Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC MILK IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200047
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health SBD	$15.68

HC MILK IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200047
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$15.68
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC MINI BAL PROCEDURE

Facility

$303.20

Service Code	CPT 94799
Hospital Charge Code	41000014
Hospital Revenue Code	410
Min. Negotiated Rate	$76.03
Max. Negotiated Rate	$436.07
Rate for Payer: Aetna Commercial	$257.72
Rate for Payer: Aetna Medicare	$144.55
Rate for Payer: Aetna New Business (MI Preferred)	$197.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$173.74
Rate for Payer: Amish Plain Church Group Commercial	$173.74
Rate for Payer: BCBS Complete	$79.84
Rate for Payer: BCBS MAPPO	$138.99
Rate for Payer: BCBS Trust/PPO	$422.58
Rate for Payer: BCN Medicare Advantage	$138.99
Rate for Payer: Cash Price	$242.56
Rate for Payer: Cash Price	$242.56
Rate for Payer: Cofinity Commercial	$212.24
Rate for Payer: Cofinity Commercial	$260.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$138.99
Rate for Payer: Healthscope Commercial	$272.88
Rate for Payer: Mclaren Medicaid	$76.03
Rate for Payer: Mclaren Medicare	$138.99
Rate for Payer: Meridian Medicaid	$79.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$145.94
Rate for Payer: MI Amish Medical Board Commercial	$159.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.72
Rate for Payer: PACE Medicare	$132.04
Rate for Payer: PACE SWMI	$138.99
Rate for Payer: PHP Commercial	$257.72
Rate for Payer: PHP Medicare Advantage	$138.99
Rate for Payer: Priority Health Choice Medicaid	$76.03
Rate for Payer: Priority Health Cigna Priority Health	$212.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$436.07
Rate for Payer: Priority Health Medicare	$138.99
Rate for Payer: Priority Health Narrow Network	$348.85
Rate for Payer: Priority Health SBD	$191.02
Rate for Payer: Railroad Medicare Medicare	$138.99
Rate for Payer: UHC Dual Complete DSNP	$138.99
Rate for Payer: UHC Medicare Advantage	$143.16
Rate for Payer: VA VA	$138.99

HC MINI BAL PROCEDURE

Facility

$303.20

Service Code	CPT 94799
Hospital Charge Code	41000014
Hospital Revenue Code	410
Min. Negotiated Rate	$191.02
Max. Negotiated Rate	$272.88
Rate for Payer: Aetna Commercial	$257.72
Rate for Payer: Aetna New Business (MI Preferred)	$197.08
Rate for Payer: Cash Price	$242.56
Rate for Payer: Cofinity Commercial	$212.24
Rate for Payer: Cofinity Commercial	$260.75
Rate for Payer: Healthscope Commercial	$272.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.72
Rate for Payer: PHP Commercial	$257.72
Rate for Payer: Priority Health Cigna Priority Health	$212.24
Rate for Payer: Priority Health SBD	$191.02

HC MINIMUM BACTERICIDAL CONCENTRA

Facility

$30.00

Service Code	CPT 87188
Hospital Charge Code	30600103
Hospital Revenue Code	306
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$19.50
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cofinity Commercial	$21.00
Rate for Payer: Cofinity Commercial	$25.80
Rate for Payer: Healthscope Commercial	$27.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.50
Rate for Payer: PHP Commercial	$25.50
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health SBD	$18.90

HC MINIMUM BACTERICIDAL CONCENTRA

Facility

$30.00

Service Code	CPT 87188
Hospital Charge Code	30600103
Hospital Revenue Code	306
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna Medicare	$6.91
Rate for Payer: Aetna New Business (MI Preferred)	$19.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$8.30
Rate for Payer: Amish Plain Church Group Commercial	$8.30
Rate for Payer: BCBS Complete	$3.81
Rate for Payer: BCBS MAPPO	$6.64
Rate for Payer: BCBS Trust/PPO	$5.20
Rate for Payer: BCN Medicare Advantage	$6.64
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cofinity Commercial	$25.80
Rate for Payer: Cofinity Commercial	$21.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.64
Rate for Payer: Healthscope Commercial	$27.00
Rate for Payer: Mclaren Medicaid	$3.63
Rate for Payer: Mclaren Medicare	$6.64
Rate for Payer: Meridian Medicaid	$3.81
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6.97
Rate for Payer: MI Amish Medical Board Commercial	$7.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.50
Rate for Payer: PACE Medicare	$6.31
Rate for Payer: PACE SWMI	$6.64
Rate for Payer: PHP Commercial	$25.50
Rate for Payer: PHP Medicare Advantage	$6.64
Rate for Payer: Priority Health Choice Medicaid	$3.63
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health Medicare	$6.64
Rate for Payer: Priority Health SBD	$18.90
Rate for Payer: Railroad Medicare Medicare	$6.64
Rate for Payer: UHC All Payor (Choice/PPO)	$7.97
Rate for Payer: UHC Core	$11.28
Rate for Payer: UHC Dual Complete DSNP	$6.64
Rate for Payer: UHC Exchange	$6.64
Rate for Payer: UHC Medicare Advantage	$6.84
Rate for Payer: VA VA	$6.64

HC MINIMUM LETHAL CONCENTRATION (MLC)

Facility

$45.90

Service Code	CPT 87187
Hospital Charge Code	30600102
Hospital Revenue Code	306
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$32.13
Rate for Payer: Priority Health SBD	$28.92

HC MINIMUM LETHAL CONCENTRATION (MLC)

Facility

$45.90

Service Code	CPT 87187
Hospital Charge Code	30600102
Hospital Revenue Code	306
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$50.21
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna Medicare	$41.78
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$50.21
Rate for Payer: Amish Plain Church Group Commercial	$50.21
Rate for Payer: BCBS Complete	$23.07
Rate for Payer: BCBS MAPPO	$40.17
Rate for Payer: BCBS Trust/PPO	$31.46
Rate for Payer: BCN Medicare Advantage	$40.17
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$40.17
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Mclaren Medicaid	$21.97
Rate for Payer: Mclaren Medicare	$40.17
Rate for Payer: Meridian Medicaid	$23.07
Rate for Payer: Meridian Wellcare - Medicare Advantage	$42.18
Rate for Payer: MI Amish Medical Board Commercial	$46.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.02
Rate for Payer: PACE Medicare	$38.16
Rate for Payer: PACE SWMI	$40.17
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: PHP Medicare Advantage	$40.17
Rate for Payer: Priority Health Choice Medicaid	$21.97
Rate for Payer: Priority Health Cigna Priority Health	$32.13
Rate for Payer: Priority Health Medicare	$40.17
Rate for Payer: Priority Health SBD	$28.92
Rate for Payer: Railroad Medicare Medicare	$40.17
Rate for Payer: UHC All Payor (Choice/PPO)	$48.20
Rate for Payer: UHC Core	$17.62
Rate for Payer: UHC Dual Complete DSNP	$40.17
Rate for Payer: UHC Exchange	$40.17
Rate for Payer: UHC Medicare Advantage	$41.38
Rate for Payer: VA VA	$40.17

HC MINOR PROCEDURE WO SEDATION

Facility

$521.12

Hospital Charge Code	36000076
Hospital Revenue Code	360
Min. Negotiated Rate	$328.31
Max. Negotiated Rate	$469.01
Rate for Payer: Aetna Commercial	$442.95
Rate for Payer: Aetna New Business (MI Preferred)	$338.73
Rate for Payer: Cash Price	$416.90
Rate for Payer: Cofinity Commercial	$364.78
Rate for Payer: Cofinity Commercial	$448.16
Rate for Payer: Healthscope Commercial	$469.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$442.95
Rate for Payer: PHP Commercial	$442.95
Rate for Payer: Priority Health Cigna Priority Health	$364.78
Rate for Payer: Priority Health SBD	$328.31

HC MINOR PROCEDURE WO SEDATION

Facility

$521.12

Hospital Charge Code	36000076
Hospital Revenue Code	360
Min. Negotiated Rate	$208.45
Max. Negotiated Rate	$469.01
Rate for Payer: Aetna Commercial	$442.95
Rate for Payer: Aetna New Business (MI Preferred)	$338.73
Rate for Payer: BCBS Complete	$208.45
Rate for Payer: Cash Price	$416.90
Rate for Payer: Cofinity Commercial	$364.78
Rate for Payer: Cofinity Commercial	$448.16
Rate for Payer: Healthscope Commercial	$469.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$442.95
Rate for Payer: PHP Commercial	$442.95
Rate for Payer: Priority Health Cigna Priority Health	$364.78
Rate for Payer: Priority Health SBD	$328.31

HC MINOR PROCEDURE W SEDATION

Facility

$603.84

Hospital Charge Code	36000075
Hospital Revenue Code	360
Min. Negotiated Rate	$241.54
Max. Negotiated Rate	$543.46
Rate for Payer: Aetna Commercial	$513.26
Rate for Payer: Aetna New Business (MI Preferred)	$392.50
Rate for Payer: BCBS Complete	$241.54
Rate for Payer: Cash Price	$483.07
Rate for Payer: Cofinity Commercial	$422.69
Rate for Payer: Cofinity Commercial	$519.30
Rate for Payer: Healthscope Commercial	$543.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$513.26
Rate for Payer: PHP Commercial	$513.26
Rate for Payer: Priority Health Cigna Priority Health	$422.69
Rate for Payer: Priority Health SBD	$380.42

HC MINOR PROCEDURE W SEDATION

Facility

$603.84

Hospital Charge Code	36000075
Hospital Revenue Code	360
Min. Negotiated Rate	$380.42
Max. Negotiated Rate	$543.46
Rate for Payer: Aetna Commercial	$513.26
Rate for Payer: Aetna New Business (MI Preferred)	$392.50
Rate for Payer: Cash Price	$483.07
Rate for Payer: Cofinity Commercial	$422.69
Rate for Payer: Cofinity Commercial	$519.30
Rate for Payer: Healthscope Commercial	$543.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$513.26
Rate for Payer: PHP Commercial	$513.26
Rate for Payer: Priority Health Cigna Priority Health	$422.69
Rate for Payer: Priority Health SBD	$380.42

HC MITOTANE (LYSODREN)

Facility

$115.22

Service Code	CPT 80299
Hospital Charge Code	30100731
Hospital Revenue Code	301
Min. Negotiated Rate	$72.59
Max. Negotiated Rate	$103.70
Rate for Payer: Aetna Commercial	$97.94
Rate for Payer: Aetna New Business (MI Preferred)	$74.89
Rate for Payer: Cash Price	$92.18
Rate for Payer: Cofinity Commercial	$80.65
Rate for Payer: Cofinity Commercial	$99.09
Rate for Payer: Healthscope Commercial	$103.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.94
Rate for Payer: PHP Commercial	$97.94
Rate for Payer: Priority Health Cigna Priority Health	$80.65
Rate for Payer: Priority Health SBD	$72.59

HC MITOTANE (LYSODREN)

Facility

$115.22

Service Code	CPT 80299
Hospital Charge Code	30100731
Hospital Revenue Code	301
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$103.70
Rate for Payer: Aetna Commercial	$97.94
Rate for Payer: Aetna Medicare	$19.39
Rate for Payer: Aetna New Business (MI Preferred)	$74.89
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	$10.71
Rate for Payer: BCBS MAPPO	$18.64
Rate for Payer: BCBS Trust/PPO	$14.60
Rate for Payer: BCN Medicare Advantage	$18.64
Rate for Payer: Cash Price	$92.18
Rate for Payer: Cash Price	$92.18
Rate for Payer: Cofinity Commercial	$99.09
Rate for Payer: Cofinity Commercial	$80.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.64
Rate for Payer: Healthscope Commercial	$103.70
Rate for Payer: Mclaren Medicaid	$10.20
Rate for Payer: Mclaren Medicare	$18.64
Rate for Payer: Meridian Medicaid	$10.71
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.57
Rate for Payer: MI Amish Medical Board Commercial	$21.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.94
Rate for Payer: PACE Medicare	$17.71
Rate for Payer: PACE SWMI	$18.64
Rate for Payer: PHP Commercial	$97.94
Rate for Payer: PHP Medicare Advantage	$18.64
Rate for Payer: Priority Health Choice Medicaid	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$80.65
Rate for Payer: Priority Health Medicare	$18.64
Rate for Payer: Priority Health SBD	$72.59
Rate for Payer: Railroad Medicare Medicare	$18.64
Rate for Payer: UHC All Payor (Choice/PPO)	$22.37
Rate for Payer: UHC Core	$23.28
Rate for Payer: UHC Dual Complete DSNP	$18.64
Rate for Payer: UHC Exchange	$18.64
Rate for Payer: UHC Medicare Advantage	$19.20
Rate for Payer: VA VA	$18.64

HC MMR VACCINE

Facility

$107.10

Service Code	CPT 90707
Hospital Charge Code	63600027
Hospital Revenue Code	636
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna New Business (MI Preferred)	$69.62
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Commercial	$74.97
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.04
Rate for Payer: PHP Commercial	$91.04
Rate for Payer: Priority Health Cigna Priority Health	$74.97
Rate for Payer: Priority Health SBD	$67.47

HC MMR VACCINE

Facility

$107.10

Service Code	CPT 90707
Hospital Charge Code	63600027
Hospital Revenue Code	636
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$256.63
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna New Business (MI Preferred)	$69.62
Rate for Payer: BCBS Complete	$42.84
Rate for Payer: BCBS Trust/PPO	$256.63
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Cofinity Commercial	$74.97
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.04
Rate for Payer: PHP Commercial	$91.04
Rate for Payer: Priority Health Cigna Priority Health	$74.97
Rate for Payer: Priority Health SBD	$67.47

HC MNT GROUP 2ND REFERRAL 30 MIN

Facility

$50.59

Service Code	HCPCS G0271
Hospital Charge Code	94200009
Hospital Revenue Code	942
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$45.53
Rate for Payer: Aetna Commercial	$43.00
Rate for Payer: Aetna New Business (MI Preferred)	$32.88
Rate for Payer: BCBS Complete	$20.24
Rate for Payer: BCBS Trust/PPO	$36.84
Rate for Payer: Cash Price	$40.47
Rate for Payer: Cash Price	$40.47
Rate for Payer: Cofinity Commercial	$43.51
Rate for Payer: Cofinity Commercial	$35.41
Rate for Payer: Healthscope Commercial	$45.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.00
Rate for Payer: PHP Commercial	$43.00
Rate for Payer: Priority Health Cigna Priority Health	$35.41
Rate for Payer: Priority Health SBD	$31.87
Rate for Payer: UHC All Payor (Choice/PPO)	$16.57
Rate for Payer: UHC Exchange	$15.06

HC MNT GROUP 2ND REFERRAL 30 MIN

Facility

$50.59

Service Code	HCPCS G0271
Hospital Charge Code	94200009
Hospital Revenue Code	942
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$45.53
Rate for Payer: Aetna Commercial	$43.00
Rate for Payer: Aetna New Business (MI Preferred)	$32.88
Rate for Payer: Cash Price	$40.47
Rate for Payer: Cofinity Commercial	$35.41
Rate for Payer: Cofinity Commercial	$43.51
Rate for Payer: Healthscope Commercial	$45.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.00
Rate for Payer: PHP Commercial	$43.00
Rate for Payer: Priority Health Cigna Priority Health	$35.41
Rate for Payer: Priority Health SBD	$31.87

HC MNT GROUP 30 MIN

Facility

$59.34

Service Code	CPT 97804
Hospital Charge Code	94200004
Hospital Revenue Code	942
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$53.41
Rate for Payer: Aetna Commercial	$50.44
Rate for Payer: Aetna New Business (MI Preferred)	$38.57
Rate for Payer: BCBS Complete	$23.74
Rate for Payer: BCBS Trust/PPO	$36.84
Rate for Payer: Cash Price	$47.47
Rate for Payer: Cash Price	$47.47
Rate for Payer: Cofinity Commercial	$51.03
Rate for Payer: Cofinity Commercial	$41.54
Rate for Payer: Healthscope Commercial	$53.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.44
Rate for Payer: PHP Commercial	$50.44
Rate for Payer: Priority Health Cigna Priority Health	$41.54
Rate for Payer: Priority Health SBD	$37.38
Rate for Payer: UHC All Payor (Choice/PPO)	$16.57
Rate for Payer: UHC Exchange	$15.06

HC MNT GROUP 30 MIN

Facility

$59.34

Service Code	CPT 97804
Hospital Charge Code	94200004
Hospital Revenue Code	942
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$53.41
Rate for Payer: Aetna Commercial	$50.44
Rate for Payer: Aetna New Business (MI Preferred)	$38.57
Rate for Payer: Cash Price	$47.47
Rate for Payer: Cofinity Commercial	$41.54
Rate for Payer: Cofinity Commercial	$51.03
Rate for Payer: Healthscope Commercial	$53.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.44
Rate for Payer: PHP Commercial	$50.44
Rate for Payer: Priority Health Cigna Priority Health	$41.54
Rate for Payer: Priority Health SBD	$37.38

HC MNT INITIAL 15 MIN

Facility

$135.94

Service Code	CPT 97802
Hospital Charge Code	94200002
Hospital Revenue Code	942
Min. Negotiated Rate	$31.11
Max. Negotiated Rate	$122.35
Rate for Payer: Aetna Commercial	$115.55
Rate for Payer: Aetna New Business (MI Preferred)	$88.36
Rate for Payer: BCBS Complete	$54.38
Rate for Payer: BCBS Trust/PPO	$84.44
Rate for Payer: Cash Price	$108.75
Rate for Payer: Cash Price	$108.75
Rate for Payer: Cofinity Commercial	$95.16
Rate for Payer: Cofinity Commercial	$116.91
Rate for Payer: Healthscope Commercial	$122.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$115.55
Rate for Payer: PHP Commercial	$115.55
Rate for Payer: Priority Health Cigna Priority Health	$95.16
Rate for Payer: Priority Health SBD	$85.64
Rate for Payer: UHC All Payor (Choice/PPO)	$34.22
Rate for Payer: UHC Exchange	$31.11

HC MNT INITIAL 15 MIN

Facility

$135.94

Service Code	CPT 97802
Hospital Charge Code	94200002
Hospital Revenue Code	942
Min. Negotiated Rate	$85.64
Max. Negotiated Rate	$122.35
Rate for Payer: Aetna Commercial	$115.55
Rate for Payer: Aetna New Business (MI Preferred)	$88.36
Rate for Payer: Cash Price	$108.75
Rate for Payer: Cofinity Commercial	$116.91
Rate for Payer: Cofinity Commercial	$95.16
Rate for Payer: Healthscope Commercial	$122.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$115.55
Rate for Payer: PHP Commercial	$115.55
Rate for Payer: Priority Health Cigna Priority Health	$95.16
Rate for Payer: Priority Health SBD	$85.64

HC MNT REASSESS & INTERVENT 15 MIN

Facility

$120.16

Service Code	CPT 97803
Hospital Charge Code	94200003
Hospital Revenue Code	942
Min. Negotiated Rate	$75.70
Max. Negotiated Rate	$108.14
Rate for Payer: Aetna Commercial	$102.14
Rate for Payer: Aetna New Business (MI Preferred)	$78.10
Rate for Payer: Cash Price	$96.13
Rate for Payer: Cofinity Commercial	$103.34
Rate for Payer: Cofinity Commercial	$84.11
Rate for Payer: Healthscope Commercial	$108.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.14
Rate for Payer: PHP Commercial	$102.14
Rate for Payer: Priority Health Cigna Priority Health	$84.11
Rate for Payer: Priority Health SBD	$75.70

HC MNT REASSESS & INTERVENT 15 MIN

Facility

$120.16

Service Code	CPT 97803
Hospital Charge Code	94200003
Hospital Revenue Code	942
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$108.14
Rate for Payer: Aetna Commercial	$102.14
Rate for Payer: Aetna New Business (MI Preferred)	$78.10
Rate for Payer: BCBS Complete	$48.06
Rate for Payer: BCBS Trust/PPO	$75.23
Rate for Payer: Cash Price	$96.13
Rate for Payer: Cash Price	$96.13
Rate for Payer: Cofinity Commercial	$84.11
Rate for Payer: Cofinity Commercial	$103.34
Rate for Payer: Healthscope Commercial	$108.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.14
Rate for Payer: PHP Commercial	$102.14
Rate for Payer: Priority Health Cigna Priority Health	$84.11
Rate for Payer: Priority Health SBD	$75.70
Rate for Payer: UHC All Payor (Choice/PPO)	$29.17
Rate for Payer: UHC Exchange	$26.52

HC MOG FACS, S

Facility

$525.00

Service Code	CPT 86255
Hospital Charge Code	30200476
Hospital Revenue Code	302
Min. Negotiated Rate	$330.75
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Commercial	$446.25
Rate for Payer: Aetna New Business (MI Preferred)	$341.25
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cofinity Commercial	$451.50
Rate for Payer: Cofinity Commercial	$367.50
Rate for Payer: Healthscope Commercial	$472.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$446.25
Rate for Payer: PHP Commercial	$446.25
Rate for Payer: Priority Health Cigna Priority Health	$367.50
Rate for Payer: Priority Health SBD	$330.75

Know your out-of-pocket cost for care.

All Charges