Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DILATOR SIZE 12

Facility

$34.57

Hospital Charge Code	27000055
Hospital Revenue Code	270
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$31.11
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna New Business (MI Preferred)	$22.47
Rate for Payer: Cash Price	$27.66
Rate for Payer: Cofinity Commercial	$24.20
Rate for Payer: Cofinity Commercial	$29.73
Rate for Payer: Cofinity Medicare Advantage	$24.20
Rate for Payer: Encore Health Key Benefits Commercial	$27.66
Rate for Payer: Healthscope Commercial	$31.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.38
Rate for Payer: PHP Commercial	$29.38
Rate for Payer: Priority Health Cigna Priority Health	$22.47
Rate for Payer: Priority Health SBD	$21.78

HC DILATOR SIZE 7

Facility

$25.30

Hospital Charge Code	27000056
Hospital Revenue Code	270
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$22.77
Rate for Payer: Aetna Commercial	$21.50
Rate for Payer: Aetna Medicare	$12.65
Rate for Payer: Aetna New Business (MI Preferred)	$16.45
Rate for Payer: BCBS Complete	$10.12
Rate for Payer: Cash Price	$20.24
Rate for Payer: Cofinity Commercial	$17.71
Rate for Payer: Cofinity Commercial	$21.76
Rate for Payer: Cofinity Medicare Advantage	$17.71
Rate for Payer: Encore Health Key Benefits Commercial	$20.24
Rate for Payer: Healthscope Commercial	$22.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.50
Rate for Payer: PHP Commercial	$21.50
Rate for Payer: Priority Health Cigna Priority Health	$16.45
Rate for Payer: Priority Health SBD	$15.94

HC DILATOR SIZE 7

Facility

$25.30

Hospital Charge Code	27000056
Hospital Revenue Code	270
Min. Negotiated Rate	$15.94
Max. Negotiated Rate	$22.77
Rate for Payer: Aetna Commercial	$21.50
Rate for Payer: Aetna New Business (MI Preferred)	$16.45
Rate for Payer: Cash Price	$20.24
Rate for Payer: Cofinity Commercial	$17.71
Rate for Payer: Cofinity Commercial	$21.76
Rate for Payer: Cofinity Medicare Advantage	$17.71
Rate for Payer: Encore Health Key Benefits Commercial	$20.24
Rate for Payer: Healthscope Commercial	$22.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.50
Rate for Payer: PHP Commercial	$21.50
Rate for Payer: Priority Health Cigna Priority Health	$16.45
Rate for Payer: Priority Health SBD	$15.94

HC DILATOR SIZE 9

Facility

$25.30

Hospital Charge Code	27000057
Hospital Revenue Code	270
Min. Negotiated Rate	$15.94
Max. Negotiated Rate	$22.77
Rate for Payer: Aetna Commercial	$21.50
Rate for Payer: Aetna New Business (MI Preferred)	$16.45
Rate for Payer: Cash Price	$20.24
Rate for Payer: Cofinity Commercial	$17.71
Rate for Payer: Cofinity Commercial	$21.76
Rate for Payer: Cofinity Medicare Advantage	$17.71
Rate for Payer: Encore Health Key Benefits Commercial	$20.24
Rate for Payer: Healthscope Commercial	$22.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.50
Rate for Payer: PHP Commercial	$21.50
Rate for Payer: Priority Health Cigna Priority Health	$16.45
Rate for Payer: Priority Health SBD	$15.94

HC DILATOR SIZE 9

Facility

$25.30

Hospital Charge Code	27000057
Hospital Revenue Code	270
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$22.77
Rate for Payer: Aetna Commercial	$21.50
Rate for Payer: Aetna Medicare	$12.65
Rate for Payer: Aetna New Business (MI Preferred)	$16.45
Rate for Payer: BCBS Complete	$10.12
Rate for Payer: Cash Price	$20.24
Rate for Payer: Cofinity Commercial	$17.71
Rate for Payer: Cofinity Commercial	$21.76
Rate for Payer: Cofinity Medicare Advantage	$17.71
Rate for Payer: Encore Health Key Benefits Commercial	$20.24
Rate for Payer: Healthscope Commercial	$22.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.50
Rate for Payer: PHP Commercial	$21.50
Rate for Payer: Priority Health Cigna Priority Health	$16.45
Rate for Payer: Priority Health SBD	$15.94

HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS

Facility

$4,567.36

Service Code	CPT 50437
Hospital Charge Code	32000329
Hospital Revenue Code	320
Min. Negotiated Rate	$1,802.95
Max. Negotiated Rate	$9,468.51
Rate for Payer: Aetna Commercial	$3,882.26
Rate for Payer: Aetna Medicare	$3,498.26
Rate for Payer: Aetna New Business (MI Preferred)	$2,968.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,204.64
Rate for Payer: Amish Plain Church Group Commercial	$4,204.64
Rate for Payer: BCBS Complete	$1,893.10
Rate for Payer: BCBS MAPPO	$3,363.71
Rate for Payer: BCN Medicare Advantage	$3,363.71
Rate for Payer: Cash Price	$3,653.89
Rate for Payer: Cash Price	$3,653.89
Rate for Payer: Cofinity Commercial	$3,927.93
Rate for Payer: Cofinity Commercial	$3,197.15
Rate for Payer: Cofinity Medicare Advantage	$3,197.15
Rate for Payer: Encore Health Key Benefits Commercial	$3,653.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,363.71
Rate for Payer: Healthscope Commercial	$4,110.62
Rate for Payer: Mclaren Medicaid	$1,802.95
Rate for Payer: Mclaren Medicare	$3,363.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,531.90
Rate for Payer: Meridian Medicaid	$1,893.10
Rate for Payer: MI Amish Medical Board Commercial	$3,868.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,882.26
Rate for Payer: PACE Medicare	$3,195.52
Rate for Payer: PACE SWMI	$3,363.71
Rate for Payer: PHP Commercial	$3,882.26
Rate for Payer: PHP Medicare Advantage	$3,363.71
Rate for Payer: Priority Health Choice Medicaid	$1,802.95
Rate for Payer: Priority Health Cigna Priority Health	$2,968.78
Rate for Payer: Priority Health Medicare	$3,363.71
Rate for Payer: Priority Health SBD	$2,877.44
Rate for Payer: Railroad Medicare Medicare	$3,363.71
Rate for Payer: UHC All Payor (Choice/PPO)	$9,468.51
Rate for Payer: UHC Core	$3,379.85
Rate for Payer: UHC Dual Complete DSNP	$3,363.71
Rate for Payer: UHC Exchange	$3,379.85
Rate for Payer: UHC Medicare Advantage	$3,363.71
Rate for Payer: UHCCP Medicaid	$1,893.77
Rate for Payer: VA VA	$3,363.71

HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS

Facility

$4,567.36

Service Code	CPT 50437
Hospital Charge Code	32000329
Hospital Revenue Code	320
Min. Negotiated Rate	$2,877.44
Max. Negotiated Rate	$4,110.62
Rate for Payer: Aetna Commercial	$3,882.26
Rate for Payer: Aetna New Business (MI Preferred)	$2,968.78
Rate for Payer: Cash Price	$3,653.89
Rate for Payer: Cofinity Commercial	$3,197.15
Rate for Payer: Cofinity Commercial	$3,927.93
Rate for Payer: Cofinity Medicare Advantage	$3,197.15
Rate for Payer: Encore Health Key Benefits Commercial	$3,653.89
Rate for Payer: Healthscope Commercial	$4,110.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,882.26
Rate for Payer: PHP Commercial	$3,882.26
Rate for Payer: Priority Health Cigna Priority Health	$2,968.78
Rate for Payer: Priority Health SBD	$2,877.44

HC DIPHTHERIA/TETANUS AB PANEL, S

Facility

$45.39

Service Code	CPT 86317
Hospital Charge Code	30200506
Hospital Revenue Code	302
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$42.20
Rate for Payer: Aetna Commercial	$38.58
Rate for Payer: Aetna Medicare	$15.59
Rate for Payer: Aetna New Business (MI Preferred)	$29.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.74
Rate for Payer: Amish Plain Church Group Commercial	$18.74
Rate for Payer: BCBS Complete	$8.44
Rate for Payer: BCBS MAPPO	$14.99
Rate for Payer: BCN Medicare Advantage	$14.99
Rate for Payer: Cash Price	$36.31
Rate for Payer: Cash Price	$36.31
Rate for Payer: Cofinity Commercial	$39.04
Rate for Payer: Cofinity Commercial	$31.77
Rate for Payer: Cofinity Medicare Advantage	$31.77
Rate for Payer: Encore Health Key Benefits Commercial	$36.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.99
Rate for Payer: Healthscope Commercial	$40.85
Rate for Payer: Mclaren Medicaid	$8.03
Rate for Payer: Mclaren Medicare	$14.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.74
Rate for Payer: Meridian Medicaid	$8.44
Rate for Payer: MI Amish Medical Board Commercial	$17.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.58
Rate for Payer: PACE Medicare	$14.24
Rate for Payer: PACE SWMI	$14.99
Rate for Payer: PHP Commercial	$38.58
Rate for Payer: PHP Medicare Advantage	$14.99
Rate for Payer: Priority Health Choice Medicaid	$8.03
Rate for Payer: Priority Health Cigna Priority Health	$29.50
Rate for Payer: Priority Health Medicare	$14.99
Rate for Payer: Priority Health SBD	$28.60
Rate for Payer: Railroad Medicare Medicare	$14.99
Rate for Payer: UHC All Payor (Choice/PPO)	$42.20
Rate for Payer: UHC Dual Complete DSNP	$14.99
Rate for Payer: UHC Medicare Advantage	$14.99
Rate for Payer: UHCCP Medicaid	$8.44
Rate for Payer: VA VA	$14.99

HC DIPHTHERIA/TETANUS AB PANEL, S

Facility

$45.39

Service Code	CPT 86317
Hospital Charge Code	30200506
Hospital Revenue Code	302
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$40.85
Rate for Payer: Aetna Commercial	$38.58
Rate for Payer: Aetna New Business (MI Preferred)	$29.50
Rate for Payer: Cash Price	$36.31
Rate for Payer: Cofinity Commercial	$31.77
Rate for Payer: Cofinity Commercial	$39.04
Rate for Payer: Cofinity Medicare Advantage	$31.77
Rate for Payer: Encore Health Key Benefits Commercial	$36.31
Rate for Payer: Healthscope Commercial	$40.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.58
Rate for Payer: PHP Commercial	$38.58
Rate for Payer: Priority Health Cigna Priority Health	$29.50
Rate for Payer: Priority Health SBD	$28.60

HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM

Facility

$123.60

Service Code	CPT 90698
Hospital Charge Code	63600080
Hospital Revenue Code	636
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$111.24
Rate for Payer: Aetna Commercial	$105.06
Rate for Payer: Aetna Medicare	$61.80
Rate for Payer: Aetna New Business (MI Preferred)	$80.34
Rate for Payer: BCBS Complete	$49.44
Rate for Payer: Cash Price	$98.88
Rate for Payer: Cofinity Commercial	$106.30
Rate for Payer: Cofinity Commercial	$86.52
Rate for Payer: Cofinity Medicare Advantage	$86.52
Rate for Payer: Encore Health Key Benefits Commercial	$98.88
Rate for Payer: Healthscope Commercial	$111.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.06
Rate for Payer: PHP Commercial	$105.06
Rate for Payer: Priority Health Cigna Priority Health	$80.34
Rate for Payer: Priority Health SBD	$77.87

HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM

Facility

$123.60

Service Code	CPT 90698
Hospital Charge Code	63600080
Hospital Revenue Code	636
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$111.24
Rate for Payer: Aetna Commercial	$105.06
Rate for Payer: Aetna New Business (MI Preferred)	$80.34
Rate for Payer: Cash Price	$98.88
Rate for Payer: Cofinity Commercial	$106.30
Rate for Payer: Cofinity Commercial	$86.52
Rate for Payer: Cofinity Medicare Advantage	$86.52
Rate for Payer: Encore Health Key Benefits Commercial	$98.88
Rate for Payer: Healthscope Commercial	$111.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.06
Rate for Payer: PHP Commercial	$105.06
Rate for Payer: Priority Health Cigna Priority Health	$80.34
Rate for Payer: Priority Health SBD	$77.87

HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM

Facility

$53.78

Service Code	CPT 90700
Hospital Charge Code	63600081
Hospital Revenue Code	636
Min. Negotiated Rate	$33.88
Max. Negotiated Rate	$48.40
Rate for Payer: Aetna Commercial	$45.71
Rate for Payer: Aetna New Business (MI Preferred)	$34.96
Rate for Payer: Cash Price	$43.02
Rate for Payer: Cofinity Commercial	$37.65
Rate for Payer: Cofinity Commercial	$46.25
Rate for Payer: Cofinity Medicare Advantage	$37.65
Rate for Payer: Encore Health Key Benefits Commercial	$43.02
Rate for Payer: Healthscope Commercial	$48.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.71
Rate for Payer: PHP Commercial	$45.71
Rate for Payer: Priority Health Cigna Priority Health	$34.96
Rate for Payer: Priority Health SBD	$33.88

HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM

Facility

$53.78

Service Code	CPT 90700
Hospital Charge Code	63600081
Hospital Revenue Code	636
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$48.40
Rate for Payer: Aetna Commercial	$45.71
Rate for Payer: Aetna Medicare	$26.89
Rate for Payer: Aetna New Business (MI Preferred)	$34.96
Rate for Payer: BCBS Complete	$21.51
Rate for Payer: Cash Price	$43.02
Rate for Payer: Cofinity Commercial	$37.65
Rate for Payer: Cofinity Commercial	$46.25
Rate for Payer: Cofinity Medicare Advantage	$37.65
Rate for Payer: Encore Health Key Benefits Commercial	$43.02
Rate for Payer: Healthscope Commercial	$48.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.71
Rate for Payer: PHP Commercial	$45.71
Rate for Payer: Priority Health Cigna Priority Health	$34.96
Rate for Payer: Priority Health SBD	$33.88

HC DIRECT ADMIT TO OBS

Facility

$154.83

Service Code	HCPCS G0379
Hospital Charge Code	76200001
Hospital Revenue Code	762
Min. Negotiated Rate	$97.54
Max. Negotiated Rate	$1,683.14
Rate for Payer: Aetna Commercial	$131.61
Rate for Payer: Aetna Medicare	$621.86
Rate for Payer: Aetna New Business (MI Preferred)	$100.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$747.42
Rate for Payer: Amish Plain Church Group Commercial	$747.42
Rate for Payer: BCBS Complete	$336.52
Rate for Payer: BCBS MAPPO	$597.94
Rate for Payer: BCN Medicare Advantage	$597.94
Rate for Payer: Cash Price	$123.86
Rate for Payer: Cash Price	$123.86
Rate for Payer: Cash Price	$123.86
Rate for Payer: Cofinity Commercial	$133.15
Rate for Payer: Cofinity Commercial	$108.38
Rate for Payer: Cofinity Medicare Advantage	$108.38
Rate for Payer: Encore Health Key Benefits Commercial	$123.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$597.94
Rate for Payer: Healthscope Commercial	$139.35
Rate for Payer: Mclaren Medicaid	$320.50
Rate for Payer: Mclaren Medicare	$597.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$627.84
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: MI Amish Medical Board Commercial	$687.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.61
Rate for Payer: PACE Medicare	$568.04
Rate for Payer: PACE SWMI	$597.94
Rate for Payer: PHP Commercial	$131.61
Rate for Payer: PHP Medicare Advantage	$597.94
Rate for Payer: Priority Health Choice Medicaid	$320.50
Rate for Payer: Priority Health Cigna Priority Health	$100.64
Rate for Payer: Priority Health Medicare	$597.94
Rate for Payer: Priority Health SBD	$97.54
Rate for Payer: Railroad Medicare Medicare	$597.94
Rate for Payer: UHC All Payor (Choice/PPO)	$1,683.14
Rate for Payer: UHC Core	$114.57
Rate for Payer: UHC Dual Complete DSNP	$597.94
Rate for Payer: UHC Exchange	$114.57
Rate for Payer: UHC Medicare Advantage	$597.94
Rate for Payer: UHCCP Medicaid	$336.64
Rate for Payer: VA VA	$597.94

HC DIRECT ADMIT TO OBS

Facility

$154.83

Service Code	HCPCS G0379
Hospital Charge Code	76200001
Hospital Revenue Code	762
Min. Negotiated Rate	$97.54
Max. Negotiated Rate	$139.35
Rate for Payer: Aetna Commercial	$131.61
Rate for Payer: Aetna New Business (MI Preferred)	$100.64
Rate for Payer: Cash Price	$123.86
Rate for Payer: Cofinity Commercial	$108.38
Rate for Payer: Cofinity Commercial	$133.15
Rate for Payer: Cofinity Medicare Advantage	$108.38
Rate for Payer: Encore Health Key Benefits Commercial	$123.86
Rate for Payer: Healthscope Commercial	$139.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.61
Rate for Payer: PHP Commercial	$131.61
Rate for Payer: Priority Health Cigna Priority Health	$100.64
Rate for Payer: Priority Health SBD	$97.54

HC DIRECT COOMBS

Facility

$65.65

Service Code	CPT 86880
Hospital Charge Code	30200343
Hospital Revenue Code	302
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$59.09
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna Medicare	$5.61
Rate for Payer: Aetna New Business (MI Preferred)	$42.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.74
Rate for Payer: Amish Plain Church Group Commercial	$6.74
Rate for Payer: BCBS Complete	$3.03
Rate for Payer: BCBS MAPPO	$5.39
Rate for Payer: BCN Medicare Advantage	$5.39
Rate for Payer: Cash Price	$52.52
Rate for Payer: Cash Price	$52.52
Rate for Payer: Cofinity Commercial	$56.46
Rate for Payer: Cofinity Commercial	$45.95
Rate for Payer: Cofinity Medicare Advantage	$45.95
Rate for Payer: Encore Health Key Benefits Commercial	$52.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.39
Rate for Payer: Healthscope Commercial	$59.09
Rate for Payer: Mclaren Medicaid	$2.89
Rate for Payer: Mclaren Medicare	$5.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.66
Rate for Payer: Meridian Medicaid	$3.03
Rate for Payer: MI Amish Medical Board Commercial	$6.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.80
Rate for Payer: PACE Medicare	$5.12
Rate for Payer: PACE SWMI	$5.39
Rate for Payer: PHP Commercial	$55.80
Rate for Payer: PHP Medicare Advantage	$5.39
Rate for Payer: Priority Health Choice Medicaid	$2.89
Rate for Payer: Priority Health Cigna Priority Health	$42.67
Rate for Payer: Priority Health Medicare	$5.39
Rate for Payer: Priority Health SBD	$41.36
Rate for Payer: Railroad Medicare Medicare	$5.39
Rate for Payer: UHC All Payor (Choice/PPO)	$15.17
Rate for Payer: UHC Dual Complete DSNP	$5.39
Rate for Payer: UHC Medicare Advantage	$5.39
Rate for Payer: UHCCP Medicaid	$3.03
Rate for Payer: VA VA	$5.39

HC DIRECT COOMBS

Facility

$65.65

Service Code	CPT 86880
Hospital Charge Code	30200343
Hospital Revenue Code	302
Min. Negotiated Rate	$41.36
Max. Negotiated Rate	$59.09
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna New Business (MI Preferred)	$42.67
Rate for Payer: Cash Price	$52.52
Rate for Payer: Cofinity Commercial	$45.95
Rate for Payer: Cofinity Commercial	$56.46
Rate for Payer: Cofinity Medicare Advantage	$45.95
Rate for Payer: Encore Health Key Benefits Commercial	$52.52
Rate for Payer: Healthscope Commercial	$59.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.80
Rate for Payer: PHP Commercial	$55.80
Rate for Payer: Priority Health Cigna Priority Health	$42.67
Rate for Payer: Priority Health SBD	$41.36

HC DISACCHARIDASE ANALYSIS

Facility

$153.00

Service Code	CPT 82657
Hospital Charge Code	30100755
Hospital Revenue Code	301
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC DISACCHARIDASE ANALYSIS

Facility

$153.00

Service Code	CPT 82657
Hospital Charge Code	30100755
Hospital Revenue Code	301
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna Medicare	$23.06
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$27.71
Rate for Payer: Amish Plain Church Group Commercial	$27.71
Rate for Payer: BCBS Complete	$12.48
Rate for Payer: BCBS MAPPO	$22.17
Rate for Payer: BCN Medicare Advantage	$22.17
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.17
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Mclaren Medicaid	$11.88
Rate for Payer: Mclaren Medicare	$22.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$23.28
Rate for Payer: Meridian Medicaid	$12.48
Rate for Payer: MI Amish Medical Board Commercial	$25.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PACE Medicare	$21.06
Rate for Payer: PACE SWMI	$22.17
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: PHP Medicare Advantage	$22.17
Rate for Payer: Priority Health Choice Medicaid	$11.88
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health Medicare	$22.17
Rate for Payer: Priority Health SBD	$96.39
Rate for Payer: Railroad Medicare Medicare	$22.17
Rate for Payer: UHC All Payor (Choice/PPO)	$62.41
Rate for Payer: UHC Dual Complete DSNP	$22.17
Rate for Payer: UHC Medicare Advantage	$22.17
Rate for Payer: UHCCP Medicaid	$12.48
Rate for Payer: VA VA	$22.17

HC DISASTER COVERAGE

Facility

$144.84

Hospital Charge Code	27000704
Hospital Revenue Code	270
Min. Negotiated Rate	$57.94
Max. Negotiated Rate	$130.36
Rate for Payer: Aetna Commercial	$123.11
Rate for Payer: Aetna Medicare	$72.42
Rate for Payer: Aetna New Business (MI Preferred)	$94.15
Rate for Payer: BCBS Complete	$57.94
Rate for Payer: Cash Price	$115.87
Rate for Payer: Cofinity Commercial	$101.39
Rate for Payer: Cofinity Commercial	$124.56
Rate for Payer: Cofinity Medicare Advantage	$101.39
Rate for Payer: Encore Health Key Benefits Commercial	$115.87
Rate for Payer: Healthscope Commercial	$130.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.11
Rate for Payer: PHP Commercial	$123.11
Rate for Payer: Priority Health Cigna Priority Health	$94.15
Rate for Payer: Priority Health SBD	$91.25

HC DISASTER COVERAGE

Facility

$144.84

Hospital Charge Code	27000704
Hospital Revenue Code	270
Min. Negotiated Rate	$91.25
Max. Negotiated Rate	$130.36
Rate for Payer: Aetna Commercial	$123.11
Rate for Payer: Aetna New Business (MI Preferred)	$94.15
Rate for Payer: Cash Price	$115.87
Rate for Payer: Cofinity Commercial	$101.39
Rate for Payer: Cofinity Commercial	$124.56
Rate for Payer: Cofinity Medicare Advantage	$101.39
Rate for Payer: Encore Health Key Benefits Commercial	$115.87
Rate for Payer: Healthscope Commercial	$130.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.11
Rate for Payer: PHP Commercial	$123.11
Rate for Payer: Priority Health Cigna Priority Health	$94.15
Rate for Payer: Priority Health SBD	$91.25

HC DISP FEE CONTRALATERAL BINAURAL

Facility

$484.50

Service Code	CPT V5240
Hospital Charge Code	27100022
Hospital Revenue Code	271
Min. Negotiated Rate	$305.24
Max. Negotiated Rate	$436.05
Rate for Payer: Aetna Commercial	$411.82
Rate for Payer: Aetna New Business (MI Preferred)	$314.93
Rate for Payer: Cash Price	$387.60
Rate for Payer: Cofinity Commercial	$339.15
Rate for Payer: Cofinity Commercial	$416.67
Rate for Payer: Cofinity Medicare Advantage	$339.15
Rate for Payer: Encore Health Key Benefits Commercial	$387.60
Rate for Payer: Healthscope Commercial	$436.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.82
Rate for Payer: PHP Commercial	$411.82
Rate for Payer: Priority Health Cigna Priority Health	$314.93
Rate for Payer: Priority Health SBD	$305.24

HC DISP FEE CONTRALATERAL BINAURAL

Facility

$484.50

Service Code	CPT V5240
Hospital Charge Code	27100022
Hospital Revenue Code	271
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$436.05
Rate for Payer: Aetna Commercial	$411.82
Rate for Payer: Aetna Medicare	$242.25
Rate for Payer: Aetna New Business (MI Preferred)	$314.93
Rate for Payer: BCBS Complete	$193.80
Rate for Payer: Cash Price	$387.60
Rate for Payer: Cofinity Commercial	$339.15
Rate for Payer: Cofinity Commercial	$416.67
Rate for Payer: Cofinity Medicare Advantage	$339.15
Rate for Payer: Encore Health Key Benefits Commercial	$387.60
Rate for Payer: Healthscope Commercial	$436.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.82
Rate for Payer: PHP Commercial	$411.82
Rate for Payer: Priority Health Cigna Priority Health	$314.93
Rate for Payer: Priority Health SBD	$305.24

HC DISP FEE CONTRALATERAL MONAURAL

Facility

$280.50

Service Code	CPT V5200
Hospital Charge Code	27100021
Hospital Revenue Code	271
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72

HC DISP FEE CONTRALATERAL MONAURAL

Facility

$280.50

Service Code	CPT V5200
Hospital Charge Code	27100021
Hospital Revenue Code	271
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna Medicare	$140.25
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: BCBS Complete	$112.20
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72

Know your out-of-pocket cost for care.

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