Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMPRESS BURN GARM GAUNTLET-EL

Facility

$87.72

Service Code	HCPCS A6505
Hospital Charge Code	98300069
Hospital Revenue Code	270
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$78.95
Rate for Payer: Aetna Commercial	$74.56
Rate for Payer: Aetna Medicare	$43.86
Rate for Payer: Aetna New Business (MI Preferred)	$57.02
Rate for Payer: BCBS Complete	$35.09
Rate for Payer: Cash Price	$70.18
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Commercial	$75.44
Rate for Payer: Cofinity Medicare Advantage	$61.40
Rate for Payer: Encore Health Key Benefits Commercial	$70.18
Rate for Payer: Healthscope Commercial	$78.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.56
Rate for Payer: PHP Commercial	$74.56
Rate for Payer: Priority Health Cigna Priority Health	$57.02
Rate for Payer: Priority Health SBD	$55.26

HC CONDITIONING PLAY AUDIOMETRY

Facility

$148.92

Service Code	CPT 92582
Hospital Charge Code	76100512
Hospital Revenue Code	471
Min. Negotiated Rate	$81.79
Max. Negotiated Rate	$429.53
Rate for Payer: Aetna Commercial	$126.58
Rate for Payer: Aetna Medicare	$158.69
Rate for Payer: Aetna New Business (MI Preferred)	$96.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$190.74
Rate for Payer: Amish Plain Church Group Commercial	$190.74
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: BCBS MAPPO	$152.59
Rate for Payer: BCN Medicare Advantage	$152.59
Rate for Payer: Cash Price	$119.14
Rate for Payer: Cash Price	$119.14
Rate for Payer: Cofinity Commercial	$128.07
Rate for Payer: Cofinity Commercial	$104.24
Rate for Payer: Cofinity Medicare Advantage	$104.24
Rate for Payer: Encore Health Key Benefits Commercial	$119.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$152.59
Rate for Payer: Healthscope Commercial	$134.03
Rate for Payer: Mclaren Medicaid	$81.79
Rate for Payer: Mclaren Medicare	$152.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$160.22
Rate for Payer: Meridian Medicaid	$85.88
Rate for Payer: MI Amish Medical Board Commercial	$175.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.58
Rate for Payer: PACE Medicare	$144.96
Rate for Payer: PACE SWMI	$152.59
Rate for Payer: PHP Commercial	$126.58
Rate for Payer: PHP Medicare Advantage	$152.59
Rate for Payer: Priority Health Choice Medicaid	$81.79
Rate for Payer: Priority Health Cigna Priority Health	$96.80
Rate for Payer: Priority Health Medicare	$152.59
Rate for Payer: Priority Health SBD	$93.82
Rate for Payer: Railroad Medicare Medicare	$152.59
Rate for Payer: UHC All Payor (Choice/PPO)	$429.53
Rate for Payer: UHC Core	$110.20
Rate for Payer: UHC Dual Complete DSNP	$152.59
Rate for Payer: UHC Exchange	$110.20
Rate for Payer: UHC Medicare Advantage	$152.59
Rate for Payer: UHCCP Medicaid	$85.91
Rate for Payer: VA VA	$152.59

HC CONDITIONING PLAY AUDIOMETRY

Facility

$148.92

Service Code	CPT 92582
Hospital Charge Code	76100512
Hospital Revenue Code	471
Min. Negotiated Rate	$93.82
Max. Negotiated Rate	$134.03
Rate for Payer: Aetna Commercial	$126.58
Rate for Payer: Aetna New Business (MI Preferred)	$96.80
Rate for Payer: Cash Price	$119.14
Rate for Payer: Cofinity Commercial	$104.24
Rate for Payer: Cofinity Commercial	$128.07
Rate for Payer: Cofinity Medicare Advantage	$104.24
Rate for Payer: Encore Health Key Benefits Commercial	$119.14
Rate for Payer: Healthscope Commercial	$134.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.58
Rate for Payer: PHP Commercial	$126.58
Rate for Payer: Priority Health Cigna Priority Health	$96.80
Rate for Payer: Priority Health SBD	$93.82

HC CONFIRMED DRUG ABUSE PANEL 9 U

Facility

$104.04

Service Code	CPT 80307
Hospital Charge Code	30100643
Hospital Revenue Code	301
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$174.92
Rate for Payer: Aetna Commercial	$88.43
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$67.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$77.67
Rate for Payer: Amish Plain Church Group Commercial	$77.67
Rate for Payer: BCBS Complete	$34.97
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cofinity Commercial	$89.47
Rate for Payer: Cofinity Commercial	$72.83
Rate for Payer: Cofinity Medicare Advantage	$72.83
Rate for Payer: Encore Health Key Benefits Commercial	$83.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$93.64
Rate for Payer: Mclaren Medicaid	$33.31
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65.25
Rate for Payer: Meridian Medicaid	$34.97
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.43
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$88.43
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$33.31
Rate for Payer: Priority Health Cigna Priority Health	$67.63
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health SBD	$65.55
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$174.92
Rate for Payer: UHC Dual Complete DSNP	$62.14
Rate for Payer: UHC Medicare Advantage	$62.14
Rate for Payer: UHCCP Medicaid	$34.98
Rate for Payer: VA VA	$62.14

HC CONFIRMED DRUG ABUSE PANEL 9 U

Facility

$104.04

Service Code	CPT 80307
Hospital Charge Code	30100643
Hospital Revenue Code	301
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$93.64
Rate for Payer: Aetna Commercial	$88.43
Rate for Payer: Aetna New Business (MI Preferred)	$67.63
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cofinity Commercial	$72.83
Rate for Payer: Cofinity Commercial	$89.47
Rate for Payer: Cofinity Medicare Advantage	$72.83
Rate for Payer: Encore Health Key Benefits Commercial	$83.23
Rate for Payer: Healthscope Commercial	$93.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.43
Rate for Payer: PHP Commercial	$88.43
Rate for Payer: Priority Health Cigna Priority Health	$67.63
Rate for Payer: Priority Health SBD	$65.55

HC CONIZ CERVIX W/WO D&C RPR ELTRD EXC

Facility

$7,945.53

Service Code	CPT 57522
Hospital Charge Code	76100334
Hospital Revenue Code	761
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Commercial	$6,753.70
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Aetna New Business (MI Preferred)	$5,164.59
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Cash Price	$6,356.42
Rate for Payer: Cash Price	$6,356.42
Rate for Payer: Cofinity Commercial	$6,833.16
Rate for Payer: Cofinity Commercial	$5,561.87
Rate for Payer: Cofinity Medicare Advantage	$5,561.87
Rate for Payer: Encore Health Key Benefits Commercial	$6,356.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Healthscope Commercial	$7,150.98
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,753.70
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Commercial	$6,753.70
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Cigna Priority Health	$5,164.59
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Priority Health SBD	$5,005.68
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,745.82
Rate for Payer: VA VA	$3,100.93

HC CONIZ CERVIX W/WO D&C RPR ELTRD EXC

Facility

$7,945.53

Service Code	CPT 57522
Hospital Charge Code	76100334
Hospital Revenue Code	761
Min. Negotiated Rate	$5,005.68
Max. Negotiated Rate	$7,150.98
Rate for Payer: Aetna Commercial	$6,753.70
Rate for Payer: Aetna New Business (MI Preferred)	$5,164.59
Rate for Payer: Cash Price	$6,356.42
Rate for Payer: Cofinity Commercial	$5,561.87
Rate for Payer: Cofinity Commercial	$6,833.16
Rate for Payer: Cofinity Medicare Advantage	$5,561.87
Rate for Payer: Encore Health Key Benefits Commercial	$6,356.42
Rate for Payer: Healthscope Commercial	$7,150.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,753.70
Rate for Payer: PHP Commercial	$6,753.70
Rate for Payer: Priority Health Cigna Priority Health	$5,164.59
Rate for Payer: Priority Health SBD	$5,005.68

HC CONNECTIVE TISSUE CASCADE ANA & CCP

Facility

$31.83

Service Code	CPT 86200
Hospital Charge Code	30200156
Hospital Revenue Code	302
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$36.45
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna Medicare	$13.47
Rate for Payer: Aetna New Business (MI Preferred)	$20.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.19
Rate for Payer: Amish Plain Church Group Commercial	$16.19
Rate for Payer: BCBS Complete	$7.29
Rate for Payer: BCBS MAPPO	$12.95
Rate for Payer: BCN Medicare Advantage	$12.95
Rate for Payer: Cash Price	$25.46
Rate for Payer: Cash Price	$25.46
Rate for Payer: Cofinity Commercial	$27.37
Rate for Payer: Cofinity Commercial	$22.28
Rate for Payer: Cofinity Medicare Advantage	$22.28
Rate for Payer: Encore Health Key Benefits Commercial	$25.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.95
Rate for Payer: Healthscope Commercial	$28.65
Rate for Payer: Mclaren Medicaid	$6.94
Rate for Payer: Mclaren Medicare	$12.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.60
Rate for Payer: Meridian Medicaid	$7.29
Rate for Payer: MI Amish Medical Board Commercial	$14.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.06
Rate for Payer: PACE Medicare	$12.30
Rate for Payer: PACE SWMI	$12.95
Rate for Payer: PHP Commercial	$27.06
Rate for Payer: PHP Medicare Advantage	$12.95
Rate for Payer: Priority Health Choice Medicaid	$6.94
Rate for Payer: Priority Health Cigna Priority Health	$20.69
Rate for Payer: Priority Health Medicare	$12.95
Rate for Payer: Priority Health SBD	$20.05
Rate for Payer: Railroad Medicare Medicare	$12.95
Rate for Payer: UHC All Payor (Choice/PPO)	$36.45
Rate for Payer: UHC Dual Complete DSNP	$12.95
Rate for Payer: UHC Medicare Advantage	$12.95
Rate for Payer: UHCCP Medicaid	$7.29
Rate for Payer: VA VA	$12.95

HC CONNECTIVE TISSUE CASCADE ANA & CCP

Facility

$31.83

Service Code	CPT 86200
Hospital Charge Code	30200156
Hospital Revenue Code	302
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$28.65
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna New Business (MI Preferred)	$20.69
Rate for Payer: Cash Price	$25.46
Rate for Payer: Cofinity Commercial	$22.28
Rate for Payer: Cofinity Commercial	$27.37
Rate for Payer: Cofinity Medicare Advantage	$22.28
Rate for Payer: Encore Health Key Benefits Commercial	$25.46
Rate for Payer: Healthscope Commercial	$28.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.06
Rate for Payer: PHP Commercial	$27.06
Rate for Payer: Priority Health Cigna Priority Health	$20.69
Rate for Payer: Priority Health SBD	$20.05

HC CONNECTOR 3/8 W/ LL

Facility

$5.36

Hospital Charge Code	27000448
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR 3/8 W/ LL

Facility

$5.36

Hospital Charge Code	27000448
Hospital Revenue Code	270
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare	$2.68
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: BCBS Complete	$2.14
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR REDUCER

Facility

$5.36

Hospital Charge Code	27000651
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR REDUCER

Facility

$5.36

Hospital Charge Code	27000651
Hospital Revenue Code	270
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare	$2.68
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: BCBS Complete	$2.14
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR ST 1/2 X 1/2

Facility

$7.65

Hospital Charge Code	27000047
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna Medicare	$3.83
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: BCBS Complete	$3.06
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

HC CONNECTOR ST 1/2 X 1/2

Facility

$7.65

Hospital Charge Code	27000047
Hospital Revenue Code	270
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

HC CONNECTOR ST 3/8 OR 1/4

Facility

$5.36

Hospital Charge Code	27000685
Hospital Revenue Code	270
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare	$2.68
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: BCBS Complete	$2.14
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR ST 3/8 OR 1/4

Facility

$5.36

Hospital Charge Code	27000685
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR V

Facility

$7.65

Hospital Charge Code	27000678
Hospital Revenue Code	270
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

HC CONNECTOR V

Facility

$7.65

Hospital Charge Code	27000678
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna Medicare	$3.83
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: BCBS Complete	$3.06
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

HC CONNECTOR Y

Facility

$5.36

Hospital Charge Code	27000048
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONNECTOR Y

Facility

$5.36

Hospital Charge Code	27000048
Hospital Revenue Code	270
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare	$2.68
Rate for Payer: Aetna New Business (MI Preferred)	$3.48
Rate for Payer: BCBS Complete	$2.14
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Medicare Advantage	$3.75
Rate for Payer: Encore Health Key Benefits Commercial	$4.29
Rate for Payer: Healthscope Commercial	$4.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.56
Rate for Payer: PHP Commercial	$4.56
Rate for Payer: Priority Health Cigna Priority Health	$3.48
Rate for Payer: Priority Health SBD	$3.38

HC CONSULT NUTRITIONAL

Facility

$34.96

Hospital Charge Code	94200010
Hospital Revenue Code	942
Min. Negotiated Rate	$22.02
Max. Negotiated Rate	$31.46
Rate for Payer: Aetna Commercial	$29.72
Rate for Payer: Aetna New Business (MI Preferred)	$22.72
Rate for Payer: Cash Price	$27.97
Rate for Payer: Cofinity Commercial	$24.47
Rate for Payer: Cofinity Commercial	$30.07
Rate for Payer: Cofinity Medicare Advantage	$24.47
Rate for Payer: Encore Health Key Benefits Commercial	$27.97
Rate for Payer: Healthscope Commercial	$31.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.72
Rate for Payer: PHP Commercial	$29.72
Rate for Payer: Priority Health Cigna Priority Health	$22.72
Rate for Payer: Priority Health SBD	$22.02

HC CONSULT NUTRITIONAL

Facility

$34.96

Hospital Charge Code	94200010
Hospital Revenue Code	942
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$31.46
Rate for Payer: Aetna Commercial	$29.72
Rate for Payer: Aetna Medicare	$17.48
Rate for Payer: Aetna New Business (MI Preferred)	$22.72
Rate for Payer: BCBS Complete	$13.98
Rate for Payer: Cash Price	$27.97
Rate for Payer: Cofinity Commercial	$24.47
Rate for Payer: Cofinity Commercial	$30.07
Rate for Payer: Cofinity Medicare Advantage	$24.47
Rate for Payer: Encore Health Key Benefits Commercial	$27.97
Rate for Payer: Healthscope Commercial	$31.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.72
Rate for Payer: PHP Commercial	$29.72
Rate for Payer: Priority Health Cigna Priority Health	$22.72
Rate for Payer: Priority Health SBD	$22.02
Rate for Payer: UHC Core	$25.87
Rate for Payer: UHC Exchange	$25.87

HC CONT GLUCOSE MONITOR OFFICE EQUIP

Facility

$984.59

Service Code	CPT 95250
Hospital Charge Code	94200001
Hospital Revenue Code	942
Min. Negotiated Rate	$67.36
Max. Negotiated Rate	$886.13
Rate for Payer: Aetna Commercial	$836.90
Rate for Payer: Aetna Medicare	$130.71
Rate for Payer: Aetna New Business (MI Preferred)	$639.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$157.10
Rate for Payer: Amish Plain Church Group Commercial	$157.10
Rate for Payer: BCBS Complete	$70.73
Rate for Payer: BCBS MAPPO	$125.68
Rate for Payer: BCN Medicare Advantage	$125.68
Rate for Payer: Cash Price	$787.67
Rate for Payer: Cash Price	$787.67
Rate for Payer: Cofinity Commercial	$846.75
Rate for Payer: Cofinity Commercial	$689.21
Rate for Payer: Cofinity Medicare Advantage	$689.21
Rate for Payer: Encore Health Key Benefits Commercial	$787.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$125.68
Rate for Payer: Healthscope Commercial	$886.13
Rate for Payer: Mclaren Medicaid	$67.36
Rate for Payer: Mclaren Medicare	$125.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$131.96
Rate for Payer: Meridian Medicaid	$70.73
Rate for Payer: MI Amish Medical Board Commercial	$144.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$836.90
Rate for Payer: PACE Medicare	$119.40
Rate for Payer: PACE SWMI	$125.68
Rate for Payer: PHP Commercial	$836.90
Rate for Payer: PHP Medicare Advantage	$125.68
Rate for Payer: Priority Health Choice Medicaid	$67.36
Rate for Payer: Priority Health Cigna Priority Health	$639.98
Rate for Payer: Priority Health Medicare	$125.68
Rate for Payer: Priority Health SBD	$620.29
Rate for Payer: Railroad Medicare Medicare	$125.68
Rate for Payer: UHC All Payor (Choice/PPO)	$353.78
Rate for Payer: UHC Core	$728.60
Rate for Payer: UHC Dual Complete DSNP	$125.68
Rate for Payer: UHC Exchange	$728.60
Rate for Payer: UHC Medicare Advantage	$125.68
Rate for Payer: UHCCP Medicaid	$70.76
Rate for Payer: VA VA	$125.68

HC CONT GLUCOSE MONITOR OFFICE EQUIP

Facility

$984.59

Service Code	CPT 95250
Hospital Charge Code	94200001
Hospital Revenue Code	942
Min. Negotiated Rate	$620.29
Max. Negotiated Rate	$886.13
Rate for Payer: Aetna Commercial	$836.90
Rate for Payer: Aetna New Business (MI Preferred)	$639.98
Rate for Payer: Cash Price	$787.67
Rate for Payer: Cofinity Commercial	$689.21
Rate for Payer: Cofinity Commercial	$846.75
Rate for Payer: Cofinity Medicare Advantage	$689.21
Rate for Payer: Encore Health Key Benefits Commercial	$787.67
Rate for Payer: Healthscope Commercial	$886.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$836.90
Rate for Payer: PHP Commercial	$836.90
Rate for Payer: Priority Health Cigna Priority Health	$639.98
Rate for Payer: Priority Health SBD	$620.29

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