Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PET SKULL-MIDTHIGH

Facility

$4,863.36

Service Code	CPT 78812
Hospital Charge Code	40400009
Hospital Revenue Code	404
Min. Negotiated Rate	$762.48
Max. Negotiated Rate	$4,377.02
Rate for Payer: Aetna Commercial	$4,133.86
Rate for Payer: Aetna Medicare	$1,479.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,161.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,778.16
Rate for Payer: Amish Plain Church Group Commercial	$1,778.16
Rate for Payer: BCBS Complete	$800.60
Rate for Payer: BCBS MAPPO	$1,422.53
Rate for Payer: BCN Medicare Advantage	$1,422.53
Rate for Payer: Cash Price	$3,890.69
Rate for Payer: Cash Price	$3,890.69
Rate for Payer: Cofinity Commercial	$4,182.49
Rate for Payer: Cofinity Commercial	$3,404.35
Rate for Payer: Cofinity Medicare Advantage	$3,404.35
Rate for Payer: Encore Health Key Benefits Commercial	$3,890.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,422.53
Rate for Payer: Healthscope Commercial	$4,377.02
Rate for Payer: Mclaren Medicaid	$762.48
Rate for Payer: Mclaren Medicare	$1,422.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,493.66
Rate for Payer: Meridian Medicaid	$800.60
Rate for Payer: MI Amish Medical Board Commercial	$1,635.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,133.86
Rate for Payer: PACE Medicare	$1,351.40
Rate for Payer: PACE SWMI	$1,422.53
Rate for Payer: PHP Commercial	$4,133.86
Rate for Payer: PHP Medicare Advantage	$1,422.53
Rate for Payer: Priority Health Choice Medicaid	$762.48
Rate for Payer: Priority Health Cigna Priority Health	$3,161.18
Rate for Payer: Priority Health Medicare	$1,422.53
Rate for Payer: Priority Health SBD	$3,063.92
Rate for Payer: Railroad Medicare Medicare	$1,422.53
Rate for Payer: UHC All Payor (Choice/PPO)	$4,004.28
Rate for Payer: UHC Core	$3,598.89
Rate for Payer: UHC Dual Complete DSNP	$1,422.53
Rate for Payer: UHC Exchange	$3,598.89
Rate for Payer: UHC Medicare Advantage	$1,422.53
Rate for Payer: UHCCP Medicaid	$800.88
Rate for Payer: VA VA	$1,422.53

HC PET SKULL-MIDTHIGH

Facility

$4,863.36

Service Code	CPT 78812
Hospital Charge Code	40400009
Hospital Revenue Code	404
Min. Negotiated Rate	$3,063.92
Max. Negotiated Rate	$4,377.02
Rate for Payer: Aetna Commercial	$4,133.86
Rate for Payer: Aetna New Business (MI Preferred)	$3,161.18
Rate for Payer: Cash Price	$3,890.69
Rate for Payer: Cofinity Commercial	$3,404.35
Rate for Payer: Cofinity Commercial	$4,182.49
Rate for Payer: Cofinity Medicare Advantage	$3,404.35
Rate for Payer: Encore Health Key Benefits Commercial	$3,890.69
Rate for Payer: Healthscope Commercial	$4,377.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,133.86
Rate for Payer: PHP Commercial	$4,133.86
Rate for Payer: Priority Health Cigna Priority Health	$3,161.18
Rate for Payer: Priority Health SBD	$3,063.92

HC PET TUMOR SKULL TO THIGH

Facility

$4,328.06

Service Code	CPT 78815
Hospital Charge Code	40400004
Hospital Revenue Code	404
Min. Negotiated Rate	$2,726.68
Max. Negotiated Rate	$3,895.25
Rate for Payer: Aetna Commercial	$3,678.85
Rate for Payer: Aetna New Business (MI Preferred)	$2,813.24
Rate for Payer: Cash Price	$3,462.45
Rate for Payer: Cofinity Commercial	$3,029.64
Rate for Payer: Cofinity Commercial	$3,722.13
Rate for Payer: Cofinity Medicare Advantage	$3,029.64
Rate for Payer: Encore Health Key Benefits Commercial	$3,462.45
Rate for Payer: Healthscope Commercial	$3,895.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,678.85
Rate for Payer: PHP Commercial	$3,678.85
Rate for Payer: Priority Health Cigna Priority Health	$2,813.24
Rate for Payer: Priority Health SBD	$2,726.68

HC PET TUMOR SKULL TO THIGH

Facility

$4,328.06

Service Code	CPT 78815
Hospital Charge Code	40400004
Hospital Revenue Code	404
Min. Negotiated Rate	$762.48
Max. Negotiated Rate	$4,004.28
Rate for Payer: Aetna Commercial	$3,678.85
Rate for Payer: Aetna Medicare	$1,479.43
Rate for Payer: Aetna New Business (MI Preferred)	$2,813.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,778.16
Rate for Payer: Amish Plain Church Group Commercial	$1,778.16
Rate for Payer: BCBS Complete	$800.60
Rate for Payer: BCBS MAPPO	$1,422.53
Rate for Payer: BCN Medicare Advantage	$1,422.53
Rate for Payer: Cash Price	$3,462.45
Rate for Payer: Cash Price	$3,462.45
Rate for Payer: Cofinity Commercial	$3,722.13
Rate for Payer: Cofinity Commercial	$3,029.64
Rate for Payer: Cofinity Medicare Advantage	$3,029.64
Rate for Payer: Encore Health Key Benefits Commercial	$3,462.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,422.53
Rate for Payer: Healthscope Commercial	$3,895.25
Rate for Payer: Mclaren Medicaid	$762.48
Rate for Payer: Mclaren Medicare	$1,422.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,493.66
Rate for Payer: Meridian Medicaid	$800.60
Rate for Payer: MI Amish Medical Board Commercial	$1,635.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,678.85
Rate for Payer: PACE Medicare	$1,351.40
Rate for Payer: PACE SWMI	$1,422.53
Rate for Payer: PHP Commercial	$3,678.85
Rate for Payer: PHP Medicare Advantage	$1,422.53
Rate for Payer: Priority Health Choice Medicaid	$762.48
Rate for Payer: Priority Health Cigna Priority Health	$2,813.24
Rate for Payer: Priority Health Medicare	$1,422.53
Rate for Payer: Priority Health SBD	$2,726.68
Rate for Payer: Railroad Medicare Medicare	$1,422.53
Rate for Payer: UHC All Payor (Choice/PPO)	$4,004.28
Rate for Payer: UHC Core	$3,202.76
Rate for Payer: UHC Dual Complete DSNP	$1,422.53
Rate for Payer: UHC Exchange	$3,202.76
Rate for Payer: UHC Medicare Advantage	$1,422.53
Rate for Payer: UHCCP Medicaid	$800.88
Rate for Payer: VA VA	$1,422.53

HC PET WHOLE BODY

Facility

$5,702.43

Service Code	CPT 78813
Hospital Charge Code	40400011
Hospital Revenue Code	404
Min. Negotiated Rate	$3,592.53
Max. Negotiated Rate	$5,132.19
Rate for Payer: Aetna Commercial	$4,847.07
Rate for Payer: Aetna New Business (MI Preferred)	$3,706.58
Rate for Payer: Cash Price	$4,561.94
Rate for Payer: Cofinity Commercial	$3,991.70
Rate for Payer: Cofinity Commercial	$4,904.09
Rate for Payer: Cofinity Medicare Advantage	$3,991.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,561.94
Rate for Payer: Healthscope Commercial	$5,132.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,847.07
Rate for Payer: PHP Commercial	$4,847.07
Rate for Payer: Priority Health Cigna Priority Health	$3,706.58
Rate for Payer: Priority Health SBD	$3,592.53

HC PET WHOLE BODY

Facility

$5,702.43

Service Code	CPT 78813
Hospital Charge Code	40400011
Hospital Revenue Code	404
Min. Negotiated Rate	$762.48
Max. Negotiated Rate	$5,132.19
Rate for Payer: Aetna Commercial	$4,847.07
Rate for Payer: Aetna Medicare	$1,479.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,706.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,778.16
Rate for Payer: Amish Plain Church Group Commercial	$1,778.16
Rate for Payer: BCBS Complete	$800.60
Rate for Payer: BCBS MAPPO	$1,422.53
Rate for Payer: BCN Medicare Advantage	$1,422.53
Rate for Payer: Cash Price	$4,561.94
Rate for Payer: Cash Price	$4,561.94
Rate for Payer: Cofinity Commercial	$4,904.09
Rate for Payer: Cofinity Commercial	$3,991.70
Rate for Payer: Cofinity Medicare Advantage	$3,991.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,561.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,422.53
Rate for Payer: Healthscope Commercial	$5,132.19
Rate for Payer: Mclaren Medicaid	$762.48
Rate for Payer: Mclaren Medicare	$1,422.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,493.66
Rate for Payer: Meridian Medicaid	$800.60
Rate for Payer: MI Amish Medical Board Commercial	$1,635.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,847.07
Rate for Payer: PACE Medicare	$1,351.40
Rate for Payer: PACE SWMI	$1,422.53
Rate for Payer: PHP Commercial	$4,847.07
Rate for Payer: PHP Medicare Advantage	$1,422.53
Rate for Payer: Priority Health Choice Medicaid	$762.48
Rate for Payer: Priority Health Cigna Priority Health	$3,706.58
Rate for Payer: Priority Health Medicare	$1,422.53
Rate for Payer: Priority Health SBD	$3,592.53
Rate for Payer: Railroad Medicare Medicare	$1,422.53
Rate for Payer: UHC All Payor (Choice/PPO)	$4,004.28
Rate for Payer: UHC Core	$4,219.80
Rate for Payer: UHC Dual Complete DSNP	$1,422.53
Rate for Payer: UHC Exchange	$4,219.80
Rate for Payer: UHC Medicare Advantage	$1,422.53
Rate for Payer: UHCCP Medicaid	$800.88
Rate for Payer: VA VA	$1,422.53

HC PET WMC CT WHOLE BODY

Facility

$7,236.90

Service Code	CPT 78816
Hospital Charge Code	40400008
Hospital Revenue Code	404
Min. Negotiated Rate	$4,559.25
Max. Negotiated Rate	$6,513.21
Rate for Payer: Aetna Commercial	$6,151.36
Rate for Payer: Aetna New Business (MI Preferred)	$4,703.98
Rate for Payer: Cash Price	$5,789.52
Rate for Payer: Cofinity Commercial	$5,065.83
Rate for Payer: Cofinity Commercial	$6,223.73
Rate for Payer: Cofinity Medicare Advantage	$5,065.83
Rate for Payer: Encore Health Key Benefits Commercial	$5,789.52
Rate for Payer: Healthscope Commercial	$6,513.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,151.36
Rate for Payer: PHP Commercial	$6,151.36
Rate for Payer: Priority Health Cigna Priority Health	$4,703.98
Rate for Payer: Priority Health SBD	$4,559.25

HC PET WMC CT WHOLE BODY

Facility

$7,236.90

Service Code	CPT 78816
Hospital Charge Code	40400008
Hospital Revenue Code	404
Min. Negotiated Rate	$762.48
Max. Negotiated Rate	$6,513.21
Rate for Payer: Aetna Commercial	$6,151.36
Rate for Payer: Aetna Medicare	$1,479.43
Rate for Payer: Aetna New Business (MI Preferred)	$4,703.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,778.16
Rate for Payer: Amish Plain Church Group Commercial	$1,778.16
Rate for Payer: BCBS Complete	$800.60
Rate for Payer: BCBS MAPPO	$1,422.53
Rate for Payer: BCN Medicare Advantage	$1,422.53
Rate for Payer: Cash Price	$5,789.52
Rate for Payer: Cash Price	$5,789.52
Rate for Payer: Cofinity Commercial	$6,223.73
Rate for Payer: Cofinity Commercial	$5,065.83
Rate for Payer: Cofinity Medicare Advantage	$5,065.83
Rate for Payer: Encore Health Key Benefits Commercial	$5,789.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,422.53
Rate for Payer: Healthscope Commercial	$6,513.21
Rate for Payer: Mclaren Medicaid	$762.48
Rate for Payer: Mclaren Medicare	$1,422.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,493.66
Rate for Payer: Meridian Medicaid	$800.60
Rate for Payer: MI Amish Medical Board Commercial	$1,635.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,151.36
Rate for Payer: PACE Medicare	$1,351.40
Rate for Payer: PACE SWMI	$1,422.53
Rate for Payer: PHP Commercial	$6,151.36
Rate for Payer: PHP Medicare Advantage	$1,422.53
Rate for Payer: Priority Health Choice Medicaid	$762.48
Rate for Payer: Priority Health Cigna Priority Health	$4,703.98
Rate for Payer: Priority Health Medicare	$1,422.53
Rate for Payer: Priority Health SBD	$4,559.25
Rate for Payer: Railroad Medicare Medicare	$1,422.53
Rate for Payer: UHC All Payor (Choice/PPO)	$4,004.28
Rate for Payer: UHC Core	$5,355.31
Rate for Payer: UHC Dual Complete DSNP	$1,422.53
Rate for Payer: UHC Exchange	$5,355.31
Rate for Payer: UHC Medicare Advantage	$1,422.53
Rate for Payer: UHCCP Medicaid	$800.88
Rate for Payer: VA VA	$1,422.53

HC PFO

Facility

$27,024.06

Service Code	CPT 93580
Hospital Charge Code	48100111
Hospital Revenue Code	481
Min. Negotiated Rate	$9,386.88
Max. Negotiated Rate	$49,296.87
Rate for Payer: Aetna Commercial	$22,970.45
Rate for Payer: Aetna Medicare	$18,213.34
Rate for Payer: Aetna New Business (MI Preferred)	$17,565.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,891.04
Rate for Payer: Amish Plain Church Group Commercial	$21,891.04
Rate for Payer: BCBS Complete	$9,856.22
Rate for Payer: BCBS MAPPO	$17,512.83
Rate for Payer: BCN Medicare Advantage	$17,512.83
Rate for Payer: Cash Price	$21,619.25
Rate for Payer: Cash Price	$21,619.25
Rate for Payer: Cofinity Commercial	$23,240.69
Rate for Payer: Cofinity Commercial	$18,916.84
Rate for Payer: Cofinity Medicare Advantage	$18,916.84
Rate for Payer: Encore Health Key Benefits Commercial	$21,619.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,512.83
Rate for Payer: Healthscope Commercial	$24,321.65
Rate for Payer: Mclaren Medicaid	$9,386.88
Rate for Payer: Mclaren Medicare	$17,512.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,388.47
Rate for Payer: Meridian Medicaid	$9,856.22
Rate for Payer: MI Amish Medical Board Commercial	$20,139.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22,970.45
Rate for Payer: PACE Medicare	$16,637.19
Rate for Payer: PACE SWMI	$17,512.83
Rate for Payer: PHP Commercial	$22,970.45
Rate for Payer: PHP Medicare Advantage	$17,512.83
Rate for Payer: Priority Health Choice Medicaid	$9,386.88
Rate for Payer: Priority Health Cigna Priority Health	$17,565.64
Rate for Payer: Priority Health Medicare	$17,512.83
Rate for Payer: Priority Health SBD	$17,025.16
Rate for Payer: Railroad Medicare Medicare	$17,512.83
Rate for Payer: UHC All Payor (Choice/PPO)	$49,296.87
Rate for Payer: UHC Dual Complete DSNP	$17,512.83
Rate for Payer: UHC Medicare Advantage	$17,512.83
Rate for Payer: UHCCP Medicaid	$9,859.72
Rate for Payer: VA VA	$17,512.83

HC PFO

Facility

$27,024.06

Service Code	CPT 93580
Hospital Charge Code	48100111
Hospital Revenue Code	481
Min. Negotiated Rate	$17,025.16
Max. Negotiated Rate	$24,321.65
Rate for Payer: Aetna Commercial	$22,970.45
Rate for Payer: Aetna New Business (MI Preferred)	$17,565.64
Rate for Payer: Cash Price	$21,619.25
Rate for Payer: Cofinity Commercial	$18,916.84
Rate for Payer: Cofinity Commercial	$23,240.69
Rate for Payer: Cofinity Medicare Advantage	$18,916.84
Rate for Payer: Encore Health Key Benefits Commercial	$21,619.25
Rate for Payer: Healthscope Commercial	$24,321.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22,970.45
Rate for Payer: PHP Commercial	$22,970.45
Rate for Payer: Priority Health Cigna Priority Health	$17,565.64
Rate for Payer: Priority Health SBD	$17,025.16

HC PFO OCCLUDER

Facility

$11,470.41

Service Code	HCPCS C1817
Hospital Charge Code	27800116
Hospital Revenue Code	278
Min. Negotiated Rate	$7,226.36
Max. Negotiated Rate	$10,323.37
Rate for Payer: Aetna Commercial	$9,749.85
Rate for Payer: Aetna New Business (MI Preferred)	$7,455.77
Rate for Payer: Cash Price	$9,176.33
Rate for Payer: Cofinity Commercial	$8,029.29
Rate for Payer: Cofinity Commercial	$9,864.55
Rate for Payer: Cofinity Medicare Advantage	$8,029.29
Rate for Payer: Encore Health Key Benefits Commercial	$9,176.33
Rate for Payer: Healthscope Commercial	$10,323.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,749.85
Rate for Payer: PHP Commercial	$9,749.85
Rate for Payer: Priority Health Cigna Priority Health	$7,455.77
Rate for Payer: Priority Health SBD	$7,226.36

HC PFO OCCLUDER

Facility

$11,470.41

Service Code	HCPCS C1817
Hospital Charge Code	27800116
Hospital Revenue Code	278
Min. Negotiated Rate	$4,588.16
Max. Negotiated Rate	$10,323.37
Rate for Payer: Aetna Commercial	$9,749.85
Rate for Payer: Aetna Medicare	$5,735.20
Rate for Payer: Aetna New Business (MI Preferred)	$7,455.77
Rate for Payer: BCBS Complete	$4,588.16
Rate for Payer: Cash Price	$9,176.33
Rate for Payer: Cofinity Commercial	$8,029.29
Rate for Payer: Cofinity Commercial	$9,864.55
Rate for Payer: Cofinity Medicare Advantage	$8,029.29
Rate for Payer: Encore Health Key Benefits Commercial	$9,176.33
Rate for Payer: Healthscope Commercial	$10,323.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,749.85
Rate for Payer: PHP Commercial	$9,749.85
Rate for Payer: Priority Health Cigna Priority Health	$7,455.77
Rate for Payer: Priority Health SBD	$7,226.36

HC PHARMA AGENT CHALLENGE

Facility

$3,878.57

Service Code	CPT 93463
Hospital Charge Code	48100022
Hospital Revenue Code	481
Min. Negotiated Rate	$1,551.43
Max. Negotiated Rate	$3,490.71
Rate for Payer: Aetna Commercial	$3,296.78
Rate for Payer: Aetna Medicare	$1,939.29
Rate for Payer: Aetna New Business (MI Preferred)	$2,521.07
Rate for Payer: BCBS Complete	$1,551.43
Rate for Payer: Cash Price	$3,102.86
Rate for Payer: Cofinity Commercial	$2,715.00
Rate for Payer: Cofinity Commercial	$3,335.57
Rate for Payer: Cofinity Medicare Advantage	$2,715.00
Rate for Payer: Encore Health Key Benefits Commercial	$3,102.86
Rate for Payer: Healthscope Commercial	$3,490.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,296.78
Rate for Payer: PHP Commercial	$3,296.78
Rate for Payer: Priority Health Cigna Priority Health	$2,521.07
Rate for Payer: Priority Health SBD	$2,443.50

HC PHARMA AGENT CHALLENGE

Facility

$3,878.57

Service Code	CPT 93463
Hospital Charge Code	48100022
Hospital Revenue Code	481
Min. Negotiated Rate	$2,443.50
Max. Negotiated Rate	$3,490.71
Rate for Payer: Aetna Commercial	$3,296.78
Rate for Payer: Aetna New Business (MI Preferred)	$2,521.07
Rate for Payer: Cash Price	$3,102.86
Rate for Payer: Cofinity Commercial	$2,715.00
Rate for Payer: Cofinity Commercial	$3,335.57
Rate for Payer: Cofinity Medicare Advantage	$2,715.00
Rate for Payer: Encore Health Key Benefits Commercial	$3,102.86
Rate for Payer: Healthscope Commercial	$3,490.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,296.78
Rate for Payer: PHP Commercial	$3,296.78
Rate for Payer: Priority Health Cigna Priority Health	$2,521.07
Rate for Payer: Priority Health SBD	$2,443.50

HC PHARYNX AND OR CERVICAL ESOPHAGUS

Facility

$276.82

Service Code	CPT 74210
Hospital Charge Code	32000295
Hospital Revenue Code	320
Min. Negotiated Rate	$93.06
Max. Negotiated Rate	$488.72
Rate for Payer: Aetna Commercial	$235.30
Rate for Payer: Aetna Medicare	$180.56
Rate for Payer: Aetna New Business (MI Preferred)	$179.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$217.03
Rate for Payer: Amish Plain Church Group Commercial	$217.03
Rate for Payer: BCBS Complete	$97.71
Rate for Payer: BCBS MAPPO	$173.62
Rate for Payer: BCN Medicare Advantage	$173.62
Rate for Payer: Cash Price	$221.46
Rate for Payer: Cash Price	$221.46
Rate for Payer: Cofinity Commercial	$238.07
Rate for Payer: Cofinity Commercial	$193.77
Rate for Payer: Cofinity Medicare Advantage	$193.77
Rate for Payer: Encore Health Key Benefits Commercial	$221.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$173.62
Rate for Payer: Healthscope Commercial	$249.14
Rate for Payer: Mclaren Medicaid	$93.06
Rate for Payer: Mclaren Medicare	$173.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$182.30
Rate for Payer: Meridian Medicaid	$97.71
Rate for Payer: MI Amish Medical Board Commercial	$199.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.30
Rate for Payer: PACE Medicare	$164.94
Rate for Payer: PACE SWMI	$173.62
Rate for Payer: PHP Commercial	$235.30
Rate for Payer: PHP Medicare Advantage	$173.62
Rate for Payer: Priority Health Choice Medicaid	$93.06
Rate for Payer: Priority Health Cigna Priority Health	$179.93
Rate for Payer: Priority Health Medicare	$173.62
Rate for Payer: Priority Health SBD	$174.40
Rate for Payer: Railroad Medicare Medicare	$173.62
Rate for Payer: UHC All Payor (Choice/PPO)	$488.72
Rate for Payer: UHC Core	$204.85
Rate for Payer: UHC Dual Complete DSNP	$173.62
Rate for Payer: UHC Exchange	$204.85
Rate for Payer: UHC Medicare Advantage	$173.62
Rate for Payer: UHCCP Medicaid	$97.75
Rate for Payer: VA VA	$173.62

HC PHARYNX AND OR CERVICAL ESOPHAGUS

Facility

$276.82

Service Code	CPT 74210
Hospital Charge Code	32000295
Hospital Revenue Code	320
Min. Negotiated Rate	$174.40
Max. Negotiated Rate	$249.14
Rate for Payer: Aetna Commercial	$235.30
Rate for Payer: Aetna New Business (MI Preferred)	$179.93
Rate for Payer: Cash Price	$221.46
Rate for Payer: Cofinity Commercial	$193.77
Rate for Payer: Cofinity Commercial	$238.07
Rate for Payer: Cofinity Medicare Advantage	$193.77
Rate for Payer: Encore Health Key Benefits Commercial	$221.46
Rate for Payer: Healthscope Commercial	$249.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.30
Rate for Payer: PHP Commercial	$235.30
Rate for Payer: Priority Health Cigna Priority Health	$179.93
Rate for Payer: Priority Health SBD	$174.40

HC PHASE III REHAB FULL MONTH

Facility

$50.00

Hospital Charge Code	99000048
Hospital Revenue Code	990
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Cofinity Medicare Advantage	$35.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$32.50
Rate for Payer: Priority Health SBD	$31.50

HC PHASE III REHAB FULL MONTH

Facility

$50.00

Hospital Charge Code	99000048
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Cofinity Medicare Advantage	$35.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$32.50
Rate for Payer: Priority Health SBD	$31.50

HC PHASE III REHAB PARTIAL MONTH

Facility

$25.00

Hospital Charge Code	99000049
Hospital Revenue Code	990
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$21.25
Rate for Payer: Aetna New Business (MI Preferred)	$16.25
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cofinity Commercial	$17.50
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Medicare Advantage	$17.50
Rate for Payer: Encore Health Key Benefits Commercial	$20.00
Rate for Payer: Healthscope Commercial	$22.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.25
Rate for Payer: PHP Commercial	$21.25
Rate for Payer: Priority Health Cigna Priority Health	$16.25
Rate for Payer: Priority Health SBD	$15.75

HC PHASE III REHAB PARTIAL MONTH

Facility

$25.00

Hospital Charge Code	99000049
Hospital Revenue Code	990
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$21.25
Rate for Payer: Aetna Medicare	$12.50
Rate for Payer: Aetna New Business (MI Preferred)	$16.25
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cofinity Commercial	$17.50
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Medicare Advantage	$17.50
Rate for Payer: Encore Health Key Benefits Commercial	$20.00
Rate for Payer: Healthscope Commercial	$22.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.25
Rate for Payer: PHP Commercial	$21.25
Rate for Payer: Priority Health Cigna Priority Health	$16.25
Rate for Payer: Priority Health SBD	$15.75

HC PH BLOOD

Facility

$69.36

Service Code	CPT 82800
Hospital Charge Code	30100215
Hospital Revenue Code	301
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare	$11.44
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$13.75
Rate for Payer: Amish Plain Church Group Commercial	$13.75
Rate for Payer: BCBS Complete	$6.19
Rate for Payer: BCBS MAPPO	$11.00
Rate for Payer: BCN Medicare Advantage	$11.00
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Medicare Advantage	$48.55
Rate for Payer: Encore Health Key Benefits Commercial	$55.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.00
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Mclaren Medicaid	$5.90
Rate for Payer: Mclaren Medicare	$11.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11.55
Rate for Payer: Meridian Medicaid	$6.19
Rate for Payer: MI Amish Medical Board Commercial	$12.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.96
Rate for Payer: PACE Medicare	$10.45
Rate for Payer: PACE SWMI	$11.00
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: PHP Medicare Advantage	$11.00
Rate for Payer: Priority Health Choice Medicaid	$5.90
Rate for Payer: Priority Health Cigna Priority Health	$45.08
Rate for Payer: Priority Health Medicare	$11.00
Rate for Payer: Priority Health SBD	$43.70
Rate for Payer: Railroad Medicare Medicare	$11.00
Rate for Payer: UHC All Payor (Choice/PPO)	$30.96
Rate for Payer: UHC Dual Complete DSNP	$11.00
Rate for Payer: UHC Medicare Advantage	$11.00
Rate for Payer: UHCCP Medicaid	$6.19
Rate for Payer: VA VA	$11.00

HC PH BLOOD

Facility

$69.36

Service Code	CPT 82800
Hospital Charge Code	30100215
Hospital Revenue Code	301
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Cofinity Medicare Advantage	$48.55
Rate for Payer: Encore Health Key Benefits Commercial	$55.49
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.96
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: Priority Health Cigna Priority Health	$45.08
Rate for Payer: Priority Health SBD	$43.70

HC PH BODY FLUID

Facility

$25.17

Service Code	CPT 83986
Hospital Charge Code	30100384
Hospital Revenue Code	301
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$22.65
Rate for Payer: Aetna Commercial	$21.39
Rate for Payer: Aetna New Business (MI Preferred)	$16.36
Rate for Payer: Cash Price	$20.14
Rate for Payer: Cofinity Commercial	$17.62
Rate for Payer: Cofinity Commercial	$21.65
Rate for Payer: Cofinity Medicare Advantage	$17.62
Rate for Payer: Encore Health Key Benefits Commercial	$20.14
Rate for Payer: Healthscope Commercial	$22.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.39
Rate for Payer: PHP Commercial	$21.39
Rate for Payer: Priority Health Cigna Priority Health	$16.36
Rate for Payer: Priority Health SBD	$15.86

HC PH BODY FLUID

Facility

$25.17

Service Code	CPT 83986
Hospital Charge Code	30100384
Hospital Revenue Code	301
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$22.65
Rate for Payer: Aetna Commercial	$21.39
Rate for Payer: Aetna Medicare	$3.72
Rate for Payer: Aetna New Business (MI Preferred)	$16.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$4.47
Rate for Payer: Amish Plain Church Group Commercial	$4.47
Rate for Payer: BCBS Complete	$2.01
Rate for Payer: BCBS MAPPO	$3.58
Rate for Payer: BCN Medicare Advantage	$3.58
Rate for Payer: Cash Price	$20.14
Rate for Payer: Cash Price	$20.14
Rate for Payer: Cofinity Commercial	$21.65
Rate for Payer: Cofinity Commercial	$17.62
Rate for Payer: Cofinity Medicare Advantage	$17.62
Rate for Payer: Encore Health Key Benefits Commercial	$20.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$3.58
Rate for Payer: Healthscope Commercial	$22.65
Rate for Payer: Mclaren Medicaid	$1.92
Rate for Payer: Mclaren Medicare	$3.58
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3.76
Rate for Payer: Meridian Medicaid	$2.01
Rate for Payer: MI Amish Medical Board Commercial	$4.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.39
Rate for Payer: PACE Medicare	$3.40
Rate for Payer: PACE SWMI	$3.58
Rate for Payer: PHP Commercial	$21.39
Rate for Payer: PHP Medicare Advantage	$3.58
Rate for Payer: Priority Health Choice Medicaid	$1.92
Rate for Payer: Priority Health Cigna Priority Health	$16.36
Rate for Payer: Priority Health Medicare	$3.58
Rate for Payer: Priority Health SBD	$15.86
Rate for Payer: Railroad Medicare Medicare	$3.58
Rate for Payer: UHC All Payor (Choice/PPO)	$10.08
Rate for Payer: UHC Dual Complete DSNP	$3.58
Rate for Payer: UHC Medicare Advantage	$3.58
Rate for Payer: UHCCP Medicaid	$2.02
Rate for Payer: VA VA	$3.58

HC PHENOBARB LVL

Facility

$100.57

Service Code	CPT 80184
Hospital Charge Code	30100587
Hospital Revenue Code	301
Min. Negotiated Rate	$63.36
Max. Negotiated Rate	$90.51
Rate for Payer: Aetna Commercial	$85.48
Rate for Payer: Aetna New Business (MI Preferred)	$65.37
Rate for Payer: Cash Price	$80.46
Rate for Payer: Cofinity Commercial	$70.40
Rate for Payer: Cofinity Commercial	$86.49
Rate for Payer: Cofinity Medicare Advantage	$70.40
Rate for Payer: Encore Health Key Benefits Commercial	$80.46
Rate for Payer: Healthscope Commercial	$90.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.48
Rate for Payer: PHP Commercial	$85.48
Rate for Payer: Priority Health Cigna Priority Health	$65.37
Rate for Payer: Priority Health SBD	$63.36

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