Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC GASTROGRAFIN PER ML

Facility

$3.41

Service Code	HCPCS Q9963
Hospital Charge Code	63600010
Hospital Revenue Code	636
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$3.07
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna New Business (MI Preferred)	$2.22
Rate for Payer: Cash Price	$2.73
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Cofinity Commercial	$2.93
Rate for Payer: Healthscope Commercial	$3.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.90
Rate for Payer: PHP Commercial	$2.90
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.15

HC GASTROSCOPY

Facility

$1,923.68

Hospital Charge Code	36000047
Hospital Revenue Code	360
Min. Negotiated Rate	$1,211.92
Max. Negotiated Rate	$1,731.31
Rate for Payer: Aetna Commercial	$1,635.13
Rate for Payer: Aetna New Business (MI Preferred)	$1,250.39
Rate for Payer: Cash Price	$1,538.94
Rate for Payer: Cofinity Commercial	$1,346.58
Rate for Payer: Cofinity Commercial	$1,654.36
Rate for Payer: Healthscope Commercial	$1,731.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,635.13
Rate for Payer: PHP Commercial	$1,635.13
Rate for Payer: Priority Health Cigna Priority Health	$1,346.58
Rate for Payer: Priority Health SBD	$1,211.92

HC GASTROSCOPY

Facility

$1,923.68

Hospital Charge Code	36000047
Hospital Revenue Code	360
Min. Negotiated Rate	$769.47
Max. Negotiated Rate	$1,731.31
Rate for Payer: Aetna Commercial	$1,635.13
Rate for Payer: Aetna New Business (MI Preferred)	$1,250.39
Rate for Payer: BCBS Complete	$769.47
Rate for Payer: Cash Price	$1,538.94
Rate for Payer: Cofinity Commercial	$1,346.58
Rate for Payer: Cofinity Commercial	$1,654.36
Rate for Payer: Healthscope Commercial	$1,731.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,635.13
Rate for Payer: PHP Commercial	$1,635.13
Rate for Payer: Priority Health Cigna Priority Health	$1,346.58
Rate for Payer: Priority Health SBD	$1,211.92

HC GEN ANES ADDL 15 MIN

Facility

$146.98

Hospital Charge Code	37000001
Hospital Revenue Code	370
Min. Negotiated Rate	$58.79
Max. Negotiated Rate	$132.28
Rate for Payer: Aetna Commercial	$124.93
Rate for Payer: Aetna New Business (MI Preferred)	$95.54
Rate for Payer: BCBS Complete	$58.79
Rate for Payer: Cash Price	$117.58
Rate for Payer: Cofinity Commercial	$102.89
Rate for Payer: Cofinity Commercial	$126.40
Rate for Payer: Healthscope Commercial	$132.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$124.93
Rate for Payer: PHP Commercial	$124.93
Rate for Payer: Priority Health Cigna Priority Health	$102.89
Rate for Payer: Priority Health SBD	$92.60

HC GEN ANES ADDL 15 MIN

Facility

$146.98

Hospital Charge Code	37000001
Hospital Revenue Code	370
Min. Negotiated Rate	$92.60
Max. Negotiated Rate	$132.28
Rate for Payer: Aetna Commercial	$124.93
Rate for Payer: Aetna New Business (MI Preferred)	$95.54
Rate for Payer: Cash Price	$117.58
Rate for Payer: Cofinity Commercial	$102.89
Rate for Payer: Cofinity Commercial	$126.40
Rate for Payer: Healthscope Commercial	$132.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$124.93
Rate for Payer: PHP Commercial	$124.93
Rate for Payer: Priority Health Cigna Priority Health	$102.89
Rate for Payer: Priority Health SBD	$92.60

HC GEN ANES INIT 30 MIN

Facility

$578.16

Hospital Charge Code	37000002
Hospital Revenue Code	370
Min. Negotiated Rate	$231.26
Max. Negotiated Rate	$520.34
Rate for Payer: Aetna Commercial	$491.44
Rate for Payer: Aetna New Business (MI Preferred)	$375.80
Rate for Payer: BCBS Complete	$231.26
Rate for Payer: Cash Price	$462.53
Rate for Payer: Cofinity Commercial	$404.71
Rate for Payer: Cofinity Commercial	$497.22
Rate for Payer: Healthscope Commercial	$520.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$491.44
Rate for Payer: PHP Commercial	$491.44
Rate for Payer: Priority Health Cigna Priority Health	$404.71
Rate for Payer: Priority Health SBD	$364.24

HC GEN ANES INIT 30 MIN

Facility

$578.16

Hospital Charge Code	37000002
Hospital Revenue Code	370
Min. Negotiated Rate	$364.24
Max. Negotiated Rate	$520.34
Rate for Payer: Aetna Commercial	$491.44
Rate for Payer: Aetna New Business (MI Preferred)	$375.80
Rate for Payer: Cash Price	$462.53
Rate for Payer: Cofinity Commercial	$404.71
Rate for Payer: Cofinity Commercial	$497.22
Rate for Payer: Healthscope Commercial	$520.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$491.44
Rate for Payer: PHP Commercial	$491.44
Rate for Payer: Priority Health Cigna Priority Health	$404.71
Rate for Payer: Priority Health SBD	$364.24

HC GENERAL HEALTH PANEL

Facility

$226.20

Service Code	CPT 80050
Hospital Charge Code	30100011
Hospital Revenue Code	301
Min. Negotiated Rate	$142.51
Max. Negotiated Rate	$203.58
Rate for Payer: Aetna Commercial	$192.27
Rate for Payer: Aetna New Business (MI Preferred)	$147.03
Rate for Payer: Cash Price	$180.96
Rate for Payer: Cofinity Commercial	$158.34
Rate for Payer: Cofinity Commercial	$194.53
Rate for Payer: Healthscope Commercial	$203.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.27
Rate for Payer: PHP Commercial	$192.27
Rate for Payer: Priority Health Cigna Priority Health	$158.34
Rate for Payer: Priority Health SBD	$142.51

HC GENERAL HEALTH PANEL

Facility

$226.20

Service Code	CPT 80050
Hospital Charge Code	30100011
Hospital Revenue Code	301
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$203.58
Rate for Payer: Aetna Commercial	$192.27
Rate for Payer: Aetna New Business (MI Preferred)	$147.03
Rate for Payer: BCBS Complete	$90.48
Rate for Payer: BCBS Trust/PPO	$37.35
Rate for Payer: Cash Price	$180.96
Rate for Payer: Cash Price	$180.96
Rate for Payer: Cofinity Commercial	$194.53
Rate for Payer: Cofinity Commercial	$158.34
Rate for Payer: Healthscope Commercial	$203.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.27
Rate for Payer: PHP Commercial	$192.27
Rate for Payer: Priority Health Cigna Priority Health	$158.34
Rate for Payer: Priority Health SBD	$142.51
Rate for Payer: UHC Core	$47.38

HC GENTAMICIN LEVEL

Facility

$120.60

Service Code	CPT 80170
Hospital Charge Code	30100030
Hospital Revenue Code	301
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$108.54
Rate for Payer: Aetna Commercial	$102.51
Rate for Payer: Aetna Medicare	$17.04
Rate for Payer: Aetna New Business (MI Preferred)	$78.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$20.48
Rate for Payer: Amish Plain Church Group Commercial	$20.48
Rate for Payer: BCBS Complete	$9.41
Rate for Payer: BCBS MAPPO	$16.38
Rate for Payer: BCBS Trust/PPO	$12.83
Rate for Payer: BCN Medicare Advantage	$16.38
Rate for Payer: Cash Price	$96.48
Rate for Payer: Cash Price	$96.48
Rate for Payer: Cofinity Commercial	$84.42
Rate for Payer: Cofinity Commercial	$103.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$16.38
Rate for Payer: Healthscope Commercial	$108.54
Rate for Payer: Mclaren Medicaid	$8.96
Rate for Payer: Mclaren Medicare	$16.38
Rate for Payer: Meridian Medicaid	$9.41
Rate for Payer: Meridian Wellcare - Medicare Advantage	$17.20
Rate for Payer: MI Amish Medical Board Commercial	$18.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.51
Rate for Payer: PACE Medicare	$15.56
Rate for Payer: PACE SWMI	$16.38
Rate for Payer: PHP Commercial	$102.51
Rate for Payer: PHP Medicare Advantage	$16.38
Rate for Payer: Priority Health Choice Medicaid	$8.96
Rate for Payer: Priority Health Cigna Priority Health	$84.42
Rate for Payer: Priority Health Medicare	$16.38
Rate for Payer: Priority Health SBD	$75.98
Rate for Payer: Railroad Medicare Medicare	$16.38
Rate for Payer: UHC All Payor (Choice/PPO)	$19.66
Rate for Payer: UHC Core	$27.85
Rate for Payer: UHC Dual Complete DSNP	$16.38
Rate for Payer: UHC Exchange	$16.38
Rate for Payer: UHC Medicare Advantage	$16.87
Rate for Payer: VA VA	$16.38

HC GENTAMICIN LEVEL

Facility

$120.60

Service Code	CPT 80170
Hospital Charge Code	30100030
Hospital Revenue Code	301
Min. Negotiated Rate	$75.98
Max. Negotiated Rate	$108.54
Rate for Payer: Aetna Commercial	$102.51
Rate for Payer: Aetna New Business (MI Preferred)	$78.39
Rate for Payer: Cash Price	$96.48
Rate for Payer: Cofinity Commercial	$103.72
Rate for Payer: Cofinity Commercial	$84.42
Rate for Payer: Healthscope Commercial	$108.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.51
Rate for Payer: PHP Commercial	$102.51
Rate for Payer: Priority Health Cigna Priority Health	$84.42
Rate for Payer: Priority Health SBD	$75.98

HC GGTP

Facility

$68.00

Service Code	CPT 82977
Hospital Charge Code	30100229
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna Medicare	$7.49
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$9.00
Rate for Payer: Amish Plain Church Group Commercial	$9.00
Rate for Payer: BCBS Complete	$4.14
Rate for Payer: BCBS MAPPO	$7.20
Rate for Payer: BCN Medicare Advantage	$7.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$7.20
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Mclaren Medicaid	$3.94
Rate for Payer: Mclaren Medicare	$7.20
Rate for Payer: Meridian Medicaid	$4.14
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7.56
Rate for Payer: MI Amish Medical Board Commercial	$8.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.80
Rate for Payer: PACE Medicare	$6.84
Rate for Payer: PACE SWMI	$7.20
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: PHP Medicare Advantage	$7.20
Rate for Payer: Priority Health Choice Medicaid	$3.94
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: Priority Health Medicare	$7.20
Rate for Payer: Priority Health SBD	$42.84
Rate for Payer: Railroad Medicare Medicare	$7.20
Rate for Payer: UHC All Payor (Choice/PPO)	$8.64
Rate for Payer: UHC Core	$12.24
Rate for Payer: UHC Dual Complete DSNP	$7.20
Rate for Payer: UHC Exchange	$7.20
Rate for Payer: UHC Medicare Advantage	$7.42
Rate for Payer: VA VA	$7.20

HC GGTP

Facility

$68.00

Service Code	CPT 82977
Hospital Charge Code	30100229
Hospital Revenue Code	301
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: Priority Health SBD	$42.84

HC GIARDIA SCREEN

Facility

$44.88

Service Code	CPT 87329
Hospital Charge Code	30600119
Hospital Revenue Code	306
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$40.39
Rate for Payer: Aetna Commercial	$38.15
Rate for Payer: Aetna Medicare	$12.46
Rate for Payer: Aetna New Business (MI Preferred)	$29.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$14.98
Rate for Payer: Amish Plain Church Group Commercial	$14.98
Rate for Payer: BCBS Complete	$6.88
Rate for Payer: BCBS MAPPO	$11.98
Rate for Payer: BCBS Trust/PPO	$9.39
Rate for Payer: BCN Medicare Advantage	$11.98
Rate for Payer: Cash Price	$35.90
Rate for Payer: Cash Price	$35.90
Rate for Payer: Cofinity Commercial	$38.60
Rate for Payer: Cofinity Commercial	$31.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.98
Rate for Payer: Healthscope Commercial	$40.39
Rate for Payer: Mclaren Medicaid	$6.55
Rate for Payer: Mclaren Medicare	$11.98
Rate for Payer: Meridian Medicaid	$6.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.58
Rate for Payer: MI Amish Medical Board Commercial	$13.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.15
Rate for Payer: PACE Medicare	$11.38
Rate for Payer: PACE SWMI	$11.98
Rate for Payer: PHP Commercial	$38.15
Rate for Payer: PHP Medicare Advantage	$11.98
Rate for Payer: Priority Health Choice Medicaid	$6.55
Rate for Payer: Priority Health Cigna Priority Health	$31.42
Rate for Payer: Priority Health Medicare	$11.98
Rate for Payer: Priority Health SBD	$28.27
Rate for Payer: Railroad Medicare Medicare	$11.98
Rate for Payer: UHC All Payor (Choice/PPO)	$14.38
Rate for Payer: UHC Core	$20.39
Rate for Payer: UHC Dual Complete DSNP	$11.98
Rate for Payer: UHC Exchange	$11.98
Rate for Payer: UHC Medicare Advantage	$12.34
Rate for Payer: VA VA	$11.98

HC GIARDIA SCREEN

Facility

$44.88

Service Code	CPT 87329
Hospital Charge Code	30600119
Hospital Revenue Code	306
Min. Negotiated Rate	$28.27
Max. Negotiated Rate	$40.39
Rate for Payer: Aetna Commercial	$38.15
Rate for Payer: Aetna New Business (MI Preferred)	$29.17
Rate for Payer: Cash Price	$35.90
Rate for Payer: Cofinity Commercial	$31.42
Rate for Payer: Cofinity Commercial	$38.60
Rate for Payer: Healthscope Commercial	$40.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.15
Rate for Payer: PHP Commercial	$38.15
Rate for Payer: Priority Health Cigna Priority Health	$31.42
Rate for Payer: Priority Health SBD	$28.27

HC GI CONVERT G TO GJ TUBE W

Facility

$1,761.21

Service Code	CPT 49446
Hospital Charge Code	36100228
Hospital Revenue Code	361
Min. Negotiated Rate	$139.49
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$1,497.03
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,144.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,116.40
Rate for Payer: Amish Plain Church Group Commercial	$2,116.40
Rate for Payer: BCBS Complete	$972.53
Rate for Payer: BCBS MAPPO	$1,693.12
Rate for Payer: BCBS Trust/PPO	$1,260.58
Rate for Payer: BCN Medicare Advantage	$1,693.12
Rate for Payer: Cash Price	$1,408.97
Rate for Payer: Cash Price	$1,408.97
Rate for Payer: Cofinity Commercial	$1,514.64
Rate for Payer: Cofinity Commercial	$1,232.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$1,585.09
Rate for Payer: Mclaren Medicaid	$926.14
Rate for Payer: Mclaren Medicare	$1,693.12
Rate for Payer: Meridian Medicaid	$972.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,777.78
Rate for Payer: MI Amish Medical Board Commercial	$1,947.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,497.03
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$1,497.03
Rate for Payer: PHP Medicare Advantage	$1,693.12
Rate for Payer: Priority Health Choice Medicaid	$926.14
Rate for Payer: Priority Health Cigna Priority Health	$1,232.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,222.22
Rate for Payer: Priority Health Medicare	$1,693.12
Rate for Payer: Priority Health Narrow Network	$4,177.77
Rate for Payer: Priority Health SBD	$1,109.56
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$153.44
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$139.49
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

HC GI CONVERT G TO GJ TUBE W

Facility

$1,761.21

Service Code	CPT 49446
Hospital Charge Code	36100228
Hospital Revenue Code	361
Min. Negotiated Rate	$1,109.56
Max. Negotiated Rate	$1,585.09
Rate for Payer: Aetna Commercial	$1,497.03
Rate for Payer: Aetna New Business (MI Preferred)	$1,144.79
Rate for Payer: Cash Price	$1,408.97
Rate for Payer: Cofinity Commercial	$1,232.85
Rate for Payer: Cofinity Commercial	$1,514.64
Rate for Payer: Healthscope Commercial	$1,585.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,497.03
Rate for Payer: PHP Commercial	$1,497.03
Rate for Payer: Priority Health Cigna Priority Health	$1,232.85
Rate for Payer: Priority Health SBD	$1,109.56

HC GI FOREIGN BODY REMOVAL

Facility

$1,775.59

Hospital Charge Code	36000049
Hospital Revenue Code	360
Min. Negotiated Rate	$1,118.62
Max. Negotiated Rate	$1,598.03
Rate for Payer: Aetna Commercial	$1,509.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,154.13
Rate for Payer: Cash Price	$1,420.47
Rate for Payer: Cofinity Commercial	$1,242.91
Rate for Payer: Cofinity Commercial	$1,527.01
Rate for Payer: Healthscope Commercial	$1,598.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,509.25
Rate for Payer: PHP Commercial	$1,509.25
Rate for Payer: Priority Health Cigna Priority Health	$1,242.91
Rate for Payer: Priority Health SBD	$1,118.62

HC GI FOREIGN BODY REMOVAL

Facility

$1,775.59

Hospital Charge Code	36000049
Hospital Revenue Code	360
Min. Negotiated Rate	$710.24
Max. Negotiated Rate	$1,598.03
Rate for Payer: Aetna Commercial	$1,509.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,154.13
Rate for Payer: BCBS Complete	$710.24
Rate for Payer: Cash Price	$1,420.47
Rate for Payer: Cofinity Commercial	$1,242.91
Rate for Payer: Cofinity Commercial	$1,527.01
Rate for Payer: Healthscope Commercial	$1,598.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,509.25
Rate for Payer: PHP Commercial	$1,509.25
Rate for Payer: Priority Health Cigna Priority Health	$1,242.91
Rate for Payer: Priority Health SBD	$1,118.62

HC GI GASTRIC TUBE REPOSITION

Facility

$1,243.08

Service Code	CPT 43761
Hospital Charge Code	36100192
Hospital Revenue Code	361
Min. Negotiated Rate	$101.18
Max. Negotiated Rate	$1,118.77
Rate for Payer: Aetna Commercial	$1,056.62
Rate for Payer: Aetna Medicare	$228.71
Rate for Payer: Aetna New Business (MI Preferred)	$808.00
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	$298.32
Rate for Payer: BCN Medicare Advantage	$219.91
Rate for Payer: Cash Price	$994.46
Rate for Payer: Cash Price	$994.46
Rate for Payer: Cofinity Commercial	$870.16
Rate for Payer: Cofinity Commercial	$1,069.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$219.91
Rate for Payer: Healthscope Commercial	$1,118.77
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	$1,056.62
Rate for Payer: PACE Medicare	$208.91
Rate for Payer: PACE SWMI	$219.91
Rate for Payer: PHP Commercial	$1,056.62
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	$870.16
Rate for Payer: Priority Health Medicare	$219.91
Rate for Payer: Priority Health SBD	$783.14
Rate for Payer: Railroad Medicare Medicare	$219.91
Rate for Payer: UHC All Payor (Choice/PPO)	$111.30
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$219.91
Rate for Payer: UHC Exchange	$101.18
Rate for Payer: UHC Medicare Advantage	$226.51
Rate for Payer: VA VA	$219.91

HC GI GASTRIC TUBE REPOSITION

Facility

$1,243.08

Service Code	CPT 43761
Hospital Charge Code	36100192
Hospital Revenue Code	361
Min. Negotiated Rate	$783.14
Max. Negotiated Rate	$1,118.77
Rate for Payer: Aetna Commercial	$1,056.62
Rate for Payer: Aetna New Business (MI Preferred)	$808.00
Rate for Payer: Cash Price	$994.46
Rate for Payer: Cofinity Commercial	$1,069.05
Rate for Payer: Cofinity Commercial	$870.16
Rate for Payer: Healthscope Commercial	$1,118.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,056.62
Rate for Payer: PHP Commercial	$1,056.62
Rate for Payer: Priority Health Cigna Priority Health	$870.16
Rate for Payer: Priority Health SBD	$783.14

HC GI INTRALUMINAL IMAGING ESOPHAGUS

Facility

$1,202.46

Service Code	CPT 91111
Hospital Charge Code	75000009
Hospital Revenue Code	750
Min. Negotiated Rate	$757.55
Max. Negotiated Rate	$1,082.21
Rate for Payer: Aetna Commercial	$1,022.09
Rate for Payer: Aetna New Business (MI Preferred)	$781.60
Rate for Payer: Cash Price	$961.97
Rate for Payer: Cofinity Commercial	$1,034.12
Rate for Payer: Cofinity Commercial	$841.72
Rate for Payer: Healthscope Commercial	$1,082.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,022.09
Rate for Payer: PHP Commercial	$1,022.09
Rate for Payer: Priority Health Cigna Priority Health	$841.72
Rate for Payer: Priority Health SBD	$757.55

HC GI INTRALUMINAL IMAGING ESOPHAGUS

Facility

$1,202.46

Service Code	CPT 91111
Hospital Charge Code	75000009
Hospital Revenue Code	750
Min. Negotiated Rate	$441.20
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Commercial	$1,022.09
Rate for Payer: Aetna Medicare	$838.84
Rate for Payer: Aetna New Business (MI Preferred)	$781.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,008.22
Rate for Payer: Amish Plain Church Group Commercial	$1,008.22
Rate for Payer: BCBS Complete	$463.30
Rate for Payer: BCBS MAPPO	$806.58
Rate for Payer: BCN Medicare Advantage	$806.58
Rate for Payer: Cash Price	$961.97
Rate for Payer: Cash Price	$961.97
Rate for Payer: Cofinity Commercial	$841.72
Rate for Payer: Cofinity Commercial	$1,034.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$806.58
Rate for Payer: Healthscope Commercial	$1,082.21
Rate for Payer: Mclaren Medicaid	$441.20
Rate for Payer: Mclaren Medicare	$806.58
Rate for Payer: Meridian Medicaid	$463.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$846.91
Rate for Payer: MI Amish Medical Board Commercial	$927.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,022.09
Rate for Payer: PACE Medicare	$766.25
Rate for Payer: PACE SWMI	$806.58
Rate for Payer: PHP Commercial	$1,022.09
Rate for Payer: PHP Medicare Advantage	$806.58
Rate for Payer: Priority Health Choice Medicaid	$441.20
Rate for Payer: Priority Health Cigna Priority Health	$841.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,519.41
Rate for Payer: Priority Health Medicare	$806.58
Rate for Payer: Priority Health Narrow Network	$2,015.53
Rate for Payer: Priority Health SBD	$757.55
Rate for Payer: Railroad Medicare Medicare	$806.58
Rate for Payer: UHC All Payor (Choice/PPO)	$945.13
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$806.58
Rate for Payer: UHC Exchange	$859.21
Rate for Payer: UHC Medicare Advantage	$830.78
Rate for Payer: VA VA	$806.58

HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM

Facility

$1,322.71

Service Code	CPT 91110
Hospital Charge Code	75000008
Hospital Revenue Code	750
Min. Negotiated Rate	$833.31
Max. Negotiated Rate	$1,190.44
Rate for Payer: Aetna Commercial	$1,124.30
Rate for Payer: Aetna New Business (MI Preferred)	$859.76
Rate for Payer: Cash Price	$1,058.17
Rate for Payer: Cofinity Commercial	$1,137.53
Rate for Payer: Cofinity Commercial	$925.90
Rate for Payer: Healthscope Commercial	$1,190.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,124.30
Rate for Payer: PHP Commercial	$1,124.30
Rate for Payer: Priority Health Cigna Priority Health	$925.90
Rate for Payer: Priority Health SBD	$833.31

HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM

Facility

$1,322.71

Service Code	CPT 91110
Hospital Charge Code	75000008
Hospital Revenue Code	750
Min. Negotiated Rate	$441.20
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Commercial	$1,124.30
Rate for Payer: Aetna Medicare	$838.84
Rate for Payer: Aetna New Business (MI Preferred)	$859.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,008.22
Rate for Payer: Amish Plain Church Group Commercial	$1,008.22
Rate for Payer: BCBS Complete	$463.30
Rate for Payer: BCBS MAPPO	$806.58
Rate for Payer: BCBS Trust/PPO	$2,922.79
Rate for Payer: BCN Medicare Advantage	$806.58
Rate for Payer: Cash Price	$1,058.17
Rate for Payer: Cash Price	$1,058.17
Rate for Payer: Cofinity Commercial	$1,137.53
Rate for Payer: Cofinity Commercial	$925.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$806.58
Rate for Payer: Healthscope Commercial	$1,190.44
Rate for Payer: Mclaren Medicaid	$441.20
Rate for Payer: Mclaren Medicare	$806.58
Rate for Payer: Meridian Medicaid	$463.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$846.91
Rate for Payer: MI Amish Medical Board Commercial	$927.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,124.30
Rate for Payer: PACE Medicare	$766.25
Rate for Payer: PACE SWMI	$806.58
Rate for Payer: PHP Commercial	$1,124.30
Rate for Payer: PHP Medicare Advantage	$806.58
Rate for Payer: Priority Health Choice Medicaid	$441.20
Rate for Payer: Priority Health Cigna Priority Health	$925.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,519.41
Rate for Payer: Priority Health Medicare	$806.58
Rate for Payer: Priority Health Narrow Network	$2,015.53
Rate for Payer: Priority Health SBD	$833.31
Rate for Payer: Railroad Medicare Medicare	$806.58
Rate for Payer: UHC All Payor (Choice/PPO)	$788.81
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$806.58
Rate for Payer: UHC Exchange	$717.10
Rate for Payer: UHC Medicare Advantage	$830.78
Rate for Payer: VA VA	$806.58

Know your out-of-pocket cost for care.

All Charges