Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC VERPLSTY W WO BONE BX L S 1ST

Facility

$4,321.70

Service Code	CPT 22511
Hospital Charge Code	36100464
Hospital Revenue Code	361
Min. Negotiated Rate	$395.55
Max. Negotiated Rate	$8,817.68
Rate for Payer: Aetna Commercial	$3,673.44
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$2,809.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$2,282.66
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$3,457.36
Rate for Payer: Cash Price	$3,457.36
Rate for Payer: Cofinity Commercial	$3,716.66
Rate for Payer: Cofinity Commercial	$3,025.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$3,889.53
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,673.44
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$3,673.44
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$3,025.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,817.68
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health Narrow Network	$7,054.14
Rate for Payer: Priority Health SBD	$2,722.67
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$435.10
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$395.55
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

HC VERSACROSS KIT

Facility

$3,570.00

Hospital Charge Code	27200346
Hospital Revenue Code	272
Min. Negotiated Rate	$2,249.10
Max. Negotiated Rate	$3,213.00
Rate for Payer: Aetna Commercial	$3,034.50
Rate for Payer: Aetna New Business (MI Preferred)	$2,320.50
Rate for Payer: Cash Price	$2,856.00
Rate for Payer: Cofinity Commercial	$2,499.00
Rate for Payer: Cofinity Commercial	$3,070.20
Rate for Payer: Healthscope Commercial	$3,213.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,034.50
Rate for Payer: PHP Commercial	$3,034.50
Rate for Payer: Priority Health Cigna Priority Health	$2,499.00
Rate for Payer: Priority Health SBD	$2,249.10

HC VERSACROSS KIT

Facility

$3,570.00

Hospital Charge Code	27200346
Hospital Revenue Code	272
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$3,213.00
Rate for Payer: Aetna Commercial	$3,034.50
Rate for Payer: Aetna New Business (MI Preferred)	$2,320.50
Rate for Payer: BCBS Complete	$1,428.00
Rate for Payer: Cash Price	$2,856.00
Rate for Payer: Cofinity Commercial	$2,499.00
Rate for Payer: Cofinity Commercial	$3,070.20
Rate for Payer: Healthscope Commercial	$3,213.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,034.50
Rate for Payer: PHP Commercial	$3,034.50
Rate for Payer: Priority Health Cigna Priority Health	$2,499.00
Rate for Payer: Priority Health SBD	$2,249.10

HC VERT AUG W MECH DEV EA ADD

Facility

$11,379.21

Service Code	CPT 22515
Hospital Charge Code	36100469
Hospital Revenue Code	361
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$11,057.91
Rate for Payer: Aetna Commercial	$9,672.33
Rate for Payer: Aetna New Business (MI Preferred)	$7,396.49
Rate for Payer: BCBS Complete	$4,551.68
Rate for Payer: BCBS Trust/PPO	$11,057.91
Rate for Payer: Cash Price	$9,103.37
Rate for Payer: Cash Price	$9,103.37
Rate for Payer: Cofinity Commercial	$7,965.45
Rate for Payer: Cofinity Commercial	$9,786.12
Rate for Payer: Healthscope Commercial	$10,241.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,672.33
Rate for Payer: PHP Commercial	$9,672.33
Rate for Payer: Priority Health Cigna Priority Health	$7,965.45
Rate for Payer: Priority Health SBD	$7,168.90
Rate for Payer: UHC All Payor (Choice/PPO)	$232.32
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$211.20

HC VERT AUG W MECH DEV EA ADD

Facility

$11,379.21

Service Code	CPT 22515
Hospital Charge Code	36100469
Hospital Revenue Code	361
Min. Negotiated Rate	$7,168.90
Max. Negotiated Rate	$10,241.29
Rate for Payer: Aetna Commercial	$9,672.33
Rate for Payer: Aetna New Business (MI Preferred)	$7,396.49
Rate for Payer: Cash Price	$9,103.37
Rate for Payer: Cofinity Commercial	$7,965.45
Rate for Payer: Cofinity Commercial	$9,786.12
Rate for Payer: Healthscope Commercial	$10,241.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,672.33
Rate for Payer: PHP Commercial	$9,672.33
Rate for Payer: Priority Health Cigna Priority Health	$7,965.45
Rate for Payer: Priority Health SBD	$7,168.90

HC VERT AUG W MECH DEV LUMB 1ST

Facility

$10,344.74

Service Code	CPT 22514
Hospital Charge Code	36100468
Hospital Revenue Code	361
Min. Negotiated Rate	$6,517.19
Max. Negotiated Rate	$9,310.27
Rate for Payer: Aetna Commercial	$8,793.03
Rate for Payer: Aetna New Business (MI Preferred)	$6,724.08
Rate for Payer: Cash Price	$8,275.79
Rate for Payer: Cofinity Commercial	$8,896.48
Rate for Payer: Cofinity Commercial	$7,241.32
Rate for Payer: Healthscope Commercial	$9,310.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,793.03
Rate for Payer: PHP Commercial	$8,793.03
Rate for Payer: Priority Health Cigna Priority Health	$7,241.32
Rate for Payer: Priority Health SBD	$6,517.19

HC VERT AUG W MECH DEV LUMB 1ST

Facility

$10,344.74

Service Code	CPT 22514
Hospital Charge Code	36100468
Hospital Revenue Code	361
Min. Negotiated Rate	$464.31
Max. Negotiated Rate	$19,502.65
Rate for Payer: Aetna Commercial	$8,793.03
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$6,724.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$5,393.74
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$8,275.79
Rate for Payer: Cash Price	$8,275.79
Rate for Payer: Cofinity Commercial	$7,241.32
Rate for Payer: Cofinity Commercial	$8,896.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$9,310.27
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,793.03
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$8,793.03
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$7,241.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,502.65
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,602.12
Rate for Payer: Priority Health SBD	$6,517.19
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$510.74
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$464.31
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

HC VERT AUG W MECH DEV THOR 1ST

Facility

$10,344.74

Service Code	CPT 22513
Hospital Charge Code	36100467
Hospital Revenue Code	361
Min. Negotiated Rate	$6,517.19
Max. Negotiated Rate	$9,310.27
Rate for Payer: Aetna Commercial	$8,793.03
Rate for Payer: Aetna New Business (MI Preferred)	$6,724.08
Rate for Payer: Cash Price	$8,275.79
Rate for Payer: Cofinity Commercial	$7,241.32
Rate for Payer: Cofinity Commercial	$8,896.48
Rate for Payer: Healthscope Commercial	$9,310.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,793.03
Rate for Payer: PHP Commercial	$8,793.03
Rate for Payer: Priority Health Cigna Priority Health	$7,241.32
Rate for Payer: Priority Health SBD	$6,517.19

HC VERT AUG W MECH DEV THOR 1ST

Facility

$10,344.74

Service Code	CPT 22513
Hospital Charge Code	36100467
Hospital Revenue Code	361
Min. Negotiated Rate	$498.04
Max. Negotiated Rate	$19,502.65
Rate for Payer: Aetna Commercial	$8,793.03
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$6,724.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$5,325.22
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$8,275.79
Rate for Payer: Cash Price	$8,275.79
Rate for Payer: Cofinity Commercial	$8,896.48
Rate for Payer: Cofinity Commercial	$7,241.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$9,310.27
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,793.03
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$8,793.03
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$7,241.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,502.65
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,602.12
Rate for Payer: Priority Health SBD	$6,517.19
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$547.84
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$498.04
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

HC VERTEBROPLASTY CEMENT

Facility

$1,226.49

Service Code	HCPCS C1713
Hospital Charge Code	27800112
Hospital Revenue Code	278
Min. Negotiated Rate	$490.60
Max. Negotiated Rate	$1,103.84
Rate for Payer: Aetna Commercial	$1,042.52
Rate for Payer: Aetna New Business (MI Preferred)	$797.22
Rate for Payer: BCBS Complete	$490.60
Rate for Payer: Cash Price	$981.19
Rate for Payer: Cofinity Commercial	$1,054.78
Rate for Payer: Cofinity Commercial	$858.54
Rate for Payer: Healthscope Commercial	$1,103.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,042.52
Rate for Payer: PHP Commercial	$1,042.52
Rate for Payer: Priority Health Cigna Priority Health	$858.54
Rate for Payer: Priority Health SBD	$772.69

HC VERTEBROPLASTY CEMENT

Facility

$1,226.49

Service Code	HCPCS C1713
Hospital Charge Code	27800112
Hospital Revenue Code	278
Min. Negotiated Rate	$772.69
Max. Negotiated Rate	$1,103.84
Rate for Payer: Aetna Commercial	$1,042.52
Rate for Payer: Aetna New Business (MI Preferred)	$797.22
Rate for Payer: Cash Price	$981.19
Rate for Payer: Cofinity Commercial	$1,054.78
Rate for Payer: Cofinity Commercial	$858.54
Rate for Payer: Healthscope Commercial	$1,103.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,042.52
Rate for Payer: PHP Commercial	$1,042.52
Rate for Payer: Priority Health Cigna Priority Health	$858.54
Rate for Payer: Priority Health SBD	$772.69

HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING

Facility

$6,140.04

Service Code	CPT 0201T
Hospital Charge Code	36100298
Hospital Revenue Code	361
Min. Negotiated Rate	$3,868.23
Max. Negotiated Rate	$5,526.04
Rate for Payer: Aetna Commercial	$5,219.03
Rate for Payer: Aetna New Business (MI Preferred)	$3,991.03
Rate for Payer: Cash Price	$4,912.03
Rate for Payer: Cofinity Commercial	$4,298.03
Rate for Payer: Cofinity Commercial	$5,280.43
Rate for Payer: Healthscope Commercial	$5,526.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,219.03
Rate for Payer: PHP Commercial	$5,219.03
Rate for Payer: Priority Health Cigna Priority Health	$4,298.03
Rate for Payer: Priority Health SBD	$3,868.23

HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING

Facility

$6,140.04

Service Code	CPT 0201T
Hospital Charge Code	36100298
Hospital Revenue Code	361
Min. Negotiated Rate	$3,482.00
Max. Negotiated Rate	$19,834.21
Rate for Payer: Aetna Commercial	$5,219.03
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$3,991.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$4,912.03
Rate for Payer: Cash Price	$4,912.03
Rate for Payer: Cofinity Commercial	$4,298.03
Rate for Payer: Cofinity Commercial	$5,280.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$5,526.04
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,219.03
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$5,219.03
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$4,298.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,834.21
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,867.37
Rate for Payer: Priority Health SBD	$3,868.23
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING

Facility

$4,912.03

Service Code	CPT 0200T
Hospital Charge Code	36100299
Hospital Revenue Code	361
Min. Negotiated Rate	$3,094.58
Max. Negotiated Rate	$19,834.21
Rate for Payer: Aetna Commercial	$4,175.23
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$3,192.82
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$3,929.62
Rate for Payer: Cash Price	$3,929.62
Rate for Payer: Cofinity Commercial	$4,224.35
Rate for Payer: Cofinity Commercial	$3,438.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$4,420.83
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,175.23
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$4,175.23
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$3,438.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,834.21
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,867.37
Rate for Payer: Priority Health SBD	$3,094.58
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING

Facility

$4,912.03

Service Code	CPT 0200T
Hospital Charge Code	36100299
Hospital Revenue Code	361
Min. Negotiated Rate	$3,094.58
Max. Negotiated Rate	$4,420.83
Rate for Payer: Aetna Commercial	$4,175.23
Rate for Payer: Aetna New Business (MI Preferred)	$3,192.82
Rate for Payer: Cash Price	$3,929.62
Rate for Payer: Cofinity Commercial	$3,438.42
Rate for Payer: Cofinity Commercial	$4,224.35
Rate for Payer: Healthscope Commercial	$4,420.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,175.23
Rate for Payer: PHP Commercial	$4,175.23
Rate for Payer: Priority Health Cigna Priority Health	$3,438.42
Rate for Payer: Priority Health SBD	$3,094.58

HC VEST SUPPLY

Facility

$455.60

Hospital Charge Code	27000169
Hospital Revenue Code	270
Min. Negotiated Rate	$182.24
Max. Negotiated Rate	$410.04
Rate for Payer: Aetna Commercial	$387.26
Rate for Payer: Aetna New Business (MI Preferred)	$296.14
Rate for Payer: BCBS Complete	$182.24
Rate for Payer: Cash Price	$364.48
Rate for Payer: Cofinity Commercial	$318.92
Rate for Payer: Cofinity Commercial	$391.82
Rate for Payer: Healthscope Commercial	$410.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$387.26
Rate for Payer: PHP Commercial	$387.26
Rate for Payer: Priority Health Cigna Priority Health	$318.92
Rate for Payer: Priority Health SBD	$287.03

HC VEST SUPPLY

Facility

$455.60

Hospital Charge Code	27000169
Hospital Revenue Code	270
Min. Negotiated Rate	$287.03
Max. Negotiated Rate	$410.04
Rate for Payer: Aetna Commercial	$387.26
Rate for Payer: Aetna New Business (MI Preferred)	$296.14
Rate for Payer: Cash Price	$364.48
Rate for Payer: Cofinity Commercial	$318.92
Rate for Payer: Cofinity Commercial	$391.82
Rate for Payer: Healthscope Commercial	$410.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$387.26
Rate for Payer: PHP Commercial	$387.26
Rate for Payer: Priority Health Cigna Priority Health	$318.92
Rate for Payer: Priority Health SBD	$287.03

HC VIABAHN 2

Facility

$7,954.90

Service Code	HCPCS C1874
Hospital Charge Code	27800034
Hospital Revenue Code	278
Min. Negotiated Rate	$3,181.96
Max. Negotiated Rate	$7,159.41
Rate for Payer: Aetna Commercial	$6,761.66
Rate for Payer: Aetna New Business (MI Preferred)	$5,170.68
Rate for Payer: BCBS Complete	$3,181.96
Rate for Payer: Cash Price	$6,363.92
Rate for Payer: Cofinity Commercial	$5,568.43
Rate for Payer: Cofinity Commercial	$6,841.21
Rate for Payer: Healthscope Commercial	$7,159.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,761.66
Rate for Payer: PHP Commercial	$6,761.66
Rate for Payer: Priority Health Cigna Priority Health	$5,568.43
Rate for Payer: Priority Health SBD	$5,011.59

HC VIABAHN 2

Facility

$7,954.90

Service Code	HCPCS C1874
Hospital Charge Code	27800034
Hospital Revenue Code	278
Min. Negotiated Rate	$5,011.59
Max. Negotiated Rate	$7,159.41
Rate for Payer: Aetna Commercial	$6,761.66
Rate for Payer: Aetna New Business (MI Preferred)	$5,170.68
Rate for Payer: Cash Price	$6,363.92
Rate for Payer: Cofinity Commercial	$5,568.43
Rate for Payer: Cofinity Commercial	$6,841.21
Rate for Payer: Healthscope Commercial	$7,159.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,761.66
Rate for Payer: PHP Commercial	$6,761.66
Rate for Payer: Priority Health Cigna Priority Health	$5,568.43
Rate for Payer: Priority Health SBD	$5,011.59

HC VISCOSITY

Facility

$69.36

Service Code	CPT 85810
Hospital Charge Code	30500065
Hospital Revenue Code	305
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.96
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: Priority Health Cigna Priority Health	$48.55
Rate for Payer: Priority Health SBD	$43.70

HC VISCOSITY

Facility

$69.36

Service Code	CPT 85810
Hospital Charge Code	30500065
Hospital Revenue Code	305
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare	$12.14
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$14.59
Rate for Payer: Amish Plain Church Group Commercial	$14.59
Rate for Payer: BCBS Complete	$6.70
Rate for Payer: BCBS MAPPO	$11.67
Rate for Payer: BCBS Trust/PPO	$9.14
Rate for Payer: BCN Medicare Advantage	$11.67
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.67
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Mclaren Medicaid	$6.38
Rate for Payer: Mclaren Medicare	$11.67
Rate for Payer: Meridian Medicaid	$6.70
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.25
Rate for Payer: MI Amish Medical Board Commercial	$13.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.96
Rate for Payer: PACE Medicare	$11.09
Rate for Payer: PACE SWMI	$11.67
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: PHP Medicare Advantage	$11.67
Rate for Payer: Priority Health Choice Medicaid	$6.38
Rate for Payer: Priority Health Cigna Priority Health	$48.55
Rate for Payer: Priority Health Medicare	$11.67
Rate for Payer: Priority Health SBD	$43.70
Rate for Payer: Railroad Medicare Medicare	$11.67
Rate for Payer: UHC All Payor (Choice/PPO)	$14.00
Rate for Payer: UHC Core	$19.84
Rate for Payer: UHC Dual Complete DSNP	$11.67
Rate for Payer: UHC Exchange	$11.67
Rate for Payer: UHC Medicare Advantage	$12.02
Rate for Payer: VA VA	$11.67

HC VISIPAQUE 320 PER ML

Facility

$2.78

Service Code	HCPCS Q9967
Hospital Charge Code	63600019
Hospital Revenue Code	636
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cofinity Commercial	$1.95
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.36
Rate for Payer: PHP Commercial	$2.36
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: Priority Health SBD	$1.75

HC VISIPAQUE 320 PER ML

Facility

$2.78

Service Code	HCPCS Q9967
Hospital Charge Code	63600019
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: BCBS Complete	$1.11
Rate for Payer: BCBS Trust/PPO	$0.13
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cofinity Commercial	$1.95
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.36
Rate for Payer: PHP Commercial	$2.36
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: Priority Health SBD	$1.75

HC VISUAL ACUITY SCREEN

Facility

$38.95

Service Code	CPT 99173
Hospital Charge Code	51000099
Hospital Revenue Code	510
Min. Negotiated Rate	$24.54
Max. Negotiated Rate	$35.06
Rate for Payer: Aetna Commercial	$33.11
Rate for Payer: Aetna New Business (MI Preferred)	$25.32
Rate for Payer: Cash Price	$31.16
Rate for Payer: Cofinity Commercial	$27.26
Rate for Payer: Cofinity Commercial	$33.50
Rate for Payer: Healthscope Commercial	$35.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.11
Rate for Payer: PHP Commercial	$33.11
Rate for Payer: Priority Health Cigna Priority Health	$27.26
Rate for Payer: Priority Health SBD	$24.54

HC VISUAL ACUITY SCREEN

Facility

$38.95

Service Code	CPT 99173
Hospital Charge Code	51000099
Hospital Revenue Code	510
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$35.06
Rate for Payer: Aetna Commercial	$33.11
Rate for Payer: Aetna New Business (MI Preferred)	$25.32
Rate for Payer: BCBS Complete	$15.58
Rate for Payer: BCBS Trust/PPO	$12.29
Rate for Payer: Cash Price	$31.16
Rate for Payer: Cash Price	$31.16
Rate for Payer: Cofinity Commercial	$33.50
Rate for Payer: Cofinity Commercial	$27.26
Rate for Payer: Healthscope Commercial	$35.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.11
Rate for Payer: PHP Commercial	$33.11
Rate for Payer: Priority Health Cigna Priority Health	$27.26
Rate for Payer: Priority Health SBD	$24.54
Rate for Payer: UHC All Payor (Choice/PPO)	$3.60
Rate for Payer: UHC Exchange	$3.27

Know your out-of-pocket cost for care.

All Charges