Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NUSHIELD 2X3 PER SQ CM

Facility

$322.52

Service Code	HCPCS Q4160
Hospital Charge Code	63600154
Hospital Revenue Code	636
Min. Negotiated Rate	$129.01
Max. Negotiated Rate	$290.27
Rate for Payer: Aetna Commercial	$274.14
Rate for Payer: Aetna New Business (MI Preferred)	$209.64
Rate for Payer: BCBS Complete	$129.01
Rate for Payer: Cash Price	$258.02
Rate for Payer: Cofinity Commercial	$225.76
Rate for Payer: Cofinity Commercial	$277.37
Rate for Payer: Healthscope Commercial	$290.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.14
Rate for Payer: PHP Commercial	$274.14
Rate for Payer: Priority Health Cigna Priority Health	$225.76
Rate for Payer: Priority Health SBD	$203.19

HC NUSHIELD 2X3 PER SQ CM

Facility

$322.52

Service Code	HCPCS Q4160
Hospital Charge Code	63600154
Hospital Revenue Code	636
Min. Negotiated Rate	$203.19
Max. Negotiated Rate	$290.27
Rate for Payer: Aetna Commercial	$274.14
Rate for Payer: Aetna New Business (MI Preferred)	$209.64
Rate for Payer: Cash Price	$258.02
Rate for Payer: Cofinity Commercial	$225.76
Rate for Payer: Cofinity Commercial	$277.37
Rate for Payer: Healthscope Commercial	$290.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.14
Rate for Payer: PHP Commercial	$274.14
Rate for Payer: Priority Health Cigna Priority Health	$225.76
Rate for Payer: Priority Health SBD	$203.19

HC NUSHIELD 2X4 PER SQ CM

Facility

$302.82

Service Code	HCPCS Q4160
Hospital Charge Code	63600175
Hospital Revenue Code	636
Min. Negotiated Rate	$190.78
Max. Negotiated Rate	$272.54
Rate for Payer: Aetna Commercial	$257.40
Rate for Payer: Aetna New Business (MI Preferred)	$196.83
Rate for Payer: Cash Price	$242.26
Rate for Payer: Cofinity Commercial	$211.97
Rate for Payer: Cofinity Commercial	$260.43
Rate for Payer: Healthscope Commercial	$272.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.40
Rate for Payer: PHP Commercial	$257.40
Rate for Payer: Priority Health Cigna Priority Health	$211.97
Rate for Payer: Priority Health SBD	$190.78

HC NUSHIELD 2X4 PER SQ CM

Facility

$302.82

Service Code	HCPCS Q4160
Hospital Charge Code	63600175
Hospital Revenue Code	636
Min. Negotiated Rate	$121.13
Max. Negotiated Rate	$272.54
Rate for Payer: Aetna Commercial	$257.40
Rate for Payer: Aetna New Business (MI Preferred)	$196.83
Rate for Payer: BCBS Complete	$121.13
Rate for Payer: Cash Price	$242.26
Rate for Payer: Cofinity Commercial	$211.97
Rate for Payer: Cofinity Commercial	$260.43
Rate for Payer: Healthscope Commercial	$272.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.40
Rate for Payer: PHP Commercial	$257.40
Rate for Payer: Priority Health Cigna Priority Health	$211.97
Rate for Payer: Priority Health SBD	$190.78

HC NUSHIELD 3X4 PER SQ CM

Facility

$292.19

Service Code	HCPCS Q4160
Hospital Charge Code	63600176
Hospital Revenue Code	636
Min. Negotiated Rate	$184.08
Max. Negotiated Rate	$262.97
Rate for Payer: Aetna Commercial	$248.36
Rate for Payer: Aetna New Business (MI Preferred)	$189.92
Rate for Payer: Cash Price	$233.75
Rate for Payer: Cofinity Commercial	$204.53
Rate for Payer: Cofinity Commercial	$251.28
Rate for Payer: Healthscope Commercial	$262.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$248.36
Rate for Payer: PHP Commercial	$248.36
Rate for Payer: Priority Health Cigna Priority Health	$204.53
Rate for Payer: Priority Health SBD	$184.08

HC NUSHIELD 3X4 PER SQ CM

Facility

$292.19

Service Code	HCPCS Q4160
Hospital Charge Code	63600176
Hospital Revenue Code	636
Min. Negotiated Rate	$116.88
Max. Negotiated Rate	$262.97
Rate for Payer: Aetna Commercial	$248.36
Rate for Payer: Aetna New Business (MI Preferred)	$189.92
Rate for Payer: BCBS Complete	$116.88
Rate for Payer: Cash Price	$233.75
Rate for Payer: Cofinity Commercial	$204.53
Rate for Payer: Cofinity Commercial	$251.28
Rate for Payer: Healthscope Commercial	$262.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$248.36
Rate for Payer: PHP Commercial	$248.36
Rate for Payer: Priority Health Cigna Priority Health	$204.53
Rate for Payer: Priority Health SBD	$184.08

HC NUSHIELD 4X4 PER SQ CM

Facility

$227.11

Service Code	CPT Q4160
Hospital Charge Code	63600177
Hospital Revenue Code	636
Min. Negotiated Rate	$143.08
Max. Negotiated Rate	$204.40
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna New Business (MI Preferred)	$147.62
Rate for Payer: Cash Price	$181.69
Rate for Payer: Cofinity Commercial	$158.98
Rate for Payer: Cofinity Commercial	$195.31
Rate for Payer: Healthscope Commercial	$204.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.04
Rate for Payer: PHP Commercial	$193.04
Rate for Payer: Priority Health Cigna Priority Health	$158.98
Rate for Payer: Priority Health SBD	$143.08

HC NUSHIELD 4X4 PER SQ CM

Facility

$227.11

Service Code	CPT Q4160
Hospital Charge Code	63600177
Hospital Revenue Code	636
Min. Negotiated Rate	$90.84
Max. Negotiated Rate	$204.40
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna New Business (MI Preferred)	$147.62
Rate for Payer: BCBS Complete	$90.84
Rate for Payer: Cash Price	$181.69
Rate for Payer: Cofinity Commercial	$158.98
Rate for Payer: Cofinity Commercial	$195.31
Rate for Payer: Healthscope Commercial	$204.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.04
Rate for Payer: PHP Commercial	$193.04
Rate for Payer: Priority Health Cigna Priority Health	$158.98
Rate for Payer: Priority Health SBD	$143.08

HC NUSHIELD 4X6 PER SQ CM

Facility

$159.38

Service Code	HCPCS Q4160
Hospital Charge Code	63600178
Hospital Revenue Code	636
Min. Negotiated Rate	$100.41
Max. Negotiated Rate	$143.44
Rate for Payer: Aetna Commercial	$135.47
Rate for Payer: Aetna New Business (MI Preferred)	$103.60
Rate for Payer: Cash Price	$127.50
Rate for Payer: Cofinity Commercial	$111.57
Rate for Payer: Cofinity Commercial	$137.07
Rate for Payer: Healthscope Commercial	$143.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$135.47
Rate for Payer: PHP Commercial	$135.47
Rate for Payer: Priority Health Cigna Priority Health	$111.57
Rate for Payer: Priority Health SBD	$100.41

HC NUSHIELD 4X6 PER SQ CM

Facility

$159.38

Service Code	HCPCS Q4160
Hospital Charge Code	63600178
Hospital Revenue Code	636
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$143.44
Rate for Payer: Aetna Commercial	$135.47
Rate for Payer: Aetna New Business (MI Preferred)	$103.60
Rate for Payer: BCBS Complete	$63.75
Rate for Payer: Cash Price	$127.50
Rate for Payer: Cofinity Commercial	$111.57
Rate for Payer: Cofinity Commercial	$137.07
Rate for Payer: Healthscope Commercial	$143.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$135.47
Rate for Payer: PHP Commercial	$135.47
Rate for Payer: Priority Health Cigna Priority Health	$111.57
Rate for Payer: Priority Health SBD	$100.41

HC NUSHIELD 6X6 PER SQ CM

Facility

$141.11

Service Code	HCPCS Q4160
Hospital Charge Code	63600166
Hospital Revenue Code	636
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$127.00
Rate for Payer: Aetna Commercial	$119.94
Rate for Payer: Aetna New Business (MI Preferred)	$91.72
Rate for Payer: Cash Price	$112.89
Rate for Payer: Cofinity Commercial	$121.35
Rate for Payer: Cofinity Commercial	$98.78
Rate for Payer: Healthscope Commercial	$127.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.94
Rate for Payer: PHP Commercial	$119.94
Rate for Payer: Priority Health Cigna Priority Health	$98.78
Rate for Payer: Priority Health SBD	$88.90

HC NUSHIELD 6X6 PER SQ CM

Facility

$141.11

Service Code	HCPCS Q4160
Hospital Charge Code	63600166
Hospital Revenue Code	636
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$127.00
Rate for Payer: Aetna Commercial	$119.94
Rate for Payer: Aetna New Business (MI Preferred)	$91.72
Rate for Payer: BCBS Complete	$56.44
Rate for Payer: Cash Price	$112.89
Rate for Payer: Cofinity Commercial	$121.35
Rate for Payer: Cofinity Commercial	$98.78
Rate for Payer: Healthscope Commercial	$127.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.94
Rate for Payer: PHP Commercial	$119.94
Rate for Payer: Priority Health Cigna Priority Health	$98.78
Rate for Payer: Priority Health SBD	$88.90

HC NUT ALLERGEN PANEL

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200123
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	$17.42
Rate for Payer: Cofinity Commercial	$21.41
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 NUT ALLERGEN PANEL

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200123
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 NVU OBSERVATION PER HOUR

Facility

$134.33

Service Code	HCPCS G0378
Hospital Charge Code	76200004
Hospital Revenue Code	762
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$114.18
Rate for Payer: Aetna New Business (MI Preferred)	$87.31
Rate for Payer: BCBS Complete	$53.73
Rate for Payer: BCBS Trust/PPO	$108.91
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cofinity Commercial	$94.03
Rate for Payer: Cofinity Commercial	$115.52
Rate for Payer: Healthscope Commercial	$120.90
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.18
Rate for Payer: PHP Commercial	$114.18
Rate for Payer: Priority Health Cigna Priority Health	$94.03
Rate for Payer: Priority Health SBD	$84.63

HC NVU OBSERVATION PER HOUR

Facility

$134.33

Service Code	HCPCS G0378
Hospital Charge Code	76200004
Hospital Revenue Code	762
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$120.90
Rate for Payer: Aetna Commercial	$114.18
Rate for Payer: Aetna New Business (MI Preferred)	$87.31
Rate for Payer: Cash Price	$107.46
Rate for Payer: Cofinity Commercial	$115.52
Rate for Payer: Cofinity Commercial	$94.03
Rate for Payer: Healthscope Commercial	$120.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.18
Rate for Payer: PHP Commercial	$114.18
Rate for Payer: Priority Health Cigna Priority Health	$94.03
Rate for Payer: Priority Health SBD	$84.63

HC OAK IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200050
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	$17.42
Rate for Payer: Cofinity Commercial	$21.41
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 OAK IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200050
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 OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM

Facility

$53.13

Service Code	HCPCS Q4124
Hospital Charge Code	63600059
Hospital Revenue Code	636
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$47.82
Rate for Payer: Aetna Commercial	$45.16
Rate for Payer: Aetna New Business (MI Preferred)	$34.53
Rate for Payer: BCBS Complete	$21.25
Rate for Payer: BCBS Trust/PPO	$6.53
Rate for Payer: Cash Price	$42.50
Rate for Payer: Cash Price	$42.50
Rate for Payer: Cofinity Commercial	$45.69
Rate for Payer: Cofinity Commercial	$37.19
Rate for Payer: Healthscope Commercial	$47.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.16
Rate for Payer: PHP Commercial	$45.16
Rate for Payer: Priority Health Cigna Priority Health	$37.19
Rate for Payer: Priority Health SBD	$33.47

HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM

Facility

$53.13

Service Code	HCPCS Q4124
Hospital Charge Code	63600059
Hospital Revenue Code	636
Min. Negotiated Rate	$33.47
Max. Negotiated Rate	$47.82
Rate for Payer: Aetna Commercial	$45.16
Rate for Payer: Aetna New Business (MI Preferred)	$34.53
Rate for Payer: Cash Price	$42.50
Rate for Payer: Cofinity Commercial	$37.19
Rate for Payer: Cofinity Commercial	$45.69
Rate for Payer: Healthscope Commercial	$47.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.16
Rate for Payer: PHP Commercial	$45.16
Rate for Payer: Priority Health Cigna Priority Health	$37.19
Rate for Payer: Priority Health SBD	$33.47

HC OASIS WD MATRIX PER SQ CM

Facility

$31.29

Service Code	HCPCS Q4102
Hospital Charge Code	63600050
Hospital Revenue Code	636
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$909.03
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna New Business (MI Preferred)	$20.34
Rate for Payer: BCBS Complete	$12.52
Rate for Payer: BCBS Trust/PPO	$909.03
Rate for Payer: Cash Price	$25.03
Rate for Payer: Cash Price	$25.03
Rate for Payer: Cofinity Commercial	$21.90
Rate for Payer: Cofinity Commercial	$26.91
Rate for Payer: Healthscope Commercial	$28.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.60
Rate for Payer: PHP Commercial	$26.60
Rate for Payer: Priority Health Cigna Priority Health	$21.90
Rate for Payer: Priority Health SBD	$19.71

HC OASIS WD MATRIX PER SQ CM

Facility

$31.29

Service Code	HCPCS Q4102
Hospital Charge Code	63600050
Hospital Revenue Code	636
Min. Negotiated Rate	$19.71
Max. Negotiated Rate	$28.16
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna New Business (MI Preferred)	$20.34
Rate for Payer: Cash Price	$25.03
Rate for Payer: Cofinity Commercial	$21.90
Rate for Payer: Cofinity Commercial	$26.91
Rate for Payer: Healthscope Commercial	$28.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.60
Rate for Payer: PHP Commercial	$26.60
Rate for Payer: Priority Health Cigna Priority Health	$21.90
Rate for Payer: Priority Health SBD	$19.71

HC OAT IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200051
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	$17.42
Rate for Payer: Cofinity Commercial	$21.41
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 OAT IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200051
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 OB ANTEPARTUM R&B

Facility

$3,563.34

Hospital Charge Code	20000003
Hospital Revenue Code	110
Min. Negotiated Rate	$2,244.90
Max. Negotiated Rate	$3,207.01
Rate for Payer: Aetna Commercial	$3,028.84
Rate for Payer: Aetna New Business (MI Preferred)	$2,316.17
Rate for Payer: Cash Price	$2,850.67
Rate for Payer: Cofinity Commercial	$2,494.34
Rate for Payer: Cofinity Commercial	$3,064.47
Rate for Payer: Healthscope Commercial	$3,207.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,028.84
Rate for Payer: PHP Commercial	$3,028.84
Rate for Payer: Priority Health Cigna Priority Health	$2,494.34
Rate for Payer: Priority Health SBD	$2,244.90

Know your out-of-pocket cost for care.

All Charges