Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC HAI ESTABLISHED PATIENT LEVEL I

Facility

$148.19

Service Code	CPT 99211
Hospital Charge Code	51000014
Hospital Revenue Code	510
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$133.37
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna New Business (MI Preferred)	$96.32
Rate for Payer: BCBS Complete	$59.28
Rate for Payer: BCBS Trust/PPO	$51.75
Rate for Payer: BCCCP Commercial	$22.00
Rate for Payer: Cash Price	$118.55
Rate for Payer: Cash Price	$118.55
Rate for Payer: Cofinity Commercial	$127.44
Rate for Payer: Cofinity Commercial	$103.73
Rate for Payer: Healthscope Commercial	$133.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$125.96
Rate for Payer: PHP Commercial	$125.96
Rate for Payer: Priority Health Cigna Priority Health	$103.73
Rate for Payer: Priority Health SBD	$93.36
Rate for Payer: UHC All Payor (Choice/PPO)	$9.36
Rate for Payer: UHC Exchange	$8.51

HC HAI ESTABLISHED PATIENT LEVEL I

Facility

$148.19

Service Code	CPT 99211
Hospital Charge Code	51000014
Hospital Revenue Code	510
Min. Negotiated Rate	$93.36
Max. Negotiated Rate	$133.37
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna New Business (MI Preferred)	$96.32
Rate for Payer: Cash Price	$118.55
Rate for Payer: Cofinity Commercial	$103.73
Rate for Payer: Cofinity Commercial	$127.44
Rate for Payer: Healthscope Commercial	$133.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$125.96
Rate for Payer: PHP Commercial	$125.96
Rate for Payer: Priority Health Cigna Priority Health	$103.73
Rate for Payer: Priority Health SBD	$93.36

HC HAI PICC FLUSH

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000060
Hospital Revenue Code	761
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: BCBS Complete	$53.88
Rate for Payer: BCBS Trust/PPO	$51.75
Rate for Payer: BCCCP Commercial	$22.00
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$84.87
Rate for Payer: UHC All Payor (Choice/PPO)	$9.36
Rate for Payer: UHC Exchange	$8.51

HC HAI PICC FLUSH

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000060
Hospital Revenue Code	761
Min. Negotiated Rate	$84.87
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$84.87

HC HAI PORTA CATH ACCESS

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000058
Hospital Revenue Code	761
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: BCBS Complete	$53.88
Rate for Payer: BCBS Trust/PPO	$51.75
Rate for Payer: BCCCP Commercial	$22.00
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$84.87
Rate for Payer: UHC All Payor (Choice/PPO)	$9.36
Rate for Payer: UHC Exchange	$8.51

HC HAI PORTA CATH ACCESS

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000058
Hospital Revenue Code	761
Min. Negotiated Rate	$84.87
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$84.87

HC HALOPERIDOL LEVEL

Facility

$104.00

Service Code	CPT 80173
Hospital Charge Code	30100031
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$88.40
Rate for Payer: Aetna Medicare	$16.41
Rate for Payer: Aetna New Business (MI Preferred)	$67.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$19.72
Rate for Payer: Amish Plain Church Group Commercial	$19.72
Rate for Payer: BCBS Complete	$9.06
Rate for Payer: BCBS MAPPO	$15.78
Rate for Payer: BCBS Trust/PPO	$12.36
Rate for Payer: BCN Medicare Advantage	$15.78
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cofinity Commercial	$89.44
Rate for Payer: Cofinity Commercial	$72.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.78
Rate for Payer: Healthscope Commercial	$93.60
Rate for Payer: Mclaren Medicaid	$8.63
Rate for Payer: Mclaren Medicare	$15.78
Rate for Payer: Meridian Medicaid	$9.06
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16.57
Rate for Payer: MI Amish Medical Board Commercial	$18.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.40
Rate for Payer: PACE Medicare	$14.99
Rate for Payer: PACE SWMI	$15.78
Rate for Payer: PHP Commercial	$88.40
Rate for Payer: PHP Medicare Advantage	$15.78
Rate for Payer: Priority Health Choice Medicaid	$8.63
Rate for Payer: Priority Health Cigna Priority Health	$72.80
Rate for Payer: Priority Health Medicare	$15.78
Rate for Payer: Priority Health SBD	$65.52
Rate for Payer: Railroad Medicare Medicare	$15.78
Rate for Payer: UHC All Payor (Choice/PPO)	$18.94
Rate for Payer: UHC Core	$24.74
Rate for Payer: UHC Dual Complete DSNP	$15.78
Rate for Payer: UHC Exchange	$15.78
Rate for Payer: UHC Medicare Advantage	$16.25
Rate for Payer: VA VA	$15.78

HC HALOPERIDOL LEVEL

Facility

$104.00

Service Code	CPT 80173
Hospital Charge Code	30100031
Hospital Revenue Code	301
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$88.40
Rate for Payer: Aetna New Business (MI Preferred)	$67.60
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cofinity Commercial	$72.80
Rate for Payer: Cofinity Commercial	$89.44
Rate for Payer: Healthscope Commercial	$93.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.40
Rate for Payer: PHP Commercial	$88.40
Rate for Payer: Priority Health Cigna Priority Health	$72.80
Rate for Payer: Priority Health SBD	$65.52

HC HALO RING APPLICATION

Facility

$2,460.76

Hospital Charge Code	27000085
Hospital Revenue Code	270
Min. Negotiated Rate	$1,550.28
Max. Negotiated Rate	$2,214.68
Rate for Payer: Aetna Commercial	$2,091.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,599.49
Rate for Payer: Cash Price	$1,968.61
Rate for Payer: Cofinity Commercial	$1,722.53
Rate for Payer: Cofinity Commercial	$2,116.25
Rate for Payer: Healthscope Commercial	$2,214.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,091.65
Rate for Payer: PHP Commercial	$2,091.65
Rate for Payer: Priority Health Cigna Priority Health	$1,722.53
Rate for Payer: Priority Health SBD	$1,550.28

HC HALO RING APPLICATION

Facility

$2,460.76

Hospital Charge Code	27000085
Hospital Revenue Code	270
Min. Negotiated Rate	$984.30
Max. Negotiated Rate	$2,214.68
Rate for Payer: Aetna Commercial	$2,091.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,599.49
Rate for Payer: BCBS Complete	$984.30
Rate for Payer: Cash Price	$1,968.61
Rate for Payer: Cofinity Commercial	$1,722.53
Rate for Payer: Cofinity Commercial	$2,116.25
Rate for Payer: Healthscope Commercial	$2,214.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,091.65
Rate for Payer: PHP Commercial	$2,091.65
Rate for Payer: Priority Health Cigna Priority Health	$1,722.53
Rate for Payer: Priority Health SBD	$1,550.28

HC HALO RING & VEST

Facility

$6,162.09

Hospital Charge Code	27000084
Hospital Revenue Code	270
Min. Negotiated Rate	$2,464.84
Max. Negotiated Rate	$5,545.88
Rate for Payer: Aetna Commercial	$5,237.78
Rate for Payer: Aetna New Business (MI Preferred)	$4,005.36
Rate for Payer: BCBS Complete	$2,464.84
Rate for Payer: Cash Price	$4,929.67
Rate for Payer: Cofinity Commercial	$4,313.46
Rate for Payer: Cofinity Commercial	$5,299.40
Rate for Payer: Healthscope Commercial	$5,545.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,237.78
Rate for Payer: PHP Commercial	$5,237.78
Rate for Payer: Priority Health Cigna Priority Health	$4,313.46
Rate for Payer: Priority Health SBD	$3,882.12

HC HALO RING & VEST

Facility

$6,162.09

Hospital Charge Code	27000084
Hospital Revenue Code	270
Min. Negotiated Rate	$3,882.12
Max. Negotiated Rate	$5,545.88
Rate for Payer: Aetna Commercial	$5,237.78
Rate for Payer: Aetna New Business (MI Preferred)	$4,005.36
Rate for Payer: Cash Price	$4,929.67
Rate for Payer: Cofinity Commercial	$4,313.46
Rate for Payer: Cofinity Commercial	$5,299.40
Rate for Payer: Healthscope Commercial	$5,545.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,237.78
Rate for Payer: PHP Commercial	$5,237.78
Rate for Payer: Priority Health Cigna Priority Health	$4,313.46
Rate for Payer: Priority Health SBD	$3,882.12

HC HALO VEST APPLICATION

Facility

$5,653.12

Hospital Charge Code	27000086
Hospital Revenue Code	270
Min. Negotiated Rate	$2,261.25
Max. Negotiated Rate	$5,087.81
Rate for Payer: Aetna Commercial	$4,805.15
Rate for Payer: Aetna New Business (MI Preferred)	$3,674.53
Rate for Payer: BCBS Complete	$2,261.25
Rate for Payer: Cash Price	$4,522.50
Rate for Payer: Cofinity Commercial	$3,957.18
Rate for Payer: Cofinity Commercial	$4,861.68
Rate for Payer: Healthscope Commercial	$5,087.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,805.15
Rate for Payer: PHP Commercial	$4,805.15
Rate for Payer: Priority Health Cigna Priority Health	$3,957.18
Rate for Payer: Priority Health SBD	$3,561.47

HC HALO VEST APPLICATION

Facility

$5,653.12

Hospital Charge Code	27000086
Hospital Revenue Code	270
Min. Negotiated Rate	$3,561.47
Max. Negotiated Rate	$5,087.81
Rate for Payer: Aetna Commercial	$4,805.15
Rate for Payer: Aetna New Business (MI Preferred)	$3,674.53
Rate for Payer: Cash Price	$4,522.50
Rate for Payer: Cofinity Commercial	$4,861.68
Rate for Payer: Cofinity Commercial	$3,957.18
Rate for Payer: Healthscope Commercial	$5,087.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,805.15
Rate for Payer: PHP Commercial	$4,805.15
Rate for Payer: Priority Health Cigna Priority Health	$3,957.18
Rate for Payer: Priority Health SBD	$3,561.47

HC HAPTOGLOGIN

Facility

$83.00

Service Code	CPT 83010
Hospital Charge Code	30100234
Hospital Revenue Code	301
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$70.55
Rate for Payer: Aetna Medicare	$13.08
Rate for Payer: Aetna New Business (MI Preferred)	$53.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.72
Rate for Payer: Amish Plain Church Group Commercial	$15.72
Rate for Payer: BCBS Complete	$7.23
Rate for Payer: BCBS MAPPO	$12.58
Rate for Payer: BCBS Trust/PPO	$9.86
Rate for Payer: BCN Medicare Advantage	$12.58
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$71.38
Rate for Payer: Cofinity Commercial	$58.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.58
Rate for Payer: Healthscope Commercial	$74.70
Rate for Payer: Mclaren Medicaid	$6.88
Rate for Payer: Mclaren Medicare	$12.58
Rate for Payer: Meridian Medicaid	$7.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13.21
Rate for Payer: MI Amish Medical Board Commercial	$14.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.55
Rate for Payer: PACE Medicare	$11.95
Rate for Payer: PACE SWMI	$12.58
Rate for Payer: PHP Commercial	$70.55
Rate for Payer: PHP Medicare Advantage	$12.58
Rate for Payer: Priority Health Choice Medicaid	$6.88
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health SBD	$52.29
Rate for Payer: Railroad Medicare Medicare	$12.58
Rate for Payer: UHC All Payor (Choice/PPO)	$15.10
Rate for Payer: UHC Core	$21.38
Rate for Payer: UHC Dual Complete DSNP	$12.58
Rate for Payer: UHC Exchange	$12.58
Rate for Payer: UHC Medicare Advantage	$12.96
Rate for Payer: VA VA	$12.58

HC HAPTOGLOGIN

Facility

$83.00

Service Code	CPT 83010
Hospital Charge Code	30100234
Hospital Revenue Code	301
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$70.55
Rate for Payer: Aetna New Business (MI Preferred)	$53.95
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$58.10
Rate for Payer: Cofinity Commercial	$71.38
Rate for Payer: Healthscope Commercial	$74.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.55
Rate for Payer: PHP Commercial	$70.55
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: Priority Health SBD	$52.29

HC HAZELNUT FILBERT IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200043
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health SBD	$15.68

HC HAZELNUT FILBERT IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200043
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
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	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.40
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	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.16
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	$17.42
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$15.68
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 HBO PER 30 MINUTES

Facility

$641.40

Service Code	HCPCS G0277
Hospital Charge Code	41300001
Hospital Revenue Code	413
Min. Negotiated Rate	$404.08
Max. Negotiated Rate	$577.26
Rate for Payer: Aetna Commercial	$545.19
Rate for Payer: Aetna New Business (MI Preferred)	$416.91
Rate for Payer: Cash Price	$513.12
Rate for Payer: Cofinity Commercial	$448.98
Rate for Payer: Cofinity Commercial	$551.60
Rate for Payer: Healthscope Commercial	$577.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$545.19
Rate for Payer: PHP Commercial	$545.19
Rate for Payer: Priority Health Cigna Priority Health	$448.98
Rate for Payer: Priority Health SBD	$404.08

HC HBO PER 30 MINUTES

Facility

$641.40

Service Code	HCPCS G0277
Hospital Charge Code	41300001
Hospital Revenue Code	413
Min. Negotiated Rate	$67.54
Max. Negotiated Rate	$577.26
Rate for Payer: Aetna Commercial	$545.19
Rate for Payer: Aetna Medicare	$128.41
Rate for Payer: Aetna New Business (MI Preferred)	$416.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$154.34
Rate for Payer: Amish Plain Church Group Commercial	$154.34
Rate for Payer: BCBS Complete	$70.92
Rate for Payer: BCBS MAPPO	$123.47
Rate for Payer: BCBS Trust/PPO	$322.33
Rate for Payer: BCN Medicare Advantage	$123.47
Rate for Payer: Cash Price	$513.12
Rate for Payer: Cash Price	$513.12
Rate for Payer: Cofinity Commercial	$551.60
Rate for Payer: Cofinity Commercial	$448.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$123.47
Rate for Payer: Healthscope Commercial	$577.26
Rate for Payer: Mclaren Medicaid	$67.54
Rate for Payer: Mclaren Medicare	$123.47
Rate for Payer: Meridian Medicaid	$70.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$129.64
Rate for Payer: MI Amish Medical Board Commercial	$141.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$545.19
Rate for Payer: PACE Medicare	$117.30
Rate for Payer: PACE SWMI	$123.47
Rate for Payer: PHP Commercial	$545.19
Rate for Payer: PHP Medicare Advantage	$123.47
Rate for Payer: Priority Health Choice Medicaid	$67.54
Rate for Payer: Priority Health Cigna Priority Health	$448.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$375.01
Rate for Payer: Priority Health Medicare	$123.47
Rate for Payer: Priority Health Narrow Network	$300.01
Rate for Payer: Priority Health SBD	$404.08
Rate for Payer: Railroad Medicare Medicare	$123.47
Rate for Payer: UHC All Payor (Choice/PPO)	$197.02
Rate for Payer: UHC Dual Complete DSNP	$123.47
Rate for Payer: UHC Exchange	$179.11
Rate for Payer: UHC Medicare Advantage	$127.17
Rate for Payer: VA VA	$123.47

HC HBO TCPO2 ARTERIAL STUDY COMPLETE

Facility

$819.04

Service Code	CPT 93923
Hospital Charge Code	92100005
Hospital Revenue Code	921
Min. Negotiated Rate	$516.00
Max. Negotiated Rate	$737.14
Rate for Payer: Aetna Commercial	$696.18
Rate for Payer: Aetna New Business (MI Preferred)	$532.38
Rate for Payer: Cash Price	$655.23
Rate for Payer: Cofinity Commercial	$573.33
Rate for Payer: Cofinity Commercial	$704.37
Rate for Payer: Healthscope Commercial	$737.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.18
Rate for Payer: PHP Commercial	$696.18
Rate for Payer: Priority Health Cigna Priority Health	$573.33
Rate for Payer: Priority Health SBD	$516.00

HC HBO TCPO2 ARTERIAL STUDY COMPLETE

Facility

$819.04

Service Code	CPT 93923
Hospital Charge Code	92100005
Hospital Revenue Code	921
Min. Negotiated Rate	$76.03
Max. Negotiated Rate	$737.14
Rate for Payer: Aetna Commercial	$696.18
Rate for Payer: Aetna Medicare	$144.55
Rate for Payer: Aetna New Business (MI Preferred)	$532.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$173.74
Rate for Payer: Amish Plain Church Group Commercial	$173.74
Rate for Payer: BCBS Complete	$79.84
Rate for Payer: BCBS MAPPO	$138.99
Rate for Payer: BCBS Trust/PPO	$491.24
Rate for Payer: BCN Medicare Advantage	$138.99
Rate for Payer: Cash Price	$655.23
Rate for Payer: Cash Price	$655.23
Rate for Payer: Cofinity Commercial	$573.33
Rate for Payer: Cofinity Commercial	$704.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$138.99
Rate for Payer: Healthscope Commercial	$737.14
Rate for Payer: Mclaren Medicaid	$76.03
Rate for Payer: Mclaren Medicare	$138.99
Rate for Payer: Meridian Medicaid	$79.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$145.94
Rate for Payer: MI Amish Medical Board Commercial	$159.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.18
Rate for Payer: PACE Medicare	$132.04
Rate for Payer: PACE SWMI	$138.99
Rate for Payer: PHP Commercial	$696.18
Rate for Payer: PHP Medicare Advantage	$138.99
Rate for Payer: Priority Health Choice Medicaid	$76.03
Rate for Payer: Priority Health Cigna Priority Health	$573.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$436.07
Rate for Payer: Priority Health Medicare	$138.99
Rate for Payer: Priority Health Narrow Network	$348.85
Rate for Payer: Priority Health SBD	$516.00
Rate for Payer: Railroad Medicare Medicare	$138.99
Rate for Payer: UHC All Payor (Choice/PPO)	$140.83
Rate for Payer: UHC Dual Complete DSNP	$138.99
Rate for Payer: UHC Exchange	$128.03
Rate for Payer: UHC Medicare Advantage	$143.16
Rate for Payer: VA VA	$138.99

HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED

Facility

$525.25

Service Code	CPT 93922
Hospital Charge Code	92100033
Hospital Revenue Code	921
Min. Negotiated Rate	$330.91
Max. Negotiated Rate	$472.72
Rate for Payer: Aetna Commercial	$446.46
Rate for Payer: Aetna New Business (MI Preferred)	$341.41
Rate for Payer: Cash Price	$420.20
Rate for Payer: Cofinity Commercial	$367.68
Rate for Payer: Cofinity Commercial	$451.72
Rate for Payer: Healthscope Commercial	$472.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$446.46
Rate for Payer: PHP Commercial	$446.46
Rate for Payer: Priority Health Cigna Priority Health	$367.68
Rate for Payer: Priority Health SBD	$330.91

HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED

Facility

$525.25

Service Code	CPT 93922
Hospital Charge Code	92100033
Hospital Revenue Code	921
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$472.72
Rate for Payer: Aetna Commercial	$446.46
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$341.41
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	$322.36
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$420.20
Rate for Payer: Cash Price	$420.20
Rate for Payer: Cofinity Commercial	$367.68
Rate for Payer: Cofinity Commercial	$451.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$472.72
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	$446.46
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$446.46
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	$367.68
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	$330.91
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$88.97
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$80.88
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC HCCORO/CABG ANGIOS ONLY

Facility

$6,358.90

Service Code	CPT 93455
Hospital Charge Code	48100014
Hospital Revenue Code	481
Min. Negotiated Rate	$4,006.11
Max. Negotiated Rate	$5,723.01
Rate for Payer: Aetna Commercial	$5,405.06
Rate for Payer: Aetna New Business (MI Preferred)	$4,133.28
Rate for Payer: Cash Price	$5,087.12
Rate for Payer: Cofinity Commercial	$4,451.23
Rate for Payer: Cofinity Commercial	$5,468.65
Rate for Payer: Healthscope Commercial	$5,723.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,405.06
Rate for Payer: PHP Commercial	$5,405.06
Rate for Payer: Priority Health Cigna Priority Health	$4,451.23
Rate for Payer: Priority Health SBD	$4,006.11

Know your out-of-pocket cost for care.

All Charges