Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OT EVAL LOW COMPLEXITY

Facility

$223.99

Service Code	CPT 97165
Hospital Charge Code	43400007
Hospital Revenue Code	434
Min. Negotiated Rate	$59.35
Max. Negotiated Rate	$201.59
Rate for Payer: Aetna Commercial	$190.39
Rate for Payer: Aetna New Business (MI Preferred)	$145.59
Rate for Payer: BCBS Complete	$89.60
Rate for Payer: BCBS Trust/PPO	$59.35
Rate for Payer: Cash Price	$179.19
Rate for Payer: Cash Price	$179.19
Rate for Payer: Cofinity Commercial	$156.79
Rate for Payer: Cofinity Commercial	$192.63
Rate for Payer: Healthscope Commercial	$201.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.39
Rate for Payer: PHP Commercial	$190.39
Rate for Payer: Priority Health Cigna Priority Health	$156.79
Rate for Payer: Priority Health SBD	$141.11
Rate for Payer: UHC All Payor (Choice/PPO)	$109.49
Rate for Payer: UHC Exchange	$99.54

HC OT EVAL LOW COMPLEXITY

Facility

$223.99

Service Code	CPT 97165
Hospital Charge Code	43400007
Hospital Revenue Code	434
Min. Negotiated Rate	$141.11
Max. Negotiated Rate	$201.59
Rate for Payer: Aetna Commercial	$190.39
Rate for Payer: Aetna New Business (MI Preferred)	$145.59
Rate for Payer: Cash Price	$179.19
Rate for Payer: Cofinity Commercial	$156.79
Rate for Payer: Cofinity Commercial	$192.63
Rate for Payer: Healthscope Commercial	$201.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.39
Rate for Payer: PHP Commercial	$190.39
Rate for Payer: Priority Health Cigna Priority Health	$156.79
Rate for Payer: Priority Health SBD	$141.11

HC OT EVAL MODERATE COMPLEXITY

Facility

$248.88

Service Code	CPT 97166
Hospital Charge Code	43400008
Hospital Revenue Code	434
Min. Negotiated Rate	$59.12
Max. Negotiated Rate	$223.99
Rate for Payer: Aetna Commercial	$211.55
Rate for Payer: Aetna New Business (MI Preferred)	$161.77
Rate for Payer: BCBS Complete	$99.55
Rate for Payer: BCBS Trust/PPO	$59.12
Rate for Payer: Cash Price	$199.10
Rate for Payer: Cash Price	$199.10
Rate for Payer: Cofinity Commercial	$214.04
Rate for Payer: Cofinity Commercial	$174.22
Rate for Payer: Healthscope Commercial	$223.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.55
Rate for Payer: PHP Commercial	$211.55
Rate for Payer: Priority Health Cigna Priority Health	$174.22
Rate for Payer: Priority Health SBD	$156.79
Rate for Payer: UHC All Payor (Choice/PPO)	$109.49
Rate for Payer: UHC Exchange	$99.54

HC OT EVAL MODERATE COMPLEXITY

Facility

$248.88

Service Code	CPT 97166
Hospital Charge Code	43400008
Hospital Revenue Code	434
Min. Negotiated Rate	$156.79
Max. Negotiated Rate	$223.99
Rate for Payer: Aetna Commercial	$211.55
Rate for Payer: Aetna New Business (MI Preferred)	$161.77
Rate for Payer: Cash Price	$199.10
Rate for Payer: Cofinity Commercial	$174.22
Rate for Payer: Cofinity Commercial	$214.04
Rate for Payer: Healthscope Commercial	$223.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.55
Rate for Payer: PHP Commercial	$211.55
Rate for Payer: Priority Health Cigna Priority Health	$174.22
Rate for Payer: Priority Health SBD	$156.79

HC OT RE-EVALUATION

Facility

$118.00

Service Code	CPT 97168
Hospital Charge Code	43400010
Hospital Revenue Code	434
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna Commercial	$100.30
Rate for Payer: Aetna New Business (MI Preferred)	$76.70
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Cofinity Commercial	$101.48
Rate for Payer: Healthscope Commercial	$106.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.30
Rate for Payer: PHP Commercial	$100.30
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health SBD	$74.34

HC OT RE-EVALUATION

Facility

$118.00

Service Code	CPT 97168
Hospital Charge Code	43400010
Hospital Revenue Code	434
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna Commercial	$100.30
Rate for Payer: Aetna New Business (MI Preferred)	$76.70
Rate for Payer: BCBS Complete	$47.20
Rate for Payer: BCBS Trust/PPO	$40.94
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cofinity Commercial	$101.48
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Healthscope Commercial	$106.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.30
Rate for Payer: PHP Commercial	$100.30
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health SBD	$74.34
Rate for Payer: UHC All Payor (Choice/PPO)	$75.64
Rate for Payer: UHC Exchange	$68.76

HC OT Z GAUNTLET EA $100

Facility

$100.00

Service Code	HCPCS A6549
Hospital Charge Code	98300074
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health SBD	$63.00

HC OT Z GAUNTLET EA $100

Facility

$100.00

Service Code	HCPCS A6549
Hospital Charge Code	98300074
Hospital Revenue Code	270
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health SBD	$63.00

HC OT Z GAUNTLET EA $125

Facility

$125.00

Service Code	HCPCS A6549
Hospital Charge Code	98300075
Hospital Revenue Code	270
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$106.25
Rate for Payer: Aetna New Business (MI Preferred)	$81.25
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$87.50
Rate for Payer: Cofinity Commercial	$107.50
Rate for Payer: Healthscope Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: PHP Commercial	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health SBD	$78.75

HC OT Z GAUNTLET EA $125

Facility

$125.00

Service Code	HCPCS A6549
Hospital Charge Code	98300075
Hospital Revenue Code	270
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$106.25
Rate for Payer: Aetna New Business (MI Preferred)	$81.25
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$107.50
Rate for Payer: Cofinity Commercial	$87.50
Rate for Payer: Healthscope Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: PHP Commercial	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health SBD	$78.75

HC OT Z GAUNTLET EA $150

Facility

$150.00

Service Code	HCPCS A6549
Hospital Charge Code	98300076
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC OT Z GAUNTLET EA $150

Facility

$150.00

Service Code	HCPCS A6549
Hospital Charge Code	98300076
Hospital Revenue Code	270
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC OT Z GAUNTLET EA $175

Facility

$175.00

Service Code	HCPCS A6549
Hospital Charge Code	98300077
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Cofinity Commercial	$122.50
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.75
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health Cigna Priority Health	$122.50
Rate for Payer: Priority Health SBD	$110.25

HC OT Z GAUNTLET EA $175

Facility

$175.00

Service Code	HCPCS A6549
Hospital Charge Code	98300077
Hospital Revenue Code	270
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Commercial	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.75
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health Cigna Priority Health	$122.50
Rate for Payer: Priority Health SBD	$110.25

HC OT Z GAUNTLET EA $20

Facility

$20.00

Service Code	HCPCS A6549
Hospital Charge Code	98300078
Hospital Revenue Code	270
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health SBD	$12.60

HC OT Z GAUNTLET EA $20

Facility

$20.00

Service Code	HCPCS A6549
Hospital Charge Code	98300078
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health SBD	$12.60

HC OT Z GAUNTLET EA $200

Facility

$200.00

Service Code	HCPCS A6549
Hospital Charge Code	98300079
Hospital Revenue Code	270
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna New Business (MI Preferred)	$130.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$172.00
Rate for Payer: Cofinity Commercial	$140.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.00
Rate for Payer: PHP Commercial	$170.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health SBD	$126.00

HC OT Z GAUNTLET EA $200

Facility

$200.00

Service Code	HCPCS A6549
Hospital Charge Code	98300079
Hospital Revenue Code	270
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna New Business (MI Preferred)	$130.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$140.00
Rate for Payer: Cofinity Commercial	$172.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.00
Rate for Payer: PHP Commercial	$170.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health SBD	$126.00

HC OT Z GAUNTLET EA $225

Facility

$225.00

Service Code	HCPCS A6549
Hospital Charge Code	98300080
Hospital Revenue Code	270
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$146.25
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cofinity Commercial	$193.50
Rate for Payer: Cofinity Commercial	$157.50
Rate for Payer: Healthscope Commercial	$202.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.25
Rate for Payer: PHP Commercial	$191.25
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health SBD	$141.75

HC OT Z GAUNTLET EA $225

Facility

$225.00

Service Code	HCPCS A6549
Hospital Charge Code	98300080
Hospital Revenue Code	270
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$146.25
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cofinity Commercial	$157.50
Rate for Payer: Cofinity Commercial	$193.50
Rate for Payer: Healthscope Commercial	$202.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.25
Rate for Payer: PHP Commercial	$191.25
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health SBD	$141.75

HC OT Z GAUNTLET EA $250

Facility

$250.00

Service Code	HCPCS A6549
Hospital Charge Code	98300081
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC OT Z GAUNTLET EA $250

Facility

$250.00

Service Code	HCPCS A6549
Hospital Charge Code	98300081
Hospital Revenue Code	270
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC OT Z GAUNTLET EA $275

Facility

$275.00

Service Code	HCPCS A6549
Hospital Charge Code	98300082
Hospital Revenue Code	270
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health SBD	$173.25

HC OT Z GAUNTLET EA $275

Facility

$275.00

Service Code	HCPCS A6549
Hospital Charge Code	98300082
Hospital Revenue Code	270
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health SBD	$173.25

HC OT Z GAUNTLET EA $300

Facility

$300.00

Service Code	HCPCS A6549
Hospital Charge Code	98300083
Hospital Revenue Code	270
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$255.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health SBD	$189.00

Know your out-of-pocket cost for care.

All Charges