Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NEUROSTIMULATOR TEST KIT LVL 15

Facility

$1,530.00

Service Code	HCPCS C1897
Hospital Charge Code	27800137
Hospital Revenue Code	278
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna Medicare	$765.00
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: BCBS Complete	$612.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Cofinity Medicare Advantage	$1,071.00
Rate for Payer: Encore Health Key Benefits Commercial	$1,224.00
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,300.50
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: Priority Health Cigna Priority Health	$994.50
Rate for Payer: Priority Health SBD	$963.90

HC NEUROSTIMULATOR TEST KIT LVL 15

Facility

$1,530.00

Service Code	HCPCS C1897
Hospital Charge Code	27800137
Hospital Revenue Code	278
Min. Negotiated Rate	$963.90
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Cofinity Medicare Advantage	$1,071.00
Rate for Payer: Encore Health Key Benefits Commercial	$1,224.00
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,300.50
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: Priority Health Cigna Priority Health	$994.50
Rate for Payer: Priority Health SBD	$963.90

HC NEUROSTIMULATOR TEST KIT LVL 25

Facility

$2,550.00

Service Code	CPT C1897
Hospital Charge Code	27800138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna Commercial	$2,167.50
Rate for Payer: Aetna Medicare	$1,275.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,657.50
Rate for Payer: BCBS Complete	$1,020.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Cofinity Commercial	$1,785.00
Rate for Payer: Cofinity Commercial	$2,193.00
Rate for Payer: Cofinity Medicare Advantage	$1,785.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,040.00
Rate for Payer: Healthscope Commercial	$2,295.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,167.50
Rate for Payer: PHP Commercial	$2,167.50
Rate for Payer: Priority Health Cigna Priority Health	$1,657.50
Rate for Payer: Priority Health SBD	$1,606.50

HC NEUROSTIMULATOR TEST KIT LVL 25

Facility

$2,550.00

Service Code	CPT C1897
Hospital Charge Code	27800138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.50
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna Commercial	$2,167.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,657.50
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Cofinity Commercial	$1,785.00
Rate for Payer: Cofinity Commercial	$2,193.00
Rate for Payer: Cofinity Medicare Advantage	$1,785.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,040.00
Rate for Payer: Healthscope Commercial	$2,295.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,167.50
Rate for Payer: PHP Commercial	$2,167.50
Rate for Payer: Priority Health Cigna Priority Health	$1,657.50
Rate for Payer: Priority Health SBD	$1,606.50

HC NEUTROPHIL OXIDATIVE BURST

Facility

$158.36

Service Code	CPT 88184
Hospital Charge Code	31000003
Hospital Revenue Code	310
Min. Negotiated Rate	$99.77
Max. Negotiated Rate	$987.55
Rate for Payer: Aetna Commercial	$134.61
Rate for Payer: Aetna Medicare	$364.86
Rate for Payer: Aetna New Business (MI Preferred)	$102.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$438.54
Rate for Payer: Amish Plain Church Group Commercial	$438.54
Rate for Payer: BCBS Complete	$197.45
Rate for Payer: BCBS MAPPO	$350.83
Rate for Payer: BCN Medicare Advantage	$350.83
Rate for Payer: Cash Price	$126.69
Rate for Payer: Cash Price	$126.69
Rate for Payer: Cofinity Commercial	$110.85
Rate for Payer: Cofinity Commercial	$136.19
Rate for Payer: Cofinity Medicare Advantage	$110.85
Rate for Payer: Encore Health Key Benefits Commercial	$126.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$350.83
Rate for Payer: Healthscope Commercial	$142.52
Rate for Payer: Mclaren Medicaid	$188.04
Rate for Payer: Mclaren Medicare	$350.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$368.37
Rate for Payer: Meridian Medicaid	$197.45
Rate for Payer: MI Amish Medical Board Commercial	$403.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.61
Rate for Payer: PACE Medicare	$333.29
Rate for Payer: PACE SWMI	$350.83
Rate for Payer: PHP Commercial	$134.61
Rate for Payer: PHP Medicare Advantage	$350.83
Rate for Payer: Priority Health Choice Medicaid	$188.04
Rate for Payer: Priority Health Cigna Priority Health	$102.93
Rate for Payer: Priority Health Medicare	$350.83
Rate for Payer: Priority Health SBD	$99.77
Rate for Payer: Railroad Medicare Medicare	$350.83
Rate for Payer: UHC All Payor (Choice/PPO)	$987.55
Rate for Payer: UHC Dual Complete DSNP	$350.83
Rate for Payer: UHC Medicare Advantage	$350.83
Rate for Payer: UHCCP Medicaid	$197.52
Rate for Payer: VA VA	$350.83

HC NEUTROPHIL OXIDATIVE BURST

Facility

$158.36

Service Code	CPT 88184
Hospital Charge Code	31000003
Hospital Revenue Code	310
Min. Negotiated Rate	$99.77
Max. Negotiated Rate	$142.52
Rate for Payer: Aetna Commercial	$134.61
Rate for Payer: Aetna New Business (MI Preferred)	$102.93
Rate for Payer: Cash Price	$126.69
Rate for Payer: Cofinity Commercial	$110.85
Rate for Payer: Cofinity Commercial	$136.19
Rate for Payer: Cofinity Medicare Advantage	$110.85
Rate for Payer: Encore Health Key Benefits Commercial	$126.69
Rate for Payer: Healthscope Commercial	$142.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.61
Rate for Payer: PHP Commercial	$134.61
Rate for Payer: Priority Health Cigna Priority Health	$102.93
Rate for Payer: Priority Health SBD	$99.77

HC NEUTROPHIL OXIDATIVE BURST CMP

Facility

$56.18

Service Code	CPT 88185
Hospital Charge Code	31000012
Hospital Revenue Code	310
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$50.56
Rate for Payer: Aetna Commercial	$47.75
Rate for Payer: Aetna Medicare	$28.09
Rate for Payer: Aetna New Business (MI Preferred)	$36.52
Rate for Payer: BCBS Complete	$22.47
Rate for Payer: Cash Price	$44.94
Rate for Payer: Cofinity Commercial	$39.33
Rate for Payer: Cofinity Commercial	$48.31
Rate for Payer: Cofinity Medicare Advantage	$39.33
Rate for Payer: Encore Health Key Benefits Commercial	$44.94
Rate for Payer: Healthscope Commercial	$50.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.75
Rate for Payer: PHP Commercial	$47.75
Rate for Payer: Priority Health Cigna Priority Health	$36.52
Rate for Payer: Priority Health SBD	$35.39

HC NEUTROPHIL OXIDATIVE BURST CMP

Facility

$56.18

Service Code	CPT 88185
Hospital Charge Code	31000012
Hospital Revenue Code	310
Min. Negotiated Rate	$35.39
Max. Negotiated Rate	$50.56
Rate for Payer: Aetna Commercial	$47.75
Rate for Payer: Aetna New Business (MI Preferred)	$36.52
Rate for Payer: Cash Price	$44.94
Rate for Payer: Cofinity Commercial	$39.33
Rate for Payer: Cofinity Commercial	$48.31
Rate for Payer: Cofinity Medicare Advantage	$39.33
Rate for Payer: Encore Health Key Benefits Commercial	$44.94
Rate for Payer: Healthscope Commercial	$50.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.75
Rate for Payer: PHP Commercial	$47.75
Rate for Payer: Priority Health Cigna Priority Health	$36.52
Rate for Payer: Priority Health SBD	$35.39

HC NEW PATIENT VISIT 99202

Facility

$169.02

Service Code	CPT 99202
Hospital Charge Code	51000077
Hospital Revenue Code	761
Min. Negotiated Rate	$106.48
Max. Negotiated Rate	$152.12
Rate for Payer: Aetna Commercial	$143.67
Rate for Payer: Aetna New Business (MI Preferred)	$109.86
Rate for Payer: Cash Price	$135.22
Rate for Payer: Cofinity Commercial	$118.31
Rate for Payer: Cofinity Commercial	$145.36
Rate for Payer: Cofinity Medicare Advantage	$118.31
Rate for Payer: Encore Health Key Benefits Commercial	$135.22
Rate for Payer: Healthscope Commercial	$152.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.67
Rate for Payer: PHP Commercial	$143.67
Rate for Payer: Priority Health Cigna Priority Health	$109.86
Rate for Payer: Priority Health SBD	$106.48

HC NEW PATIENT VISIT 99202

Facility

$169.02

Service Code	CPT 99202
Hospital Charge Code	51000077
Hospital Revenue Code	761
Min. Negotiated Rate	$67.61
Max. Negotiated Rate	$152.12
Rate for Payer: Aetna Commercial	$143.67
Rate for Payer: Aetna Medicare	$84.51
Rate for Payer: Aetna New Business (MI Preferred)	$109.86
Rate for Payer: BCBS Complete	$67.61
Rate for Payer: Cash Price	$135.22
Rate for Payer: Cofinity Commercial	$118.31
Rate for Payer: Cofinity Commercial	$145.36
Rate for Payer: Cofinity Medicare Advantage	$118.31
Rate for Payer: Encore Health Key Benefits Commercial	$135.22
Rate for Payer: Healthscope Commercial	$152.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.67
Rate for Payer: PHP Commercial	$143.67
Rate for Payer: Priority Health Cigna Priority Health	$109.86
Rate for Payer: Priority Health SBD	$106.48

HC NEW PATIENT VISIT 99203

Facility

$205.10

Service Code	CPT 99203
Hospital Charge Code	51000078
Hospital Revenue Code	761
Min. Negotiated Rate	$129.21
Max. Negotiated Rate	$184.59
Rate for Payer: Aetna Commercial	$174.34
Rate for Payer: Aetna New Business (MI Preferred)	$133.31
Rate for Payer: Cash Price	$164.08
Rate for Payer: Cofinity Commercial	$143.57
Rate for Payer: Cofinity Commercial	$176.39
Rate for Payer: Cofinity Medicare Advantage	$143.57
Rate for Payer: Encore Health Key Benefits Commercial	$164.08
Rate for Payer: Healthscope Commercial	$184.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.34
Rate for Payer: PHP Commercial	$174.34
Rate for Payer: Priority Health Cigna Priority Health	$133.31
Rate for Payer: Priority Health SBD	$129.21

HC NEW PATIENT VISIT 99203

Facility

$205.10

Service Code	CPT 99203
Hospital Charge Code	51000078
Hospital Revenue Code	761
Min. Negotiated Rate	$82.04
Max. Negotiated Rate	$184.59
Rate for Payer: Aetna Commercial	$174.34
Rate for Payer: Aetna Medicare	$102.55
Rate for Payer: Aetna New Business (MI Preferred)	$133.31
Rate for Payer: BCBS Complete	$82.04
Rate for Payer: Cash Price	$164.08
Rate for Payer: Cofinity Commercial	$143.57
Rate for Payer: Cofinity Commercial	$176.39
Rate for Payer: Cofinity Medicare Advantage	$143.57
Rate for Payer: Encore Health Key Benefits Commercial	$164.08
Rate for Payer: Healthscope Commercial	$184.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.34
Rate for Payer: PHP Commercial	$174.34
Rate for Payer: Priority Health Cigna Priority Health	$133.31
Rate for Payer: Priority Health SBD	$129.21

HC NEW PATIENT VISIT 99204

Facility

$294.53

Service Code	CPT 99204
Hospital Charge Code	51000079
Hospital Revenue Code	761
Min. Negotiated Rate	$117.81
Max. Negotiated Rate	$265.08
Rate for Payer: Aetna Commercial	$250.35
Rate for Payer: Aetna Medicare	$147.26
Rate for Payer: Aetna New Business (MI Preferred)	$191.44
Rate for Payer: BCBS Complete	$117.81
Rate for Payer: Cash Price	$235.62
Rate for Payer: Cofinity Commercial	$206.17
Rate for Payer: Cofinity Commercial	$253.30
Rate for Payer: Cofinity Medicare Advantage	$206.17
Rate for Payer: Encore Health Key Benefits Commercial	$235.62
Rate for Payer: Healthscope Commercial	$265.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$250.35
Rate for Payer: PHP Commercial	$250.35
Rate for Payer: Priority Health Cigna Priority Health	$191.44
Rate for Payer: Priority Health SBD	$185.55

HC NEW PATIENT VISIT 99204

Facility

$294.53

Service Code	CPT 99204
Hospital Charge Code	51000079
Hospital Revenue Code	761
Min. Negotiated Rate	$185.55
Max. Negotiated Rate	$265.08
Rate for Payer: Aetna Commercial	$250.35
Rate for Payer: Aetna New Business (MI Preferred)	$191.44
Rate for Payer: Cash Price	$235.62
Rate for Payer: Cofinity Commercial	$206.17
Rate for Payer: Cofinity Commercial	$253.30
Rate for Payer: Cofinity Medicare Advantage	$206.17
Rate for Payer: Encore Health Key Benefits Commercial	$235.62
Rate for Payer: Healthscope Commercial	$265.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$250.35
Rate for Payer: PHP Commercial	$250.35
Rate for Payer: Priority Health Cigna Priority Health	$191.44
Rate for Payer: Priority Health SBD	$185.55

HC NEW PATIENT VISIT 99205

Facility

$490.43

Service Code	CPT 99205
Hospital Charge Code	51000080
Hospital Revenue Code	761
Min. Negotiated Rate	$196.17
Max. Negotiated Rate	$441.39
Rate for Payer: Aetna Commercial	$416.87
Rate for Payer: Aetna Medicare	$245.22
Rate for Payer: Aetna New Business (MI Preferred)	$318.78
Rate for Payer: BCBS Complete	$196.17
Rate for Payer: Cash Price	$392.34
Rate for Payer: Cofinity Commercial	$343.30
Rate for Payer: Cofinity Commercial	$421.77
Rate for Payer: Cofinity Medicare Advantage	$343.30
Rate for Payer: Encore Health Key Benefits Commercial	$392.34
Rate for Payer: Healthscope Commercial	$441.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$416.87
Rate for Payer: PHP Commercial	$416.87
Rate for Payer: Priority Health Cigna Priority Health	$318.78
Rate for Payer: Priority Health SBD	$308.97

HC NEW PATIENT VISIT 99205

Facility

$490.43

Service Code	CPT 99205
Hospital Charge Code	51000080
Hospital Revenue Code	761
Min. Negotiated Rate	$308.97
Max. Negotiated Rate	$441.39
Rate for Payer: Aetna Commercial	$416.87
Rate for Payer: Aetna New Business (MI Preferred)	$318.78
Rate for Payer: Cash Price	$392.34
Rate for Payer: Cofinity Commercial	$343.30
Rate for Payer: Cofinity Commercial	$421.77
Rate for Payer: Cofinity Medicare Advantage	$343.30
Rate for Payer: Encore Health Key Benefits Commercial	$392.34
Rate for Payer: Healthscope Commercial	$441.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$416.87
Rate for Payer: PHP Commercial	$416.87
Rate for Payer: Priority Health Cigna Priority Health	$318.78
Rate for Payer: Priority Health SBD	$308.97

HC NICOTINE AND METABOLITES BLD

Facility

$62.22

Service Code	CPT 80323
Hospital Charge Code	30100599
Hospital Revenue Code	301
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$52.89
Rate for Payer: Aetna Medicare	$31.11
Rate for Payer: Aetna New Business (MI Preferred)	$40.44
Rate for Payer: BCBS Complete	$24.89
Rate for Payer: Cash Price	$49.78
Rate for Payer: Cofinity Commercial	$43.55
Rate for Payer: Cofinity Commercial	$53.51
Rate for Payer: Cofinity Medicare Advantage	$43.55
Rate for Payer: Encore Health Key Benefits Commercial	$49.78
Rate for Payer: Healthscope Commercial	$56.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.89
Rate for Payer: PHP Commercial	$52.89
Rate for Payer: Priority Health Cigna Priority Health	$40.44
Rate for Payer: Priority Health SBD	$39.20

HC NICOTINE AND METABOLITES BLD

Facility

$62.22

Service Code	CPT 80323
Hospital Charge Code	30100599
Hospital Revenue Code	301
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$52.89
Rate for Payer: Aetna New Business (MI Preferred)	$40.44
Rate for Payer: Cash Price	$49.78
Rate for Payer: Cofinity Commercial	$43.55
Rate for Payer: Cofinity Commercial	$53.51
Rate for Payer: Cofinity Medicare Advantage	$43.55
Rate for Payer: Encore Health Key Benefits Commercial	$49.78
Rate for Payer: Healthscope Commercial	$56.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.89
Rate for Payer: PHP Commercial	$52.89
Rate for Payer: Priority Health Cigna Priority Health	$40.44
Rate for Payer: Priority Health SBD	$39.20

HC NICOTINE AND METABOLITES URN

Facility

$51.00

Service Code	CPT 80323
Hospital Charge Code	30100613
Hospital Revenue Code	301
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Medicare Advantage	$35.70
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health SBD	$32.13

HC NICOTINE AND METABOLITES URN

Facility

$51.00

Service Code	CPT 80323
Hospital Charge Code	30100613
Hospital Revenue Code	301
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Medicare Advantage	$35.70
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health SBD	$32.13

HC NICU LEVEL 2 R&B

Facility

$3,430.50

Hospital Charge Code	17200001
Hospital Revenue Code	172
Min. Negotiated Rate	$2,161.22
Max. Negotiated Rate	$3,087.45
Rate for Payer: Aetna Commercial	$2,915.93
Rate for Payer: Aetna New Business (MI Preferred)	$2,229.82
Rate for Payer: Cash Price	$2,744.40
Rate for Payer: Cofinity Commercial	$2,401.35
Rate for Payer: Cofinity Commercial	$2,950.23
Rate for Payer: Cofinity Medicare Advantage	$2,401.35
Rate for Payer: Encore Health Key Benefits Commercial	$2,744.40
Rate for Payer: Healthscope Commercial	$3,087.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,915.93
Rate for Payer: PHP Commercial	$2,915.93
Rate for Payer: Priority Health Cigna Priority Health	$2,229.82
Rate for Payer: Priority Health SBD	$2,161.22

HC NICU LEVEL 3 R&B

Facility

$5,085.75

Hospital Charge Code	17300001
Hospital Revenue Code	173
Min. Negotiated Rate	$3,204.02
Max. Negotiated Rate	$4,577.18
Rate for Payer: Aetna Commercial	$4,322.89
Rate for Payer: Aetna New Business (MI Preferred)	$3,305.74
Rate for Payer: Cash Price	$4,068.60
Rate for Payer: Cofinity Commercial	$4,373.74
Rate for Payer: Cofinity Commercial	$3,560.03
Rate for Payer: Cofinity Medicare Advantage	$3,560.03
Rate for Payer: Encore Health Key Benefits Commercial	$4,068.60
Rate for Payer: Healthscope Commercial	$4,577.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,322.89
Rate for Payer: PHP Commercial	$4,322.89
Rate for Payer: Priority Health Cigna Priority Health	$3,305.74
Rate for Payer: Priority Health SBD	$3,204.02

HC NICU LEVEL 4 R&B

Facility

$5,325.60

Hospital Charge Code	17400001
Hospital Revenue Code	174
Min. Negotiated Rate	$3,355.13
Max. Negotiated Rate	$4,793.04
Rate for Payer: Aetna Commercial	$4,526.76
Rate for Payer: Aetna New Business (MI Preferred)	$3,461.64
Rate for Payer: Cash Price	$4,260.48
Rate for Payer: Cofinity Commercial	$3,727.92
Rate for Payer: Cofinity Commercial	$4,580.02
Rate for Payer: Cofinity Medicare Advantage	$3,727.92
Rate for Payer: Encore Health Key Benefits Commercial	$4,260.48
Rate for Payer: Healthscope Commercial	$4,793.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,526.76
Rate for Payer: PHP Commercial	$4,526.76
Rate for Payer: Priority Health Cigna Priority Health	$3,461.64
Rate for Payer: Priority Health SBD	$3,355.13

HC NICU OBSERVATION PER HOUR

Facility

$200.94

Service Code	HCPCS G0378
Hospital Charge Code	76200013
Hospital Revenue Code	762
Min. Negotiated Rate	$80.38
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$170.80
Rate for Payer: Aetna Medicare	$100.47
Rate for Payer: Aetna New Business (MI Preferred)	$130.61
Rate for Payer: BCBS Complete	$80.38
Rate for Payer: Cash Price	$160.75
Rate for Payer: Cash Price	$160.75
Rate for Payer: Cofinity Commercial	$140.66
Rate for Payer: Cofinity Commercial	$172.81
Rate for Payer: Cofinity Medicare Advantage	$140.66
Rate for Payer: Encore Health Key Benefits Commercial	$160.75
Rate for Payer: Healthscope Commercial	$180.85
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.80
Rate for Payer: PHP Commercial	$170.80
Rate for Payer: Priority Health Cigna Priority Health	$130.61
Rate for Payer: Priority Health SBD	$126.59
Rate for Payer: UHC Core	$148.70
Rate for Payer: UHC Exchange	$148.70

HC NICU OBSERVATION PER HOUR

Facility

$200.94

Service Code	HCPCS G0378
Hospital Charge Code	76200013
Hospital Revenue Code	762
Min. Negotiated Rate	$126.59
Max. Negotiated Rate	$180.85
Rate for Payer: Aetna Commercial	$170.80
Rate for Payer: Aetna New Business (MI Preferred)	$130.61
Rate for Payer: Cash Price	$160.75
Rate for Payer: Cofinity Commercial	$140.66
Rate for Payer: Cofinity Commercial	$172.81
Rate for Payer: Cofinity Medicare Advantage	$140.66
Rate for Payer: Encore Health Key Benefits Commercial	$160.75
Rate for Payer: Healthscope Commercial	$180.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.80
Rate for Payer: PHP Commercial	$170.80
Rate for Payer: Priority Health Cigna Priority Health	$130.61
Rate for Payer: Priority Health SBD	$126.59

Know your out-of-pocket cost for care.

All Charges