Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PSYCHOTHERAPY COMPLEX INTERACTIVE

Facility

$46.82

Service Code	CPT 90785
Hospital Charge Code	91400012
Hospital Revenue Code	914
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Advantage	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.12
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health SBD	$29.50

HC PSYCHOTHERAPY COMPLEX INTERACTIVE

Facility

$46.82

Service Code	CPT 90785
Hospital Charge Code	91400012
Hospital Revenue Code	914
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna Medicare	$23.41
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: BCBS Complete	$18.73
Rate for Payer: BCBS Trust/PPO	$11.67
Rate for Payer: BCN Commercial	$11.67
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Advantage	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: MI Amish Medical Board Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.12
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health SBD	$29.50

HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN

Facility

$120.69

Service Code	CPT 90840
Hospital Charge Code	91400014
Hospital Revenue Code	914
Min. Negotiated Rate	$76.03
Max. Negotiated Rate	$108.62
Rate for Payer: Aetna Commercial	$102.59
Rate for Payer: Aetna New Business (MI Preferred)	$78.45
Rate for Payer: Cash Price	$96.55
Rate for Payer: Cofinity Advantage	$84.48
Rate for Payer: Cofinity Commercial	$103.79
Rate for Payer: Encore Health Key Benefits Commercial	$96.55
Rate for Payer: Healthscope Commercial	$108.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.52
Rate for Payer: PHP Commercial	$102.59
Rate for Payer: Priority Health SBD	$76.03

HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN

Facility

$120.69

Service Code	CPT 90840
Hospital Charge Code	91400014
Hospital Revenue Code	914
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$108.62
Rate for Payer: Aetna Commercial	$102.59
Rate for Payer: Aetna Medicare	$60.34
Rate for Payer: Aetna New Business (MI Preferred)	$78.45
Rate for Payer: BCBS Complete	$48.28
Rate for Payer: Cash Price	$96.55
Rate for Payer: Cofinity Advantage	$84.48
Rate for Payer: Cofinity Commercial	$103.79
Rate for Payer: Encore Health Key Benefits Commercial	$96.55
Rate for Payer: Healthscope Commercial	$108.62
Rate for Payer: MI Amish Medical Board Commercial	$96.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.52
Rate for Payer: PHP Commercial	$102.59
Rate for Payer: Priority Health SBD	$76.03

HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN

Facility

$234.09

Service Code	CPT 90839
Hospital Charge Code	91400003
Hospital Revenue Code	914
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$571.94
Rate for Payer: Aetna Commercial	$198.98
Rate for Payer: Aetna Medicare	$183.93
Rate for Payer: Aetna New Business (MI Preferred)	$152.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$221.07
Rate for Payer: Amish Plain Church Group Commercial	$221.07
Rate for Payer: BCBS Complete	$97.13
Rate for Payer: BCBS MAPPO	$176.86
Rate for Payer: BCN Medicare Advantage	$176.86
Rate for Payer: Cash Price	$187.27
Rate for Payer: Cash Price	$187.27
Rate for Payer: Cofinity Advantage	$163.86
Rate for Payer: Cofinity Commercial	$201.32
Rate for Payer: Encore Health Key Benefits Commercial	$187.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$176.86
Rate for Payer: Healthscope Commercial	$210.68
Rate for Payer: Mclaren Medicaid	$92.50
Rate for Payer: Mclaren Medicare	$176.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$185.70
Rate for Payer: Meridian Medicaid	$185.70
Rate for Payer: MI Amish Medical Board Commercial	$203.39
Rate for Payer: Molina Medicare/Medicaid	$194.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$198.98
Rate for Payer: Nomi Health Commercial	$530.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.57
Rate for Payer: PACE Medicare	$168.02
Rate for Payer: PACE SWMI	$176.86
Rate for Payer: PHP Commercial	$198.98
Rate for Payer: PHP Medicare Advantage	$176.86
Rate for Payer: Priority Health Choice Medicaid	$92.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$571.94
Rate for Payer: Priority Health Medicare	$176.86
Rate for Payer: Priority Health SBD	$147.48
Rate for Payer: Priority Health Tiered Network	$457.55
Rate for Payer: Railroad Medicare Medicare	$176.86
Rate for Payer: UHC Medicaid	$92.50
Rate for Payer: UHCCP Medicaid	$92.50
Rate for Payer: VA VA	$176.86

HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN

Facility

$234.09

Service Code	CPT 90839
Hospital Charge Code	91400003
Hospital Revenue Code	914
Min. Negotiated Rate	$147.48
Max. Negotiated Rate	$210.68
Rate for Payer: Aetna Commercial	$198.98
Rate for Payer: Aetna New Business (MI Preferred)	$152.16
Rate for Payer: Cash Price	$187.27
Rate for Payer: Cofinity Advantage	$163.86
Rate for Payer: Cofinity Commercial	$201.32
Rate for Payer: Encore Health Key Benefits Commercial	$187.27
Rate for Payer: Healthscope Commercial	$210.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$198.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.57
Rate for Payer: PHP Commercial	$198.98
Rate for Payer: Priority Health SBD	$147.48

HC PTCA ADD/BRANCH

Facility

$7,436.42

Service Code	CPT 92921
Hospital Charge Code	48100099
Hospital Revenue Code	481
Min. Negotiated Rate	$350.37
Max. Negotiated Rate	$6,692.78
Rate for Payer: Aetna Commercial	$6,320.96
Rate for Payer: Aetna Medicare	$3,718.21
Rate for Payer: Aetna New Business (MI Preferred)	$4,833.67
Rate for Payer: BCBS Complete	$2,974.57
Rate for Payer: BCBS Trust/PPO	$350.37
Rate for Payer: BCN Commercial	$350.37
Rate for Payer: Cash Price	$5,949.14
Rate for Payer: Cash Price	$5,949.14
Rate for Payer: Cofinity Advantage	$5,205.49
Rate for Payer: Cofinity Commercial	$6,395.32
Rate for Payer: Encore Health Key Benefits Commercial	$5,949.14
Rate for Payer: Healthscope Commercial	$6,692.78
Rate for Payer: MI Amish Medical Board Commercial	$5,949.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,320.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,577.31
Rate for Payer: PHP Commercial	$6,320.96
Rate for Payer: Priority Health SBD	$4,684.94

HC PTCA ADD/BRANCH

Facility

$7,436.42

Service Code	CPT 92921
Hospital Charge Code	48100099
Hospital Revenue Code	481
Min. Negotiated Rate	$4,684.94
Max. Negotiated Rate	$6,692.78
Rate for Payer: Aetna Commercial	$6,320.96
Rate for Payer: Aetna New Business (MI Preferred)	$4,833.67
Rate for Payer: Cash Price	$5,949.14
Rate for Payer: Cofinity Advantage	$5,205.49
Rate for Payer: Cofinity Commercial	$6,395.32
Rate for Payer: Encore Health Key Benefits Commercial	$5,949.14
Rate for Payer: Healthscope Commercial	$6,692.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,320.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,577.31
Rate for Payer: PHP Commercial	$6,320.96
Rate for Payer: Priority Health SBD	$4,684.94

HC PTCA VESSEL/BRANCH

Facility

$11,423.75

Service Code	CPT 92920
Hospital Charge Code	48100098
Hospital Revenue Code	481
Min. Negotiated Rate	$7,196.96
Max. Negotiated Rate	$10,281.38
Rate for Payer: Aetna Commercial	$9,710.19
Rate for Payer: Aetna New Business (MI Preferred)	$7,425.44
Rate for Payer: Cash Price	$9,139.00
Rate for Payer: Cofinity Advantage	$7,996.62
Rate for Payer: Cofinity Commercial	$9,824.42
Rate for Payer: Encore Health Key Benefits Commercial	$9,139.00
Rate for Payer: Healthscope Commercial	$10,281.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,710.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,567.81
Rate for Payer: PHP Commercial	$9,710.19
Rate for Payer: Priority Health SBD	$7,196.96

HC PTCA VESSEL/BRANCH

Facility

$11,423.75

Service Code	CPT 92920
Hospital Charge Code	48100098
Hospital Revenue Code	481
Min. Negotiated Rate	$2,965.99
Max. Negotiated Rate	$18,339.80
Rate for Payer: Aetna Commercial	$9,710.19
Rate for Payer: Aetna Medicare	$5,897.94
Rate for Payer: Aetna New Business (MI Preferred)	$7,425.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,088.88
Rate for Payer: Amish Plain Church Group Commercial	$7,088.88
Rate for Payer: BCBS Complete	$3,114.57
Rate for Payer: BCBS MAPPO	$5,671.10
Rate for Payer: BCBS Trust/PPO	$3,709.54
Rate for Payer: BCN Commercial	$3,709.54
Rate for Payer: BCN Medicare Advantage	$5,671.10
Rate for Payer: Cash Price	$9,139.00
Rate for Payer: Cash Price	$9,139.00
Rate for Payer: Cash Price	$9,139.00
Rate for Payer: Cofinity Advantage	$7,996.62
Rate for Payer: Cofinity Commercial	$9,824.42
Rate for Payer: Encore Health Key Benefits Commercial	$9,139.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,671.10
Rate for Payer: Healthscope Commercial	$10,281.38
Rate for Payer: Mclaren Medicaid	$2,965.99
Rate for Payer: Mclaren Medicare	$5,671.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,954.65
Rate for Payer: Meridian Medicaid	$5,954.65
Rate for Payer: MI Amish Medical Board Commercial	$6,521.77
Rate for Payer: Molina Medicare/Medicaid	$6,238.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,710.19
Rate for Payer: Nomi Health Commercial	$17,013.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,567.81
Rate for Payer: PACE Medicare	$5,387.55
Rate for Payer: PACE SWMI	$5,671.10
Rate for Payer: PHP Commercial	$9,710.19
Rate for Payer: PHP Medicare Advantage	$5,671.10
Rate for Payer: Priority Health Choice Medicaid	$2,965.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$18,339.80
Rate for Payer: Priority Health Medicare	$5,671.10
Rate for Payer: Priority Health SBD	$7,196.96
Rate for Payer: Priority Health Tiered Network	$14,671.84
Rate for Payer: Railroad Medicare Medicare	$5,671.10
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,671.10
Rate for Payer: UHC Medicaid	$2,965.99
Rate for Payer: UHCCP Medicaid	$2,965.99
Rate for Payer: VA VA	$5,671.10

HC PTCRAWDES ADD.BRANCH

Facility

$19,483.94

Service Code	CPT C9603
Hospital Charge Code	48100080
Hospital Revenue Code	481
Min. Negotiated Rate	$12,274.88
Max. Negotiated Rate	$17,535.55
Rate for Payer: Aetna Commercial	$16,561.35
Rate for Payer: Aetna New Business (MI Preferred)	$12,664.56
Rate for Payer: Cash Price	$15,587.15
Rate for Payer: Cofinity Advantage	$13,638.76
Rate for Payer: Cofinity Commercial	$16,756.19
Rate for Payer: Encore Health Key Benefits Commercial	$15,587.15
Rate for Payer: Healthscope Commercial	$17,535.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,561.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,612.95
Rate for Payer: PHP Commercial	$16,561.35
Rate for Payer: Priority Health SBD	$12,274.88

HC PTCRAWDES ADD.BRANCH

Facility

$19,483.94

Service Code	CPT C9603
Hospital Charge Code	48100080
Hospital Revenue Code	481
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$17,535.55
Rate for Payer: Aetna Commercial	$16,561.35
Rate for Payer: Aetna Medicare	$9,741.97
Rate for Payer: Aetna New Business (MI Preferred)	$12,664.56
Rate for Payer: BCBS Complete	$7,793.58
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$15,587.15
Rate for Payer: Cash Price	$15,587.15
Rate for Payer: Cofinity Advantage	$13,638.76
Rate for Payer: Cofinity Commercial	$16,756.19
Rate for Payer: Encore Health Key Benefits Commercial	$15,587.15
Rate for Payer: Healthscope Commercial	$17,535.55
Rate for Payer: MI Amish Medical Board Commercial	$15,587.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,561.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,612.95
Rate for Payer: PHP Commercial	$16,561.35
Rate for Payer: Priority Health SBD	$12,274.88

HC PTCRAWDES VES/BRANCH

Facility

$29,741.77

Service Code	CPT C9602
Hospital Charge Code	48100079
Hospital Revenue Code	481
Min. Negotiated Rate	$9,552.97
Max. Negotiated Rate	$59,069.70
Rate for Payer: Aetna Commercial	$25,280.50
Rate for Payer: Aetna Medicare	$18,996.35
Rate for Payer: Aetna New Business (MI Preferred)	$19,332.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,832.15
Rate for Payer: Amish Plain Church Group Commercial	$22,832.15
Rate for Payer: BCBS Complete	$10,031.53
Rate for Payer: BCBS MAPPO	$18,265.72
Rate for Payer: BCBS Trust/PPO	$10,149.17
Rate for Payer: BCN Commercial	$10,149.17
Rate for Payer: BCN Medicare Advantage	$18,265.72
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cofinity Advantage	$20,819.24
Rate for Payer: Cofinity Commercial	$25,577.92
Rate for Payer: Encore Health Key Benefits Commercial	$23,793.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,265.72
Rate for Payer: Healthscope Commercial	$26,767.59
Rate for Payer: Mclaren Medicaid	$9,552.97
Rate for Payer: Mclaren Medicare	$18,265.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,179.01
Rate for Payer: Meridian Medicaid	$19,179.01
Rate for Payer: MI Amish Medical Board Commercial	$21,005.58
Rate for Payer: Molina Medicare/Medicaid	$20,092.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,280.50
Rate for Payer: Nomi Health Commercial	$54,797.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$22,306.33
Rate for Payer: PACE Medicare	$17,352.43
Rate for Payer: PACE SWMI	$18,265.72
Rate for Payer: PHP Commercial	$25,280.50
Rate for Payer: PHP Medicare Advantage	$18,265.72
Rate for Payer: Priority Health Choice Medicaid	$9,552.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$59,069.70
Rate for Payer: Priority Health Medicare	$18,265.72
Rate for Payer: Priority Health SBD	$18,737.32
Rate for Payer: Priority Health Tiered Network	$47,255.76
Rate for Payer: Railroad Medicare Medicare	$18,265.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,265.72
Rate for Payer: UHC Medicaid	$9,552.97
Rate for Payer: UHCCP Medicaid	$9,552.97
Rate for Payer: VA VA	$18,265.72

HC PTCRAWDES VES/BRANCH

Facility

$29,741.77

Service Code	CPT C9602
Hospital Charge Code	48100079
Hospital Revenue Code	481
Min. Negotiated Rate	$18,737.32
Max. Negotiated Rate	$26,767.59
Rate for Payer: Aetna Commercial	$25,280.50
Rate for Payer: Aetna New Business (MI Preferred)	$19,332.15
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cofinity Advantage	$20,819.24
Rate for Payer: Cofinity Commercial	$25,577.92
Rate for Payer: Encore Health Key Benefits Commercial	$23,793.42
Rate for Payer: Healthscope Commercial	$26,767.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,280.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$22,306.33
Rate for Payer: PHP Commercial	$25,280.50
Rate for Payer: Priority Health SBD	$18,737.32

HC PTCRAWPTCA ADD.BRANCH

Facility

$12,179.11

Service Code	CPT 92925
Hospital Charge Code	48100097
Hospital Revenue Code	481
Min. Negotiated Rate	$218.76
Max. Negotiated Rate	$10,961.20
Rate for Payer: Aetna Commercial	$10,352.24
Rate for Payer: Aetna Medicare	$6,089.56
Rate for Payer: Aetna New Business (MI Preferred)	$7,916.42
Rate for Payer: BCBS Complete	$4,871.64
Rate for Payer: BCBS Trust/PPO	$218.76
Rate for Payer: BCN Commercial	$218.76
Rate for Payer: Cash Price	$9,743.29
Rate for Payer: Cash Price	$9,743.29
Rate for Payer: Cofinity Advantage	$8,525.38
Rate for Payer: Cofinity Commercial	$10,474.03
Rate for Payer: Encore Health Key Benefits Commercial	$9,743.29
Rate for Payer: Healthscope Commercial	$10,961.20
Rate for Payer: MI Amish Medical Board Commercial	$9,743.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,352.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$9,134.33
Rate for Payer: PHP Commercial	$10,352.24
Rate for Payer: Priority Health SBD	$7,672.84

HC PTCRAWPTCA ADD.BRANCH

Facility

$12,179.11

Service Code	CPT 92925
Hospital Charge Code	48100097
Hospital Revenue Code	481
Min. Negotiated Rate	$7,672.84
Max. Negotiated Rate	$10,961.20
Rate for Payer: Aetna Commercial	$10,352.24
Rate for Payer: Aetna New Business (MI Preferred)	$7,916.42
Rate for Payer: Cash Price	$9,743.29
Rate for Payer: Cofinity Advantage	$8,525.38
Rate for Payer: Cofinity Commercial	$10,474.03
Rate for Payer: Encore Health Key Benefits Commercial	$9,743.29
Rate for Payer: Healthscope Commercial	$10,961.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,352.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$9,134.33
Rate for Payer: PHP Commercial	$10,352.24
Rate for Payer: Priority Health SBD	$7,672.84

HC PTCRAWSTENT ADD.BRANCH

Facility

$19,483.94

Service Code	CPT 92934
Hospital Charge Code	48100078
Hospital Revenue Code	481
Min. Negotiated Rate	$229.06
Max. Negotiated Rate	$17,535.55
Rate for Payer: Aetna Commercial	$16,561.35
Rate for Payer: Aetna Medicare	$9,741.97
Rate for Payer: Aetna New Business (MI Preferred)	$12,664.56
Rate for Payer: BCBS Complete	$7,793.58
Rate for Payer: BCBS Trust/PPO	$229.06
Rate for Payer: BCN Commercial	$229.06
Rate for Payer: Cash Price	$15,587.15
Rate for Payer: Cash Price	$15,587.15
Rate for Payer: Cofinity Advantage	$13,638.76
Rate for Payer: Cofinity Commercial	$16,756.19
Rate for Payer: Encore Health Key Benefits Commercial	$15,587.15
Rate for Payer: Healthscope Commercial	$17,535.55
Rate for Payer: MI Amish Medical Board Commercial	$15,587.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,561.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,612.95
Rate for Payer: PHP Commercial	$16,561.35
Rate for Payer: Priority Health SBD	$12,274.88

HC PTCRAWSTENT ADD.BRANCH

Facility

$19,483.94

Service Code	CPT 92934
Hospital Charge Code	48100078
Hospital Revenue Code	481
Min. Negotiated Rate	$12,274.88
Max. Negotiated Rate	$17,535.55
Rate for Payer: Aetna Commercial	$16,561.35
Rate for Payer: Aetna New Business (MI Preferred)	$12,664.56
Rate for Payer: Cash Price	$15,587.15
Rate for Payer: Cofinity Advantage	$13,638.76
Rate for Payer: Cofinity Commercial	$16,756.19
Rate for Payer: Encore Health Key Benefits Commercial	$15,587.15
Rate for Payer: Healthscope Commercial	$17,535.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,561.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,612.95
Rate for Payer: PHP Commercial	$16,561.35
Rate for Payer: Priority Health SBD	$12,274.88

HC PTCRAWSTENT VES/BRANCH

Facility

$29,741.77

Service Code	CPT 92933
Hospital Charge Code	48100077
Hospital Revenue Code	481
Min. Negotiated Rate	$187.07
Max. Negotiated Rate	$59,069.70
Rate for Payer: Aetna Commercial	$25,280.50
Rate for Payer: Aetna Medicare	$18,996.35
Rate for Payer: Aetna New Business (MI Preferred)	$19,332.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,832.15
Rate for Payer: Amish Plain Church Group Commercial	$22,832.15
Rate for Payer: BCBS Complete	$10,031.53
Rate for Payer: BCBS MAPPO	$18,265.72
Rate for Payer: BCBS Trust/PPO	$187.07
Rate for Payer: BCN Commercial	$187.07
Rate for Payer: BCN Medicare Advantage	$18,265.72
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cofinity Advantage	$20,819.24
Rate for Payer: Cofinity Commercial	$25,577.92
Rate for Payer: Encore Health Key Benefits Commercial	$23,793.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,265.72
Rate for Payer: Healthscope Commercial	$26,767.59
Rate for Payer: Mclaren Medicaid	$9,552.97
Rate for Payer: Mclaren Medicare	$18,265.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,179.01
Rate for Payer: Meridian Medicaid	$19,179.01
Rate for Payer: MI Amish Medical Board Commercial	$21,005.58
Rate for Payer: Molina Medicare/Medicaid	$20,092.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,280.50
Rate for Payer: Nomi Health Commercial	$54,797.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$22,306.33
Rate for Payer: PACE Medicare	$17,352.43
Rate for Payer: PACE SWMI	$18,265.72
Rate for Payer: PHP Commercial	$25,280.50
Rate for Payer: PHP Medicare Advantage	$18,265.72
Rate for Payer: Priority Health Choice Medicaid	$9,552.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$59,069.70
Rate for Payer: Priority Health Medicare	$18,265.72
Rate for Payer: Priority Health SBD	$18,737.32
Rate for Payer: Priority Health Tiered Network	$47,255.76
Rate for Payer: Railroad Medicare Medicare	$18,265.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,265.72
Rate for Payer: UHC Medicaid	$9,552.97
Rate for Payer: UHCCP Medicaid	$9,552.97
Rate for Payer: VA VA	$18,265.72

HC PTCRAWSTENT VES/BRANCH

Facility

$29,741.77

Service Code	CPT 92933
Hospital Charge Code	48100077
Hospital Revenue Code	481
Min. Negotiated Rate	$18,737.32
Max. Negotiated Rate	$26,767.59
Rate for Payer: Aetna Commercial	$25,280.50
Rate for Payer: Aetna New Business (MI Preferred)	$19,332.15
Rate for Payer: Cash Price	$23,793.42
Rate for Payer: Cofinity Advantage	$20,819.24
Rate for Payer: Cofinity Commercial	$25,577.92
Rate for Payer: Encore Health Key Benefits Commercial	$23,793.42
Rate for Payer: Healthscope Commercial	$26,767.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,280.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$22,306.33
Rate for Payer: PHP Commercial	$25,280.50
Rate for Payer: Priority Health SBD	$18,737.32

HC PT EVAL HIGH COMPLEXITY

Facility

$321.01

Service Code	CPT 97163
Hospital Charge Code	42400008
Hospital Revenue Code	424
Min. Negotiated Rate	$60.80
Max. Negotiated Rate	$288.91
Rate for Payer: Aetna Commercial	$272.86
Rate for Payer: Aetna Medicare	$160.50
Rate for Payer: Aetna New Business (MI Preferred)	$208.66
Rate for Payer: BCBS Complete	$128.40
Rate for Payer: BCBS Trust/PPO	$80.08
Rate for Payer: BCN Commercial	$80.08
Rate for Payer: Cash Price	$256.81
Rate for Payer: Cash Price	$256.81
Rate for Payer: Cash Price	$256.81
Rate for Payer: Cofinity Advantage	$224.71
Rate for Payer: Cofinity Commercial	$276.07
Rate for Payer: Encore Health Key Benefits Commercial	$256.81
Rate for Payer: Healthscope Commercial	$288.91
Rate for Payer: MI Amish Medical Board Commercial	$256.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.86
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$240.76
Rate for Payer: PHP Commercial	$272.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$76.00
Rate for Payer: Priority Health SBD	$202.24
Rate for Payer: Priority Health Tiered Network	$60.80
Rate for Payer: UHC All Payor (Choice/PPO)	$208.66
Rate for Payer: UHC Core	$167.25
Rate for Payer: UHC Exchange	$126.16

HC PT EVAL HIGH COMPLEXITY

Facility

$321.01

Service Code	CPT 97163
Hospital Charge Code	42400008
Hospital Revenue Code	424
Min. Negotiated Rate	$202.24
Max. Negotiated Rate	$288.91
Rate for Payer: Aetna Commercial	$272.86
Rate for Payer: Aetna New Business (MI Preferred)	$208.66
Rate for Payer: Cash Price	$256.81
Rate for Payer: Cofinity Advantage	$224.71
Rate for Payer: Cofinity Commercial	$276.07
Rate for Payer: Encore Health Key Benefits Commercial	$256.81
Rate for Payer: Healthscope Commercial	$288.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$240.76
Rate for Payer: PHP Commercial	$272.86
Rate for Payer: Priority Health SBD	$202.24

HC PT EVAL LOW COMPLEXITY

Facility

$262.65

Service Code	CPT 97161
Hospital Charge Code	42400006
Hospital Revenue Code	424
Min. Negotiated Rate	$165.47
Max. Negotiated Rate	$236.38
Rate for Payer: Aetna Commercial	$223.25
Rate for Payer: Aetna New Business (MI Preferred)	$170.72
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cofinity Advantage	$183.85
Rate for Payer: Cofinity Commercial	$225.88
Rate for Payer: Encore Health Key Benefits Commercial	$210.12
Rate for Payer: Healthscope Commercial	$236.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.99
Rate for Payer: PHP Commercial	$223.25
Rate for Payer: Priority Health SBD	$165.47

HC PT EVAL LOW COMPLEXITY

Facility

$262.65

Service Code	CPT 97161
Hospital Charge Code	42400006
Hospital Revenue Code	424
Min. Negotiated Rate	$60.80
Max. Negotiated Rate	$236.38
Rate for Payer: Aetna Commercial	$223.25
Rate for Payer: Aetna Medicare	$131.32
Rate for Payer: Aetna New Business (MI Preferred)	$170.72
Rate for Payer: BCBS Complete	$105.06
Rate for Payer: BCBS Trust/PPO	$80.08
Rate for Payer: BCN Commercial	$80.08
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cofinity Advantage	$183.85
Rate for Payer: Cofinity Commercial	$225.88
Rate for Payer: Encore Health Key Benefits Commercial	$210.12
Rate for Payer: Healthscope Commercial	$236.38
Rate for Payer: MI Amish Medical Board Commercial	$210.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.25
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.99
Rate for Payer: PHP Commercial	$223.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$76.00
Rate for Payer: Priority Health SBD	$165.47
Rate for Payer: Priority Health Tiered Network	$60.80
Rate for Payer: UHC All Payor (Choice/PPO)	$170.72
Rate for Payer: UHC Core	$136.84
Rate for Payer: UHC Exchange	$103.22

HC PT EVAL MODERATE COMPLEXITY

Facility

$291.83

Service Code	CPT 97162
Hospital Charge Code	42400007
Hospital Revenue Code	424
Min. Negotiated Rate	$183.85
Max. Negotiated Rate	$262.65
Rate for Payer: Aetna Commercial	$248.06
Rate for Payer: Aetna New Business (MI Preferred)	$189.69
Rate for Payer: Cash Price	$233.46
Rate for Payer: Cofinity Advantage	$204.28
Rate for Payer: Cofinity Commercial	$250.97
Rate for Payer: Encore Health Key Benefits Commercial	$233.46
Rate for Payer: Healthscope Commercial	$262.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$248.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$218.87
Rate for Payer: PHP Commercial	$248.06
Rate for Payer: Priority Health SBD	$183.85

Know your out-of-pocket cost for care.

All Charges