Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OR LEVEL 4 BASE CHARGE

Facility

$1,226.00

Hospital Charge Code	36000132
Hospital Revenue Code	360
Min. Negotiated Rate	$772.38
Max. Negotiated Rate	$1,103.40
Rate for Payer: Aetna Commercial	$1,042.10
Rate for Payer: Aetna New Business (MI Preferred)	$796.90
Rate for Payer: Cash Price	$980.80
Rate for Payer: Cofinity Commercial	$1,054.36
Rate for Payer: Cofinity Commercial	$858.20
Rate for Payer: Cofinity Medicare Advantage	$858.20
Rate for Payer: Encore Health Key Benefits Commercial	$980.80
Rate for Payer: Healthscope Commercial	$1,103.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,042.10
Rate for Payer: PHP Commercial	$1,042.10
Rate for Payer: Priority Health Cigna Priority Health	$796.90
Rate for Payer: Priority Health SBD	$772.38

HC OR LEVEL 4 BASE CHARGE

Facility

$1,226.00

Hospital Charge Code	36000132
Hospital Revenue Code	360
Min. Negotiated Rate	$490.40
Max. Negotiated Rate	$1,103.40
Rate for Payer: Aetna Commercial	$1,042.10
Rate for Payer: Aetna Medicare	$613.00
Rate for Payer: Aetna New Business (MI Preferred)	$796.90
Rate for Payer: BCBS Complete	$490.40
Rate for Payer: Cash Price	$980.80
Rate for Payer: Cofinity Commercial	$1,054.36
Rate for Payer: Cofinity Commercial	$858.20
Rate for Payer: Cofinity Medicare Advantage	$858.20
Rate for Payer: Encore Health Key Benefits Commercial	$980.80
Rate for Payer: Healthscope Commercial	$1,103.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,042.10
Rate for Payer: PHP Commercial	$1,042.10
Rate for Payer: Priority Health Cigna Priority Health	$796.90
Rate for Payer: Priority Health SBD	$772.38

HC OR LEVEL 4 PER MINUTE

Facility

$111.00

Hospital Charge Code	36000133
Hospital Revenue Code	360
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna Commercial	$94.35
Rate for Payer: Aetna Medicare	$55.50
Rate for Payer: Aetna New Business (MI Preferred)	$72.15
Rate for Payer: BCBS Complete	$44.40
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cofinity Commercial	$77.70
Rate for Payer: Cofinity Commercial	$95.46
Rate for Payer: Cofinity Medicare Advantage	$77.70
Rate for Payer: Encore Health Key Benefits Commercial	$88.80
Rate for Payer: Healthscope Commercial	$99.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.35
Rate for Payer: PHP Commercial	$94.35
Rate for Payer: Priority Health Cigna Priority Health	$72.15
Rate for Payer: Priority Health SBD	$69.93

HC OR LEVEL 4 PER MINUTE

Facility

$111.00

Hospital Charge Code	36000133
Hospital Revenue Code	360
Min. Negotiated Rate	$69.93
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna Commercial	$94.35
Rate for Payer: Aetna New Business (MI Preferred)	$72.15
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cofinity Commercial	$77.70
Rate for Payer: Cofinity Commercial	$95.46
Rate for Payer: Cofinity Medicare Advantage	$77.70
Rate for Payer: Encore Health Key Benefits Commercial	$88.80
Rate for Payer: Healthscope Commercial	$99.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.35
Rate for Payer: PHP Commercial	$94.35
Rate for Payer: Priority Health Cigna Priority Health	$72.15
Rate for Payer: Priority Health SBD	$69.93

HC OR LEVEL 5 BASE CHARGE

Facility

$1,454.00

Hospital Charge Code	36000134
Hospital Revenue Code	360
Min. Negotiated Rate	$916.02
Max. Negotiated Rate	$1,308.60
Rate for Payer: Aetna Commercial	$1,235.90
Rate for Payer: Aetna New Business (MI Preferred)	$945.10
Rate for Payer: Cash Price	$1,163.20
Rate for Payer: Cofinity Commercial	$1,017.80
Rate for Payer: Cofinity Commercial	$1,250.44
Rate for Payer: Cofinity Medicare Advantage	$1,017.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,163.20
Rate for Payer: Healthscope Commercial	$1,308.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,235.90
Rate for Payer: PHP Commercial	$1,235.90
Rate for Payer: Priority Health Cigna Priority Health	$945.10
Rate for Payer: Priority Health SBD	$916.02

HC OR LEVEL 5 BASE CHARGE

Facility

$1,454.00

Hospital Charge Code	36000134
Hospital Revenue Code	360
Min. Negotiated Rate	$581.60
Max. Negotiated Rate	$1,308.60
Rate for Payer: Aetna Commercial	$1,235.90
Rate for Payer: Aetna Medicare	$727.00
Rate for Payer: Aetna New Business (MI Preferred)	$945.10
Rate for Payer: BCBS Complete	$581.60
Rate for Payer: Cash Price	$1,163.20
Rate for Payer: Cofinity Commercial	$1,017.80
Rate for Payer: Cofinity Commercial	$1,250.44
Rate for Payer: Cofinity Medicare Advantage	$1,017.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,163.20
Rate for Payer: Healthscope Commercial	$1,308.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,235.90
Rate for Payer: PHP Commercial	$1,235.90
Rate for Payer: Priority Health Cigna Priority Health	$945.10
Rate for Payer: Priority Health SBD	$916.02

HC OR LEVEL 5 PER MINUTE

Facility

$121.00

Hospital Charge Code	36000135
Hospital Revenue Code	360
Min. Negotiated Rate	$76.23
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna Commercial	$102.85
Rate for Payer: Aetna New Business (MI Preferred)	$78.65
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cofinity Commercial	$104.06
Rate for Payer: Cofinity Commercial	$84.70
Rate for Payer: Cofinity Medicare Advantage	$84.70
Rate for Payer: Encore Health Key Benefits Commercial	$96.80
Rate for Payer: Healthscope Commercial	$108.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.85
Rate for Payer: PHP Commercial	$102.85
Rate for Payer: Priority Health Cigna Priority Health	$78.65
Rate for Payer: Priority Health SBD	$76.23

HC OR LEVEL 5 PER MINUTE

Facility

$121.00

Hospital Charge Code	36000135
Hospital Revenue Code	360
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna Commercial	$102.85
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: Aetna New Business (MI Preferred)	$78.65
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cofinity Commercial	$104.06
Rate for Payer: Cofinity Commercial	$84.70
Rate for Payer: Cofinity Medicare Advantage	$84.70
Rate for Payer: Encore Health Key Benefits Commercial	$96.80
Rate for Payer: Healthscope Commercial	$108.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.85
Rate for Payer: PHP Commercial	$102.85
Rate for Payer: Priority Health Cigna Priority Health	$78.65
Rate for Payer: Priority Health SBD	$76.23

HC ORPHENADRINE INJECTION, PER 60MG

Facility

$30.17

Service Code	HCPCS J2360
Hospital Charge Code	63600143
Hospital Revenue Code	636
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$27.15
Rate for Payer: Aetna Commercial	$25.64
Rate for Payer: Aetna Medicare	$15.09
Rate for Payer: Aetna New Business (MI Preferred)	$19.61
Rate for Payer: BCBS Complete	$12.07
Rate for Payer: Cash Price	$24.14
Rate for Payer: Cofinity Commercial	$21.12
Rate for Payer: Cofinity Commercial	$25.95
Rate for Payer: Cofinity Medicare Advantage	$21.12
Rate for Payer: Encore Health Key Benefits Commercial	$24.14
Rate for Payer: Healthscope Commercial	$27.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.64
Rate for Payer: PHP Commercial	$25.64
Rate for Payer: Priority Health Cigna Priority Health	$19.61
Rate for Payer: Priority Health SBD	$19.01

HC ORPHENADRINE INJECTION, PER 60MG

Facility

$30.17

Service Code	HCPCS J2360
Hospital Charge Code	63600143
Hospital Revenue Code	636
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$27.15
Rate for Payer: Aetna Commercial	$25.64
Rate for Payer: Aetna New Business (MI Preferred)	$19.61
Rate for Payer: Cash Price	$24.14
Rate for Payer: Cofinity Commercial	$21.12
Rate for Payer: Cofinity Commercial	$25.95
Rate for Payer: Cofinity Medicare Advantage	$21.12
Rate for Payer: Encore Health Key Benefits Commercial	$24.14
Rate for Payer: Healthscope Commercial	$27.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.64
Rate for Payer: PHP Commercial	$25.64
Rate for Payer: Priority Health Cigna Priority Health	$19.61
Rate for Payer: Priority Health SBD	$19.01

HC ORTHOPOX (AKA MONKEY)

Facility

$123.27

Service Code	CPT 87593
Hospital Charge Code	30600334
Hospital Revenue Code	306
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$144.43
Rate for Payer: Aetna Commercial	$104.78
Rate for Payer: Aetna Medicare	$53.36
Rate for Payer: Aetna New Business (MI Preferred)	$80.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$64.14
Rate for Payer: Amish Plain Church Group Commercial	$64.14
Rate for Payer: BCBS Complete	$28.88
Rate for Payer: BCBS MAPPO	$51.31
Rate for Payer: BCN Medicare Advantage	$51.31
Rate for Payer: Cash Price	$98.62
Rate for Payer: Cash Price	$98.62
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Cofinity Commercial	$106.01
Rate for Payer: Cofinity Medicare Advantage	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$98.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.31
Rate for Payer: Healthscope Commercial	$110.94
Rate for Payer: Mclaren Medicaid	$27.50
Rate for Payer: Mclaren Medicare	$51.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$53.88
Rate for Payer: Meridian Medicaid	$28.88
Rate for Payer: MI Amish Medical Board Commercial	$59.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$104.78
Rate for Payer: PACE Medicare	$48.74
Rate for Payer: PACE SWMI	$51.31
Rate for Payer: PHP Commercial	$104.78
Rate for Payer: PHP Medicare Advantage	$51.31
Rate for Payer: Priority Health Choice Medicaid	$27.50
Rate for Payer: Priority Health Cigna Priority Health	$80.13
Rate for Payer: Priority Health Medicare	$51.31
Rate for Payer: Priority Health SBD	$77.66
Rate for Payer: Railroad Medicare Medicare	$51.31
Rate for Payer: UHC All Payor (Choice/PPO)	$144.43
Rate for Payer: UHC Dual Complete DSNP	$51.31
Rate for Payer: UHC Medicare Advantage	$51.31
Rate for Payer: UHCCP Medicaid	$28.89
Rate for Payer: VA VA	$51.31

HC ORTHOPOX (AKA MONKEY)

Facility

$123.27

Service Code	CPT 87593
Hospital Charge Code	30600334
Hospital Revenue Code	306
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$110.94
Rate for Payer: Aetna Commercial	$104.78
Rate for Payer: Aetna New Business (MI Preferred)	$80.13
Rate for Payer: Cash Price	$98.62
Rate for Payer: Cofinity Commercial	$106.01
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Cofinity Medicare Advantage	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$98.62
Rate for Payer: Healthscope Commercial	$110.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$104.78
Rate for Payer: PHP Commercial	$104.78
Rate for Payer: Priority Health Cigna Priority Health	$80.13
Rate for Payer: Priority Health SBD	$77.66

HC ORTHOPOX DNA, PCR

Facility

$76.50

Service Code	CPT 87593
Hospital Charge Code	30600332
Hospital Revenue Code	306
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$144.43
Rate for Payer: Aetna Commercial	$65.03
Rate for Payer: Aetna Medicare	$53.36
Rate for Payer: Aetna New Business (MI Preferred)	$49.73
Rate for Payer: Allen County Amish Medical Aid Commercial	$64.14
Rate for Payer: Amish Plain Church Group Commercial	$64.14
Rate for Payer: BCBS Complete	$28.88
Rate for Payer: BCBS MAPPO	$51.31
Rate for Payer: BCN Medicare Advantage	$51.31
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Medicare Advantage	$53.55
Rate for Payer: Encore Health Key Benefits Commercial	$61.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.31
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$27.50
Rate for Payer: Mclaren Medicare	$51.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$53.88
Rate for Payer: Meridian Medicaid	$28.88
Rate for Payer: MI Amish Medical Board Commercial	$59.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.03
Rate for Payer: PACE Medicare	$48.74
Rate for Payer: PACE SWMI	$51.31
Rate for Payer: PHP Commercial	$65.03
Rate for Payer: PHP Medicare Advantage	$51.31
Rate for Payer: Priority Health Choice Medicaid	$27.50
Rate for Payer: Priority Health Cigna Priority Health	$49.73
Rate for Payer: Priority Health Medicare	$51.31
Rate for Payer: Priority Health SBD	$48.20
Rate for Payer: Railroad Medicare Medicare	$51.31
Rate for Payer: UHC All Payor (Choice/PPO)	$144.43
Rate for Payer: UHC Dual Complete DSNP	$51.31
Rate for Payer: UHC Medicare Advantage	$51.31
Rate for Payer: UHCCP Medicaid	$28.89
Rate for Payer: VA VA	$51.31

HC ORTHOPOX DNA, PCR

Facility

$76.50

Service Code	CPT 87593
Hospital Charge Code	30600332
Hospital Revenue Code	306
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.03
Rate for Payer: Aetna New Business (MI Preferred)	$49.73
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Cofinity Medicare Advantage	$53.55
Rate for Payer: Encore Health Key Benefits Commercial	$61.20
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.03
Rate for Payer: PHP Commercial	$65.03
Rate for Payer: Priority Health Cigna Priority Health	$49.73
Rate for Payer: Priority Health SBD	$48.20

HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN

Facility

$129.45

Service Code	CPT 97763
Hospital Charge Code	42000056
Hospital Revenue Code	420
Min. Negotiated Rate	$51.78
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$110.03
Rate for Payer: Aetna Medicare	$64.72
Rate for Payer: Aetna New Business (MI Preferred)	$84.14
Rate for Payer: BCBS Complete	$51.78
Rate for Payer: Cash Price	$103.56
Rate for Payer: Cash Price	$103.56
Rate for Payer: Cofinity Commercial	$90.61
Rate for Payer: Cofinity Commercial	$111.33
Rate for Payer: Cofinity Medicare Advantage	$90.61
Rate for Payer: Encore Health Key Benefits Commercial	$103.56
Rate for Payer: Healthscope Commercial	$116.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.03
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$110.03
Rate for Payer: Priority Health Cigna Priority Health	$84.14
Rate for Payer: Priority Health SBD	$81.55
Rate for Payer: UHC Core	$95.79
Rate for Payer: UHC Exchange	$95.79

HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN

Facility

$129.45

Service Code	CPT 97763
Hospital Charge Code	42000056
Hospital Revenue Code	420
Min. Negotiated Rate	$81.55
Max. Negotiated Rate	$116.50
Rate for Payer: Aetna Commercial	$110.03
Rate for Payer: Aetna New Business (MI Preferred)	$84.14
Rate for Payer: Cash Price	$103.56
Rate for Payer: Cofinity Commercial	$111.33
Rate for Payer: Cofinity Commercial	$90.61
Rate for Payer: Cofinity Medicare Advantage	$90.61
Rate for Payer: Encore Health Key Benefits Commercial	$103.56
Rate for Payer: Healthscope Commercial	$116.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.03
Rate for Payer: PHP Commercial	$110.03
Rate for Payer: Priority Health Cigna Priority Health	$84.14
Rate for Payer: Priority Health SBD	$81.55

HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN

Facility

$125.37

Service Code	CPT 97760
Hospital Charge Code	42000039
Hospital Revenue Code	420
Min. Negotiated Rate	$78.98
Max. Negotiated Rate	$112.83
Rate for Payer: Aetna Commercial	$106.56
Rate for Payer: Aetna New Business (MI Preferred)	$81.49
Rate for Payer: Cash Price	$100.30
Rate for Payer: Cofinity Commercial	$107.82
Rate for Payer: Cofinity Commercial	$87.76
Rate for Payer: Cofinity Medicare Advantage	$87.76
Rate for Payer: Encore Health Key Benefits Commercial	$100.30
Rate for Payer: Healthscope Commercial	$112.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.56
Rate for Payer: PHP Commercial	$106.56
Rate for Payer: Priority Health Cigna Priority Health	$81.49
Rate for Payer: Priority Health SBD	$78.98

HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN

Facility

$125.37

Service Code	CPT 97760
Hospital Charge Code	42000039
Hospital Revenue Code	420
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$106.56
Rate for Payer: Aetna Medicare	$62.69
Rate for Payer: Aetna New Business (MI Preferred)	$81.49
Rate for Payer: BCBS Complete	$50.15
Rate for Payer: Cash Price	$100.30
Rate for Payer: Cash Price	$100.30
Rate for Payer: Cofinity Commercial	$87.76
Rate for Payer: Cofinity Commercial	$107.82
Rate for Payer: Cofinity Medicare Advantage	$87.76
Rate for Payer: Encore Health Key Benefits Commercial	$100.30
Rate for Payer: Healthscope Commercial	$112.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.56
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$106.56
Rate for Payer: Priority Health Cigna Priority Health	$81.49
Rate for Payer: Priority Health SBD	$78.98
Rate for Payer: UHC Core	$92.77
Rate for Payer: UHC Exchange	$92.77

HC OSCILLATOR INIT DAY

Facility

$2,410.38

Service Code	CPT 94002
Hospital Charge Code	41000039
Hospital Revenue Code	410
Min. Negotiated Rate	$345.59
Max. Negotiated Rate	$2,169.34
Rate for Payer: Aetna Commercial	$2,048.82
Rate for Payer: Aetna Medicare	$670.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,566.75
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	$1,928.30
Rate for Payer: Cash Price	$1,928.30
Rate for Payer: Cofinity Commercial	$2,072.93
Rate for Payer: Cofinity Commercial	$1,687.27
Rate for Payer: Cofinity Medicare Advantage	$1,687.27
Rate for Payer: Encore Health Key Benefits Commercial	$1,928.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$644.76
Rate for Payer: Healthscope Commercial	$2,169.34
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	$2,048.82
Rate for Payer: PACE Medicare	$612.52
Rate for Payer: PACE SWMI	$644.76
Rate for Payer: PHP Commercial	$2,048.82
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	$1,566.75
Rate for Payer: Priority Health Medicare	$644.76
Rate for Payer: Priority Health SBD	$1,518.54
Rate for Payer: Railroad Medicare Medicare	$644.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1,814.93
Rate for Payer: UHC Core	$1,783.68
Rate for Payer: UHC Dual Complete DSNP	$644.76
Rate for Payer: UHC Exchange	$1,783.68
Rate for Payer: UHC Medicare Advantage	$644.76
Rate for Payer: UHCCP Medicaid	$363.00
Rate for Payer: VA VA	$644.76

HC OSCILLATOR INIT DAY

Facility

$2,410.38

Service Code	CPT 94002
Hospital Charge Code	41000039
Hospital Revenue Code	410
Min. Negotiated Rate	$1,518.54
Max. Negotiated Rate	$2,169.34
Rate for Payer: Aetna Commercial	$2,048.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,566.75
Rate for Payer: Cash Price	$1,928.30
Rate for Payer: Cofinity Commercial	$1,687.27
Rate for Payer: Cofinity Commercial	$2,072.93
Rate for Payer: Cofinity Medicare Advantage	$1,687.27
Rate for Payer: Encore Health Key Benefits Commercial	$1,928.30
Rate for Payer: Healthscope Commercial	$2,169.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,048.82
Rate for Payer: PHP Commercial	$2,048.82
Rate for Payer: Priority Health Cigna Priority Health	$1,566.75
Rate for Payer: Priority Health SBD	$1,518.54

HC OSCILLATOR SUB DAY

Facility

$1,348.28

Service Code	CPT 94003
Hospital Charge Code	41000040
Hospital Revenue Code	410
Min. Negotiated Rate	$849.42
Max. Negotiated Rate	$1,213.45
Rate for Payer: Aetna Commercial	$1,146.04
Rate for Payer: Aetna New Business (MI Preferred)	$876.38
Rate for Payer: Cash Price	$1,078.62
Rate for Payer: Cofinity Commercial	$1,159.52
Rate for Payer: Cofinity Commercial	$943.80
Rate for Payer: Cofinity Medicare Advantage	$943.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,078.62
Rate for Payer: Healthscope Commercial	$1,213.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,146.04
Rate for Payer: PHP Commercial	$1,146.04
Rate for Payer: Priority Health Cigna Priority Health	$876.38
Rate for Payer: Priority Health SBD	$849.42

HC OSCILLATOR SUB DAY

Facility

$1,348.28

Service Code	CPT 94003
Hospital Charge Code	41000040
Hospital Revenue Code	410
Min. Negotiated Rate	$345.59
Max. Negotiated Rate	$1,814.93
Rate for Payer: Aetna Commercial	$1,146.04
Rate for Payer: Aetna Medicare	$670.55
Rate for Payer: Aetna New Business (MI Preferred)	$876.38
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	$1,078.62
Rate for Payer: Cash Price	$1,078.62
Rate for Payer: Cofinity Commercial	$943.80
Rate for Payer: Cofinity Commercial	$1,159.52
Rate for Payer: Cofinity Medicare Advantage	$943.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,078.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$644.76
Rate for Payer: Healthscope Commercial	$1,213.45
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	$1,146.04
Rate for Payer: PACE Medicare	$612.52
Rate for Payer: PACE SWMI	$644.76
Rate for Payer: PHP Commercial	$1,146.04
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	$876.38
Rate for Payer: Priority Health Medicare	$644.76
Rate for Payer: Priority Health SBD	$849.42
Rate for Payer: Railroad Medicare Medicare	$644.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1,814.93
Rate for Payer: UHC Core	$997.73
Rate for Payer: UHC Dual Complete DSNP	$644.76
Rate for Payer: UHC Exchange	$997.73
Rate for Payer: UHC Medicare Advantage	$644.76
Rate for Payer: UHCCP Medicaid	$363.00
Rate for Payer: VA VA	$644.76

HC OSMOLALITY SERUM

Facility

$54.94

Service Code	CPT 83930
Hospital Charge Code	30100378
Hospital Revenue Code	301
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$49.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna New Business (MI Preferred)	$35.71
Rate for Payer: Cash Price	$43.95
Rate for Payer: Cofinity Commercial	$38.46
Rate for Payer: Cofinity Commercial	$47.25
Rate for Payer: Cofinity Medicare Advantage	$38.46
Rate for Payer: Encore Health Key Benefits Commercial	$43.95
Rate for Payer: Healthscope Commercial	$49.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.70
Rate for Payer: PHP Commercial	$46.70
Rate for Payer: Priority Health Cigna Priority Health	$35.71
Rate for Payer: Priority Health SBD	$34.61

HC OSMOLALITY SERUM

Facility

$54.94

Service Code	CPT 83930
Hospital Charge Code	30100378
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$49.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare	$6.87
Rate for Payer: Aetna New Business (MI Preferred)	$35.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$8.26
Rate for Payer: Amish Plain Church Group Commercial	$8.26
Rate for Payer: BCBS Complete	$3.72
Rate for Payer: BCBS MAPPO	$6.61
Rate for Payer: BCN Medicare Advantage	$6.61
Rate for Payer: Cash Price	$43.95
Rate for Payer: Cash Price	$43.95
Rate for Payer: Cofinity Commercial	$47.25
Rate for Payer: Cofinity Commercial	$38.46
Rate for Payer: Cofinity Medicare Advantage	$38.46
Rate for Payer: Encore Health Key Benefits Commercial	$43.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.61
Rate for Payer: Healthscope Commercial	$49.45
Rate for Payer: Mclaren Medicaid	$3.54
Rate for Payer: Mclaren Medicare	$6.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6.94
Rate for Payer: Meridian Medicaid	$3.72
Rate for Payer: MI Amish Medical Board Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.70
Rate for Payer: PACE Medicare	$6.28
Rate for Payer: PACE SWMI	$6.61
Rate for Payer: PHP Commercial	$46.70
Rate for Payer: PHP Medicare Advantage	$6.61
Rate for Payer: Priority Health Choice Medicaid	$3.54
Rate for Payer: Priority Health Cigna Priority Health	$35.71
Rate for Payer: Priority Health Medicare	$6.61
Rate for Payer: Priority Health SBD	$34.61
Rate for Payer: Railroad Medicare Medicare	$6.61
Rate for Payer: UHC All Payor (Choice/PPO)	$18.61
Rate for Payer: UHC Dual Complete DSNP	$6.61
Rate for Payer: UHC Medicare Advantage	$6.61
Rate for Payer: UHCCP Medicaid	$3.72
Rate for Payer: VA VA	$6.61

HC OSMOLALITY URINE

Facility

$53.86

Service Code	CPT 83935
Hospital Charge Code	30100379
Hospital Revenue Code	301
Min. Negotiated Rate	$33.93
Max. Negotiated Rate	$48.47
Rate for Payer: Aetna Commercial	$45.78
Rate for Payer: Aetna New Business (MI Preferred)	$35.01
Rate for Payer: Cash Price	$43.09
Rate for Payer: Cofinity Commercial	$37.70
Rate for Payer: Cofinity Commercial	$46.32
Rate for Payer: Cofinity Medicare Advantage	$37.70
Rate for Payer: Encore Health Key Benefits Commercial	$43.09
Rate for Payer: Healthscope Commercial	$48.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.78
Rate for Payer: PHP Commercial	$45.78
Rate for Payer: Priority Health Cigna Priority Health	$35.01
Rate for Payer: Priority Health SBD	$33.93

Know your out-of-pocket cost for care.

All Charges