Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC SICKLE CELL CMS INITIAL COMP

Facility

$450.00

Service Code	CPT 99215
Hospital Charge Code	51500009
Hospital Revenue Code	515
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna New Business (MI Preferred)	$292.50
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cofinity Commercial	$315.00
Rate for Payer: Cofinity Commercial	$387.00
Rate for Payer: Cofinity Medicare Advantage	$315.00
Rate for Payer: Encore Health Key Benefits Commercial	$360.00
Rate for Payer: Healthscope Commercial	$405.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$382.50
Rate for Payer: PHP Commercial	$382.50
Rate for Payer: Priority Health Cigna Priority Health	$292.50
Rate for Payer: Priority Health SBD	$283.50

HC SICKLE CELL CMS INITIAL COMP

Facility

$450.00

Service Code	CPT 99215
Hospital Charge Code	51500009
Hospital Revenue Code	515
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare	$225.00
Rate for Payer: Aetna New Business (MI Preferred)	$292.50
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cofinity Commercial	$315.00
Rate for Payer: Cofinity Commercial	$387.00
Rate for Payer: Cofinity Medicare Advantage	$315.00
Rate for Payer: Encore Health Key Benefits Commercial	$360.00
Rate for Payer: Healthscope Commercial	$405.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$382.50
Rate for Payer: PHP Commercial	$382.50
Rate for Payer: Priority Health Cigna Priority Health	$292.50
Rate for Payer: Priority Health SBD	$283.50

HC SICKLE CELL CMS SUPP/SERV

Facility

$75.00

Service Code	CPT 99211
Hospital Charge Code	51500012
Hospital Revenue Code	515
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$63.75
Rate for Payer: Aetna New Business (MI Preferred)	$48.75
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cofinity Commercial	$52.50
Rate for Payer: Cofinity Commercial	$64.50
Rate for Payer: Cofinity Medicare Advantage	$52.50
Rate for Payer: Encore Health Key Benefits Commercial	$60.00
Rate for Payer: Healthscope Commercial	$67.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.75
Rate for Payer: PHP Commercial	$63.75
Rate for Payer: Priority Health Cigna Priority Health	$48.75
Rate for Payer: Priority Health SBD	$47.25

HC SICKLE CELL CMS SUPP/SERV

Facility

$75.00

Service Code	CPT 99211
Hospital Charge Code	51500012
Hospital Revenue Code	515
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$63.75
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: Aetna New Business (MI Preferred)	$48.75
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cofinity Commercial	$52.50
Rate for Payer: Cofinity Commercial	$64.50
Rate for Payer: Cofinity Medicare Advantage	$52.50
Rate for Payer: Encore Health Key Benefits Commercial	$60.00
Rate for Payer: Healthscope Commercial	$67.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.75
Rate for Payer: PHP Commercial	$63.75
Rate for Payer: Priority Health Cigna Priority Health	$48.75
Rate for Payer: Priority Health SBD	$47.25

HC SICKLE CELLS CMS COMP

Facility

$300.00

Service Code	CPT 99215
Hospital Charge Code	51500010
Hospital Revenue Code	515
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Cofinity Medicare Advantage	$210.00
Rate for Payer: Encore Health Key Benefits Commercial	$240.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$255.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health Cigna Priority Health	$195.00
Rate for Payer: Priority Health SBD	$189.00

HC SICKLE CELLS CMS COMP

Facility

$300.00

Service Code	CPT 99215
Hospital Charge Code	51500010
Hospital Revenue Code	515
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare	$150.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Cofinity Medicare Advantage	$210.00
Rate for Payer: Encore Health Key Benefits Commercial	$240.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$255.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health Cigna Priority Health	$195.00
Rate for Payer: Priority Health SBD	$189.00

HC SICKLE CELL TEST

Facility

$31.31

Service Code	CPT 85660
Hospital Charge Code	30500061
Hospital Revenue Code	305
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$28.18
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna Medicare	$5.73
Rate for Payer: Aetna New Business (MI Preferred)	$20.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.89
Rate for Payer: Amish Plain Church Group Commercial	$6.89
Rate for Payer: BCBS Complete	$3.10
Rate for Payer: BCBS MAPPO	$5.51
Rate for Payer: BCN Medicare Advantage	$5.51
Rate for Payer: Cash Price	$25.05
Rate for Payer: Cash Price	$25.05
Rate for Payer: Cofinity Commercial	$26.93
Rate for Payer: Cofinity Commercial	$21.92
Rate for Payer: Cofinity Medicare Advantage	$21.92
Rate for Payer: Encore Health Key Benefits Commercial	$25.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.51
Rate for Payer: Healthscope Commercial	$28.18
Rate for Payer: Mclaren Medicaid	$2.95
Rate for Payer: Mclaren Medicare	$5.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.79
Rate for Payer: Meridian Medicaid	$3.10
Rate for Payer: MI Amish Medical Board Commercial	$6.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.61
Rate for Payer: PACE Medicare	$5.23
Rate for Payer: PACE SWMI	$5.51
Rate for Payer: PHP Commercial	$26.61
Rate for Payer: PHP Medicare Advantage	$5.51
Rate for Payer: Priority Health Choice Medicaid	$2.95
Rate for Payer: Priority Health Cigna Priority Health	$20.35
Rate for Payer: Priority Health Medicare	$5.51
Rate for Payer: Priority Health SBD	$19.73
Rate for Payer: Railroad Medicare Medicare	$5.51
Rate for Payer: UHC All Payor (Choice/PPO)	$15.51
Rate for Payer: UHC Dual Complete DSNP	$5.51
Rate for Payer: UHC Medicare Advantage	$5.51
Rate for Payer: UHCCP Medicaid	$3.10
Rate for Payer: VA VA	$5.51

HC SICKLE CELL TEST

Facility

$31.31

Service Code	CPT 85660
Hospital Charge Code	30500061
Hospital Revenue Code	305
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$28.18
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna New Business (MI Preferred)	$20.35
Rate for Payer: Cash Price	$25.05
Rate for Payer: Cofinity Commercial	$21.92
Rate for Payer: Cofinity Commercial	$26.93
Rate for Payer: Cofinity Medicare Advantage	$21.92
Rate for Payer: Encore Health Key Benefits Commercial	$25.05
Rate for Payer: Healthscope Commercial	$28.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.61
Rate for Payer: PHP Commercial	$26.61
Rate for Payer: Priority Health Cigna Priority Health	$20.35
Rate for Payer: Priority Health SBD	$19.73

HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA

Facility

$1,162.48

Service Code	CPT 45330
Hospital Charge Code	76100186
Hospital Revenue Code	761
Min. Negotiated Rate	$732.36
Max. Negotiated Rate	$1,046.23
Rate for Payer: Aetna Commercial	$988.11
Rate for Payer: Aetna New Business (MI Preferred)	$755.61
Rate for Payer: Cash Price	$929.98
Rate for Payer: Cofinity Commercial	$813.74
Rate for Payer: Cofinity Commercial	$999.73
Rate for Payer: Cofinity Medicare Advantage	$813.74
Rate for Payer: Encore Health Key Benefits Commercial	$929.98
Rate for Payer: Healthscope Commercial	$1,046.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$988.11
Rate for Payer: PHP Commercial	$988.11
Rate for Payer: Priority Health Cigna Priority Health	$755.61
Rate for Payer: Priority Health SBD	$732.36

HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA

Facility

$1,162.48

Service Code	CPT 45330
Hospital Charge Code	76100186
Hospital Revenue Code	761
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Commercial	$988.11
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Aetna New Business (MI Preferred)	$755.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Cash Price	$929.98
Rate for Payer: Cash Price	$929.98
Rate for Payer: Cofinity Commercial	$999.73
Rate for Payer: Cofinity Commercial	$813.74
Rate for Payer: Cofinity Medicare Advantage	$813.74
Rate for Payer: Encore Health Key Benefits Commercial	$929.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Healthscope Commercial	$1,046.23
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$988.11
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Commercial	$988.11
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Cigna Priority Health	$755.61
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Priority Health SBD	$732.36
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$500.60
Rate for Payer: VA VA	$889.17

HC SIGMOIDOSCOPY W EUS EXAM

Facility

$2,621.12

Hospital Charge Code	36000082
Hospital Revenue Code	360
Min. Negotiated Rate	$1,651.31
Max. Negotiated Rate	$2,359.01
Rate for Payer: Aetna Commercial	$2,227.95
Rate for Payer: Aetna New Business (MI Preferred)	$1,703.73
Rate for Payer: Cash Price	$2,096.90
Rate for Payer: Cofinity Commercial	$1,834.78
Rate for Payer: Cofinity Commercial	$2,254.16
Rate for Payer: Cofinity Medicare Advantage	$1,834.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,096.90
Rate for Payer: Healthscope Commercial	$2,359.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,227.95
Rate for Payer: PHP Commercial	$2,227.95
Rate for Payer: Priority Health Cigna Priority Health	$1,703.73
Rate for Payer: Priority Health SBD	$1,651.31

HC SIGMOIDOSCOPY W EUS EXAM

Facility

$2,621.12

Hospital Charge Code	36000082
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.45
Max. Negotiated Rate	$2,359.01
Rate for Payer: Aetna Commercial	$2,227.95
Rate for Payer: Aetna Medicare	$1,310.56
Rate for Payer: Aetna New Business (MI Preferred)	$1,703.73
Rate for Payer: BCBS Complete	$1,048.45
Rate for Payer: Cash Price	$2,096.90
Rate for Payer: Cofinity Commercial	$1,834.78
Rate for Payer: Cofinity Commercial	$2,254.16
Rate for Payer: Cofinity Medicare Advantage	$1,834.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,096.90
Rate for Payer: Healthscope Commercial	$2,359.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,227.95
Rate for Payer: PHP Commercial	$2,227.95
Rate for Payer: Priority Health Cigna Priority Health	$1,703.73
Rate for Payer: Priority Health SBD	$1,651.31

HC SIGMOIDOSCOPY WITH BIOPSY

Facility

$1,264.83

Service Code	CPT 45331
Hospital Charge Code	36000111
Hospital Revenue Code	761
Min. Negotiated Rate	$796.84
Max. Negotiated Rate	$1,138.35
Rate for Payer: Aetna Commercial	$1,075.11
Rate for Payer: Aetna New Business (MI Preferred)	$822.14
Rate for Payer: Cash Price	$1,011.86
Rate for Payer: Cofinity Commercial	$1,087.75
Rate for Payer: Cofinity Commercial	$885.38
Rate for Payer: Cofinity Medicare Advantage	$885.38
Rate for Payer: Encore Health Key Benefits Commercial	$1,011.86
Rate for Payer: Healthscope Commercial	$1,138.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,075.11
Rate for Payer: PHP Commercial	$1,075.11
Rate for Payer: Priority Health Cigna Priority Health	$822.14
Rate for Payer: Priority Health SBD	$796.84

HC SIGMOIDOSCOPY WITH BIOPSY

Facility

$1,264.83

Service Code	CPT 45331
Hospital Charge Code	36000111
Hospital Revenue Code	761
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Commercial	$1,075.11
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Aetna New Business (MI Preferred)	$822.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Cash Price	$1,011.86
Rate for Payer: Cash Price	$1,011.86
Rate for Payer: Cofinity Commercial	$1,087.75
Rate for Payer: Cofinity Commercial	$885.38
Rate for Payer: Cofinity Medicare Advantage	$885.38
Rate for Payer: Encore Health Key Benefits Commercial	$1,011.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Healthscope Commercial	$1,138.35
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,075.11
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Commercial	$1,075.11
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Cigna Priority Health	$822.14
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Priority Health SBD	$796.84
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$500.60
Rate for Payer: VA VA	$889.17

HC SIGNAL AVERAGE EKG

Facility

$252.87

Service Code	CPT 93278
Hospital Charge Code	73100004
Hospital Revenue Code	731
Min. Negotiated Rate	$159.31
Max. Negotiated Rate	$227.58
Rate for Payer: Aetna Commercial	$214.94
Rate for Payer: Aetna New Business (MI Preferred)	$164.37
Rate for Payer: Cash Price	$202.30
Rate for Payer: Cofinity Commercial	$177.01
Rate for Payer: Cofinity Commercial	$217.47
Rate for Payer: Cofinity Medicare Advantage	$177.01
Rate for Payer: Encore Health Key Benefits Commercial	$202.30
Rate for Payer: Healthscope Commercial	$227.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.94
Rate for Payer: PHP Commercial	$214.94
Rate for Payer: Priority Health Cigna Priority Health	$164.37
Rate for Payer: Priority Health SBD	$159.31

HC SIGNAL AVERAGE EKG

Facility

$252.87

Service Code	CPT 93278
Hospital Charge Code	73100004
Hospital Revenue Code	731
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$227.58
Rate for Payer: Aetna Commercial	$214.94
Rate for Payer: Aetna Medicare	$60.25
Rate for Payer: Aetna New Business (MI Preferred)	$164.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$72.41
Rate for Payer: Amish Plain Church Group Commercial	$72.41
Rate for Payer: BCBS Complete	$32.60
Rate for Payer: BCBS MAPPO	$57.93
Rate for Payer: BCN Medicare Advantage	$57.93
Rate for Payer: Cash Price	$202.30
Rate for Payer: Cash Price	$202.30
Rate for Payer: Cofinity Commercial	$217.47
Rate for Payer: Cofinity Commercial	$177.01
Rate for Payer: Cofinity Medicare Advantage	$177.01
Rate for Payer: Encore Health Key Benefits Commercial	$202.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$57.93
Rate for Payer: Healthscope Commercial	$227.58
Rate for Payer: Mclaren Medicaid	$31.05
Rate for Payer: Mclaren Medicare	$57.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$60.83
Rate for Payer: Meridian Medicaid	$32.60
Rate for Payer: MI Amish Medical Board Commercial	$66.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.94
Rate for Payer: PACE Medicare	$55.03
Rate for Payer: PACE SWMI	$57.93
Rate for Payer: PHP Commercial	$214.94
Rate for Payer: PHP Medicare Advantage	$57.93
Rate for Payer: Priority Health Choice Medicaid	$31.05
Rate for Payer: Priority Health Cigna Priority Health	$164.37
Rate for Payer: Priority Health Medicare	$57.93
Rate for Payer: Priority Health SBD	$159.31
Rate for Payer: Railroad Medicare Medicare	$57.93
Rate for Payer: UHC All Payor (Choice/PPO)	$163.07
Rate for Payer: UHC Core	$187.12
Rate for Payer: UHC Dual Complete DSNP	$57.93
Rate for Payer: UHC Exchange	$187.12
Rate for Payer: UHC Medicare Advantage	$57.93
Rate for Payer: UHCCP Medicaid	$32.61
Rate for Payer: VA VA	$57.93

HC SILICA CLOTTING TIME ASSAY

Facility

$26.01

Service Code	CPT 85730
Hospital Charge Code	30500099
Hospital Revenue Code	305
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna Medicare	$6.25
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$7.51
Rate for Payer: Amish Plain Church Group Commercial	$7.51
Rate for Payer: BCBS Complete	$3.38
Rate for Payer: BCBS MAPPO	$6.01
Rate for Payer: BCN Medicare Advantage	$6.01
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.01
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Mclaren Medicaid	$3.22
Rate for Payer: Mclaren Medicare	$6.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6.31
Rate for Payer: Meridian Medicaid	$3.38
Rate for Payer: MI Amish Medical Board Commercial	$6.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PACE Medicare	$5.71
Rate for Payer: PACE SWMI	$6.01
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: PHP Medicare Advantage	$6.01
Rate for Payer: Priority Health Choice Medicaid	$3.22
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health Medicare	$6.01
Rate for Payer: Priority Health SBD	$16.39
Rate for Payer: Railroad Medicare Medicare	$6.01
Rate for Payer: UHC All Payor (Choice/PPO)	$16.92
Rate for Payer: UHC Dual Complete DSNP	$6.01
Rate for Payer: UHC Medicare Advantage	$6.01
Rate for Payer: UHCCP Medicaid	$3.38
Rate for Payer: VA VA	$6.01

HC SILICA CLOTTING TIME ASSAY

Facility

$26.01

Service Code	CPT 85730
Hospital Charge Code	30500099
Hospital Revenue Code	305
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health SBD	$16.39

HC SILVADENE 400 GM

Facility

$253.52

Hospital Charge Code	27100016
Hospital Revenue Code	271
Min. Negotiated Rate	$159.72
Max. Negotiated Rate	$228.17
Rate for Payer: Aetna Commercial	$215.49
Rate for Payer: Aetna New Business (MI Preferred)	$164.79
Rate for Payer: Cash Price	$202.82
Rate for Payer: Cofinity Commercial	$177.46
Rate for Payer: Cofinity Commercial	$218.03
Rate for Payer: Cofinity Medicare Advantage	$177.46
Rate for Payer: Encore Health Key Benefits Commercial	$202.82
Rate for Payer: Healthscope Commercial	$228.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.49
Rate for Payer: PHP Commercial	$215.49
Rate for Payer: Priority Health Cigna Priority Health	$164.79
Rate for Payer: Priority Health SBD	$159.72

HC SILVADENE 400 GM

Facility

$253.52

Hospital Charge Code	27100016
Hospital Revenue Code	271
Min. Negotiated Rate	$101.41
Max. Negotiated Rate	$228.17
Rate for Payer: Aetna Commercial	$215.49
Rate for Payer: Aetna Medicare	$126.76
Rate for Payer: Aetna New Business (MI Preferred)	$164.79
Rate for Payer: BCBS Complete	$101.41
Rate for Payer: Cash Price	$202.82
Rate for Payer: Cofinity Commercial	$177.46
Rate for Payer: Cofinity Commercial	$218.03
Rate for Payer: Cofinity Medicare Advantage	$177.46
Rate for Payer: Encore Health Key Benefits Commercial	$202.82
Rate for Payer: Healthscope Commercial	$228.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.49
Rate for Payer: PHP Commercial	$215.49
Rate for Payer: Priority Health Cigna Priority Health	$164.79
Rate for Payer: Priority Health SBD	$159.72

HC SILVADENE 85 GM

Facility

$104.62

Hospital Charge Code	27100017
Hospital Revenue Code	271
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$94.16
Rate for Payer: Aetna Commercial	$88.93
Rate for Payer: Aetna Medicare	$52.31
Rate for Payer: Aetna New Business (MI Preferred)	$68.00
Rate for Payer: BCBS Complete	$41.85
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cofinity Commercial	$73.23
Rate for Payer: Cofinity Commercial	$89.97
Rate for Payer: Cofinity Medicare Advantage	$73.23
Rate for Payer: Encore Health Key Benefits Commercial	$83.70
Rate for Payer: Healthscope Commercial	$94.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.93
Rate for Payer: PHP Commercial	$88.93
Rate for Payer: Priority Health Cigna Priority Health	$68.00
Rate for Payer: Priority Health SBD	$65.91

HC SILVADENE 85 GM

Facility

$104.62

Hospital Charge Code	27100017
Hospital Revenue Code	271
Min. Negotiated Rate	$65.91
Max. Negotiated Rate	$94.16
Rate for Payer: Aetna Commercial	$88.93
Rate for Payer: Aetna New Business (MI Preferred)	$68.00
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cofinity Commercial	$73.23
Rate for Payer: Cofinity Commercial	$89.97
Rate for Payer: Cofinity Medicare Advantage	$73.23
Rate for Payer: Encore Health Key Benefits Commercial	$83.70
Rate for Payer: Healthscope Commercial	$94.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.93
Rate for Payer: PHP Commercial	$88.93
Rate for Payer: Priority Health Cigna Priority Health	$68.00
Rate for Payer: Priority Health SBD	$65.91

HC SILVER 4X4

Facility

$65.41

Hospital Charge Code	27000146
Hospital Revenue Code	270
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$58.87
Rate for Payer: Aetna Commercial	$55.60
Rate for Payer: Aetna New Business (MI Preferred)	$42.52
Rate for Payer: Cash Price	$52.33
Rate for Payer: Cofinity Commercial	$45.79
Rate for Payer: Cofinity Commercial	$56.25
Rate for Payer: Cofinity Medicare Advantage	$45.79
Rate for Payer: Encore Health Key Benefits Commercial	$52.33
Rate for Payer: Healthscope Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.60
Rate for Payer: PHP Commercial	$55.60
Rate for Payer: Priority Health Cigna Priority Health	$42.52
Rate for Payer: Priority Health SBD	$41.21

HC SILVER 4X4

Facility

$65.41

Hospital Charge Code	27000146
Hospital Revenue Code	270
Min. Negotiated Rate	$26.16
Max. Negotiated Rate	$58.87
Rate for Payer: Aetna Commercial	$55.60
Rate for Payer: Aetna Medicare	$32.70
Rate for Payer: Aetna New Business (MI Preferred)	$42.52
Rate for Payer: BCBS Complete	$26.16
Rate for Payer: Cash Price	$52.33
Rate for Payer: Cofinity Commercial	$45.79
Rate for Payer: Cofinity Commercial	$56.25
Rate for Payer: Cofinity Medicare Advantage	$45.79
Rate for Payer: Encore Health Key Benefits Commercial	$52.33
Rate for Payer: Healthscope Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.60
Rate for Payer: PHP Commercial	$55.60
Rate for Payer: Priority Health Cigna Priority Health	$42.52
Rate for Payer: Priority Health SBD	$41.21

HC SILVER HAWK CATHETER

Facility

$8,746.56

Service Code	HCPCS C1888
Hospital Charge Code	27200070
Hospital Revenue Code	272
Min. Negotiated Rate	$5,510.33
Max. Negotiated Rate	$7,871.90
Rate for Payer: Aetna Commercial	$7,434.58
Rate for Payer: Aetna New Business (MI Preferred)	$5,685.26
Rate for Payer: Cash Price	$6,997.25
Rate for Payer: Cofinity Commercial	$6,122.59
Rate for Payer: Cofinity Commercial	$7,522.04
Rate for Payer: Cofinity Medicare Advantage	$6,122.59
Rate for Payer: Encore Health Key Benefits Commercial	$6,997.25
Rate for Payer: Healthscope Commercial	$7,871.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,434.58
Rate for Payer: PHP Commercial	$7,434.58
Rate for Payer: Priority Health Cigna Priority Health	$5,685.26
Rate for Payer: Priority Health SBD	$5,510.33

Know your out-of-pocket cost for care.

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