Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OPIOID DRUG PANEL URN. CMPT

Facility

$96.42

Service Code	CPT 80307
Hospital Charge Code	30100646
Hospital Revenue Code	301
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$93.21
Rate for Payer: Aetna Commercial	$81.96
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$62.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$77.67
Rate for Payer: Amish Plain Church Group Commercial	$77.67
Rate for Payer: BCBS Complete	$34.13
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCBS Trust/PPO	$66.26
Rate for Payer: BCN Commercial	$66.26
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$77.14
Rate for Payer: Cash Price	$77.14
Rate for Payer: Cofinity Advantage	$67.49
Rate for Payer: Cofinity Commercial	$82.92
Rate for Payer: Encore Health Key Benefits Commercial	$77.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$86.78
Rate for Payer: Mclaren Medicaid	$32.50
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65.25
Rate for Payer: Meridian Medicaid	$65.25
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Molina Medicare/Medicaid	$68.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.96
Rate for Payer: Nomi Health Commercial	$93.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.31
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$81.96
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$32.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$62.14
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health SBD	$60.74
Rate for Payer: Priority Health Tiered Network	$49.71
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$93.21
Rate for Payer: UHC Core	$93.21
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$62.14
Rate for Payer: UHC Exchange	$93.21
Rate for Payer: UHC Medicaid	$32.50
Rate for Payer: UHCCP Medicaid	$32.50
Rate for Payer: VA VA	$62.14

HC OPIOID DRUG PANEL URN. CMPT

Facility

$96.42

Service Code	CPT 80307
Hospital Charge Code	30100646
Hospital Revenue Code	301
Min. Negotiated Rate	$60.74
Max. Negotiated Rate	$86.78
Rate for Payer: Aetna Commercial	$81.96
Rate for Payer: Aetna New Business (MI Preferred)	$62.67
Rate for Payer: Cash Price	$77.14
Rate for Payer: Cofinity Advantage	$67.49
Rate for Payer: Cofinity Commercial	$82.92
Rate for Payer: Encore Health Key Benefits Commercial	$77.14
Rate for Payer: Healthscope Commercial	$86.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.31
Rate for Payer: PHP Commercial	$81.96
Rate for Payer: Priority Health SBD	$60.74

HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI

Facility

$2,091.00

Service Code	CPT 34715
Hospital Charge Code	36000123
Hospital Revenue Code	360
Min. Negotiated Rate	$814.56
Max. Negotiated Rate	$1,881.90
Rate for Payer: Aetna Commercial	$1,777.35
Rate for Payer: Aetna Medicare	$1,045.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,359.15
Rate for Payer: BCBS Complete	$836.40
Rate for Payer: BCBS Trust/PPO	$814.56
Rate for Payer: BCN Commercial	$814.56
Rate for Payer: Cash Price	$1,672.80
Rate for Payer: Cash Price	$1,672.80
Rate for Payer: Cofinity Advantage	$1,463.70
Rate for Payer: Cofinity Commercial	$1,798.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,672.80
Rate for Payer: Healthscope Commercial	$1,881.90
Rate for Payer: MI Amish Medical Board Commercial	$1,672.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,777.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,568.25
Rate for Payer: PHP Commercial	$1,777.35
Rate for Payer: Priority Health SBD	$1,317.33

HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI

Facility

$2,091.00

Service Code	CPT 34715
Hospital Charge Code	36000123
Hospital Revenue Code	360
Min. Negotiated Rate	$1,317.33
Max. Negotiated Rate	$1,881.90
Rate for Payer: Aetna Commercial	$1,777.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,359.15
Rate for Payer: Cash Price	$1,672.80
Rate for Payer: Cofinity Advantage	$1,463.70
Rate for Payer: Cofinity Commercial	$1,798.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,672.80
Rate for Payer: Healthscope Commercial	$1,881.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,777.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,568.25
Rate for Payer: PHP Commercial	$1,777.35
Rate for Payer: Priority Health SBD	$1,317.33

HC OPSITE LGE SHEET

Facility

$63.16

Hospital Charge Code	27000128
Hospital Revenue Code	270
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$56.84
Rate for Payer: Aetna Commercial	$53.69
Rate for Payer: Aetna Medicare	$31.58
Rate for Payer: Aetna New Business (MI Preferred)	$41.05
Rate for Payer: BCBS Complete	$25.26
Rate for Payer: Cash Price	$50.53
Rate for Payer: Cofinity Advantage	$44.21
Rate for Payer: Cofinity Commercial	$54.32
Rate for Payer: Encore Health Key Benefits Commercial	$50.53
Rate for Payer: Healthscope Commercial	$56.84
Rate for Payer: MI Amish Medical Board Commercial	$50.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.37
Rate for Payer: PHP Commercial	$53.69
Rate for Payer: Priority Health SBD	$39.79
Rate for Payer: UHC All Payor (Choice/PPO)	$41.05
Rate for Payer: UHC Core	$32.91
Rate for Payer: UHC Exchange	$24.82

HC OPSITE LGE SHEET

Facility

$63.16

Hospital Charge Code	27000128
Hospital Revenue Code	270
Min. Negotiated Rate	$39.79
Max. Negotiated Rate	$56.84
Rate for Payer: Aetna Commercial	$53.69
Rate for Payer: Aetna New Business (MI Preferred)	$41.05
Rate for Payer: Cash Price	$50.53
Rate for Payer: Cofinity Advantage	$44.21
Rate for Payer: Cofinity Commercial	$54.32
Rate for Payer: Encore Health Key Benefits Commercial	$50.53
Rate for Payer: Healthscope Commercial	$56.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.37
Rate for Payer: PHP Commercial	$53.69
Rate for Payer: Priority Health SBD	$39.79

HC OPTISON 1ST ML

Facility

$93.39

Service Code	HCPCS Q9956
Hospital Charge Code	63600168
Hospital Revenue Code	636
Min. Negotiated Rate	$58.84
Max. Negotiated Rate	$84.05
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna New Business (MI Preferred)	$60.70
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cofinity Advantage	$65.37
Rate for Payer: Cofinity Commercial	$80.32
Rate for Payer: Encore Health Key Benefits Commercial	$74.71
Rate for Payer: Healthscope Commercial	$84.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.04
Rate for Payer: PHP Commercial	$79.38
Rate for Payer: Priority Health SBD	$58.84

HC OPTISON 1ST ML

Facility

$93.39

Service Code	HCPCS Q9956
Hospital Charge Code	63600168
Hospital Revenue Code	636
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$100.86
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna Medicare	$46.70
Rate for Payer: Aetna New Business (MI Preferred)	$60.70
Rate for Payer: BCBS Complete	$37.36
Rate for Payer: BCBS Trust/PPO	$100.86
Rate for Payer: BCN Commercial	$100.86
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cofinity Advantage	$65.37
Rate for Payer: Cofinity Commercial	$80.32
Rate for Payer: Encore Health Key Benefits Commercial	$74.71
Rate for Payer: Healthscope Commercial	$84.05
Rate for Payer: MI Amish Medical Board Commercial	$74.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.04
Rate for Payer: PHP Commercial	$79.38
Rate for Payer: Priority Health SBD	$58.84
Rate for Payer: UHC All Payor (Choice/PPO)	$66.35
Rate for Payer: UHC Core	$66.35
Rate for Payer: UHC Exchange	$66.35

HC OPTISON 2ND ML

Facility

$93.39

Service Code	HCPCS Q9956
Hospital Charge Code	63600169
Hospital Revenue Code	636
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$100.86
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna Medicare	$46.70
Rate for Payer: Aetna New Business (MI Preferred)	$60.70
Rate for Payer: BCBS Complete	$37.36
Rate for Payer: BCBS Trust/PPO	$100.86
Rate for Payer: BCN Commercial	$100.86
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cofinity Advantage	$65.37
Rate for Payer: Cofinity Commercial	$80.32
Rate for Payer: Encore Health Key Benefits Commercial	$74.71
Rate for Payer: Healthscope Commercial	$84.05
Rate for Payer: MI Amish Medical Board Commercial	$74.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.04
Rate for Payer: PHP Commercial	$79.38
Rate for Payer: Priority Health SBD	$58.84
Rate for Payer: UHC All Payor (Choice/PPO)	$66.35
Rate for Payer: UHC Core	$66.35
Rate for Payer: UHC Exchange	$66.35

HC OPTISON 2ND ML

Facility

$93.39

Service Code	HCPCS Q9956
Hospital Charge Code	63600169
Hospital Revenue Code	636
Min. Negotiated Rate	$58.84
Max. Negotiated Rate	$84.05
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna New Business (MI Preferred)	$60.70
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cofinity Advantage	$65.37
Rate for Payer: Cofinity Commercial	$80.32
Rate for Payer: Encore Health Key Benefits Commercial	$74.71
Rate for Payer: Healthscope Commercial	$84.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.04
Rate for Payer: PHP Commercial	$79.38
Rate for Payer: Priority Health SBD	$58.84

HC OPTISON 3RD ML

Facility

$93.39

Service Code	HCPCS Q9956
Hospital Charge Code	63600170
Hospital Revenue Code	636
Min. Negotiated Rate	$58.84
Max. Negotiated Rate	$84.05
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna New Business (MI Preferred)	$60.70
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cofinity Advantage	$65.37
Rate for Payer: Cofinity Commercial	$80.32
Rate for Payer: Encore Health Key Benefits Commercial	$74.71
Rate for Payer: Healthscope Commercial	$84.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.04
Rate for Payer: PHP Commercial	$79.38
Rate for Payer: Priority Health SBD	$58.84

HC OPTISON 3RD ML

Facility

$93.39

Service Code	HCPCS Q9956
Hospital Charge Code	63600170
Hospital Revenue Code	636
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$100.86
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna Medicare	$46.70
Rate for Payer: Aetna New Business (MI Preferred)	$60.70
Rate for Payer: BCBS Complete	$37.36
Rate for Payer: BCBS Trust/PPO	$100.86
Rate for Payer: BCN Commercial	$100.86
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cash Price	$74.71
Rate for Payer: Cofinity Advantage	$65.37
Rate for Payer: Cofinity Commercial	$80.32
Rate for Payer: Encore Health Key Benefits Commercial	$74.71
Rate for Payer: Healthscope Commercial	$84.05
Rate for Payer: MI Amish Medical Board Commercial	$74.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.04
Rate for Payer: PHP Commercial	$79.38
Rate for Payer: Priority Health SBD	$58.84
Rate for Payer: UHC All Payor (Choice/PPO)	$66.35
Rate for Payer: UHC Core	$66.35
Rate for Payer: UHC Exchange	$66.35

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	$139.19
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 Advantage	$108.25
Rate for Payer: Cofinity Commercial	$133.00
Rate for Payer: Encore Health Key Benefits Commercial	$123.72
Rate for Payer: Healthscope Commercial	$139.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.99
Rate for Payer: PHP Commercial	$131.45
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	$21.87
Max. Negotiated Rate	$139.19
Rate for Payer: Aetna Commercial	$131.45
Rate for Payer: Aetna Medicare	$77.33
Rate for Payer: Aetna New Business (MI Preferred)	$100.52
Rate for Payer: BCBS Complete	$61.86
Rate for Payer: BCBS Trust/PPO	$49.51
Rate for Payer: BCCCP Commercial	$21.87
Rate for Payer: BCN Commercial	$49.51
Rate for Payer: Cash Price	$123.72
Rate for Payer: Cash Price	$123.72
Rate for Payer: Cofinity Advantage	$108.25
Rate for Payer: Cofinity Commercial	$133.00
Rate for Payer: Encore Health Key Benefits Commercial	$123.72
Rate for Payer: Healthscope Commercial	$139.19
Rate for Payer: MI Amish Medical Board Commercial	$123.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.99
Rate for Payer: PHP Commercial	$131.45
Rate for Payer: Priority Health SBD	$97.43
Rate for Payer: UHC All Payor (Choice/PPO)	$100.52
Rate for Payer: UHC Core	$80.57
Rate for Payer: UHC Exchange	$60.78

HC OP VISIT LEVEL 2

Facility

$174.09

Service Code	CPT 99212
Hospital Charge Code	51000020
Hospital Revenue Code	761
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$156.68
Rate for Payer: Aetna Commercial	$147.98
Rate for Payer: Aetna Medicare	$87.05
Rate for Payer: Aetna New Business (MI Preferred)	$113.16
Rate for Payer: BCBS Complete	$69.64
Rate for Payer: BCBS Trust/PPO	$88.95
Rate for Payer: BCCCP Commercial	$21.87
Rate for Payer: BCN Commercial	$88.95
Rate for Payer: Cash Price	$139.27
Rate for Payer: Cash Price	$139.27
Rate for Payer: Cofinity Advantage	$121.86
Rate for Payer: Cofinity Commercial	$149.72
Rate for Payer: Encore Health Key Benefits Commercial	$139.27
Rate for Payer: Healthscope Commercial	$156.68
Rate for Payer: MI Amish Medical Board Commercial	$139.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.57
Rate for Payer: PHP Commercial	$147.98
Rate for Payer: Priority Health SBD	$109.68
Rate for Payer: UHC All Payor (Choice/PPO)	$113.16
Rate for Payer: UHC Core	$90.70
Rate for Payer: UHC Exchange	$68.42

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 Advantage	$121.86
Rate for Payer: Cofinity Commercial	$149.72
Rate for Payer: Encore Health Key Benefits Commercial	$139.27
Rate for Payer: Healthscope Commercial	$156.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.57
Rate for Payer: PHP Commercial	$147.98
Rate for Payer: Priority Health SBD	$109.68

HC OP VISIT LEVEL 3

Facility

$211.25

Service Code	CPT 99213
Hospital Charge Code	51000026
Hospital Revenue Code	761
Min. Negotiated Rate	$83.02
Max. Negotiated Rate	$190.12
Rate for Payer: Aetna Commercial	$179.56
Rate for Payer: Aetna Medicare	$105.62
Rate for Payer: Aetna New Business (MI Preferred)	$137.31
Rate for Payer: BCBS Complete	$84.50
Rate for Payer: BCBS Trust/PPO	$119.83
Rate for Payer: BCCCP Commercial	$87.68
Rate for Payer: BCN Commercial	$119.83
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cofinity Advantage	$147.88
Rate for Payer: Cofinity Commercial	$181.68
Rate for Payer: Encore Health Key Benefits Commercial	$169.00
Rate for Payer: Healthscope Commercial	$190.12
Rate for Payer: MI Amish Medical Board Commercial	$169.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.44
Rate for Payer: PHP Commercial	$179.56
Rate for Payer: Priority Health SBD	$133.09
Rate for Payer: UHC All Payor (Choice/PPO)	$137.31
Rate for Payer: UHC Core	$110.06
Rate for Payer: UHC Exchange	$83.02

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 Advantage	$147.88
Rate for Payer: Cofinity Commercial	$181.68
Rate for Payer: Encore Health Key Benefits Commercial	$169.00
Rate for Payer: Healthscope Commercial	$190.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.44
Rate for Payer: PHP Commercial	$179.56
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 Advantage	$212.36
Rate for Payer: Cofinity Commercial	$260.90
Rate for Payer: Encore Health Key Benefits Commercial	$242.70
Rate for Payer: Healthscope Commercial	$273.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$227.53
Rate for Payer: PHP Commercial	$257.86
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	$87.68
Max. Negotiated Rate	$273.03
Rate for Payer: Aetna Commercial	$257.86
Rate for Payer: Aetna Medicare	$151.69
Rate for Payer: Aetna New Business (MI Preferred)	$197.19
Rate for Payer: BCBS Complete	$121.35
Rate for Payer: BCBS Trust/PPO	$163.92
Rate for Payer: BCCCP Commercial	$87.68
Rate for Payer: BCN Commercial	$163.92
Rate for Payer: Cash Price	$242.70
Rate for Payer: Cash Price	$242.70
Rate for Payer: Cofinity Advantage	$212.36
Rate for Payer: Cofinity Commercial	$260.90
Rate for Payer: Encore Health Key Benefits Commercial	$242.70
Rate for Payer: Healthscope Commercial	$273.03
Rate for Payer: MI Amish Medical Board Commercial	$242.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$227.53
Rate for Payer: PHP Commercial	$257.86
Rate for Payer: Priority Health SBD	$191.12
Rate for Payer: UHC All Payor (Choice/PPO)	$197.19
Rate for Payer: UHC Core	$158.06
Rate for Payer: UHC Exchange	$119.22

HC OP VISIT LEVEL 5

Facility

$505.14

Service Code	CPT 99215
Hospital Charge Code	51000037
Hospital Revenue Code	761
Min. Negotiated Rate	$198.52
Max. Negotiated Rate	$454.63
Rate for Payer: Aetna Commercial	$429.37
Rate for Payer: Aetna Medicare	$252.57
Rate for Payer: Aetna New Business (MI Preferred)	$328.34
Rate for Payer: BCBS Complete	$202.06
Rate for Payer: BCBS Trust/PPO	$211.09
Rate for Payer: BCN Commercial	$211.09
Rate for Payer: Cash Price	$404.11
Rate for Payer: Cash Price	$404.11
Rate for Payer: Cofinity Advantage	$353.60
Rate for Payer: Cofinity Commercial	$434.42
Rate for Payer: Encore Health Key Benefits Commercial	$404.11
Rate for Payer: Healthscope Commercial	$454.63
Rate for Payer: MI Amish Medical Board Commercial	$404.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$429.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.86
Rate for Payer: PHP Commercial	$429.37
Rate for Payer: Priority Health SBD	$318.24
Rate for Payer: UHC All Payor (Choice/PPO)	$328.34
Rate for Payer: UHC Core	$263.18
Rate for Payer: UHC Exchange	$198.52

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 Advantage	$353.60
Rate for Payer: Cofinity Commercial	$434.42
Rate for Payer: Encore Health Key Benefits Commercial	$404.11
Rate for Payer: Healthscope Commercial	$454.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$429.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.86
Rate for Payer: PHP Commercial	$429.37
Rate for Payer: Priority Health SBD	$318.24

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 Advantage	$94.30
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Encore Health Key Benefits Commercial	$107.77
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.03
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health SBD	$84.87

HC ORAL CHEMO ADMINISTRATION

Facility

$134.71

Service Code	CPT 99211
Hospital Charge Code	51000089
Hospital Revenue Code	510
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$121.24
Rate for Payer: Aetna Commercial	$114.50
Rate for Payer: Aetna Medicare	$67.36
Rate for Payer: Aetna New Business (MI Preferred)	$87.56
Rate for Payer: BCBS Complete	$53.88
Rate for Payer: BCBS Trust/PPO	$49.51
Rate for Payer: BCCCP Commercial	$21.87
Rate for Payer: BCN Commercial	$49.51
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cash Price	$107.77
Rate for Payer: Cofinity Advantage	$94.30
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Encore Health Key Benefits Commercial	$107.77
Rate for Payer: Healthscope Commercial	$121.24
Rate for Payer: MI Amish Medical Board Commercial	$107.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.03
Rate for Payer: PHP Commercial	$114.50
Rate for Payer: Priority Health SBD	$84.87
Rate for Payer: UHC All Payor (Choice/PPO)	$87.56
Rate for Payer: UHC Core	$70.18
Rate for Payer: UHC Exchange	$52.94

HC ORCHARD GRASS IGE

Facility

$25.90

Service Code	CPT 86003
Hospital Charge Code	30200052
Hospital Revenue Code	302
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$23.31
Rate for Payer: Aetna Commercial	$22.02
Rate for Payer: Aetna New Business (MI Preferred)	$16.84
Rate for Payer: Cash Price	$20.72
Rate for Payer: Cofinity Advantage	$18.13
Rate for Payer: Cofinity Commercial	$22.27
Rate for Payer: Encore Health Key Benefits Commercial	$20.72
Rate for Payer: Healthscope Commercial	$23.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.43
Rate for Payer: PHP Commercial	$22.02
Rate for Payer: Priority Health SBD	$16.32

Know your out-of-pocket cost for care.

All Charges