Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OPIOID DRUG PANEL URIN

Facility

$30.60

Service Code	CPT 80305
Hospital Charge Code	30100645
Hospital Revenue Code	301
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$27.54
Rate for Payer: Aetna Commercial	$26.01
Rate for Payer: Aetna New Business (MI Preferred)	$19.89
Rate for Payer: Cash Price	$24.48
Rate for Payer: Cofinity Commercial	$21.42
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Healthscope Commercial	$27.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.01
Rate for Payer: PHP Commercial	$26.01
Rate for Payer: Priority Health Cigna Priority Health	$21.42
Rate for Payer: Priority Health SBD	$19.28

HC OPIOID DRUG PANEL URN.

Facility

$95.40

Service Code	CPT 80307
Hospital Charge Code	30100644
Hospital Revenue Code	301
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$95.77
Rate for Payer: Aetna Commercial	$81.09
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$62.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$77.68
Rate for Payer: Amish Plain Church Group Commercial	$77.68
Rate for Payer: BCBS Complete	$35.69
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCBS Trust/PPO	$48.67
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$76.32
Rate for Payer: Cash Price	$76.32
Rate for Payer: Cofinity Commercial	$82.04
Rate for Payer: Cofinity Commercial	$66.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$85.86
Rate for Payer: Mclaren Medicaid	$33.99
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Medicaid	$35.69
Rate for Payer: Meridian Wellcare - Medicare Advantage	$65.25
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.09
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$81.09
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$33.99
Rate for Payer: Priority Health Cigna Priority Health	$66.78
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health SBD	$60.10
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$74.57
Rate for Payer: UHC Core	$95.77
Rate for Payer: UHC Dual Complete DSNP	$62.14
Rate for Payer: UHC Exchange	$62.14
Rate for Payer: UHC Medicare Advantage	$64.00
Rate for Payer: VA VA	$62.14

HC OPIOID DRUG PANEL URN.

Facility

$95.40

Service Code	CPT 80307
Hospital Charge Code	30100644
Hospital Revenue Code	301
Min. Negotiated Rate	$60.10
Max. Negotiated Rate	$85.86
Rate for Payer: Aetna Commercial	$81.09
Rate for Payer: Aetna New Business (MI Preferred)	$62.01
Rate for Payer: Cash Price	$76.32
Rate for Payer: Cofinity Commercial	$66.78
Rate for Payer: Cofinity Commercial	$82.04
Rate for Payer: Healthscope Commercial	$85.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.09
Rate for Payer: PHP Commercial	$81.09
Rate for Payer: Priority Health Cigna Priority Health	$66.78
Rate for Payer: Priority Health SBD	$60.10

HC OPIOID DRUG PANEL URN. CMPT

Facility

$92.68

Service Code	CPT 80307
Hospital Charge Code	30100646
Hospital Revenue Code	301
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$83.41
Rate for Payer: Aetna Commercial	$78.78
Rate for Payer: Aetna New Business (MI Preferred)	$60.24
Rate for Payer: Cash Price	$74.14
Rate for Payer: Cofinity Commercial	$79.70
Rate for Payer: Cofinity Commercial	$64.88
Rate for Payer: Healthscope Commercial	$83.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.78
Rate for Payer: PHP Commercial	$78.78
Rate for Payer: Priority Health Cigna Priority Health	$64.88
Rate for Payer: Priority Health SBD	$58.39

HC OPIOID DRUG PANEL URN. CMPT

Facility

$92.68

Service Code	CPT 80307
Hospital Charge Code	30100646
Hospital Revenue Code	301
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$95.77
Rate for Payer: Aetna Commercial	$78.78
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$60.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$77.68
Rate for Payer: Amish Plain Church Group Commercial	$77.68
Rate for Payer: BCBS Complete	$35.69
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCBS Trust/PPO	$48.67
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$74.14
Rate for Payer: Cash Price	$74.14
Rate for Payer: Cofinity Commercial	$64.88
Rate for Payer: Cofinity Commercial	$79.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$83.41
Rate for Payer: Mclaren Medicaid	$33.99
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Medicaid	$35.69
Rate for Payer: Meridian Wellcare - Medicare Advantage	$65.25
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.78
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$78.78
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$33.99
Rate for Payer: Priority Health Cigna Priority Health	$64.88
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health SBD	$58.39
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$74.57
Rate for Payer: UHC Core	$95.77
Rate for Payer: UHC Dual Complete DSNP	$62.14
Rate for Payer: UHC Exchange	$62.14
Rate for Payer: UHC Medicare Advantage	$64.00
Rate for Payer: VA VA	$62.14

HC OPSITE LGE SHEET

Facility

$60.71

Hospital Charge Code	27000128
Hospital Revenue Code	270
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$54.64
Rate for Payer: Aetna Commercial	$51.60
Rate for Payer: Aetna New Business (MI Preferred)	$39.46
Rate for Payer: BCBS Complete	$24.28
Rate for Payer: Cash Price	$48.57
Rate for Payer: Cofinity Commercial	$42.50
Rate for Payer: Cofinity Commercial	$52.21
Rate for Payer: Healthscope Commercial	$54.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.60
Rate for Payer: PHP Commercial	$51.60
Rate for Payer: Priority Health Cigna Priority Health	$42.50
Rate for Payer: Priority Health SBD	$38.25

HC OPSITE LGE SHEET

Facility

$60.71

Hospital Charge Code	27000128
Hospital Revenue Code	270
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$54.64
Rate for Payer: Aetna Commercial	$51.60
Rate for Payer: Aetna New Business (MI Preferred)	$39.46
Rate for Payer: Cash Price	$48.57
Rate for Payer: Cofinity Commercial	$42.50
Rate for Payer: Cofinity Commercial	$52.21
Rate for Payer: Healthscope Commercial	$54.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.60
Rate for Payer: PHP Commercial	$51.60
Rate for Payer: Priority Health Cigna Priority Health	$42.50
Rate for Payer: Priority Health SBD	$38.25

HC OPTISON 1ST ML

Facility

$89.76

Service Code	HCPCS Q9956
Hospital Charge Code	63600168
Hospital Revenue Code	636
Min. Negotiated Rate	$35.90
Max. Negotiated Rate	$80.78
Rate for Payer: Aetna Commercial	$76.30
Rate for Payer: Aetna New Business (MI Preferred)	$58.34
Rate for Payer: BCBS Complete	$35.90
Rate for Payer: BCBS Trust/PPO	$45.44
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cofinity Commercial	$77.19
Rate for Payer: Cofinity Commercial	$62.83
Rate for Payer: Healthscope Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.30
Rate for Payer: PHP Commercial	$76.30
Rate for Payer: Priority Health Cigna Priority Health	$62.83
Rate for Payer: Priority Health SBD	$56.55

HC OPTISON 1ST ML

Facility

$89.76

Service Code	HCPCS Q9956
Hospital Charge Code	63600168
Hospital Revenue Code	636
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$80.78
Rate for Payer: Aetna Commercial	$76.30
Rate for Payer: Aetna New Business (MI Preferred)	$58.34
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cofinity Commercial	$62.83
Rate for Payer: Cofinity Commercial	$77.19
Rate for Payer: Healthscope Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.30
Rate for Payer: PHP Commercial	$76.30
Rate for Payer: Priority Health Cigna Priority Health	$62.83
Rate for Payer: Priority Health SBD	$56.55

HC OPTISON 2ND ML

Facility

$89.76

Service Code	HCPCS Q9956
Hospital Charge Code	63600169
Hospital Revenue Code	636
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$80.78
Rate for Payer: Aetna Commercial	$76.30
Rate for Payer: Aetna New Business (MI Preferred)	$58.34
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cofinity Commercial	$62.83
Rate for Payer: Cofinity Commercial	$77.19
Rate for Payer: Healthscope Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.30
Rate for Payer: PHP Commercial	$76.30
Rate for Payer: Priority Health Cigna Priority Health	$62.83
Rate for Payer: Priority Health SBD	$56.55

HC OPTISON 2ND ML

Facility

$89.76

Service Code	HCPCS Q9956
Hospital Charge Code	63600169
Hospital Revenue Code	636
Min. Negotiated Rate	$35.90
Max. Negotiated Rate	$80.78
Rate for Payer: Aetna Commercial	$76.30
Rate for Payer: Aetna New Business (MI Preferred)	$58.34
Rate for Payer: BCBS Complete	$35.90
Rate for Payer: BCBS Trust/PPO	$45.44
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cofinity Commercial	$62.83
Rate for Payer: Cofinity Commercial	$77.19
Rate for Payer: Healthscope Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.30
Rate for Payer: PHP Commercial	$76.30
Rate for Payer: Priority Health Cigna Priority Health	$62.83
Rate for Payer: Priority Health SBD	$56.55

HC OPTISON 3RD ML

Facility

$89.76

Service Code	HCPCS Q9956
Hospital Charge Code	63600170
Hospital Revenue Code	636
Min. Negotiated Rate	$35.90
Max. Negotiated Rate	$80.78
Rate for Payer: Aetna Commercial	$76.30
Rate for Payer: Aetna New Business (MI Preferred)	$58.34
Rate for Payer: BCBS Complete	$35.90
Rate for Payer: BCBS Trust/PPO	$45.44
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cofinity Commercial	$62.83
Rate for Payer: Cofinity Commercial	$77.19
Rate for Payer: Healthscope Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.30
Rate for Payer: PHP Commercial	$76.30
Rate for Payer: Priority Health Cigna Priority Health	$62.83
Rate for Payer: Priority Health SBD	$56.55

HC OPTISON 3RD ML

Facility

$89.76

Service Code	HCPCS Q9956
Hospital Charge Code	63600170
Hospital Revenue Code	636
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$80.78
Rate for Payer: Aetna Commercial	$76.30
Rate for Payer: Aetna New Business (MI Preferred)	$58.34
Rate for Payer: Cash Price	$71.81
Rate for Payer: Cofinity Commercial	$62.83
Rate for Payer: Cofinity Commercial	$77.19
Rate for Payer: Healthscope Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.30
Rate for Payer: PHP Commercial	$76.30
Rate for Payer: Priority Health Cigna Priority Health	$62.83
Rate for Payer: Priority Health SBD	$56.55

HC OP VISIT LEVEL 1

Facility

$154.65

Service Code	CPT 99211
Hospital Charge Code	51000015
Hospital Revenue Code	761
Min. Negotiated Rate	$97.43
Max. Negotiated Rate	$139.18
Rate for Payer: Aetna Commercial	$131.45
Rate for Payer: Aetna New Business (MI Preferred)	$100.52
Rate for Payer: Cash Price	$123.72
Rate for Payer: Cofinity Commercial	$108.26
Rate for Payer: Cofinity Commercial	$133.00
Rate for Payer: Healthscope Commercial	$139.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$131.45
Rate for Payer: PHP Commercial	$131.45
Rate for Payer: Priority Health Cigna Priority Health	$108.26
Rate for Payer: Priority Health SBD	$97.43

HC OP VISIT LEVEL 1

Facility

$154.65

Service Code	CPT 99211
Hospital Charge Code	51000015
Hospital Revenue Code	761
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$139.18
Rate for Payer: Aetna Commercial	$131.45
Rate for Payer: Aetna New Business (MI Preferred)	$100.52
Rate for Payer: BCBS Complete	$61.86
Rate for Payer: BCBS Trust/PPO	$51.75
Rate for Payer: BCCCP Commercial	$22.00
Rate for Payer: Cash Price	$123.72
Rate for Payer: Cash Price	$123.72
Rate for Payer: Cofinity Commercial	$108.26
Rate for Payer: Cofinity Commercial	$133.00
Rate for Payer: Healthscope Commercial	$139.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$131.45
Rate for Payer: PHP Commercial	$131.45
Rate for Payer: Priority Health Cigna Priority Health	$108.26
Rate for Payer: Priority Health SBD	$97.43
Rate for Payer: UHC All Payor (Choice/PPO)	$9.36
Rate for Payer: UHC Exchange	$8.51

HC OP VISIT LEVEL 2

Facility

$174.09

Service Code	CPT 99212
Hospital Charge Code	51000020
Hospital Revenue Code	761
Min. Negotiated Rate	$109.68
Max. Negotiated Rate	$156.68
Rate for Payer: Aetna Commercial	$147.98
Rate for Payer: Aetna New Business (MI Preferred)	$113.16
Rate for Payer: Cash Price	$139.27
Rate for Payer: Cofinity Commercial	$121.86
Rate for Payer: Cofinity Commercial	$149.72
Rate for Payer: Healthscope Commercial	$156.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.98
Rate for Payer: PHP Commercial	$147.98
Rate for Payer: Priority Health Cigna Priority Health	$121.86
Rate for Payer: Priority Health SBD	$109.68

HC OP VISIT LEVEL 2

Facility

$174.09

Service Code	CPT 99212
Hospital Charge Code	51000020
Hospital Revenue Code	761
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$156.68
Rate for Payer: Aetna Commercial	$147.98
Rate for Payer: Aetna New Business (MI Preferred)	$113.16
Rate for Payer: BCBS Complete	$69.64
Rate for Payer: BCBS Trust/PPO	$92.98
Rate for Payer: BCCCP Commercial	$22.00
Rate for Payer: Cash Price	$139.27
Rate for Payer: Cash Price	$139.27
Rate for Payer: Cofinity Commercial	$149.72
Rate for Payer: Cofinity Commercial	$121.86
Rate for Payer: Healthscope Commercial	$156.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.98
Rate for Payer: PHP Commercial	$147.98
Rate for Payer: Priority Health Cigna Priority Health	$121.86
Rate for Payer: Priority Health SBD	$109.68
Rate for Payer: UHC All Payor (Choice/PPO)	$37.82
Rate for Payer: UHC Exchange	$34.38

HC OP VISIT LEVEL 3

Facility

$211.25

Service Code	CPT 99213
Hospital Charge Code	51000026
Hospital Revenue Code	761
Min. Negotiated Rate	$64.18
Max. Negotiated Rate	$190.12
Rate for Payer: Aetna Commercial	$179.56
Rate for Payer: Aetna New Business (MI Preferred)	$137.31
Rate for Payer: BCBS Complete	$84.50
Rate for Payer: BCBS Trust/PPO	$125.26
Rate for Payer: BCCCP Commercial	$72.85
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cofinity Commercial	$181.68
Rate for Payer: Cofinity Commercial	$147.88
Rate for Payer: Healthscope Commercial	$190.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$179.56
Rate for Payer: PHP Commercial	$179.56
Rate for Payer: Priority Health Cigna Priority Health	$147.88
Rate for Payer: Priority Health SBD	$133.09
Rate for Payer: UHC All Payor (Choice/PPO)	$70.60
Rate for Payer: UHC Exchange	$64.18

HC OP VISIT LEVEL 3

Facility

$211.25

Service Code	CPT 99213
Hospital Charge Code	51000026
Hospital Revenue Code	761
Min. Negotiated Rate	$133.09
Max. Negotiated Rate	$190.12
Rate for Payer: Aetna Commercial	$179.56
Rate for Payer: Aetna New Business (MI Preferred)	$137.31
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cofinity Commercial	$181.68
Rate for Payer: Cofinity Commercial	$147.88
Rate for Payer: Healthscope Commercial	$190.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$179.56
Rate for Payer: PHP Commercial	$179.56
Rate for Payer: Priority Health Cigna Priority Health	$147.88
Rate for Payer: Priority Health SBD	$133.09

HC OP VISIT LEVEL 4

Facility

$303.37

Service Code	CPT 99214
Hospital Charge Code	51000030
Hospital Revenue Code	761
Min. Negotiated Rate	$191.12
Max. Negotiated Rate	$273.03
Rate for Payer: Aetna Commercial	$257.86
Rate for Payer: Aetna New Business (MI Preferred)	$197.19
Rate for Payer: Cash Price	$242.70
Rate for Payer: Cofinity Commercial	$212.36
Rate for Payer: Cofinity Commercial	$260.90
Rate for Payer: Healthscope Commercial	$273.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.86
Rate for Payer: PHP Commercial	$257.86
Rate for Payer: Priority Health Cigna Priority Health	$212.36
Rate for Payer: Priority Health SBD	$191.12

HC OP VISIT LEVEL 4

Facility

$303.37

Service Code	CPT 99214
Hospital Charge Code	51000030
Hospital Revenue Code	761
Min. Negotiated Rate	$72.85
Max. Negotiated Rate	$273.03
Rate for Payer: Aetna Commercial	$257.86
Rate for Payer: Aetna New Business (MI Preferred)	$197.19
Rate for Payer: BCBS Complete	$121.35
Rate for Payer: BCBS Trust/PPO	$171.35
Rate for Payer: BCCCP Commercial	$72.85
Rate for Payer: Cash Price	$242.70
Rate for Payer: Cash Price	$242.70
Rate for Payer: Cofinity Commercial	$212.36
Rate for Payer: Cofinity Commercial	$260.90
Rate for Payer: Healthscope Commercial	$273.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.86
Rate for Payer: PHP Commercial	$257.86
Rate for Payer: Priority Health Cigna Priority Health	$212.36
Rate for Payer: Priority Health SBD	$191.12
Rate for Payer: UHC All Payor (Choice/PPO)	$104.09
Rate for Payer: UHC Exchange	$94.63

HC OP VISIT LEVEL 5

Facility

$505.14

Service Code	CPT 99215
Hospital Charge Code	51000037
Hospital Revenue Code	761
Min. Negotiated Rate	$318.24
Max. Negotiated Rate	$454.63
Rate for Payer: Aetna Commercial	$429.37
Rate for Payer: Aetna New Business (MI Preferred)	$328.34
Rate for Payer: Cash Price	$404.11
Rate for Payer: Cofinity Commercial	$353.60
Rate for Payer: Cofinity Commercial	$434.42
Rate for Payer: Healthscope Commercial	$454.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$429.37
Rate for Payer: PHP Commercial	$429.37
Rate for Payer: Priority Health Cigna Priority Health	$353.60
Rate for Payer: Priority Health SBD	$318.24

HC OP VISIT LEVEL 5

Facility

$505.14

Service Code	CPT 99215
Hospital Charge Code	51000037
Hospital Revenue Code	761
Min. Negotiated Rate	$140.47
Max. Negotiated Rate	$454.63
Rate for Payer: Aetna Commercial	$429.37
Rate for Payer: Aetna New Business (MI Preferred)	$328.34
Rate for Payer: BCBS Complete	$202.06
Rate for Payer: BCBS Trust/PPO	$218.48
Rate for Payer: Cash Price	$404.11
Rate for Payer: Cash Price	$404.11
Rate for Payer: Cofinity Commercial	$434.42
Rate for Payer: Cofinity Commercial	$353.60
Rate for Payer: Healthscope Commercial	$454.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$429.37
Rate for Payer: PHP Commercial	$429.37
Rate for Payer: Priority Health Cigna Priority Health	$353.60
Rate for Payer: Priority Health SBD	$318.24
Rate for Payer: UHC All Payor (Choice/PPO)	$154.52
Rate for Payer: UHC Exchange	$140.47

HC ORAL CHEMO ADMINISTRATION

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000089
Hospital Revenue Code	510
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: BCBS Complete	$53.88
Rate for Payer: BCBS Trust/PPO	$51.75
Rate for Payer: BCCCP Commercial	$22.00
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$84.87
Rate for Payer: UHC All Payor (Choice/PPO)	$9.36
Rate for Payer: UHC Exchange	$8.51

HC ORAL CHEMO ADMINISTRATION

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000089
Hospital Revenue Code	510
Min. Negotiated Rate	$84.87
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.50
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$84.87

Know your out-of-pocket cost for care.

All Charges