Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC DESTRUCT VAGINAL LESION(S) SIMPLE

Facility

$3,822.09

Service Code	CPT 57061
Hospital Charge Code	36100583
Hospital Revenue Code	761
Min. Negotiated Rate	$1,520.09
Max. Negotiated Rate	$3,822.09
Rate for Payer: Aetna Commercial	$3,439.88
Rate for Payer: Aetna Medicare	$2,778.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,473.69
Rate for Payer: Amish Plain Church Group Commercial	$3,473.69
Rate for Payer: ASR ASR	$3,707.43
Rate for Payer: BCBS Complete	$1,596.23
Rate for Payer: BCBS MAPPO	$2,778.95
Rate for Payer: BCBS Trust/PPO	$2,963.27
Rate for Payer: BCN Commercial	$2,963.27
Rate for Payer: BCN Medicare Advantage	$2,778.95
Rate for Payer: Cash Price	$3,057.67
Rate for Payer: Cash Price	$3,057.67
Rate for Payer: Cofinity Commercial	$3,592.76
Rate for Payer: Encore Health Key Benefits Commercial	$3,057.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,778.95
Rate for Payer: Healthscope Commercial	$3,822.09
Rate for Payer: Healthscope Whirlpool	$3,707.43
Rate for Payer: Humana Choice PPO Medicare	$2,778.95
Rate for Payer: Mclaren Commercial	$3,439.88
Rate for Payer: Mclaren Medicaid	$1,520.09
Rate for Payer: Mclaren Medicare	$2,778.95
Rate for Payer: Meridian Medicaid	$1,596.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,917.90
Rate for Payer: MI Amish Medical Board Commercial	$3,195.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,248.78
Rate for Payer: PACE Medicare	$2,640.00
Rate for Payer: PACE SWMI	$2,778.95
Rate for Payer: PHP Commercial	$3,056.84
Rate for Payer: PHP Medicaid	$1,520.09
Rate for Payer: PHP Medicare Advantage	$2,778.95
Rate for Payer: Priority Health Choice Medicaid	$1,520.09
Rate for Payer: Priority Health Cigna Priority Health	$2,675.46
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,403.69
Rate for Payer: Priority Health Medicare	$2,778.95
Rate for Payer: Priority Health Narrow Network	$2,722.95
Rate for Payer: Railroad Medicare Medicare	$2,778.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,363.44
Rate for Payer: UHC Medicare Advantage	$2,862.32
Rate for Payer: VA VA	$2,778.95

HC DESTRUCT VAGINAL LESION(S) SIMPLE

Facility

$3,822.09

Service Code	CPT 57061
Hospital Charge Code	36100583
Hospital Revenue Code	761
Min. Negotiated Rate	$2,675.46
Max. Negotiated Rate	$3,822.09
Rate for Payer: Aetna Commercial	$3,439.88
Rate for Payer: ASR ASR	$3,707.43
Rate for Payer: BCBS Trust/PPO	$2,963.27
Rate for Payer: BCN Commercial	$2,963.27
Rate for Payer: Cash Price	$3,057.67
Rate for Payer: Cofinity Commercial	$3,592.76
Rate for Payer: Encore Health Key Benefits Commercial	$3,057.67
Rate for Payer: Healthscope Commercial	$3,822.09
Rate for Payer: Healthscope Whirlpool	$3,707.43
Rate for Payer: Mclaren Commercial	$3,439.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,248.78
Rate for Payer: Priority Health Cigna Priority Health	$2,675.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,363.44

HC DES VESSEL/BRANCH

Facility

$24,183.90

Service Code	CPT C9600
Hospital Charge Code	48100075
Hospital Revenue Code	481
Min. Negotiated Rate	$16,928.73
Max. Negotiated Rate	$24,183.90
Rate for Payer: Aetna Commercial	$21,765.51
Rate for Payer: ASR ASR	$23,458.38
Rate for Payer: BCBS Trust/PPO	$18,749.78
Rate for Payer: BCN Commercial	$18,749.78
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cofinity Commercial	$22,732.87
Rate for Payer: Encore Health Key Benefits Commercial	$19,347.12
Rate for Payer: Healthscope Commercial	$24,183.90
Rate for Payer: Healthscope Whirlpool	$23,458.38
Rate for Payer: Mclaren Commercial	$21,765.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20,556.32
Rate for Payer: Priority Health Cigna Priority Health	$16,928.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21,281.83

HC DES VESSEL/BRANCH

Facility

$24,183.90

Service Code	CPT C9600
Hospital Charge Code	48100075
Hospital Revenue Code	481
Min. Negotiated Rate	$5,348.94
Max. Negotiated Rate	$24,183.90
Rate for Payer: Aetna Commercial	$21,765.51
Rate for Payer: Aetna Medicare	$9,778.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,223.36
Rate for Payer: Amish Plain Church Group Commercial	$12,223.36
Rate for Payer: ASR ASR	$23,458.38
Rate for Payer: BCBS Complete	$5,616.88
Rate for Payer: BCBS MAPPO	$9,778.69
Rate for Payer: BCBS Trust/PPO	$18,749.78
Rate for Payer: BCN Commercial	$18,749.78
Rate for Payer: BCN Medicare Advantage	$9,778.69
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cofinity Commercial	$22,732.87
Rate for Payer: Encore Health Key Benefits Commercial	$19,347.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,778.69
Rate for Payer: Healthscope Commercial	$24,183.90
Rate for Payer: Healthscope Whirlpool	$23,458.38
Rate for Payer: Humana Choice PPO Medicare	$9,778.69
Rate for Payer: Mclaren Commercial	$21,765.51
Rate for Payer: Mclaren Medicaid	$5,348.94
Rate for Payer: Mclaren Medicare	$9,778.69
Rate for Payer: Meridian Medicaid	$5,616.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,267.62
Rate for Payer: MI Amish Medical Board Commercial	$11,245.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20,556.32
Rate for Payer: PACE Medicare	$9,289.76
Rate for Payer: PACE SWMI	$9,778.69
Rate for Payer: PHP Commercial	$10,756.56
Rate for Payer: PHP Medicaid	$5,348.94
Rate for Payer: PHP Medicare Advantage	$9,778.69
Rate for Payer: Priority Health Choice Medicaid	$5,348.94
Rate for Payer: Priority Health Cigna Priority Health	$16,928.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,306.60
Rate for Payer: Priority Health Medicare	$9,778.69
Rate for Payer: Priority Health Narrow Network	$6,645.28
Rate for Payer: Railroad Medicare Medicare	$9,778.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21,281.83
Rate for Payer: UHC Medicare Advantage	$10,072.05
Rate for Payer: VA VA	$9,778.69

HC DEVELOPMENTAL TESTING

Facility

$371.75

Service Code	CPT 96110
Hospital Charge Code	51000057
Hospital Revenue Code	761
Min. Negotiated Rate	$260.22
Max. Negotiated Rate	$371.75
Rate for Payer: Aetna Commercial	$334.58
Rate for Payer: ASR ASR	$360.60
Rate for Payer: BCBS Trust/PPO	$288.22
Rate for Payer: BCN Commercial	$288.22
Rate for Payer: Cash Price	$297.40
Rate for Payer: Cofinity Commercial	$349.44
Rate for Payer: Encore Health Key Benefits Commercial	$297.40
Rate for Payer: Healthscope Commercial	$371.75
Rate for Payer: Healthscope Whirlpool	$360.60
Rate for Payer: Mclaren Commercial	$334.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$315.99
Rate for Payer: Priority Health Cigna Priority Health	$260.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$327.14

HC DEVELOPMENTAL TESTING

Facility

$371.75

Service Code	CPT 96110
Hospital Charge Code	51000057
Hospital Revenue Code	761
Min. Negotiated Rate	$148.70
Max. Negotiated Rate	$371.75
Rate for Payer: Aetna Commercial	$334.58
Rate for Payer: ASR ASR	$360.60
Rate for Payer: BCBS Complete	$148.70
Rate for Payer: BCBS Trust/PPO	$288.22
Rate for Payer: BCN Commercial	$288.22
Rate for Payer: Cash Price	$297.40
Rate for Payer: Cofinity Commercial	$349.44
Rate for Payer: Encore Health Key Benefits Commercial	$297.40
Rate for Payer: Healthscope Commercial	$371.75
Rate for Payer: Healthscope Whirlpool	$360.60
Rate for Payer: Mclaren Commercial	$334.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$315.99
Rate for Payer: Priority Health Cigna Priority Health	$260.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$338.29
Rate for Payer: Priority Health Narrow Network	$263.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$327.14

HC DEVICE NOT RETURNED ACTIWATCH

Professional

Both

$949.00

Service Code	HCPCS 00615
Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$664.30
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: Cash Price	$759.20
Rate for Payer: Priority Health Cigna Priority Health	$664.30

HC DEVICE NOT RETURNED ACTIWATCH

Facility

$949.00

Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$664.30
Max. Negotiated Rate	$949.00
Rate for Payer: Aetna Commercial	$854.10
Rate for Payer: ASR ASR	$920.53
Rate for Payer: BCBS Trust/PPO	$735.76
Rate for Payer: BCN Commercial	$735.76
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cofinity Commercial	$892.06
Rate for Payer: Encore Health Key Benefits Commercial	$759.20
Rate for Payer: Healthscope Commercial	$949.00
Rate for Payer: Healthscope Whirlpool	$920.53
Rate for Payer: Mclaren Commercial	$854.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$806.65
Rate for Payer: Priority Health Cigna Priority Health	$664.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$835.12

HC DEVICE NOT RETURNED ACTIWATCH

Professional

Both

$949.00

Service Code	HCPCS 00615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$664.30
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: Cash Price	$759.20
Rate for Payer: Priority Health Cigna Priority Health	$664.30

HC DEVICE NOT RETURNED ACTIWATCH

Facility

$949.00

Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$949.00
Rate for Payer: Aetna Commercial	$854.10
Rate for Payer: ASR ASR	$920.53
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: BCBS Trust/PPO	$735.76
Rate for Payer: BCN Commercial	$735.76
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cofinity Commercial	$892.06
Rate for Payer: Encore Health Key Benefits Commercial	$759.20
Rate for Payer: Healthscope Commercial	$949.00
Rate for Payer: Healthscope Whirlpool	$920.53
Rate for Payer: Mclaren Commercial	$854.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$806.65
Rate for Payer: Priority Health Cigna Priority Health	$664.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$863.59
Rate for Payer: Priority Health Narrow Network	$673.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$835.12

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Professional

Both

$310.00

Service Code	HCPCS 00616
Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$217.00
Rate for Payer: BCBS Complete	$124.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Priority Health Cigna Priority Health	$217.00

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Professional

Both

$310.00

Service Code	HCPCS 00616
Hospital Revenue Code	270
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$217.00
Rate for Payer: BCBS Complete	$124.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Priority Health Cigna Priority Health	$217.00

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Facility

$310.00

Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$279.00
Rate for Payer: ASR ASR	$300.70
Rate for Payer: BCBS Complete	$124.00
Rate for Payer: BCBS Trust/PPO	$240.34
Rate for Payer: BCN Commercial	$240.34
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cofinity Commercial	$291.40
Rate for Payer: Encore Health Key Benefits Commercial	$248.00
Rate for Payer: Healthscope Commercial	$310.00
Rate for Payer: Healthscope Whirlpool	$300.70
Rate for Payer: Mclaren Commercial	$279.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.50
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$282.10
Rate for Payer: Priority Health Narrow Network	$220.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$272.80

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Facility

$310.00

Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$279.00
Rate for Payer: ASR ASR	$300.70
Rate for Payer: BCBS Trust/PPO	$240.34
Rate for Payer: BCN Commercial	$240.34
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cofinity Commercial	$291.40
Rate for Payer: Encore Health Key Benefits Commercial	$248.00
Rate for Payer: Healthscope Commercial	$310.00
Rate for Payer: Healthscope Whirlpool	$300.70
Rate for Payer: Mclaren Commercial	$279.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.50
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$272.80

HC DEVICE NOT RETURNED APNEALINK

Professional

Both

$828.00

Service Code	HCPCS 00602
Hospital Revenue Code	270
Min. Negotiated Rate	$331.20
Max. Negotiated Rate	$579.60
Rate for Payer: BCBS Complete	$331.20
Rate for Payer: Cash Price	$662.40
Rate for Payer: Priority Health Cigna Priority Health	$579.60

HC DEVICE NOT RETURNED APNEALINK PLUS

Professional

Both

$1,548.00

Service Code	HCPCS 00603
Hospital Revenue Code	270
Min. Negotiated Rate	$619.20
Max. Negotiated Rate	$1,083.60
Rate for Payer: BCBS Complete	$619.20
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Priority Health Cigna Priority Health	$1,083.60

HC DEVICE NOT RETURNED APNEALINK PLUS

Facility

$1,548.00

Hospital Charge Code	27000603
Hospital Revenue Code	270
Min. Negotiated Rate	$1,083.60
Max. Negotiated Rate	$1,548.00
Rate for Payer: Aetna Commercial	$1,393.20
Rate for Payer: ASR ASR	$1,501.56
Rate for Payer: BCBS Trust/PPO	$1,200.16
Rate for Payer: BCN Commercial	$1,200.16
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cofinity Commercial	$1,455.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,238.40
Rate for Payer: Healthscope Commercial	$1,548.00
Rate for Payer: Healthscope Whirlpool	$1,501.56
Rate for Payer: Mclaren Commercial	$1,393.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,315.80
Rate for Payer: Priority Health Cigna Priority Health	$1,083.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,362.24

HC DEVICE NOT RETURNED APNEALINK PLUS

Professional

Both

$1,548.00

Service Code	HCPCS 00603
Hospital Charge Code	27000603
Hospital Revenue Code	270
Min. Negotiated Rate	$619.20
Max. Negotiated Rate	$1,083.60
Rate for Payer: BCBS Complete	$619.20
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Priority Health Cigna Priority Health	$1,083.60

HC DEVICE NOT RETURNED APNEALINK PLUS

Facility

$1,548.00

Hospital Charge Code	27000603
Hospital Revenue Code	270
Min. Negotiated Rate	$619.20
Max. Negotiated Rate	$1,548.00
Rate for Payer: Aetna Commercial	$1,393.20
Rate for Payer: ASR ASR	$1,501.56
Rate for Payer: BCBS Complete	$619.20
Rate for Payer: BCBS Trust/PPO	$1,200.16
Rate for Payer: BCN Commercial	$1,200.16
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cofinity Commercial	$1,455.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,238.40
Rate for Payer: Healthscope Commercial	$1,548.00
Rate for Payer: Healthscope Whirlpool	$1,501.56
Rate for Payer: Mclaren Commercial	$1,393.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,315.80
Rate for Payer: Priority Health Cigna Priority Health	$1,083.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,408.68
Rate for Payer: Priority Health Narrow Network	$1,099.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,362.24

HC DEVICE NOT RETURNED CADD PUMP

Facility

$3,723.00

Hospital Charge Code	27000642
Hospital Revenue Code	270
Min. Negotiated Rate	$1,489.20
Max. Negotiated Rate	$3,723.00
Rate for Payer: Aetna Commercial	$3,350.70
Rate for Payer: ASR ASR	$3,611.31
Rate for Payer: BCBS Complete	$1,489.20
Rate for Payer: BCBS Trust/PPO	$2,886.44
Rate for Payer: BCN Commercial	$2,886.44
Rate for Payer: Cash Price	$2,978.40
Rate for Payer: Cofinity Commercial	$3,499.62
Rate for Payer: Encore Health Key Benefits Commercial	$2,978.40
Rate for Payer: Healthscope Commercial	$3,723.00
Rate for Payer: Healthscope Whirlpool	$3,611.31
Rate for Payer: Mclaren Commercial	$3,350.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,164.55
Rate for Payer: Priority Health Cigna Priority Health	$2,606.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,387.93
Rate for Payer: Priority Health Narrow Network	$2,643.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,276.24

HC DEVICE NOT RETURNED CADD PUMP

Facility

$3,723.00

Hospital Charge Code	27000642
Hospital Revenue Code	270
Min. Negotiated Rate	$2,606.10
Max. Negotiated Rate	$3,723.00
Rate for Payer: Aetna Commercial	$3,350.70
Rate for Payer: ASR ASR	$3,611.31
Rate for Payer: BCBS Trust/PPO	$2,886.44
Rate for Payer: BCN Commercial	$2,886.44
Rate for Payer: Cash Price	$2,978.40
Rate for Payer: Cofinity Commercial	$3,499.62
Rate for Payer: Encore Health Key Benefits Commercial	$2,978.40
Rate for Payer: Healthscope Commercial	$3,723.00
Rate for Payer: Healthscope Whirlpool	$3,611.31
Rate for Payer: Mclaren Commercial	$3,350.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,164.55
Rate for Payer: Priority Health Cigna Priority Health	$2,606.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,276.24

HC DEVICE NOT RETURNED RU SLEEPING

Facility

$495.00

Hospital Charge Code	27000614
Hospital Revenue Code	270
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$445.50
Rate for Payer: ASR ASR	$480.15
Rate for Payer: BCBS Complete	$198.00
Rate for Payer: BCBS Trust/PPO	$383.77
Rate for Payer: BCN Commercial	$383.77
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cofinity Commercial	$465.30
Rate for Payer: Encore Health Key Benefits Commercial	$396.00
Rate for Payer: Healthscope Commercial	$495.00
Rate for Payer: Healthscope Whirlpool	$480.15
Rate for Payer: Mclaren Commercial	$445.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$420.75
Rate for Payer: Priority Health Cigna Priority Health	$346.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.45
Rate for Payer: Priority Health Narrow Network	$351.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$435.60

HC DEVICE NOT RETURNED RU SLEEPING

Professional

Both

$495.00

Service Code	HCPCS 00614
Hospital Revenue Code	270
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$346.50
Rate for Payer: BCBS Complete	$198.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Priority Health Cigna Priority Health	$346.50

HC DEVICE NOT RETURNED RU SLEEPING

Professional

Both

$495.00

Service Code	HCPCS 00614
Hospital Charge Code	27000614
Hospital Revenue Code	270
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$346.50
Rate for Payer: BCBS Complete	$198.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Priority Health Cigna Priority Health	$346.50

HC DEVICE NOT RETURNED RU SLEEPING

Facility

$495.00

Hospital Charge Code	27000614
Hospital Revenue Code	270
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$445.50
Rate for Payer: ASR ASR	$480.15
Rate for Payer: BCBS Trust/PPO	$383.77
Rate for Payer: BCN Commercial	$383.77
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cofinity Commercial	$465.30
Rate for Payer: Encore Health Key Benefits Commercial	$396.00
Rate for Payer: Healthscope Commercial	$495.00
Rate for Payer: Healthscope Whirlpool	$480.15
Rate for Payer: Mclaren Commercial	$445.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$420.75
Rate for Payer: Priority Health Cigna Priority Health	$346.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$435.60

Know your out-of-pocket cost for care.

All Charges