Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC EXTENDED RECOVERY 0-6 HRS

Facility

$1,760.92

Hospital Charge Code	71000005
Hospital Revenue Code	710
Min. Negotiated Rate	$704.37
Max. Negotiated Rate	$1,584.83
Rate for Payer: Aetna Commercial	$1,496.78
Rate for Payer: Aetna Medicare	$880.46
Rate for Payer: Aetna New Business (MI Preferred)	$1,144.60
Rate for Payer: BCBS Complete	$704.37
Rate for Payer: Cash Price	$1,408.74
Rate for Payer: Cofinity Commercial	$1,232.64
Rate for Payer: Cofinity Commercial	$1,514.39
Rate for Payer: Cofinity Medicare Advantage	$1,232.64
Rate for Payer: Encore Health Key Benefits Commercial	$1,408.74
Rate for Payer: Healthscope Commercial	$1,584.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,496.78
Rate for Payer: PHP Commercial	$1,496.78
Rate for Payer: Priority Health Cigna Priority Health	$1,144.60
Rate for Payer: Priority Health SBD	$1,109.38

HC EXTENDED RECOVERY 12-18 HRS

Facility

$2,058.81

Hospital Charge Code	71000006
Hospital Revenue Code	710
Min. Negotiated Rate	$823.52
Max. Negotiated Rate	$1,852.93
Rate for Payer: Aetna Commercial	$1,749.99
Rate for Payer: Aetna Medicare	$1,029.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,338.23
Rate for Payer: BCBS Complete	$823.52
Rate for Payer: Cash Price	$1,647.05
Rate for Payer: Cofinity Commercial	$1,441.17
Rate for Payer: Cofinity Commercial	$1,770.58
Rate for Payer: Cofinity Medicare Advantage	$1,441.17
Rate for Payer: Encore Health Key Benefits Commercial	$1,647.05
Rate for Payer: Healthscope Commercial	$1,852.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,749.99
Rate for Payer: PHP Commercial	$1,749.99
Rate for Payer: Priority Health Cigna Priority Health	$1,338.23
Rate for Payer: Priority Health SBD	$1,297.05

HC EXTENDED RECOVERY 12-18 HRS

Facility

$2,058.81

Hospital Charge Code	71000006
Hospital Revenue Code	710
Min. Negotiated Rate	$1,297.05
Max. Negotiated Rate	$1,852.93
Rate for Payer: Aetna Commercial	$1,749.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,338.23
Rate for Payer: Cash Price	$1,647.05
Rate for Payer: Cofinity Commercial	$1,441.17
Rate for Payer: Cofinity Commercial	$1,770.58
Rate for Payer: Cofinity Medicare Advantage	$1,441.17
Rate for Payer: Encore Health Key Benefits Commercial	$1,647.05
Rate for Payer: Healthscope Commercial	$1,852.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,749.99
Rate for Payer: PHP Commercial	$1,749.99
Rate for Payer: Priority Health Cigna Priority Health	$1,338.23
Rate for Payer: Priority Health SBD	$1,297.05

HC EXTENDED RECOVERY 18-24 HRS

Facility

$2,250.28

Hospital Charge Code	71000007
Hospital Revenue Code	710
Min. Negotiated Rate	$1,417.68
Max. Negotiated Rate	$2,025.25
Rate for Payer: Aetna Commercial	$1,912.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,462.68
Rate for Payer: Cash Price	$1,800.22
Rate for Payer: Cofinity Commercial	$1,575.20
Rate for Payer: Cofinity Commercial	$1,935.24
Rate for Payer: Cofinity Medicare Advantage	$1,575.20
Rate for Payer: Encore Health Key Benefits Commercial	$1,800.22
Rate for Payer: Healthscope Commercial	$2,025.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,912.74
Rate for Payer: PHP Commercial	$1,912.74
Rate for Payer: Priority Health Cigna Priority Health	$1,462.68
Rate for Payer: Priority Health SBD	$1,417.68

HC EXTENDED RECOVERY 18-24 HRS

Facility

$2,250.28

Hospital Charge Code	71000007
Hospital Revenue Code	710
Min. Negotiated Rate	$900.11
Max. Negotiated Rate	$2,025.25
Rate for Payer: Aetna Commercial	$1,912.74
Rate for Payer: Aetna Medicare	$1,125.14
Rate for Payer: Aetna New Business (MI Preferred)	$1,462.68
Rate for Payer: BCBS Complete	$900.11
Rate for Payer: Cash Price	$1,800.22
Rate for Payer: Cofinity Commercial	$1,575.20
Rate for Payer: Cofinity Commercial	$1,935.24
Rate for Payer: Cofinity Medicare Advantage	$1,575.20
Rate for Payer: Encore Health Key Benefits Commercial	$1,800.22
Rate for Payer: Healthscope Commercial	$2,025.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,912.74
Rate for Payer: PHP Commercial	$1,912.74
Rate for Payer: Priority Health Cigna Priority Health	$1,462.68
Rate for Payer: Priority Health SBD	$1,417.68

HC EXTENDED RECOVERY 6-12 HRS

Facility

$1,925.80

Hospital Charge Code	71000008
Hospital Revenue Code	710
Min. Negotiated Rate	$770.32
Max. Negotiated Rate	$1,733.22
Rate for Payer: Aetna Commercial	$1,636.93
Rate for Payer: Aetna Medicare	$962.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,251.77
Rate for Payer: BCBS Complete	$770.32
Rate for Payer: Cash Price	$1,540.64
Rate for Payer: Cofinity Commercial	$1,348.06
Rate for Payer: Cofinity Commercial	$1,656.19
Rate for Payer: Cofinity Medicare Advantage	$1,348.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,540.64
Rate for Payer: Healthscope Commercial	$1,733.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,636.93
Rate for Payer: PHP Commercial	$1,636.93
Rate for Payer: Priority Health Cigna Priority Health	$1,251.77
Rate for Payer: Priority Health SBD	$1,213.25

HC EXTENDED RECOVERY 6-12 HRS

Facility

$1,925.80

Hospital Charge Code	71000008
Hospital Revenue Code	710
Min. Negotiated Rate	$1,213.25
Max. Negotiated Rate	$1,733.22
Rate for Payer: Aetna Commercial	$1,636.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,251.77
Rate for Payer: Cash Price	$1,540.64
Rate for Payer: Cofinity Commercial	$1,348.06
Rate for Payer: Cofinity Commercial	$1,656.19
Rate for Payer: Cofinity Medicare Advantage	$1,348.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,540.64
Rate for Payer: Healthscope Commercial	$1,733.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,636.93
Rate for Payer: PHP Commercial	$1,636.93
Rate for Payer: Priority Health Cigna Priority Health	$1,251.77
Rate for Payer: Priority Health SBD	$1,213.25

HC EXTENSION KIT

Facility

$2,031.98

Service Code	HCPCS C1883
Hospital Charge Code	27800052
Hospital Revenue Code	278
Min. Negotiated Rate	$1,280.15
Max. Negotiated Rate	$1,828.78
Rate for Payer: Aetna Commercial	$1,727.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,320.79
Rate for Payer: Cash Price	$1,625.58
Rate for Payer: Cofinity Commercial	$1,422.39
Rate for Payer: Cofinity Commercial	$1,747.50
Rate for Payer: Cofinity Medicare Advantage	$1,422.39
Rate for Payer: Encore Health Key Benefits Commercial	$1,625.58
Rate for Payer: Healthscope Commercial	$1,828.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,727.18
Rate for Payer: PHP Commercial	$1,727.18
Rate for Payer: Priority Health Cigna Priority Health	$1,320.79
Rate for Payer: Priority Health SBD	$1,280.15

HC EXTENSION KIT

Facility

$2,031.98

Service Code	HCPCS C1883
Hospital Charge Code	27800052
Hospital Revenue Code	278
Min. Negotiated Rate	$812.79
Max. Negotiated Rate	$1,828.78
Rate for Payer: Aetna Commercial	$1,727.18
Rate for Payer: Aetna Medicare	$1,015.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,320.79
Rate for Payer: BCBS Complete	$812.79
Rate for Payer: Cash Price	$1,625.58
Rate for Payer: Cofinity Commercial	$1,422.39
Rate for Payer: Cofinity Commercial	$1,747.50
Rate for Payer: Cofinity Medicare Advantage	$1,422.39
Rate for Payer: Encore Health Key Benefits Commercial	$1,625.58
Rate for Payer: Healthscope Commercial	$1,828.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,727.18
Rate for Payer: PHP Commercial	$1,727.18
Rate for Payer: Priority Health Cigna Priority Health	$1,320.79
Rate for Payer: Priority Health SBD	$1,280.15

HC EXTENSION ST JUDE

Facility

$2,370.66

Service Code	HCPCS C1883
Hospital Charge Code	27800053
Hospital Revenue Code	278
Min. Negotiated Rate	$948.26
Max. Negotiated Rate	$2,133.59
Rate for Payer: Aetna Commercial	$2,015.06
Rate for Payer: Aetna Medicare	$1,185.33
Rate for Payer: Aetna New Business (MI Preferred)	$1,540.93
Rate for Payer: BCBS Complete	$948.26
Rate for Payer: Cash Price	$1,896.53
Rate for Payer: Cofinity Commercial	$1,659.46
Rate for Payer: Cofinity Commercial	$2,038.77
Rate for Payer: Cofinity Medicare Advantage	$1,659.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,896.53
Rate for Payer: Healthscope Commercial	$2,133.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,015.06
Rate for Payer: PHP Commercial	$2,015.06
Rate for Payer: Priority Health Cigna Priority Health	$1,540.93
Rate for Payer: Priority Health SBD	$1,493.52

HC EXTENSION ST JUDE

Facility

$2,370.66

Service Code	HCPCS C1883
Hospital Charge Code	27800053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.52
Max. Negotiated Rate	$2,133.59
Rate for Payer: Aetna Commercial	$2,015.06
Rate for Payer: Aetna New Business (MI Preferred)	$1,540.93
Rate for Payer: Cash Price	$1,896.53
Rate for Payer: Cofinity Commercial	$1,659.46
Rate for Payer: Cofinity Commercial	$2,038.77
Rate for Payer: Cofinity Medicare Advantage	$1,659.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,896.53
Rate for Payer: Healthscope Commercial	$2,133.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,015.06
Rate for Payer: PHP Commercial	$2,015.06
Rate for Payer: Priority Health Cigna Priority Health	$1,540.93
Rate for Payer: Priority Health SBD	$1,493.52

HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS

Facility

$91.13

Service Code	CPT 93242
Hospital Charge Code	48000030
Hospital Revenue Code	480
Min. Negotiated Rate	$57.41
Max. Negotiated Rate	$82.02
Rate for Payer: Aetna Commercial	$77.46
Rate for Payer: Aetna New Business (MI Preferred)	$59.23
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cofinity Commercial	$63.79
Rate for Payer: Cofinity Commercial	$78.37
Rate for Payer: Cofinity Medicare Advantage	$63.79
Rate for Payer: Encore Health Key Benefits Commercial	$72.90
Rate for Payer: Healthscope Commercial	$82.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.46
Rate for Payer: PHP Commercial	$77.46
Rate for Payer: Priority Health Cigna Priority Health	$59.23
Rate for Payer: Priority Health SBD	$57.41

HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS

Facility

$91.13

Service Code	CPT 93242
Hospital Charge Code	48000030
Hospital Revenue Code	480
Min. Negotiated Rate	$20.52
Max. Negotiated Rate	$107.75
Rate for Payer: Aetna Commercial	$77.46
Rate for Payer: Aetna Medicare	$39.81
Rate for Payer: Aetna New Business (MI Preferred)	$59.23
Rate for Payer: Allen County Amish Medical Aid Commercial	$47.85
Rate for Payer: Amish Plain Church Group Commercial	$47.85
Rate for Payer: BCBS Complete	$21.54
Rate for Payer: BCBS MAPPO	$38.28
Rate for Payer: BCN Medicare Advantage	$38.28
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cofinity Commercial	$78.37
Rate for Payer: Cofinity Commercial	$63.79
Rate for Payer: Cofinity Medicare Advantage	$63.79
Rate for Payer: Encore Health Key Benefits Commercial	$72.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$38.28
Rate for Payer: Healthscope Commercial	$82.02
Rate for Payer: Mclaren Medicaid	$20.52
Rate for Payer: Mclaren Medicare	$38.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$40.19
Rate for Payer: Meridian Medicaid	$21.54
Rate for Payer: MI Amish Medical Board Commercial	$44.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.46
Rate for Payer: PACE Medicare	$36.37
Rate for Payer: PACE SWMI	$38.28
Rate for Payer: PHP Commercial	$77.46
Rate for Payer: PHP Medicare Advantage	$38.28
Rate for Payer: Priority Health Choice Medicaid	$20.52
Rate for Payer: Priority Health Cigna Priority Health	$59.23
Rate for Payer: Priority Health Medicare	$38.28
Rate for Payer: Priority Health SBD	$57.41
Rate for Payer: Railroad Medicare Medicare	$38.28
Rate for Payer: UHC All Payor (Choice/PPO)	$107.75
Rate for Payer: UHC Core	$67.44
Rate for Payer: UHC Dual Complete DSNP	$38.28
Rate for Payer: UHC Exchange	$67.44
Rate for Payer: UHC Medicare Advantage	$38.28
Rate for Payer: UHCCP Medicaid	$21.55
Rate for Payer: VA VA	$38.28

HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS

Facility

$137.39

Service Code	CPT 93246
Hospital Charge Code	48000031
Hospital Revenue Code	480
Min. Negotiated Rate	$20.52
Max. Negotiated Rate	$123.65
Rate for Payer: Aetna Commercial	$116.78
Rate for Payer: Aetna Medicare	$39.81
Rate for Payer: Aetna New Business (MI Preferred)	$89.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$47.85
Rate for Payer: Amish Plain Church Group Commercial	$47.85
Rate for Payer: BCBS Complete	$21.54
Rate for Payer: BCBS MAPPO	$38.28
Rate for Payer: BCN Medicare Advantage	$38.28
Rate for Payer: Cash Price	$109.91
Rate for Payer: Cash Price	$109.91
Rate for Payer: Cofinity Commercial	$96.17
Rate for Payer: Cofinity Commercial	$118.16
Rate for Payer: Cofinity Medicare Advantage	$96.17
Rate for Payer: Encore Health Key Benefits Commercial	$109.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$38.28
Rate for Payer: Healthscope Commercial	$123.65
Rate for Payer: Mclaren Medicaid	$20.52
Rate for Payer: Mclaren Medicare	$38.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$40.19
Rate for Payer: Meridian Medicaid	$21.54
Rate for Payer: MI Amish Medical Board Commercial	$44.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.78
Rate for Payer: PACE Medicare	$36.37
Rate for Payer: PACE SWMI	$38.28
Rate for Payer: PHP Commercial	$116.78
Rate for Payer: PHP Medicare Advantage	$38.28
Rate for Payer: Priority Health Choice Medicaid	$20.52
Rate for Payer: Priority Health Cigna Priority Health	$89.30
Rate for Payer: Priority Health Medicare	$38.28
Rate for Payer: Priority Health SBD	$86.56
Rate for Payer: Railroad Medicare Medicare	$38.28
Rate for Payer: UHC All Payor (Choice/PPO)	$107.75
Rate for Payer: UHC Core	$101.67
Rate for Payer: UHC Dual Complete DSNP	$38.28
Rate for Payer: UHC Exchange	$101.67
Rate for Payer: UHC Medicare Advantage	$38.28
Rate for Payer: UHCCP Medicaid	$21.55
Rate for Payer: VA VA	$38.28

HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS

Facility

$137.39

Service Code	CPT 93246
Hospital Charge Code	48000031
Hospital Revenue Code	480
Min. Negotiated Rate	$86.56
Max. Negotiated Rate	$123.65
Rate for Payer: Aetna Commercial	$116.78
Rate for Payer: Aetna New Business (MI Preferred)	$89.30
Rate for Payer: Cash Price	$109.91
Rate for Payer: Cofinity Commercial	$118.16
Rate for Payer: Cofinity Commercial	$96.17
Rate for Payer: Cofinity Medicare Advantage	$96.17
Rate for Payer: Encore Health Key Benefits Commercial	$109.91
Rate for Payer: Healthscope Commercial	$123.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.78
Rate for Payer: PHP Commercial	$116.78
Rate for Payer: Priority Health Cigna Priority Health	$89.30
Rate for Payer: Priority Health SBD	$86.56

HC EXTERNAL PACER

Facility

$576.43

Service Code	CPT 92953
Hospital Charge Code	48000001
Hospital Revenue Code	480
Min. Negotiated Rate	$363.15
Max. Negotiated Rate	$518.79
Rate for Payer: Aetna Commercial	$489.97
Rate for Payer: Aetna New Business (MI Preferred)	$374.68
Rate for Payer: Cash Price	$461.14
Rate for Payer: Cofinity Commercial	$403.50
Rate for Payer: Cofinity Commercial	$495.73
Rate for Payer: Cofinity Medicare Advantage	$403.50
Rate for Payer: Encore Health Key Benefits Commercial	$461.14
Rate for Payer: Healthscope Commercial	$518.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$489.97
Rate for Payer: PHP Commercial	$489.97
Rate for Payer: Priority Health Cigna Priority Health	$374.68
Rate for Payer: Priority Health SBD	$363.15

HC EXTERNAL PACER

Facility

$576.43

Service Code	CPT 92953
Hospital Charge Code	48000001
Hospital Revenue Code	480
Min. Negotiated Rate	$342.08
Max. Negotiated Rate	$1,796.47
Rate for Payer: Aetna Commercial	$489.97
Rate for Payer: Aetna Medicare	$663.73
Rate for Payer: Aetna New Business (MI Preferred)	$374.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$797.75
Rate for Payer: Amish Plain Church Group Commercial	$797.75
Rate for Payer: BCBS Complete	$359.18
Rate for Payer: BCBS MAPPO	$638.20
Rate for Payer: BCN Medicare Advantage	$638.20
Rate for Payer: Cash Price	$461.14
Rate for Payer: Cash Price	$461.14
Rate for Payer: Cofinity Commercial	$495.73
Rate for Payer: Cofinity Commercial	$403.50
Rate for Payer: Cofinity Medicare Advantage	$403.50
Rate for Payer: Encore Health Key Benefits Commercial	$461.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$638.20
Rate for Payer: Healthscope Commercial	$518.79
Rate for Payer: Mclaren Medicaid	$342.08
Rate for Payer: Mclaren Medicare	$638.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$670.11
Rate for Payer: Meridian Medicaid	$359.18
Rate for Payer: MI Amish Medical Board Commercial	$733.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$489.97
Rate for Payer: PACE Medicare	$606.29
Rate for Payer: PACE SWMI	$638.20
Rate for Payer: PHP Commercial	$489.97
Rate for Payer: PHP Medicare Advantage	$638.20
Rate for Payer: Priority Health Choice Medicaid	$342.08
Rate for Payer: Priority Health Cigna Priority Health	$374.68
Rate for Payer: Priority Health Medicare	$638.20
Rate for Payer: Priority Health SBD	$363.15
Rate for Payer: Railroad Medicare Medicare	$638.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,796.47
Rate for Payer: UHC Core	$426.56
Rate for Payer: UHC Dual Complete DSNP	$638.20
Rate for Payer: UHC Exchange	$426.56
Rate for Payer: UHC Medicare Advantage	$638.20
Rate for Payer: UHCCP Medicaid	$359.31
Rate for Payer: VA VA	$638.20

HC EXTERNAL VERSION

Facility

$2,838.32

Service Code	CPT 59412
Hospital Charge Code	36100121
Hospital Revenue Code	761
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Commercial	$2,412.57
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Aetna New Business (MI Preferred)	$1,844.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Cash Price	$2,270.66
Rate for Payer: Cash Price	$2,270.66
Rate for Payer: Cofinity Commercial	$2,440.96
Rate for Payer: Cofinity Commercial	$1,986.82
Rate for Payer: Cofinity Medicare Advantage	$1,986.82
Rate for Payer: Encore Health Key Benefits Commercial	$2,270.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Healthscope Commercial	$2,554.49
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,412.57
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Commercial	$2,412.57
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Cigna Priority Health	$1,844.91
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Priority Health SBD	$1,788.14
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,745.82
Rate for Payer: VA VA	$3,100.93

HC EXTERNAL VERSION

Facility

$2,838.32

Service Code	CPT 59412
Hospital Charge Code	36100121
Hospital Revenue Code	761
Min. Negotiated Rate	$1,788.14
Max. Negotiated Rate	$2,554.49
Rate for Payer: Aetna Commercial	$2,412.57
Rate for Payer: Aetna New Business (MI Preferred)	$1,844.91
Rate for Payer: Cash Price	$2,270.66
Rate for Payer: Cofinity Commercial	$1,986.82
Rate for Payer: Cofinity Commercial	$2,440.96
Rate for Payer: Cofinity Medicare Advantage	$1,986.82
Rate for Payer: Encore Health Key Benefits Commercial	$2,270.66
Rate for Payer: Healthscope Commercial	$2,554.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,412.57
Rate for Payer: PHP Commercial	$2,412.57
Rate for Payer: Priority Health Cigna Priority Health	$1,844.91
Rate for Payer: Priority Health SBD	$1,788.14

HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING

Facility

$390.69

Service Code	CPT 41015
Hospital Charge Code	76100137
Hospital Revenue Code	761
Min. Negotiated Rate	$246.13
Max. Negotiated Rate	$1,398.05
Rate for Payer: Aetna Commercial	$332.09
Rate for Payer: Aetna Medicare	$516.53
Rate for Payer: Aetna New Business (MI Preferred)	$253.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$620.83
Rate for Payer: Amish Plain Church Group Commercial	$620.83
Rate for Payer: BCBS Complete	$279.52
Rate for Payer: BCBS MAPPO	$496.66
Rate for Payer: BCN Medicare Advantage	$496.66
Rate for Payer: Cash Price	$312.55
Rate for Payer: Cash Price	$312.55
Rate for Payer: Cofinity Commercial	$335.99
Rate for Payer: Cofinity Commercial	$273.48
Rate for Payer: Cofinity Medicare Advantage	$273.48
Rate for Payer: Encore Health Key Benefits Commercial	$312.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$496.66
Rate for Payer: Healthscope Commercial	$351.62
Rate for Payer: Mclaren Medicaid	$266.21
Rate for Payer: Mclaren Medicare	$496.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$521.49
Rate for Payer: Meridian Medicaid	$279.52
Rate for Payer: MI Amish Medical Board Commercial	$571.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.09
Rate for Payer: PACE Medicare	$471.83
Rate for Payer: PACE SWMI	$496.66
Rate for Payer: PHP Commercial	$332.09
Rate for Payer: PHP Medicare Advantage	$496.66
Rate for Payer: Priority Health Choice Medicaid	$266.21
Rate for Payer: Priority Health Cigna Priority Health	$253.95
Rate for Payer: Priority Health Medicare	$496.66
Rate for Payer: Priority Health SBD	$246.13
Rate for Payer: Railroad Medicare Medicare	$496.66
Rate for Payer: UHC All Payor (Choice/PPO)	$1,398.05
Rate for Payer: UHC Dual Complete DSNP	$496.66
Rate for Payer: UHC Medicare Advantage	$496.66
Rate for Payer: UHCCP Medicaid	$279.62
Rate for Payer: VA VA	$496.66

HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING

Facility

$390.69

Service Code	CPT 41015
Hospital Charge Code	76100137
Hospital Revenue Code	761
Min. Negotiated Rate	$246.13
Max. Negotiated Rate	$351.62
Rate for Payer: Aetna Commercial	$332.09
Rate for Payer: Aetna New Business (MI Preferred)	$253.95
Rate for Payer: Cash Price	$312.55
Rate for Payer: Cofinity Commercial	$273.48
Rate for Payer: Cofinity Commercial	$335.99
Rate for Payer: Cofinity Medicare Advantage	$273.48
Rate for Payer: Encore Health Key Benefits Commercial	$312.55
Rate for Payer: Healthscope Commercial	$351.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.09
Rate for Payer: PHP Commercial	$332.09
Rate for Payer: Priority Health Cigna Priority Health	$253.95
Rate for Payer: Priority Health SBD	$246.13

HC EZPAP SUPPLY

Facility

$127.99

Hospital Charge Code	27000072
Hospital Revenue Code	270
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$115.19
Rate for Payer: Aetna Commercial	$108.79
Rate for Payer: Aetna Medicare	$63.99
Rate for Payer: Aetna New Business (MI Preferred)	$83.19
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.39
Rate for Payer: Cofinity Commercial	$110.07
Rate for Payer: Cofinity Commercial	$89.59
Rate for Payer: Cofinity Medicare Advantage	$89.59
Rate for Payer: Encore Health Key Benefits Commercial	$102.39
Rate for Payer: Healthscope Commercial	$115.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.79
Rate for Payer: PHP Commercial	$108.79
Rate for Payer: Priority Health Cigna Priority Health	$83.19
Rate for Payer: Priority Health SBD	$80.63

HC EZPAP SUPPLY

Facility

$127.99

Hospital Charge Code	27000072
Hospital Revenue Code	270
Min. Negotiated Rate	$80.63
Max. Negotiated Rate	$115.19
Rate for Payer: Aetna Commercial	$108.79
Rate for Payer: Aetna New Business (MI Preferred)	$83.19
Rate for Payer: Cash Price	$102.39
Rate for Payer: Cofinity Commercial	$110.07
Rate for Payer: Cofinity Commercial	$89.59
Rate for Payer: Cofinity Medicare Advantage	$89.59
Rate for Payer: Encore Health Key Benefits Commercial	$102.39
Rate for Payer: Healthscope Commercial	$115.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.79
Rate for Payer: PHP Commercial	$108.79
Rate for Payer: Priority Health Cigna Priority Health	$83.19
Rate for Payer: Priority Health SBD	$80.63

HC F-18 SODIUM FLUORIDE <=30MCI

Facility

$484.74

Service Code	HCPCS A9580
Hospital Charge Code	34300028
Hospital Revenue Code	343
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$436.27
Rate for Payer: Aetna Commercial	$412.03
Rate for Payer: Aetna Medicare	$242.37
Rate for Payer: Aetna New Business (MI Preferred)	$315.08
Rate for Payer: BCBS Complete	$193.90
Rate for Payer: Cash Price	$387.79
Rate for Payer: Cofinity Commercial	$339.32
Rate for Payer: Cofinity Commercial	$416.88
Rate for Payer: Cofinity Medicare Advantage	$339.32
Rate for Payer: Encore Health Key Benefits Commercial	$387.79
Rate for Payer: Healthscope Commercial	$436.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$412.03
Rate for Payer: PHP Commercial	$412.03
Rate for Payer: Priority Health Cigna Priority Health	$315.08
Rate for Payer: Priority Health SBD	$305.39

HC F-18 SODIUM FLUORIDE <=30MCI

Facility

$484.74

Service Code	HCPCS A9580
Hospital Charge Code	34300028
Hospital Revenue Code	343
Min. Negotiated Rate	$305.39
Max. Negotiated Rate	$436.27
Rate for Payer: Aetna Commercial	$412.03
Rate for Payer: Aetna New Business (MI Preferred)	$315.08
Rate for Payer: Cash Price	$387.79
Rate for Payer: Cofinity Commercial	$339.32
Rate for Payer: Cofinity Commercial	$416.88
Rate for Payer: Cofinity Medicare Advantage	$339.32
Rate for Payer: Encore Health Key Benefits Commercial	$387.79
Rate for Payer: Healthscope Commercial	$436.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$412.03
Rate for Payer: PHP Commercial	$412.03
Rate for Payer: Priority Health Cigna Priority Health	$315.08
Rate for Payer: Priority Health SBD	$305.39

Know your out-of-pocket cost for care.

All Charges