Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS

Facility

$632.43

Service Code	CPT 11042
Hospital Charge Code	76100025
Hospital Revenue Code	761
Min. Negotiated Rate	$398.43
Max. Negotiated Rate	$569.19
Rate for Payer: Aetna Commercial	$537.57
Rate for Payer: Aetna New Business (MI Preferred)	$411.08
Rate for Payer: Cash Price	$505.94
Rate for Payer: Cofinity Commercial	$442.70
Rate for Payer: Cofinity Commercial	$543.89
Rate for Payer: Healthscope Commercial	$569.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$537.57
Rate for Payer: PHP Commercial	$537.57
Rate for Payer: Priority Health Cigna Priority Health	$442.70
Rate for Payer: Priority Health SBD	$398.43

HC DECALCIFICATION

Facility

$36.82

Service Code	CPT 88311
Hospital Charge Code	31000051
Hospital Revenue Code	310
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$31.30
Rate for Payer: Aetna New Business (MI Preferred)	$23.93
Rate for Payer: Cash Price	$29.46
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Commercial	$31.67
Rate for Payer: Healthscope Commercial	$33.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.30
Rate for Payer: PHP Commercial	$31.30
Rate for Payer: Priority Health Cigna Priority Health	$25.77
Rate for Payer: Priority Health SBD	$23.20

HC DECALCIFICATION

Facility

$36.82

Service Code	CPT 88311
Hospital Charge Code	31000051
Hospital Revenue Code	310
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$31.30
Rate for Payer: Aetna New Business (MI Preferred)	$23.93
Rate for Payer: BCBS Complete	$14.73
Rate for Payer: BCBS Trust/PPO	$10.35
Rate for Payer: Cash Price	$29.46
Rate for Payer: Cash Price	$29.46
Rate for Payer: Cofinity Commercial	$31.67
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Healthscope Commercial	$33.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.30
Rate for Payer: PHP Commercial	$31.30
Rate for Payer: Priority Health Cigna Priority Health	$25.77
Rate for Payer: Priority Health SBD	$23.20
Rate for Payer: UHC All Payor (Choice/PPO)	$21.97
Rate for Payer: UHC Core	$13.39
Rate for Payer: UHC Exchange	$19.97

HC DECLOT BY THROMBOLYTIC

Facility

$473.69

Service Code	CPT 36593
Hospital Charge Code	76100005
Hospital Revenue Code	761
Min. Negotiated Rate	$298.42
Max. Negotiated Rate	$426.32
Rate for Payer: Aetna Commercial	$402.64
Rate for Payer: Aetna New Business (MI Preferred)	$307.90
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cofinity Commercial	$331.58
Rate for Payer: Cofinity Commercial	$407.37
Rate for Payer: Healthscope Commercial	$426.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$402.64
Rate for Payer: PHP Commercial	$402.64
Rate for Payer: Priority Health Cigna Priority Health	$331.58
Rate for Payer: Priority Health SBD	$298.42

HC DECLOT BY THROMBOLYTIC

Facility

$473.69

Service Code	CPT 36593
Hospital Charge Code	76100005
Hospital Revenue Code	761
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$947.66
Rate for Payer: Aetna Commercial	$402.64
Rate for Payer: Aetna Medicare	$313.39
Rate for Payer: Aetna New Business (MI Preferred)	$307.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$376.68
Rate for Payer: Amish Plain Church Group Commercial	$376.68
Rate for Payer: BCBS Complete	$173.09
Rate for Payer: BCBS MAPPO	$301.34
Rate for Payer: BCBS Trust/PPO	$207.92
Rate for Payer: BCN Medicare Advantage	$301.34
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cofinity Commercial	$407.37
Rate for Payer: Cofinity Commercial	$331.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$301.34
Rate for Payer: Healthscope Commercial	$426.32
Rate for Payer: Mclaren Medicaid	$164.83
Rate for Payer: Mclaren Medicare	$301.34
Rate for Payer: Meridian Medicaid	$173.09
Rate for Payer: Meridian Wellcare - Medicare Advantage	$316.41
Rate for Payer: MI Amish Medical Board Commercial	$346.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$402.64
Rate for Payer: PACE Medicare	$286.27
Rate for Payer: PACE SWMI	$301.34
Rate for Payer: PHP Commercial	$402.64
Rate for Payer: PHP Medicare Advantage	$301.34
Rate for Payer: Priority Health Choice Medicaid	$164.83
Rate for Payer: Priority Health Cigna Priority Health	$331.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$947.66
Rate for Payer: Priority Health Medicare	$301.34
Rate for Payer: Priority Health Narrow Network	$758.13
Rate for Payer: Priority Health SBD	$298.42
Rate for Payer: Railroad Medicare Medicare	$301.34
Rate for Payer: UHC All Payor (Choice/PPO)	$37.46
Rate for Payer: UHC Dual Complete DSNP	$301.34
Rate for Payer: UHC Exchange	$34.05
Rate for Payer: UHC Medicare Advantage	$310.38
Rate for Payer: VA VA	$301.34

HC DECONTAMINATION AMB/SELF-DIRECTED

Facility

$140.57

Hospital Charge Code	27000613
Hospital Revenue Code	270
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$126.51
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: Aetna New Business (MI Preferred)	$91.37
Rate for Payer: Cash Price	$112.46
Rate for Payer: Cofinity Commercial	$120.89
Rate for Payer: Cofinity Commercial	$98.40
Rate for Payer: Healthscope Commercial	$126.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.48
Rate for Payer: PHP Commercial	$119.48
Rate for Payer: Priority Health Cigna Priority Health	$98.40
Rate for Payer: Priority Health SBD	$88.56

HC DECONTAMINATION AMB/SELF-DIRECTED

Facility

$140.57

Hospital Charge Code	27000613
Hospital Revenue Code	270
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$126.51
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: Aetna New Business (MI Preferred)	$91.37
Rate for Payer: BCBS Complete	$56.23
Rate for Payer: Cash Price	$112.46
Rate for Payer: Cofinity Commercial	$120.89
Rate for Payer: Cofinity Commercial	$98.40
Rate for Payer: Healthscope Commercial	$126.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.48
Rate for Payer: PHP Commercial	$119.48
Rate for Payer: Priority Health Cigna Priority Health	$98.40
Rate for Payer: Priority Health SBD	$88.56

HC DECONTAMINATION AMB W/ASSIST

Facility

$807.11

Hospital Charge Code	27000026
Hospital Revenue Code	270
Min. Negotiated Rate	$322.84
Max. Negotiated Rate	$726.40
Rate for Payer: Aetna Commercial	$686.04
Rate for Payer: Aetna New Business (MI Preferred)	$524.62
Rate for Payer: BCBS Complete	$322.84
Rate for Payer: Cash Price	$645.69
Rate for Payer: Cofinity Commercial	$564.98
Rate for Payer: Cofinity Commercial	$694.11
Rate for Payer: Healthscope Commercial	$726.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$686.04
Rate for Payer: PHP Commercial	$686.04
Rate for Payer: Priority Health Cigna Priority Health	$564.98
Rate for Payer: Priority Health SBD	$508.48

HC DECONTAMINATION AMB W/ASSIST

Facility

$807.11

Hospital Charge Code	27000026
Hospital Revenue Code	270
Min. Negotiated Rate	$508.48
Max. Negotiated Rate	$726.40
Rate for Payer: Aetna Commercial	$686.04
Rate for Payer: Aetna New Business (MI Preferred)	$524.62
Rate for Payer: Cash Price	$645.69
Rate for Payer: Cofinity Commercial	$564.98
Rate for Payer: Cofinity Commercial	$694.11
Rate for Payer: Healthscope Commercial	$726.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$686.04
Rate for Payer: PHP Commercial	$686.04
Rate for Payer: Priority Health Cigna Priority Health	$564.98
Rate for Payer: Priority Health SBD	$508.48

HC DECONTAMINATION NON AMBULATORY

Facility

$1,614.20

Hospital Charge Code	27000126
Hospital Revenue Code	270
Min. Negotiated Rate	$645.68
Max. Negotiated Rate	$1,452.78
Rate for Payer: Aetna Commercial	$1,372.07
Rate for Payer: Aetna New Business (MI Preferred)	$1,049.23
Rate for Payer: BCBS Complete	$645.68
Rate for Payer: Cash Price	$1,291.36
Rate for Payer: Cofinity Commercial	$1,129.94
Rate for Payer: Cofinity Commercial	$1,388.21
Rate for Payer: Healthscope Commercial	$1,452.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,372.07
Rate for Payer: PHP Commercial	$1,372.07
Rate for Payer: Priority Health Cigna Priority Health	$1,129.94
Rate for Payer: Priority Health SBD	$1,016.95

HC DECONTAMINATION NON AMBULATORY

Facility

$1,614.20

Hospital Charge Code	27000126
Hospital Revenue Code	270
Min. Negotiated Rate	$1,016.95
Max. Negotiated Rate	$1,452.78
Rate for Payer: Aetna Commercial	$1,372.07
Rate for Payer: Aetna New Business (MI Preferred)	$1,049.23
Rate for Payer: Cash Price	$1,291.36
Rate for Payer: Cofinity Commercial	$1,129.94
Rate for Payer: Cofinity Commercial	$1,388.21
Rate for Payer: Healthscope Commercial	$1,452.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,372.07
Rate for Payer: PHP Commercial	$1,372.07
Rate for Payer: Priority Health Cigna Priority Health	$1,129.94
Rate for Payer: Priority Health SBD	$1,016.95

HC DEFINITY CONTRAST 1ST ML

Facility

$290.29

Service Code	HCPCS Q9957
Hospital Charge Code	63600002
Hospital Revenue Code	636
Min. Negotiated Rate	$182.88
Max. Negotiated Rate	$261.26
Rate for Payer: Aetna Commercial	$246.75
Rate for Payer: Aetna New Business (MI Preferred)	$188.69
Rate for Payer: Cash Price	$232.23
Rate for Payer: Cofinity Commercial	$203.20
Rate for Payer: Cofinity Commercial	$249.65
Rate for Payer: Healthscope Commercial	$261.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.75
Rate for Payer: PHP Commercial	$246.75
Rate for Payer: Priority Health Cigna Priority Health	$203.20
Rate for Payer: Priority Health SBD	$182.88

HC DEFINITY CONTRAST 1ST ML

Facility

$290.29

Service Code	HCPCS Q9957
Hospital Charge Code	63600002
Hospital Revenue Code	636
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$261.26
Rate for Payer: Aetna Commercial	$246.75
Rate for Payer: Aetna New Business (MI Preferred)	$188.69
Rate for Payer: BCBS Complete	$116.12
Rate for Payer: BCBS Trust/PPO	$45.44
Rate for Payer: Cash Price	$232.23
Rate for Payer: Cash Price	$232.23
Rate for Payer: Cofinity Commercial	$203.20
Rate for Payer: Cofinity Commercial	$249.65
Rate for Payer: Healthscope Commercial	$261.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.75
Rate for Payer: PHP Commercial	$246.75
Rate for Payer: Priority Health Cigna Priority Health	$203.20
Rate for Payer: Priority Health SBD	$182.88

HC DEFINITY CONTRAST 2ND ML

Facility

$290.29

Service Code	HCPCS Q9957
Hospital Charge Code	63600003
Hospital Revenue Code	636
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$261.26
Rate for Payer: Aetna Commercial	$246.75
Rate for Payer: Aetna New Business (MI Preferred)	$188.69
Rate for Payer: BCBS Complete	$116.12
Rate for Payer: BCBS Trust/PPO	$45.44
Rate for Payer: Cash Price	$232.23
Rate for Payer: Cash Price	$232.23
Rate for Payer: Cofinity Commercial	$203.20
Rate for Payer: Cofinity Commercial	$249.65
Rate for Payer: Healthscope Commercial	$261.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.75
Rate for Payer: PHP Commercial	$246.75
Rate for Payer: Priority Health Cigna Priority Health	$203.20
Rate for Payer: Priority Health SBD	$182.88

HC DEFINITY CONTRAST 2ND ML

Facility

$290.29

Service Code	HCPCS Q9957
Hospital Charge Code	63600003
Hospital Revenue Code	636
Min. Negotiated Rate	$182.88
Max. Negotiated Rate	$261.26
Rate for Payer: Aetna Commercial	$246.75
Rate for Payer: Aetna New Business (MI Preferred)	$188.69
Rate for Payer: Cash Price	$232.23
Rate for Payer: Cofinity Commercial	$203.20
Rate for Payer: Cofinity Commercial	$249.65
Rate for Payer: Healthscope Commercial	$261.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.75
Rate for Payer: PHP Commercial	$246.75
Rate for Payer: Priority Health Cigna Priority Health	$203.20
Rate for Payer: Priority Health SBD	$182.88

HC DEGARELIX INJECTION PER 1MG

Facility

$6.12

Service Code	HCPCS J9155
Hospital Charge Code	63600146
Hospital Revenue Code	636
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: Aetna Medicare	$4.35
Rate for Payer: Aetna New Business (MI Preferred)	$3.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.23
Rate for Payer: Amish Plain Church Group Commercial	$5.23
Rate for Payer: BCBS Complete	$2.41
Rate for Payer: BCBS MAPPO	$4.19
Rate for Payer: BCBS Trust/PPO	$12.38
Rate for Payer: BCN Medicare Advantage	$4.19
Rate for Payer: Cash Price	$4.90
Rate for Payer: Cash Price	$4.90
Rate for Payer: Cofinity Commercial	$5.26
Rate for Payer: Cofinity Commercial	$4.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.19
Rate for Payer: Healthscope Commercial	$5.51
Rate for Payer: Mclaren Medicaid	$2.29
Rate for Payer: Mclaren Medicare	$4.19
Rate for Payer: Meridian Medicaid	$2.41
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4.40
Rate for Payer: MI Amish Medical Board Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.20
Rate for Payer: PACE Medicare	$3.98
Rate for Payer: PACE SWMI	$4.19
Rate for Payer: PHP Commercial	$5.20
Rate for Payer: PHP Medicare Advantage	$4.19
Rate for Payer: Priority Health Choice Medicaid	$2.29
Rate for Payer: Priority Health Cigna Priority Health	$4.28
Rate for Payer: Priority Health Medicare	$4.19
Rate for Payer: Priority Health SBD	$3.86
Rate for Payer: Railroad Medicare Medicare	$4.19
Rate for Payer: UHC Dual Complete DSNP	$4.19
Rate for Payer: UHC Medicare Advantage	$4.31
Rate for Payer: VA VA	$4.19

HC DEGARELIX INJECTION PER 1MG

Facility

$6.12

Service Code	HCPCS J9155
Hospital Charge Code	63600146
Hospital Revenue Code	636
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$5.51
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: Aetna New Business (MI Preferred)	$3.98
Rate for Payer: Cash Price	$4.90
Rate for Payer: Cofinity Commercial	$4.28
Rate for Payer: Cofinity Commercial	$5.26
Rate for Payer: Healthscope Commercial	$5.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.20
Rate for Payer: PHP Commercial	$5.20
Rate for Payer: Priority Health Cigna Priority Health	$4.28
Rate for Payer: Priority Health SBD	$3.86

HC DEGLYCEROLIZED RED BLOOD CELLS

Facility

$925.55

Service Code	HCPCS P9039
Hospital Charge Code	39000049
Hospital Revenue Code	390
Min. Negotiated Rate	$583.10
Max. Negotiated Rate	$833.00
Rate for Payer: Aetna Commercial	$786.72
Rate for Payer: Aetna New Business (MI Preferred)	$601.61
Rate for Payer: Cash Price	$740.44
Rate for Payer: Cofinity Commercial	$647.88
Rate for Payer: Cofinity Commercial	$795.97
Rate for Payer: Healthscope Commercial	$833.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$786.72
Rate for Payer: PHP Commercial	$786.72
Rate for Payer: Priority Health Cigna Priority Health	$647.88
Rate for Payer: Priority Health SBD	$583.10

HC DEGLYCEROLIZED RED BLOOD CELLS

Facility

$925.55

Service Code	HCPCS P9039
Hospital Charge Code	39000049
Hospital Revenue Code	390
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$1,239.09
Rate for Payer: Aetna Commercial	$786.72
Rate for Payer: Aetna Medicare	$302.16
Rate for Payer: Aetna New Business (MI Preferred)	$601.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$363.18
Rate for Payer: Amish Plain Church Group Commercial	$363.18
Rate for Payer: BCBS Complete	$166.89
Rate for Payer: BCBS MAPPO	$290.54
Rate for Payer: BCBS Trust/PPO	$1,200.72
Rate for Payer: BCN Medicare Advantage	$290.54
Rate for Payer: Cash Price	$740.44
Rate for Payer: Cash Price	$740.44
Rate for Payer: Cofinity Commercial	$647.88
Rate for Payer: Cofinity Commercial	$795.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$290.54
Rate for Payer: Healthscope Commercial	$833.00
Rate for Payer: Mclaren Medicaid	$158.93
Rate for Payer: Mclaren Medicare	$290.54
Rate for Payer: Meridian Medicaid	$166.89
Rate for Payer: Meridian Wellcare - Medicare Advantage	$305.07
Rate for Payer: MI Amish Medical Board Commercial	$334.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$786.72
Rate for Payer: PACE Medicare	$276.01
Rate for Payer: PACE SWMI	$290.54
Rate for Payer: PHP Commercial	$786.72
Rate for Payer: PHP Medicare Advantage	$290.54
Rate for Payer: Priority Health Choice Medicaid	$158.93
Rate for Payer: Priority Health Cigna Priority Health	$647.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,239.09
Rate for Payer: Priority Health Medicare	$290.54
Rate for Payer: Priority Health Narrow Network	$991.27
Rate for Payer: Priority Health SBD	$583.10
Rate for Payer: Railroad Medicare Medicare	$290.54
Rate for Payer: UHC Dual Complete DSNP	$290.54
Rate for Payer: UHC Medicare Advantage	$299.26
Rate for Payer: VA VA	$290.54

HC DELIVERY/BIRTH RM RESUSCITATION

Facility

$820.78

Service Code	CPT 99465
Hospital Charge Code	72000011
Hospital Revenue Code	720
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$1,749.11
Rate for Payer: Aetna Commercial	$697.66
Rate for Payer: Aetna Medicare	$602.26
Rate for Payer: Aetna New Business (MI Preferred)	$533.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$723.88
Rate for Payer: Amish Plain Church Group Commercial	$723.88
Rate for Payer: BCBS Complete	$332.64
Rate for Payer: BCBS MAPPO	$579.10
Rate for Payer: BCN Medicare Advantage	$579.10
Rate for Payer: Cash Price	$656.62
Rate for Payer: Cash Price	$656.62
Rate for Payer: Cofinity Commercial	$574.55
Rate for Payer: Cofinity Commercial	$705.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$579.10
Rate for Payer: Healthscope Commercial	$738.70
Rate for Payer: Mclaren Medicaid	$316.77
Rate for Payer: Mclaren Medicare	$579.10
Rate for Payer: Meridian Medicaid	$332.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$608.06
Rate for Payer: MI Amish Medical Board Commercial	$665.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$697.66
Rate for Payer: PACE Medicare	$550.14
Rate for Payer: PACE SWMI	$579.10
Rate for Payer: PHP Commercial	$697.66
Rate for Payer: PHP Medicare Advantage	$579.10
Rate for Payer: Priority Health Choice Medicaid	$316.77
Rate for Payer: Priority Health Cigna Priority Health	$574.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,749.11
Rate for Payer: Priority Health Medicare	$579.10
Rate for Payer: Priority Health Narrow Network	$1,399.29
Rate for Payer: Priority Health SBD	$517.09
Rate for Payer: Railroad Medicare Medicare	$579.10
Rate for Payer: UHC All Payor (Choice/PPO)	$151.64
Rate for Payer: UHC Dual Complete DSNP	$579.10
Rate for Payer: UHC Exchange	$137.85
Rate for Payer: UHC Medicare Advantage	$596.47
Rate for Payer: VA VA	$579.10

HC DELIVERY/BIRTH RM RESUSCITATION

Facility

$820.78

Service Code	CPT 99465
Hospital Charge Code	72000011
Hospital Revenue Code	720
Min. Negotiated Rate	$517.09
Max. Negotiated Rate	$738.70
Rate for Payer: Aetna Commercial	$697.66
Rate for Payer: Aetna New Business (MI Preferred)	$533.51
Rate for Payer: Cash Price	$656.62
Rate for Payer: Cofinity Commercial	$574.55
Rate for Payer: Cofinity Commercial	$705.87
Rate for Payer: Healthscope Commercial	$738.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$697.66
Rate for Payer: PHP Commercial	$697.66
Rate for Payer: Priority Health Cigna Priority Health	$574.55
Rate for Payer: Priority Health SBD	$517.09

HC DEMO EVAL NEB MDI IPPB

Facility

$240.13

Service Code	CPT 94664
Hospital Charge Code	41000009
Hospital Revenue Code	410
Min. Negotiated Rate	$151.28
Max. Negotiated Rate	$216.12
Rate for Payer: Aetna Commercial	$204.11
Rate for Payer: Aetna New Business (MI Preferred)	$156.08
Rate for Payer: Cash Price	$192.10
Rate for Payer: Cofinity Commercial	$168.09
Rate for Payer: Cofinity Commercial	$206.51
Rate for Payer: Healthscope Commercial	$216.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$204.11
Rate for Payer: PHP Commercial	$204.11
Rate for Payer: Priority Health Cigna Priority Health	$168.09
Rate for Payer: Priority Health SBD	$151.28

HC DEMO EVAL NEB MDI IPPB

Facility

$240.13

Service Code	CPT 94664
Hospital Charge Code	41000009
Hospital Revenue Code	410
Min. Negotiated Rate	$17.68
Max. Negotiated Rate	$237.22
Rate for Payer: Aetna Commercial	$204.11
Rate for Payer: Aetna Medicare	$197.37
Rate for Payer: Aetna New Business (MI Preferred)	$156.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$237.22
Rate for Payer: Amish Plain Church Group Commercial	$237.22
Rate for Payer: BCBS Complete	$109.01
Rate for Payer: BCBS MAPPO	$189.78
Rate for Payer: BCBS Trust/PPO	$76.77
Rate for Payer: BCN Medicare Advantage	$189.78
Rate for Payer: Cash Price	$192.10
Rate for Payer: Cash Price	$192.10
Rate for Payer: Cofinity Commercial	$168.09
Rate for Payer: Cofinity Commercial	$206.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$189.78
Rate for Payer: Healthscope Commercial	$216.12
Rate for Payer: Mclaren Medicaid	$103.81
Rate for Payer: Mclaren Medicare	$189.78
Rate for Payer: Meridian Medicaid	$109.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$199.27
Rate for Payer: MI Amish Medical Board Commercial	$218.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$204.11
Rate for Payer: PACE Medicare	$180.29
Rate for Payer: PACE SWMI	$189.78
Rate for Payer: PHP Commercial	$204.11
Rate for Payer: PHP Medicare Advantage	$189.78
Rate for Payer: Priority Health Choice Medicaid	$103.81
Rate for Payer: Priority Health Cigna Priority Health	$168.09
Rate for Payer: Priority Health Medicare	$189.78
Rate for Payer: Priority Health SBD	$151.28
Rate for Payer: Railroad Medicare Medicare	$189.78
Rate for Payer: UHC All Payor (Choice/PPO)	$19.45
Rate for Payer: UHC Dual Complete DSNP	$189.78
Rate for Payer: UHC Exchange	$17.68
Rate for Payer: UHC Medicare Advantage	$195.47
Rate for Payer: VA VA	$189.78

HC DEMO HOME USE INR MONITOR

Facility

$555.42

Service Code	HCPCS G0248
Hospital Charge Code	51000042
Hospital Revenue Code	761
Min. Negotiated Rate	$64.34
Max. Negotiated Rate	$499.88
Rate for Payer: Aetna Commercial	$472.11
Rate for Payer: Aetna Medicare	$122.32
Rate for Payer: Aetna New Business (MI Preferred)	$361.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$147.02
Rate for Payer: Amish Plain Church Group Commercial	$147.02
Rate for Payer: BCBS Complete	$67.56
Rate for Payer: BCBS MAPPO	$117.62
Rate for Payer: BCBS Trust/PPO	$440.56
Rate for Payer: BCN Medicare Advantage	$117.62
Rate for Payer: Cash Price	$444.34
Rate for Payer: Cash Price	$444.34
Rate for Payer: Cofinity Commercial	$477.66
Rate for Payer: Cofinity Commercial	$388.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$117.62
Rate for Payer: Healthscope Commercial	$499.88
Rate for Payer: Mclaren Medicaid	$64.34
Rate for Payer: Mclaren Medicare	$117.62
Rate for Payer: Meridian Medicaid	$67.56
Rate for Payer: Meridian Wellcare - Medicare Advantage	$123.50
Rate for Payer: MI Amish Medical Board Commercial	$135.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$472.11
Rate for Payer: PACE Medicare	$111.74
Rate for Payer: PACE SWMI	$117.62
Rate for Payer: PHP Commercial	$472.11
Rate for Payer: PHP Medicare Advantage	$117.62
Rate for Payer: Priority Health Choice Medicaid	$64.34
Rate for Payer: Priority Health Cigna Priority Health	$388.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$362.41
Rate for Payer: Priority Health Medicare	$117.62
Rate for Payer: Priority Health Narrow Network	$289.93
Rate for Payer: Priority Health SBD	$349.91
Rate for Payer: Railroad Medicare Medicare	$117.62
Rate for Payer: UHC All Payor (Choice/PPO)	$108.05
Rate for Payer: UHC Dual Complete DSNP	$117.62
Rate for Payer: UHC Exchange	$98.23
Rate for Payer: UHC Medicare Advantage	$121.15
Rate for Payer: VA VA	$117.62

HC DEMO HOME USE INR MONITOR

Facility

$555.42

Service Code	HCPCS G0248
Hospital Charge Code	51000042
Hospital Revenue Code	761
Min. Negotiated Rate	$349.91
Max. Negotiated Rate	$499.88
Rate for Payer: Aetna Commercial	$472.11
Rate for Payer: Aetna New Business (MI Preferred)	$361.02
Rate for Payer: Cash Price	$444.34
Rate for Payer: Cofinity Commercial	$388.79
Rate for Payer: Cofinity Commercial	$477.66
Rate for Payer: Healthscope Commercial	$499.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$472.11
Rate for Payer: PHP Commercial	$472.11
Rate for Payer: Priority Health Cigna Priority Health	$388.79
Rate for Payer: Priority Health SBD	$349.91

Know your out-of-pocket cost for care.

All Charges