Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC FIBRINOGEN

Facility

$75.40

Service Code	CPT 85384
Hospital Charge Code	30500045
Hospital Revenue Code	305
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$67.86
Rate for Payer: Aetna Commercial	$64.09
Rate for Payer: Aetna New Business (MI Preferred)	$49.01
Rate for Payer: Cash Price	$60.32
Rate for Payer: Cofinity Commercial	$52.78
Rate for Payer: Cofinity Commercial	$64.84
Rate for Payer: Healthscope Commercial	$67.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.09
Rate for Payer: PHP Commercial	$64.09
Rate for Payer: Priority Health Cigna Priority Health	$52.78
Rate for Payer: Priority Health SBD	$47.50

HC FIBRINOGEN

Facility

$75.40

Service Code	CPT 85384
Hospital Charge Code	30500045
Hospital Revenue Code	305
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$67.86
Rate for Payer: Aetna Commercial	$64.09
Rate for Payer: Aetna Medicare	$10.11
Rate for Payer: Aetna New Business (MI Preferred)	$49.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$12.15
Rate for Payer: Amish Plain Church Group Commercial	$12.15
Rate for Payer: BCBS Complete	$5.58
Rate for Payer: BCBS MAPPO	$9.72
Rate for Payer: BCBS Trust/PPO	$7.61
Rate for Payer: BCN Medicare Advantage	$9.72
Rate for Payer: Cash Price	$60.32
Rate for Payer: Cash Price	$60.32
Rate for Payer: Cofinity Commercial	$64.84
Rate for Payer: Cofinity Commercial	$52.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$9.72
Rate for Payer: Healthscope Commercial	$67.86
Rate for Payer: Mclaren Medicaid	$5.32
Rate for Payer: Mclaren Medicare	$9.72
Rate for Payer: Meridian Medicaid	$5.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10.21
Rate for Payer: MI Amish Medical Board Commercial	$11.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.09
Rate for Payer: PACE Medicare	$9.23
Rate for Payer: PACE SWMI	$9.72
Rate for Payer: PHP Commercial	$64.09
Rate for Payer: PHP Medicare Advantage	$9.72
Rate for Payer: Priority Health Choice Medicaid	$5.32
Rate for Payer: Priority Health Cigna Priority Health	$52.78
Rate for Payer: Priority Health Medicare	$9.72
Rate for Payer: Priority Health SBD	$47.50
Rate for Payer: Railroad Medicare Medicare	$9.72
Rate for Payer: UHC All Payor (Choice/PPO)	$11.66
Rate for Payer: UHC Core	$14.44
Rate for Payer: UHC Dual Complete DSNP	$9.72
Rate for Payer: UHC Exchange	$9.72
Rate for Payer: UHC Medicare Advantage	$10.01
Rate for Payer: VA VA	$9.72

HC FIBROTEST-ACTITEST, S

Facility

$285.00

Service Code	CPT 81596
Hospital Charge Code	30000155
Hospital Revenue Code	300
Min. Negotiated Rate	$39.49
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$242.25
Rate for Payer: Aetna Medicare	$75.08
Rate for Payer: Aetna New Business (MI Preferred)	$185.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$90.24
Rate for Payer: Amish Plain Church Group Commercial	$90.24
Rate for Payer: BCBS Complete	$41.47
Rate for Payer: BCBS MAPPO	$72.19
Rate for Payer: BCBS Trust/PPO	$56.53
Rate for Payer: BCN Medicare Advantage	$72.19
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Commercial	$199.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$72.19
Rate for Payer: Healthscope Commercial	$256.50
Rate for Payer: Mclaren Medicaid	$39.49
Rate for Payer: Mclaren Medicare	$72.19
Rate for Payer: Meridian Medicaid	$41.47
Rate for Payer: Meridian Wellcare - Medicare Advantage	$75.80
Rate for Payer: MI Amish Medical Board Commercial	$83.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$242.25
Rate for Payer: PACE Medicare	$68.58
Rate for Payer: PACE SWMI	$72.19
Rate for Payer: PHP Commercial	$242.25
Rate for Payer: PHP Medicare Advantage	$72.19
Rate for Payer: Priority Health Choice Medicaid	$39.49
Rate for Payer: Priority Health Cigna Priority Health	$199.50
Rate for Payer: Priority Health Medicare	$72.19
Rate for Payer: Priority Health SBD	$179.55
Rate for Payer: Railroad Medicare Medicare	$72.19
Rate for Payer: UHC All Payor (Choice/PPO)	$86.63
Rate for Payer: UHC Core	$86.63
Rate for Payer: UHC Dual Complete DSNP	$72.19
Rate for Payer: UHC Exchange	$72.19
Rate for Payer: UHC Medicare Advantage	$74.36
Rate for Payer: VA VA	$72.19

HC FIBROTEST-ACTITEST, S

Facility

$285.00

Service Code	CPT 81596
Hospital Charge Code	30000155
Hospital Revenue Code	300
Min. Negotiated Rate	$179.55
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$242.25
Rate for Payer: Aetna New Business (MI Preferred)	$185.25
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cofinity Commercial	$199.50
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Healthscope Commercial	$256.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$242.25
Rate for Payer: PHP Commercial	$242.25
Rate for Payer: Priority Health Cigna Priority Health	$199.50
Rate for Payer: Priority Health SBD	$179.55

HC FILSHIE CLIP

Facility

$329.24

Hospital Charge Code	27000076
Hospital Revenue Code	270
Min. Negotiated Rate	$131.70
Max. Negotiated Rate	$296.32
Rate for Payer: Aetna Commercial	$279.85
Rate for Payer: Aetna New Business (MI Preferred)	$214.01
Rate for Payer: BCBS Complete	$131.70
Rate for Payer: Cash Price	$263.39
Rate for Payer: Cofinity Commercial	$230.47
Rate for Payer: Cofinity Commercial	$283.15
Rate for Payer: Healthscope Commercial	$296.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$279.85
Rate for Payer: PHP Commercial	$279.85
Rate for Payer: Priority Health Cigna Priority Health	$230.47
Rate for Payer: Priority Health SBD	$207.42

HC FILSHIE CLIP

Facility

$329.24

Hospital Charge Code	27000076
Hospital Revenue Code	270
Min. Negotiated Rate	$207.42
Max. Negotiated Rate	$296.32
Rate for Payer: Aetna Commercial	$279.85
Rate for Payer: Aetna New Business (MI Preferred)	$214.01
Rate for Payer: Cash Price	$263.39
Rate for Payer: Cofinity Commercial	$230.47
Rate for Payer: Cofinity Commercial	$283.15
Rate for Payer: Healthscope Commercial	$296.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$279.85
Rate for Payer: PHP Commercial	$279.85
Rate for Payer: Priority Health Cigna Priority Health	$230.47
Rate for Payer: Priority Health SBD	$207.42

HC FILTER ATS LIPIGUARD

Facility

$57.00

Hospital Charge Code	27000121
Hospital Revenue Code	270
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna New Business (MI Preferred)	$37.05
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cofinity Commercial	$39.90
Rate for Payer: Cofinity Commercial	$49.02
Rate for Payer: Healthscope Commercial	$51.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.45
Rate for Payer: PHP Commercial	$48.45
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health SBD	$35.91

HC FILTER ATS LIPIGUARD

Facility

$57.00

Hospital Charge Code	27000121
Hospital Revenue Code	270
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna New Business (MI Preferred)	$37.05
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cofinity Commercial	$39.90
Rate for Payer: Cofinity Commercial	$49.02
Rate for Payer: Healthscope Commercial	$51.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.45
Rate for Payer: PHP Commercial	$48.45
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health SBD	$35.91

HC FILTERWIRE

Facility

$3,739.66

Service Code	HCPCS C1884
Hospital Charge Code	27800011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,495.86
Max. Negotiated Rate	$3,365.69
Rate for Payer: Aetna Commercial	$3,178.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,430.78
Rate for Payer: BCBS Complete	$1,495.86
Rate for Payer: Cash Price	$2,991.73
Rate for Payer: Cofinity Commercial	$2,617.76
Rate for Payer: Cofinity Commercial	$3,216.11
Rate for Payer: Healthscope Commercial	$3,365.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,178.71
Rate for Payer: PHP Commercial	$3,178.71
Rate for Payer: Priority Health Cigna Priority Health	$2,617.76
Rate for Payer: Priority Health SBD	$2,355.99

HC FILTERWIRE

Facility

$3,739.66

Service Code	HCPCS C1884
Hospital Charge Code	27800011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,355.99
Max. Negotiated Rate	$3,365.69
Rate for Payer: Aetna Commercial	$3,178.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,430.78
Rate for Payer: Cash Price	$2,991.73
Rate for Payer: Cofinity Commercial	$2,617.76
Rate for Payer: Cofinity Commercial	$3,216.11
Rate for Payer: Healthscope Commercial	$3,365.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,178.71
Rate for Payer: PHP Commercial	$3,178.71
Rate for Payer: Priority Health Cigna Priority Health	$2,617.76
Rate for Payer: Priority Health SBD	$2,355.99

HC FINGER SPLINT, STATIC, SUPPLY

Facility

$20.40

Hospital Charge Code	27000646
Hospital Revenue Code	270
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: BCBS Complete	$8.16
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$12.85

HC FINGER SPLINT, STATIC, SUPPLY

Facility

$20.40

Hospital Charge Code	27000646
Hospital Revenue Code	270
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$12.85

HC FISH PRENATAL ANEUPLOIDY

Facility

$165.24

Service Code	CPT 88275
Hospital Charge Code	31000034
Hospital Revenue Code	310
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$148.72
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: Aetna New Business (MI Preferred)	$107.41
Rate for Payer: Cash Price	$132.19
Rate for Payer: Cofinity Commercial	$115.67
Rate for Payer: Cofinity Commercial	$142.11
Rate for Payer: Healthscope Commercial	$148.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$140.45
Rate for Payer: PHP Commercial	$140.45
Rate for Payer: Priority Health Cigna Priority Health	$115.67
Rate for Payer: Priority Health SBD	$104.10

HC FISH PRENATAL ANEUPLOIDY

Facility

$165.24

Service Code	CPT 88275
Hospital Charge Code	31000034
Hospital Revenue Code	310
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$148.72
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: Aetna Medicare	$53.24
Rate for Payer: Aetna New Business (MI Preferred)	$107.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$63.99
Rate for Payer: Amish Plain Church Group Commercial	$63.99
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: BCBS MAPPO	$51.19
Rate for Payer: BCBS Trust/PPO	$40.08
Rate for Payer: BCN Medicare Advantage	$51.19
Rate for Payer: Cash Price	$132.19
Rate for Payer: Cash Price	$132.19
Rate for Payer: Cofinity Commercial	$115.67
Rate for Payer: Cofinity Commercial	$142.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.19
Rate for Payer: Healthscope Commercial	$148.72
Rate for Payer: Mclaren Medicaid	$28.00
Rate for Payer: Mclaren Medicare	$51.19
Rate for Payer: Meridian Medicaid	$29.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$53.75
Rate for Payer: MI Amish Medical Board Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$140.45
Rate for Payer: PACE Medicare	$48.63
Rate for Payer: PACE SWMI	$51.19
Rate for Payer: PHP Commercial	$140.45
Rate for Payer: PHP Medicare Advantage	$51.19
Rate for Payer: Priority Health Choice Medicaid	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$115.67
Rate for Payer: Priority Health Medicare	$51.19
Rate for Payer: Priority Health SBD	$104.10
Rate for Payer: Railroad Medicare Medicare	$51.19
Rate for Payer: UHC All Payor (Choice/PPO)	$61.43
Rate for Payer: UHC Core	$68.26
Rate for Payer: UHC Dual Complete DSNP	$51.19
Rate for Payer: UHC Exchange	$51.19
Rate for Payer: UHC Medicare Advantage	$52.73
Rate for Payer: VA VA	$51.19

HC FISH PROBES

Facility

$76.34

Service Code	CPT 88275
Hospital Charge Code	31000067
Hospital Revenue Code	310
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$68.71
Rate for Payer: Aetna Commercial	$64.89
Rate for Payer: Aetna Medicare	$53.24
Rate for Payer: Aetna New Business (MI Preferred)	$49.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$63.99
Rate for Payer: Amish Plain Church Group Commercial	$63.99
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: BCBS MAPPO	$51.19
Rate for Payer: BCBS Trust/PPO	$40.08
Rate for Payer: BCN Medicare Advantage	$51.19
Rate for Payer: Cash Price	$61.07
Rate for Payer: Cash Price	$61.07
Rate for Payer: Cofinity Commercial	$65.65
Rate for Payer: Cofinity Commercial	$53.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.19
Rate for Payer: Healthscope Commercial	$68.71
Rate for Payer: Mclaren Medicaid	$28.00
Rate for Payer: Mclaren Medicare	$51.19
Rate for Payer: Meridian Medicaid	$29.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$53.75
Rate for Payer: MI Amish Medical Board Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.89
Rate for Payer: PACE Medicare	$48.63
Rate for Payer: PACE SWMI	$51.19
Rate for Payer: PHP Commercial	$64.89
Rate for Payer: PHP Medicare Advantage	$51.19
Rate for Payer: Priority Health Choice Medicaid	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$53.44
Rate for Payer: Priority Health Medicare	$51.19
Rate for Payer: Priority Health SBD	$48.09
Rate for Payer: Railroad Medicare Medicare	$51.19
Rate for Payer: UHC All Payor (Choice/PPO)	$61.43
Rate for Payer: UHC Core	$68.26
Rate for Payer: UHC Dual Complete DSNP	$51.19
Rate for Payer: UHC Exchange	$51.19
Rate for Payer: UHC Medicare Advantage	$52.73
Rate for Payer: VA VA	$51.19

HC FISH PROBES

Facility

$76.34

Service Code	CPT 88275
Hospital Charge Code	31000067
Hospital Revenue Code	310
Min. Negotiated Rate	$48.09
Max. Negotiated Rate	$68.71
Rate for Payer: Aetna Commercial	$64.89
Rate for Payer: Aetna New Business (MI Preferred)	$49.62
Rate for Payer: Cash Price	$61.07
Rate for Payer: Cofinity Commercial	$53.44
Rate for Payer: Cofinity Commercial	$65.65
Rate for Payer: Healthscope Commercial	$68.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.89
Rate for Payer: PHP Commercial	$64.89
Rate for Payer: Priority Health Cigna Priority Health	$53.44
Rate for Payer: Priority Health SBD	$48.09

HC FISTULA SHUNTOGRAM

Facility

$2,209.94

Hospital Charge Code	32000264
Hospital Revenue Code	360
Min. Negotiated Rate	$1,392.26
Max. Negotiated Rate	$1,988.95
Rate for Payer: Aetna Commercial	$1,878.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,436.46
Rate for Payer: Cash Price	$1,767.95
Rate for Payer: Cofinity Commercial	$1,546.96
Rate for Payer: Cofinity Commercial	$1,900.55
Rate for Payer: Healthscope Commercial	$1,988.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,878.45
Rate for Payer: PHP Commercial	$1,878.45
Rate for Payer: Priority Health Cigna Priority Health	$1,546.96
Rate for Payer: Priority Health SBD	$1,392.26

HC FISTULA SHUNTOGRAM

Facility

$2,209.94

Hospital Charge Code	32000264
Hospital Revenue Code	360
Min. Negotiated Rate	$883.98
Max. Negotiated Rate	$1,988.95
Rate for Payer: Aetna Commercial	$1,878.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,436.46
Rate for Payer: BCBS Complete	$883.98
Rate for Payer: Cash Price	$1,767.95
Rate for Payer: Cofinity Commercial	$1,546.96
Rate for Payer: Cofinity Commercial	$1,900.55
Rate for Payer: Healthscope Commercial	$1,988.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,878.45
Rate for Payer: PHP Commercial	$1,878.45
Rate for Payer: Priority Health Cigna Priority Health	$1,546.96
Rate for Payer: Priority Health SBD	$1,392.26

HC FIT INSERT INTRAVAG SUPPORT DEVICE

Facility

$253.88

Service Code	CPT 57150
Hospital Charge Code	76100203
Hospital Revenue Code	761
Min. Negotiated Rate	$25.21
Max. Negotiated Rate	$228.49
Rate for Payer: Aetna Commercial	$215.80
Rate for Payer: Aetna Medicare	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$165.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$68.04
Rate for Payer: Amish Plain Church Group Commercial	$68.04
Rate for Payer: BCBS Complete	$31.26
Rate for Payer: BCBS MAPPO	$54.43
Rate for Payer: BCBS Trust/PPO	$52.06
Rate for Payer: BCN Medicare Advantage	$54.43
Rate for Payer: Cash Price	$203.10
Rate for Payer: Cash Price	$203.10
Rate for Payer: Cofinity Commercial	$218.34
Rate for Payer: Cofinity Commercial	$177.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$54.43
Rate for Payer: Healthscope Commercial	$228.49
Rate for Payer: Mclaren Medicaid	$29.77
Rate for Payer: Mclaren Medicare	$54.43
Rate for Payer: Meridian Medicaid	$31.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$57.15
Rate for Payer: MI Amish Medical Board Commercial	$62.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.80
Rate for Payer: PACE Medicare	$51.71
Rate for Payer: PACE SWMI	$54.43
Rate for Payer: PHP Commercial	$215.80
Rate for Payer: PHP Medicare Advantage	$54.43
Rate for Payer: Priority Health Choice Medicaid	$29.77
Rate for Payer: Priority Health Cigna Priority Health	$177.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.33
Rate for Payer: Priority Health Medicare	$54.43
Rate for Payer: Priority Health Narrow Network	$138.66
Rate for Payer: Priority Health SBD	$159.94
Rate for Payer: Railroad Medicare Medicare	$54.43
Rate for Payer: UHC All Payor (Choice/PPO)	$27.73
Rate for Payer: UHC Dual Complete DSNP	$54.43
Rate for Payer: UHC Exchange	$25.21
Rate for Payer: UHC Medicare Advantage	$56.06
Rate for Payer: VA VA	$54.43

HC FIT INSERT INTRAVAG SUPPORT DEVICE

Facility

$253.88

Service Code	CPT 57150
Hospital Charge Code	76100203
Hospital Revenue Code	761
Min. Negotiated Rate	$159.94
Max. Negotiated Rate	$228.49
Rate for Payer: Aetna Commercial	$215.80
Rate for Payer: Aetna New Business (MI Preferred)	$165.02
Rate for Payer: Cash Price	$203.10
Rate for Payer: Cofinity Commercial	$177.72
Rate for Payer: Cofinity Commercial	$218.34
Rate for Payer: Healthscope Commercial	$228.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.80
Rate for Payer: PHP Commercial	$215.80
Rate for Payer: Priority Health Cigna Priority Health	$177.72
Rate for Payer: Priority Health SBD	$159.94

HC FIT & INSERT PESSARY/OTHER DEVICE

Facility

$514.66

Service Code	CPT 57160
Hospital Charge Code	76100357
Hospital Revenue Code	761
Min. Negotiated Rate	$324.24
Max. Negotiated Rate	$463.19
Rate for Payer: Aetna Commercial	$437.46
Rate for Payer: Aetna New Business (MI Preferred)	$334.53
Rate for Payer: Cash Price	$411.73
Rate for Payer: Cofinity Commercial	$360.26
Rate for Payer: Cofinity Commercial	$442.61
Rate for Payer: Healthscope Commercial	$463.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$437.46
Rate for Payer: PHP Commercial	$437.46
Rate for Payer: Priority Health Cigna Priority Health	$360.26
Rate for Payer: Priority Health SBD	$324.24

HC FIT & INSERT PESSARY/OTHER DEVICE

Facility

$514.66

Service Code	CPT 57160
Hospital Charge Code	76100357
Hospital Revenue Code	761
Min. Negotiated Rate	$44.86
Max. Negotiated Rate	$463.19
Rate for Payer: Aetna Commercial	$437.46
Rate for Payer: Aetna Medicare	$184.40
Rate for Payer: Aetna New Business (MI Preferred)	$334.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$221.64
Rate for Payer: Amish Plain Church Group Commercial	$221.64
Rate for Payer: BCBS Complete	$101.85
Rate for Payer: BCBS MAPPO	$177.31
Rate for Payer: BCBS Trust/PPO	$111.35
Rate for Payer: BCN Medicare Advantage	$177.31
Rate for Payer: Cash Price	$411.73
Rate for Payer: Cash Price	$411.73
Rate for Payer: Cofinity Commercial	$360.26
Rate for Payer: Cofinity Commercial	$442.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$177.31
Rate for Payer: Healthscope Commercial	$463.19
Rate for Payer: Mclaren Medicaid	$96.99
Rate for Payer: Mclaren Medicare	$177.31
Rate for Payer: Meridian Medicaid	$101.85
Rate for Payer: Meridian Wellcare - Medicare Advantage	$186.18
Rate for Payer: MI Amish Medical Board Commercial	$203.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$437.46
Rate for Payer: PACE Medicare	$168.44
Rate for Payer: PACE SWMI	$177.31
Rate for Payer: PHP Commercial	$437.46
Rate for Payer: PHP Medicare Advantage	$177.31
Rate for Payer: Priority Health Choice Medicaid	$96.99
Rate for Payer: Priority Health Cigna Priority Health	$360.26
Rate for Payer: Priority Health Medicare	$177.31
Rate for Payer: Priority Health SBD	$324.24
Rate for Payer: Railroad Medicare Medicare	$177.31
Rate for Payer: UHC All Payor (Choice/PPO)	$49.35
Rate for Payer: UHC Dual Complete DSNP	$177.31
Rate for Payer: UHC Exchange	$44.86
Rate for Payer: UHC Medicare Advantage	$182.63
Rate for Payer: VA VA	$177.31

HC FLEXIBLE SIGMOIDOSCOPY

Facility

$1,743.04

Hospital Charge Code	36000044
Hospital Revenue Code	360
Min. Negotiated Rate	$697.22
Max. Negotiated Rate	$1,568.74
Rate for Payer: Aetna Commercial	$1,481.58
Rate for Payer: Aetna New Business (MI Preferred)	$1,132.98
Rate for Payer: BCBS Complete	$697.22
Rate for Payer: Cash Price	$1,394.43
Rate for Payer: Cofinity Commercial	$1,220.13
Rate for Payer: Cofinity Commercial	$1,499.01
Rate for Payer: Healthscope Commercial	$1,568.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,481.58
Rate for Payer: PHP Commercial	$1,481.58
Rate for Payer: Priority Health Cigna Priority Health	$1,220.13
Rate for Payer: Priority Health SBD	$1,098.12

HC FLEXIBLE SIGMOIDOSCOPY

Facility

$1,743.04

Hospital Charge Code	36000044
Hospital Revenue Code	360
Min. Negotiated Rate	$1,098.12
Max. Negotiated Rate	$1,568.74
Rate for Payer: Aetna Commercial	$1,481.58
Rate for Payer: Aetna New Business (MI Preferred)	$1,132.98
Rate for Payer: Cash Price	$1,394.43
Rate for Payer: Cofinity Commercial	$1,220.13
Rate for Payer: Cofinity Commercial	$1,499.01
Rate for Payer: Healthscope Commercial	$1,568.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,481.58
Rate for Payer: PHP Commercial	$1,481.58
Rate for Payer: Priority Health Cigna Priority Health	$1,220.13
Rate for Payer: Priority Health SBD	$1,098.12

HC FLEX SHEATH INTRO

Facility

$249.93

Service Code	HCPCS C1894
Hospital Charge Code	27200041
Hospital Revenue Code	272
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$224.94
Rate for Payer: Aetna Commercial	$212.44
Rate for Payer: Aetna New Business (MI Preferred)	$162.45
Rate for Payer: Cash Price	$199.94
Rate for Payer: Cofinity Commercial	$174.95
Rate for Payer: Cofinity Commercial	$214.94
Rate for Payer: Healthscope Commercial	$224.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.44
Rate for Payer: PHP Commercial	$212.44
Rate for Payer: Priority Health Cigna Priority Health	$174.95
Rate for Payer: Priority Health SBD	$157.46

Know your out-of-pocket cost for care.

All Charges