Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OBSERVATION OVERFLOW PER HOUR

Facility

$160.00

Hospital Charge Code	76900005
Hospital Revenue Code	769
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: MI Amish Medical Board Commercial	$128.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80
Rate for Payer: UHC All Payor (Choice/PPO)	$104.00
Rate for Payer: UHC Core	$83.36
Rate for Payer: UHC Exchange	$62.88

HC OBSERVATION OVERFLOW PER HOUR

Facility

$160.00

Hospital Charge Code	76900005
Hospital Revenue Code	769
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80

HC OBSERVATION PER HOUR

Facility

$160.00

Service Code	HCPCS G0378
Hospital Charge Code	76200023
Hospital Revenue Code	762
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80

HC OBSERVATION PER HOUR

Facility

$160.00

Service Code	HCPCS G0378
Hospital Charge Code	76200023
Hospital Revenue Code	762
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$1,608.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: BCBS Trust/PPO	$112.58
Rate for Payer: BCN Commercial	$112.58
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: MI Amish Medical Board Commercial	$128.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80
Rate for Payer: UHC Medicaid	$1,608.00
Rate for Payer: UHCCP Medicaid	$810.00

HC OBS OVERFLOW PER HR

Facility

$160.00

Hospital Charge Code	76900002
Hospital Revenue Code	769
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80

HC OBS OVERFLOW PER HR

Facility

$160.00

Hospital Charge Code	76900002
Hospital Revenue Code	769
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: MI Amish Medical Board Commercial	$128.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80
Rate for Payer: UHC All Payor (Choice/PPO)	$104.00
Rate for Payer: UHC Core	$83.36
Rate for Payer: UHC Exchange	$62.88

HC OB SURGERY ADDL 15 MIN

Facility

$279.50

Hospital Charge Code	36000104
Hospital Revenue Code	360
Min. Negotiated Rate	$176.09
Max. Negotiated Rate	$251.55
Rate for Payer: Aetna Commercial	$237.57
Rate for Payer: Aetna New Business (MI Preferred)	$181.68
Rate for Payer: Cash Price	$223.60
Rate for Payer: Cofinity Advantage	$195.65
Rate for Payer: Cofinity Commercial	$240.37
Rate for Payer: Encore Health Key Benefits Commercial	$223.60
Rate for Payer: Healthscope Commercial	$251.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$237.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$209.62
Rate for Payer: PHP Commercial	$237.57
Rate for Payer: Priority Health SBD	$176.09

HC OB SURGERY ADDL 15 MIN

Facility

$279.50

Hospital Charge Code	36000104
Hospital Revenue Code	360
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$251.55
Rate for Payer: Aetna Commercial	$237.57
Rate for Payer: Aetna Medicare	$139.75
Rate for Payer: Aetna New Business (MI Preferred)	$181.68
Rate for Payer: BCBS Complete	$111.80
Rate for Payer: Cash Price	$223.60
Rate for Payer: Cofinity Advantage	$195.65
Rate for Payer: Cofinity Commercial	$240.37
Rate for Payer: Encore Health Key Benefits Commercial	$223.60
Rate for Payer: Healthscope Commercial	$251.55
Rate for Payer: MI Amish Medical Board Commercial	$223.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$237.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$209.62
Rate for Payer: PHP Commercial	$237.57
Rate for Payer: Priority Health SBD	$176.09

HC OB SURGERY INITIAL 30 MIN

Facility

$1,482.63

Hospital Charge Code	36000077
Hospital Revenue Code	360
Min. Negotiated Rate	$934.06
Max. Negotiated Rate	$1,334.37
Rate for Payer: Aetna Commercial	$1,260.24
Rate for Payer: Aetna New Business (MI Preferred)	$963.71
Rate for Payer: Cash Price	$1,186.10
Rate for Payer: Cofinity Advantage	$1,037.84
Rate for Payer: Cofinity Commercial	$1,275.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,186.10
Rate for Payer: Healthscope Commercial	$1,334.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,260.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,111.97
Rate for Payer: PHP Commercial	$1,260.24
Rate for Payer: Priority Health SBD	$934.06

HC OB SURGERY INITIAL 30 MIN

Facility

$1,482.63

Hospital Charge Code	36000077
Hospital Revenue Code	360
Min. Negotiated Rate	$593.05
Max. Negotiated Rate	$1,334.37
Rate for Payer: Aetna Commercial	$1,260.24
Rate for Payer: Aetna Medicare	$741.32
Rate for Payer: Aetna New Business (MI Preferred)	$963.71
Rate for Payer: BCBS Complete	$593.05
Rate for Payer: Cash Price	$1,186.10
Rate for Payer: Cofinity Advantage	$1,037.84
Rate for Payer: Cofinity Commercial	$1,275.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,186.10
Rate for Payer: Healthscope Commercial	$1,334.37
Rate for Payer: MI Amish Medical Board Commercial	$1,186.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,260.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,111.97
Rate for Payer: PHP Commercial	$1,260.24
Rate for Payer: Priority Health SBD	$934.06

HC OB VAC DEL KIT DISP (OB)

Facility

$262.93

Hospital Charge Code	27000127
Hospital Revenue Code	272
Min. Negotiated Rate	$165.65
Max. Negotiated Rate	$236.64
Rate for Payer: Aetna Commercial	$223.49
Rate for Payer: Aetna New Business (MI Preferred)	$170.90
Rate for Payer: Cash Price	$210.34
Rate for Payer: Cofinity Advantage	$184.05
Rate for Payer: Cofinity Commercial	$226.12
Rate for Payer: Encore Health Key Benefits Commercial	$210.34
Rate for Payer: Healthscope Commercial	$236.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.20
Rate for Payer: PHP Commercial	$223.49
Rate for Payer: Priority Health SBD	$165.65

HC OB VAC DEL KIT DISP (OB)

Facility

$262.93

Hospital Charge Code	27000127
Hospital Revenue Code	272
Min. Negotiated Rate	$103.33
Max. Negotiated Rate	$236.64
Rate for Payer: Aetna Commercial	$223.49
Rate for Payer: Aetna Medicare	$131.47
Rate for Payer: Aetna New Business (MI Preferred)	$170.90
Rate for Payer: BCBS Complete	$105.17
Rate for Payer: Cash Price	$210.34
Rate for Payer: Cofinity Advantage	$184.05
Rate for Payer: Cofinity Commercial	$226.12
Rate for Payer: Encore Health Key Benefits Commercial	$210.34
Rate for Payer: Healthscope Commercial	$236.64
Rate for Payer: MI Amish Medical Board Commercial	$210.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.20
Rate for Payer: PHP Commercial	$223.49
Rate for Payer: Priority Health SBD	$165.65
Rate for Payer: UHC All Payor (Choice/PPO)	$170.90
Rate for Payer: UHC Core	$136.99
Rate for Payer: UHC Exchange	$103.33

HC OCCLUSION CATH

Facility

$4,849.72

Service Code	HCPCS C2628
Hospital Charge Code	27200344
Hospital Revenue Code	272
Min. Negotiated Rate	$1,905.94
Max. Negotiated Rate	$4,364.75
Rate for Payer: Aetna Commercial	$4,122.26
Rate for Payer: Aetna Medicare	$2,424.86
Rate for Payer: Aetna New Business (MI Preferred)	$3,152.32
Rate for Payer: BCBS Complete	$1,939.89
Rate for Payer: Cash Price	$3,879.78
Rate for Payer: Cofinity Advantage	$3,394.80
Rate for Payer: Cofinity Commercial	$4,170.76
Rate for Payer: Encore Health Key Benefits Commercial	$3,879.78
Rate for Payer: Healthscope Commercial	$4,364.75
Rate for Payer: MI Amish Medical Board Commercial	$3,879.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,122.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,637.29
Rate for Payer: PHP Commercial	$4,122.26
Rate for Payer: Priority Health SBD	$3,055.32
Rate for Payer: UHC All Payor (Choice/PPO)	$3,152.32
Rate for Payer: UHC Core	$2,526.70
Rate for Payer: UHC Exchange	$1,905.94

HC OCCLUSION CATH

Facility

$4,849.72

Service Code	HCPCS C2628
Hospital Charge Code	27200344
Hospital Revenue Code	272
Min. Negotiated Rate	$3,055.32
Max. Negotiated Rate	$4,364.75
Rate for Payer: Aetna Commercial	$4,122.26
Rate for Payer: Aetna New Business (MI Preferred)	$3,152.32
Rate for Payer: Cash Price	$3,879.78
Rate for Payer: Cofinity Advantage	$3,394.80
Rate for Payer: Cofinity Commercial	$4,170.76
Rate for Payer: Encore Health Key Benefits Commercial	$3,879.78
Rate for Payer: Healthscope Commercial	$4,364.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,122.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,637.29
Rate for Payer: PHP Commercial	$4,122.26
Rate for Payer: Priority Health SBD	$3,055.32

HC OCCULT BLOOD OTHER SOURCES

Facility

$31.31

Service Code	CPT 82271
Hospital Charge Code	30100122
Hospital Revenue Code	301
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$28.18
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna Medicare	$5.53
Rate for Payer: Aetna New Business (MI Preferred)	$20.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.65
Rate for Payer: Amish Plain Church Group Commercial	$6.65
Rate for Payer: BCBS Complete	$2.92
Rate for Payer: BCBS MAPPO	$5.32
Rate for Payer: BCBS Trust/PPO	$5.67
Rate for Payer: BCN Commercial	$5.67
Rate for Payer: BCN Medicare Advantage	$5.32
Rate for Payer: Cash Price	$25.05
Rate for Payer: Cash Price	$25.05
Rate for Payer: Cofinity Advantage	$21.92
Rate for Payer: Cofinity Commercial	$26.93
Rate for Payer: Encore Health Key Benefits Commercial	$25.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.32
Rate for Payer: Healthscope Commercial	$28.18
Rate for Payer: Mclaren Medicaid	$2.78
Rate for Payer: Mclaren Medicare	$5.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.59
Rate for Payer: Meridian Medicaid	$5.59
Rate for Payer: MI Amish Medical Board Commercial	$6.12
Rate for Payer: Molina Medicare/Medicaid	$5.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.61
Rate for Payer: Nomi Health Commercial	$7.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.48
Rate for Payer: PACE Medicare	$5.05
Rate for Payer: PACE SWMI	$5.32
Rate for Payer: PHP Commercial	$26.61
Rate for Payer: PHP Medicare Advantage	$5.32
Rate for Payer: Priority Health Choice Medicaid	$2.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$5.32
Rate for Payer: Priority Health Medicare	$5.32
Rate for Payer: Priority Health SBD	$19.73
Rate for Payer: Priority Health Tiered Network	$4.26
Rate for Payer: Railroad Medicare Medicare	$5.32
Rate for Payer: UHC All Payor (Choice/PPO)	$7.98
Rate for Payer: UHC Core	$7.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5.32
Rate for Payer: UHC Exchange	$7.98
Rate for Payer: UHC Medicaid	$2.78
Rate for Payer: UHCCP Medicaid	$2.78
Rate for Payer: VA VA	$5.32

HC OCCULT BLOOD OTHER SOURCES

Facility

$31.31

Service Code	CPT 82271
Hospital Charge Code	30100122
Hospital Revenue Code	301
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$28.18
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna New Business (MI Preferred)	$20.35
Rate for Payer: Cash Price	$25.05
Rate for Payer: Cofinity Advantage	$21.92
Rate for Payer: Cofinity Commercial	$26.93
Rate for Payer: Encore Health Key Benefits Commercial	$25.05
Rate for Payer: Healthscope Commercial	$28.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.48
Rate for Payer: PHP Commercial	$26.61
Rate for Payer: Priority Health SBD	$19.73

HC OCT CATHETER

Facility

$2,631.90

Service Code	HCPCS C1753
Hospital Charge Code	27200243
Hospital Revenue Code	272
Min. Negotiated Rate	$1,034.34
Max. Negotiated Rate	$2,368.71
Rate for Payer: Aetna Commercial	$2,237.11
Rate for Payer: Aetna Medicare	$1,315.95
Rate for Payer: Aetna New Business (MI Preferred)	$1,710.73
Rate for Payer: BCBS Complete	$1,052.76
Rate for Payer: Cash Price	$2,105.52
Rate for Payer: Cofinity Advantage	$1,842.33
Rate for Payer: Cofinity Commercial	$2,263.43
Rate for Payer: Encore Health Key Benefits Commercial	$2,105.52
Rate for Payer: Healthscope Commercial	$2,368.71
Rate for Payer: MI Amish Medical Board Commercial	$2,105.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,237.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,973.92
Rate for Payer: PHP Commercial	$2,237.11
Rate for Payer: Priority Health SBD	$1,658.10
Rate for Payer: UHC All Payor (Choice/PPO)	$1,710.73
Rate for Payer: UHC Core	$1,371.22
Rate for Payer: UHC Exchange	$1,034.34

HC OCT CATHETER

Facility

$2,631.90

Service Code	HCPCS C1753
Hospital Charge Code	27200243
Hospital Revenue Code	272
Min. Negotiated Rate	$1,658.10
Max. Negotiated Rate	$2,368.71
Rate for Payer: Aetna Commercial	$2,237.11
Rate for Payer: Aetna New Business (MI Preferred)	$1,710.73
Rate for Payer: Cash Price	$2,105.52
Rate for Payer: Cofinity Advantage	$1,842.33
Rate for Payer: Cofinity Commercial	$2,263.43
Rate for Payer: Encore Health Key Benefits Commercial	$2,105.52
Rate for Payer: Healthscope Commercial	$2,368.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,237.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,973.92
Rate for Payer: PHP Commercial	$2,237.11
Rate for Payer: Priority Health SBD	$1,658.10

HC OCTOPUS SET CARDIOPLEGIA

Facility

$46.82

Hospital Charge Code	27000106
Hospital Revenue Code	270
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Advantage	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.12
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health SBD	$29.50

HC OCTOPUS SET CARDIOPLEGIA

Facility

$46.82

Hospital Charge Code	27000106
Hospital Revenue Code	270
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna Medicare	$23.41
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: BCBS Complete	$18.73
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Advantage	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: MI Amish Medical Board Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.12
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health SBD	$29.50
Rate for Payer: UHC All Payor (Choice/PPO)	$30.43
Rate for Payer: UHC Core	$24.39
Rate for Payer: UHC Exchange	$18.40

HC OCULAR INSTRMNT SCREEN BILAT

Facility

$53.06

Service Code	CPT 99174
Hospital Charge Code	51000105
Hospital Revenue Code	510
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$47.75
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare	$26.53
Rate for Payer: Aetna New Business (MI Preferred)	$34.49
Rate for Payer: BCBS Complete	$21.22
Rate for Payer: Cash Price	$42.45
Rate for Payer: Cofinity Advantage	$37.14
Rate for Payer: Cofinity Commercial	$45.63
Rate for Payer: Encore Health Key Benefits Commercial	$42.45
Rate for Payer: Healthscope Commercial	$47.75
Rate for Payer: MI Amish Medical Board Commercial	$42.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.80
Rate for Payer: PHP Commercial	$45.10
Rate for Payer: Priority Health SBD	$33.43
Rate for Payer: UHC All Payor (Choice/PPO)	$34.49
Rate for Payer: UHC Core	$27.64
Rate for Payer: UHC Exchange	$20.85

HC OCULAR INSTRMNT SCREEN BILAT

Facility

$53.06

Service Code	CPT 99174
Hospital Charge Code	51000105
Hospital Revenue Code	510
Min. Negotiated Rate	$33.43
Max. Negotiated Rate	$47.75
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna New Business (MI Preferred)	$34.49
Rate for Payer: Cash Price	$42.45
Rate for Payer: Cofinity Advantage	$37.14
Rate for Payer: Cofinity Commercial	$45.63
Rate for Payer: Encore Health Key Benefits Commercial	$42.45
Rate for Payer: Healthscope Commercial	$47.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.80
Rate for Payer: PHP Commercial	$45.10
Rate for Payer: Priority Health SBD	$33.43

HC OLIGOCLONAL BANDS

Facility

$49.02

Service Code	CPT 83916
Hospital Charge Code	30100371
Hospital Revenue Code	301
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$44.12
Rate for Payer: Aetna Commercial	$41.67
Rate for Payer: Aetna Medicare	$28.49
Rate for Payer: Aetna New Business (MI Preferred)	$31.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$34.24
Rate for Payer: Amish Plain Church Group Commercial	$34.24
Rate for Payer: BCBS Complete	$15.04
Rate for Payer: BCBS MAPPO	$27.39
Rate for Payer: BCBS Trust/PPO	$29.20
Rate for Payer: BCN Commercial	$29.20
Rate for Payer: BCN Medicare Advantage	$27.39
Rate for Payer: Cash Price	$39.22
Rate for Payer: Cash Price	$39.22
Rate for Payer: Cofinity Advantage	$34.31
Rate for Payer: Cofinity Commercial	$42.16
Rate for Payer: Encore Health Key Benefits Commercial	$39.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.39
Rate for Payer: Healthscope Commercial	$44.12
Rate for Payer: Mclaren Medicaid	$14.32
Rate for Payer: Mclaren Medicare	$27.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28.76
Rate for Payer: Meridian Medicaid	$28.76
Rate for Payer: MI Amish Medical Board Commercial	$31.50
Rate for Payer: Molina Medicare/Medicaid	$30.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.67
Rate for Payer: Nomi Health Commercial	$41.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.77
Rate for Payer: PACE Medicare	$26.02
Rate for Payer: PACE SWMI	$27.39
Rate for Payer: PHP Commercial	$41.67
Rate for Payer: PHP Medicare Advantage	$27.39
Rate for Payer: Priority Health Choice Medicaid	$14.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$27.39
Rate for Payer: Priority Health Medicare	$27.39
Rate for Payer: Priority Health SBD	$30.88
Rate for Payer: Priority Health Tiered Network	$21.91
Rate for Payer: Railroad Medicare Medicare	$27.39
Rate for Payer: UHC All Payor (Choice/PPO)	$41.09
Rate for Payer: UHC Core	$41.09
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27.39
Rate for Payer: UHC Exchange	$41.09
Rate for Payer: UHC Medicaid	$14.32
Rate for Payer: UHCCP Medicaid	$14.32
Rate for Payer: VA VA	$27.39

HC OLIGOCLONAL BANDS

Facility

$49.02

Service Code	CPT 83916
Hospital Charge Code	30100371
Hospital Revenue Code	301
Min. Negotiated Rate	$30.88
Max. Negotiated Rate	$44.12
Rate for Payer: Aetna Commercial	$41.67
Rate for Payer: Aetna New Business (MI Preferred)	$31.86
Rate for Payer: Cash Price	$39.22
Rate for Payer: Cofinity Advantage	$34.31
Rate for Payer: Cofinity Commercial	$42.16
Rate for Payer: Encore Health Key Benefits Commercial	$39.22
Rate for Payer: Healthscope Commercial	$44.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.77
Rate for Payer: PHP Commercial	$41.67
Rate for Payer: Priority Health SBD	$30.88

HC OLIGOCLONAL BANDS CMPT

Facility

$49.02

Service Code	CPT 83916
Hospital Charge Code	30100551
Hospital Revenue Code	301
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$44.12
Rate for Payer: Aetna Commercial	$41.67
Rate for Payer: Aetna Medicare	$28.49
Rate for Payer: Aetna New Business (MI Preferred)	$31.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$34.24
Rate for Payer: Amish Plain Church Group Commercial	$34.24
Rate for Payer: BCBS Complete	$15.04
Rate for Payer: BCBS MAPPO	$27.39
Rate for Payer: BCBS Trust/PPO	$29.20
Rate for Payer: BCN Commercial	$29.20
Rate for Payer: BCN Medicare Advantage	$27.39
Rate for Payer: Cash Price	$39.22
Rate for Payer: Cash Price	$39.22
Rate for Payer: Cofinity Advantage	$34.31
Rate for Payer: Cofinity Commercial	$42.16
Rate for Payer: Encore Health Key Benefits Commercial	$39.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.39
Rate for Payer: Healthscope Commercial	$44.12
Rate for Payer: Mclaren Medicaid	$14.32
Rate for Payer: Mclaren Medicare	$27.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28.76
Rate for Payer: Meridian Medicaid	$28.76
Rate for Payer: MI Amish Medical Board Commercial	$31.50
Rate for Payer: Molina Medicare/Medicaid	$30.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.67
Rate for Payer: Nomi Health Commercial	$41.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.77
Rate for Payer: PACE Medicare	$26.02
Rate for Payer: PACE SWMI	$27.39
Rate for Payer: PHP Commercial	$41.67
Rate for Payer: PHP Medicare Advantage	$27.39
Rate for Payer: Priority Health Choice Medicaid	$14.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$27.39
Rate for Payer: Priority Health Medicare	$27.39
Rate for Payer: Priority Health SBD	$30.88
Rate for Payer: Priority Health Tiered Network	$21.91
Rate for Payer: Railroad Medicare Medicare	$27.39
Rate for Payer: UHC All Payor (Choice/PPO)	$41.09
Rate for Payer: UHC Core	$41.09
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27.39
Rate for Payer: UHC Exchange	$41.09
Rate for Payer: UHC Medicaid	$14.32
Rate for Payer: UHCCP Medicaid	$14.32
Rate for Payer: VA VA	$27.39

Know your out-of-pocket cost for care.

All Charges