Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$314.00

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$125.60
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$266.90
Rate for Payer: Aetna New Business (MI Preferred)	$204.10
Rate for Payer: BCBS Complete	$125.60
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cofinity Commercial	$270.04
Rate for Payer: Cofinity Commercial	$219.80
Rate for Payer: Healthscope Commercial	$282.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$266.90
Rate for Payer: PHP Commercial	$266.90
Rate for Payer: Priority Health Cigna Priority Health	$219.80
Rate for Payer: Priority Health SBD	$197.82

HC COMP BURN GARM SUIT SLVLS-TWO LEGS

Facility

$368.00

Service Code	HCPCS A6512
Hospital Charge Code	98300062
Hospital Revenue Code	270
Min. Negotiated Rate	$231.84
Max. Negotiated Rate	$331.20
Rate for Payer: Aetna Commercial	$312.80
Rate for Payer: Aetna New Business (MI Preferred)	$239.20
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cofinity Commercial	$257.60
Rate for Payer: Cofinity Commercial	$316.48
Rate for Payer: Healthscope Commercial	$331.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$312.80
Rate for Payer: PHP Commercial	$312.80
Rate for Payer: Priority Health Cigna Priority Health	$257.60
Rate for Payer: Priority Health SBD	$231.84

HC COMP BURN GARM SUIT SLVLS-TWO LEGS

Facility

$368.00

Service Code	HCPCS A6512
Hospital Charge Code	98300062
Hospital Revenue Code	270
Min. Negotiated Rate	$147.20
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$312.80
Rate for Payer: Aetna New Business (MI Preferred)	$239.20
Rate for Payer: BCBS Complete	$147.20
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cofinity Commercial	$257.60
Rate for Payer: Cofinity Commercial	$316.48
Rate for Payer: Healthscope Commercial	$331.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$312.80
Rate for Payer: PHP Commercial	$312.80
Rate for Payer: Priority Health Cigna Priority Health	$257.60
Rate for Payer: Priority Health SBD	$231.84

HC COMP BURN GARM SUSPENDERS ATTA

Facility

$45.00

Service Code	HCPCS A9900
Hospital Charge Code	98300063
Hospital Revenue Code	270
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health SBD	$28.35

HC COMP BURN GARM SUSPENDERS ATTA

Facility

$45.00

Service Code	HCPCS A9900
Hospital Charge Code	98300063
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$587.24
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Trust/PPO	$587.24
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health SBD	$28.35

HC COMP BURN GARM SUSPENDERS REMO

Facility

$12.00

Service Code	HCPCS A9900
Hospital Charge Code	98300064
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

HC COMP BURN GARM SUSPENDERS REMO

Facility

$12.00

Service Code	HCPCS A9900
Hospital Charge Code	98300064
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$587.24
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$587.24
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

HC COMP BURN GARM TWO LEGS PREGNA

Facility

$250.00

Service Code	HCPCS A6512
Hospital Charge Code	98300065
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC COMP BURN GARM TWO LEGS PREGNA

Facility

$250.00

Service Code	HCPCS A6512
Hospital Charge Code	98300065
Hospital Revenue Code	270
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC COMP BURN GARM VEST SLEEVED

Facility

$250.00

Service Code	HCPCS A6509
Hospital Charge Code	98300066
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC COMP BURN GARM VEST SLEEVED

Facility

$250.00

Service Code	HCPCS A6509
Hospital Charge Code	98300066
Hospital Revenue Code	270
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$470.72
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCBS Trust/PPO	$470.72
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC COMP BURN GARM VEST SLEEVELESS

Facility

$132.00

Service Code	HCPCS A6509
Hospital Charge Code	98300067
Hospital Revenue Code	270
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$470.72
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCBS Trust/PPO	$470.72
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health SBD	$83.16

HC COMP BURN GARM VEST SLEEVELESS

Facility

$132.00

Service Code	HCPCS A6509
Hospital Charge Code	98300067
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health SBD	$83.16

HC COMP BURN GARM ZIPPER

Facility

$45.00

Service Code	HCPCS A9900
Hospital Charge Code	98300068
Hospital Revenue Code	270
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health SBD	$28.35

HC COMP BURN GARM ZIPPER

Facility

$45.00

Service Code	HCPCS A9900
Hospital Charge Code	98300068
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$587.24
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Trust/PPO	$587.24
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health SBD	$28.35

HC COMPLEMENT C 3

Facility

$113.00

Service Code	CPT 86160
Hospital Charge Code	30200150
Hospital Revenue Code	302
Min. Negotiated Rate	$71.19
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna Commercial	$96.05
Rate for Payer: Aetna New Business (MI Preferred)	$73.45
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cofinity Commercial	$79.10
Rate for Payer: Cofinity Commercial	$97.18
Rate for Payer: Healthscope Commercial	$101.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.05
Rate for Payer: PHP Commercial	$96.05
Rate for Payer: Priority Health Cigna Priority Health	$79.10
Rate for Payer: Priority Health SBD	$71.19

HC COMPLEMENT C 3

Facility

$113.00

Service Code	CPT 86160
Hospital Charge Code	30200150
Hospital Revenue Code	302
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna Commercial	$96.05
Rate for Payer: Aetna Medicare	$12.48
Rate for Payer: Aetna New Business (MI Preferred)	$73.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.00
Rate for Payer: Amish Plain Church Group Commercial	$15.00
Rate for Payer: BCBS Complete	$6.89
Rate for Payer: BCBS MAPPO	$12.00
Rate for Payer: BCBS Trust/PPO	$9.40
Rate for Payer: BCN Medicare Advantage	$12.00
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cofinity Commercial	$97.18
Rate for Payer: Cofinity Commercial	$79.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.00
Rate for Payer: Healthscope Commercial	$101.70
Rate for Payer: Mclaren Medicaid	$6.56
Rate for Payer: Mclaren Medicare	$12.00
Rate for Payer: Meridian Medicaid	$6.89
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.60
Rate for Payer: MI Amish Medical Board Commercial	$13.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.05
Rate for Payer: PACE Medicare	$11.40
Rate for Payer: PACE SWMI	$12.00
Rate for Payer: PHP Commercial	$96.05
Rate for Payer: PHP Medicare Advantage	$12.00
Rate for Payer: Priority Health Choice Medicaid	$6.56
Rate for Payer: Priority Health Cigna Priority Health	$79.10
Rate for Payer: Priority Health Medicare	$12.00
Rate for Payer: Priority Health SBD	$71.19
Rate for Payer: Railroad Medicare Medicare	$12.00
Rate for Payer: UHC All Payor (Choice/PPO)	$14.40
Rate for Payer: UHC Core	$20.41
Rate for Payer: UHC Dual Complete DSNP	$12.00
Rate for Payer: UHC Exchange	$12.00
Rate for Payer: UHC Medicare Advantage	$12.36
Rate for Payer: VA VA	$12.00

HC COMPLEMENT C 4

Facility

$113.00

Service Code	CPT 86160
Hospital Charge Code	30200151
Hospital Revenue Code	302
Min. Negotiated Rate	$71.19
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna Commercial	$96.05
Rate for Payer: Aetna New Business (MI Preferred)	$73.45
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cofinity Commercial	$79.10
Rate for Payer: Cofinity Commercial	$97.18
Rate for Payer: Healthscope Commercial	$101.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.05
Rate for Payer: PHP Commercial	$96.05
Rate for Payer: Priority Health Cigna Priority Health	$79.10
Rate for Payer: Priority Health SBD	$71.19

HC COMPLEMENT C 4

Facility

$113.00

Service Code	CPT 86160
Hospital Charge Code	30200151
Hospital Revenue Code	302
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna Commercial	$96.05
Rate for Payer: Aetna Medicare	$12.48
Rate for Payer: Aetna New Business (MI Preferred)	$73.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.00
Rate for Payer: Amish Plain Church Group Commercial	$15.00
Rate for Payer: BCBS Complete	$6.89
Rate for Payer: BCBS MAPPO	$12.00
Rate for Payer: BCBS Trust/PPO	$9.40
Rate for Payer: BCN Medicare Advantage	$12.00
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cofinity Commercial	$97.18
Rate for Payer: Cofinity Commercial	$79.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.00
Rate for Payer: Healthscope Commercial	$101.70
Rate for Payer: Mclaren Medicaid	$6.56
Rate for Payer: Mclaren Medicare	$12.00
Rate for Payer: Meridian Medicaid	$6.89
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.60
Rate for Payer: MI Amish Medical Board Commercial	$13.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.05
Rate for Payer: PACE Medicare	$11.40
Rate for Payer: PACE SWMI	$12.00
Rate for Payer: PHP Commercial	$96.05
Rate for Payer: PHP Medicare Advantage	$12.00
Rate for Payer: Priority Health Choice Medicaid	$6.56
Rate for Payer: Priority Health Cigna Priority Health	$79.10
Rate for Payer: Priority Health Medicare	$12.00
Rate for Payer: Priority Health SBD	$71.19
Rate for Payer: Railroad Medicare Medicare	$12.00
Rate for Payer: UHC All Payor (Choice/PPO)	$14.40
Rate for Payer: UHC Core	$20.41
Rate for Payer: UHC Dual Complete DSNP	$12.00
Rate for Payer: UHC Exchange	$12.00
Rate for Payer: UHC Medicare Advantage	$12.36
Rate for Payer: VA VA	$12.00

HC COMPLEMENT C 5

Facility

$71.40

Service Code	CPT 86160
Hospital Charge Code	30200152
Hospital Revenue Code	302
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna Medicare	$12.48
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.00
Rate for Payer: Amish Plain Church Group Commercial	$15.00
Rate for Payer: BCBS Complete	$6.89
Rate for Payer: BCBS MAPPO	$12.00
Rate for Payer: BCBS Trust/PPO	$9.40
Rate for Payer: BCN Medicare Advantage	$12.00
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.00
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Mclaren Medicaid	$6.56
Rate for Payer: Mclaren Medicare	$12.00
Rate for Payer: Meridian Medicaid	$6.89
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.60
Rate for Payer: MI Amish Medical Board Commercial	$13.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.69
Rate for Payer: PACE Medicare	$11.40
Rate for Payer: PACE SWMI	$12.00
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: PHP Medicare Advantage	$12.00
Rate for Payer: Priority Health Choice Medicaid	$6.56
Rate for Payer: Priority Health Cigna Priority Health	$49.98
Rate for Payer: Priority Health Medicare	$12.00
Rate for Payer: Priority Health SBD	$44.98
Rate for Payer: Railroad Medicare Medicare	$12.00
Rate for Payer: UHC All Payor (Choice/PPO)	$14.40
Rate for Payer: UHC Core	$20.41
Rate for Payer: UHC Dual Complete DSNP	$12.00
Rate for Payer: UHC Exchange	$12.00
Rate for Payer: UHC Medicare Advantage	$12.36
Rate for Payer: VA VA	$12.00

HC COMPLEMENT C 5

Facility

$71.40

Service Code	CPT 86160
Hospital Charge Code	30200152
Hospital Revenue Code	302
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$49.98
Rate for Payer: Priority Health SBD	$44.98

HC COMPLEMENT CH50 TOTAL

Facility

$38.76

Service Code	CPT 86162
Hospital Charge Code	30200154
Hospital Revenue Code	302
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$32.95
Rate for Payer: Aetna Medicare	$21.13
Rate for Payer: Aetna New Business (MI Preferred)	$25.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$25.40
Rate for Payer: Amish Plain Church Group Commercial	$25.40
Rate for Payer: BCBS Complete	$11.67
Rate for Payer: BCBS MAPPO	$20.32
Rate for Payer: BCBS Trust/PPO	$15.91
Rate for Payer: BCN Medicare Advantage	$20.32
Rate for Payer: Cash Price	$31.01
Rate for Payer: Cash Price	$31.01
Rate for Payer: Cofinity Commercial	$27.13
Rate for Payer: Cofinity Commercial	$33.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.32
Rate for Payer: Healthscope Commercial	$34.88
Rate for Payer: Mclaren Medicaid	$11.12
Rate for Payer: Mclaren Medicare	$20.32
Rate for Payer: Meridian Medicaid	$11.67
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21.34
Rate for Payer: MI Amish Medical Board Commercial	$23.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.95
Rate for Payer: PACE Medicare	$19.30
Rate for Payer: PACE SWMI	$20.32
Rate for Payer: PHP Commercial	$32.95
Rate for Payer: PHP Medicare Advantage	$20.32
Rate for Payer: Priority Health Choice Medicaid	$11.12
Rate for Payer: Priority Health Cigna Priority Health	$27.13
Rate for Payer: Priority Health Medicare	$20.32
Rate for Payer: Priority Health SBD	$24.42
Rate for Payer: Railroad Medicare Medicare	$20.32
Rate for Payer: UHC All Payor (Choice/PPO)	$24.38
Rate for Payer: UHC Core	$34.54
Rate for Payer: UHC Dual Complete DSNP	$20.32
Rate for Payer: UHC Exchange	$20.32
Rate for Payer: UHC Medicare Advantage	$20.93
Rate for Payer: VA VA	$20.32

HC COMPLEMENT CH50 TOTAL

Facility

$38.76

Service Code	CPT 86162
Hospital Charge Code	30200154
Hospital Revenue Code	302
Min. Negotiated Rate	$24.42
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$32.95
Rate for Payer: Aetna New Business (MI Preferred)	$25.19
Rate for Payer: Cash Price	$31.01
Rate for Payer: Cofinity Commercial	$27.13
Rate for Payer: Cofinity Commercial	$33.33
Rate for Payer: Healthscope Commercial	$34.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.95
Rate for Payer: PHP Commercial	$32.95
Rate for Payer: Priority Health Cigna Priority Health	$27.13
Rate for Payer: Priority Health SBD	$24.42

HC COMPLEX CYSTOMETROGRAM

Facility

$389.48

Service Code	CPT 51726
Hospital Charge Code	76100190
Hospital Revenue Code	761
Min. Negotiated Rate	$245.37
Max. Negotiated Rate	$350.53
Rate for Payer: Aetna Commercial	$331.06
Rate for Payer: Aetna New Business (MI Preferred)	$253.16
Rate for Payer: Cash Price	$311.58
Rate for Payer: Cofinity Commercial	$272.64
Rate for Payer: Cofinity Commercial	$334.95
Rate for Payer: Healthscope Commercial	$350.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$331.06
Rate for Payer: PHP Commercial	$331.06
Rate for Payer: Priority Health Cigna Priority Health	$272.64
Rate for Payer: Priority Health SBD	$245.37

HC COMPLEX CYSTOMETROGRAM

Facility

$389.48

Service Code	CPT 51726
Hospital Charge Code	76100190
Hospital Revenue Code	761
Min. Negotiated Rate	$120.29
Max. Negotiated Rate	$350.53
Rate for Payer: Aetna Commercial	$331.06
Rate for Payer: Aetna Medicare	$228.71
Rate for Payer: Aetna New Business (MI Preferred)	$253.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$274.89
Rate for Payer: Amish Plain Church Group Commercial	$274.89
Rate for Payer: BCBS Complete	$126.32
Rate for Payer: BCBS MAPPO	$219.91
Rate for Payer: BCBS Trust/PPO	$280.21
Rate for Payer: BCN Medicare Advantage	$219.91
Rate for Payer: Cash Price	$311.58
Rate for Payer: Cash Price	$311.58
Rate for Payer: Cofinity Commercial	$272.64
Rate for Payer: Cofinity Commercial	$334.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$219.91
Rate for Payer: Healthscope Commercial	$350.53
Rate for Payer: Mclaren Medicaid	$120.29
Rate for Payer: Mclaren Medicare	$219.91
Rate for Payer: Meridian Medicaid	$126.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$230.91
Rate for Payer: MI Amish Medical Board Commercial	$252.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$331.06
Rate for Payer: PACE Medicare	$208.91
Rate for Payer: PACE SWMI	$219.91
Rate for Payer: PHP Commercial	$331.06
Rate for Payer: PHP Medicare Advantage	$219.91
Rate for Payer: Priority Health Choice Medicaid	$120.29
Rate for Payer: Priority Health Cigna Priority Health	$272.64
Rate for Payer: Priority Health Medicare	$219.91
Rate for Payer: Priority Health SBD	$245.37
Rate for Payer: Railroad Medicare Medicare	$219.91
Rate for Payer: UHC All Payor (Choice/PPO)	$324.53
Rate for Payer: UHC Dual Complete DSNP	$219.91
Rate for Payer: UHC Exchange	$295.03
Rate for Payer: UHC Medicare Advantage	$226.51
Rate for Payer: VA VA	$219.91

Know your out-of-pocket cost for care.

All Charges