Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NEUTROPHIL OXIDATIVE BURST

Facility

$155.25

Service Code	CPT 88184
Hospital Charge Code	31000003
Hospital Revenue Code	310
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$906.83
Rate for Payer: Aetna Commercial	$131.96
Rate for Payer: Aetna Medicare	$332.63
Rate for Payer: Aetna New Business (MI Preferred)	$100.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$399.80
Rate for Payer: Amish Plain Church Group Commercial	$399.80
Rate for Payer: BCBS Complete	$183.72
Rate for Payer: BCBS MAPPO	$319.84
Rate for Payer: BCBS Trust/PPO	$91.84
Rate for Payer: BCN Medicare Advantage	$319.84
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cofinity Commercial	$133.52
Rate for Payer: Cofinity Commercial	$108.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$319.84
Rate for Payer: Healthscope Commercial	$139.72
Rate for Payer: Mclaren Medicaid	$174.95
Rate for Payer: Mclaren Medicare	$319.84
Rate for Payer: Meridian Medicaid	$183.72
Rate for Payer: Meridian Wellcare - Medicare Advantage	$335.83
Rate for Payer: MI Amish Medical Board Commercial	$367.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$131.96
Rate for Payer: PACE Medicare	$303.85
Rate for Payer: PACE SWMI	$319.84
Rate for Payer: PHP Commercial	$131.96
Rate for Payer: PHP Medicare Advantage	$319.84
Rate for Payer: Priority Health Choice Medicaid	$174.95
Rate for Payer: Priority Health Cigna Priority Health	$108.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$906.83
Rate for Payer: Priority Health Medicare	$319.84
Rate for Payer: Priority Health Narrow Network	$725.46
Rate for Payer: Priority Health SBD	$97.81
Rate for Payer: Railroad Medicare Medicare	$319.84
Rate for Payer: UHC All Payor (Choice/PPO)	$84.28
Rate for Payer: UHC Core	$20.50
Rate for Payer: UHC Dual Complete DSNP	$319.84
Rate for Payer: UHC Exchange	$76.62
Rate for Payer: UHC Medicare Advantage	$329.44
Rate for Payer: VA VA	$319.84

HC NEUTROPHIL OXIDATIVE BURST CMP

Facility

$55.08

Service Code	CPT 88185
Hospital Charge Code	31000012
Hospital Revenue Code	310
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$49.57
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna New Business (MI Preferred)	$35.80
Rate for Payer: Cash Price	$44.06
Rate for Payer: Cofinity Commercial	$38.56
Rate for Payer: Cofinity Commercial	$47.37
Rate for Payer: Healthscope Commercial	$49.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.82
Rate for Payer: PHP Commercial	$46.82
Rate for Payer: Priority Health Cigna Priority Health	$38.56
Rate for Payer: Priority Health SBD	$34.70

HC NEUTROPHIL OXIDATIVE BURST CMP

Facility

$55.08

Service Code	CPT 88185
Hospital Charge Code	31000012
Hospital Revenue Code	310
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$49.57
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna New Business (MI Preferred)	$35.80
Rate for Payer: BCBS Complete	$22.03
Rate for Payer: BCBS Trust/PPO	$29.37
Rate for Payer: Cash Price	$44.06
Rate for Payer: Cash Price	$44.06
Rate for Payer: Cofinity Commercial	$47.37
Rate for Payer: Cofinity Commercial	$38.56
Rate for Payer: Healthscope Commercial	$49.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.82
Rate for Payer: PHP Commercial	$46.82
Rate for Payer: Priority Health Cigna Priority Health	$38.56
Rate for Payer: Priority Health SBD	$34.70
Rate for Payer: UHC All Payor (Choice/PPO)	$25.58
Rate for Payer: UHC Core	$20.50
Rate for Payer: UHC Exchange	$23.25

HC NEW PATIENT VISIT 99202

Facility

$169.02

Service Code	CPT 99202
Hospital Charge Code	51000077
Hospital Revenue Code	761
Min. Negotiated Rate	$106.48
Max. Negotiated Rate	$152.12
Rate for Payer: Aetna Commercial	$143.67
Rate for Payer: Aetna New Business (MI Preferred)	$109.86
Rate for Payer: Cash Price	$135.22
Rate for Payer: Cofinity Commercial	$118.31
Rate for Payer: Cofinity Commercial	$145.36
Rate for Payer: Healthscope Commercial	$152.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$143.67
Rate for Payer: PHP Commercial	$143.67
Rate for Payer: Priority Health Cigna Priority Health	$118.31
Rate for Payer: Priority Health SBD	$106.48

HC NEW PATIENT VISIT 99202

Facility

$169.02

Service Code	CPT 99202
Hospital Charge Code	51000077
Hospital Revenue Code	761
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$152.12
Rate for Payer: Aetna Commercial	$143.67
Rate for Payer: Aetna New Business (MI Preferred)	$109.86
Rate for Payer: BCBS Complete	$67.61
Rate for Payer: BCBS Trust/PPO	$126.05
Rate for Payer: BCCCP Commercial	$45.00
Rate for Payer: Cash Price	$135.22
Rate for Payer: Cash Price	$135.22
Rate for Payer: Cofinity Commercial	$118.31
Rate for Payer: Cofinity Commercial	$145.36
Rate for Payer: Healthscope Commercial	$152.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$143.67
Rate for Payer: PHP Commercial	$143.67
Rate for Payer: Priority Health Cigna Priority Health	$118.31
Rate for Payer: Priority Health SBD	$106.48
Rate for Payer: UHC All Payor (Choice/PPO)	$50.79
Rate for Payer: UHC Exchange	$46.17

HC NEW PATIENT VISIT 99203

Facility

$205.10

Service Code	CPT 99203
Hospital Charge Code	51000078
Hospital Revenue Code	761
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$184.59
Rate for Payer: Aetna Commercial	$174.34
Rate for Payer: Aetna New Business (MI Preferred)	$133.32
Rate for Payer: BCBS Complete	$82.04
Rate for Payer: BCBS Trust/PPO	$166.58
Rate for Payer: BCCCP Commercial	$107.15
Rate for Payer: Cash Price	$164.08
Rate for Payer: Cash Price	$164.08
Rate for Payer: Cofinity Commercial	$176.39
Rate for Payer: Cofinity Commercial	$143.57
Rate for Payer: Healthscope Commercial	$184.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$174.34
Rate for Payer: PHP Commercial	$174.34
Rate for Payer: Priority Health Cigna Priority Health	$143.57
Rate for Payer: Priority Health SBD	$129.21
Rate for Payer: UHC All Payor (Choice/PPO)	$87.89
Rate for Payer: UHC Exchange	$79.90

HC NEW PATIENT VISIT 99203

Facility

$205.10

Service Code	CPT 99203
Hospital Charge Code	51000078
Hospital Revenue Code	761
Min. Negotiated Rate	$129.21
Max. Negotiated Rate	$184.59
Rate for Payer: Aetna Commercial	$174.34
Rate for Payer: Aetna New Business (MI Preferred)	$133.32
Rate for Payer: Cash Price	$164.08
Rate for Payer: Cofinity Commercial	$143.57
Rate for Payer: Cofinity Commercial	$176.39
Rate for Payer: Healthscope Commercial	$184.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$174.34
Rate for Payer: PHP Commercial	$174.34
Rate for Payer: Priority Health Cigna Priority Health	$143.57
Rate for Payer: Priority Health SBD	$129.21

HC NEW PATIENT VISIT 99204

Facility

$294.53

Service Code	CPT 99204
Hospital Charge Code	51000079
Hospital Revenue Code	761
Min. Negotiated Rate	$107.15
Max. Negotiated Rate	$265.08
Rate for Payer: Aetna Commercial	$250.35
Rate for Payer: Aetna New Business (MI Preferred)	$191.44
Rate for Payer: BCBS Complete	$117.81
Rate for Payer: BCBS Trust/PPO	$222.84
Rate for Payer: BCCCP Commercial	$107.15
Rate for Payer: Cash Price	$235.62
Rate for Payer: Cash Price	$235.62
Rate for Payer: Cofinity Commercial	$206.17
Rate for Payer: Cofinity Commercial	$253.30
Rate for Payer: Healthscope Commercial	$265.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$250.35
Rate for Payer: PHP Commercial	$250.35
Rate for Payer: Priority Health Cigna Priority Health	$206.17
Rate for Payer: Priority Health SBD	$185.55
Rate for Payer: UHC All Payor (Choice/PPO)	$142.99
Rate for Payer: UHC Exchange	$129.99

HC NEW PATIENT VISIT 99204

Facility

$294.53

Service Code	CPT 99204
Hospital Charge Code	51000079
Hospital Revenue Code	761
Min. Negotiated Rate	$185.55
Max. Negotiated Rate	$265.08
Rate for Payer: Aetna Commercial	$250.35
Rate for Payer: Aetna New Business (MI Preferred)	$191.44
Rate for Payer: Cash Price	$235.62
Rate for Payer: Cofinity Commercial	$206.17
Rate for Payer: Cofinity Commercial	$253.30
Rate for Payer: Healthscope Commercial	$265.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$250.35
Rate for Payer: PHP Commercial	$250.35
Rate for Payer: Priority Health Cigna Priority Health	$206.17
Rate for Payer: Priority Health SBD	$185.55

HC NEW PATIENT VISIT 99205

Facility

$490.43

Service Code	CPT 99205
Hospital Charge Code	51000080
Hospital Revenue Code	761
Min. Negotiated Rate	$107.15
Max. Negotiated Rate	$441.39
Rate for Payer: Aetna Commercial	$416.87
Rate for Payer: Aetna New Business (MI Preferred)	$318.78
Rate for Payer: BCBS Complete	$196.17
Rate for Payer: BCBS Trust/PPO	$270.08
Rate for Payer: BCCCP Commercial	$107.15
Rate for Payer: Cash Price	$392.34
Rate for Payer: Cash Price	$392.34
Rate for Payer: Cofinity Commercial	$343.30
Rate for Payer: Cofinity Commercial	$421.77
Rate for Payer: Healthscope Commercial	$441.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$416.87
Rate for Payer: PHP Commercial	$416.87
Rate for Payer: Priority Health Cigna Priority Health	$343.30
Rate for Payer: Priority Health SBD	$308.97
Rate for Payer: UHC All Payor (Choice/PPO)	$194.50
Rate for Payer: UHC Exchange	$176.82

HC NEW PATIENT VISIT 99205

Facility

$490.43

Service Code	CPT 99205
Hospital Charge Code	51000080
Hospital Revenue Code	761
Min. Negotiated Rate	$308.97
Max. Negotiated Rate	$441.39
Rate for Payer: Aetna Commercial	$416.87
Rate for Payer: Aetna New Business (MI Preferred)	$318.78
Rate for Payer: Cash Price	$392.34
Rate for Payer: Cofinity Commercial	$343.30
Rate for Payer: Cofinity Commercial	$421.77
Rate for Payer: Healthscope Commercial	$441.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$416.87
Rate for Payer: PHP Commercial	$416.87
Rate for Payer: Priority Health Cigna Priority Health	$343.30
Rate for Payer: Priority Health SBD	$308.97

HC NICOTINE AND METABOLITES BLD

Facility

$61.00

Service Code	CPT 80323
Hospital Charge Code	30100599
Hospital Revenue Code	301
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna Commercial	$51.85
Rate for Payer: Aetna New Business (MI Preferred)	$39.65
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cofinity Commercial	$52.46
Rate for Payer: Cofinity Commercial	$42.70
Rate for Payer: Healthscope Commercial	$54.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.85
Rate for Payer: PHP Commercial	$51.85
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health SBD	$38.43
Rate for Payer: UHC Core	$49.02

HC NICOTINE AND METABOLITES BLD

Facility

$61.00

Service Code	CPT 80323
Hospital Charge Code	30100599
Hospital Revenue Code	301
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna Commercial	$51.85
Rate for Payer: Aetna New Business (MI Preferred)	$39.65
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cofinity Commercial	$42.70
Rate for Payer: Cofinity Commercial	$52.46
Rate for Payer: Healthscope Commercial	$54.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.85
Rate for Payer: PHP Commercial	$51.85
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health SBD	$38.43

HC NICOTINE AND METABOLITES URN

Facility

$50.00

Service Code	CPT 80323
Hospital Charge Code	30100613
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health SBD	$31.50

HC NICOTINE AND METABOLITES URN

Facility

$50.00

Service Code	CPT 80323
Hospital Charge Code	30100613
Hospital Revenue Code	301
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$49.02
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health SBD	$31.50
Rate for Payer: UHC Core	$49.02

HC NICU LEVEL 2 R&B

Facility

$3,363.24

Hospital Charge Code	17200001
Hospital Revenue Code	172
Min. Negotiated Rate	$2,032.00
Max. Negotiated Rate	$3,026.92
Rate for Payer: Aetna Commercial	$2,858.75
Rate for Payer: Aetna New Business (MI Preferred)	$2,186.11
Rate for Payer: Cash Price	$2,690.59
Rate for Payer: Cash Price	$2,690.59
Rate for Payer: Cofinity Commercial	$2,892.39
Rate for Payer: Cofinity Commercial	$2,354.27
Rate for Payer: Healthscope Commercial	$3,026.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,858.75
Rate for Payer: PHP Commercial	$2,858.75
Rate for Payer: Priority Health Cigna Priority Health	$2,354.27
Rate for Payer: Priority Health SBD	$2,118.84
Rate for Payer: UHC Exchange	$2,032.00

HC NICU LEVEL 3 R&B

Facility

$4,986.03

Hospital Charge Code	17300001
Hospital Revenue Code	173
Min. Negotiated Rate	$2,835.00
Max. Negotiated Rate	$4,487.43
Rate for Payer: Aetna Commercial	$4,238.13
Rate for Payer: Aetna New Business (MI Preferred)	$3,240.92
Rate for Payer: Cash Price	$3,988.82
Rate for Payer: Cash Price	$3,988.82
Rate for Payer: Cofinity Commercial	$4,287.99
Rate for Payer: Cofinity Commercial	$3,490.22
Rate for Payer: Healthscope Commercial	$4,487.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,238.13
Rate for Payer: PHP Commercial	$4,238.13
Rate for Payer: Priority Health Cigna Priority Health	$3,490.22
Rate for Payer: Priority Health SBD	$3,141.20
Rate for Payer: UHC Exchange	$2,835.00

HC NICU LEVEL 4 R&B

Facility

$5,221.18

Hospital Charge Code	17400001
Hospital Revenue Code	174
Min. Negotiated Rate	$3,255.00
Max. Negotiated Rate	$4,699.06
Rate for Payer: Aetna Commercial	$4,438.00
Rate for Payer: Aetna New Business (MI Preferred)	$3,393.77
Rate for Payer: Cash Price	$4,176.94
Rate for Payer: Cash Price	$4,176.94
Rate for Payer: Cofinity Commercial	$4,490.21
Rate for Payer: Cofinity Commercial	$3,654.83
Rate for Payer: Healthscope Commercial	$4,699.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,438.00
Rate for Payer: PHP Commercial	$4,438.00
Rate for Payer: Priority Health Cigna Priority Health	$3,654.83
Rate for Payer: Priority Health SBD	$3,289.34
Rate for Payer: UHC Exchange	$3,255.00

HC NICU OBSERVATION PER HOUR

Facility

$186.06

Service Code	HCPCS G0378
Hospital Charge Code	76200013
Hospital Revenue Code	762
Min. Negotiated Rate	$117.22
Max. Negotiated Rate	$167.45
Rate for Payer: Aetna Commercial	$158.15
Rate for Payer: Aetna New Business (MI Preferred)	$120.94
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cofinity Commercial	$130.24
Rate for Payer: Cofinity Commercial	$160.01
Rate for Payer: Healthscope Commercial	$167.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$158.15
Rate for Payer: PHP Commercial	$158.15
Rate for Payer: Priority Health Cigna Priority Health	$130.24
Rate for Payer: Priority Health SBD	$117.22

HC NICU OBSERVATION PER HOUR

Facility

$186.06

Service Code	HCPCS G0378
Hospital Charge Code	76200013
Hospital Revenue Code	762
Min. Negotiated Rate	$74.42
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$158.15
Rate for Payer: Aetna New Business (MI Preferred)	$120.94
Rate for Payer: BCBS Complete	$74.42
Rate for Payer: BCBS Trust/PPO	$108.91
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cofinity Commercial	$130.24
Rate for Payer: Cofinity Commercial	$160.01
Rate for Payer: Healthscope Commercial	$167.45
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$158.15
Rate for Payer: PHP Commercial	$158.15
Rate for Payer: Priority Health Cigna Priority Health	$130.24
Rate for Payer: Priority Health SBD	$117.22

HC NICU OR OB NURSERY R&B

Facility

$2,250.16

Hospital Charge Code	17000001
Hospital Revenue Code	170
Min. Negotiated Rate	$919.00
Max. Negotiated Rate	$2,025.14
Rate for Payer: Aetna Commercial	$1,912.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,462.60
Rate for Payer: Cash Price	$1,800.13
Rate for Payer: Cash Price	$1,800.13
Rate for Payer: Cofinity Commercial	$1,935.14
Rate for Payer: Cofinity Commercial	$1,575.11
Rate for Payer: Healthscope Commercial	$2,025.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,912.64
Rate for Payer: PHP Commercial	$1,912.64
Rate for Payer: Priority Health Cigna Priority Health	$1,575.11
Rate for Payer: Priority Health SBD	$1,417.60
Rate for Payer: UHC Exchange	$919.00

HC NIFOMETER

Facility

$82.48

Hospital Charge Code	27000125
Hospital Revenue Code	270
Min. Negotiated Rate	$51.96
Max. Negotiated Rate	$74.23
Rate for Payer: Aetna Commercial	$70.11
Rate for Payer: Aetna New Business (MI Preferred)	$53.61
Rate for Payer: Cash Price	$65.98
Rate for Payer: Cofinity Commercial	$57.74
Rate for Payer: Cofinity Commercial	$70.93
Rate for Payer: Healthscope Commercial	$74.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.11
Rate for Payer: PHP Commercial	$70.11
Rate for Payer: Priority Health Cigna Priority Health	$57.74
Rate for Payer: Priority Health SBD	$51.96

HC NIFOMETER

Facility

$82.48

Hospital Charge Code	27000125
Hospital Revenue Code	270
Min. Negotiated Rate	$32.99
Max. Negotiated Rate	$74.23
Rate for Payer: Aetna Commercial	$70.11
Rate for Payer: Aetna New Business (MI Preferred)	$53.61
Rate for Payer: BCBS Complete	$32.99
Rate for Payer: Cash Price	$65.98
Rate for Payer: Cofinity Commercial	$57.74
Rate for Payer: Cofinity Commercial	$70.93
Rate for Payer: Healthscope Commercial	$74.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.11
Rate for Payer: PHP Commercial	$70.11
Rate for Payer: Priority Health Cigna Priority Health	$57.74
Rate for Payer: Priority Health SBD	$51.96

HC NITRIC OXIDE EXPIRED GAS DETERMINATION

Facility

$49.14

Service Code	CPT 95012
Hospital Charge Code	46000031
Hospital Revenue Code	460
Min. Negotiated Rate	$18.66
Max. Negotiated Rate	$44.60
Rate for Payer: Aetna Commercial	$41.77
Rate for Payer: Aetna Medicare	$37.11
Rate for Payer: Aetna New Business (MI Preferred)	$31.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$44.60
Rate for Payer: Amish Plain Church Group Commercial	$44.60
Rate for Payer: BCBS Complete	$20.49
Rate for Payer: BCBS MAPPO	$35.68
Rate for Payer: BCBS Trust/PPO	$23.17
Rate for Payer: BCN Medicare Advantage	$35.68
Rate for Payer: Cash Price	$39.31
Rate for Payer: Cash Price	$39.31
Rate for Payer: Cofinity Commercial	$42.26
Rate for Payer: Cofinity Commercial	$34.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.68
Rate for Payer: Healthscope Commercial	$44.23
Rate for Payer: Mclaren Medicaid	$19.52
Rate for Payer: Mclaren Medicare	$35.68
Rate for Payer: Meridian Medicaid	$20.49
Rate for Payer: Meridian Wellcare - Medicare Advantage	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$41.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.77
Rate for Payer: PACE Medicare	$33.90
Rate for Payer: PACE SWMI	$35.68
Rate for Payer: PHP Commercial	$41.77
Rate for Payer: PHP Medicare Advantage	$35.68
Rate for Payer: Priority Health Choice Medicaid	$19.52
Rate for Payer: Priority Health Cigna Priority Health	$34.40
Rate for Payer: Priority Health Medicare	$35.68
Rate for Payer: Priority Health SBD	$30.96
Rate for Payer: Railroad Medicare Medicare	$35.68
Rate for Payer: UHC All Payor (Choice/PPO)	$20.53
Rate for Payer: UHC Dual Complete DSNP	$35.68
Rate for Payer: UHC Exchange	$18.66
Rate for Payer: UHC Medicare Advantage	$36.75
Rate for Payer: VA VA	$35.68

HC NITRIC OXIDE EXPIRED GAS DETERMINATION

Facility

$49.14

Service Code	CPT 95012
Hospital Charge Code	46000031
Hospital Revenue Code	460
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$44.23
Rate for Payer: Aetna Commercial	$41.77
Rate for Payer: Aetna New Business (MI Preferred)	$31.94
Rate for Payer: Cash Price	$39.31
Rate for Payer: Cofinity Commercial	$34.40
Rate for Payer: Cofinity Commercial	$42.26
Rate for Payer: Healthscope Commercial	$44.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.77
Rate for Payer: PHP Commercial	$41.77
Rate for Payer: Priority Health Cigna Priority Health	$34.40
Rate for Payer: Priority Health SBD	$30.96

Know your out-of-pocket cost for care.

All Charges