95.47
Rate for Payer: Priority Health SBD	$92.53

HC LOCALIZATION DEVICE LEVEL 1

Facility

$146.88

Service Code	HCPCS A4648
Hospital Charge Code	27800350
Hospital Revenue Code	278
Min. Negotiated Rate	$58.75
Max. Negotiated Rate	$132.19
Rate for Payer: Aetna Commercial	$124.85
Rate for Payer: Aetna Medicare	$73.44
Rate for Payer: Aetna New Business (MI Preferred)	$95.47
Rate for Payer: BCBS Complete	$58.75
Rate for Payer: Cash Price	$117.50
Rate for Payer: Cofinity Commercial	$102.82
Rate for Payer: Cofinity Commercial	$126.32
Rate for Payer: Cofinity Medicare Advantage	$102.82
Rate for Payer: Encore Health Key Benefits Commercial	$117.50
Rate for Payer: Healthscope Commercial	$132.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.85
Rate for Payer: PHP Commercial	$124.85
Rate for Payer: Priority Health Cigna Priority Health	$95.47
Rate for Payer: Priority Health SBD	$92.53

HC LOC INFIL W/CS 15 MIN

Facility

$144.37

Hospital Charge Code	37000007
Hospital Revenue Code	370
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$129.93
Rate for Payer: Aetna Commercial	$122.71
Rate for Payer: Aetna Medicare	$72.18
Rate for Payer: Aetna New Business (MI Preferred)	$93.84
Rate for Payer: BCBS Complete	$57.75
Rate for Payer: Cash Price	$115.50
Rate for Payer: Cofinity Commercial	$101.06
Rate for Payer: Cofinity Commercial	$124.16
Rate for Payer: Cofinity Medicare Advantage	$101.06
Rate for Payer: Encore Health Key Benefits Commercial	$115.50
Rate for Payer: Healthscope Commercial	$129.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.71
Rate for Payer: PHP Commercial	$122.71
Rate for Payer: Priority Health Cigna Priority Health	$93.84
Rate for Payer: Priority Health SBD	$90.95

HC LOC INFIL W/CS 15 MIN

Facility

$144.37

Hospital Charge Code	37000007
Hospital Revenue Code	370
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$129.93
Rate for Payer: Aetna Commercial	$122.71
Rate for Payer: Aetna New Business (MI Preferred)	$93.84
Rate for Payer: Cash Price	$115.50
Rate for Payer: Cofinity Commercial	$101.06
Rate for Payer: Cofinity Commercial	$124.16
Rate for Payer: Cofinity Medicare Advantage	$101.06
Rate for Payer: Encore Health Key Benefits Commercial	$115.50
Rate for Payer: Healthscope Commercial	$129.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.71
Rate for Payer: PHP Commercial	$122.71
Rate for Payer: Priority Health Cigna Priority Health	$93.84
Rate for Payer: Priority Health SBD	$90.95

HC LOC INFIL W/CS 30 MIN

Facility

$721.58

Hospital Charge Code	37000008
Hospital Revenue Code	370
Min. Negotiated Rate	$454.60
Max. Negotiated Rate	$649.42
Rate for Payer: Aetna Commercial	$613.34
Rate for Payer: Aetna New Business (MI Preferred)	$469.03
Rate for Payer: Cash Price	$577.26
Rate for Payer: Cofinity Commercial	$505.11
Rate for Payer: Cofinity Commercial	$620.56
Rate for Payer: Cofinity Medicare Advantage	$505.11
Rate for Payer: Encore Health Key Benefits Commercial	$577.26
Rate for Payer: Healthscope Commercial	$649.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$613.34
Rate for Payer: PHP Commercial	$613.34
Rate for Payer: Priority Health Cigna Priority Health	$469.03
Rate for Payer: Priority Health SBD	$454.60

HC LOC INFIL W/CS 30 MIN

Facility

$721.58

Hospital Charge Code	37000008
Hospital Revenue Code	370
Min. Negotiated Rate	$288.63
Max. Negotiated Rate	$649.42
Rate for Payer: Aetna Commercial	$613.34
Rate for Payer: Aetna Medicare	$360.79
Rate for Payer: Aetna New Business (MI Preferred)	$469.03
Rate for Payer: BCBS Complete	$288.63
Rate for Payer: Cash Price	$577.26
Rate for Payer: Cofinity Commercial	$505.11
Rate for Payer: Cofinity Commercial	$620.56
Rate for Payer: Cofinity Medicare Advantage	$505.11
Rate for Payer: Encore Health Key Benefits Commercial	$577.26
Rate for Payer: Healthscope Commercial	$649.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$613.34
Rate for Payer: PHP Commercial	$613.34
Rate for Payer: Priority Health Cigna Priority Health	$469.03
Rate for Payer: Priority Health SBD	$454.60

HC LOCM 100-199 MG/ML IODINE/ML1

Facility

$3.75

Service Code	HCPCS Q9965
Hospital Charge Code	25500002
Hospital Revenue Code	255
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna Medicare	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: BCBS Trust/PPO	$2.27
Rate for Payer: BCN Commercial	$2.27
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

HC LOCM 100-199 MG/ML IODINE/ML1

Facility

$3.75

Service Code	HCPCS Q9965
Hospital Charge Code	25500002
Hospital Revenue Code	255
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

HC LOOP AV 3/8 INCH OR 1/2 INCH

Facility

$216.04

Hospital Charge Code	27000444
Hospital Revenue Code	270
Min. Negotiated Rate	$86.42
Max. Negotiated Rate	$194.44
Rate for Payer: Aetna Commercial	$183.63
Rate for Payer: Aetna Medicare	$108.02
Rate for Payer: Aetna New Business (MI Preferred)	$140.43
Rate for Payer: BCBS Complete	$86.42
Rate for Payer: Cash Price	$172.83
Rate for Payer: Cofinity Commercial	$151.23
Rate for Payer: Cofinity Commercial	$185.79
Rate for Payer: Cofinity Medicare Advantage	$151.23
Rate for Payer: Encore Health Key Benefits Commercial	$172.83
Rate for Payer: Healthscope Commercial	$194.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.63
Rate for Payer: PHP Commercial	$183.63
Rate for Payer: Priority Health Cigna Priority Health	$140.43
Rate for Payer: Priority Health SBD	$136.11

Know your out-of-pocket cost for care.

All Charges