Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC ANCHOR/SCREW IMPLANTS

Facility

$16.56

Service Code	HCPCS C1713
Hospital Charge Code	27800001
Hospital Revenue Code	278
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$16.56
Rate for Payer: Aetna Commercial	$14.90
Rate for Payer: ASR ASR	$16.06
Rate for Payer: BCBS Trust/PPO	$12.84
Rate for Payer: BCN Commercial	$12.84
Rate for Payer: Cash Price	$13.25
Rate for Payer: Cofinity Commercial	$15.57
Rate for Payer: Encore Health Key Benefits Commercial	$13.25
Rate for Payer: Healthscope Commercial	$16.56
Rate for Payer: Healthscope Whirlpool	$16.06
Rate for Payer: Mclaren Commercial	$14.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.08
Rate for Payer: Priority Health Cigna Priority Health	$11.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.57

HC ANCHOR/SCREW IMPLANTS

Facility

$16.56

Service Code	HCPCS C1713
Hospital Charge Code	27800001
Hospital Revenue Code	278
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$16.56
Rate for Payer: Aetna Commercial	$14.90
Rate for Payer: ASR ASR	$16.06
Rate for Payer: BCBS Complete	$6.62
Rate for Payer: BCBS Trust/PPO	$12.84
Rate for Payer: BCN Commercial	$12.84
Rate for Payer: Cash Price	$13.25
Rate for Payer: Cofinity Commercial	$15.57
Rate for Payer: Encore Health Key Benefits Commercial	$13.25
Rate for Payer: Healthscope Commercial	$16.56
Rate for Payer: Healthscope Whirlpool	$16.06
Rate for Payer: Mclaren Commercial	$14.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.08
Rate for Payer: Priority Health Cigna Priority Health	$11.59
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.07
Rate for Payer: Priority Health Narrow Network	$11.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.57

HC ANDROSTENEDIONE LEVEL

Facility

$53.04

Service Code	CPT 82157
Hospital Charge Code	30100102
Hospital Revenue Code	301
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$100.57
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: Aetna Medicare	$29.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$36.60
Rate for Payer: Amish Plain Church Group Commercial	$36.60
Rate for Payer: ASR ASR	$51.45
Rate for Payer: BCBS Complete	$16.82
Rate for Payer: BCBS MAPPO	$29.28
Rate for Payer: BCBS Trust/PPO	$41.12
Rate for Payer: BCN Commercial	$41.12
Rate for Payer: BCN Medicare Advantage	$29.28
Rate for Payer: Cash Price	$42.43
Rate for Payer: Cash Price	$42.43
Rate for Payer: Cofinity Commercial	$49.86
Rate for Payer: Encore Health Key Benefits Commercial	$42.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$29.28
Rate for Payer: Healthscope Commercial	$53.04
Rate for Payer: Healthscope Whirlpool	$51.45
Rate for Payer: Humana Choice PPO Medicare	$29.28
Rate for Payer: Mclaren Commercial	$47.74
Rate for Payer: Mclaren Medicaid	$16.02
Rate for Payer: Mclaren Medicare	$29.28
Rate for Payer: Meridian Medicaid	$16.82
Rate for Payer: Meridian Wellcare - Medicare Advantage	$30.74
Rate for Payer: MI Amish Medical Board Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.08
Rate for Payer: PACE Medicare	$27.82
Rate for Payer: PACE SWMI	$29.28
Rate for Payer: PHP Commercial	$32.21
Rate for Payer: PHP Medicaid	$16.02
Rate for Payer: PHP Medicare Advantage	$29.28
Rate for Payer: Priority Health Choice Medicaid	$16.02
Rate for Payer: Priority Health Cigna Priority Health	$37.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.57
Rate for Payer: Priority Health Medicare	$29.28
Rate for Payer: Priority Health Narrow Network	$80.46
Rate for Payer: Railroad Medicare Medicare	$29.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$46.68
Rate for Payer: UHC Medicare Advantage	$30.16
Rate for Payer: VA VA	$29.28

HC ANDROSTENEDIONE LEVEL

Facility

$53.04

Service Code	CPT 82157
Hospital Charge Code	30100102
Hospital Revenue Code	301
Min. Negotiated Rate	$37.13
Max. Negotiated Rate	$53.04
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: ASR ASR	$51.45
Rate for Payer: BCBS Trust/PPO	$41.12
Rate for Payer: BCN Commercial	$41.12
Rate for Payer: Cash Price	$42.43
Rate for Payer: Cofinity Commercial	$49.86
Rate for Payer: Encore Health Key Benefits Commercial	$42.43
Rate for Payer: Healthscope Commercial	$53.04
Rate for Payer: Healthscope Whirlpool	$51.45
Rate for Payer: Mclaren Commercial	$47.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.08
Rate for Payer: Priority Health Cigna Priority Health	$37.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$46.68

HC ANDROSTENEDIONE, SERUM

Facility

$99.00

Service Code	CPT 82157
Hospital Charge Code	30100748
Hospital Revenue Code	301
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$100.57
Rate for Payer: Aetna Commercial	$89.10
Rate for Payer: Aetna Medicare	$29.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$36.60
Rate for Payer: Amish Plain Church Group Commercial	$36.60
Rate for Payer: ASR ASR	$96.03
Rate for Payer: BCBS Complete	$16.82
Rate for Payer: BCBS MAPPO	$29.28
Rate for Payer: BCBS Trust/PPO	$76.75
Rate for Payer: BCN Commercial	$76.75
Rate for Payer: BCN Medicare Advantage	$29.28
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cofinity Commercial	$93.06
Rate for Payer: Encore Health Key Benefits Commercial	$79.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$29.28
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Healthscope Whirlpool	$96.03
Rate for Payer: Humana Choice PPO Medicare	$29.28
Rate for Payer: Mclaren Commercial	$89.10
Rate for Payer: Mclaren Medicaid	$16.02
Rate for Payer: Mclaren Medicare	$29.28
Rate for Payer: Meridian Medicaid	$16.82
Rate for Payer: Meridian Wellcare - Medicare Advantage	$30.74
Rate for Payer: MI Amish Medical Board Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.15
Rate for Payer: PACE Medicare	$27.82
Rate for Payer: PACE SWMI	$29.28
Rate for Payer: PHP Commercial	$32.21
Rate for Payer: PHP Medicaid	$16.02
Rate for Payer: PHP Medicare Advantage	$29.28
Rate for Payer: Priority Health Choice Medicaid	$16.02
Rate for Payer: Priority Health Cigna Priority Health	$69.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.57
Rate for Payer: Priority Health Medicare	$29.28
Rate for Payer: Priority Health Narrow Network	$80.46
Rate for Payer: Railroad Medicare Medicare	$29.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$87.12
Rate for Payer: UHC Medicare Advantage	$30.16
Rate for Payer: VA VA	$29.28

HC ANDROSTENEDIONE, SERUM

Facility

$99.00

Service Code	CPT 82157
Hospital Charge Code	30100748
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$89.10
Rate for Payer: ASR ASR	$96.03
Rate for Payer: BCBS Trust/PPO	$76.75
Rate for Payer: BCN Commercial	$76.75
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cofinity Commercial	$93.06
Rate for Payer: Encore Health Key Benefits Commercial	$79.20
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Healthscope Whirlpool	$96.03
Rate for Payer: Mclaren Commercial	$89.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.15
Rate for Payer: Priority Health Cigna Priority Health	$69.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$87.12

HC ANESTHESIA BY ANESTHESIOLOGY

Facility

$426.86

Hospital Charge Code	37100001
Hospital Revenue Code	371
Min. Negotiated Rate	$170.74
Max. Negotiated Rate	$426.86
Rate for Payer: Aetna Commercial	$384.17
Rate for Payer: ASR ASR	$414.05
Rate for Payer: BCBS Complete	$170.74
Rate for Payer: BCBS Trust/PPO	$330.94
Rate for Payer: BCN Commercial	$330.94
Rate for Payer: Cash Price	$341.49
Rate for Payer: Cofinity Commercial	$401.25
Rate for Payer: Encore Health Key Benefits Commercial	$341.49
Rate for Payer: Healthscope Commercial	$426.86
Rate for Payer: Healthscope Whirlpool	$414.05
Rate for Payer: Mclaren Commercial	$384.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$362.83
Rate for Payer: Priority Health Cigna Priority Health	$298.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$388.44
Rate for Payer: Priority Health Narrow Network	$303.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$375.64

HC ANESTHESIA BY ANESTHESIOLOGY

Facility

$426.86

Hospital Charge Code	37100001
Hospital Revenue Code	371
Min. Negotiated Rate	$298.80
Max. Negotiated Rate	$426.86
Rate for Payer: Aetna Commercial	$384.17
Rate for Payer: ASR ASR	$414.05
Rate for Payer: BCBS Trust/PPO	$330.94
Rate for Payer: BCN Commercial	$330.94
Rate for Payer: Cash Price	$341.49
Rate for Payer: Cofinity Commercial	$401.25
Rate for Payer: Encore Health Key Benefits Commercial	$341.49
Rate for Payer: Healthscope Commercial	$426.86
Rate for Payer: Healthscope Whirlpool	$414.05
Rate for Payer: Mclaren Commercial	$384.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$362.83
Rate for Payer: Priority Health Cigna Priority Health	$298.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$375.64

HC ANEUPLOIDY DETECTION CMPT

Facility

$49.98

Service Code	CPT 88271
Hospital Charge Code	31000028
Hospital Revenue Code	310
Min. Negotiated Rate	$34.99
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Commercial	$44.98
Rate for Payer: ASR ASR	$48.48
Rate for Payer: BCBS Trust/PPO	$38.75
Rate for Payer: BCN Commercial	$38.75
Rate for Payer: Cash Price	$39.98
Rate for Payer: Cofinity Commercial	$46.98
Rate for Payer: Encore Health Key Benefits Commercial	$39.98
Rate for Payer: Healthscope Commercial	$49.98
Rate for Payer: Healthscope Whirlpool	$48.48
Rate for Payer: Mclaren Commercial	$44.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.48
Rate for Payer: Priority Health Cigna Priority Health	$34.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.98

HC ANEUPLOIDY DETECTION CMPT

Facility

$49.98

Service Code	CPT 88271
Hospital Charge Code	31000028
Hospital Revenue Code	310
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Commercial	$44.98
Rate for Payer: Aetna Medicare	$21.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.78
Rate for Payer: Amish Plain Church Group Commercial	$26.78
Rate for Payer: ASR ASR	$48.48
Rate for Payer: BCBS Complete	$12.30
Rate for Payer: BCBS MAPPO	$21.42
Rate for Payer: BCBS Trust/PPO	$38.75
Rate for Payer: BCN Commercial	$38.75
Rate for Payer: BCN Medicare Advantage	$21.42
Rate for Payer: Cash Price	$39.98
Rate for Payer: Cash Price	$39.98
Rate for Payer: Cofinity Commercial	$46.98
Rate for Payer: Encore Health Key Benefits Commercial	$39.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.42
Rate for Payer: Healthscope Commercial	$49.98
Rate for Payer: Healthscope Whirlpool	$48.48
Rate for Payer: Humana Choice PPO Medicare	$21.42
Rate for Payer: Mclaren Commercial	$44.98
Rate for Payer: Mclaren Medicaid	$11.72
Rate for Payer: Mclaren Medicare	$21.42
Rate for Payer: Meridian Medicaid	$12.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.49
Rate for Payer: MI Amish Medical Board Commercial	$24.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.48
Rate for Payer: PACE Medicare	$20.35
Rate for Payer: PACE SWMI	$21.42
Rate for Payer: PHP Commercial	$23.56
Rate for Payer: PHP Medicaid	$11.72
Rate for Payer: PHP Medicare Advantage	$21.42
Rate for Payer: Priority Health Choice Medicaid	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$34.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.48
Rate for Payer: Priority Health Medicare	$21.42
Rate for Payer: Priority Health Narrow Network	$35.49
Rate for Payer: Railroad Medicare Medicare	$21.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.98
Rate for Payer: UHC Medicare Advantage	$22.06
Rate for Payer: VA VA	$21.42

HC ANEUPLOIDY DETECTION POC FISH

Facility

$135.66

Service Code	CPT 88275
Hospital Charge Code	31000038
Hospital Revenue Code	310
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Commercial	$122.09
Rate for Payer: Aetna Medicare	$51.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$63.99
Rate for Payer: Amish Plain Church Group Commercial	$63.99
Rate for Payer: ASR ASR	$131.59
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: BCBS MAPPO	$51.19
Rate for Payer: BCBS Trust/PPO	$105.18
Rate for Payer: BCN Commercial	$105.18
Rate for Payer: BCN Medicare Advantage	$51.19
Rate for Payer: Cash Price	$108.53
Rate for Payer: Cash Price	$108.53
Rate for Payer: Cofinity Commercial	$127.52
Rate for Payer: Encore Health Key Benefits Commercial	$108.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.19
Rate for Payer: Healthscope Commercial	$135.66
Rate for Payer: Healthscope Whirlpool	$131.59
Rate for Payer: Humana Choice PPO Medicare	$51.19
Rate for Payer: Mclaren Commercial	$122.09
Rate for Payer: Mclaren Medicaid	$28.00
Rate for Payer: Mclaren Medicare	$51.19
Rate for Payer: Meridian Medicaid	$29.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$53.75
Rate for Payer: MI Amish Medical Board Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$115.31
Rate for Payer: PACE Medicare	$48.63
Rate for Payer: PACE SWMI	$51.19
Rate for Payer: PHP Commercial	$56.31
Rate for Payer: PHP Medicaid	$28.00
Rate for Payer: PHP Medicare Advantage	$51.19
Rate for Payer: Priority Health Choice Medicaid	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$94.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.45
Rate for Payer: Priority Health Medicare	$51.19
Rate for Payer: Priority Health Narrow Network	$96.32
Rate for Payer: Railroad Medicare Medicare	$51.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$119.38
Rate for Payer: UHC Medicare Advantage	$52.73
Rate for Payer: VA VA	$51.19

HC ANEUPLOIDY DETECTION POC FISH

Facility

$135.66

Service Code	CPT 88275
Hospital Charge Code	31000038
Hospital Revenue Code	310
Min. Negotiated Rate	$94.96
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Commercial	$122.09
Rate for Payer: ASR ASR	$131.59
Rate for Payer: BCBS Trust/PPO	$105.18
Rate for Payer: BCN Commercial	$105.18
Rate for Payer: Cash Price	$108.53
Rate for Payer: Cofinity Commercial	$127.52
Rate for Payer: Encore Health Key Benefits Commercial	$108.53
Rate for Payer: Healthscope Commercial	$135.66
Rate for Payer: Healthscope Whirlpool	$131.59
Rate for Payer: Mclaren Commercial	$122.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$115.31
Rate for Payer: Priority Health Cigna Priority Health	$94.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$119.38

HC ANGIOPLASTY CENTRAL DIALYSIS W IMAGING

Facility

$2,314.44

Service Code	CPT 36907
Hospital Charge Code	36100531
Hospital Revenue Code	361
Min. Negotiated Rate	$1,620.11
Max. Negotiated Rate	$2,314.44
Rate for Payer: Aetna Commercial	$2,083.00
Rate for Payer: ASR ASR	$2,245.01
Rate for Payer: BCBS Trust/PPO	$1,794.39
Rate for Payer: BCN Commercial	$1,794.39
Rate for Payer: Cash Price	$1,851.55
Rate for Payer: Cofinity Commercial	$2,175.57
Rate for Payer: Encore Health Key Benefits Commercial	$1,851.55
Rate for Payer: Healthscope Commercial	$2,314.44
Rate for Payer: Healthscope Whirlpool	$2,245.01
Rate for Payer: Mclaren Commercial	$2,083.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,967.27
Rate for Payer: Priority Health Cigna Priority Health	$1,620.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,036.71

HC ANGIOPLASTY CENTRAL DIALYSIS W IMAGING

Facility

$2,314.44

Service Code	CPT 36907
Hospital Charge Code	36100531
Hospital Revenue Code	361
Min. Negotiated Rate	$925.78
Max. Negotiated Rate	$2,314.44
Rate for Payer: Aetna Commercial	$2,083.00
Rate for Payer: ASR ASR	$2,245.01
Rate for Payer: BCBS Complete	$925.78
Rate for Payer: BCBS Trust/PPO	$1,794.39
Rate for Payer: BCN Commercial	$1,794.39
Rate for Payer: Cash Price	$1,851.55
Rate for Payer: Cofinity Commercial	$2,175.57
Rate for Payer: Encore Health Key Benefits Commercial	$1,851.55
Rate for Payer: Healthscope Commercial	$2,314.44
Rate for Payer: Healthscope Whirlpool	$2,245.01
Rate for Payer: Mclaren Commercial	$2,083.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,967.27
Rate for Payer: Priority Health Cigna Priority Health	$1,620.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,106.14
Rate for Payer: Priority Health Narrow Network	$1,643.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,036.71

HC ANGIOPLASTY EACH ADDL ARTERY WITH IMAGING

Facility

$492.56

Service Code	CPT 37247
Hospital Charge Code	36100535
Hospital Revenue Code	361
Min. Negotiated Rate	$197.02
Max. Negotiated Rate	$492.56
Rate for Payer: Aetna Commercial	$443.30
Rate for Payer: ASR ASR	$477.78
Rate for Payer: BCBS Complete	$197.02
Rate for Payer: BCBS Trust/PPO	$381.88
Rate for Payer: BCN Commercial	$381.88
Rate for Payer: Cash Price	$394.05
Rate for Payer: Cofinity Commercial	$463.01
Rate for Payer: Encore Health Key Benefits Commercial	$394.05
Rate for Payer: Healthscope Commercial	$492.56
Rate for Payer: Healthscope Whirlpool	$477.78
Rate for Payer: Mclaren Commercial	$443.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$418.68
Rate for Payer: Priority Health Cigna Priority Health	$344.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$448.23
Rate for Payer: Priority Health Narrow Network	$349.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$433.45

HC ANGIOPLASTY EACH ADDL ARTERY WITH IMAGING

Facility

$492.56

Service Code	CPT 37247
Hospital Charge Code	36100535
Hospital Revenue Code	361
Min. Negotiated Rate	$344.79
Max. Negotiated Rate	$492.56
Rate for Payer: Aetna Commercial	$443.30
Rate for Payer: ASR ASR	$477.78
Rate for Payer: BCBS Trust/PPO	$381.88
Rate for Payer: BCN Commercial	$381.88
Rate for Payer: Cash Price	$394.05
Rate for Payer: Cofinity Commercial	$463.01
Rate for Payer: Encore Health Key Benefits Commercial	$394.05
Rate for Payer: Healthscope Commercial	$492.56
Rate for Payer: Healthscope Whirlpool	$477.78
Rate for Payer: Mclaren Commercial	$443.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$418.68
Rate for Payer: Priority Health Cigna Priority Health	$344.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$433.45

HC ANGIOPLASTY EACH ADDL VEIN WITH IMAGING

Facility

$541.81

Service Code	CPT 37249
Hospital Charge Code	36100537
Hospital Revenue Code	361
Min. Negotiated Rate	$379.27
Max. Negotiated Rate	$541.81
Rate for Payer: Aetna Commercial	$487.63
Rate for Payer: ASR ASR	$525.56
Rate for Payer: BCBS Trust/PPO	$420.07
Rate for Payer: BCN Commercial	$420.07
Rate for Payer: Cash Price	$433.45
Rate for Payer: Cofinity Commercial	$509.30
Rate for Payer: Encore Health Key Benefits Commercial	$433.45
Rate for Payer: Healthscope Commercial	$541.81
Rate for Payer: Healthscope Whirlpool	$525.56
Rate for Payer: Mclaren Commercial	$487.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$460.54
Rate for Payer: Priority Health Cigna Priority Health	$379.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$476.79

HC ANGIOPLASTY EACH ADDL VEIN WITH IMAGING

Facility

$541.81

Service Code	CPT 37249
Hospital Charge Code	36100537
Hospital Revenue Code	361
Min. Negotiated Rate	$216.72
Max. Negotiated Rate	$541.81
Rate for Payer: Aetna Commercial	$487.63
Rate for Payer: ASR ASR	$525.56
Rate for Payer: BCBS Complete	$216.72
Rate for Payer: BCBS Trust/PPO	$420.07
Rate for Payer: BCN Commercial	$420.07
Rate for Payer: Cash Price	$433.45
Rate for Payer: Cofinity Commercial	$509.30
Rate for Payer: Encore Health Key Benefits Commercial	$433.45
Rate for Payer: Healthscope Commercial	$541.81
Rate for Payer: Healthscope Whirlpool	$525.56
Rate for Payer: Mclaren Commercial	$487.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$460.54
Rate for Payer: Priority Health Cigna Priority Health	$379.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$493.05
Rate for Payer: Priority Health Narrow Network	$384.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$476.79

HC ANGIOPLASTY INITIAL ARTERY WITH IMAGING

Facility

$6,381.71

Service Code	CPT 37246
Hospital Charge Code	36100534
Hospital Revenue Code	361
Min. Negotiated Rate	$2,779.05
Max. Negotiated Rate	$6,381.71
Rate for Payer: Aetna Commercial	$5,743.54
Rate for Payer: Aetna Medicare	$5,080.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,350.66
Rate for Payer: Amish Plain Church Group Commercial	$6,350.66
Rate for Payer: ASR ASR	$6,190.26
Rate for Payer: BCBS Complete	$2,918.26
Rate for Payer: BCBS MAPPO	$5,080.53
Rate for Payer: BCBS Trust/PPO	$4,947.74
Rate for Payer: BCN Commercial	$4,947.74
Rate for Payer: BCN Medicare Advantage	$5,080.53
Rate for Payer: Cash Price	$5,105.37
Rate for Payer: Cash Price	$5,105.37
Rate for Payer: Cofinity Commercial	$5,998.81
Rate for Payer: Encore Health Key Benefits Commercial	$5,105.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,080.53
Rate for Payer: Healthscope Commercial	$6,381.71
Rate for Payer: Healthscope Whirlpool	$6,190.26
Rate for Payer: Humana Choice PPO Medicare	$5,080.53
Rate for Payer: Mclaren Commercial	$5,743.54
Rate for Payer: Mclaren Medicaid	$2,779.05
Rate for Payer: Mclaren Medicare	$5,080.53
Rate for Payer: Meridian Medicaid	$2,918.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,334.56
Rate for Payer: MI Amish Medical Board Commercial	$5,842.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,424.45
Rate for Payer: PACE Medicare	$4,826.50
Rate for Payer: PACE SWMI	$5,080.53
Rate for Payer: PHP Commercial	$5,588.58
Rate for Payer: PHP Medicaid	$2,779.05
Rate for Payer: PHP Medicare Advantage	$5,080.53
Rate for Payer: Priority Health Choice Medicaid	$2,779.05
Rate for Payer: Priority Health Cigna Priority Health	$4,467.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,807.36
Rate for Payer: Priority Health Medicare	$5,080.53
Rate for Payer: Priority Health Narrow Network	$4,531.01
Rate for Payer: Railroad Medicare Medicare	$5,080.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,615.90
Rate for Payer: UHC Medicare Advantage	$5,232.95
Rate for Payer: VA VA	$5,080.53

HC ANGIOPLASTY INITIAL ARTERY WITH IMAGING

Facility

$6,381.71

Service Code	CPT 37246
Hospital Charge Code	36100534
Hospital Revenue Code	361
Min. Negotiated Rate	$4,467.20
Max. Negotiated Rate	$6,381.71
Rate for Payer: Aetna Commercial	$5,743.54
Rate for Payer: ASR ASR	$6,190.26
Rate for Payer: BCBS Trust/PPO	$4,947.74
Rate for Payer: BCN Commercial	$4,947.74
Rate for Payer: Cash Price	$5,105.37
Rate for Payer: Cofinity Commercial	$5,998.81
Rate for Payer: Encore Health Key Benefits Commercial	$5,105.37
Rate for Payer: Healthscope Commercial	$6,381.71
Rate for Payer: Healthscope Whirlpool	$6,190.26
Rate for Payer: Mclaren Commercial	$5,743.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,424.45
Rate for Payer: Priority Health Cigna Priority Health	$4,467.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,615.90

HC ANGIOPLASTY INITIAL VEIN WITH IMAGING

Facility

$6,381.71

Service Code	CPT 37248
Hospital Charge Code	36100536
Hospital Revenue Code	361
Min. Negotiated Rate	$2,779.05
Max. Negotiated Rate	$6,381.71
Rate for Payer: Aetna Commercial	$5,743.54
Rate for Payer: Aetna Medicare	$5,080.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,350.66
Rate for Payer: Amish Plain Church Group Commercial	$6,350.66
Rate for Payer: ASR ASR	$6,190.26
Rate for Payer: BCBS Complete	$2,918.26
Rate for Payer: BCBS MAPPO	$5,080.53
Rate for Payer: BCBS Trust/PPO	$4,947.74
Rate for Payer: BCN Commercial	$4,947.74
Rate for Payer: BCN Medicare Advantage	$5,080.53
Rate for Payer: Cash Price	$5,105.37
Rate for Payer: Cash Price	$5,105.37
Rate for Payer: Cofinity Commercial	$5,998.81
Rate for Payer: Encore Health Key Benefits Commercial	$5,105.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,080.53
Rate for Payer: Healthscope Commercial	$6,381.71
Rate for Payer: Healthscope Whirlpool	$6,190.26
Rate for Payer: Humana Choice PPO Medicare	$5,080.53
Rate for Payer: Mclaren Commercial	$5,743.54
Rate for Payer: Mclaren Medicaid	$2,779.05
Rate for Payer: Mclaren Medicare	$5,080.53
Rate for Payer: Meridian Medicaid	$2,918.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,334.56
Rate for Payer: MI Amish Medical Board Commercial	$5,842.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,424.45
Rate for Payer: PACE Medicare	$4,826.50
Rate for Payer: PACE SWMI	$5,080.53
Rate for Payer: PHP Commercial	$5,588.58
Rate for Payer: PHP Medicaid	$2,779.05
Rate for Payer: PHP Medicare Advantage	$5,080.53
Rate for Payer: Priority Health Choice Medicaid	$2,779.05
Rate for Payer: Priority Health Cigna Priority Health	$4,467.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,807.36
Rate for Payer: Priority Health Medicare	$5,080.53
Rate for Payer: Priority Health Narrow Network	$4,531.01
Rate for Payer: Railroad Medicare Medicare	$5,080.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,615.90
Rate for Payer: UHC Medicare Advantage	$5,232.95
Rate for Payer: VA VA	$5,080.53

HC ANGIOPLASTY INITIAL VEIN WITH IMAGING

Facility

$6,381.71

Service Code	CPT 37248
Hospital Charge Code	36100536
Hospital Revenue Code	361
Min. Negotiated Rate	$4,467.20
Max. Negotiated Rate	$6,381.71
Rate for Payer: Aetna Commercial	$5,743.54
Rate for Payer: ASR ASR	$6,190.26
Rate for Payer: BCBS Trust/PPO	$4,947.74
Rate for Payer: BCN Commercial	$4,947.74
Rate for Payer: Cash Price	$5,105.37
Rate for Payer: Cofinity Commercial	$5,998.81
Rate for Payer: Encore Health Key Benefits Commercial	$5,105.37
Rate for Payer: Healthscope Commercial	$6,381.71
Rate for Payer: Healthscope Whirlpool	$6,190.26
Rate for Payer: Mclaren Commercial	$5,743.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,424.45
Rate for Payer: Priority Health Cigna Priority Health	$4,467.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,615.90

HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL DIFF FAM

Facility

$991.53

Service Code	CPT 61642
Hospital Charge Code	36100277
Hospital Revenue Code	361
Min. Negotiated Rate	$694.07
Max. Negotiated Rate	$991.53
Rate for Payer: Aetna Commercial	$892.38
Rate for Payer: ASR ASR	$961.78
Rate for Payer: BCBS Trust/PPO	$768.73
Rate for Payer: BCN Commercial	$768.73
Rate for Payer: Cash Price	$793.22
Rate for Payer: Cofinity Commercial	$932.04
Rate for Payer: Encore Health Key Benefits Commercial	$793.22
Rate for Payer: Healthscope Commercial	$991.53
Rate for Payer: Healthscope Whirlpool	$961.78
Rate for Payer: Mclaren Commercial	$892.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$842.80
Rate for Payer: Priority Health Cigna Priority Health	$694.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$872.55

HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL DIFF FAM

Facility

$991.53

Service Code	CPT 61642
Hospital Charge Code	36100277
Hospital Revenue Code	361
Min. Negotiated Rate	$396.61
Max. Negotiated Rate	$991.53
Rate for Payer: Aetna Commercial	$892.38
Rate for Payer: ASR ASR	$961.78
Rate for Payer: BCBS Complete	$396.61
Rate for Payer: BCBS Trust/PPO	$768.73
Rate for Payer: BCN Commercial	$768.73
Rate for Payer: Cash Price	$793.22
Rate for Payer: Cofinity Commercial	$932.04
Rate for Payer: Encore Health Key Benefits Commercial	$793.22
Rate for Payer: Healthscope Commercial	$991.53
Rate for Payer: Healthscope Whirlpool	$961.78
Rate for Payer: Mclaren Commercial	$892.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$842.80
Rate for Payer: Priority Health Cigna Priority Health	$694.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$902.29
Rate for Payer: Priority Health Narrow Network	$703.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$872.55

HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL SAME FAM

Facility

$991.53

Service Code	CPT 61641
Hospital Charge Code	36100276
Hospital Revenue Code	361
Min. Negotiated Rate	$396.61
Max. Negotiated Rate	$991.53
Rate for Payer: Aetna Commercial	$892.38
Rate for Payer: ASR ASR	$961.78
Rate for Payer: BCBS Complete	$396.61
Rate for Payer: BCBS Trust/PPO	$768.73
Rate for Payer: BCN Commercial	$768.73
Rate for Payer: Cash Price	$793.22
Rate for Payer: Cofinity Commercial	$932.04
Rate for Payer: Encore Health Key Benefits Commercial	$793.22
Rate for Payer: Healthscope Commercial	$991.53
Rate for Payer: Healthscope Whirlpool	$961.78
Rate for Payer: Mclaren Commercial	$892.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$842.80
Rate for Payer: Priority Health Cigna Priority Health	$694.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$902.29
Rate for Payer: Priority Health Narrow Network	$703.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$872.55

Know your out-of-pocket cost for care.

All Charges