Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC VERPLSTY W WO BONE BX EA ADD

Facility

$5,456.20

Service Code	CPT 22512
Hospital Charge Code	36100466
Hospital Revenue Code	361
Min. Negotiated Rate	$3,437.41
Max. Negotiated Rate	$4,910.58
Rate for Payer: Aetna Commercial	$4,637.77
Rate for Payer: Aetna New Business (MI Preferred)	$3,546.53
Rate for Payer: Cash Price	$4,364.96
Rate for Payer: Cofinity Commercial	$3,819.34
Rate for Payer: Cofinity Commercial	$4,692.33
Rate for Payer: Cofinity Medicare Advantage	$3,819.34
Rate for Payer: Encore Health Key Benefits Commercial	$4,364.96
Rate for Payer: Healthscope Commercial	$4,910.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,637.77
Rate for Payer: PHP Commercial	$4,637.77
Rate for Payer: Priority Health Cigna Priority Health	$3,546.53
Rate for Payer: Priority Health SBD	$3,437.41

HC VERPLSTY W WO BONE BX L S 1ST

Facility

$4,768.21

Service Code	CPT 22511
Hospital Charge Code	36100464
Hospital Revenue Code	361
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Commercial	$4,052.98
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Aetna New Business (MI Preferred)	$3,099.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Cash Price	$3,814.57
Rate for Payer: Cash Price	$3,814.57
Rate for Payer: Cofinity Commercial	$4,100.66
Rate for Payer: Cofinity Commercial	$3,337.75
Rate for Payer: Cofinity Medicare Advantage	$3,337.75
Rate for Payer: Encore Health Key Benefits Commercial	$3,814.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Healthscope Commercial	$4,291.39
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,052.98
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Commercial	$4,052.98
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Cigna Priority Health	$3,099.34
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Priority Health SBD	$3,003.97
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

HC VERPLSTY W WO BONE BX L S 1ST

Facility

$4,768.21

Service Code	CPT 22511
Hospital Charge Code	36100464
Hospital Revenue Code	361
Min. Negotiated Rate	$3,003.97
Max. Negotiated Rate	$4,291.39
Rate for Payer: Aetna Commercial	$4,052.98
Rate for Payer: Aetna New Business (MI Preferred)	$3,099.34
Rate for Payer: Cash Price	$3,814.57
Rate for Payer: Cofinity Commercial	$3,337.75
Rate for Payer: Cofinity Commercial	$4,100.66
Rate for Payer: Cofinity Medicare Advantage	$3,337.75
Rate for Payer: Encore Health Key Benefits Commercial	$3,814.57
Rate for Payer: Healthscope Commercial	$4,291.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,052.98
Rate for Payer: PHP Commercial	$4,052.98
Rate for Payer: Priority Health Cigna Priority Health	$3,099.34
Rate for Payer: Priority Health SBD	$3,003.97

HC VERSACROSS KIT

Facility

$3,641.40

Hospital Charge Code	27200346
Hospital Revenue Code	272
Min. Negotiated Rate	$2,294.08
Max. Negotiated Rate	$3,277.26
Rate for Payer: Aetna Commercial	$3,095.19
Rate for Payer: Aetna New Business (MI Preferred)	$2,366.91
Rate for Payer: Cash Price	$2,913.12
Rate for Payer: Cofinity Commercial	$2,548.98
Rate for Payer: Cofinity Commercial	$3,131.60
Rate for Payer: Cofinity Medicare Advantage	$2,548.98
Rate for Payer: Encore Health Key Benefits Commercial	$2,913.12
Rate for Payer: Healthscope Commercial	$3,277.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,095.19
Rate for Payer: PHP Commercial	$3,095.19
Rate for Payer: Priority Health Cigna Priority Health	$2,366.91
Rate for Payer: Priority Health SBD	$2,294.08

HC VERSACROSS KIT

Facility

$3,641.40

Hospital Charge Code	27200346
Hospital Revenue Code	272
Min. Negotiated Rate	$1,456.56
Max. Negotiated Rate	$3,277.26
Rate for Payer: Aetna Commercial	$3,095.19
Rate for Payer: Aetna Medicare	$1,820.70
Rate for Payer: Aetna New Business (MI Preferred)	$2,366.91
Rate for Payer: BCBS Complete	$1,456.56
Rate for Payer: Cash Price	$2,913.12
Rate for Payer: Cofinity Commercial	$2,548.98
Rate for Payer: Cofinity Commercial	$3,131.60
Rate for Payer: Cofinity Medicare Advantage	$2,548.98
Rate for Payer: Encore Health Key Benefits Commercial	$2,913.12
Rate for Payer: Healthscope Commercial	$3,277.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,095.19
Rate for Payer: PHP Commercial	$3,095.19
Rate for Payer: Priority Health Cigna Priority Health	$2,366.91
Rate for Payer: Priority Health SBD	$2,294.08

HC VERT AUG W MECH DEV EA ADD

Facility

$11,606.79

Service Code	CPT 22515
Hospital Charge Code	36100469
Hospital Revenue Code	361
Min. Negotiated Rate	$7,312.28
Max. Negotiated Rate	$10,446.11
Rate for Payer: Aetna Commercial	$9,865.77
Rate for Payer: Aetna New Business (MI Preferred)	$7,544.41
Rate for Payer: Cash Price	$9,285.43
Rate for Payer: Cofinity Commercial	$8,124.75
Rate for Payer: Cofinity Commercial	$9,981.84
Rate for Payer: Cofinity Medicare Advantage	$8,124.75
Rate for Payer: Encore Health Key Benefits Commercial	$9,285.43
Rate for Payer: Healthscope Commercial	$10,446.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,865.77
Rate for Payer: PHP Commercial	$9,865.77
Rate for Payer: Priority Health Cigna Priority Health	$7,544.41
Rate for Payer: Priority Health SBD	$7,312.28

HC VERT AUG W MECH DEV EA ADD

Facility

$11,606.79

Service Code	CPT 22515
Hospital Charge Code	36100469
Hospital Revenue Code	361
Min. Negotiated Rate	$4,642.72
Max. Negotiated Rate	$10,446.11
Rate for Payer: Aetna Commercial	$9,865.77
Rate for Payer: Aetna Medicare	$5,803.40
Rate for Payer: Aetna New Business (MI Preferred)	$7,544.41
Rate for Payer: BCBS Complete	$4,642.72
Rate for Payer: Cash Price	$9,285.43
Rate for Payer: Cofinity Commercial	$8,124.75
Rate for Payer: Cofinity Commercial	$9,981.84
Rate for Payer: Cofinity Medicare Advantage	$8,124.75
Rate for Payer: Encore Health Key Benefits Commercial	$9,285.43
Rate for Payer: Healthscope Commercial	$10,446.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,865.77
Rate for Payer: PHP Commercial	$9,865.77
Rate for Payer: Priority Health Cigna Priority Health	$7,544.41
Rate for Payer: Priority Health SBD	$7,312.28

HC VERT AUG W MECH DEV LUMB 1ST

Facility

$11,266.87

Service Code	CPT 22514
Hospital Charge Code	36100468
Hospital Revenue Code	361
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Commercial	$9,576.84
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Aetna New Business (MI Preferred)	$7,323.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Cash Price	$9,013.50
Rate for Payer: Cash Price	$9,013.50
Rate for Payer: Cofinity Commercial	$9,689.51
Rate for Payer: Cofinity Commercial	$7,886.81
Rate for Payer: Cofinity Medicare Advantage	$7,886.81
Rate for Payer: Encore Health Key Benefits Commercial	$9,013.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Healthscope Commercial	$10,140.18
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,576.84
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Commercial	$9,576.84
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Cigna Priority Health	$7,323.47
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Priority Health SBD	$7,098.13
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

HC VERT AUG W MECH DEV LUMB 1ST

Facility

$11,266.87

Service Code	CPT 22514
Hospital Charge Code	36100468
Hospital Revenue Code	361
Min. Negotiated Rate	$7,098.13
Max. Negotiated Rate	$10,140.18
Rate for Payer: Aetna Commercial	$9,576.84
Rate for Payer: Aetna New Business (MI Preferred)	$7,323.47
Rate for Payer: Cash Price	$9,013.50
Rate for Payer: Cofinity Commercial	$7,886.81
Rate for Payer: Cofinity Commercial	$9,689.51
Rate for Payer: Cofinity Medicare Advantage	$7,886.81
Rate for Payer: Encore Health Key Benefits Commercial	$9,013.50
Rate for Payer: Healthscope Commercial	$10,140.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,576.84
Rate for Payer: PHP Commercial	$9,576.84
Rate for Payer: Priority Health Cigna Priority Health	$7,323.47
Rate for Payer: Priority Health SBD	$7,098.13

HC VERT AUG W MECH DEV THOR 1ST

Facility

$11,123.75

Service Code	CPT 22513
Hospital Charge Code	36100467
Hospital Revenue Code	361
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Commercial	$9,455.19
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Aetna New Business (MI Preferred)	$7,230.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Cash Price	$8,899.00
Rate for Payer: Cash Price	$8,899.00
Rate for Payer: Cofinity Commercial	$7,786.62
Rate for Payer: Cofinity Commercial	$9,566.42
Rate for Payer: Cofinity Medicare Advantage	$7,786.62
Rate for Payer: Encore Health Key Benefits Commercial	$8,899.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Healthscope Commercial	$10,011.38
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,455.19
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Commercial	$9,455.19
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Cigna Priority Health	$7,230.44
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Priority Health SBD	$7,007.96
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

HC VERT AUG W MECH DEV THOR 1ST

Facility

$11,123.75

Service Code	CPT 22513
Hospital Charge Code	36100467
Hospital Revenue Code	361
Min. Negotiated Rate	$7,007.96
Max. Negotiated Rate	$10,011.38
Rate for Payer: Aetna Commercial	$9,455.19
Rate for Payer: Aetna New Business (MI Preferred)	$7,230.44
Rate for Payer: Cash Price	$8,899.00
Rate for Payer: Cofinity Commercial	$7,786.62
Rate for Payer: Cofinity Commercial	$9,566.42
Rate for Payer: Cofinity Medicare Advantage	$7,786.62
Rate for Payer: Encore Health Key Benefits Commercial	$8,899.00
Rate for Payer: Healthscope Commercial	$10,011.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,455.19
Rate for Payer: PHP Commercial	$9,455.19
Rate for Payer: Priority Health Cigna Priority Health	$7,230.44
Rate for Payer: Priority Health SBD	$7,007.96

HC VERTEBROPLASTY CEMENT

Facility

$1,251.02

Service Code	HCPCS C1713
Hospital Charge Code	27800112
Hospital Revenue Code	278
Min. Negotiated Rate	$500.41
Max. Negotiated Rate	$1,125.92
Rate for Payer: Aetna Commercial	$1,063.37
Rate for Payer: Aetna Medicare	$625.51
Rate for Payer: Aetna New Business (MI Preferred)	$813.16
Rate for Payer: BCBS Complete	$500.41
Rate for Payer: Cash Price	$1,000.82
Rate for Payer: Cofinity Commercial	$1,075.88
Rate for Payer: Cofinity Commercial	$875.71
Rate for Payer: Cofinity Medicare Advantage	$875.71
Rate for Payer: Encore Health Key Benefits Commercial	$1,000.82
Rate for Payer: Healthscope Commercial	$1,125.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,063.37
Rate for Payer: PHP Commercial	$1,063.37
Rate for Payer: Priority Health Cigna Priority Health	$813.16
Rate for Payer: Priority Health SBD	$788.14

HC VERTEBROPLASTY CEMENT

Facility

$1,251.02

Service Code	HCPCS C1713
Hospital Charge Code	27800112
Hospital Revenue Code	278
Min. Negotiated Rate	$788.14
Max. Negotiated Rate	$1,125.92
Rate for Payer: Aetna Commercial	$1,063.37
Rate for Payer: Aetna New Business (MI Preferred)	$813.16
Rate for Payer: Cash Price	$1,000.82
Rate for Payer: Cofinity Commercial	$1,075.88
Rate for Payer: Cofinity Commercial	$875.71
Rate for Payer: Cofinity Medicare Advantage	$875.71
Rate for Payer: Encore Health Key Benefits Commercial	$1,000.82
Rate for Payer: Healthscope Commercial	$1,125.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,063.37
Rate for Payer: PHP Commercial	$1,063.37
Rate for Payer: Priority Health Cigna Priority Health	$813.16
Rate for Payer: Priority Health SBD	$788.14

HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING

Facility

$6,262.84

Service Code	CPT 0201T
Hospital Charge Code	36100298
Hospital Revenue Code	361
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Commercial	$5,323.41
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Aetna New Business (MI Preferred)	$4,070.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Cash Price	$5,010.27
Rate for Payer: Cash Price	$5,010.27
Rate for Payer: Cofinity Commercial	$5,386.04
Rate for Payer: Cofinity Commercial	$4,383.99
Rate for Payer: Cofinity Medicare Advantage	$4,383.99
Rate for Payer: Encore Health Key Benefits Commercial	$5,010.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Healthscope Commercial	$5,636.56
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,323.41
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Commercial	$5,323.41
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Cigna Priority Health	$4,070.85
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Priority Health SBD	$3,945.59
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING

Facility

$6,262.84

Service Code	CPT 0201T
Hospital Charge Code	36100298
Hospital Revenue Code	361
Min. Negotiated Rate	$3,945.59
Max. Negotiated Rate	$5,636.56
Rate for Payer: Aetna Commercial	$5,323.41
Rate for Payer: Aetna New Business (MI Preferred)	$4,070.85
Rate for Payer: Cash Price	$5,010.27
Rate for Payer: Cofinity Commercial	$4,383.99
Rate for Payer: Cofinity Commercial	$5,386.04
Rate for Payer: Cofinity Medicare Advantage	$4,383.99
Rate for Payer: Encore Health Key Benefits Commercial	$5,010.27
Rate for Payer: Healthscope Commercial	$5,636.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,323.41
Rate for Payer: PHP Commercial	$5,323.41
Rate for Payer: Priority Health Cigna Priority Health	$4,070.85
Rate for Payer: Priority Health SBD	$3,945.59

HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING

Facility

$5,010.27

Service Code	CPT 0200T
Hospital Charge Code	36100299
Hospital Revenue Code	361
Min. Negotiated Rate	$3,156.47
Max. Negotiated Rate	$4,509.24
Rate for Payer: Aetna Commercial	$4,258.73
Rate for Payer: Aetna New Business (MI Preferred)	$3,256.68
Rate for Payer: Cash Price	$4,008.22
Rate for Payer: Cofinity Commercial	$3,507.19
Rate for Payer: Cofinity Commercial	$4,308.83
Rate for Payer: Cofinity Medicare Advantage	$3,507.19
Rate for Payer: Encore Health Key Benefits Commercial	$4,008.22
Rate for Payer: Healthscope Commercial	$4,509.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,258.73
Rate for Payer: PHP Commercial	$4,258.73
Rate for Payer: Priority Health Cigna Priority Health	$3,256.68
Rate for Payer: Priority Health SBD	$3,156.47

HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING

Facility

$5,010.27

Service Code	CPT 0200T
Hospital Charge Code	36100299
Hospital Revenue Code	361
Min. Negotiated Rate	$3,156.47
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Commercial	$4,258.73
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Aetna New Business (MI Preferred)	$3,256.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Cash Price	$4,008.22
Rate for Payer: Cash Price	$4,008.22
Rate for Payer: Cofinity Commercial	$4,308.83
Rate for Payer: Cofinity Commercial	$3,507.19
Rate for Payer: Cofinity Medicare Advantage	$3,507.19
Rate for Payer: Encore Health Key Benefits Commercial	$4,008.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Healthscope Commercial	$4,509.24
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,258.73
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Commercial	$4,258.73
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Cigna Priority Health	$3,256.68
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Priority Health SBD	$3,156.47
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

HC VEST SUPPLY

Facility

$464.71

Hospital Charge Code	27000169
Hospital Revenue Code	270
Min. Negotiated Rate	$185.88
Max. Negotiated Rate	$418.24
Rate for Payer: Aetna Commercial	$395.00
Rate for Payer: Aetna Medicare	$232.35
Rate for Payer: Aetna New Business (MI Preferred)	$302.06
Rate for Payer: BCBS Complete	$185.88
Rate for Payer: Cash Price	$371.77
Rate for Payer: Cofinity Commercial	$325.30
Rate for Payer: Cofinity Commercial	$399.65
Rate for Payer: Cofinity Medicare Advantage	$325.30
Rate for Payer: Encore Health Key Benefits Commercial	$371.77
Rate for Payer: Healthscope Commercial	$418.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.00
Rate for Payer: PHP Commercial	$395.00
Rate for Payer: Priority Health Cigna Priority Health	$302.06
Rate for Payer: Priority Health SBD	$292.77

HC VEST SUPPLY

Facility

$464.71

Hospital Charge Code	27000169
Hospital Revenue Code	270
Min. Negotiated Rate	$292.77
Max. Negotiated Rate	$418.24
Rate for Payer: Aetna Commercial	$395.00
Rate for Payer: Aetna New Business (MI Preferred)	$302.06
Rate for Payer: Cash Price	$371.77
Rate for Payer: Cofinity Commercial	$325.30
Rate for Payer: Cofinity Commercial	$399.65
Rate for Payer: Cofinity Medicare Advantage	$325.30
Rate for Payer: Encore Health Key Benefits Commercial	$371.77
Rate for Payer: Healthscope Commercial	$418.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.00
Rate for Payer: PHP Commercial	$395.00
Rate for Payer: Priority Health Cigna Priority Health	$302.06
Rate for Payer: Priority Health SBD	$292.77

HC VIABAHN 2

Facility

$8,114.00

Service Code	HCPCS C1874
Hospital Charge Code	27800034
Hospital Revenue Code	278
Min. Negotiated Rate	$3,245.60
Max. Negotiated Rate	$7,302.60
Rate for Payer: Aetna Commercial	$6,896.90
Rate for Payer: Aetna Medicare	$4,057.00
Rate for Payer: Aetna New Business (MI Preferred)	$5,274.10
Rate for Payer: BCBS Complete	$3,245.60
Rate for Payer: Cash Price	$6,491.20
Rate for Payer: Cofinity Commercial	$5,679.80
Rate for Payer: Cofinity Commercial	$6,978.04
Rate for Payer: Cofinity Medicare Advantage	$5,679.80
Rate for Payer: Encore Health Key Benefits Commercial	$6,491.20
Rate for Payer: Healthscope Commercial	$7,302.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,896.90
Rate for Payer: PHP Commercial	$6,896.90
Rate for Payer: Priority Health Cigna Priority Health	$5,274.10
Rate for Payer: Priority Health SBD	$5,111.82

HC VIABAHN 2

Facility

$8,114.00

Service Code	HCPCS C1874
Hospital Charge Code	27800034
Hospital Revenue Code	278
Min. Negotiated Rate	$5,111.82
Max. Negotiated Rate	$7,302.60
Rate for Payer: Aetna Commercial	$6,896.90
Rate for Payer: Aetna New Business (MI Preferred)	$5,274.10
Rate for Payer: Cash Price	$6,491.20
Rate for Payer: Cofinity Commercial	$5,679.80
Rate for Payer: Cofinity Commercial	$6,978.04
Rate for Payer: Cofinity Medicare Advantage	$5,679.80
Rate for Payer: Encore Health Key Benefits Commercial	$6,491.20
Rate for Payer: Healthscope Commercial	$7,302.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,896.90
Rate for Payer: PHP Commercial	$6,896.90
Rate for Payer: Priority Health Cigna Priority Health	$5,274.10
Rate for Payer: Priority Health SBD	$5,111.82

HC VISCOSITY

Facility

$70.75

Service Code	CPT 85810
Hospital Charge Code	30500065
Hospital Revenue Code	305
Min. Negotiated Rate	$44.57
Max. Negotiated Rate	$63.67
Rate for Payer: Aetna Commercial	$60.14
Rate for Payer: Aetna New Business (MI Preferred)	$45.99
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cofinity Commercial	$49.52
Rate for Payer: Cofinity Commercial	$60.84
Rate for Payer: Cofinity Medicare Advantage	$49.52
Rate for Payer: Encore Health Key Benefits Commercial	$56.60
Rate for Payer: Healthscope Commercial	$63.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.14
Rate for Payer: PHP Commercial	$60.14
Rate for Payer: Priority Health Cigna Priority Health	$45.99
Rate for Payer: Priority Health SBD	$44.57

HC VISCOSITY

Facility

$70.75

Service Code	CPT 85810
Hospital Charge Code	30500065
Hospital Revenue Code	305
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$63.67
Rate for Payer: Aetna Commercial	$60.14
Rate for Payer: Aetna Medicare	$12.14
Rate for Payer: Aetna New Business (MI Preferred)	$45.99
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	$6.57
Rate for Payer: BCBS MAPPO	$11.67
Rate for Payer: BCN Medicare Advantage	$11.67
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cofinity Commercial	$60.84
Rate for Payer: Cofinity Commercial	$49.52
Rate for Payer: Cofinity Medicare Advantage	$49.52
Rate for Payer: Encore Health Key Benefits Commercial	$56.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.67
Rate for Payer: Healthscope Commercial	$63.67
Rate for Payer: Mclaren Medicaid	$6.26
Rate for Payer: Mclaren Medicare	$11.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12.25
Rate for Payer: Meridian Medicaid	$6.57
Rate for Payer: MI Amish Medical Board Commercial	$13.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.14
Rate for Payer: PACE Medicare	$11.09
Rate for Payer: PACE SWMI	$11.67
Rate for Payer: PHP Commercial	$60.14
Rate for Payer: PHP Medicare Advantage	$11.67
Rate for Payer: Priority Health Choice Medicaid	$6.26
Rate for Payer: Priority Health Cigna Priority Health	$45.99
Rate for Payer: Priority Health Medicare	$11.67
Rate for Payer: Priority Health SBD	$44.57
Rate for Payer: Railroad Medicare Medicare	$11.67
Rate for Payer: UHC All Payor (Choice/PPO)	$32.85
Rate for Payer: UHC Dual Complete DSNP	$11.67
Rate for Payer: UHC Medicare Advantage	$11.67
Rate for Payer: UHCCP Medicaid	$6.57
Rate for Payer: VA VA	$11.67

HC VISIPAQUE 320 PER ML

Facility

$2.84

Service Code	HCPCS Q9967
Hospital Charge Code	63600019
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.41
Rate for Payer: Aetna Medicare	$1.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: BCBS Complete	$1.14
Rate for Payer: Cash Price	$2.27
Rate for Payer: Cofinity Commercial	$1.99
Rate for Payer: Cofinity Commercial	$2.44
Rate for Payer: Cofinity Medicare Advantage	$1.99
Rate for Payer: Encore Health Key Benefits Commercial	$2.27
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.41
Rate for Payer: PHP Commercial	$2.41
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.79

HC VISIPAQUE 320 PER ML

Facility

$2.84

Service Code	HCPCS Q9967
Hospital Charge Code	63600019
Hospital Revenue Code	636
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.41
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: Cash Price	$2.27
Rate for Payer: Cofinity Commercial	$1.99
Rate for Payer: Cofinity Commercial	$2.44
Rate for Payer: Cofinity Medicare Advantage	$1.99
Rate for Payer: Encore Health Key Benefits Commercial	$2.27
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.41
Rate for Payer: PHP Commercial	$2.41
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.79

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