Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ABLATION RF LUNG

Facility

$6,017.36

Service Code	CPT 32998
Hospital Charge Code	36100055
Hospital Revenue Code	361
Min. Negotiated Rate	$3,790.94
Max. Negotiated Rate	$5,415.62
Rate for Payer: Aetna Commercial	$5,114.76
Rate for Payer: Aetna New Business (MI Preferred)	$3,911.28
Rate for Payer: Cash Price	$4,813.89
Rate for Payer: Cofinity Commercial	$4,212.15
Rate for Payer: Cofinity Commercial	$5,174.93
Rate for Payer: Cofinity Medicare Advantage	$4,212.15
Rate for Payer: Encore Health Key Benefits Commercial	$4,813.89
Rate for Payer: Healthscope Commercial	$5,415.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,114.76
Rate for Payer: PHP Commercial	$5,114.76
Rate for Payer: Priority Health Cigna Priority Health	$3,911.28
Rate for Payer: Priority Health SBD	$3,790.94

HC ABLATION VEIN OF MARSHALL

Facility

$8,899.96

Service Code	CPT 93799
Hospital Charge Code	48100122
Hospital Revenue Code	481
Min. Negotiated Rate	$81.79
Max. Negotiated Rate	$8,009.96
Rate for Payer: Aetna Commercial	$7,564.97
Rate for Payer: Aetna Medicare	$158.69
Rate for Payer: Aetna New Business (MI Preferred)	$5,784.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$190.74
Rate for Payer: Amish Plain Church Group Commercial	$190.74
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: BCBS MAPPO	$152.59
Rate for Payer: BCN Medicare Advantage	$152.59
Rate for Payer: Cash Price	$7,119.97
Rate for Payer: Cash Price	$7,119.97
Rate for Payer: Cofinity Commercial	$7,653.97
Rate for Payer: Cofinity Commercial	$6,229.97
Rate for Payer: Cofinity Medicare Advantage	$6,229.97
Rate for Payer: Encore Health Key Benefits Commercial	$7,119.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$152.59
Rate for Payer: Healthscope Commercial	$8,009.96
Rate for Payer: Mclaren Medicaid	$81.79
Rate for Payer: Mclaren Medicare	$152.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$160.22
Rate for Payer: Meridian Medicaid	$85.88
Rate for Payer: MI Amish Medical Board Commercial	$175.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,564.97
Rate for Payer: PACE Medicare	$144.96
Rate for Payer: PACE SWMI	$152.59
Rate for Payer: PHP Commercial	$7,564.97
Rate for Payer: PHP Medicare Advantage	$152.59
Rate for Payer: Priority Health Choice Medicaid	$81.79
Rate for Payer: Priority Health Cigna Priority Health	$5,784.97
Rate for Payer: Priority Health Medicare	$152.59
Rate for Payer: Priority Health SBD	$5,606.97
Rate for Payer: Railroad Medicare Medicare	$152.59
Rate for Payer: UHC All Payor (Choice/PPO)	$429.53
Rate for Payer: UHC Dual Complete DSNP	$152.59
Rate for Payer: UHC Medicare Advantage	$152.59
Rate for Payer: UHCCP Medicaid	$85.91
Rate for Payer: VA VA	$152.59

HC ABLATION VEIN OF MARSHALL

Facility

$8,899.96

Service Code	CPT 93799
Hospital Charge Code	48100122
Hospital Revenue Code	481
Min. Negotiated Rate	$5,606.97
Max. Negotiated Rate	$8,009.96
Rate for Payer: Aetna Commercial	$7,564.97
Rate for Payer: Aetna New Business (MI Preferred)	$5,784.97
Rate for Payer: Cash Price	$7,119.97
Rate for Payer: Cofinity Commercial	$6,229.97
Rate for Payer: Cofinity Commercial	$7,653.97
Rate for Payer: Cofinity Medicare Advantage	$6,229.97
Rate for Payer: Encore Health Key Benefits Commercial	$7,119.97
Rate for Payer: Healthscope Commercial	$8,009.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,564.97
Rate for Payer: PHP Commercial	$7,564.97
Rate for Payer: Priority Health Cigna Priority Health	$5,784.97
Rate for Payer: Priority Health SBD	$5,606.97

HC ABLAVAR

Facility

$26.52

Service Code	HCPCS A9583
Hospital Charge Code	63600007
Hospital Revenue Code	636
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$23.87
Rate for Payer: Aetna Commercial	$22.54
Rate for Payer: Aetna Medicare	$13.26
Rate for Payer: Aetna New Business (MI Preferred)	$17.24
Rate for Payer: BCBS Complete	$10.61
Rate for Payer: Cash Price	$21.22
Rate for Payer: Cofinity Commercial	$18.56
Rate for Payer: Cofinity Commercial	$22.81
Rate for Payer: Cofinity Medicare Advantage	$18.56
Rate for Payer: Encore Health Key Benefits Commercial	$21.22
Rate for Payer: Healthscope Commercial	$23.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.54
Rate for Payer: PHP Commercial	$22.54
Rate for Payer: Priority Health Cigna Priority Health	$17.24
Rate for Payer: Priority Health SBD	$16.71

HC ABLAVAR

Facility

$26.52

Service Code	HCPCS A9583
Hospital Charge Code	63600007
Hospital Revenue Code	636
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$23.87
Rate for Payer: Aetna Commercial	$22.54
Rate for Payer: Aetna New Business (MI Preferred)	$17.24
Rate for Payer: Cash Price	$21.22
Rate for Payer: Cofinity Commercial	$18.56
Rate for Payer: Cofinity Commercial	$22.81
Rate for Payer: Cofinity Medicare Advantage	$18.56
Rate for Payer: Encore Health Key Benefits Commercial	$21.22
Rate for Payer: Healthscope Commercial	$23.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.54
Rate for Payer: PHP Commercial	$22.54
Rate for Payer: Priority Health Cigna Priority Health	$17.24
Rate for Payer: Priority Health SBD	$16.71

HC ABSCESS DRAINAGE COMPLICATED

Facility

$498.64

Service Code	CPT 10061
Hospital Charge Code	76100037
Hospital Revenue Code	761
Min. Negotiated Rate	$314.14
Max. Negotiated Rate	$448.78
Rate for Payer: Aetna Commercial	$423.84
Rate for Payer: Aetna New Business (MI Preferred)	$324.12
Rate for Payer: Cash Price	$398.91
Rate for Payer: Cofinity Commercial	$349.05
Rate for Payer: Cofinity Commercial	$428.83
Rate for Payer: Cofinity Medicare Advantage	$349.05
Rate for Payer: Encore Health Key Benefits Commercial	$398.91
Rate for Payer: Healthscope Commercial	$448.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$423.84
Rate for Payer: PHP Commercial	$423.84
Rate for Payer: Priority Health Cigna Priority Health	$324.12
Rate for Payer: Priority Health SBD	$314.14

HC ABSCESS DRAINAGE COMPLICATED

Facility

$498.64

Service Code	CPT 10061
Hospital Charge Code	76100037
Hospital Revenue Code	761
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$423.84
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$324.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$398.91
Rate for Payer: Cash Price	$398.91
Rate for Payer: Cofinity Commercial	$428.83
Rate for Payer: Cofinity Commercial	$349.05
Rate for Payer: Cofinity Medicare Advantage	$349.05
Rate for Payer: Encore Health Key Benefits Commercial	$398.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$448.78
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$423.84
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$423.84
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$324.12
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$314.14
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HC ABSCESS DRAINAGE SIMPLE

Facility

$399.83

Service Code	CPT 10060
Hospital Charge Code	36100002
Hospital Revenue Code	761
Min. Negotiated Rate	$251.89
Max. Negotiated Rate	$359.85
Rate for Payer: Aetna Commercial	$339.86
Rate for Payer: Aetna New Business (MI Preferred)	$259.89
Rate for Payer: Cash Price	$319.86
Rate for Payer: Cofinity Commercial	$279.88
Rate for Payer: Cofinity Commercial	$343.85
Rate for Payer: Cofinity Medicare Advantage	$279.88
Rate for Payer: Encore Health Key Benefits Commercial	$319.86
Rate for Payer: Healthscope Commercial	$359.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.86
Rate for Payer: PHP Commercial	$339.86
Rate for Payer: Priority Health Cigna Priority Health	$259.89
Rate for Payer: Priority Health SBD	$251.89

HC ABSCESS DRAINAGE SIMPLE

Facility

$399.83

Service Code	CPT 10060
Hospital Charge Code	36100002
Hospital Revenue Code	761
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Commercial	$339.86
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Aetna New Business (MI Preferred)	$259.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Cash Price	$319.86
Rate for Payer: Cash Price	$319.86
Rate for Payer: Cofinity Commercial	$279.88
Rate for Payer: Cofinity Commercial	$343.85
Rate for Payer: Cofinity Medicare Advantage	$279.88
Rate for Payer: Encore Health Key Benefits Commercial	$319.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Healthscope Commercial	$359.85
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.86
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Commercial	$339.86
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$259.89
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Priority Health SBD	$251.89
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

HC ABSCESS ISHIO/PERIRECTAL

Facility

$1,789.39

Service Code	CPT 46040
Hospital Charge Code	36100196
Hospital Revenue Code	761
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Commercial	$1,520.98
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,163.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Cash Price	$1,431.51
Rate for Payer: Cash Price	$1,431.51
Rate for Payer: Cofinity Commercial	$1,538.88
Rate for Payer: Cofinity Commercial	$1,252.57
Rate for Payer: Cofinity Medicare Advantage	$1,252.57
Rate for Payer: Encore Health Key Benefits Commercial	$1,431.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Healthscope Commercial	$1,610.45
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,520.98
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Commercial	$1,520.98
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Cigna Priority Health	$1,163.10
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Priority Health SBD	$1,127.32
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$647.41
Rate for Payer: VA VA	$1,149.93

HC ABSCESS ISHIO/PERIRECTAL

Facility

$1,789.39

Service Code	CPT 46040
Hospital Charge Code	36100196
Hospital Revenue Code	761
Min. Negotiated Rate	$1,127.32
Max. Negotiated Rate	$1,610.45
Rate for Payer: Aetna Commercial	$1,520.98
Rate for Payer: Aetna New Business (MI Preferred)	$1,163.10
Rate for Payer: Cash Price	$1,431.51
Rate for Payer: Cofinity Commercial	$1,252.57
Rate for Payer: Cofinity Commercial	$1,538.88
Rate for Payer: Cofinity Medicare Advantage	$1,252.57
Rate for Payer: Encore Health Key Benefits Commercial	$1,431.51
Rate for Payer: Healthscope Commercial	$1,610.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,520.98
Rate for Payer: PHP Commercial	$1,520.98
Rate for Payer: Priority Health Cigna Priority Health	$1,163.10
Rate for Payer: Priority Health SBD	$1,127.32

HC ACAPELLA SUPPLY

Facility

$195.98

Hospital Charge Code	27000025
Hospital Revenue Code	270
Min. Negotiated Rate	$78.39
Max. Negotiated Rate	$176.38
Rate for Payer: Aetna Commercial	$166.58
Rate for Payer: Aetna Medicare	$97.99
Rate for Payer: Aetna New Business (MI Preferred)	$127.39
Rate for Payer: BCBS Complete	$78.39
Rate for Payer: Cash Price	$156.78
Rate for Payer: Cofinity Commercial	$137.19
Rate for Payer: Cofinity Commercial	$168.54
Rate for Payer: Cofinity Medicare Advantage	$137.19
Rate for Payer: Encore Health Key Benefits Commercial	$156.78
Rate for Payer: Healthscope Commercial	$176.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.58
Rate for Payer: PHP Commercial	$166.58
Rate for Payer: Priority Health Cigna Priority Health	$127.39
Rate for Payer: Priority Health SBD	$123.47

HC ACAPELLA SUPPLY

Facility

$195.98

Hospital Charge Code	27000025
Hospital Revenue Code	270
Min. Negotiated Rate	$123.47
Max. Negotiated Rate	$176.38
Rate for Payer: Aetna Commercial	$166.58
Rate for Payer: Aetna New Business (MI Preferred)	$127.39
Rate for Payer: Cash Price	$156.78
Rate for Payer: Cofinity Commercial	$137.19
Rate for Payer: Cofinity Commercial	$168.54
Rate for Payer: Cofinity Medicare Advantage	$137.19
Rate for Payer: Encore Health Key Benefits Commercial	$156.78
Rate for Payer: Healthscope Commercial	$176.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.58
Rate for Payer: PHP Commercial	$166.58
Rate for Payer: Priority Health Cigna Priority Health	$127.39
Rate for Payer: Priority Health SBD	$123.47

HC ACB APLIGRAF PER SQ CM

Facility

$94.29

Service Code	HCPCS Q4101
Hospital Charge Code	63600031
Hospital Revenue Code	636
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$84.86
Rate for Payer: Aetna Commercial	$80.15
Rate for Payer: Aetna New Business (MI Preferred)	$61.29
Rate for Payer: Cash Price	$75.43
Rate for Payer: Cofinity Commercial	$66.00
Rate for Payer: Cofinity Commercial	$81.09
Rate for Payer: Cofinity Medicare Advantage	$66.00
Rate for Payer: Encore Health Key Benefits Commercial	$75.43
Rate for Payer: Healthscope Commercial	$84.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.15
Rate for Payer: PHP Commercial	$80.15
Rate for Payer: Priority Health Cigna Priority Health	$61.29
Rate for Payer: Priority Health SBD	$59.40

HC ACB APLIGRAF PER SQ CM

Facility

$94.29

Service Code	HCPCS Q4101
Hospital Charge Code	63600031
Hospital Revenue Code	636
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$84.86
Rate for Payer: Aetna Commercial	$80.15
Rate for Payer: Aetna Medicare	$47.15
Rate for Payer: Aetna New Business (MI Preferred)	$61.29
Rate for Payer: BCBS Complete	$37.72
Rate for Payer: Cash Price	$75.43
Rate for Payer: Cofinity Commercial	$66.00
Rate for Payer: Cofinity Commercial	$81.09
Rate for Payer: Cofinity Medicare Advantage	$66.00
Rate for Payer: Encore Health Key Benefits Commercial	$75.43
Rate for Payer: Healthscope Commercial	$84.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.15
Rate for Payer: PHP Commercial	$80.15
Rate for Payer: Priority Health Cigna Priority Health	$61.29
Rate for Payer: Priority Health SBD	$59.40

HC ACB ESTABLISHED PT LEVEL 1

Facility

$355.31

Service Code	CPT 99211
Hospital Charge Code	51000072
Hospital Revenue Code	510
Min. Negotiated Rate	$223.85
Max. Negotiated Rate	$319.78
Rate for Payer: Aetna Commercial	$302.01
Rate for Payer: Aetna New Business (MI Preferred)	$230.95
Rate for Payer: Cash Price	$284.25
Rate for Payer: Cofinity Commercial	$248.72
Rate for Payer: Cofinity Commercial	$305.57
Rate for Payer: Cofinity Medicare Advantage	$248.72
Rate for Payer: Encore Health Key Benefits Commercial	$284.25
Rate for Payer: Healthscope Commercial	$319.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.01
Rate for Payer: PHP Commercial	$302.01
Rate for Payer: Priority Health Cigna Priority Health	$230.95
Rate for Payer: Priority Health SBD	$223.85

HC ACB ESTABLISHED PT LEVEL 1

Facility

$355.31

Service Code	CPT 99211
Hospital Charge Code	51000072
Hospital Revenue Code	510
Min. Negotiated Rate	$142.12
Max. Negotiated Rate	$319.78
Rate for Payer: Aetna Commercial	$302.01
Rate for Payer: Aetna Medicare	$177.66
Rate for Payer: Aetna New Business (MI Preferred)	$230.95
Rate for Payer: BCBS Complete	$142.12
Rate for Payer: Cash Price	$284.25
Rate for Payer: Cofinity Commercial	$248.72
Rate for Payer: Cofinity Commercial	$305.57
Rate for Payer: Cofinity Medicare Advantage	$248.72
Rate for Payer: Encore Health Key Benefits Commercial	$284.25
Rate for Payer: Healthscope Commercial	$319.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.01
Rate for Payer: PHP Commercial	$302.01
Rate for Payer: Priority Health Cigna Priority Health	$230.95
Rate for Payer: Priority Health SBD	$223.85

HC ACB ESTABLISHED PT LEVEL 2

Facility

$494.43

Service Code	CPT 99212
Hospital Charge Code	51000073
Hospital Revenue Code	510
Min. Negotiated Rate	$197.77
Max. Negotiated Rate	$444.99
Rate for Payer: Aetna Commercial	$420.27
Rate for Payer: Aetna Medicare	$247.22
Rate for Payer: Aetna New Business (MI Preferred)	$321.38
Rate for Payer: BCBS Complete	$197.77
Rate for Payer: Cash Price	$395.54
Rate for Payer: Cofinity Commercial	$346.10
Rate for Payer: Cofinity Commercial	$425.21
Rate for Payer: Cofinity Medicare Advantage	$346.10
Rate for Payer: Encore Health Key Benefits Commercial	$395.54
Rate for Payer: Healthscope Commercial	$444.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.27
Rate for Payer: PHP Commercial	$420.27
Rate for Payer: Priority Health Cigna Priority Health	$321.38
Rate for Payer: Priority Health SBD	$311.49

HC ACB ESTABLISHED PT LEVEL 2

Facility

$494.43

Service Code	CPT 99212
Hospital Charge Code	51000073
Hospital Revenue Code	510
Min. Negotiated Rate	$311.49
Max. Negotiated Rate	$444.99
Rate for Payer: Aetna Commercial	$420.27
Rate for Payer: Aetna New Business (MI Preferred)	$321.38
Rate for Payer: Cash Price	$395.54
Rate for Payer: Cofinity Commercial	$346.10
Rate for Payer: Cofinity Commercial	$425.21
Rate for Payer: Cofinity Medicare Advantage	$346.10
Rate for Payer: Encore Health Key Benefits Commercial	$395.54
Rate for Payer: Healthscope Commercial	$444.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.27
Rate for Payer: PHP Commercial	$420.27
Rate for Payer: Priority Health Cigna Priority Health	$321.38
Rate for Payer: Priority Health SBD	$311.49

HC ACB ESTABLISHED PT LEVEL 3

Facility

$688.85

Service Code	CPT 99213
Hospital Charge Code	51000074
Hospital Revenue Code	510
Min. Negotiated Rate	$433.98
Max. Negotiated Rate	$619.97
Rate for Payer: Aetna Commercial	$585.52
Rate for Payer: Aetna New Business (MI Preferred)	$447.75
Rate for Payer: Cash Price	$551.08
Rate for Payer: Cofinity Commercial	$482.19
Rate for Payer: Cofinity Commercial	$592.41
Rate for Payer: Cofinity Medicare Advantage	$482.19
Rate for Payer: Encore Health Key Benefits Commercial	$551.08
Rate for Payer: Healthscope Commercial	$619.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.52
Rate for Payer: PHP Commercial	$585.52
Rate for Payer: Priority Health Cigna Priority Health	$447.75
Rate for Payer: Priority Health SBD	$433.98

HC ACB ESTABLISHED PT LEVEL 3

Facility

$688.85

Service Code	CPT 99213
Hospital Charge Code	51000074
Hospital Revenue Code	510
Min. Negotiated Rate	$275.54
Max. Negotiated Rate	$619.97
Rate for Payer: Aetna Commercial	$585.52
Rate for Payer: Aetna Medicare	$344.43
Rate for Payer: Aetna New Business (MI Preferred)	$447.75
Rate for Payer: BCBS Complete	$275.54
Rate for Payer: Cash Price	$551.08
Rate for Payer: Cofinity Commercial	$482.19
Rate for Payer: Cofinity Commercial	$592.41
Rate for Payer: Cofinity Medicare Advantage	$482.19
Rate for Payer: Encore Health Key Benefits Commercial	$551.08
Rate for Payer: Healthscope Commercial	$619.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.52
Rate for Payer: PHP Commercial	$585.52
Rate for Payer: Priority Health Cigna Priority Health	$447.75
Rate for Payer: Priority Health SBD	$433.98

HC ACB ESTABLISHED PT LEVEL 4

Facility

$874.52

Service Code	CPT 99214
Hospital Charge Code	51000075
Hospital Revenue Code	510
Min. Negotiated Rate	$550.95
Max. Negotiated Rate	$787.07
Rate for Payer: Aetna Commercial	$743.34
Rate for Payer: Aetna New Business (MI Preferred)	$568.44
Rate for Payer: Cash Price	$699.62
Rate for Payer: Cofinity Commercial	$612.16
Rate for Payer: Cofinity Commercial	$752.09
Rate for Payer: Cofinity Medicare Advantage	$612.16
Rate for Payer: Encore Health Key Benefits Commercial	$699.62
Rate for Payer: Healthscope Commercial	$787.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$743.34
Rate for Payer: PHP Commercial	$743.34
Rate for Payer: Priority Health Cigna Priority Health	$568.44
Rate for Payer: Priority Health SBD	$550.95

HC ACB ESTABLISHED PT LEVEL 4

Facility

$874.52

Service Code	CPT 99214
Hospital Charge Code	51000075
Hospital Revenue Code	510
Min. Negotiated Rate	$349.81
Max. Negotiated Rate	$787.07
Rate for Payer: Aetna Commercial	$743.34
Rate for Payer: Aetna Medicare	$437.26
Rate for Payer: Aetna New Business (MI Preferred)	$568.44
Rate for Payer: BCBS Complete	$349.81
Rate for Payer: Cash Price	$699.62
Rate for Payer: Cofinity Commercial	$612.16
Rate for Payer: Cofinity Commercial	$752.09
Rate for Payer: Cofinity Medicare Advantage	$612.16
Rate for Payer: Encore Health Key Benefits Commercial	$699.62
Rate for Payer: Healthscope Commercial	$787.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$743.34
Rate for Payer: PHP Commercial	$743.34
Rate for Payer: Priority Health Cigna Priority Health	$568.44
Rate for Payer: Priority Health SBD	$550.95

HC ACB ESTABLISHED PT LEVEL 5

Facility

$1,042.88

Service Code	CPT 99215
Hospital Charge Code	51000076
Hospital Revenue Code	510
Min. Negotiated Rate	$417.15
Max. Negotiated Rate	$938.59
Rate for Payer: Aetna Commercial	$886.45
Rate for Payer: Aetna Medicare	$521.44
Rate for Payer: Aetna New Business (MI Preferred)	$677.87
Rate for Payer: BCBS Complete	$417.15
Rate for Payer: Cash Price	$834.30
Rate for Payer: Cofinity Commercial	$730.02
Rate for Payer: Cofinity Commercial	$896.88
Rate for Payer: Cofinity Medicare Advantage	$730.02
Rate for Payer: Encore Health Key Benefits Commercial	$834.30
Rate for Payer: Healthscope Commercial	$938.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$886.45
Rate for Payer: PHP Commercial	$886.45
Rate for Payer: Priority Health Cigna Priority Health	$677.87
Rate for Payer: Priority Health SBD	$657.01

HC ACB ESTABLISHED PT LEVEL 5

Facility

$1,042.88

Service Code	CPT 99215
Hospital Charge Code	51000076
Hospital Revenue Code	510
Min. Negotiated Rate	$657.01
Max. Negotiated Rate	$938.59
Rate for Payer: Aetna Commercial	$886.45
Rate for Payer: Aetna New Business (MI Preferred)	$677.87
Rate for Payer: Cash Price	$834.30
Rate for Payer: Cofinity Commercial	$730.02
Rate for Payer: Cofinity Commercial	$896.88
Rate for Payer: Cofinity Medicare Advantage	$730.02
Rate for Payer: Encore Health Key Benefits Commercial	$834.30
Rate for Payer: Healthscope Commercial	$938.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$886.45
Rate for Payer: PHP Commercial	$886.45
Rate for Payer: Priority Health Cigna Priority Health	$677.87
Rate for Payer: Priority Health SBD	$657.01

Know your out-of-pocket cost for care.

All Charges