Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OP VISIT LEVEL 2

Facility

$174.09

Service Code	CPT 99212
Hospital Charge Code	51000020
Hospital Revenue Code	761
Min. Negotiated Rate	$69.64
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: Cash Price	$139.27
Rate for Payer: Cofinity Commercial	$121.86
Rate for Payer: Cofinity Commercial	$149.72
Rate for Payer: Cofinity Medicare Advantage	$121.86
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: PHP Commercial	$147.98
Rate for Payer: Priority Health Cigna Priority Health	$113.16
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	$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 Commercial	$147.88
Rate for Payer: Cofinity Commercial	$181.68
Rate for Payer: Cofinity Medicare Advantage	$147.88
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: PHP Commercial	$179.56
Rate for Payer: Priority Health Cigna Priority Health	$137.31
Rate for Payer: Priority Health SBD	$133.09

HC OP VISIT LEVEL 3

Facility

$211.25

Service Code	CPT 99213
Hospital Charge Code	51000026
Hospital Revenue Code	761
Min. Negotiated Rate	$84.50
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: Cash Price	$169.00
Rate for Payer: Cofinity Commercial	$147.88
Rate for Payer: Cofinity Commercial	$181.68
Rate for Payer: Cofinity Medicare Advantage	$147.88
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: PHP Commercial	$179.56
Rate for Payer: Priority Health Cigna Priority Health	$137.31
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 Commercial	$212.36
Rate for Payer: Cofinity Commercial	$260.90
Rate for Payer: Cofinity Medicare Advantage	$212.36
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: PHP Commercial	$257.86
Rate for Payer: Priority Health Cigna Priority Health	$197.19
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	$121.35
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: Cash Price	$242.70
Rate for Payer: Cofinity Commercial	$212.36
Rate for Payer: Cofinity Commercial	$260.90
Rate for Payer: Cofinity Medicare Advantage	$212.36
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: PHP Commercial	$257.86
Rate for Payer: Priority Health Cigna Priority Health	$197.19
Rate for Payer: Priority Health SBD	$191.12

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 Commercial	$353.60
Rate for Payer: Cofinity Commercial	$434.42
Rate for Payer: Cofinity Medicare Advantage	$353.60
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: PHP Commercial	$429.37
Rate for Payer: Priority Health Cigna Priority Health	$328.34
Rate for Payer: Priority Health SBD	$318.24

HC OP VISIT LEVEL 5

Facility

$505.14

Service Code	CPT 99215
Hospital Charge Code	51000037
Hospital Revenue Code	761
Min. Negotiated Rate	$202.06
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: Cash Price	$404.11
Rate for Payer: Cofinity Commercial	$353.60
Rate for Payer: Cofinity Commercial	$434.42
Rate for Payer: Cofinity Medicare Advantage	$353.60
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: PHP Commercial	$429.37
Rate for Payer: Priority Health Cigna Priority Health	$328.34
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	$53.88
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: Cash Price	$107.77
Rate for Payer: Cofinity Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Cofinity Medicare Advantage	$94.30
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: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$87.56
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	$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 Commercial	$115.85
Rate for Payer: Cofinity Commercial	$94.30
Rate for Payer: Cofinity Medicare Advantage	$94.30
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: PHP Commercial	$114.50
Rate for Payer: Priority Health Cigna Priority Health	$87.56
Rate for Payer: Priority Health SBD	$84.87

HC ORCHARD GRASS IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200052
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 ORCHARD GRASS IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200052
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 ORGANIC ACIDS SCREEN URINE

Facility

$75.48

Service Code	CPT 83918
Hospital Charge Code	30100372
Hospital Revenue Code	301
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$67.93
Rate for Payer: Aetna Commercial	$64.16
Rate for Payer: Aetna Medicare	$24.54
Rate for Payer: Aetna New Business (MI Preferred)	$49.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$29.50
Rate for Payer: Amish Plain Church Group Commercial	$29.50
Rate for Payer: BCBS Complete	$13.28
Rate for Payer: BCBS MAPPO	$23.60
Rate for Payer: BCN Medicare Advantage	$23.60
Rate for Payer: Cash Price	$60.38
Rate for Payer: Cash Price	$60.38
Rate for Payer: Cofinity Commercial	$64.91
Rate for Payer: Cofinity Commercial	$52.84
Rate for Payer: Cofinity Medicare Advantage	$52.84
Rate for Payer: Encore Health Key Benefits Commercial	$60.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$23.60
Rate for Payer: Healthscope Commercial	$67.93
Rate for Payer: Mclaren Medicaid	$12.65
Rate for Payer: Mclaren Medicare	$23.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$24.78
Rate for Payer: Meridian Medicaid	$13.28
Rate for Payer: MI Amish Medical Board Commercial	$27.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$64.16
Rate for Payer: PACE Medicare	$22.42
Rate for Payer: PACE SWMI	$23.60
Rate for Payer: PHP Commercial	$64.16
Rate for Payer: PHP Medicare Advantage	$23.60
Rate for Payer: Priority Health Choice Medicaid	$12.65
Rate for Payer: Priority Health Cigna Priority Health	$49.06
Rate for Payer: Priority Health Medicare	$23.60
Rate for Payer: Priority Health SBD	$47.55
Rate for Payer: Railroad Medicare Medicare	$23.60
Rate for Payer: UHC All Payor (Choice/PPO)	$66.43
Rate for Payer: UHC Dual Complete DSNP	$23.60
Rate for Payer: UHC Medicare Advantage	$23.60
Rate for Payer: UHCCP Medicaid	$13.29
Rate for Payer: VA VA	$23.60

HC ORGANIC ACIDS SCREEN URINE

Facility

$75.48

Service Code	CPT 83918
Hospital Charge Code	30100372
Hospital Revenue Code	301
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$67.93
Rate for Payer: Aetna Commercial	$64.16
Rate for Payer: Aetna New Business (MI Preferred)	$49.06
Rate for Payer: Cash Price	$60.38
Rate for Payer: Cofinity Commercial	$52.84
Rate for Payer: Cofinity Commercial	$64.91
Rate for Payer: Cofinity Medicare Advantage	$52.84
Rate for Payer: Encore Health Key Benefits Commercial	$60.38
Rate for Payer: Healthscope Commercial	$67.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$64.16
Rate for Payer: PHP Commercial	$64.16
Rate for Payer: Priority Health Cigna Priority Health	$49.06
Rate for Payer: Priority Health SBD	$47.55

HC OR LEVEL 1 BASE CHARGE

Facility

$275.00

Hospital Charge Code	36000126
Hospital Revenue Code	360
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Cofinity Medicare Advantage	$192.50
Rate for Payer: Encore Health Key Benefits Commercial	$220.00
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$178.75
Rate for Payer: Priority Health SBD	$173.25

HC OR LEVEL 1 BASE CHARGE

Facility

$275.00

Hospital Charge Code	36000126
Hospital Revenue Code	360
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna Medicare	$137.50
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Cofinity Medicare Advantage	$192.50
Rate for Payer: Encore Health Key Benefits Commercial	$220.00
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$178.75
Rate for Payer: Priority Health SBD	$173.25

HC OR LEVEL 1 PER MINUTE

Facility

$60.00

Hospital Charge Code	36000127
Hospital Revenue Code	360
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Cofinity Medicare Advantage	$42.00
Rate for Payer: Encore Health Key Benefits Commercial	$48.00
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$39.00
Rate for Payer: Priority Health SBD	$37.80

HC OR LEVEL 1 PER MINUTE

Facility

$60.00

Hospital Charge Code	36000127
Hospital Revenue Code	360
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Cofinity Medicare Advantage	$42.00
Rate for Payer: Encore Health Key Benefits Commercial	$48.00
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$39.00
Rate for Payer: Priority Health SBD	$37.80

HC OR LEVEL 2 BASE CHARGE

Facility

$737.00

Hospital Charge Code	36000128
Hospital Revenue Code	360
Min. Negotiated Rate	$294.80
Max. Negotiated Rate	$663.30
Rate for Payer: Aetna Commercial	$626.45
Rate for Payer: Aetna Medicare	$368.50
Rate for Payer: Aetna New Business (MI Preferred)	$479.05
Rate for Payer: BCBS Complete	$294.80
Rate for Payer: Cash Price	$589.60
Rate for Payer: Cofinity Commercial	$515.90
Rate for Payer: Cofinity Commercial	$633.82
Rate for Payer: Cofinity Medicare Advantage	$515.90
Rate for Payer: Encore Health Key Benefits Commercial	$589.60
Rate for Payer: Healthscope Commercial	$663.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.45
Rate for Payer: PHP Commercial	$626.45
Rate for Payer: Priority Health Cigna Priority Health	$479.05
Rate for Payer: Priority Health SBD	$464.31

HC OR LEVEL 2 BASE CHARGE

Facility

$737.00

Hospital Charge Code	36000128
Hospital Revenue Code	360
Min. Negotiated Rate	$464.31
Max. Negotiated Rate	$663.30
Rate for Payer: Aetna Commercial	$626.45
Rate for Payer: Aetna New Business (MI Preferred)	$479.05
Rate for Payer: Cash Price	$589.60
Rate for Payer: Cofinity Commercial	$515.90
Rate for Payer: Cofinity Commercial	$633.82
Rate for Payer: Cofinity Medicare Advantage	$515.90
Rate for Payer: Encore Health Key Benefits Commercial	$589.60
Rate for Payer: Healthscope Commercial	$663.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.45
Rate for Payer: PHP Commercial	$626.45
Rate for Payer: Priority Health Cigna Priority Health	$479.05
Rate for Payer: Priority Health SBD	$464.31

HC OR LEVEL 2 PER MINUTE

Facility

$83.00

Hospital Charge Code	36000129
Hospital Revenue Code	360
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$70.55
Rate for Payer: Aetna Medicare	$41.50
Rate for Payer: Aetna New Business (MI Preferred)	$53.95
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$58.10
Rate for Payer: Cofinity Commercial	$71.38
Rate for Payer: Cofinity Medicare Advantage	$58.10
Rate for Payer: Encore Health Key Benefits Commercial	$66.40
Rate for Payer: Healthscope Commercial	$74.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.55
Rate for Payer: PHP Commercial	$70.55
Rate for Payer: Priority Health Cigna Priority Health	$53.95
Rate for Payer: Priority Health SBD	$52.29

HC OR LEVEL 2 PER MINUTE

Facility

$83.00

Hospital Charge Code	36000129
Hospital Revenue Code	360
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$70.55
Rate for Payer: Aetna New Business (MI Preferred)	$53.95
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$58.10
Rate for Payer: Cofinity Commercial	$71.38
Rate for Payer: Cofinity Medicare Advantage	$58.10
Rate for Payer: Encore Health Key Benefits Commercial	$66.40
Rate for Payer: Healthscope Commercial	$74.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.55
Rate for Payer: PHP Commercial	$70.55
Rate for Payer: Priority Health Cigna Priority Health	$53.95
Rate for Payer: Priority Health SBD	$52.29

HC OR LEVEL 3 BASE CHARGE

Facility

$857.00

Hospital Charge Code	36000130
Hospital Revenue Code	360
Min. Negotiated Rate	$342.80
Max. Negotiated Rate	$771.30
Rate for Payer: Aetna Commercial	$728.45
Rate for Payer: Aetna Medicare	$428.50
Rate for Payer: Aetna New Business (MI Preferred)	$557.05
Rate for Payer: BCBS Complete	$342.80
Rate for Payer: Cash Price	$685.60
Rate for Payer: Cofinity Commercial	$599.90
Rate for Payer: Cofinity Commercial	$737.02
Rate for Payer: Cofinity Medicare Advantage	$599.90
Rate for Payer: Encore Health Key Benefits Commercial	$685.60
Rate for Payer: Healthscope Commercial	$771.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$728.45
Rate for Payer: PHP Commercial	$728.45
Rate for Payer: Priority Health Cigna Priority Health	$557.05
Rate for Payer: Priority Health SBD	$539.91

HC OR LEVEL 3 BASE CHARGE

Facility

$857.00

Hospital Charge Code	36000130
Hospital Revenue Code	360
Min. Negotiated Rate	$539.91
Max. Negotiated Rate	$771.30
Rate for Payer: Aetna Commercial	$728.45
Rate for Payer: Aetna New Business (MI Preferred)	$557.05
Rate for Payer: Cash Price	$685.60
Rate for Payer: Cofinity Commercial	$599.90
Rate for Payer: Cofinity Commercial	$737.02
Rate for Payer: Cofinity Medicare Advantage	$599.90
Rate for Payer: Encore Health Key Benefits Commercial	$685.60
Rate for Payer: Healthscope Commercial	$771.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$728.45
Rate for Payer: PHP Commercial	$728.45
Rate for Payer: Priority Health Cigna Priority Health	$557.05
Rate for Payer: Priority Health SBD	$539.91

HC OR LEVEL 3 PER MINUTE

Facility

$99.00

Hospital Charge Code	36000131
Hospital Revenue Code	360
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna Commercial	$84.15
Rate for Payer: Aetna Medicare	$49.50
Rate for Payer: Aetna New Business (MI Preferred)	$64.35
Rate for Payer: BCBS Complete	$39.60
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cofinity Commercial	$69.30
Rate for Payer: Cofinity Commercial	$85.14
Rate for Payer: Cofinity Medicare Advantage	$69.30
Rate for Payer: Encore Health Key Benefits Commercial	$79.20
Rate for Payer: Healthscope Commercial	$89.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.15
Rate for Payer: PHP Commercial	$84.15
Rate for Payer: Priority Health Cigna Priority Health	$64.35
Rate for Payer: Priority Health SBD	$62.37

HC OR LEVEL 3 PER MINUTE

Facility

$99.00

Hospital Charge Code	36000131
Hospital Revenue Code	360
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna Commercial	$84.15
Rate for Payer: Aetna New Business (MI Preferred)	$64.35
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cofinity Commercial	$69.30
Rate for Payer: Cofinity Commercial	$85.14
Rate for Payer: Cofinity Medicare Advantage	$69.30
Rate for Payer: Encore Health Key Benefits Commercial	$79.20
Rate for Payer: Healthscope Commercial	$89.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.15
Rate for Payer: PHP Commercial	$84.15
Rate for Payer: Priority Health Cigna Priority Health	$64.35
Rate for Payer: Priority Health SBD	$62.37

Know your out-of-pocket cost for care.

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