Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC CANNULA OSTIAL SPRIT FLEX ANGLE 6 MM

Facility

$302.94

Hospital Charge Code	27000664
Hospital Revenue Code	270
Min. Negotiated Rate	$190.85
Max. Negotiated Rate	$272.65
Rate for Payer: Aetna Commercial	$257.50
Rate for Payer: Aetna New Business (MI Preferred)	$196.91
Rate for Payer: Cash Price	$242.35
Rate for Payer: Cofinity Commercial	$212.06
Rate for Payer: Cofinity Commercial	$260.53
Rate for Payer: Cofinity Medicare Advantage	$212.06
Rate for Payer: Encore Health Key Benefits Commercial	$242.35
Rate for Payer: Healthscope Commercial	$272.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.50
Rate for Payer: PHP Commercial	$257.50
Rate for Payer: Priority Health Cigna Priority Health	$196.91
Rate for Payer: Priority Health SBD	$190.85

HC CANNULA OSTIAL SPRIT FLEX ANGLE 6 MM

Facility

$302.94

Hospital Charge Code	27000664
Hospital Revenue Code	270
Min. Negotiated Rate	$121.18
Max. Negotiated Rate	$272.65
Rate for Payer: Aetna Commercial	$257.50
Rate for Payer: Aetna Medicare	$151.47
Rate for Payer: Aetna New Business (MI Preferred)	$196.91
Rate for Payer: BCBS Complete	$121.18
Rate for Payer: Cash Price	$242.35
Rate for Payer: Cofinity Commercial	$212.06
Rate for Payer: Cofinity Commercial	$260.53
Rate for Payer: Cofinity Medicare Advantage	$212.06
Rate for Payer: Encore Health Key Benefits Commercial	$242.35
Rate for Payer: Healthscope Commercial	$272.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.50
Rate for Payer: PHP Commercial	$257.50
Rate for Payer: Priority Health Cigna Priority Health	$196.91
Rate for Payer: Priority Health SBD	$190.85

HC CANNULA RCSP PVC AUTO 15 FR

Facility

$260.10

Hospital Charge Code	27000683
Hospital Revenue Code	270
Min. Negotiated Rate	$163.86
Max. Negotiated Rate	$234.09
Rate for Payer: Aetna Commercial	$221.09
Rate for Payer: Aetna New Business (MI Preferred)	$169.06
Rate for Payer: Cash Price	$208.08
Rate for Payer: Cofinity Commercial	$182.07
Rate for Payer: Cofinity Commercial	$223.69
Rate for Payer: Cofinity Medicare Advantage	$182.07
Rate for Payer: Encore Health Key Benefits Commercial	$208.08
Rate for Payer: Healthscope Commercial	$234.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.09
Rate for Payer: PHP Commercial	$221.09
Rate for Payer: Priority Health Cigna Priority Health	$169.06
Rate for Payer: Priority Health SBD	$163.86

HC CANNULA RCSP PVC AUTO 15 FR

Facility

$260.10

Hospital Charge Code	27000683
Hospital Revenue Code	270
Min. Negotiated Rate	$104.04
Max. Negotiated Rate	$234.09
Rate for Payer: Aetna Commercial	$221.09
Rate for Payer: Aetna Medicare	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$169.06
Rate for Payer: BCBS Complete	$104.04
Rate for Payer: Cash Price	$208.08
Rate for Payer: Cofinity Commercial	$182.07
Rate for Payer: Cofinity Commercial	$223.69
Rate for Payer: Cofinity Medicare Advantage	$182.07
Rate for Payer: Encore Health Key Benefits Commercial	$208.08
Rate for Payer: Healthscope Commercial	$234.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.09
Rate for Payer: PHP Commercial	$221.09
Rate for Payer: Priority Health Cigna Priority Health	$169.06
Rate for Payer: Priority Health SBD	$163.86

HC CANNULA RETROGRADE

Facility

$208.08

Hospital Charge Code	27000142
Hospital Revenue Code	270
Min. Negotiated Rate	$131.09
Max. Negotiated Rate	$187.27
Rate for Payer: Aetna Commercial	$176.87
Rate for Payer: Aetna New Business (MI Preferred)	$135.25
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$145.66
Rate for Payer: Cofinity Commercial	$178.95
Rate for Payer: Cofinity Medicare Advantage	$145.66
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$187.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.87
Rate for Payer: PHP Commercial	$176.87
Rate for Payer: Priority Health Cigna Priority Health	$135.25
Rate for Payer: Priority Health SBD	$131.09

HC CANNULA RETROGRADE

Facility

$208.08

Hospital Charge Code	27000142
Hospital Revenue Code	270
Min. Negotiated Rate	$83.23
Max. Negotiated Rate	$187.27
Rate for Payer: Aetna Commercial	$176.87
Rate for Payer: Aetna Medicare	$104.04
Rate for Payer: Aetna New Business (MI Preferred)	$135.25
Rate for Payer: BCBS Complete	$83.23
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$145.66
Rate for Payer: Cofinity Commercial	$178.95
Rate for Payer: Cofinity Medicare Advantage	$145.66
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$187.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.87
Rate for Payer: PHP Commercial	$176.87
Rate for Payer: Priority Health Cigna Priority Health	$135.25
Rate for Payer: Priority Health SBD	$131.09

HC CANNULA RETROGRD 15 FR

Facility

$311.01

Hospital Charge Code	27000447
Hospital Revenue Code	270
Min. Negotiated Rate	$124.40
Max. Negotiated Rate	$279.91
Rate for Payer: Aetna Commercial	$264.36
Rate for Payer: Aetna Medicare	$155.50
Rate for Payer: Aetna New Business (MI Preferred)	$202.16
Rate for Payer: BCBS Complete	$124.40
Rate for Payer: Cash Price	$248.81
Rate for Payer: Cofinity Commercial	$217.71
Rate for Payer: Cofinity Commercial	$267.47
Rate for Payer: Cofinity Medicare Advantage	$217.71
Rate for Payer: Encore Health Key Benefits Commercial	$248.81
Rate for Payer: Healthscope Commercial	$279.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.36
Rate for Payer: PHP Commercial	$264.36
Rate for Payer: Priority Health Cigna Priority Health	$202.16
Rate for Payer: Priority Health SBD	$195.94

HC CANNULA RETROGRD 15 FR

Facility

$311.01

Hospital Charge Code	27000447
Hospital Revenue Code	270
Min. Negotiated Rate	$195.94
Max. Negotiated Rate	$279.91
Rate for Payer: Aetna Commercial	$264.36
Rate for Payer: Aetna New Business (MI Preferred)	$202.16
Rate for Payer: Cash Price	$248.81
Rate for Payer: Cofinity Commercial	$217.71
Rate for Payer: Cofinity Commercial	$267.47
Rate for Payer: Cofinity Medicare Advantage	$217.71
Rate for Payer: Encore Health Key Benefits Commercial	$248.81
Rate for Payer: Healthscope Commercial	$279.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.36
Rate for Payer: PHP Commercial	$264.36
Rate for Payer: Priority Health Cigna Priority Health	$202.16
Rate for Payer: Priority Health SBD	$195.94

HC CANNULA VEIN GRAFT

Facility

$35.19

Hospital Charge Code	27000096
Hospital Revenue Code	270
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$31.67
Rate for Payer: Aetna Commercial	$29.91
Rate for Payer: Aetna New Business (MI Preferred)	$22.87
Rate for Payer: Cash Price	$28.15
Rate for Payer: Cofinity Commercial	$24.63
Rate for Payer: Cofinity Commercial	$30.26
Rate for Payer: Cofinity Medicare Advantage	$24.63
Rate for Payer: Encore Health Key Benefits Commercial	$28.15
Rate for Payer: Healthscope Commercial	$31.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.91
Rate for Payer: PHP Commercial	$29.91
Rate for Payer: Priority Health Cigna Priority Health	$22.87
Rate for Payer: Priority Health SBD	$22.17

HC CANNULA VEIN GRAFT

Facility

$35.19

Hospital Charge Code	27000096
Hospital Revenue Code	270
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$31.67
Rate for Payer: Aetna Commercial	$29.91
Rate for Payer: Aetna Medicare	$17.59
Rate for Payer: Aetna New Business (MI Preferred)	$22.87
Rate for Payer: BCBS Complete	$14.08
Rate for Payer: Cash Price	$28.15
Rate for Payer: Cofinity Commercial	$24.63
Rate for Payer: Cofinity Commercial	$30.26
Rate for Payer: Cofinity Medicare Advantage	$24.63
Rate for Payer: Encore Health Key Benefits Commercial	$28.15
Rate for Payer: Healthscope Commercial	$31.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.91
Rate for Payer: PHP Commercial	$29.91
Rate for Payer: Priority Health Cigna Priority Health	$22.87
Rate for Payer: Priority Health SBD	$22.17

HC CANNULA VENOUS RT PVC

Facility

$85.68

Hospital Charge Code	27000681
Hospital Revenue Code	270
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$72.83
Rate for Payer: Aetna Medicare	$42.84
Rate for Payer: Aetna New Business (MI Preferred)	$55.69
Rate for Payer: BCBS Complete	$34.27
Rate for Payer: Cash Price	$68.54
Rate for Payer: Cofinity Commercial	$59.98
Rate for Payer: Cofinity Commercial	$73.68
Rate for Payer: Cofinity Medicare Advantage	$59.98
Rate for Payer: Encore Health Key Benefits Commercial	$68.54
Rate for Payer: Healthscope Commercial	$77.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.83
Rate for Payer: PHP Commercial	$72.83
Rate for Payer: Priority Health Cigna Priority Health	$55.69
Rate for Payer: Priority Health SBD	$53.98

HC CANNULA VENOUS RT PVC

Facility

$85.68

Hospital Charge Code	27000681
Hospital Revenue Code	270
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$72.83
Rate for Payer: Aetna New Business (MI Preferred)	$55.69
Rate for Payer: Cash Price	$68.54
Rate for Payer: Cofinity Commercial	$59.98
Rate for Payer: Cofinity Commercial	$73.68
Rate for Payer: Cofinity Medicare Advantage	$59.98
Rate for Payer: Encore Health Key Benefits Commercial	$68.54
Rate for Payer: Healthscope Commercial	$77.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.83
Rate for Payer: PHP Commercial	$72.83
Rate for Payer: Priority Health Cigna Priority Health	$55.69
Rate for Payer: Priority Health SBD	$53.98

HC CANNULA VEN SINGLE STAGE

Facility

$73.44

Hospital Charge Code	27000263
Hospital Revenue Code	270
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Medicare	$36.72
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: BCBS Complete	$29.38
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cofinity Commercial	$51.41
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Medicare Advantage	$51.41
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health SBD	$46.27

HC CANNULA VEN SINGLE STAGE

Facility

$73.44

Hospital Charge Code	27000263
Hospital Revenue Code	270
Min. Negotiated Rate	$46.27
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cofinity Commercial	$51.41
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Medicare Advantage	$51.41
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health SBD	$46.27

HC CANNULA VEN SNGL STG RT ANG

Facility

$97.92

Hospital Charge Code	27000267
Hospital Revenue Code	270
Min. Negotiated Rate	$61.69
Max. Negotiated Rate	$88.13
Rate for Payer: Aetna Commercial	$83.23
Rate for Payer: Aetna New Business (MI Preferred)	$63.65
Rate for Payer: Cash Price	$78.34
Rate for Payer: Cofinity Commercial	$68.54
Rate for Payer: Cofinity Commercial	$84.21
Rate for Payer: Cofinity Medicare Advantage	$68.54
Rate for Payer: Encore Health Key Benefits Commercial	$78.34
Rate for Payer: Healthscope Commercial	$88.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.23
Rate for Payer: PHP Commercial	$83.23
Rate for Payer: Priority Health Cigna Priority Health	$63.65
Rate for Payer: Priority Health SBD	$61.69

HC CANNULA VEN SNGL STG RT ANG

Facility

$97.92

Hospital Charge Code	27000267
Hospital Revenue Code	270
Min. Negotiated Rate	$39.17
Max. Negotiated Rate	$88.13
Rate for Payer: Aetna Commercial	$83.23
Rate for Payer: Aetna Medicare	$48.96
Rate for Payer: Aetna New Business (MI Preferred)	$63.65
Rate for Payer: BCBS Complete	$39.17
Rate for Payer: Cash Price	$78.34
Rate for Payer: Cofinity Commercial	$68.54
Rate for Payer: Cofinity Commercial	$84.21
Rate for Payer: Cofinity Medicare Advantage	$68.54
Rate for Payer: Encore Health Key Benefits Commercial	$78.34
Rate for Payer: Healthscope Commercial	$88.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.23
Rate for Payer: PHP Commercial	$83.23
Rate for Payer: Priority Health Cigna Priority Health	$63.65
Rate for Payer: Priority Health SBD	$61.69

HC CANNULA VEN TRIPLE STAGE

Facility

$73.44

Hospital Charge Code	27000035
Hospital Revenue Code	270
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Medicare	$36.72
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: BCBS Complete	$29.38
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cofinity Commercial	$51.41
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Medicare Advantage	$51.41
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health SBD	$46.27

HC CANNULA VEN TRIPLE STAGE

Facility

$73.44

Hospital Charge Code	27000035
Hospital Revenue Code	270
Min. Negotiated Rate	$46.27
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cofinity Commercial	$51.41
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Medicare Advantage	$51.41
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health SBD	$46.27

HC CARB 10,11 EPXID

Facility

$44.76

Service Code	CPT 80161
Hospital Charge Code	30100742
Hospital Revenue Code	301
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$52.47
Rate for Payer: Aetna Commercial	$38.05
Rate for Payer: Aetna Medicare	$19.39
Rate for Payer: Aetna New Business (MI Preferred)	$29.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.30
Rate for Payer: Amish Plain Church Group Commercial	$23.30
Rate for Payer: BCBS Complete	$10.49
Rate for Payer: BCBS MAPPO	$18.64
Rate for Payer: BCN Medicare Advantage	$18.64
Rate for Payer: Cash Price	$35.81
Rate for Payer: Cash Price	$35.81
Rate for Payer: Cofinity Commercial	$38.49
Rate for Payer: Cofinity Commercial	$31.33
Rate for Payer: Cofinity Medicare Advantage	$31.33
Rate for Payer: Encore Health Key Benefits Commercial	$35.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.64
Rate for Payer: Healthscope Commercial	$40.28
Rate for Payer: Mclaren Medicaid	$9.99
Rate for Payer: Mclaren Medicare	$18.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19.57
Rate for Payer: Meridian Medicaid	$10.49
Rate for Payer: MI Amish Medical Board Commercial	$21.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.05
Rate for Payer: PACE Medicare	$17.71
Rate for Payer: PACE SWMI	$18.64
Rate for Payer: PHP Commercial	$38.05
Rate for Payer: PHP Medicare Advantage	$18.64
Rate for Payer: Priority Health Choice Medicaid	$9.99
Rate for Payer: Priority Health Cigna Priority Health	$29.09
Rate for Payer: Priority Health Medicare	$18.64
Rate for Payer: Priority Health SBD	$28.20
Rate for Payer: Railroad Medicare Medicare	$18.64
Rate for Payer: UHC All Payor (Choice/PPO)	$52.47
Rate for Payer: UHC Dual Complete DSNP	$18.64
Rate for Payer: UHC Medicare Advantage	$18.64
Rate for Payer: UHCCP Medicaid	$10.49
Rate for Payer: VA VA	$18.64

HC CARB 10,11 EPXID

Facility

$44.76

Service Code	CPT 80161
Hospital Charge Code	30100742
Hospital Revenue Code	301
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$40.28
Rate for Payer: Aetna Commercial	$38.05
Rate for Payer: Aetna New Business (MI Preferred)	$29.09
Rate for Payer: Cash Price	$35.81
Rate for Payer: Cofinity Commercial	$31.33
Rate for Payer: Cofinity Commercial	$38.49
Rate for Payer: Cofinity Medicare Advantage	$31.33
Rate for Payer: Encore Health Key Benefits Commercial	$35.81
Rate for Payer: Healthscope Commercial	$40.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.05
Rate for Payer: PHP Commercial	$38.05
Rate for Payer: Priority Health Cigna Priority Health	$29.09
Rate for Payer: Priority Health SBD	$28.20

HC CARBAMAZEPINE 10 11 EPOXIDE

Facility

$45.78

Service Code	CPT 80156
Hospital Charge Code	30100022
Hospital Revenue Code	301
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare	$15.15
Rate for Payer: Aetna New Business (MI Preferred)	$29.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.21
Rate for Payer: Amish Plain Church Group Commercial	$18.21
Rate for Payer: BCBS Complete	$8.20
Rate for Payer: BCBS MAPPO	$14.57
Rate for Payer: BCN Medicare Advantage	$14.57
Rate for Payer: Cash Price	$36.62
Rate for Payer: Cash Price	$36.62
Rate for Payer: Cofinity Commercial	$39.37
Rate for Payer: Cofinity Commercial	$32.05
Rate for Payer: Cofinity Medicare Advantage	$32.05
Rate for Payer: Encore Health Key Benefits Commercial	$36.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.57
Rate for Payer: Healthscope Commercial	$41.20
Rate for Payer: Mclaren Medicaid	$7.81
Rate for Payer: Mclaren Medicare	$14.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.30
Rate for Payer: Meridian Medicaid	$8.20
Rate for Payer: MI Amish Medical Board Commercial	$16.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.91
Rate for Payer: PACE Medicare	$13.84
Rate for Payer: PACE SWMI	$14.57
Rate for Payer: PHP Commercial	$38.91
Rate for Payer: PHP Medicare Advantage	$14.57
Rate for Payer: Priority Health Choice Medicaid	$7.81
Rate for Payer: Priority Health Cigna Priority Health	$29.76
Rate for Payer: Priority Health Medicare	$14.57
Rate for Payer: Priority Health SBD	$28.84
Rate for Payer: Railroad Medicare Medicare	$14.57
Rate for Payer: UHC All Payor (Choice/PPO)	$41.01
Rate for Payer: UHC Dual Complete DSNP	$14.57
Rate for Payer: UHC Medicare Advantage	$14.57
Rate for Payer: UHCCP Medicaid	$8.20
Rate for Payer: VA VA	$14.57

HC CARBAMAZEPINE 10 11 EPOXIDE

Facility

$45.78

Service Code	CPT 80156
Hospital Charge Code	30100022
Hospital Revenue Code	301
Min. Negotiated Rate	$28.84
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna New Business (MI Preferred)	$29.76
Rate for Payer: Cash Price	$36.62
Rate for Payer: Cofinity Commercial	$32.05
Rate for Payer: Cofinity Commercial	$39.37
Rate for Payer: Cofinity Medicare Advantage	$32.05
Rate for Payer: Encore Health Key Benefits Commercial	$36.62
Rate for Payer: Healthscope Commercial	$41.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.91
Rate for Payer: PHP Commercial	$38.91
Rate for Payer: Priority Health Cigna Priority Health	$29.76
Rate for Payer: Priority Health SBD	$28.84

HC CARBAMAZEPINE 10 11 EPOXIDE CMPT

Facility

$44.74

Service Code	CPT 80299
Hospital Charge Code	30100060
Hospital Revenue Code	301
Min. Negotiated Rate	$28.19
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$38.03
Rate for Payer: Aetna New Business (MI Preferred)	$29.08
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cofinity Commercial	$31.32
Rate for Payer: Cofinity Commercial	$38.48
Rate for Payer: Cofinity Medicare Advantage	$31.32
Rate for Payer: Encore Health Key Benefits Commercial	$35.79
Rate for Payer: Healthscope Commercial	$40.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.03
Rate for Payer: PHP Commercial	$38.03
Rate for Payer: Priority Health Cigna Priority Health	$29.08
Rate for Payer: Priority Health SBD	$28.19

HC CARBAMAZEPINE 10 11 EPOXIDE CMPT

Facility

$44.74

Service Code	CPT 80299
Hospital Charge Code	30100060
Hospital Revenue Code	301
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$52.47
Rate for Payer: Aetna Commercial	$38.03
Rate for Payer: Aetna Medicare	$19.39
Rate for Payer: Aetna New Business (MI Preferred)	$29.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.30
Rate for Payer: Amish Plain Church Group Commercial	$23.30
Rate for Payer: BCBS Complete	$10.49
Rate for Payer: BCBS MAPPO	$18.64
Rate for Payer: BCN Medicare Advantage	$18.64
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cofinity Commercial	$38.48
Rate for Payer: Cofinity Commercial	$31.32
Rate for Payer: Cofinity Medicare Advantage	$31.32
Rate for Payer: Encore Health Key Benefits Commercial	$35.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.64
Rate for Payer: Healthscope Commercial	$40.27
Rate for Payer: Mclaren Medicaid	$9.99
Rate for Payer: Mclaren Medicare	$18.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19.57
Rate for Payer: Meridian Medicaid	$10.49
Rate for Payer: MI Amish Medical Board Commercial	$21.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.03
Rate for Payer: PACE Medicare	$17.71
Rate for Payer: PACE SWMI	$18.64
Rate for Payer: PHP Commercial	$38.03
Rate for Payer: PHP Medicare Advantage	$18.64
Rate for Payer: Priority Health Choice Medicaid	$9.99
Rate for Payer: Priority Health Cigna Priority Health	$29.08
Rate for Payer: Priority Health Medicare	$18.64
Rate for Payer: Priority Health SBD	$28.19
Rate for Payer: Railroad Medicare Medicare	$18.64
Rate for Payer: UHC All Payor (Choice/PPO)	$52.47
Rate for Payer: UHC Dual Complete DSNP	$18.64
Rate for Payer: UHC Medicare Advantage	$18.64
Rate for Payer: UHCCP Medicaid	$10.49
Rate for Payer: VA VA	$18.64

HC CARBON DIOXIDE (BICARB)

Facility

$21.64

Service Code	CPT 82374
Hospital Charge Code	30100133
Hospital Revenue Code	301
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$19.48
Rate for Payer: Aetna Commercial	$18.39
Rate for Payer: Aetna New Business (MI Preferred)	$14.07
Rate for Payer: Cash Price	$17.31
Rate for Payer: Cofinity Commercial	$15.15
Rate for Payer: Cofinity Commercial	$18.61
Rate for Payer: Cofinity Medicare Advantage	$15.15
Rate for Payer: Encore Health Key Benefits Commercial	$17.31
Rate for Payer: Healthscope Commercial	$19.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.39
Rate for Payer: PHP Commercial	$18.39
Rate for Payer: Priority Health Cigna Priority Health	$14.07
Rate for Payer: Priority Health SBD	$13.63

Know your out-of-pocket cost for care.

All Charges