Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NEG PRES WND THRPY DSG EXLGE

Facility

$381.25

Hospital Charge Code	27200137
Hospital Revenue Code	272
Min. Negotiated Rate	$152.50
Max. Negotiated Rate	$343.12
Rate for Payer: Aetna Commercial	$324.06
Rate for Payer: Aetna Medicare	$190.62
Rate for Payer: Aetna New Business (MI Preferred)	$247.81
Rate for Payer: BCBS Complete	$152.50
Rate for Payer: Cash Price	$305.00
Rate for Payer: Cofinity Commercial	$266.88
Rate for Payer: Cofinity Commercial	$327.88
Rate for Payer: Cofinity Medicare Advantage	$266.88
Rate for Payer: Encore Health Key Benefits Commercial	$305.00
Rate for Payer: Healthscope Commercial	$343.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$324.06
Rate for Payer: PHP Commercial	$324.06
Rate for Payer: Priority Health Cigna Priority Health	$247.81
Rate for Payer: Priority Health SBD	$240.19

HC NEG PRES WND THRPY DSG EXLGE

Facility

$381.25

Hospital Charge Code	27200137
Hospital Revenue Code	272
Min. Negotiated Rate	$240.19
Max. Negotiated Rate	$343.12
Rate for Payer: Aetna Commercial	$324.06
Rate for Payer: Aetna New Business (MI Preferred)	$247.81
Rate for Payer: Cash Price	$305.00
Rate for Payer: Cofinity Commercial	$266.88
Rate for Payer: Cofinity Commercial	$327.88
Rate for Payer: Cofinity Medicare Advantage	$266.88
Rate for Payer: Encore Health Key Benefits Commercial	$305.00
Rate for Payer: Healthscope Commercial	$343.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$324.06
Rate for Payer: PHP Commercial	$324.06
Rate for Payer: Priority Health Cigna Priority Health	$247.81
Rate for Payer: Priority Health SBD	$240.19

HC NEG PRES WND THRPY DSG SET LAR

Facility

$202.55

Hospital Charge Code	27200138
Hospital Revenue Code	272
Min. Negotiated Rate	$81.02
Max. Negotiated Rate	$182.29
Rate for Payer: Aetna Commercial	$172.17
Rate for Payer: Aetna Medicare	$101.28
Rate for Payer: Aetna New Business (MI Preferred)	$131.66
Rate for Payer: BCBS Complete	$81.02
Rate for Payer: Cash Price	$162.04
Rate for Payer: Cofinity Commercial	$141.78
Rate for Payer: Cofinity Commercial	$174.19
Rate for Payer: Cofinity Medicare Advantage	$141.78
Rate for Payer: Encore Health Key Benefits Commercial	$162.04
Rate for Payer: Healthscope Commercial	$182.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.17
Rate for Payer: PHP Commercial	$172.17
Rate for Payer: Priority Health Cigna Priority Health	$131.66
Rate for Payer: Priority Health SBD	$127.61

HC NEG PRES WND THRPY DSG SET LAR

Facility

$202.55

Hospital Charge Code	27200138
Hospital Revenue Code	272
Min. Negotiated Rate	$127.61
Max. Negotiated Rate	$182.29
Rate for Payer: Aetna Commercial	$172.17
Rate for Payer: Aetna New Business (MI Preferred)	$131.66
Rate for Payer: Cash Price	$162.04
Rate for Payer: Cofinity Commercial	$141.78
Rate for Payer: Cofinity Commercial	$174.19
Rate for Payer: Cofinity Medicare Advantage	$141.78
Rate for Payer: Encore Health Key Benefits Commercial	$162.04
Rate for Payer: Healthscope Commercial	$182.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.17
Rate for Payer: PHP Commercial	$172.17
Rate for Payer: Priority Health Cigna Priority Health	$131.66
Rate for Payer: Priority Health SBD	$127.61

HC NEG PRES WND THRPY DSG SET MED

Facility

$145.92

Hospital Charge Code	27200139
Hospital Revenue Code	272
Min. Negotiated Rate	$58.37
Max. Negotiated Rate	$131.33
Rate for Payer: Aetna Commercial	$124.03
Rate for Payer: Aetna Medicare	$72.96
Rate for Payer: Aetna New Business (MI Preferred)	$94.85
Rate for Payer: BCBS Complete	$58.37
Rate for Payer: Cash Price	$116.74
Rate for Payer: Cofinity Commercial	$102.14
Rate for Payer: Cofinity Commercial	$125.49
Rate for Payer: Cofinity Medicare Advantage	$102.14
Rate for Payer: Encore Health Key Benefits Commercial	$116.74
Rate for Payer: Healthscope Commercial	$131.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.03
Rate for Payer: PHP Commercial	$124.03
Rate for Payer: Priority Health Cigna Priority Health	$94.85
Rate for Payer: Priority Health SBD	$91.93

HC NEG PRES WND THRPY DSG SET MED

Facility

$145.92

Hospital Charge Code	27200139
Hospital Revenue Code	272
Min. Negotiated Rate	$91.93
Max. Negotiated Rate	$131.33
Rate for Payer: Aetna Commercial	$124.03
Rate for Payer: Aetna New Business (MI Preferred)	$94.85
Rate for Payer: Cash Price	$116.74
Rate for Payer: Cofinity Commercial	$102.14
Rate for Payer: Cofinity Commercial	$125.49
Rate for Payer: Cofinity Medicare Advantage	$102.14
Rate for Payer: Encore Health Key Benefits Commercial	$116.74
Rate for Payer: Healthscope Commercial	$131.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.03
Rate for Payer: PHP Commercial	$124.03
Rate for Payer: Priority Health Cigna Priority Health	$94.85
Rate for Payer: Priority Health SBD	$91.93

HC NEG PRES WND THRPY DSG SET SIL

Facility

$272.48

Hospital Charge Code	27200140
Hospital Revenue Code	272
Min. Negotiated Rate	$108.99
Max. Negotiated Rate	$245.23
Rate for Payer: Aetna Commercial	$231.61
Rate for Payer: Aetna Medicare	$136.24
Rate for Payer: Aetna New Business (MI Preferred)	$177.11
Rate for Payer: BCBS Complete	$108.99
Rate for Payer: Cash Price	$217.98
Rate for Payer: Cofinity Commercial	$190.74
Rate for Payer: Cofinity Commercial	$234.33
Rate for Payer: Cofinity Medicare Advantage	$190.74
Rate for Payer: Encore Health Key Benefits Commercial	$217.98
Rate for Payer: Healthscope Commercial	$245.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.61
Rate for Payer: PHP Commercial	$231.61
Rate for Payer: Priority Health Cigna Priority Health	$177.11
Rate for Payer: Priority Health SBD	$171.66

HC NEG PRES WND THRPY DSG SET SIL

Facility

$272.48

Hospital Charge Code	27200140
Hospital Revenue Code	272
Min. Negotiated Rate	$171.66
Max. Negotiated Rate	$245.23
Rate for Payer: Aetna Commercial	$231.61
Rate for Payer: Aetna New Business (MI Preferred)	$177.11
Rate for Payer: Cash Price	$217.98
Rate for Payer: Cofinity Commercial	$190.74
Rate for Payer: Cofinity Commercial	$234.33
Rate for Payer: Cofinity Medicare Advantage	$190.74
Rate for Payer: Encore Health Key Benefits Commercial	$217.98
Rate for Payer: Healthscope Commercial	$245.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.61
Rate for Payer: PHP Commercial	$231.61
Rate for Payer: Priority Health Cigna Priority Health	$177.11
Rate for Payer: Priority Health SBD	$171.66

HC NEG PRES WND THRPY DSG SET SMA

Facility

$115.99

Hospital Charge Code	27200141
Hospital Revenue Code	272
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$104.39
Rate for Payer: Aetna Commercial	$98.59
Rate for Payer: Aetna Medicare	$57.99
Rate for Payer: Aetna New Business (MI Preferred)	$75.39
Rate for Payer: BCBS Complete	$46.40
Rate for Payer: Cash Price	$92.79
Rate for Payer: Cofinity Commercial	$81.19
Rate for Payer: Cofinity Commercial	$99.75
Rate for Payer: Cofinity Medicare Advantage	$81.19
Rate for Payer: Encore Health Key Benefits Commercial	$92.79
Rate for Payer: Healthscope Commercial	$104.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.59
Rate for Payer: PHP Commercial	$98.59
Rate for Payer: Priority Health Cigna Priority Health	$75.39
Rate for Payer: Priority Health SBD	$73.07

HC NEG PRES WND THRPY DSG SET SMA

Facility

$115.99

Hospital Charge Code	27200141
Hospital Revenue Code	272
Min. Negotiated Rate	$73.07
Max. Negotiated Rate	$104.39
Rate for Payer: Aetna Commercial	$98.59
Rate for Payer: Aetna New Business (MI Preferred)	$75.39
Rate for Payer: Cash Price	$92.79
Rate for Payer: Cofinity Commercial	$81.19
Rate for Payer: Cofinity Commercial	$99.75
Rate for Payer: Cofinity Medicare Advantage	$81.19
Rate for Payer: Encore Health Key Benefits Commercial	$92.79
Rate for Payer: Healthscope Commercial	$104.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.59
Rate for Payer: PHP Commercial	$98.59
Rate for Payer: Priority Health Cigna Priority Health	$75.39
Rate for Payer: Priority Health SBD	$73.07

HC NEG PRES WOUND TX SET MED

Facility

$79.99

Hospital Charge Code	27200127
Hospital Revenue Code	272
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$71.99
Rate for Payer: Aetna Commercial	$67.99
Rate for Payer: Aetna Medicare	$39.99
Rate for Payer: Aetna New Business (MI Preferred)	$51.99
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: Cash Price	$63.99
Rate for Payer: Cofinity Commercial	$55.99
Rate for Payer: Cofinity Commercial	$68.79
Rate for Payer: Cofinity Medicare Advantage	$55.99
Rate for Payer: Encore Health Key Benefits Commercial	$63.99
Rate for Payer: Healthscope Commercial	$71.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.99
Rate for Payer: PHP Commercial	$67.99
Rate for Payer: Priority Health Cigna Priority Health	$51.99
Rate for Payer: Priority Health SBD	$50.39

HC NEG PRES WOUND TX SET MED

Facility

$79.99

Hospital Charge Code	27200127
Hospital Revenue Code	272
Min. Negotiated Rate	$50.39
Max. Negotiated Rate	$71.99
Rate for Payer: Aetna Commercial	$67.99
Rate for Payer: Aetna New Business (MI Preferred)	$51.99
Rate for Payer: Cash Price	$63.99
Rate for Payer: Cofinity Commercial	$55.99
Rate for Payer: Cofinity Commercial	$68.79
Rate for Payer: Cofinity Medicare Advantage	$55.99
Rate for Payer: Encore Health Key Benefits Commercial	$63.99
Rate for Payer: Healthscope Commercial	$71.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.99
Rate for Payer: PHP Commercial	$67.99
Rate for Payer: Priority Health Cigna Priority Health	$51.99
Rate for Payer: Priority Health SBD	$50.39

HC NEG PRES WOUND TX SET SMALL

Facility

$115.99

Hospital Charge Code	27200128
Hospital Revenue Code	272
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$104.39
Rate for Payer: Aetna Commercial	$98.59
Rate for Payer: Aetna Medicare	$57.99
Rate for Payer: Aetna New Business (MI Preferred)	$75.39
Rate for Payer: BCBS Complete	$46.40
Rate for Payer: Cash Price	$92.79
Rate for Payer: Cofinity Commercial	$81.19
Rate for Payer: Cofinity Commercial	$99.75
Rate for Payer: Cofinity Medicare Advantage	$81.19
Rate for Payer: Encore Health Key Benefits Commercial	$92.79
Rate for Payer: Healthscope Commercial	$104.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.59
Rate for Payer: PHP Commercial	$98.59
Rate for Payer: Priority Health Cigna Priority Health	$75.39
Rate for Payer: Priority Health SBD	$73.07

HC NEG PRES WOUND TX SET SMALL

Facility

$115.99

Hospital Charge Code	27200128
Hospital Revenue Code	272
Min. Negotiated Rate	$73.07
Max. Negotiated Rate	$104.39
Rate for Payer: Aetna Commercial	$98.59
Rate for Payer: Aetna New Business (MI Preferred)	$75.39
Rate for Payer: Cash Price	$92.79
Rate for Payer: Cofinity Commercial	$81.19
Rate for Payer: Cofinity Commercial	$99.75
Rate for Payer: Cofinity Medicare Advantage	$81.19
Rate for Payer: Encore Health Key Benefits Commercial	$92.79
Rate for Payer: Healthscope Commercial	$104.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.59
Rate for Payer: PHP Commercial	$98.59
Rate for Payer: Priority Health Cigna Priority Health	$75.39
Rate for Payer: Priority Health SBD	$73.07

HC NEG PRES Y CONNECTOR

Facility

$7.86

Hospital Charge Code	27000174
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Cofinity Medicare Advantage	$5.50
Rate for Payer: Encore Health Key Benefits Commercial	$6.29
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.11
Rate for Payer: Priority Health SBD	$4.95

HC NEG PRES Y CONNECTOR

Facility

$7.86

Hospital Charge Code	27000174
Hospital Revenue Code	270
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna Medicare	$3.93
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: BCBS Complete	$3.14
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Cofinity Medicare Advantage	$5.50
Rate for Payer: Encore Health Key Benefits Commercial	$6.29
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.11
Rate for Payer: Priority Health SBD	$4.95

HC NEISSERIA GONORRHOEAE AMP DNA

Facility

$67.63

Service Code	CPT 87591
Hospital Charge Code	30600163
Hospital Revenue Code	306
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$60.87
Rate for Payer: Aetna Commercial	$57.49
Rate for Payer: Aetna New Business (MI Preferred)	$43.96
Rate for Payer: Cash Price	$54.10
Rate for Payer: Cofinity Commercial	$47.34
Rate for Payer: Cofinity Commercial	$58.16
Rate for Payer: Cofinity Medicare Advantage	$47.34
Rate for Payer: Encore Health Key Benefits Commercial	$54.10
Rate for Payer: Healthscope Commercial	$60.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.49
Rate for Payer: PHP Commercial	$57.49
Rate for Payer: Priority Health Cigna Priority Health	$43.96
Rate for Payer: Priority Health SBD	$42.61

HC NEISSERIA GONORRHOEAE AMP DNA

Facility

$67.63

Service Code	CPT 87591
Hospital Charge Code	30600163
Hospital Revenue Code	306
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$98.77
Rate for Payer: Aetna Commercial	$57.49
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$43.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$19.75
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$54.10
Rate for Payer: Cash Price	$54.10
Rate for Payer: Cofinity Commercial	$58.16
Rate for Payer: Cofinity Commercial	$47.34
Rate for Payer: Cofinity Medicare Advantage	$47.34
Rate for Payer: Encore Health Key Benefits Commercial	$54.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$60.87
Rate for Payer: Mclaren Medicaid	$18.81
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.84
Rate for Payer: Meridian Medicaid	$19.75
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.49
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$57.49
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$18.81
Rate for Payer: Priority Health Cigna Priority Health	$43.96
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$42.61
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$98.77
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Medicare Advantage	$35.09
Rate for Payer: UHCCP Medicaid	$19.76
Rate for Payer: VA VA	$35.09

HC NEISSERIA MENINGITITIS

Facility

$52.02

Service Code	CPT 87798
Hospital Charge Code	30600275
Hospital Revenue Code	306
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$98.77
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$19.75
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Mclaren Medicaid	$18.81
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.84
Rate for Payer: Meridian Medicaid	$19.75
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$18.81
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$32.77
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$98.77
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Medicare Advantage	$35.09
Rate for Payer: UHCCP Medicaid	$19.76
Rate for Payer: VA VA	$35.09

HC NEISSERIA MENINGITITIS

Facility

$52.02

Service Code	CPT 87798
Hospital Charge Code	30600275
Hospital Revenue Code	306
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC NEONATAL VENT INIT DAY

Facility

$1,569.06

Service Code	CPT 94002
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$345.59
Max. Negotiated Rate	$1,814.93
Rate for Payer: Aetna Commercial	$1,333.70
Rate for Payer: Aetna Medicare	$670.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,019.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$805.95
Rate for Payer: Amish Plain Church Group Commercial	$805.95
Rate for Payer: BCBS Complete	$362.87
Rate for Payer: BCBS MAPPO	$644.76
Rate for Payer: BCN Medicare Advantage	$644.76
Rate for Payer: Cash Price	$1,255.25
Rate for Payer: Cash Price	$1,255.25
Rate for Payer: Cofinity Commercial	$1,349.39
Rate for Payer: Cofinity Commercial	$1,098.34
Rate for Payer: Cofinity Medicare Advantage	$1,098.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,255.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$644.76
Rate for Payer: Healthscope Commercial	$1,412.15
Rate for Payer: Mclaren Medicaid	$345.59
Rate for Payer: Mclaren Medicare	$644.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$677.00
Rate for Payer: Meridian Medicaid	$362.87
Rate for Payer: MI Amish Medical Board Commercial	$741.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,333.70
Rate for Payer: PACE Medicare	$612.52
Rate for Payer: PACE SWMI	$644.76
Rate for Payer: PHP Commercial	$1,333.70
Rate for Payer: PHP Medicare Advantage	$644.76
Rate for Payer: Priority Health Choice Medicaid	$345.59
Rate for Payer: Priority Health Cigna Priority Health	$1,019.89
Rate for Payer: Priority Health Medicare	$644.76
Rate for Payer: Priority Health SBD	$988.51
Rate for Payer: Railroad Medicare Medicare	$644.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1,814.93
Rate for Payer: UHC Core	$1,161.10
Rate for Payer: UHC Dual Complete DSNP	$644.76
Rate for Payer: UHC Exchange	$1,161.10
Rate for Payer: UHC Medicare Advantage	$644.76
Rate for Payer: UHCCP Medicaid	$363.00
Rate for Payer: VA VA	$644.76

HC NEONATAL VENT INIT DAY

Facility

$1,569.06

Service Code	CPT 94002
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$988.51
Max. Negotiated Rate	$1,412.15
Rate for Payer: Aetna Commercial	$1,333.70
Rate for Payer: Aetna New Business (MI Preferred)	$1,019.89
Rate for Payer: Cash Price	$1,255.25
Rate for Payer: Cofinity Commercial	$1,098.34
Rate for Payer: Cofinity Commercial	$1,349.39
Rate for Payer: Cofinity Medicare Advantage	$1,098.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,255.25
Rate for Payer: Healthscope Commercial	$1,412.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,333.70
Rate for Payer: PHP Commercial	$1,333.70
Rate for Payer: Priority Health Cigna Priority Health	$1,019.89
Rate for Payer: Priority Health SBD	$988.51

HC NEONATAL VENT SUB DAY

Facility

$1,197.45

Service Code	CPT 94003
Hospital Charge Code	41000038
Hospital Revenue Code	410
Min. Negotiated Rate	$345.59
Max. Negotiated Rate	$1,814.93
Rate for Payer: Aetna Commercial	$1,017.83
Rate for Payer: Aetna Medicare	$670.55
Rate for Payer: Aetna New Business (MI Preferred)	$778.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$805.95
Rate for Payer: Amish Plain Church Group Commercial	$805.95
Rate for Payer: BCBS Complete	$362.87
Rate for Payer: BCBS MAPPO	$644.76
Rate for Payer: BCN Medicare Advantage	$644.76
Rate for Payer: Cash Price	$957.96
Rate for Payer: Cash Price	$957.96
Rate for Payer: Cofinity Commercial	$838.22
Rate for Payer: Cofinity Commercial	$1,029.81
Rate for Payer: Cofinity Medicare Advantage	$838.22
Rate for Payer: Encore Health Key Benefits Commercial	$957.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$644.76
Rate for Payer: Healthscope Commercial	$1,077.70
Rate for Payer: Mclaren Medicaid	$345.59
Rate for Payer: Mclaren Medicare	$644.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$677.00
Rate for Payer: Meridian Medicaid	$362.87
Rate for Payer: MI Amish Medical Board Commercial	$741.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,017.83
Rate for Payer: PACE Medicare	$612.52
Rate for Payer: PACE SWMI	$644.76
Rate for Payer: PHP Commercial	$1,017.83
Rate for Payer: PHP Medicare Advantage	$644.76
Rate for Payer: Priority Health Choice Medicaid	$345.59
Rate for Payer: Priority Health Cigna Priority Health	$778.34
Rate for Payer: Priority Health Medicare	$644.76
Rate for Payer: Priority Health SBD	$754.39
Rate for Payer: Railroad Medicare Medicare	$644.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1,814.93
Rate for Payer: UHC Core	$886.11
Rate for Payer: UHC Dual Complete DSNP	$644.76
Rate for Payer: UHC Exchange	$886.11
Rate for Payer: UHC Medicare Advantage	$644.76
Rate for Payer: UHCCP Medicaid	$363.00
Rate for Payer: VA VA	$644.76

HC NEONATAL VENT SUB DAY

Facility

$1,197.45

Service Code	CPT 94003
Hospital Charge Code	41000038
Hospital Revenue Code	410
Min. Negotiated Rate	$754.39
Max. Negotiated Rate	$1,077.70
Rate for Payer: Aetna Commercial	$1,017.83
Rate for Payer: Aetna New Business (MI Preferred)	$778.34
Rate for Payer: Cash Price	$957.96
Rate for Payer: Cofinity Commercial	$1,029.81
Rate for Payer: Cofinity Commercial	$838.22
Rate for Payer: Cofinity Medicare Advantage	$838.22
Rate for Payer: Encore Health Key Benefits Commercial	$957.96
Rate for Payer: Healthscope Commercial	$1,077.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,017.83
Rate for Payer: PHP Commercial	$1,017.83
Rate for Payer: Priority Health Cigna Priority Health	$778.34
Rate for Payer: Priority Health SBD	$754.39

HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS

Facility

$1,363.87

Service Code	CPT 50431
Hospital Charge Code	36100503
Hospital Revenue Code	361
Min. Negotiated Rate	$859.24
Max. Negotiated Rate	$1,227.48
Rate for Payer: Aetna Commercial	$1,159.29
Rate for Payer: Aetna New Business (MI Preferred)	$886.52
Rate for Payer: Cash Price	$1,091.10
Rate for Payer: Cofinity Commercial	$1,172.93
Rate for Payer: Cofinity Commercial	$954.71
Rate for Payer: Cofinity Medicare Advantage	$954.71
Rate for Payer: Encore Health Key Benefits Commercial	$1,091.10
Rate for Payer: Healthscope Commercial	$1,227.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,159.29
Rate for Payer: PHP Commercial	$1,159.29
Rate for Payer: Priority Health Cigna Priority Health	$886.52
Rate for Payer: Priority Health SBD	$859.24

Know your out-of-pocket cost for care.

All Charges