Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC FOREIGN BODY REMOVAL

Facility

$450.54

Hospital Charge Code	45000042
Hospital Revenue Code	450
Min. Negotiated Rate	$283.84
Max. Negotiated Rate	$405.49
Rate for Payer: Aetna Commercial	$382.96
Rate for Payer: Aetna New Business (MI Preferred)	$292.85
Rate for Payer: Cash Price	$360.43
Rate for Payer: Cofinity Commercial	$315.38
Rate for Payer: Cofinity Commercial	$387.46
Rate for Payer: Healthscope Commercial	$405.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$382.96
Rate for Payer: PHP Commercial	$382.96
Rate for Payer: Priority Health Cigna Priority Health	$315.38
Rate for Payer: Priority Health SBD	$283.84

HC FOREIGN BODY REMOVAL

Facility

$450.54

Hospital Charge Code	45000042
Hospital Revenue Code	450
Min. Negotiated Rate	$180.22
Max. Negotiated Rate	$405.49
Rate for Payer: Aetna Commercial	$382.96
Rate for Payer: Aetna New Business (MI Preferred)	$292.85
Rate for Payer: BCBS Complete	$180.22
Rate for Payer: Cash Price	$360.43
Rate for Payer: Cofinity Commercial	$315.38
Rate for Payer: Cofinity Commercial	$387.46
Rate for Payer: Healthscope Commercial	$405.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$382.96
Rate for Payer: PHP Commercial	$382.96
Rate for Payer: Priority Health Cigna Priority Health	$315.38
Rate for Payer: Priority Health SBD	$283.84

HC FOREIGN BODY REMOVAL

Facility

$276.07

Service Code	CPT 10120
Hospital Charge Code	76100068
Hospital Revenue Code	761
Min. Negotiated Rate	$173.92
Max. Negotiated Rate	$248.46
Rate for Payer: Aetna Commercial	$234.66
Rate for Payer: Aetna New Business (MI Preferred)	$179.45
Rate for Payer: Cash Price	$220.86
Rate for Payer: Cofinity Commercial	$237.42
Rate for Payer: Cofinity Commercial	$193.25
Rate for Payer: Healthscope Commercial	$248.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$234.66
Rate for Payer: PHP Commercial	$234.66
Rate for Payer: Priority Health Cigna Priority Health	$193.25
Rate for Payer: Priority Health SBD	$173.92

HC FOREIGN BODY REMOVAL EAR

Facility

$212.50

Service Code	CPT 69200
Hospital Charge Code	45000060
Hospital Revenue Code	761
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$351.10
Rate for Payer: Aetna Commercial	$180.62
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$138.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$64.99
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$170.00
Rate for Payer: Cash Price	$170.00
Rate for Payer: Cofinity Commercial	$148.75
Rate for Payer: Cofinity Commercial	$182.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$191.25
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$180.62
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$180.62
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health Cigna Priority Health	$148.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Priority Health SBD	$133.88
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$51.15
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$46.50
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC FOREIGN BODY REMOVAL EAR

Facility

$212.50

Service Code	CPT 69200
Hospital Charge Code	45000060
Hospital Revenue Code	761
Min. Negotiated Rate	$133.88
Max. Negotiated Rate	$191.25
Rate for Payer: Aetna Commercial	$180.62
Rate for Payer: Aetna New Business (MI Preferred)	$138.12
Rate for Payer: Cash Price	$170.00
Rate for Payer: Cofinity Commercial	$148.75
Rate for Payer: Cofinity Commercial	$182.75
Rate for Payer: Healthscope Commercial	$191.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$180.62
Rate for Payer: PHP Commercial	$180.62
Rate for Payer: Priority Health Cigna Priority Health	$148.75
Rate for Payer: Priority Health SBD	$133.88

HC FOREIGN BODY REMOVAL MUSCLE OR TENDON SHEATH SIMPLE

Facility

$1,152.99

Service Code	CPT 20520
Hospital Charge Code	76100133
Hospital Revenue Code	761
Min. Negotiated Rate	$726.38
Max. Negotiated Rate	$1,037.69
Rate for Payer: Aetna Commercial	$980.04
Rate for Payer: Aetna New Business (MI Preferred)	$749.44
Rate for Payer: Cash Price	$922.39
Rate for Payer: Cofinity Commercial	$807.09
Rate for Payer: Cofinity Commercial	$991.57
Rate for Payer: Healthscope Commercial	$1,037.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$980.04
Rate for Payer: PHP Commercial	$980.04
Rate for Payer: Priority Health Cigna Priority Health	$807.09
Rate for Payer: Priority Health SBD	$726.38

HC FOREIGN BODY REMOVAL MUSCLE OR TENDON SHEATH SIMPLE

Facility

$1,152.99

Service Code	CPT 20520
Hospital Charge Code	76100133
Hospital Revenue Code	761
Min. Negotiated Rate	$146.37
Max. Negotiated Rate	$1,803.26
Rate for Payer: Aetna Commercial	$980.04
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$749.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$937.37
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$922.39
Rate for Payer: Cash Price	$922.39
Rate for Payer: Cofinity Commercial	$807.09
Rate for Payer: Cofinity Commercial	$991.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$1,037.69
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$980.04
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$980.04
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$807.09
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health SBD	$726.38
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$161.01
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$146.37
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

HC FOREIGN BODY REMOVAL NOSE

Facility

$227.11

Service Code	CPT 30300
Hospital Charge Code	45000059
Hospital Revenue Code	761
Min. Negotiated Rate	$42.07
Max. Negotiated Rate	$351.10
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$147.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$42.07
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$181.69
Rate for Payer: Cash Price	$181.69
Rate for Payer: Cofinity Commercial	$158.98
Rate for Payer: Cofinity Commercial	$195.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$204.40
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.04
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$193.04
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health Cigna Priority Health	$158.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Priority Health SBD	$143.08
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$133.99
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$121.81
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC FOREIGN BODY REMOVAL NOSE

Facility

$227.11

Service Code	CPT 30300
Hospital Charge Code	45000059
Hospital Revenue Code	761
Min. Negotiated Rate	$143.08
Max. Negotiated Rate	$204.40
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna New Business (MI Preferred)	$147.62
Rate for Payer: Cash Price	$181.69
Rate for Payer: Cofinity Commercial	$158.98
Rate for Payer: Cofinity Commercial	$195.31
Rate for Payer: Healthscope Commercial	$204.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.04
Rate for Payer: PHP Commercial	$193.04
Rate for Payer: Priority Health Cigna Priority Health	$158.98
Rate for Payer: Priority Health SBD	$143.08

HC FOREIGN BODY RETRIEV (VASC)

Facility

$3,820.61

Service Code	CPT 37197
Hospital Charge Code	36100375
Hospital Revenue Code	361
Min. Negotiated Rate	$2,406.98
Max. Negotiated Rate	$3,438.55
Rate for Payer: Aetna Commercial	$3,247.52
Rate for Payer: Aetna New Business (MI Preferred)	$2,483.40
Rate for Payer: Cash Price	$3,056.49
Rate for Payer: Cofinity Commercial	$2,674.43
Rate for Payer: Cofinity Commercial	$3,285.72
Rate for Payer: Healthscope Commercial	$3,438.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,247.52
Rate for Payer: PHP Commercial	$3,247.52
Rate for Payer: Priority Health Cigna Priority Health	$2,674.43
Rate for Payer: Priority Health SBD	$2,406.98

HC FOREIGN BODY RETRIEV (VASC)

Facility

$3,820.61

Service Code	CPT 37197
Hospital Charge Code	36100375
Hospital Revenue Code	361
Min. Negotiated Rate	$286.84
Max. Negotiated Rate	$8,913.25
Rate for Payer: Aetna Commercial	$3,247.52
Rate for Payer: Aetna Medicare	$2,949.65
Rate for Payer: Aetna New Business (MI Preferred)	$2,483.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,545.25
Rate for Payer: Amish Plain Church Group Commercial	$3,545.25
Rate for Payer: BCBS Complete	$1,629.11
Rate for Payer: BCBS MAPPO	$2,836.20
Rate for Payer: BCBS Trust/PPO	$1,291.86
Rate for Payer: BCN Medicare Advantage	$2,836.20
Rate for Payer: Cash Price	$3,056.49
Rate for Payer: Cash Price	$3,056.49
Rate for Payer: Cofinity Commercial	$2,674.43
Rate for Payer: Cofinity Commercial	$3,285.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,836.20
Rate for Payer: Healthscope Commercial	$3,438.55
Rate for Payer: Mclaren Medicaid	$1,551.40
Rate for Payer: Mclaren Medicare	$2,836.20
Rate for Payer: Meridian Medicaid	$1,629.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,978.01
Rate for Payer: MI Amish Medical Board Commercial	$3,261.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,247.52
Rate for Payer: PACE Medicare	$2,694.39
Rate for Payer: PACE SWMI	$2,836.20
Rate for Payer: PHP Commercial	$3,247.52
Rate for Payer: PHP Medicare Advantage	$2,836.20
Rate for Payer: Priority Health Choice Medicaid	$1,551.40
Rate for Payer: Priority Health Cigna Priority Health	$2,674.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,913.25
Rate for Payer: Priority Health Medicare	$2,836.20
Rate for Payer: Priority Health Narrow Network	$7,130.60
Rate for Payer: Priority Health SBD	$2,406.98
Rate for Payer: Railroad Medicare Medicare	$2,836.20
Rate for Payer: UHC All Payor (Choice/PPO)	$315.52
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,836.20
Rate for Payer: UHC Exchange	$286.84
Rate for Payer: UHC Medicare Advantage	$2,921.29
Rate for Payer: VA VA	$2,836.20

HC FORESKIN MANIP W LYSIS ADH AND STRETCH

Facility

$359.40

Service Code	CPT 54450
Hospital Charge Code	76100269
Hospital Revenue Code	761
Min. Negotiated Rate	$226.42
Max. Negotiated Rate	$323.46
Rate for Payer: Aetna Commercial	$305.49
Rate for Payer: Aetna New Business (MI Preferred)	$233.61
Rate for Payer: Cash Price	$287.52
Rate for Payer: Cofinity Commercial	$309.08
Rate for Payer: Cofinity Commercial	$251.58
Rate for Payer: Healthscope Commercial	$323.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$305.49
Rate for Payer: PHP Commercial	$305.49
Rate for Payer: Priority Health Cigna Priority Health	$251.58
Rate for Payer: Priority Health SBD	$226.42

HC FORESKIN MANIP W LYSIS ADH AND STRETCH

Facility

$359.40

Service Code	CPT 54450
Hospital Charge Code	76100269
Hospital Revenue Code	761
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$644.30
Rate for Payer: Aetna Commercial	$305.49
Rate for Payer: Aetna Medicare	$228.71
Rate for Payer: Aetna New Business (MI Preferred)	$233.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$274.89
Rate for Payer: Amish Plain Church Group Commercial	$274.89
Rate for Payer: BCBS Complete	$126.32
Rate for Payer: BCBS MAPPO	$219.91
Rate for Payer: BCBS Trust/PPO	$101.33
Rate for Payer: BCN Medicare Advantage	$219.91
Rate for Payer: Cash Price	$287.52
Rate for Payer: Cash Price	$287.52
Rate for Payer: Cofinity Commercial	$309.08
Rate for Payer: Cofinity Commercial	$251.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$219.91
Rate for Payer: Healthscope Commercial	$323.46
Rate for Payer: Mclaren Medicaid	$120.29
Rate for Payer: Mclaren Medicare	$219.91
Rate for Payer: Meridian Medicaid	$126.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$230.91
Rate for Payer: MI Amish Medical Board Commercial	$252.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$305.49
Rate for Payer: PACE Medicare	$208.91
Rate for Payer: PACE SWMI	$219.91
Rate for Payer: PHP Commercial	$305.49
Rate for Payer: PHP Medicare Advantage	$219.91
Rate for Payer: Priority Health Choice Medicaid	$120.29
Rate for Payer: Priority Health Cigna Priority Health	$251.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$644.30
Rate for Payer: Priority Health Medicare	$219.91
Rate for Payer: Priority Health Narrow Network	$515.44
Rate for Payer: Priority Health SBD	$226.42
Rate for Payer: Railroad Medicare Medicare	$219.91
Rate for Payer: UHC All Payor (Choice/PPO)	$60.87
Rate for Payer: UHC Dual Complete DSNP	$219.91
Rate for Payer: UHC Exchange	$55.34
Rate for Payer: UHC Medicare Advantage	$226.51
Rate for Payer: VA VA	$219.91

HC FORMALDEHYDE ALLERGY SCREEN

Facility

$23.66

Service Code	CPT 86003
Hospital Charge Code	30200017
Hospital Revenue Code	302
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$21.29
Rate for Payer: Aetna Commercial	$20.11
Rate for Payer: Aetna New Business (MI Preferred)	$15.38
Rate for Payer: Cash Price	$18.93
Rate for Payer: Cofinity Commercial	$16.56
Rate for Payer: Cofinity Commercial	$20.35
Rate for Payer: Healthscope Commercial	$21.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.11
Rate for Payer: PHP Commercial	$20.11
Rate for Payer: Priority Health Cigna Priority Health	$16.56
Rate for Payer: Priority Health SBD	$14.91

HC FORMALDEHYDE ALLERGY SCREEN

Facility

$23.66

Service Code	CPT 86003
Hospital Charge Code	30200017
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$21.29
Rate for Payer: Aetna Commercial	$20.11
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$15.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$18.93
Rate for Payer: Cash Price	$18.93
Rate for Payer: Cofinity Commercial	$20.35
Rate for Payer: Cofinity Commercial	$16.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$21.29
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.11
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$20.11
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$16.56
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$14.91
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC FORMALDEHYDE ALLERGY SCREEN REF LAB

Facility

$34.68

Service Code	CPT 86003
Hospital Charge Code	30200125
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$31.21
Rate for Payer: Aetna Commercial	$29.48
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$22.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cofinity Commercial	$29.82
Rate for Payer: Cofinity Commercial	$24.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$31.21
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.48
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$29.48
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$24.28
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$21.85
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC FORMALDEHYDE ALLERGY SCREEN REF LAB

Facility

$34.68

Service Code	CPT 86003
Hospital Charge Code	30200125
Hospital Revenue Code	302
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$31.21
Rate for Payer: Aetna Commercial	$29.48
Rate for Payer: Aetna New Business (MI Preferred)	$22.54
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cofinity Commercial	$24.28
Rate for Payer: Cofinity Commercial	$29.82
Rate for Payer: Healthscope Commercial	$31.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.48
Rate for Payer: PHP Commercial	$29.48
Rate for Payer: Priority Health Cigna Priority Health	$24.28
Rate for Payer: Priority Health SBD	$21.85

HC FRACTURE/DISLOCATION TX LEVEL 1

Facility

$690.61

Hospital Charge Code	45000044
Hospital Revenue Code	450
Min. Negotiated Rate	$276.24
Max. Negotiated Rate	$621.55
Rate for Payer: Aetna Commercial	$587.02
Rate for Payer: Aetna New Business (MI Preferred)	$448.90
Rate for Payer: BCBS Complete	$276.24
Rate for Payer: Cash Price	$552.49
Rate for Payer: Cofinity Commercial	$483.43
Rate for Payer: Cofinity Commercial	$593.92
Rate for Payer: Healthscope Commercial	$621.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$587.02
Rate for Payer: PHP Commercial	$587.02
Rate for Payer: Priority Health Cigna Priority Health	$483.43
Rate for Payer: Priority Health SBD	$435.08

HC FRACTURE/DISLOCATION TX LEVEL 1

Facility

$690.61

Hospital Charge Code	45000044
Hospital Revenue Code	450
Min. Negotiated Rate	$435.08
Max. Negotiated Rate	$621.55
Rate for Payer: Aetna Commercial	$587.02
Rate for Payer: Aetna New Business (MI Preferred)	$448.90
Rate for Payer: Cash Price	$552.49
Rate for Payer: Cofinity Commercial	$483.43
Rate for Payer: Cofinity Commercial	$593.92
Rate for Payer: Healthscope Commercial	$621.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$587.02
Rate for Payer: PHP Commercial	$587.02
Rate for Payer: Priority Health Cigna Priority Health	$483.43
Rate for Payer: Priority Health SBD	$435.08

HC FRACTURE/DISLOCATION TX LEVEL II

Facility

$3,041.50

Hospital Charge Code	45000104
Hospital Revenue Code	450
Min. Negotiated Rate	$1,216.60
Max. Negotiated Rate	$2,737.35
Rate for Payer: Aetna Commercial	$2,585.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,976.98
Rate for Payer: BCBS Complete	$1,216.60
Rate for Payer: Cash Price	$2,433.20
Rate for Payer: Cofinity Commercial	$2,129.05
Rate for Payer: Cofinity Commercial	$2,615.69
Rate for Payer: Healthscope Commercial	$2,737.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,585.28
Rate for Payer: PHP Commercial	$2,585.28
Rate for Payer: Priority Health Cigna Priority Health	$2,129.05
Rate for Payer: Priority Health SBD	$1,916.14

HC FRACTURE/DISLOCATION TX LEVEL II

Facility

$3,041.50

Hospital Charge Code	45000104
Hospital Revenue Code	450
Min. Negotiated Rate	$1,916.14
Max. Negotiated Rate	$2,737.35
Rate for Payer: Aetna Commercial	$2,585.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,976.98
Rate for Payer: Cash Price	$2,433.20
Rate for Payer: Cofinity Commercial	$2,129.05
Rate for Payer: Cofinity Commercial	$2,615.69
Rate for Payer: Healthscope Commercial	$2,737.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,585.28
Rate for Payer: PHP Commercial	$2,585.28
Rate for Payer: Priority Health Cigna Priority Health	$2,129.05
Rate for Payer: Priority Health SBD	$1,916.14

HC FRAGILEX ANALYSIS

Facility

$430.00

Service Code	CPT 81243
Hospital Charge Code	31000099
Hospital Revenue Code	310
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$365.50
Rate for Payer: Aetna Medicare	$59.32
Rate for Payer: Aetna New Business (MI Preferred)	$279.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$71.30
Rate for Payer: Amish Plain Church Group Commercial	$71.30
Rate for Payer: BCBS Complete	$32.76
Rate for Payer: BCBS MAPPO	$57.04
Rate for Payer: BCBS Trust/PPO	$44.67
Rate for Payer: BCN Medicare Advantage	$57.04
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cofinity Commercial	$369.80
Rate for Payer: Cofinity Commercial	$301.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$57.04
Rate for Payer: Healthscope Commercial	$387.00
Rate for Payer: Mclaren Medicaid	$31.20
Rate for Payer: Mclaren Medicare	$57.04
Rate for Payer: Meridian Medicaid	$32.76
Rate for Payer: Meridian Wellcare - Medicare Advantage	$59.89
Rate for Payer: MI Amish Medical Board Commercial	$65.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$365.50
Rate for Payer: PACE Medicare	$54.19
Rate for Payer: PACE SWMI	$57.04
Rate for Payer: PHP Commercial	$365.50
Rate for Payer: PHP Medicare Advantage	$57.04
Rate for Payer: Priority Health Choice Medicaid	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$301.00
Rate for Payer: Priority Health Medicare	$57.04
Rate for Payer: Priority Health SBD	$270.90
Rate for Payer: Railroad Medicare Medicare	$57.04
Rate for Payer: UHC All Payor (Choice/PPO)	$68.45
Rate for Payer: UHC Core	$68.45
Rate for Payer: UHC Dual Complete DSNP	$57.04
Rate for Payer: UHC Exchange	$57.04
Rate for Payer: UHC Medicare Advantage	$58.75
Rate for Payer: VA VA	$57.04

HC FRAGILEX ANALYSIS

Facility

$430.00

Service Code	CPT 81243
Hospital Charge Code	31000099
Hospital Revenue Code	310
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$365.50
Rate for Payer: Aetna New Business (MI Preferred)	$279.50
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cofinity Commercial	$301.00
Rate for Payer: Cofinity Commercial	$369.80
Rate for Payer: Healthscope Commercial	$387.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$365.50
Rate for Payer: PHP Commercial	$365.50
Rate for Payer: Priority Health Cigna Priority Health	$301.00
Rate for Payer: Priority Health SBD	$270.90

HC FRAGILE X FOLLOW UP

Facility

$252.00

Service Code	CPT 81244
Hospital Charge Code	30000113
Hospital Revenue Code	300
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Aetna Medicare	$46.69
Rate for Payer: Aetna New Business (MI Preferred)	$163.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$56.11
Rate for Payer: Amish Plain Church Group Commercial	$56.11
Rate for Payer: BCBS Complete	$25.78
Rate for Payer: BCBS MAPPO	$44.89
Rate for Payer: BCBS Trust/PPO	$35.15
Rate for Payer: BCN Medicare Advantage	$44.89
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cofinity Commercial	$216.72
Rate for Payer: Cofinity Commercial	$176.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$44.89
Rate for Payer: Healthscope Commercial	$226.80
Rate for Payer: Mclaren Medicaid	$24.55
Rate for Payer: Mclaren Medicare	$44.89
Rate for Payer: Meridian Medicaid	$25.78
Rate for Payer: Meridian Wellcare - Medicare Advantage	$47.13
Rate for Payer: MI Amish Medical Board Commercial	$51.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$214.20
Rate for Payer: PACE Medicare	$42.65
Rate for Payer: PACE SWMI	$44.89
Rate for Payer: PHP Commercial	$214.20
Rate for Payer: PHP Medicare Advantage	$44.89
Rate for Payer: Priority Health Choice Medicaid	$24.55
Rate for Payer: Priority Health Cigna Priority Health	$176.40
Rate for Payer: Priority Health Medicare	$44.89
Rate for Payer: Priority Health SBD	$158.76
Rate for Payer: Railroad Medicare Medicare	$44.89
Rate for Payer: UHC All Payor (Choice/PPO)	$53.87
Rate for Payer: UHC Core	$53.87
Rate for Payer: UHC Dual Complete DSNP	$44.89
Rate for Payer: UHC Exchange	$44.89
Rate for Payer: UHC Medicare Advantage	$46.24
Rate for Payer: VA VA	$44.89

HC FRAGILE X FOLLOW UP

Facility

$252.00

Service Code	CPT 81244
Hospital Charge Code	30000113
Hospital Revenue Code	300
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Aetna New Business (MI Preferred)	$163.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cofinity Commercial	$176.40
Rate for Payer: Cofinity Commercial	$216.72
Rate for Payer: Healthscope Commercial	$226.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$214.20
Rate for Payer: PHP Commercial	$214.20
Rate for Payer: Priority Health Cigna Priority Health	$176.40
Rate for Payer: Priority Health SBD	$158.76

Know your out-of-pocket cost for care.

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