Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OCCULT BLOOD OTHER SOURCES

Facility

$30.70

Service Code	CPT 82271
Hospital Charge Code	30100122
Hospital Revenue Code	301
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$27.63
Rate for Payer: Aetna Commercial	$26.09
Rate for Payer: Aetna New Business (MI Preferred)	$19.95
Rate for Payer: Cash Price	$24.56
Rate for Payer: Cofinity Commercial	$21.49
Rate for Payer: Cofinity Commercial	$26.40
Rate for Payer: Cofinity Medicare Advantage	$21.49
Rate for Payer: Encore Health Key Benefits Commercial	$24.56
Rate for Payer: Healthscope Commercial	$27.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.09
Rate for Payer: PHP Commercial	$26.09
Rate for Payer: Priority Health Cigna Priority Health	$19.95
Rate for Payer: Priority Health SBD	$19.34

HC OCT CATHETER

Facility

$2,580.29

Service Code	HCPCS C1753
Hospital Charge Code	27200243
Hospital Revenue Code	272
Min. Negotiated Rate	$1,032.12
Max. Negotiated Rate	$2,322.26
Rate for Payer: Aetna Commercial	$2,193.25
Rate for Payer: Aetna Medicare	$1,290.14
Rate for Payer: Aetna New Business (MI Preferred)	$1,677.19
Rate for Payer: BCBS Complete	$1,032.12
Rate for Payer: Cash Price	$2,064.23
Rate for Payer: Cofinity Commercial	$1,806.20
Rate for Payer: Cofinity Commercial	$2,219.05
Rate for Payer: Cofinity Medicare Advantage	$1,806.20
Rate for Payer: Encore Health Key Benefits Commercial	$2,064.23
Rate for Payer: Healthscope Commercial	$2,322.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,193.25
Rate for Payer: PHP Commercial	$2,193.25
Rate for Payer: Priority Health Cigna Priority Health	$1,677.19
Rate for Payer: Priority Health SBD	$1,625.58

HC OCT CATHETER

Facility

$2,580.29

Service Code	HCPCS C1753
Hospital Charge Code	27200243
Hospital Revenue Code	272
Min. Negotiated Rate	$1,625.58
Max. Negotiated Rate	$2,322.26
Rate for Payer: Aetna Commercial	$2,193.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,677.19
Rate for Payer: Cash Price	$2,064.23
Rate for Payer: Cofinity Commercial	$1,806.20
Rate for Payer: Cofinity Commercial	$2,219.05
Rate for Payer: Cofinity Medicare Advantage	$1,806.20
Rate for Payer: Encore Health Key Benefits Commercial	$2,064.23
Rate for Payer: Healthscope Commercial	$2,322.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,193.25
Rate for Payer: PHP Commercial	$2,193.25
Rate for Payer: Priority Health Cigna Priority Health	$1,677.19
Rate for Payer: Priority Health SBD	$1,625.58

HC OCTOPUS SET CARDIOPLEGIA

Facility

$45.90

Hospital Charge Code	27000106
Hospital Revenue Code	270
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC OCTOPUS SET CARDIOPLEGIA

Facility

$45.90

Hospital Charge Code	27000106
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna Medicare	$22.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: BCBS Complete	$18.36
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC OCULAR INSTRMNT SCREEN BILAT

Facility

$52.02

Service Code	CPT 99174
Hospital Charge Code	51000105
Hospital Revenue Code	510
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC OCULAR INSTRMNT SCREEN BILAT

Facility

$52.02

Service Code	CPT 99174
Hospital Charge Code	51000105
Hospital Revenue Code	510
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna Medicare	$26.01
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: BCBS Complete	$20.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC OLIGOCLONAL BANDS

Facility

$44.80

Service Code	CPT 83916
Hospital Charge Code	30100371
Hospital Revenue Code	301
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$77.10
Rate for Payer: Aetna Commercial	$38.08
Rate for Payer: Aetna Medicare	$28.49
Rate for Payer: Aetna New Business (MI Preferred)	$29.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$34.24
Rate for Payer: Amish Plain Church Group Commercial	$34.24
Rate for Payer: BCBS Complete	$15.42
Rate for Payer: BCBS MAPPO	$27.39
Rate for Payer: BCN Medicare Advantage	$27.39
Rate for Payer: Cash Price	$35.84
Rate for Payer: Cash Price	$35.84
Rate for Payer: Cofinity Commercial	$38.53
Rate for Payer: Cofinity Commercial	$31.36
Rate for Payer: Cofinity Medicare Advantage	$31.36
Rate for Payer: Encore Health Key Benefits Commercial	$35.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.39
Rate for Payer: Healthscope Commercial	$40.32
Rate for Payer: Mclaren Medicaid	$14.68
Rate for Payer: Mclaren Medicare	$27.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28.76
Rate for Payer: Meridian Medicaid	$15.42
Rate for Payer: MI Amish Medical Board Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.08
Rate for Payer: PACE Medicare	$26.02
Rate for Payer: PACE SWMI	$27.39
Rate for Payer: PHP Commercial	$38.08
Rate for Payer: PHP Medicare Advantage	$27.39
Rate for Payer: Priority Health Choice Medicaid	$14.68
Rate for Payer: Priority Health Cigna Priority Health	$29.12
Rate for Payer: Priority Health Medicare	$27.39
Rate for Payer: Priority Health SBD	$28.22
Rate for Payer: Railroad Medicare Medicare	$27.39
Rate for Payer: UHC All Payor (Choice/PPO)	$77.10
Rate for Payer: UHC Dual Complete DSNP	$27.39
Rate for Payer: UHC Medicare Advantage	$27.39
Rate for Payer: UHCCP Medicaid	$15.42
Rate for Payer: VA VA	$27.39

HC OLIGOCLONAL BANDS

Facility

$44.80

Service Code	CPT 83916
Hospital Charge Code	30100371
Hospital Revenue Code	301
Min. Negotiated Rate	$28.22
Max. Negotiated Rate	$40.32
Rate for Payer: Aetna Commercial	$38.08
Rate for Payer: Aetna New Business (MI Preferred)	$29.12
Rate for Payer: Cash Price	$35.84
Rate for Payer: Cofinity Commercial	$31.36
Rate for Payer: Cofinity Commercial	$38.53
Rate for Payer: Cofinity Medicare Advantage	$31.36
Rate for Payer: Encore Health Key Benefits Commercial	$35.84
Rate for Payer: Healthscope Commercial	$40.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.08
Rate for Payer: PHP Commercial	$38.08
Rate for Payer: Priority Health Cigna Priority Health	$29.12
Rate for Payer: Priority Health SBD	$28.22

HC OLIGOCLONAL BANDS CMPT

Facility

$44.80

Service Code	CPT 83916
Hospital Charge Code	30100551
Hospital Revenue Code	301
Min. Negotiated Rate	$28.22
Max. Negotiated Rate	$40.32
Rate for Payer: Aetna Commercial	$38.08
Rate for Payer: Aetna New Business (MI Preferred)	$29.12
Rate for Payer: Cash Price	$35.84
Rate for Payer: Cofinity Commercial	$31.36
Rate for Payer: Cofinity Commercial	$38.53
Rate for Payer: Cofinity Medicare Advantage	$31.36
Rate for Payer: Encore Health Key Benefits Commercial	$35.84
Rate for Payer: Healthscope Commercial	$40.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.08
Rate for Payer: PHP Commercial	$38.08
Rate for Payer: Priority Health Cigna Priority Health	$29.12
Rate for Payer: Priority Health SBD	$28.22

HC OLIGOCLONAL BANDS CMPT

Facility

$44.80

Service Code	CPT 83916
Hospital Charge Code	30100551
Hospital Revenue Code	301
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$77.10
Rate for Payer: Aetna Commercial	$38.08
Rate for Payer: Aetna Medicare	$28.49
Rate for Payer: Aetna New Business (MI Preferred)	$29.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$34.24
Rate for Payer: Amish Plain Church Group Commercial	$34.24
Rate for Payer: BCBS Complete	$15.42
Rate for Payer: BCBS MAPPO	$27.39
Rate for Payer: BCN Medicare Advantage	$27.39
Rate for Payer: Cash Price	$35.84
Rate for Payer: Cash Price	$35.84
Rate for Payer: Cofinity Commercial	$38.53
Rate for Payer: Cofinity Commercial	$31.36
Rate for Payer: Cofinity Medicare Advantage	$31.36
Rate for Payer: Encore Health Key Benefits Commercial	$35.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.39
Rate for Payer: Healthscope Commercial	$40.32
Rate for Payer: Mclaren Medicaid	$14.68
Rate for Payer: Mclaren Medicare	$27.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28.76
Rate for Payer: Meridian Medicaid	$15.42
Rate for Payer: MI Amish Medical Board Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.08
Rate for Payer: PACE Medicare	$26.02
Rate for Payer: PACE SWMI	$27.39
Rate for Payer: PHP Commercial	$38.08
Rate for Payer: PHP Medicare Advantage	$27.39
Rate for Payer: Priority Health Choice Medicaid	$14.68
Rate for Payer: Priority Health Cigna Priority Health	$29.12
Rate for Payer: Priority Health Medicare	$27.39
Rate for Payer: Priority Health SBD	$28.22
Rate for Payer: Railroad Medicare Medicare	$27.39
Rate for Payer: UHC All Payor (Choice/PPO)	$77.10
Rate for Payer: UHC Dual Complete DSNP	$27.39
Rate for Payer: UHC Medicare Advantage	$27.39
Rate for Payer: UHCCP Medicaid	$15.42
Rate for Payer: VA VA	$27.39

HC OMMAYA

Facility

$384.73

Service Code	CPT 96542
Hospital Charge Code	33500005
Hospital Revenue Code	335
Min. Negotiated Rate	$173.39
Max. Negotiated Rate	$910.59
Rate for Payer: Aetna Commercial	$327.02
Rate for Payer: Aetna Medicare	$336.43
Rate for Payer: Aetna New Business (MI Preferred)	$250.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$404.36
Rate for Payer: Amish Plain Church Group Commercial	$404.36
Rate for Payer: BCBS Complete	$182.06
Rate for Payer: BCBS MAPPO	$323.49
Rate for Payer: BCN Medicare Advantage	$323.49
Rate for Payer: Cash Price	$307.78
Rate for Payer: Cash Price	$307.78
Rate for Payer: Cofinity Commercial	$330.87
Rate for Payer: Cofinity Commercial	$269.31
Rate for Payer: Cofinity Medicare Advantage	$269.31
Rate for Payer: Encore Health Key Benefits Commercial	$307.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$323.49
Rate for Payer: Healthscope Commercial	$346.26
Rate for Payer: Mclaren Medicaid	$173.39
Rate for Payer: Mclaren Medicare	$323.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$339.66
Rate for Payer: Meridian Medicaid	$182.06
Rate for Payer: MI Amish Medical Board Commercial	$372.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.02
Rate for Payer: PACE Medicare	$307.32
Rate for Payer: PACE SWMI	$323.49
Rate for Payer: PHP Commercial	$327.02
Rate for Payer: PHP Medicare Advantage	$323.49
Rate for Payer: Priority Health Choice Medicaid	$173.39
Rate for Payer: Priority Health Cigna Priority Health	$250.07
Rate for Payer: Priority Health Medicare	$323.49
Rate for Payer: Priority Health SBD	$242.38
Rate for Payer: Railroad Medicare Medicare	$323.49
Rate for Payer: UHC All Payor (Choice/PPO)	$910.59
Rate for Payer: UHC Core	$284.70
Rate for Payer: UHC Dual Complete DSNP	$323.49
Rate for Payer: UHC Exchange	$284.70
Rate for Payer: UHC Medicare Advantage	$323.49
Rate for Payer: UHCCP Medicaid	$182.12
Rate for Payer: VA VA	$323.49

HC OMMAYA

Facility

$384.73

Service Code	CPT 96542
Hospital Charge Code	33500005
Hospital Revenue Code	335
Min. Negotiated Rate	$242.38
Max. Negotiated Rate	$346.26
Rate for Payer: Aetna Commercial	$327.02
Rate for Payer: Aetna New Business (MI Preferred)	$250.07
Rate for Payer: Cash Price	$307.78
Rate for Payer: Cofinity Commercial	$269.31
Rate for Payer: Cofinity Commercial	$330.87
Rate for Payer: Cofinity Medicare Advantage	$269.31
Rate for Payer: Encore Health Key Benefits Commercial	$307.78
Rate for Payer: Healthscope Commercial	$346.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.02
Rate for Payer: PHP Commercial	$327.02
Rate for Payer: Priority Health Cigna Priority Health	$250.07
Rate for Payer: Priority Health SBD	$242.38

HC OMNIPAQUE 300 PER ML

Facility

$1.81

Service Code	HCPCS Q9967
Hospital Charge Code	63600017
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.63
Rate for Payer: Aetna Commercial	$1.54
Rate for Payer: Aetna New Business (MI Preferred)	$1.18
Rate for Payer: Cash Price	$1.45
Rate for Payer: Cofinity Commercial	$1.27
Rate for Payer: Cofinity Commercial	$1.56
Rate for Payer: Cofinity Medicare Advantage	$1.27
Rate for Payer: Encore Health Key Benefits Commercial	$1.45
Rate for Payer: Healthscope Commercial	$1.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.54
Rate for Payer: PHP Commercial	$1.54
Rate for Payer: Priority Health Cigna Priority Health	$1.18
Rate for Payer: Priority Health SBD	$1.14

HC OMNIPAQUE 300 PER ML

Facility

$1.81

Service Code	HCPCS Q9967
Hospital Charge Code	63600017
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.63
Rate for Payer: Aetna Commercial	$1.54
Rate for Payer: Aetna Medicare	$0.91
Rate for Payer: Aetna New Business (MI Preferred)	$1.18
Rate for Payer: BCBS Complete	$0.72
Rate for Payer: Cash Price	$1.45
Rate for Payer: Cofinity Commercial	$1.27
Rate for Payer: Cofinity Commercial	$1.56
Rate for Payer: Cofinity Medicare Advantage	$1.27
Rate for Payer: Encore Health Key Benefits Commercial	$1.45
Rate for Payer: Healthscope Commercial	$1.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.54
Rate for Payer: PHP Commercial	$1.54
Rate for Payer: Priority Health Cigna Priority Health	$1.18
Rate for Payer: Priority Health SBD	$1.14

HC OPEN HEART OFF BYPASS

Facility

$5,803.80

Hospital Charge Code	27000702
Hospital Revenue Code	270
Min. Negotiated Rate	$3,656.39
Max. Negotiated Rate	$5,223.42
Rate for Payer: Aetna Commercial	$4,933.23
Rate for Payer: Aetna New Business (MI Preferred)	$3,772.47
Rate for Payer: Cash Price	$4,643.04
Rate for Payer: Cofinity Commercial	$4,062.66
Rate for Payer: Cofinity Commercial	$4,991.27
Rate for Payer: Cofinity Medicare Advantage	$4,062.66
Rate for Payer: Encore Health Key Benefits Commercial	$4,643.04
Rate for Payer: Healthscope Commercial	$5,223.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,933.23
Rate for Payer: PHP Commercial	$4,933.23
Rate for Payer: Priority Health Cigna Priority Health	$3,772.47
Rate for Payer: Priority Health SBD	$3,656.39

HC OPEN HEART OFF BYPASS

Facility

$5,803.80

Hospital Charge Code	27000702
Hospital Revenue Code	270
Min. Negotiated Rate	$2,321.52
Max. Negotiated Rate	$5,223.42
Rate for Payer: Aetna Commercial	$4,933.23
Rate for Payer: Aetna Medicare	$2,901.90
Rate for Payer: Aetna New Business (MI Preferred)	$3,772.47
Rate for Payer: BCBS Complete	$2,321.52
Rate for Payer: Cash Price	$4,643.04
Rate for Payer: Cofinity Commercial	$4,062.66
Rate for Payer: Cofinity Commercial	$4,991.27
Rate for Payer: Cofinity Medicare Advantage	$4,062.66
Rate for Payer: Encore Health Key Benefits Commercial	$4,643.04
Rate for Payer: Healthscope Commercial	$5,223.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,933.23
Rate for Payer: PHP Commercial	$4,933.23
Rate for Payer: Priority Health Cigna Priority Health	$3,772.47
Rate for Payer: Priority Health SBD	$3,656.39

HC OPEN HEART PLATELET MAPPING

Facility

$944.00

Hospital Charge Code	27000388
Hospital Revenue Code	270
Min. Negotiated Rate	$377.60
Max. Negotiated Rate	$849.60
Rate for Payer: Aetna Commercial	$802.40
Rate for Payer: Aetna Medicare	$472.00
Rate for Payer: Aetna New Business (MI Preferred)	$613.60
Rate for Payer: BCBS Complete	$377.60
Rate for Payer: Cash Price	$755.20
Rate for Payer: Cofinity Commercial	$660.80
Rate for Payer: Cofinity Commercial	$811.84
Rate for Payer: Cofinity Medicare Advantage	$660.80
Rate for Payer: Encore Health Key Benefits Commercial	$755.20
Rate for Payer: Healthscope Commercial	$849.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$802.40
Rate for Payer: PHP Commercial	$802.40
Rate for Payer: Priority Health Cigna Priority Health	$613.60
Rate for Payer: Priority Health SBD	$594.72

HC OPEN HEART PLATELET MAPPING

Facility

$944.00

Hospital Charge Code	27000388
Hospital Revenue Code	270
Min. Negotiated Rate	$594.72
Max. Negotiated Rate	$849.60
Rate for Payer: Aetna Commercial	$802.40
Rate for Payer: Aetna New Business (MI Preferred)	$613.60
Rate for Payer: Cash Price	$755.20
Rate for Payer: Cofinity Commercial	$660.80
Rate for Payer: Cofinity Commercial	$811.84
Rate for Payer: Cofinity Medicare Advantage	$660.80
Rate for Payer: Encore Health Key Benefits Commercial	$755.20
Rate for Payer: Healthscope Commercial	$849.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$802.40
Rate for Payer: PHP Commercial	$802.40
Rate for Payer: Priority Health Cigna Priority Health	$613.60
Rate for Payer: Priority Health SBD	$594.72

HC OPEN HEART TEG

Facility

$552.37

Hospital Charge Code	27000199
Hospital Revenue Code	270
Min. Negotiated Rate	$220.95
Max. Negotiated Rate	$497.13
Rate for Payer: Aetna Commercial	$469.51
Rate for Payer: Aetna Medicare	$276.19
Rate for Payer: Aetna New Business (MI Preferred)	$359.04
Rate for Payer: BCBS Complete	$220.95
Rate for Payer: Cash Price	$441.90
Rate for Payer: Cofinity Commercial	$386.66
Rate for Payer: Cofinity Commercial	$475.04
Rate for Payer: Cofinity Medicare Advantage	$386.66
Rate for Payer: Encore Health Key Benefits Commercial	$441.90
Rate for Payer: Healthscope Commercial	$497.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$469.51
Rate for Payer: PHP Commercial	$469.51
Rate for Payer: Priority Health Cigna Priority Health	$359.04
Rate for Payer: Priority Health SBD	$347.99

HC OPEN HEART TEG

Facility

$552.37

Hospital Charge Code	27000199
Hospital Revenue Code	270
Min. Negotiated Rate	$347.99
Max. Negotiated Rate	$497.13
Rate for Payer: Aetna Commercial	$469.51
Rate for Payer: Aetna New Business (MI Preferred)	$359.04
Rate for Payer: Cash Price	$441.90
Rate for Payer: Cofinity Commercial	$386.66
Rate for Payer: Cofinity Commercial	$475.04
Rate for Payer: Cofinity Medicare Advantage	$386.66
Rate for Payer: Encore Health Key Benefits Commercial	$441.90
Rate for Payer: Healthscope Commercial	$497.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$469.51
Rate for Payer: PHP Commercial	$469.51
Rate for Payer: Priority Health Cigna Priority Health	$359.04
Rate for Payer: Priority Health SBD	$347.99

HC OP FALSE LABOR 1ST HOUR

Facility

$349.23

Service Code	HCPCS S4005
Hospital Charge Code	72900001
Hospital Revenue Code	729
Min. Negotiated Rate	$220.01
Max. Negotiated Rate	$314.31
Rate for Payer: Aetna Commercial	$296.85
Rate for Payer: Aetna New Business (MI Preferred)	$227.00
Rate for Payer: Cash Price	$279.38
Rate for Payer: Cofinity Commercial	$244.46
Rate for Payer: Cofinity Commercial	$300.34
Rate for Payer: Cofinity Medicare Advantage	$244.46
Rate for Payer: Encore Health Key Benefits Commercial	$279.38
Rate for Payer: Healthscope Commercial	$314.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.85
Rate for Payer: PHP Commercial	$296.85
Rate for Payer: Priority Health Cigna Priority Health	$227.00
Rate for Payer: Priority Health SBD	$220.01

HC OP FALSE LABOR 1ST HOUR

Facility

$349.23

Service Code	HCPCS S4005
Hospital Charge Code	72900001
Hospital Revenue Code	729
Min. Negotiated Rate	$139.69
Max. Negotiated Rate	$314.31
Rate for Payer: Aetna Commercial	$296.85
Rate for Payer: Aetna Medicare	$174.62
Rate for Payer: Aetna New Business (MI Preferred)	$227.00
Rate for Payer: BCBS Complete	$139.69
Rate for Payer: Cash Price	$279.38
Rate for Payer: Cofinity Commercial	$244.46
Rate for Payer: Cofinity Commercial	$300.34
Rate for Payer: Cofinity Medicare Advantage	$244.46
Rate for Payer: Encore Health Key Benefits Commercial	$279.38
Rate for Payer: Healthscope Commercial	$314.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.85
Rate for Payer: PHP Commercial	$296.85
Rate for Payer: Priority Health Cigna Priority Health	$227.00
Rate for Payer: Priority Health SBD	$220.01
Rate for Payer: UHC Core	$258.43
Rate for Payer: UHC Exchange	$258.43

HC OP FALSE LABOR SUB HOURS

Facility

$193.26

Service Code	HCPCS S4005
Hospital Charge Code	72900002
Hospital Revenue Code	729
Min. Negotiated Rate	$77.30
Max. Negotiated Rate	$173.93
Rate for Payer: Aetna Commercial	$164.27
Rate for Payer: Aetna Medicare	$96.63
Rate for Payer: Aetna New Business (MI Preferred)	$125.62
Rate for Payer: BCBS Complete	$77.30
Rate for Payer: Cash Price	$154.61
Rate for Payer: Cofinity Commercial	$135.28
Rate for Payer: Cofinity Commercial	$166.20
Rate for Payer: Cofinity Medicare Advantage	$135.28
Rate for Payer: Encore Health Key Benefits Commercial	$154.61
Rate for Payer: Healthscope Commercial	$173.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$164.27
Rate for Payer: PHP Commercial	$164.27
Rate for Payer: Priority Health Cigna Priority Health	$125.62
Rate for Payer: Priority Health SBD	$121.75
Rate for Payer: UHC Core	$143.01
Rate for Payer: UHC Exchange	$143.01

HC OP FALSE LABOR SUB HOURS

Facility

$193.26

Service Code	HCPCS S4005
Hospital Charge Code	72900002
Hospital Revenue Code	729
Min. Negotiated Rate	$121.75
Max. Negotiated Rate	$173.93
Rate for Payer: Aetna Commercial	$164.27
Rate for Payer: Aetna New Business (MI Preferred)	$125.62
Rate for Payer: Cash Price	$154.61
Rate for Payer: Cofinity Commercial	$135.28
Rate for Payer: Cofinity Commercial	$166.20
Rate for Payer: Cofinity Medicare Advantage	$135.28
Rate for Payer: Encore Health Key Benefits Commercial	$154.61
Rate for Payer: Healthscope Commercial	$173.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$164.27
Rate for Payer: PHP Commercial	$164.27
Rate for Payer: Priority Health Cigna Priority Health	$125.62
Rate for Payer: Priority Health SBD	$121.75

Know your out-of-pocket cost for care.

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