Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE

Facility

$2,390.22

Service Code	CPT 19283
Hospital Charge Code	36100416
Hospital Revenue Code	361
Min. Negotiated Rate	$1,505.84
Max. Negotiated Rate	$2,151.20
Rate for Payer: Aetna Commercial	$2,031.69
Rate for Payer: Aetna New Business (MI Preferred)	$1,553.64
Rate for Payer: Cash Price	$1,912.18
Rate for Payer: Cofinity Commercial	$1,673.15
Rate for Payer: Cofinity Commercial	$2,055.59
Rate for Payer: Cofinity Medicare Advantage	$1,673.15
Rate for Payer: Encore Health Key Benefits Commercial	$1,912.18
Rate for Payer: Healthscope Commercial	$2,151.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,031.69
Rate for Payer: PHP Commercial	$2,031.69
Rate for Payer: Priority Health Cigna Priority Health	$1,553.64
Rate for Payer: Priority Health SBD	$1,505.84

HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE

Facility

$2,390.22

Service Code	CPT 19283
Hospital Charge Code	36100416
Hospital Revenue Code	361
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$2,151.20
Rate for Payer: Aetna Commercial	$2,031.69
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,553.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Cash Price	$1,912.18
Rate for Payer: Cash Price	$1,912.18
Rate for Payer: Cofinity Commercial	$1,673.15
Rate for Payer: Cofinity Commercial	$2,055.59
Rate for Payer: Cofinity Medicare Advantage	$1,673.15
Rate for Payer: Encore Health Key Benefits Commercial	$1,912.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Healthscope Commercial	$2,151.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,031.69
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Commercial	$2,031.69
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Cigna Priority Health	$1,553.64
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Priority Health SBD	$1,505.84
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$386.33
Rate for Payer: VA VA	$686.20

HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE

Facility

$1,962.98

Service Code	CPT 19285
Hospital Charge Code	36100418
Hospital Revenue Code	361
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Commercial	$1,668.53
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,275.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Cash Price	$1,570.38
Rate for Payer: Cash Price	$1,570.38
Rate for Payer: Cofinity Commercial	$1,374.09
Rate for Payer: Cofinity Commercial	$1,688.16
Rate for Payer: Cofinity Medicare Advantage	$1,374.09
Rate for Payer: Encore Health Key Benefits Commercial	$1,570.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Healthscope Commercial	$1,766.68
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,668.53
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Commercial	$1,668.53
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Cigna Priority Health	$1,275.94
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Priority Health SBD	$1,236.68
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$386.33
Rate for Payer: VA VA	$686.20

HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE

Facility

$1,962.98

Service Code	CPT 19285
Hospital Charge Code	36100418
Hospital Revenue Code	361
Min. Negotiated Rate	$1,236.68
Max. Negotiated Rate	$1,766.68
Rate for Payer: Aetna Commercial	$1,668.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,275.94
Rate for Payer: Cash Price	$1,570.38
Rate for Payer: Cofinity Commercial	$1,374.09
Rate for Payer: Cofinity Commercial	$1,688.16
Rate for Payer: Cofinity Medicare Advantage	$1,374.09
Rate for Payer: Encore Health Key Benefits Commercial	$1,570.38
Rate for Payer: Healthscope Commercial	$1,766.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,668.53
Rate for Payer: PHP Commercial	$1,668.53
Rate for Payer: Priority Health Cigna Priority Health	$1,275.94
Rate for Payer: Priority Health SBD	$1,236.68

HC PLACEMENT FIDUCIAL MARKERS

Facility

$1,071.00

Hospital Charge Code	36000120
Hospital Revenue Code	360
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$963.90
Rate for Payer: Aetna Commercial	$910.35
Rate for Payer: Aetna Medicare	$535.50
Rate for Payer: Aetna New Business (MI Preferred)	$696.15
Rate for Payer: BCBS Complete	$428.40
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$749.70
Rate for Payer: Cofinity Commercial	$921.06
Rate for Payer: Cofinity Medicare Advantage	$749.70
Rate for Payer: Encore Health Key Benefits Commercial	$856.80
Rate for Payer: Healthscope Commercial	$963.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$910.35
Rate for Payer: PHP Commercial	$910.35
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: Priority Health SBD	$674.73

HC PLACEMENT FIDUCIAL MARKERS

Facility

$1,071.00

Hospital Charge Code	36000120
Hospital Revenue Code	360
Min. Negotiated Rate	$674.73
Max. Negotiated Rate	$963.90
Rate for Payer: Aetna Commercial	$910.35
Rate for Payer: Aetna New Business (MI Preferred)	$696.15
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$749.70
Rate for Payer: Cofinity Commercial	$921.06
Rate for Payer: Cofinity Medicare Advantage	$749.70
Rate for Payer: Encore Health Key Benefits Commercial	$856.80
Rate for Payer: Healthscope Commercial	$963.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$910.35
Rate for Payer: PHP Commercial	$910.35
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: Priority Health SBD	$674.73

HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER

Facility

$7,265.88

Service Code	CPT 36215
Hospital Charge Code	36100106
Hospital Revenue Code	361
Min. Negotiated Rate	$2,906.35
Max. Negotiated Rate	$6,539.29
Rate for Payer: Aetna Commercial	$6,176.00
Rate for Payer: Aetna Medicare	$3,632.94
Rate for Payer: Aetna New Business (MI Preferred)	$4,722.82
Rate for Payer: BCBS Complete	$2,906.35
Rate for Payer: Cash Price	$5,812.70
Rate for Payer: Cofinity Commercial	$5,086.12
Rate for Payer: Cofinity Commercial	$6,248.66
Rate for Payer: Cofinity Medicare Advantage	$5,086.12
Rate for Payer: Encore Health Key Benefits Commercial	$5,812.70
Rate for Payer: Healthscope Commercial	$6,539.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,176.00
Rate for Payer: PHP Commercial	$6,176.00
Rate for Payer: Priority Health Cigna Priority Health	$4,722.82
Rate for Payer: Priority Health SBD	$4,577.50

HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER

Facility

$7,265.88

Service Code	CPT 36215
Hospital Charge Code	36100106
Hospital Revenue Code	361
Min. Negotiated Rate	$4,577.50
Max. Negotiated Rate	$6,539.29
Rate for Payer: Aetna Commercial	$6,176.00
Rate for Payer: Aetna New Business (MI Preferred)	$4,722.82
Rate for Payer: Cash Price	$5,812.70
Rate for Payer: Cofinity Commercial	$5,086.12
Rate for Payer: Cofinity Commercial	$6,248.66
Rate for Payer: Cofinity Medicare Advantage	$5,086.12
Rate for Payer: Encore Health Key Benefits Commercial	$5,812.70
Rate for Payer: Healthscope Commercial	$6,539.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,176.00
Rate for Payer: PHP Commercial	$6,176.00
Rate for Payer: Priority Health Cigna Priority Health	$4,722.82
Rate for Payer: Priority Health SBD	$4,577.50

HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER

Facility

$1,020.00

Service Code	CPT 36216
Hospital Charge Code	36100107
Hospital Revenue Code	361
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$918.00
Rate for Payer: Aetna Commercial	$867.00
Rate for Payer: Aetna New Business (MI Preferred)	$663.00
Rate for Payer: Cash Price	$816.00
Rate for Payer: Cofinity Commercial	$714.00
Rate for Payer: Cofinity Commercial	$877.20
Rate for Payer: Cofinity Medicare Advantage	$714.00
Rate for Payer: Encore Health Key Benefits Commercial	$816.00
Rate for Payer: Healthscope Commercial	$918.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$867.00
Rate for Payer: PHP Commercial	$867.00
Rate for Payer: Priority Health Cigna Priority Health	$663.00
Rate for Payer: Priority Health SBD	$642.60

HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER

Facility

$1,020.00

Service Code	CPT 36216
Hospital Charge Code	36100107
Hospital Revenue Code	361
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$918.00
Rate for Payer: Aetna Commercial	$867.00
Rate for Payer: Aetna Medicare	$510.00
Rate for Payer: Aetna New Business (MI Preferred)	$663.00
Rate for Payer: BCBS Complete	$408.00
Rate for Payer: Cash Price	$816.00
Rate for Payer: Cofinity Commercial	$714.00
Rate for Payer: Cofinity Commercial	$877.20
Rate for Payer: Cofinity Medicare Advantage	$714.00
Rate for Payer: Encore Health Key Benefits Commercial	$816.00
Rate for Payer: Healthscope Commercial	$918.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$867.00
Rate for Payer: PHP Commercial	$867.00
Rate for Payer: Priority Health Cigna Priority Health	$663.00
Rate for Payer: Priority Health SBD	$642.60

HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER

Facility

$845.54

Service Code	CPT 36217
Hospital Charge Code	36100108
Hospital Revenue Code	361
Min. Negotiated Rate	$338.22
Max. Negotiated Rate	$760.99
Rate for Payer: Aetna Commercial	$718.71
Rate for Payer: Aetna Medicare	$422.77
Rate for Payer: Aetna New Business (MI Preferred)	$549.60
Rate for Payer: BCBS Complete	$338.22
Rate for Payer: Cash Price	$676.43
Rate for Payer: Cofinity Commercial	$591.88
Rate for Payer: Cofinity Commercial	$727.16
Rate for Payer: Cofinity Medicare Advantage	$591.88
Rate for Payer: Encore Health Key Benefits Commercial	$676.43
Rate for Payer: Healthscope Commercial	$760.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$718.71
Rate for Payer: PHP Commercial	$718.71
Rate for Payer: Priority Health Cigna Priority Health	$549.60
Rate for Payer: Priority Health SBD	$532.69

HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER

Facility

$845.54

Service Code	CPT 36217
Hospital Charge Code	36100108
Hospital Revenue Code	361
Min. Negotiated Rate	$532.69
Max. Negotiated Rate	$760.99
Rate for Payer: Aetna Commercial	$718.71
Rate for Payer: Aetna New Business (MI Preferred)	$549.60
Rate for Payer: Cash Price	$676.43
Rate for Payer: Cofinity Commercial	$591.88
Rate for Payer: Cofinity Commercial	$727.16
Rate for Payer: Cofinity Medicare Advantage	$591.88
Rate for Payer: Encore Health Key Benefits Commercial	$676.43
Rate for Payer: Healthscope Commercial	$760.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$718.71
Rate for Payer: PHP Commercial	$718.71
Rate for Payer: Priority Health Cigna Priority Health	$549.60
Rate for Payer: Priority Health SBD	$532.69

HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER

Facility

$1,122.86

Service Code	CPT 36218
Hospital Charge Code	36100109
Hospital Revenue Code	361
Min. Negotiated Rate	$707.40
Max. Negotiated Rate	$1,010.57
Rate for Payer: Aetna Commercial	$954.43
Rate for Payer: Aetna New Business (MI Preferred)	$729.86
Rate for Payer: Cash Price	$898.29
Rate for Payer: Cofinity Commercial	$786.00
Rate for Payer: Cofinity Commercial	$965.66
Rate for Payer: Cofinity Medicare Advantage	$786.00
Rate for Payer: Encore Health Key Benefits Commercial	$898.29
Rate for Payer: Healthscope Commercial	$1,010.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$954.43
Rate for Payer: PHP Commercial	$954.43
Rate for Payer: Priority Health Cigna Priority Health	$729.86
Rate for Payer: Priority Health SBD	$707.40

HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER

Facility

$1,122.86

Service Code	CPT 36218
Hospital Charge Code	36100109
Hospital Revenue Code	361
Min. Negotiated Rate	$449.14
Max. Negotiated Rate	$1,010.57
Rate for Payer: Aetna Commercial	$954.43
Rate for Payer: Aetna Medicare	$561.43
Rate for Payer: Aetna New Business (MI Preferred)	$729.86
Rate for Payer: BCBS Complete	$449.14
Rate for Payer: Cash Price	$898.29
Rate for Payer: Cofinity Commercial	$786.00
Rate for Payer: Cofinity Commercial	$965.66
Rate for Payer: Cofinity Medicare Advantage	$786.00
Rate for Payer: Encore Health Key Benefits Commercial	$898.29
Rate for Payer: Healthscope Commercial	$1,010.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$954.43
Rate for Payer: PHP Commercial	$954.43
Rate for Payer: Priority Health Cigna Priority Health	$729.86
Rate for Payer: Priority Health SBD	$707.40

HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER

Facility

$10,446.83

Service Code	CPT 36247
Hospital Charge Code	36100112
Hospital Revenue Code	361
Min. Negotiated Rate	$6,581.50
Max. Negotiated Rate	$9,402.15
Rate for Payer: Aetna Commercial	$8,879.81
Rate for Payer: Aetna New Business (MI Preferred)	$6,790.44
Rate for Payer: Cash Price	$8,357.46
Rate for Payer: Cofinity Commercial	$7,312.78
Rate for Payer: Cofinity Commercial	$8,984.27
Rate for Payer: Cofinity Medicare Advantage	$7,312.78
Rate for Payer: Encore Health Key Benefits Commercial	$8,357.46
Rate for Payer: Healthscope Commercial	$9,402.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,879.81
Rate for Payer: PHP Commercial	$8,879.81
Rate for Payer: Priority Health Cigna Priority Health	$6,790.44
Rate for Payer: Priority Health SBD	$6,581.50

HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER

Facility

$10,446.83

Service Code	CPT 36247
Hospital Charge Code	36100112
Hospital Revenue Code	361
Min. Negotiated Rate	$4,178.73
Max. Negotiated Rate	$9,402.15
Rate for Payer: Aetna Commercial	$8,879.81
Rate for Payer: Aetna Medicare	$5,223.41
Rate for Payer: Aetna New Business (MI Preferred)	$6,790.44
Rate for Payer: BCBS Complete	$4,178.73
Rate for Payer: Cash Price	$8,357.46
Rate for Payer: Cofinity Commercial	$7,312.78
Rate for Payer: Cofinity Commercial	$8,984.27
Rate for Payer: Cofinity Medicare Advantage	$7,312.78
Rate for Payer: Encore Health Key Benefits Commercial	$8,357.46
Rate for Payer: Healthscope Commercial	$9,402.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,879.81
Rate for Payer: PHP Commercial	$8,879.81
Rate for Payer: Priority Health Cigna Priority Health	$6,790.44
Rate for Payer: Priority Health SBD	$6,581.50

HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER

Facility

$1,020.78

Service Code	CPT 36248
Hospital Charge Code	36100113
Hospital Revenue Code	361
Min. Negotiated Rate	$408.31
Max. Negotiated Rate	$918.70
Rate for Payer: Aetna Commercial	$867.66
Rate for Payer: Aetna Medicare	$510.39
Rate for Payer: Aetna New Business (MI Preferred)	$663.51
Rate for Payer: BCBS Complete	$408.31
Rate for Payer: Cash Price	$816.62
Rate for Payer: Cofinity Commercial	$714.55
Rate for Payer: Cofinity Commercial	$877.87
Rate for Payer: Cofinity Medicare Advantage	$714.55
Rate for Payer: Encore Health Key Benefits Commercial	$816.62
Rate for Payer: Healthscope Commercial	$918.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$867.66
Rate for Payer: PHP Commercial	$867.66
Rate for Payer: Priority Health Cigna Priority Health	$663.51
Rate for Payer: Priority Health SBD	$643.09

HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER

Facility

$1,020.78

Service Code	CPT 36248
Hospital Charge Code	36100113
Hospital Revenue Code	361
Min. Negotiated Rate	$643.09
Max. Negotiated Rate	$918.70
Rate for Payer: Aetna Commercial	$867.66
Rate for Payer: Aetna New Business (MI Preferred)	$663.51
Rate for Payer: Cash Price	$816.62
Rate for Payer: Cofinity Commercial	$714.55
Rate for Payer: Cofinity Commercial	$877.87
Rate for Payer: Cofinity Medicare Advantage	$714.55
Rate for Payer: Encore Health Key Benefits Commercial	$816.62
Rate for Payer: Healthscope Commercial	$918.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$867.66
Rate for Payer: PHP Commercial	$867.66
Rate for Payer: Priority Health Cigna Priority Health	$663.51
Rate for Payer: Priority Health SBD	$643.09

HC PLACEMENT SELECTIVE PULMONARY

Facility

$930.40

Service Code	CPT 36014
Hospital Charge Code	36100100
Hospital Revenue Code	361
Min. Negotiated Rate	$586.15
Max. Negotiated Rate	$837.36
Rate for Payer: Aetna Commercial	$790.84
Rate for Payer: Aetna New Business (MI Preferred)	$604.76
Rate for Payer: Cash Price	$744.32
Rate for Payer: Cofinity Commercial	$651.28
Rate for Payer: Cofinity Commercial	$800.14
Rate for Payer: Cofinity Medicare Advantage	$651.28
Rate for Payer: Encore Health Key Benefits Commercial	$744.32
Rate for Payer: Healthscope Commercial	$837.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$790.84
Rate for Payer: PHP Commercial	$790.84
Rate for Payer: Priority Health Cigna Priority Health	$604.76
Rate for Payer: Priority Health SBD	$586.15

HC PLACEMENT SELECTIVE PULMONARY

Facility

$930.40

Service Code	CPT 36014
Hospital Charge Code	36100100
Hospital Revenue Code	361
Min. Negotiated Rate	$372.16
Max. Negotiated Rate	$837.36
Rate for Payer: Aetna Commercial	$790.84
Rate for Payer: Aetna Medicare	$465.20
Rate for Payer: Aetna New Business (MI Preferred)	$604.76
Rate for Payer: BCBS Complete	$372.16
Rate for Payer: Cash Price	$744.32
Rate for Payer: Cofinity Commercial	$651.28
Rate for Payer: Cofinity Commercial	$800.14
Rate for Payer: Cofinity Medicare Advantage	$651.28
Rate for Payer: Encore Health Key Benefits Commercial	$744.32
Rate for Payer: Healthscope Commercial	$837.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$790.84
Rate for Payer: PHP Commercial	$790.84
Rate for Payer: Priority Health Cigna Priority Health	$604.76
Rate for Payer: Priority Health SBD	$586.15

HC PLACEMENT SELECTIVE VENOUS 1ST ORDER

Facility

$6,639.46

Service Code	CPT 36011
Hospital Charge Code	36100097
Hospital Revenue Code	361
Min. Negotiated Rate	$4,182.86
Max. Negotiated Rate	$5,975.51
Rate for Payer: Aetna Commercial	$5,643.54
Rate for Payer: Aetna New Business (MI Preferred)	$4,315.65
Rate for Payer: Cash Price	$5,311.57
Rate for Payer: Cofinity Commercial	$4,647.62
Rate for Payer: Cofinity Commercial	$5,709.94
Rate for Payer: Cofinity Medicare Advantage	$4,647.62
Rate for Payer: Encore Health Key Benefits Commercial	$5,311.57
Rate for Payer: Healthscope Commercial	$5,975.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,643.54
Rate for Payer: PHP Commercial	$5,643.54
Rate for Payer: Priority Health Cigna Priority Health	$4,315.65
Rate for Payer: Priority Health SBD	$4,182.86

HC PLACEMENT SELECTIVE VENOUS 1ST ORDER

Facility

$6,639.46

Service Code	CPT 36011
Hospital Charge Code	36100097
Hospital Revenue Code	361
Min. Negotiated Rate	$2,655.78
Max. Negotiated Rate	$5,975.51
Rate for Payer: Aetna Commercial	$5,643.54
Rate for Payer: Aetna Medicare	$3,319.73
Rate for Payer: Aetna New Business (MI Preferred)	$4,315.65
Rate for Payer: BCBS Complete	$2,655.78
Rate for Payer: Cash Price	$5,311.57
Rate for Payer: Cofinity Commercial	$4,647.62
Rate for Payer: Cofinity Commercial	$5,709.94
Rate for Payer: Cofinity Medicare Advantage	$4,647.62
Rate for Payer: Encore Health Key Benefits Commercial	$5,311.57
Rate for Payer: Healthscope Commercial	$5,975.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,643.54
Rate for Payer: PHP Commercial	$5,643.54
Rate for Payer: Priority Health Cigna Priority Health	$4,315.65
Rate for Payer: Priority Health SBD	$4,182.86

HC PLACEMENT SELECTIVE VENOUS 2ND ORDER

Facility

$5,517.84

Service Code	CPT 36012
Hospital Charge Code	36100098
Hospital Revenue Code	361
Min. Negotiated Rate	$3,476.24
Max. Negotiated Rate	$4,966.06
Rate for Payer: Aetna Commercial	$4,690.16
Rate for Payer: Aetna New Business (MI Preferred)	$3,586.60
Rate for Payer: Cash Price	$4,414.27
Rate for Payer: Cofinity Commercial	$3,862.49
Rate for Payer: Cofinity Commercial	$4,745.34
Rate for Payer: Cofinity Medicare Advantage	$3,862.49
Rate for Payer: Encore Health Key Benefits Commercial	$4,414.27
Rate for Payer: Healthscope Commercial	$4,966.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,690.16
Rate for Payer: PHP Commercial	$4,690.16
Rate for Payer: Priority Health Cigna Priority Health	$3,586.60
Rate for Payer: Priority Health SBD	$3,476.24

HC PLACEMENT SELECTIVE VENOUS 2ND ORDER

Facility

$5,517.84

Service Code	CPT 36012
Hospital Charge Code	36100098
Hospital Revenue Code	361
Min. Negotiated Rate	$2,207.14
Max. Negotiated Rate	$4,966.06
Rate for Payer: Aetna Commercial	$4,690.16
Rate for Payer: Aetna Medicare	$2,758.92
Rate for Payer: Aetna New Business (MI Preferred)	$3,586.60
Rate for Payer: BCBS Complete	$2,207.14
Rate for Payer: Cash Price	$4,414.27
Rate for Payer: Cofinity Commercial	$3,862.49
Rate for Payer: Cofinity Commercial	$4,745.34
Rate for Payer: Cofinity Medicare Advantage	$3,862.49
Rate for Payer: Encore Health Key Benefits Commercial	$4,414.27
Rate for Payer: Healthscope Commercial	$4,966.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,690.16
Rate for Payer: PHP Commercial	$4,690.16
Rate for Payer: Priority Health Cigna Priority Health	$3,586.60
Rate for Payer: Priority Health SBD	$3,476.24

HC PLACE NEPHROSTOMY CATHETER

Facility

$3,348.21

Service Code	CPT 50432
Hospital Charge Code	36100504
Hospital Revenue Code	361
Min. Negotiated Rate	$2,109.37
Max. Negotiated Rate	$3,013.39
Rate for Payer: Aetna Commercial	$2,845.98
Rate for Payer: Aetna New Business (MI Preferred)	$2,176.34
Rate for Payer: Cash Price	$2,678.57
Rate for Payer: Cofinity Commercial	$2,343.75
Rate for Payer: Cofinity Commercial	$2,879.46
Rate for Payer: Cofinity Medicare Advantage	$2,343.75
Rate for Payer: Encore Health Key Benefits Commercial	$2,678.57
Rate for Payer: Healthscope Commercial	$3,013.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,845.98
Rate for Payer: PHP Commercial	$2,845.98
Rate for Payer: Priority Health Cigna Priority Health	$2,176.34
Rate for Payer: Priority Health SBD	$2,109.37

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