Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC EP VISUAL

Facility

$770.51

Service Code	CPT 95930
Hospital Charge Code	92200018
Hospital Revenue Code	922
Min. Negotiated Rate	$485.42
Max. Negotiated Rate	$693.46
Rate for Payer: Aetna Commercial	$654.93
Rate for Payer: Aetna New Business (MI Preferred)	$500.83
Rate for Payer: Cash Price	$616.41
Rate for Payer: Cofinity Commercial	$539.36
Rate for Payer: Cofinity Commercial	$662.64
Rate for Payer: Healthscope Commercial	$693.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$654.93
Rate for Payer: PHP Commercial	$654.93
Rate for Payer: Priority Health Cigna Priority Health	$539.36
Rate for Payer: Priority Health SBD	$485.42

HC ERBE IRRIGATION

Facility

$309.64

Hospital Charge Code	27000070
Hospital Revenue Code	270
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$278.68
Rate for Payer: Aetna Commercial	$263.19
Rate for Payer: Aetna New Business (MI Preferred)	$201.27
Rate for Payer: Cash Price	$247.71
Rate for Payer: Cofinity Commercial	$216.75
Rate for Payer: Cofinity Commercial	$266.29
Rate for Payer: Healthscope Commercial	$278.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.19
Rate for Payer: PHP Commercial	$263.19
Rate for Payer: Priority Health Cigna Priority Health	$216.75
Rate for Payer: Priority Health SBD	$195.07

HC ERBE IRRIGATION

Facility

$309.64

Hospital Charge Code	27000070
Hospital Revenue Code	270
Min. Negotiated Rate	$123.86
Max. Negotiated Rate	$278.68
Rate for Payer: Aetna Commercial	$263.19
Rate for Payer: Aetna New Business (MI Preferred)	$201.27
Rate for Payer: BCBS Complete	$123.86
Rate for Payer: Cash Price	$247.71
Rate for Payer: Cofinity Commercial	$216.75
Rate for Payer: Cofinity Commercial	$266.29
Rate for Payer: Healthscope Commercial	$278.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.19
Rate for Payer: PHP Commercial	$263.19
Rate for Payer: Priority Health Cigna Priority Health	$216.75
Rate for Payer: Priority Health SBD	$195.07

HC ER BURN CARE

Facility

$396.15

Hospital Charge Code	45000038
Hospital Revenue Code	450
Min. Negotiated Rate	$158.46
Max. Negotiated Rate	$356.54
Rate for Payer: Aetna Commercial	$336.73
Rate for Payer: Aetna New Business (MI Preferred)	$257.50
Rate for Payer: BCBS Complete	$158.46
Rate for Payer: Cash Price	$316.92
Rate for Payer: Cofinity Commercial	$277.30
Rate for Payer: Cofinity Commercial	$340.69
Rate for Payer: Healthscope Commercial	$356.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$336.73
Rate for Payer: PHP Commercial	$336.73
Rate for Payer: Priority Health Cigna Priority Health	$277.30
Rate for Payer: Priority Health SBD	$249.57

HC ER BURN CARE

Facility

$396.15

Hospital Charge Code	45000038
Hospital Revenue Code	450
Min. Negotiated Rate	$249.57
Max. Negotiated Rate	$356.54
Rate for Payer: Aetna Commercial	$336.73
Rate for Payer: Aetna New Business (MI Preferred)	$257.50
Rate for Payer: Cash Price	$316.92
Rate for Payer: Cofinity Commercial	$277.30
Rate for Payer: Cofinity Commercial	$340.69
Rate for Payer: Healthscope Commercial	$356.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$336.73
Rate for Payer: PHP Commercial	$336.73
Rate for Payer: Priority Health Cigna Priority Health	$277.30
Rate for Payer: Priority Health SBD	$249.57

HC ERCP

Facility

$3,330.35

Hospital Charge Code	36000039
Hospital Revenue Code	360
Min. Negotiated Rate	$1,332.14
Max. Negotiated Rate	$2,997.32
Rate for Payer: Aetna Commercial	$2,830.80
Rate for Payer: Aetna New Business (MI Preferred)	$2,164.73
Rate for Payer: BCBS Complete	$1,332.14
Rate for Payer: Cash Price	$2,664.28
Rate for Payer: Cofinity Commercial	$2,331.24
Rate for Payer: Cofinity Commercial	$2,864.10
Rate for Payer: Healthscope Commercial	$2,997.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,830.80
Rate for Payer: PHP Commercial	$2,830.80
Rate for Payer: Priority Health Cigna Priority Health	$2,331.24
Rate for Payer: Priority Health SBD	$2,098.12

HC ERCP

Facility

$3,330.35

Hospital Charge Code	36000039
Hospital Revenue Code	360
Min. Negotiated Rate	$2,098.12
Max. Negotiated Rate	$2,997.32
Rate for Payer: Aetna Commercial	$2,830.80
Rate for Payer: Aetna New Business (MI Preferred)	$2,164.73
Rate for Payer: Cash Price	$2,664.28
Rate for Payer: Cofinity Commercial	$2,331.24
Rate for Payer: Cofinity Commercial	$2,864.10
Rate for Payer: Healthscope Commercial	$2,997.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,830.80
Rate for Payer: PHP Commercial	$2,830.80
Rate for Payer: Priority Health Cigna Priority Health	$2,331.24
Rate for Payer: Priority Health SBD	$2,098.12

HC ERCP SPHINCTEROTOMY

Facility

$3,966.57

Hospital Charge Code	36000040
Hospital Revenue Code	360
Min. Negotiated Rate	$1,586.63
Max. Negotiated Rate	$3,569.91
Rate for Payer: Aetna Commercial	$3,371.58
Rate for Payer: Aetna New Business (MI Preferred)	$2,578.27
Rate for Payer: BCBS Complete	$1,586.63
Rate for Payer: Cash Price	$3,173.26
Rate for Payer: Cofinity Commercial	$2,776.60
Rate for Payer: Cofinity Commercial	$3,411.25
Rate for Payer: Healthscope Commercial	$3,569.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,371.58
Rate for Payer: PHP Commercial	$3,371.58
Rate for Payer: Priority Health Cigna Priority Health	$2,776.60
Rate for Payer: Priority Health SBD	$2,498.94

HC ERCP SPHINCTEROTOMY

Facility

$3,966.57

Hospital Charge Code	36000040
Hospital Revenue Code	360
Min. Negotiated Rate	$2,498.94
Max. Negotiated Rate	$3,569.91
Rate for Payer: Aetna Commercial	$3,371.58
Rate for Payer: Aetna New Business (MI Preferred)	$2,578.27
Rate for Payer: Cash Price	$3,173.26
Rate for Payer: Cofinity Commercial	$2,776.60
Rate for Payer: Cofinity Commercial	$3,411.25
Rate for Payer: Healthscope Commercial	$3,569.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,371.58
Rate for Payer: PHP Commercial	$3,371.58
Rate for Payer: Priority Health Cigna Priority Health	$2,776.60
Rate for Payer: Priority Health SBD	$2,498.94

HC ER CRITICAL CARE EA ADDL 30 MIN

Facility

$746.13

Service Code	CPT 99292
Hospital Charge Code	45000081
Hospital Revenue Code	450
Min. Negotiated Rate	$104.13
Max. Negotiated Rate	$1,158.83
Rate for Payer: Aetna Commercial	$634.21
Rate for Payer: Aetna New Business (MI Preferred)	$484.98
Rate for Payer: BCBS Complete	$298.45
Rate for Payer: BCBS Trust/PPO	$1,158.83
Rate for Payer: Cash Price	$596.90
Rate for Payer: Cash Price	$596.90
Rate for Payer: Cofinity Commercial	$641.67
Rate for Payer: Cofinity Commercial	$522.29
Rate for Payer: Healthscope Commercial	$671.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$634.21
Rate for Payer: PHP Commercial	$634.21
Rate for Payer: Priority Health Cigna Priority Health	$522.29
Rate for Payer: Priority Health SBD	$470.06
Rate for Payer: UHC All Payor (Choice/PPO)	$114.54
Rate for Payer: UHC Exchange	$104.13

HC ER CRITICAL CARE EA ADDL 30 MIN

Facility

$746.13

Service Code	CPT 99292
Hospital Charge Code	45000081
Hospital Revenue Code	450
Min. Negotiated Rate	$470.06
Max. Negotiated Rate	$671.52
Rate for Payer: Aetna Commercial	$634.21
Rate for Payer: Aetna New Business (MI Preferred)	$484.98
Rate for Payer: Cash Price	$596.90
Rate for Payer: Cofinity Commercial	$522.29
Rate for Payer: Cofinity Commercial	$641.67
Rate for Payer: Healthscope Commercial	$671.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$634.21
Rate for Payer: PHP Commercial	$634.21
Rate for Payer: Priority Health Cigna Priority Health	$522.29
Rate for Payer: Priority Health SBD	$470.06

HC ER CRITICAL CARE INITIAL 30-74 MIN

Facility

$3,366.24

Service Code	CPT 99291
Hospital Charge Code	45000026
Hospital Revenue Code	450
Min. Negotiated Rate	$2,120.73
Max. Negotiated Rate	$3,029.62
Rate for Payer: Aetna Commercial	$2,861.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,188.06
Rate for Payer: Cash Price	$2,692.99
Rate for Payer: Cofinity Commercial	$2,356.37
Rate for Payer: Cofinity Commercial	$2,894.97
Rate for Payer: Healthscope Commercial	$3,029.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,861.30
Rate for Payer: PHP Commercial	$2,861.30
Rate for Payer: Priority Health Cigna Priority Health	$2,356.37
Rate for Payer: Priority Health SBD	$2,120.73

HC ER CRITICAL CARE INITIAL 30-74 MIN

Facility

$3,366.24

Service Code	CPT 99291
Hospital Charge Code	45000026
Hospital Revenue Code	450
Min. Negotiated Rate	$206.62
Max. Negotiated Rate	$3,657.00
Rate for Payer: Aetna Commercial	$2,861.30
Rate for Payer: Aetna Medicare	$821.16
Rate for Payer: Aetna New Business (MI Preferred)	$2,188.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$986.98
Rate for Payer: Amish Plain Church Group Commercial	$986.98
Rate for Payer: BCBS Complete	$453.53
Rate for Payer: BCBS MAPPO	$789.58
Rate for Payer: BCBS Trust/PPO	$1,118.13
Rate for Payer: BCN Medicare Advantage	$789.58
Rate for Payer: Cash Price	$2,692.99
Rate for Payer: Cash Price	$2,692.99
Rate for Payer: Cash Price	$2,692.99
Rate for Payer: Cofinity Commercial	$2,356.37
Rate for Payer: Cofinity Commercial	$2,894.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$789.58
Rate for Payer: Healthscope Commercial	$3,029.62
Rate for Payer: Mclaren Medicaid	$431.90
Rate for Payer: Mclaren Medicare	$789.58
Rate for Payer: Meridian Medicaid	$453.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$829.06
Rate for Payer: MI Amish Medical Board Commercial	$908.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,861.30
Rate for Payer: PACE Medicare	$750.10
Rate for Payer: PACE SWMI	$789.58
Rate for Payer: PHP Commercial	$2,861.30
Rate for Payer: PHP Medicare Advantage	$789.58
Rate for Payer: Priority Health Choice Medicaid	$431.90
Rate for Payer: Priority Health Cigna Priority Health	$2,356.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,319.27
Rate for Payer: Priority Health Medicare	$789.58
Rate for Payer: Priority Health Narrow Network	$1,855.42
Rate for Payer: Priority Health SBD	$2,120.73
Rate for Payer: Railroad Medicare Medicare	$789.58
Rate for Payer: UHC All Payor (Choice/PPO)	$227.28
Rate for Payer: UHC Core	$3,657.00
Rate for Payer: UHC Dual Complete DSNP	$789.58
Rate for Payer: UHC Exchange	$206.62
Rate for Payer: UHC Medicare Advantage	$813.27
Rate for Payer: VA VA	$789.58

HC ER LEVEL FIVE 99285

Facility

$2,007.51

Service Code	CPT 99285
Hospital Charge Code	45000025
Hospital Revenue Code	450
Min. Negotiated Rate	$170.27
Max. Negotiated Rate	$3,048.00
Rate for Payer: Aetna Commercial	$1,706.38
Rate for Payer: Aetna Medicare	$594.39
Rate for Payer: Aetna New Business (MI Preferred)	$1,304.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$714.41
Rate for Payer: Amish Plain Church Group Commercial	$714.41
Rate for Payer: BCBS Complete	$328.29
Rate for Payer: BCBS MAPPO	$571.53
Rate for Payer: BCBS Trust/PPO	$666.82
Rate for Payer: BCN Medicare Advantage	$571.53
Rate for Payer: Cash Price	$1,606.01
Rate for Payer: Cash Price	$1,606.01
Rate for Payer: Cash Price	$1,606.01
Rate for Payer: Cofinity Commercial	$1,405.26
Rate for Payer: Cofinity Commercial	$1,726.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$571.53
Rate for Payer: Healthscope Commercial	$1,806.76
Rate for Payer: Mclaren Medicaid	$312.63
Rate for Payer: Mclaren Medicare	$571.53
Rate for Payer: Meridian Medicaid	$328.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$600.11
Rate for Payer: MI Amish Medical Board Commercial	$657.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,706.38
Rate for Payer: PACE Medicare	$542.95
Rate for Payer: PACE SWMI	$571.53
Rate for Payer: PHP Commercial	$1,706.38
Rate for Payer: PHP Medicare Advantage	$571.53
Rate for Payer: Priority Health Choice Medicaid	$312.63
Rate for Payer: Priority Health Cigna Priority Health	$1,405.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,625.78
Rate for Payer: Priority Health Medicare	$571.53
Rate for Payer: Priority Health Narrow Network	$1,300.62
Rate for Payer: Priority Health SBD	$1,264.73
Rate for Payer: Railroad Medicare Medicare	$571.53
Rate for Payer: UHC All Payor (Choice/PPO)	$187.30
Rate for Payer: UHC Core	$3,048.00
Rate for Payer: UHC Dual Complete DSNP	$571.53
Rate for Payer: UHC Exchange	$170.27
Rate for Payer: UHC Medicare Advantage	$588.68
Rate for Payer: VA VA	$571.53

HC ER LEVEL FIVE 99285

Facility

$2,007.51

Service Code	CPT 99285
Hospital Charge Code	45000025
Hospital Revenue Code	450
Min. Negotiated Rate	$1,264.73
Max. Negotiated Rate	$1,806.76
Rate for Payer: Aetna Commercial	$1,706.38
Rate for Payer: Aetna New Business (MI Preferred)	$1,304.88
Rate for Payer: Cash Price	$1,606.01
Rate for Payer: Cofinity Commercial	$1,405.26
Rate for Payer: Cofinity Commercial	$1,726.46
Rate for Payer: Healthscope Commercial	$1,806.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,706.38
Rate for Payer: PHP Commercial	$1,706.38
Rate for Payer: Priority Health Cigna Priority Health	$1,405.26
Rate for Payer: Priority Health SBD	$1,264.73

HC ER LEVEL FOUR 99284

Facility

$1,391.19

Service Code	CPT 99284
Hospital Charge Code	45000024
Hospital Revenue Code	450
Min. Negotiated Rate	$876.45
Max. Negotiated Rate	$1,252.07
Rate for Payer: Aetna Commercial	$1,182.51
Rate for Payer: Aetna New Business (MI Preferred)	$904.27
Rate for Payer: Cash Price	$1,112.95
Rate for Payer: Cofinity Commercial	$973.83
Rate for Payer: Cofinity Commercial	$1,196.42
Rate for Payer: Healthscope Commercial	$1,252.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,182.51
Rate for Payer: PHP Commercial	$1,182.51
Rate for Payer: Priority Health Cigna Priority Health	$973.83
Rate for Payer: Priority Health SBD	$876.45

HC ER LEVEL FOUR 99284

Facility

$1,391.19

Service Code	CPT 99284
Hospital Charge Code	45000024
Hospital Revenue Code	450
Min. Negotiated Rate	$117.55
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$1,182.51
Rate for Payer: Aetna Medicare	$409.86
Rate for Payer: Aetna New Business (MI Preferred)	$904.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$492.62
Rate for Payer: Amish Plain Church Group Commercial	$492.62
Rate for Payer: BCBS Complete	$226.37
Rate for Payer: BCBS MAPPO	$394.10
Rate for Payer: BCBS Trust/PPO	$462.10
Rate for Payer: BCN Medicare Advantage	$394.10
Rate for Payer: Cash Price	$1,112.95
Rate for Payer: Cash Price	$1,112.95
Rate for Payer: Cash Price	$1,112.95
Rate for Payer: Cofinity Commercial	$973.83
Rate for Payer: Cofinity Commercial	$1,196.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$394.10
Rate for Payer: Healthscope Commercial	$1,252.07
Rate for Payer: Mclaren Medicaid	$215.57
Rate for Payer: Mclaren Medicare	$394.10
Rate for Payer: Meridian Medicaid	$226.37
Rate for Payer: Meridian Wellcare - Medicare Advantage	$413.80
Rate for Payer: MI Amish Medical Board Commercial	$453.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,182.51
Rate for Payer: PACE Medicare	$374.40
Rate for Payer: PACE SWMI	$394.10
Rate for Payer: PHP Commercial	$1,182.51
Rate for Payer: PHP Medicare Advantage	$394.10
Rate for Payer: Priority Health Choice Medicaid	$215.57
Rate for Payer: Priority Health Cigna Priority Health	$973.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,132.66
Rate for Payer: Priority Health Medicare	$394.10
Rate for Payer: Priority Health Narrow Network	$906.13
Rate for Payer: Priority Health SBD	$876.45
Rate for Payer: Railroad Medicare Medicare	$394.10
Rate for Payer: UHC All Payor (Choice/PPO)	$129.30
Rate for Payer: UHC Core	$2,377.00
Rate for Payer: UHC Dual Complete DSNP	$394.10
Rate for Payer: UHC Exchange	$117.55
Rate for Payer: UHC Medicare Advantage	$405.92
Rate for Payer: VA VA	$394.10

HC ER LEVEL ONE 99281

Facility

$252.31

Service Code	CPT 99281
Hospital Charge Code	45000020
Hospital Revenue Code	450
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$477.00
Rate for Payer: Aetna Commercial	$214.46
Rate for Payer: Aetna Medicare	$82.16
Rate for Payer: Aetna New Business (MI Preferred)	$164.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$98.75
Rate for Payer: Amish Plain Church Group Commercial	$98.75
Rate for Payer: BCBS Complete	$45.38
Rate for Payer: BCBS MAPPO	$79.00
Rate for Payer: BCBS Trust/PPO	$83.81
Rate for Payer: BCN Medicare Advantage	$79.00
Rate for Payer: Cash Price	$201.85
Rate for Payer: Cash Price	$201.85
Rate for Payer: Cash Price	$201.85
Rate for Payer: Cofinity Commercial	$216.99
Rate for Payer: Cofinity Commercial	$176.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$79.00
Rate for Payer: Healthscope Commercial	$227.08
Rate for Payer: Mclaren Medicaid	$43.21
Rate for Payer: Mclaren Medicare	$79.00
Rate for Payer: Meridian Medicaid	$45.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$82.95
Rate for Payer: MI Amish Medical Board Commercial	$90.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$214.46
Rate for Payer: PACE Medicare	$75.05
Rate for Payer: PACE SWMI	$79.00
Rate for Payer: PHP Commercial	$214.46
Rate for Payer: PHP Medicare Advantage	$79.00
Rate for Payer: Priority Health Choice Medicaid	$43.21
Rate for Payer: Priority Health Cigna Priority Health	$176.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$225.86
Rate for Payer: Priority Health Medicare	$79.00
Rate for Payer: Priority Health Narrow Network	$180.69
Rate for Payer: Priority Health SBD	$158.96
Rate for Payer: Railroad Medicare Medicare	$79.00
Rate for Payer: UHC All Payor (Choice/PPO)	$12.24
Rate for Payer: UHC Core	$477.00
Rate for Payer: UHC Dual Complete DSNP	$79.00
Rate for Payer: UHC Exchange	$11.13
Rate for Payer: UHC Medicare Advantage	$81.37
Rate for Payer: VA VA	$79.00

HC ER LEVEL ONE 99281

Facility

$252.31

Service Code	CPT 99281
Hospital Charge Code	45000020
Hospital Revenue Code	450
Min. Negotiated Rate	$158.96
Max. Negotiated Rate	$227.08
Rate for Payer: Aetna Commercial	$214.46
Rate for Payer: Aetna New Business (MI Preferred)	$164.00
Rate for Payer: Cash Price	$201.85
Rate for Payer: Cofinity Commercial	$176.62
Rate for Payer: Cofinity Commercial	$216.99
Rate for Payer: Healthscope Commercial	$227.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$214.46
Rate for Payer: PHP Commercial	$214.46
Rate for Payer: Priority Health Cigna Priority Health	$176.62
Rate for Payer: Priority Health SBD	$158.96

HC ER LEVEL THREE 99283

Facility

$885.90

Service Code	CPT 99283
Hospital Charge Code	45000022
Hospital Revenue Code	450
Min. Negotiated Rate	$558.12
Max. Negotiated Rate	$797.31
Rate for Payer: Aetna Commercial	$753.02
Rate for Payer: Aetna New Business (MI Preferred)	$575.84
Rate for Payer: Cash Price	$708.72
Rate for Payer: Cofinity Commercial	$620.13
Rate for Payer: Cofinity Commercial	$761.87
Rate for Payer: Healthscope Commercial	$797.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$753.02
Rate for Payer: PHP Commercial	$753.02
Rate for Payer: Priority Health Cigna Priority Health	$620.13
Rate for Payer: Priority Health SBD	$558.12

HC ER LEVEL THREE 99283

Facility

$885.90

Service Code	CPT 99283
Hospital Charge Code	45000022
Hospital Revenue Code	450
Min. Negotiated Rate	$69.09
Max. Negotiated Rate	$1,378.00
Rate for Payer: Aetna Commercial	$753.02
Rate for Payer: Aetna Medicare	$264.04
Rate for Payer: Aetna New Business (MI Preferred)	$575.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$317.35
Rate for Payer: Amish Plain Church Group Commercial	$317.35
Rate for Payer: BCBS Complete	$145.83
Rate for Payer: BCBS MAPPO	$253.88
Rate for Payer: BCBS Trust/PPO	$269.34
Rate for Payer: BCN Medicare Advantage	$253.88
Rate for Payer: Cash Price	$708.72
Rate for Payer: Cash Price	$708.72
Rate for Payer: Cash Price	$708.72
Rate for Payer: Cofinity Commercial	$761.87
Rate for Payer: Cofinity Commercial	$620.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$253.88
Rate for Payer: Healthscope Commercial	$797.31
Rate for Payer: Mclaren Medicaid	$138.87
Rate for Payer: Mclaren Medicare	$253.88
Rate for Payer: Meridian Medicaid	$145.83
Rate for Payer: Meridian Wellcare - Medicare Advantage	$266.57
Rate for Payer: MI Amish Medical Board Commercial	$291.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$753.02
Rate for Payer: PACE Medicare	$241.19
Rate for Payer: PACE SWMI	$253.88
Rate for Payer: PHP Commercial	$753.02
Rate for Payer: PHP Medicare Advantage	$253.88
Rate for Payer: Priority Health Choice Medicaid	$138.87
Rate for Payer: Priority Health Cigna Priority Health	$620.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$720.57
Rate for Payer: Priority Health Medicare	$253.88
Rate for Payer: Priority Health Narrow Network	$576.46
Rate for Payer: Priority Health SBD	$558.12
Rate for Payer: Railroad Medicare Medicare	$253.88
Rate for Payer: UHC All Payor (Choice/PPO)	$76.00
Rate for Payer: UHC Core	$1,378.00
Rate for Payer: UHC Dual Complete DSNP	$253.88
Rate for Payer: UHC Exchange	$69.09
Rate for Payer: UHC Medicare Advantage	$261.50
Rate for Payer: VA VA	$253.88

HC ER LEVEL TWO 99282

Facility

$502.02

Service Code	CPT 99282
Hospital Charge Code	45000021
Hospital Revenue Code	450
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$954.00
Rate for Payer: Aetna Commercial	$426.72
Rate for Payer: Aetna Medicare	$151.35
Rate for Payer: Aetna New Business (MI Preferred)	$326.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$181.91
Rate for Payer: Amish Plain Church Group Commercial	$181.91
Rate for Payer: BCBS Complete	$83.59
Rate for Payer: BCBS MAPPO	$145.53
Rate for Payer: BCBS Trust/PPO	$160.44
Rate for Payer: BCN Medicare Advantage	$145.53
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cofinity Commercial	$351.41
Rate for Payer: Cofinity Commercial	$431.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$145.53
Rate for Payer: Healthscope Commercial	$451.82
Rate for Payer: Mclaren Medicaid	$79.60
Rate for Payer: Mclaren Medicare	$145.53
Rate for Payer: Meridian Medicaid	$83.59
Rate for Payer: Meridian Wellcare - Medicare Advantage	$152.81
Rate for Payer: MI Amish Medical Board Commercial	$167.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$426.72
Rate for Payer: PACE Medicare	$138.25
Rate for Payer: PACE SWMI	$145.53
Rate for Payer: PHP Commercial	$426.72
Rate for Payer: PHP Medicare Advantage	$145.53
Rate for Payer: Priority Health Choice Medicaid	$79.60
Rate for Payer: Priority Health Cigna Priority Health	$351.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$408.99
Rate for Payer: Priority Health Medicare	$145.53
Rate for Payer: Priority Health Narrow Network	$327.19
Rate for Payer: Priority Health SBD	$316.27
Rate for Payer: Railroad Medicare Medicare	$145.53
Rate for Payer: UHC All Payor (Choice/PPO)	$44.66
Rate for Payer: UHC Core	$954.00
Rate for Payer: UHC Dual Complete DSNP	$145.53
Rate for Payer: UHC Exchange	$40.60
Rate for Payer: UHC Medicare Advantage	$149.90
Rate for Payer: VA VA	$145.53

HC ER LEVEL TWO 99282

Facility

$502.02

Service Code	CPT 99282
Hospital Charge Code	45000021
Hospital Revenue Code	450
Min. Negotiated Rate	$316.27
Max. Negotiated Rate	$451.82
Rate for Payer: Aetna Commercial	$426.72
Rate for Payer: Aetna New Business (MI Preferred)	$326.31
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cofinity Commercial	$351.41
Rate for Payer: Cofinity Commercial	$431.74
Rate for Payer: Healthscope Commercial	$451.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$426.72
Rate for Payer: PHP Commercial	$426.72
Rate for Payer: Priority Health Cigna Priority Health	$351.41
Rate for Payer: Priority Health SBD	$316.27

HC ER OBSERVATION PER HOUR

Facility

$134.33

Service Code	HCPCS G0378
Hospital Charge Code	76200002
Hospital Revenue Code	762
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$114.18
Rate for Payer: Aetna New Business (MI Preferred)	$87.31
Rate for Payer: BCBS Complete	$53.73
Rate for Payer: BCBS Trust/PPO	$108.91
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cofinity Commercial	$115.52
Rate for Payer: Cofinity Commercial	$94.03
Rate for Payer: Healthscope Commercial	$120.90
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.18
Rate for Payer: PHP Commercial	$114.18
Rate for Payer: Priority Health Cigna Priority Health	$94.03
Rate for Payer: Priority Health SBD	$84.63

HC ER OBSERVATION PER HOUR

Facility

$134.33

Service Code	HCPCS G0378
Hospital Charge Code	76200002
Hospital Revenue Code	762
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$120.90
Rate for Payer: Aetna Commercial	$114.18
Rate for Payer: Aetna New Business (MI Preferred)	$87.31
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cofinity Commercial	$115.52
Rate for Payer: Cofinity Commercial	$94.03
Rate for Payer: Healthscope Commercial	$120.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.18
Rate for Payer: PHP Commercial	$114.18
Rate for Payer: Priority Health Cigna Priority Health	$94.03
Rate for Payer: Priority Health SBD	$84.63

Know your out-of-pocket cost for care.

All Charges