Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NUC MED STRESS TEST

Facility

$948.26

Service Code	CPT 93017
Hospital Charge Code	48200005
Hospital Revenue Code	482
Min. Negotiated Rate	$597.40
Max. Negotiated Rate	$853.43
Rate for Payer: Aetna Commercial	$806.02
Rate for Payer: Aetna New Business (MI Preferred)	$616.37
Rate for Payer: Cash Price	$758.61
Rate for Payer: Cofinity Commercial	$663.78
Rate for Payer: Cofinity Commercial	$815.50
Rate for Payer: Cofinity Medicare Advantage	$663.78
Rate for Payer: Encore Health Key Benefits Commercial	$758.61
Rate for Payer: Healthscope Commercial	$853.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$806.02
Rate for Payer: PHP Commercial	$806.02
Rate for Payer: Priority Health Cigna Priority Health	$616.37
Rate for Payer: Priority Health SBD	$597.40

HC NURSEMAID ELBOW REDUCTION

Facility

$215.97

Service Code	CPT 24640
Hospital Charge Code	45000008
Hospital Revenue Code	761
Min. Negotiated Rate	$136.06
Max. Negotiated Rate	$194.37
Rate for Payer: Aetna Commercial	$183.57
Rate for Payer: Aetna New Business (MI Preferred)	$140.38
Rate for Payer: Cash Price	$172.78
Rate for Payer: Cofinity Commercial	$151.18
Rate for Payer: Cofinity Commercial	$185.73
Rate for Payer: Cofinity Medicare Advantage	$151.18
Rate for Payer: Encore Health Key Benefits Commercial	$172.78
Rate for Payer: Healthscope Commercial	$194.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.57
Rate for Payer: PHP Commercial	$183.57
Rate for Payer: Priority Health Cigna Priority Health	$140.38
Rate for Payer: Priority Health SBD	$136.06

HC NURSEMAID ELBOW REDUCTION

Facility

$215.97

Service Code	CPT 24640
Hospital Charge Code	45000008
Hospital Revenue Code	761
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$658.55
Rate for Payer: Aetna Commercial	$183.57
Rate for Payer: Aetna Medicare	$243.31
Rate for Payer: Aetna New Business (MI Preferred)	$140.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$292.44
Rate for Payer: Amish Plain Church Group Commercial	$292.44
Rate for Payer: BCBS Complete	$131.67
Rate for Payer: BCBS MAPPO	$233.95
Rate for Payer: BCN Medicare Advantage	$233.95
Rate for Payer: Cash Price	$172.78
Rate for Payer: Cash Price	$172.78
Rate for Payer: Cofinity Commercial	$185.73
Rate for Payer: Cofinity Commercial	$151.18
Rate for Payer: Cofinity Medicare Advantage	$151.18
Rate for Payer: Encore Health Key Benefits Commercial	$172.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$233.95
Rate for Payer: Healthscope Commercial	$194.37
Rate for Payer: Mclaren Medicaid	$125.40
Rate for Payer: Mclaren Medicare	$233.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$245.65
Rate for Payer: Meridian Medicaid	$131.67
Rate for Payer: MI Amish Medical Board Commercial	$269.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.57
Rate for Payer: PACE Medicare	$222.25
Rate for Payer: PACE SWMI	$233.95
Rate for Payer: PHP Commercial	$183.57
Rate for Payer: PHP Medicare Advantage	$233.95
Rate for Payer: Priority Health Choice Medicaid	$125.40
Rate for Payer: Priority Health Cigna Priority Health	$140.38
Rate for Payer: Priority Health Medicare	$233.95
Rate for Payer: Priority Health SBD	$136.06
Rate for Payer: Railroad Medicare Medicare	$233.95
Rate for Payer: UHC All Payor (Choice/PPO)	$658.55
Rate for Payer: UHC Dual Complete DSNP	$233.95
Rate for Payer: UHC Medicare Advantage	$233.95
Rate for Payer: UHCCP Medicaid	$131.71
Rate for Payer: VA VA	$233.95

HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM

Facility

$616.44

Service Code	HCPCS Q4160
Hospital Charge Code	63600153
Hospital Revenue Code	636
Min. Negotiated Rate	$246.58
Max. Negotiated Rate	$554.80
Rate for Payer: Aetna Commercial	$523.97
Rate for Payer: Aetna Medicare	$308.22
Rate for Payer: Aetna New Business (MI Preferred)	$400.69
Rate for Payer: BCBS Complete	$246.58
Rate for Payer: Cash Price	$493.15
Rate for Payer: Cofinity Commercial	$431.51
Rate for Payer: Cofinity Commercial	$530.14
Rate for Payer: Cofinity Medicare Advantage	$431.51
Rate for Payer: Encore Health Key Benefits Commercial	$493.15
Rate for Payer: Healthscope Commercial	$554.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$523.97
Rate for Payer: PHP Commercial	$523.97
Rate for Payer: Priority Health Cigna Priority Health	$400.69
Rate for Payer: Priority Health SBD	$388.36

HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM

Facility

$616.44

Service Code	HCPCS Q4160
Hospital Charge Code	63600153
Hospital Revenue Code	636
Min. Negotiated Rate	$388.36
Max. Negotiated Rate	$554.80
Rate for Payer: Aetna Commercial	$523.97
Rate for Payer: Aetna New Business (MI Preferred)	$400.69
Rate for Payer: Cash Price	$493.15
Rate for Payer: Cofinity Commercial	$431.51
Rate for Payer: Cofinity Commercial	$530.14
Rate for Payer: Cofinity Medicare Advantage	$431.51
Rate for Payer: Encore Health Key Benefits Commercial	$493.15
Rate for Payer: Healthscope Commercial	$554.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$523.97
Rate for Payer: PHP Commercial	$523.97
Rate for Payer: Priority Health Cigna Priority Health	$400.69
Rate for Payer: Priority Health SBD	$388.36

HC NUSHIELD 2X3 PER SQ CM

Facility

$328.97

Service Code	HCPCS Q4160
Hospital Charge Code	63600154
Hospital Revenue Code	636
Min. Negotiated Rate	$131.59
Max. Negotiated Rate	$296.07
Rate for Payer: Aetna Commercial	$279.62
Rate for Payer: Aetna Medicare	$164.49
Rate for Payer: Aetna New Business (MI Preferred)	$213.83
Rate for Payer: BCBS Complete	$131.59
Rate for Payer: Cash Price	$263.18
Rate for Payer: Cofinity Commercial	$230.28
Rate for Payer: Cofinity Commercial	$282.91
Rate for Payer: Cofinity Medicare Advantage	$230.28
Rate for Payer: Encore Health Key Benefits Commercial	$263.18
Rate for Payer: Healthscope Commercial	$296.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.62
Rate for Payer: PHP Commercial	$279.62
Rate for Payer: Priority Health Cigna Priority Health	$213.83
Rate for Payer: Priority Health SBD	$207.25

HC NUSHIELD 2X3 PER SQ CM

Facility

$328.97

Service Code	HCPCS Q4160
Hospital Charge Code	63600154
Hospital Revenue Code	636
Min. Negotiated Rate	$207.25
Max. Negotiated Rate	$296.07
Rate for Payer: Aetna Commercial	$279.62
Rate for Payer: Aetna New Business (MI Preferred)	$213.83
Rate for Payer: Cash Price	$263.18
Rate for Payer: Cofinity Commercial	$230.28
Rate for Payer: Cofinity Commercial	$282.91
Rate for Payer: Cofinity Medicare Advantage	$230.28
Rate for Payer: Encore Health Key Benefits Commercial	$263.18
Rate for Payer: Healthscope Commercial	$296.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.62
Rate for Payer: PHP Commercial	$279.62
Rate for Payer: Priority Health Cigna Priority Health	$213.83
Rate for Payer: Priority Health SBD	$207.25

HC NUSHIELD 2X4 PER SQ CM

Facility

$308.88

Service Code	HCPCS Q4160
Hospital Charge Code	63600175
Hospital Revenue Code	636
Min. Negotiated Rate	$194.59
Max. Negotiated Rate	$277.99
Rate for Payer: Aetna Commercial	$262.55
Rate for Payer: Aetna New Business (MI Preferred)	$200.77
Rate for Payer: Cash Price	$247.10
Rate for Payer: Cofinity Commercial	$216.22
Rate for Payer: Cofinity Commercial	$265.64
Rate for Payer: Cofinity Medicare Advantage	$216.22
Rate for Payer: Encore Health Key Benefits Commercial	$247.10
Rate for Payer: Healthscope Commercial	$277.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.55
Rate for Payer: PHP Commercial	$262.55
Rate for Payer: Priority Health Cigna Priority Health	$200.77
Rate for Payer: Priority Health SBD	$194.59

HC NUSHIELD 2X4 PER SQ CM

Facility

$308.88

Service Code	HCPCS Q4160
Hospital Charge Code	63600175
Hospital Revenue Code	636
Min. Negotiated Rate	$123.55
Max. Negotiated Rate	$277.99
Rate for Payer: Aetna Commercial	$262.55
Rate for Payer: Aetna Medicare	$154.44
Rate for Payer: Aetna New Business (MI Preferred)	$200.77
Rate for Payer: BCBS Complete	$123.55
Rate for Payer: Cash Price	$247.10
Rate for Payer: Cofinity Commercial	$216.22
Rate for Payer: Cofinity Commercial	$265.64
Rate for Payer: Cofinity Medicare Advantage	$216.22
Rate for Payer: Encore Health Key Benefits Commercial	$247.10
Rate for Payer: Healthscope Commercial	$277.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.55
Rate for Payer: PHP Commercial	$262.55
Rate for Payer: Priority Health Cigna Priority Health	$200.77
Rate for Payer: Priority Health SBD	$194.59

HC NUSHIELD 3X4 PER SQ CM

Facility

$298.03

Service Code	HCPCS Q4160
Hospital Charge Code	63600176
Hospital Revenue Code	636
Min. Negotiated Rate	$187.76
Max. Negotiated Rate	$268.23
Rate for Payer: Aetna Commercial	$253.33
Rate for Payer: Aetna New Business (MI Preferred)	$193.72
Rate for Payer: Cash Price	$238.42
Rate for Payer: Cofinity Commercial	$208.62
Rate for Payer: Cofinity Commercial	$256.31
Rate for Payer: Cofinity Medicare Advantage	$208.62
Rate for Payer: Encore Health Key Benefits Commercial	$238.42
Rate for Payer: Healthscope Commercial	$268.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.33
Rate for Payer: PHP Commercial	$253.33
Rate for Payer: Priority Health Cigna Priority Health	$193.72
Rate for Payer: Priority Health SBD	$187.76

HC NUSHIELD 3X4 PER SQ CM

Facility

$298.03

Service Code	HCPCS Q4160
Hospital Charge Code	63600176
Hospital Revenue Code	636
Min. Negotiated Rate	$119.21
Max. Negotiated Rate	$268.23
Rate for Payer: Aetna Commercial	$253.33
Rate for Payer: Aetna Medicare	$149.01
Rate for Payer: Aetna New Business (MI Preferred)	$193.72
Rate for Payer: BCBS Complete	$119.21
Rate for Payer: Cash Price	$238.42
Rate for Payer: Cofinity Commercial	$208.62
Rate for Payer: Cofinity Commercial	$256.31
Rate for Payer: Cofinity Medicare Advantage	$208.62
Rate for Payer: Encore Health Key Benefits Commercial	$238.42
Rate for Payer: Healthscope Commercial	$268.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.33
Rate for Payer: PHP Commercial	$253.33
Rate for Payer: Priority Health Cigna Priority Health	$193.72
Rate for Payer: Priority Health SBD	$187.76

HC NUSHIELD 4X4 PER SQ CM

Facility

$231.65

Service Code	CPT Q4160
Hospital Charge Code	63600177
Hospital Revenue Code	636
Min. Negotiated Rate	$145.94
Max. Negotiated Rate	$208.49
Rate for Payer: Aetna Commercial	$196.90
Rate for Payer: Aetna New Business (MI Preferred)	$150.57
Rate for Payer: Cash Price	$185.32
Rate for Payer: Cofinity Commercial	$162.16
Rate for Payer: Cofinity Commercial	$199.22
Rate for Payer: Cofinity Medicare Advantage	$162.16
Rate for Payer: Encore Health Key Benefits Commercial	$185.32
Rate for Payer: Healthscope Commercial	$208.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$196.90
Rate for Payer: PHP Commercial	$196.90
Rate for Payer: Priority Health Cigna Priority Health	$150.57
Rate for Payer: Priority Health SBD	$145.94

HC NUSHIELD 4X4 PER SQ CM

Facility

$231.65

Service Code	CPT Q4160
Hospital Charge Code	63600177
Hospital Revenue Code	636
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$208.49
Rate for Payer: Aetna Commercial	$196.90
Rate for Payer: Aetna Medicare	$115.83
Rate for Payer: Aetna New Business (MI Preferred)	$150.57
Rate for Payer: BCBS Complete	$92.66
Rate for Payer: Cash Price	$185.32
Rate for Payer: Cofinity Commercial	$162.16
Rate for Payer: Cofinity Commercial	$199.22
Rate for Payer: Cofinity Medicare Advantage	$162.16
Rate for Payer: Encore Health Key Benefits Commercial	$185.32
Rate for Payer: Healthscope Commercial	$208.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$196.90
Rate for Payer: PHP Commercial	$196.90
Rate for Payer: Priority Health Cigna Priority Health	$150.57
Rate for Payer: Priority Health SBD	$145.94

HC NUSHIELD 4X6 PER SQ CM

Facility

$162.57

Service Code	HCPCS Q4160
Hospital Charge Code	63600178
Hospital Revenue Code	636
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$146.31
Rate for Payer: Aetna Commercial	$138.18
Rate for Payer: Aetna New Business (MI Preferred)	$105.67
Rate for Payer: Cash Price	$130.06
Rate for Payer: Cofinity Commercial	$113.80
Rate for Payer: Cofinity Commercial	$139.81
Rate for Payer: Cofinity Medicare Advantage	$113.80
Rate for Payer: Encore Health Key Benefits Commercial	$130.06
Rate for Payer: Healthscope Commercial	$146.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.18
Rate for Payer: PHP Commercial	$138.18
Rate for Payer: Priority Health Cigna Priority Health	$105.67
Rate for Payer: Priority Health SBD	$102.42

HC NUSHIELD 4X6 PER SQ CM

Facility

$162.57

Service Code	HCPCS Q4160
Hospital Charge Code	63600178
Hospital Revenue Code	636
Min. Negotiated Rate	$65.03
Max. Negotiated Rate	$146.31
Rate for Payer: Aetna Commercial	$138.18
Rate for Payer: Aetna Medicare	$81.28
Rate for Payer: Aetna New Business (MI Preferred)	$105.67
Rate for Payer: BCBS Complete	$65.03
Rate for Payer: Cash Price	$130.06
Rate for Payer: Cofinity Commercial	$113.80
Rate for Payer: Cofinity Commercial	$139.81
Rate for Payer: Cofinity Medicare Advantage	$113.80
Rate for Payer: Encore Health Key Benefits Commercial	$130.06
Rate for Payer: Healthscope Commercial	$146.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.18
Rate for Payer: PHP Commercial	$138.18
Rate for Payer: Priority Health Cigna Priority Health	$105.67
Rate for Payer: Priority Health SBD	$102.42

HC NUSHIELD 6X6 PER SQ CM

Facility

$143.93

Service Code	HCPCS Q4160
Hospital Charge Code	63600166
Hospital Revenue Code	636
Min. Negotiated Rate	$90.68
Max. Negotiated Rate	$129.54
Rate for Payer: Aetna Commercial	$122.34
Rate for Payer: Aetna New Business (MI Preferred)	$93.55
Rate for Payer: Cash Price	$115.14
Rate for Payer: Cofinity Commercial	$100.75
Rate for Payer: Cofinity Commercial	$123.78
Rate for Payer: Cofinity Medicare Advantage	$100.75
Rate for Payer: Encore Health Key Benefits Commercial	$115.14
Rate for Payer: Healthscope Commercial	$129.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.34
Rate for Payer: PHP Commercial	$122.34
Rate for Payer: Priority Health Cigna Priority Health	$93.55
Rate for Payer: Priority Health SBD	$90.68

HC NUSHIELD 6X6 PER SQ CM

Facility

$143.93

Service Code	HCPCS Q4160
Hospital Charge Code	63600166
Hospital Revenue Code	636
Min. Negotiated Rate	$57.57
Max. Negotiated Rate	$129.54
Rate for Payer: Aetna Commercial	$122.34
Rate for Payer: Aetna Medicare	$71.97
Rate for Payer: Aetna New Business (MI Preferred)	$93.55
Rate for Payer: BCBS Complete	$57.57
Rate for Payer: Cash Price	$115.14
Rate for Payer: Cofinity Commercial	$100.75
Rate for Payer: Cofinity Commercial	$123.78
Rate for Payer: Cofinity Medicare Advantage	$100.75
Rate for Payer: Encore Health Key Benefits Commercial	$115.14
Rate for Payer: Healthscope Commercial	$129.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.34
Rate for Payer: PHP Commercial	$122.34
Rate for Payer: Priority Health Cigna Priority Health	$93.55
Rate for Payer: Priority Health SBD	$90.68

HC NUT ALLERGEN PANEL

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200123
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.53
Rate for Payer: Amish Plain Church Group Commercial	$6.53
Rate for Payer: BCBS Complete	$2.94
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Mclaren Medicaid	$2.80
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.48
Rate for Payer: Meridian Medicaid	$2.94
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$16.00
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$14.69
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Medicare Advantage	$5.22
Rate for Payer: UHCCP Medicaid	$2.94
Rate for Payer: VA VA	$5.22

HC NUT ALLERGEN PANEL

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200123
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health SBD	$16.00

HC NVU OBSERVATION PER HOUR

Facility

$145.08

Service Code	HCPCS G0378
Hospital Charge Code	76200004
Hospital Revenue Code	762
Min. Negotiated Rate	$58.03
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$123.32
Rate for Payer: Aetna Medicare	$72.54
Rate for Payer: Aetna New Business (MI Preferred)	$94.30
Rate for Payer: BCBS Complete	$58.03
Rate for Payer: Cash Price	$116.06
Rate for Payer: Cash Price	$116.06
Rate for Payer: Cofinity Commercial	$101.56
Rate for Payer: Cofinity Commercial	$124.77
Rate for Payer: Cofinity Medicare Advantage	$101.56
Rate for Payer: Encore Health Key Benefits Commercial	$116.06
Rate for Payer: Healthscope Commercial	$130.57
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.32
Rate for Payer: PHP Commercial	$123.32
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$91.40
Rate for Payer: UHC Core	$107.36
Rate for Payer: UHC Exchange	$107.36

HC NVU OBSERVATION PER HOUR

Facility

$145.08

Service Code	HCPCS G0378
Hospital Charge Code	76200004
Hospital Revenue Code	762
Min. Negotiated Rate	$91.40
Max. Negotiated Rate	$130.57
Rate for Payer: Aetna Commercial	$123.32
Rate for Payer: Aetna New Business (MI Preferred)	$94.30
Rate for Payer: Cash Price	$116.06
Rate for Payer: Cofinity Commercial	$101.56
Rate for Payer: Cofinity Commercial	$124.77
Rate for Payer: Cofinity Medicare Advantage	$101.56
Rate for Payer: Encore Health Key Benefits Commercial	$116.06
Rate for Payer: Healthscope Commercial	$130.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.32
Rate for Payer: PHP Commercial	$123.32
Rate for Payer: Priority Health Cigna Priority Health	$94.30
Rate for Payer: Priority Health SBD	$91.40

HC OAK IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200050
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.53
Rate for Payer: Amish Plain Church Group Commercial	$6.53
Rate for Payer: BCBS Complete	$2.94
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Mclaren Medicaid	$2.80
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.48
Rate for Payer: Meridian Medicaid	$2.94
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$16.00
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$14.69
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Medicare Advantage	$5.22
Rate for Payer: UHCCP Medicaid	$2.94
Rate for Payer: VA VA	$5.22

HC OAK IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200050
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health SBD	$16.00

HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM

Facility

$54.19

Service Code	HCPCS Q4124
Hospital Charge Code	63600059
Hospital Revenue Code	636
Min. Negotiated Rate	$34.14
Max. Negotiated Rate	$48.77
Rate for Payer: Aetna Commercial	$46.06
Rate for Payer: Aetna New Business (MI Preferred)	$35.22
Rate for Payer: Cash Price	$43.35
Rate for Payer: Cofinity Commercial	$37.93
Rate for Payer: Cofinity Commercial	$46.60
Rate for Payer: Cofinity Medicare Advantage	$37.93
Rate for Payer: Encore Health Key Benefits Commercial	$43.35
Rate for Payer: Healthscope Commercial	$48.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.06
Rate for Payer: PHP Commercial	$46.06
Rate for Payer: Priority Health Cigna Priority Health	$35.22
Rate for Payer: Priority Health SBD	$34.14

HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM

Facility

$54.19

Service Code	HCPCS Q4124
Hospital Charge Code	63600059
Hospital Revenue Code	636
Min. Negotiated Rate	$21.68
Max. Negotiated Rate	$48.77
Rate for Payer: Aetna Commercial	$46.06
Rate for Payer: Aetna Medicare	$27.09
Rate for Payer: Aetna New Business (MI Preferred)	$35.22
Rate for Payer: BCBS Complete	$21.68
Rate for Payer: Cash Price	$43.35
Rate for Payer: Cofinity Commercial	$37.93
Rate for Payer: Cofinity Commercial	$46.60
Rate for Payer: Cofinity Medicare Advantage	$37.93
Rate for Payer: Encore Health Key Benefits Commercial	$43.35
Rate for Payer: Healthscope Commercial	$48.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.06
Rate for Payer: PHP Commercial	$46.06
Rate for Payer: Priority Health Cigna Priority Health	$35.22
Rate for Payer: Priority Health SBD	$34.14

Know your out-of-pocket cost for care.

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