Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$208.07

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$131.08
Max. Negotiated Rate	$187.26
Rate for Payer: Aetna Commercial	$176.86
Rate for Payer: Aetna New Business (MI Preferred)	$135.25
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$145.65
Rate for Payer: Cofinity Commercial	$178.94
Rate for Payer: Cofinity Medicare Advantage	$145.65
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$187.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.86
Rate for Payer: PHP Commercial	$176.86
Rate for Payer: Priority Health Cigna Priority Health	$135.25
Rate for Payer: Priority Health SBD	$131.08

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$208.07

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$83.23
Max. Negotiated Rate	$187.26
Rate for Payer: Aetna Commercial	$176.86
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	$145.65
Rate for Payer: Cofinity Commercial	$178.94
Rate for Payer: Cofinity Medicare Advantage	$145.65
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$187.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.86
Rate for Payer: PHP Commercial	$176.86
Rate for Payer: Priority Health Cigna Priority Health	$135.25
Rate for Payer: Priority Health SBD	$131.08

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$315.17

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$198.56
Max. Negotiated Rate	$283.65
Rate for Payer: Aetna Commercial	$267.89
Rate for Payer: Aetna New Business (MI Preferred)	$204.86
Rate for Payer: Cash Price	$252.14
Rate for Payer: Cofinity Commercial	$220.62
Rate for Payer: Cofinity Commercial	$271.05
Rate for Payer: Cofinity Medicare Advantage	$220.62
Rate for Payer: Encore Health Key Benefits Commercial	$252.14
Rate for Payer: Healthscope Commercial	$283.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$267.89
Rate for Payer: PHP Commercial	$267.89
Rate for Payer: Priority Health Cigna Priority Health	$204.86
Rate for Payer: Priority Health SBD	$198.56

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$315.17

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$126.07
Max. Negotiated Rate	$283.65
Rate for Payer: Aetna Commercial	$267.89
Rate for Payer: Aetna Medicare	$157.58
Rate for Payer: Aetna New Business (MI Preferred)	$204.86
Rate for Payer: BCBS Complete	$126.07
Rate for Payer: Cash Price	$252.14
Rate for Payer: Cofinity Commercial	$220.62
Rate for Payer: Cofinity Commercial	$271.05
Rate for Payer: Cofinity Medicare Advantage	$220.62
Rate for Payer: Encore Health Key Benefits Commercial	$252.14
Rate for Payer: Healthscope Commercial	$283.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$267.89
Rate for Payer: PHP Commercial	$267.89
Rate for Payer: Priority Health Cigna Priority Health	$204.86
Rate for Payer: Priority Health SBD	$198.56

HC DIALYSIS CATH LVL 4 SHORT TERM

Facility

$422.27

Service Code	HCPCS C1752
Hospital Charge Code	27200085
Hospital Revenue Code	272
Min. Negotiated Rate	$168.91
Max. Negotiated Rate	$380.04
Rate for Payer: Aetna Commercial	$358.93
Rate for Payer: Aetna Medicare	$211.14
Rate for Payer: Aetna New Business (MI Preferred)	$274.48
Rate for Payer: BCBS Complete	$168.91
Rate for Payer: Cash Price	$337.82
Rate for Payer: Cofinity Commercial	$295.59
Rate for Payer: Cofinity Commercial	$363.15
Rate for Payer: Cofinity Medicare Advantage	$295.59
Rate for Payer: Encore Health Key Benefits Commercial	$337.82
Rate for Payer: Healthscope Commercial	$380.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.93
Rate for Payer: PHP Commercial	$358.93
Rate for Payer: Priority Health Cigna Priority Health	$274.48
Rate for Payer: Priority Health SBD	$266.03

HC DIALYSIS CATH LVL 4 SHORT TERM

Facility

$422.27

Service Code	HCPCS C1752
Hospital Charge Code	27200085
Hospital Revenue Code	272
Min. Negotiated Rate	$266.03
Max. Negotiated Rate	$380.04
Rate for Payer: Aetna Commercial	$358.93
Rate for Payer: Aetna New Business (MI Preferred)	$274.48
Rate for Payer: Cash Price	$337.82
Rate for Payer: Cofinity Commercial	$295.59
Rate for Payer: Cofinity Commercial	$363.15
Rate for Payer: Cofinity Medicare Advantage	$295.59
Rate for Payer: Encore Health Key Benefits Commercial	$337.82
Rate for Payer: Healthscope Commercial	$380.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.93
Rate for Payer: PHP Commercial	$358.93
Rate for Payer: Priority Health Cigna Priority Health	$274.48
Rate for Payer: Priority Health SBD	$266.03

HC DIALYSIS CATH LVL 5 SHORT TERM

Facility

$529.37

Service Code	HCPCS C1752
Hospital Charge Code	27200318
Hospital Revenue Code	272
Min. Negotiated Rate	$333.50
Max. Negotiated Rate	$476.43
Rate for Payer: Aetna Commercial	$449.96
Rate for Payer: Aetna New Business (MI Preferred)	$344.09
Rate for Payer: Cash Price	$423.50
Rate for Payer: Cofinity Commercial	$370.56
Rate for Payer: Cofinity Commercial	$455.26
Rate for Payer: Cofinity Medicare Advantage	$370.56
Rate for Payer: Encore Health Key Benefits Commercial	$423.50
Rate for Payer: Healthscope Commercial	$476.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$449.96
Rate for Payer: PHP Commercial	$449.96
Rate for Payer: Priority Health Cigna Priority Health	$344.09
Rate for Payer: Priority Health SBD	$333.50

HC DIALYSIS CATH LVL 5 SHORT TERM

Facility

$529.37

Service Code	HCPCS C1752
Hospital Charge Code	27200318
Hospital Revenue Code	272
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$476.43
Rate for Payer: Aetna Commercial	$449.96
Rate for Payer: Aetna Medicare	$264.68
Rate for Payer: Aetna New Business (MI Preferred)	$344.09
Rate for Payer: BCBS Complete	$211.75
Rate for Payer: Cash Price	$423.50
Rate for Payer: Cofinity Commercial	$370.56
Rate for Payer: Cofinity Commercial	$455.26
Rate for Payer: Cofinity Medicare Advantage	$370.56
Rate for Payer: Encore Health Key Benefits Commercial	$423.50
Rate for Payer: Healthscope Commercial	$476.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$449.96
Rate for Payer: PHP Commercial	$449.96
Rate for Payer: Priority Health Cigna Priority Health	$344.09
Rate for Payer: Priority Health SBD	$333.50

HC DIALYSIS CATH LVL 7 LONG TERM

Facility

$743.57

Service Code	CPT C1750
Hospital Charge Code	27200319
Hospital Revenue Code	272
Min. Negotiated Rate	$468.45
Max. Negotiated Rate	$669.21
Rate for Payer: Aetna Commercial	$632.03
Rate for Payer: Aetna New Business (MI Preferred)	$483.32
Rate for Payer: Cash Price	$594.86
Rate for Payer: Cofinity Commercial	$520.50
Rate for Payer: Cofinity Commercial	$639.47
Rate for Payer: Cofinity Medicare Advantage	$520.50
Rate for Payer: Encore Health Key Benefits Commercial	$594.86
Rate for Payer: Healthscope Commercial	$669.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$632.03
Rate for Payer: PHP Commercial	$632.03
Rate for Payer: Priority Health Cigna Priority Health	$483.32
Rate for Payer: Priority Health SBD	$468.45

HC DIALYSIS CATH LVL 7 LONG TERM

Facility

$743.57

Service Code	CPT C1750
Hospital Charge Code	27200319
Hospital Revenue Code	272
Min. Negotiated Rate	$297.43
Max. Negotiated Rate	$669.21
Rate for Payer: Aetna Commercial	$632.03
Rate for Payer: Aetna Medicare	$371.78
Rate for Payer: Aetna New Business (MI Preferred)	$483.32
Rate for Payer: BCBS Complete	$297.43
Rate for Payer: Cash Price	$594.86
Rate for Payer: Cofinity Commercial	$520.50
Rate for Payer: Cofinity Commercial	$639.47
Rate for Payer: Cofinity Medicare Advantage	$520.50
Rate for Payer: Encore Health Key Benefits Commercial	$594.86
Rate for Payer: Healthscope Commercial	$669.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$632.03
Rate for Payer: PHP Commercial	$632.03
Rate for Payer: Priority Health Cigna Priority Health	$483.32
Rate for Payer: Priority Health SBD	$468.45

HC DIALYSIS CATH LVL 7 SHORT TERM

Facility

$793.31

Service Code	CPT C1752
Hospital Charge Code	27200347
Hospital Revenue Code	272
Min. Negotiated Rate	$317.32
Max. Negotiated Rate	$713.98
Rate for Payer: Aetna Commercial	$674.31
Rate for Payer: Aetna Medicare	$396.66
Rate for Payer: Aetna New Business (MI Preferred)	$515.65
Rate for Payer: BCBS Complete	$317.32
Rate for Payer: Cash Price	$634.65
Rate for Payer: Cofinity Commercial	$555.32
Rate for Payer: Cofinity Commercial	$682.25
Rate for Payer: Cofinity Medicare Advantage	$555.32
Rate for Payer: Encore Health Key Benefits Commercial	$634.65
Rate for Payer: Healthscope Commercial	$713.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.31
Rate for Payer: PHP Commercial	$674.31
Rate for Payer: Priority Health Cigna Priority Health	$515.65
Rate for Payer: Priority Health SBD	$499.79

HC DIALYSIS CATH LVL 7 SHORT TERM

Facility

$793.31

Service Code	CPT C1752
Hospital Charge Code	27200347
Hospital Revenue Code	272
Min. Negotiated Rate	$499.79
Max. Negotiated Rate	$713.98
Rate for Payer: Aetna Commercial	$674.31
Rate for Payer: Aetna New Business (MI Preferred)	$515.65
Rate for Payer: Cash Price	$634.65
Rate for Payer: Cofinity Commercial	$555.32
Rate for Payer: Cofinity Commercial	$682.25
Rate for Payer: Cofinity Medicare Advantage	$555.32
Rate for Payer: Encore Health Key Benefits Commercial	$634.65
Rate for Payer: Healthscope Commercial	$713.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.31
Rate for Payer: PHP Commercial	$674.31
Rate for Payer: Priority Health Cigna Priority Health	$515.65
Rate for Payer: Priority Health SBD	$499.79

HC DIALYSIS CATH LVL 8 SHORT TERM

Facility

$850.67

Service Code	HCPCS C1752
Hospital Charge Code	27200175
Hospital Revenue Code	272
Min. Negotiated Rate	$340.27
Max. Negotiated Rate	$765.60
Rate for Payer: Aetna Commercial	$723.07
Rate for Payer: Aetna Medicare	$425.34
Rate for Payer: Aetna New Business (MI Preferred)	$552.94
Rate for Payer: BCBS Complete	$340.27
Rate for Payer: Cash Price	$680.54
Rate for Payer: Cofinity Commercial	$595.47
Rate for Payer: Cofinity Commercial	$731.58
Rate for Payer: Cofinity Medicare Advantage	$595.47
Rate for Payer: Encore Health Key Benefits Commercial	$680.54
Rate for Payer: Healthscope Commercial	$765.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$723.07
Rate for Payer: PHP Commercial	$723.07
Rate for Payer: Priority Health Cigna Priority Health	$552.94
Rate for Payer: Priority Health SBD	$535.92

HC DIALYSIS CATH LVL 8 SHORT TERM

Facility

$850.67

Service Code	HCPCS C1752
Hospital Charge Code	27200175
Hospital Revenue Code	272
Min. Negotiated Rate	$535.92
Max. Negotiated Rate	$765.60
Rate for Payer: Aetna Commercial	$723.07
Rate for Payer: Aetna New Business (MI Preferred)	$552.94
Rate for Payer: Cash Price	$680.54
Rate for Payer: Cofinity Commercial	$595.47
Rate for Payer: Cofinity Commercial	$731.58
Rate for Payer: Cofinity Medicare Advantage	$595.47
Rate for Payer: Encore Health Key Benefits Commercial	$680.54
Rate for Payer: Healthscope Commercial	$765.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$723.07
Rate for Payer: PHP Commercial	$723.07
Rate for Payer: Priority Health Cigna Priority Health	$552.94
Rate for Payer: Priority Health SBD	$535.92

HC DIALYSIS CATH LVL 9 LONG TERM

Facility

$957.77

Service Code	HCPCS C1750
Hospital Charge Code	27200320
Hospital Revenue Code	272
Min. Negotiated Rate	$383.11
Max. Negotiated Rate	$861.99
Rate for Payer: Aetna Commercial	$814.10
Rate for Payer: Aetna Medicare	$478.88
Rate for Payer: Aetna New Business (MI Preferred)	$622.55
Rate for Payer: BCBS Complete	$383.11
Rate for Payer: Cash Price	$766.22
Rate for Payer: Cofinity Commercial	$670.44
Rate for Payer: Cofinity Commercial	$823.68
Rate for Payer: Cofinity Medicare Advantage	$670.44
Rate for Payer: Encore Health Key Benefits Commercial	$766.22
Rate for Payer: Healthscope Commercial	$861.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$814.10
Rate for Payer: PHP Commercial	$814.10
Rate for Payer: Priority Health Cigna Priority Health	$622.55
Rate for Payer: Priority Health SBD	$603.40

HC DIALYSIS CATH LVL 9 LONG TERM

Facility

$957.77

Service Code	HCPCS C1750
Hospital Charge Code	27200320
Hospital Revenue Code	272
Min. Negotiated Rate	$603.40
Max. Negotiated Rate	$861.99
Rate for Payer: Aetna Commercial	$814.10
Rate for Payer: Aetna New Business (MI Preferred)	$622.55
Rate for Payer: Cash Price	$766.22
Rate for Payer: Cofinity Commercial	$670.44
Rate for Payer: Cofinity Commercial	$823.68
Rate for Payer: Cofinity Medicare Advantage	$670.44
Rate for Payer: Encore Health Key Benefits Commercial	$766.22
Rate for Payer: Healthscope Commercial	$861.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$814.10
Rate for Payer: PHP Commercial	$814.10
Rate for Payer: Priority Health Cigna Priority Health	$622.55
Rate for Payer: Priority Health SBD	$603.40

HC DIFFUSION

Facility

$396.56

Service Code	CPT 94729
Hospital Charge Code	46000009
Hospital Revenue Code	460
Min. Negotiated Rate	$249.83
Max. Negotiated Rate	$356.90
Rate for Payer: Aetna Commercial	$337.08
Rate for Payer: Aetna New Business (MI Preferred)	$257.76
Rate for Payer: Cash Price	$317.25
Rate for Payer: Cofinity Commercial	$277.59
Rate for Payer: Cofinity Commercial	$341.04
Rate for Payer: Cofinity Medicare Advantage	$277.59
Rate for Payer: Encore Health Key Benefits Commercial	$317.25
Rate for Payer: Healthscope Commercial	$356.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.08
Rate for Payer: PHP Commercial	$337.08
Rate for Payer: Priority Health Cigna Priority Health	$257.76
Rate for Payer: Priority Health SBD	$249.83

HC DIFFUSION

Facility

$396.56

Service Code	CPT 94729
Hospital Charge Code	46000009
Hospital Revenue Code	460
Min. Negotiated Rate	$56.58
Max. Negotiated Rate	$356.90
Rate for Payer: Aetna Commercial	$337.08
Rate for Payer: Aetna Medicare	$198.28
Rate for Payer: Aetna New Business (MI Preferred)	$257.76
Rate for Payer: BCBS Complete	$158.62
Rate for Payer: BCBS Trust/PPO	$212.62
Rate for Payer: BCN Commercial	$212.62
Rate for Payer: Cash Price	$317.25
Rate for Payer: Cash Price	$317.25
Rate for Payer: Cofinity Commercial	$277.59
Rate for Payer: Cofinity Commercial	$341.04
Rate for Payer: Cofinity Medicare Advantage	$277.59
Rate for Payer: Encore Health Key Benefits Commercial	$317.25
Rate for Payer: Healthscope Commercial	$356.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.08
Rate for Payer: PHP Commercial	$337.08
Rate for Payer: Priority Health Cigna Priority Health	$257.76
Rate for Payer: Priority Health SBD	$249.83
Rate for Payer: UHC All Payor (Choice/PPO)	$56.58
Rate for Payer: UHC Exchange	$293.45

HC DI GEORGE SYNDROME

Facility

$169.32

Service Code	CPT 88273
Hospital Charge Code	31000033
Hospital Revenue Code	310
Min. Negotiated Rate	$18.66
Max. Negotiated Rate	$152.39
Rate for Payer: Aetna Commercial	$143.92
Rate for Payer: Aetna Medicare	$36.20
Rate for Payer: Aetna New Business (MI Preferred)	$110.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.51
Rate for Payer: Amish Plain Church Group Commercial	$43.51
Rate for Payer: BCBS Complete	$19.59
Rate for Payer: BCBS MAPPO	$34.81
Rate for Payer: BCBS Trust/PPO	$30.82
Rate for Payer: BCN Commercial	$30.82
Rate for Payer: BCN Medicare Advantage	$34.81
Rate for Payer: Cash Price	$135.46
Rate for Payer: Cash Price	$135.46
Rate for Payer: Cofinity Commercial	$145.62
Rate for Payer: Cofinity Commercial	$118.52
Rate for Payer: Cofinity Medicare Advantage	$118.52
Rate for Payer: Encore Health Key Benefits Commercial	$135.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$34.81
Rate for Payer: Healthscope Commercial	$152.39
Rate for Payer: Mclaren Medicaid	$18.66
Rate for Payer: Mclaren Medicare	$34.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.55
Rate for Payer: Meridian Medicaid	$19.59
Rate for Payer: MI Amish Medical Board Commercial	$40.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.92
Rate for Payer: Nomi Health Commercial	$52.22
Rate for Payer: PACE Medicare	$33.07
Rate for Payer: PACE SWMI	$34.81
Rate for Payer: PHP Commercial	$143.92
Rate for Payer: PHP Medicare Advantage	$34.81
Rate for Payer: Priority Health Choice Medicaid	$18.66
Rate for Payer: Priority Health Cigna Priority Health	$110.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.81
Rate for Payer: Priority Health Medicare	$34.81
Rate for Payer: Priority Health Narrow Network	$27.85
Rate for Payer: Priority Health SBD	$106.67
Rate for Payer: Railroad Medicare Medicare	$34.81
Rate for Payer: UHC All Payor (Choice/PPO)	$41.77
Rate for Payer: UHC Dual Complete DSNP	$34.81
Rate for Payer: UHC Medicare Advantage	$34.81
Rate for Payer: UHCCP Medicaid	$19.60
Rate for Payer: VA VA	$34.81

HC DI GEORGE SYNDROME

Facility

$169.32

Service Code	CPT 88273
Hospital Charge Code	31000033
Hospital Revenue Code	310
Min. Negotiated Rate	$106.67
Max. Negotiated Rate	$152.39
Rate for Payer: Aetna Commercial	$143.92
Rate for Payer: Aetna New Business (MI Preferred)	$110.06
Rate for Payer: Cash Price	$135.46
Rate for Payer: Cofinity Commercial	$118.52
Rate for Payer: Cofinity Commercial	$145.62
Rate for Payer: Cofinity Medicare Advantage	$118.52
Rate for Payer: Encore Health Key Benefits Commercial	$135.46
Rate for Payer: Healthscope Commercial	$152.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.92
Rate for Payer: PHP Commercial	$143.92
Rate for Payer: Priority Health Cigna Priority Health	$110.06
Rate for Payer: Priority Health SBD	$106.67

HC DIGOXIN LVL

Facility

$91.87

Service Code	CPT 80162
Hospital Charge Code	30100591
Hospital Revenue Code	301
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$82.68
Rate for Payer: Aetna Commercial	$78.09
Rate for Payer: Aetna Medicare	$13.81
Rate for Payer: Aetna New Business (MI Preferred)	$59.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.60
Rate for Payer: Amish Plain Church Group Commercial	$16.60
Rate for Payer: BCBS Complete	$7.47
Rate for Payer: BCBS MAPPO	$13.28
Rate for Payer: BCBS Trust/PPO	$11.76
Rate for Payer: BCN Commercial	$11.76
Rate for Payer: BCN Medicare Advantage	$13.28
Rate for Payer: Cash Price	$73.50
Rate for Payer: Cash Price	$73.50
Rate for Payer: Cofinity Commercial	$79.01
Rate for Payer: Cofinity Commercial	$64.31
Rate for Payer: Cofinity Medicare Advantage	$64.31
Rate for Payer: Encore Health Key Benefits Commercial	$73.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.28
Rate for Payer: Healthscope Commercial	$82.68
Rate for Payer: Mclaren Medicaid	$7.12
Rate for Payer: Mclaren Medicare	$13.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.94
Rate for Payer: Meridian Medicaid	$7.47
Rate for Payer: MI Amish Medical Board Commercial	$15.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.09
Rate for Payer: Nomi Health Commercial	$19.92
Rate for Payer: PACE Medicare	$12.62
Rate for Payer: PACE SWMI	$13.28
Rate for Payer: PHP Commercial	$78.09
Rate for Payer: PHP Medicare Advantage	$13.28
Rate for Payer: Priority Health Choice Medicaid	$7.12
Rate for Payer: Priority Health Cigna Priority Health	$59.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.66
Rate for Payer: Priority Health Medicare	$13.28
Rate for Payer: Priority Health Narrow Network	$10.93
Rate for Payer: Priority Health SBD	$57.88
Rate for Payer: Railroad Medicare Medicare	$13.28
Rate for Payer: UHC All Payor (Choice/PPO)	$15.94
Rate for Payer: UHC Dual Complete DSNP	$13.28
Rate for Payer: UHC Medicare Advantage	$13.28
Rate for Payer: UHCCP Medicaid	$7.48
Rate for Payer: VA VA	$13.28

HC DIGOXIN LVL

Facility

$91.87

Service Code	CPT 80162
Hospital Charge Code	30100591
Hospital Revenue Code	301
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$82.68
Rate for Payer: Aetna Commercial	$78.09
Rate for Payer: Aetna New Business (MI Preferred)	$59.72
Rate for Payer: Cash Price	$73.50
Rate for Payer: Cofinity Commercial	$64.31
Rate for Payer: Cofinity Commercial	$79.01
Rate for Payer: Cofinity Medicare Advantage	$64.31
Rate for Payer: Encore Health Key Benefits Commercial	$73.50
Rate for Payer: Healthscope Commercial	$82.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.09
Rate for Payer: PHP Commercial	$78.09
Rate for Payer: Priority Health Cigna Priority Health	$59.72
Rate for Payer: Priority Health SBD	$57.88

HC DILANTIN LEVEL

Facility

$36.41

Service Code	CPT 80185
Hospital Charge Code	30100039
Hospital Revenue Code	301
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$32.77
Rate for Payer: Aetna Commercial	$30.95
Rate for Payer: Aetna Medicare	$13.78
Rate for Payer: Aetna New Business (MI Preferred)	$23.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.56
Rate for Payer: Amish Plain Church Group Commercial	$16.56
Rate for Payer: BCBS Complete	$7.46
Rate for Payer: BCBS MAPPO	$13.25
Rate for Payer: BCBS Trust/PPO	$11.73
Rate for Payer: BCN Commercial	$11.73
Rate for Payer: BCN Medicare Advantage	$13.25
Rate for Payer: Cash Price	$29.13
Rate for Payer: Cash Price	$29.13
Rate for Payer: Cofinity Commercial	$31.31
Rate for Payer: Cofinity Commercial	$25.49
Rate for Payer: Cofinity Medicare Advantage	$25.49
Rate for Payer: Encore Health Key Benefits Commercial	$29.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.25
Rate for Payer: Healthscope Commercial	$32.77
Rate for Payer: Mclaren Medicaid	$7.10
Rate for Payer: Mclaren Medicare	$13.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.91
Rate for Payer: Meridian Medicaid	$7.46
Rate for Payer: MI Amish Medical Board Commercial	$15.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.95
Rate for Payer: Nomi Health Commercial	$19.88
Rate for Payer: PACE Medicare	$12.59
Rate for Payer: PACE SWMI	$13.25
Rate for Payer: PHP Commercial	$30.95
Rate for Payer: PHP Medicare Advantage	$13.25
Rate for Payer: Priority Health Choice Medicaid	$7.10
Rate for Payer: Priority Health Cigna Priority Health	$23.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.64
Rate for Payer: Priority Health Medicare	$13.25
Rate for Payer: Priority Health Narrow Network	$10.91
Rate for Payer: Priority Health SBD	$22.94
Rate for Payer: Railroad Medicare Medicare	$13.25
Rate for Payer: UHC All Payor (Choice/PPO)	$15.90
Rate for Payer: UHC Dual Complete DSNP	$13.25
Rate for Payer: UHC Medicare Advantage	$13.25
Rate for Payer: UHCCP Medicaid	$7.46
Rate for Payer: VA VA	$13.25

HC DILANTIN LEVEL

Facility

$36.41

Service Code	CPT 80185
Hospital Charge Code	30100039
Hospital Revenue Code	301
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$32.77
Rate for Payer: Aetna Commercial	$30.95
Rate for Payer: Aetna New Business (MI Preferred)	$23.67
Rate for Payer: Cash Price	$29.13
Rate for Payer: Cofinity Commercial	$25.49
Rate for Payer: Cofinity Commercial	$31.31
Rate for Payer: Cofinity Medicare Advantage	$25.49
Rate for Payer: Encore Health Key Benefits Commercial	$29.13
Rate for Payer: Healthscope Commercial	$32.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.95
Rate for Payer: PHP Commercial	$30.95
Rate for Payer: Priority Health Cigna Priority Health	$23.67
Rate for Payer: Priority Health SBD	$22.94

HC DILANTIN/PHENYTOIN FREE LEVEL

Facility

$105.67

Service Code	CPT 80186
Hospital Charge Code	30100040
Hospital Revenue Code	301
Min. Negotiated Rate	$66.57
Max. Negotiated Rate	$95.10
Rate for Payer: Aetna Commercial	$89.82
Rate for Payer: Aetna New Business (MI Preferred)	$68.69
Rate for Payer: Cash Price	$84.54
Rate for Payer: Cofinity Commercial	$73.97
Rate for Payer: Cofinity Commercial	$90.88
Rate for Payer: Cofinity Medicare Advantage	$73.97
Rate for Payer: Encore Health Key Benefits Commercial	$84.54
Rate for Payer: Healthscope Commercial	$95.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.82
Rate for Payer: PHP Commercial	$89.82
Rate for Payer: Priority Health Cigna Priority Health	$68.69
Rate for Payer: Priority Health SBD	$66.57

Know your out-of-pocket cost for care.

All Charges