Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BANDING

Facility

$965.64

Hospital Charge Code	36000009
Hospital Revenue Code	360
Min. Negotiated Rate	$386.26
Max. Negotiated Rate	$869.08
Rate for Payer: Aetna Commercial	$820.79
Rate for Payer: Aetna Medicare	$482.82
Rate for Payer: Aetna New Business (MI Preferred)	$627.67
Rate for Payer: BCBS Complete	$386.26
Rate for Payer: Cash Price	$772.51
Rate for Payer: Cofinity Commercial	$675.95
Rate for Payer: Cofinity Commercial	$830.45
Rate for Payer: Cofinity Medicare Advantage	$675.95
Rate for Payer: Encore Health Key Benefits Commercial	$772.51
Rate for Payer: Healthscope Commercial	$869.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$820.79
Rate for Payer: PHP Commercial	$820.79
Rate for Payer: Priority Health Cigna Priority Health	$627.67
Rate for Payer: Priority Health SBD	$608.35

HC BANDING

Facility

$965.64

Hospital Charge Code	36000009
Hospital Revenue Code	360
Min. Negotiated Rate	$608.35
Max. Negotiated Rate	$869.08
Rate for Payer: Aetna Commercial	$820.79
Rate for Payer: Aetna New Business (MI Preferred)	$627.67
Rate for Payer: Cash Price	$772.51
Rate for Payer: Cofinity Commercial	$675.95
Rate for Payer: Cofinity Commercial	$830.45
Rate for Payer: Cofinity Medicare Advantage	$675.95
Rate for Payer: Encore Health Key Benefits Commercial	$772.51
Rate for Payer: Healthscope Commercial	$869.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$820.79
Rate for Payer: PHP Commercial	$820.79
Rate for Payer: Priority Health Cigna Priority Health	$627.67
Rate for Payer: Priority Health SBD	$608.35

HC BARBITURATE URIN

Facility

$101.66

Service Code	CPT 80307
Hospital Charge Code	30000137
Hospital Revenue Code	300
Min. Negotiated Rate	$64.05
Max. Negotiated Rate	$91.49
Rate for Payer: Aetna Commercial	$86.41
Rate for Payer: Aetna New Business (MI Preferred)	$66.08
Rate for Payer: Cash Price	$81.33
Rate for Payer: Cofinity Commercial	$71.16
Rate for Payer: Cofinity Commercial	$87.43
Rate for Payer: Cofinity Medicare Advantage	$71.16
Rate for Payer: Encore Health Key Benefits Commercial	$81.33
Rate for Payer: Healthscope Commercial	$91.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.41
Rate for Payer: PHP Commercial	$86.41
Rate for Payer: Priority Health Cigna Priority Health	$66.08
Rate for Payer: Priority Health SBD	$64.05

HC BARBITURATE URIN

Facility

$101.66

Service Code	CPT 80307
Hospital Charge Code	30000137
Hospital Revenue Code	300
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$174.92
Rate for Payer: Aetna Commercial	$86.41
Rate for Payer: Aetna Medicare	$64.63
Rate for Payer: Aetna New Business (MI Preferred)	$66.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$77.67
Rate for Payer: Amish Plain Church Group Commercial	$77.67
Rate for Payer: BCBS Complete	$34.97
Rate for Payer: BCBS MAPPO	$62.14
Rate for Payer: BCN Medicare Advantage	$62.14
Rate for Payer: Cash Price	$81.33
Rate for Payer: Cash Price	$81.33
Rate for Payer: Cofinity Commercial	$87.43
Rate for Payer: Cofinity Commercial	$71.16
Rate for Payer: Cofinity Medicare Advantage	$71.16
Rate for Payer: Encore Health Key Benefits Commercial	$81.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.14
Rate for Payer: Healthscope Commercial	$91.49
Rate for Payer: Mclaren Medicaid	$33.31
Rate for Payer: Mclaren Medicare	$62.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65.25
Rate for Payer: Meridian Medicaid	$34.97
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.41
Rate for Payer: PACE Medicare	$59.03
Rate for Payer: PACE SWMI	$62.14
Rate for Payer: PHP Commercial	$86.41
Rate for Payer: PHP Medicare Advantage	$62.14
Rate for Payer: Priority Health Choice Medicaid	$33.31
Rate for Payer: Priority Health Cigna Priority Health	$66.08
Rate for Payer: Priority Health Medicare	$62.14
Rate for Payer: Priority Health SBD	$64.05
Rate for Payer: Railroad Medicare Medicare	$62.14
Rate for Payer: UHC All Payor (Choice/PPO)	$174.92
Rate for Payer: UHC Dual Complete DSNP	$62.14
Rate for Payer: UHC Medicare Advantage	$62.14
Rate for Payer: UHCCP Medicaid	$34.98
Rate for Payer: VA VA	$62.14

HC BARBITURATE URINE CONFIRM

Facility

$63.24

Service Code	CPT 80345
Hospital Charge Code	30100571
Hospital Revenue Code	301
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna Medicare	$31.62
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: BCBS Complete	$25.30
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC BARBITURATE URINE CONFIRM

Facility

$63.24

Service Code	CPT 80345
Hospital Charge Code	30100571
Hospital Revenue Code	301
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC BARRIER ADHESION

Facility

$589.96

Service Code	HCPCS C1765
Hospital Charge Code	27000463
Hospital Revenue Code	270
Min. Negotiated Rate	$371.67
Max. Negotiated Rate	$530.96
Rate for Payer: Aetna Commercial	$501.47
Rate for Payer: Aetna New Business (MI Preferred)	$383.47
Rate for Payer: Cash Price	$471.97
Rate for Payer: Cofinity Commercial	$412.97
Rate for Payer: Cofinity Commercial	$507.37
Rate for Payer: Cofinity Medicare Advantage	$412.97
Rate for Payer: Encore Health Key Benefits Commercial	$471.97
Rate for Payer: Healthscope Commercial	$530.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$501.47
Rate for Payer: PHP Commercial	$501.47
Rate for Payer: Priority Health Cigna Priority Health	$383.47
Rate for Payer: Priority Health SBD	$371.67

HC BARRIER ADHESION

Facility

$589.96

Service Code	HCPCS C1765
Hospital Charge Code	27000463
Hospital Revenue Code	270
Min. Negotiated Rate	$235.98
Max. Negotiated Rate	$530.96
Rate for Payer: Aetna Commercial	$501.47
Rate for Payer: Aetna Medicare	$294.98
Rate for Payer: Aetna New Business (MI Preferred)	$383.47
Rate for Payer: BCBS Complete	$235.98
Rate for Payer: Cash Price	$471.97
Rate for Payer: Cofinity Commercial	$412.97
Rate for Payer: Cofinity Commercial	$507.37
Rate for Payer: Cofinity Medicare Advantage	$412.97
Rate for Payer: Encore Health Key Benefits Commercial	$471.97
Rate for Payer: Healthscope Commercial	$530.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$501.47
Rate for Payer: PHP Commercial	$501.47
Rate for Payer: Priority Health Cigna Priority Health	$383.47
Rate for Payer: Priority Health SBD	$371.67

HC BARRX 360 EXPRESS CATH BALLOON

Facility

$5,720.86

Hospital Charge Code	27200286
Hospital Revenue Code	272
Min. Negotiated Rate	$2,288.34
Max. Negotiated Rate	$5,148.77
Rate for Payer: Aetna Commercial	$4,862.73
Rate for Payer: Aetna Medicare	$2,860.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,718.56
Rate for Payer: BCBS Complete	$2,288.34
Rate for Payer: Cash Price	$4,576.69
Rate for Payer: Cofinity Commercial	$4,004.60
Rate for Payer: Cofinity Commercial	$4,919.94
Rate for Payer: Cofinity Medicare Advantage	$4,004.60
Rate for Payer: Encore Health Key Benefits Commercial	$4,576.69
Rate for Payer: Healthscope Commercial	$5,148.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,862.73
Rate for Payer: PHP Commercial	$4,862.73
Rate for Payer: Priority Health Cigna Priority Health	$3,718.56
Rate for Payer: Priority Health SBD	$3,604.14

HC BARRX 360 EXPRESS CATH BALLOON

Facility

$5,720.86

Hospital Charge Code	27200286
Hospital Revenue Code	272
Min. Negotiated Rate	$3,604.14
Max. Negotiated Rate	$5,148.77
Rate for Payer: Aetna Commercial	$4,862.73
Rate for Payer: Aetna New Business (MI Preferred)	$3,718.56
Rate for Payer: Cash Price	$4,576.69
Rate for Payer: Cofinity Commercial	$4,004.60
Rate for Payer: Cofinity Commercial	$4,919.94
Rate for Payer: Cofinity Medicare Advantage	$4,004.60
Rate for Payer: Encore Health Key Benefits Commercial	$4,576.69
Rate for Payer: Healthscope Commercial	$5,148.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,862.73
Rate for Payer: PHP Commercial	$4,862.73
Rate for Payer: Priority Health Cigna Priority Health	$3,718.56
Rate for Payer: Priority Health SBD	$3,604.14

HC BARRX 90 RFA FOCAL CATHETER

Facility

$4,350.88

Hospital Charge Code	27200287
Hospital Revenue Code	272
Min. Negotiated Rate	$2,741.05
Max. Negotiated Rate	$3,915.79
Rate for Payer: Aetna Commercial	$3,698.25
Rate for Payer: Aetna New Business (MI Preferred)	$2,828.07
Rate for Payer: Cash Price	$3,480.70
Rate for Payer: Cofinity Commercial	$3,045.62
Rate for Payer: Cofinity Commercial	$3,741.76
Rate for Payer: Cofinity Medicare Advantage	$3,045.62
Rate for Payer: Encore Health Key Benefits Commercial	$3,480.70
Rate for Payer: Healthscope Commercial	$3,915.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,698.25
Rate for Payer: PHP Commercial	$3,698.25
Rate for Payer: Priority Health Cigna Priority Health	$2,828.07
Rate for Payer: Priority Health SBD	$2,741.05

HC BARRX 90 RFA FOCAL CATHETER

Facility

$4,350.88

Hospital Charge Code	27200287
Hospital Revenue Code	272
Min. Negotiated Rate	$1,740.35
Max. Negotiated Rate	$3,915.79
Rate for Payer: Aetna Commercial	$3,698.25
Rate for Payer: Aetna Medicare	$2,175.44
Rate for Payer: Aetna New Business (MI Preferred)	$2,828.07
Rate for Payer: BCBS Complete	$1,740.35
Rate for Payer: Cash Price	$3,480.70
Rate for Payer: Cofinity Commercial	$3,045.62
Rate for Payer: Cofinity Commercial	$3,741.76
Rate for Payer: Cofinity Medicare Advantage	$3,045.62
Rate for Payer: Encore Health Key Benefits Commercial	$3,480.70
Rate for Payer: Healthscope Commercial	$3,915.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,698.25
Rate for Payer: PHP Commercial	$3,698.25
Rate for Payer: Priority Health Cigna Priority Health	$2,828.07
Rate for Payer: Priority Health SBD	$2,741.05

HC BARRX RFA

Facility

$2,044.39

Hospital Charge Code	36000101
Hospital Revenue Code	360
Min. Negotiated Rate	$817.76
Max. Negotiated Rate	$1,839.95
Rate for Payer: Aetna Commercial	$1,737.73
Rate for Payer: Aetna Medicare	$1,022.20
Rate for Payer: Aetna New Business (MI Preferred)	$1,328.85
Rate for Payer: BCBS Complete	$817.76
Rate for Payer: Cash Price	$1,635.51
Rate for Payer: Cofinity Commercial	$1,431.07
Rate for Payer: Cofinity Commercial	$1,758.18
Rate for Payer: Cofinity Medicare Advantage	$1,431.07
Rate for Payer: Encore Health Key Benefits Commercial	$1,635.51
Rate for Payer: Healthscope Commercial	$1,839.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,737.73
Rate for Payer: PHP Commercial	$1,737.73
Rate for Payer: Priority Health Cigna Priority Health	$1,328.85
Rate for Payer: Priority Health SBD	$1,287.97

HC BARRX RFA

Facility

$2,044.39

Hospital Charge Code	36000101
Hospital Revenue Code	360
Min. Negotiated Rate	$1,287.97
Max. Negotiated Rate	$1,839.95
Rate for Payer: Aetna Commercial	$1,737.73
Rate for Payer: Aetna New Business (MI Preferred)	$1,328.85
Rate for Payer: Cash Price	$1,635.51
Rate for Payer: Cofinity Commercial	$1,431.07
Rate for Payer: Cofinity Commercial	$1,758.18
Rate for Payer: Cofinity Medicare Advantage	$1,431.07
Rate for Payer: Encore Health Key Benefits Commercial	$1,635.51
Rate for Payer: Healthscope Commercial	$1,839.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,737.73
Rate for Payer: PHP Commercial	$1,737.73
Rate for Payer: Priority Health Cigna Priority Health	$1,328.85
Rate for Payer: Priority Health SBD	$1,287.97

HC BARRX ULTRA LONG RFA FOCAL CATHETER

Facility

$4,420.13

Hospital Charge Code	27200288
Hospital Revenue Code	272
Min. Negotiated Rate	$2,784.68
Max. Negotiated Rate	$3,978.12
Rate for Payer: Aetna Commercial	$3,757.11
Rate for Payer: Aetna New Business (MI Preferred)	$2,873.08
Rate for Payer: Cash Price	$3,536.10
Rate for Payer: Cofinity Commercial	$3,094.09
Rate for Payer: Cofinity Commercial	$3,801.31
Rate for Payer: Cofinity Medicare Advantage	$3,094.09
Rate for Payer: Encore Health Key Benefits Commercial	$3,536.10
Rate for Payer: Healthscope Commercial	$3,978.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,757.11
Rate for Payer: PHP Commercial	$3,757.11
Rate for Payer: Priority Health Cigna Priority Health	$2,873.08
Rate for Payer: Priority Health SBD	$2,784.68

HC BARRX ULTRA LONG RFA FOCAL CATHETER

Facility

$4,420.13

Hospital Charge Code	27200288
Hospital Revenue Code	272
Min. Negotiated Rate	$1,768.05
Max. Negotiated Rate	$3,978.12
Rate for Payer: Aetna Commercial	$3,757.11
Rate for Payer: Aetna Medicare	$2,210.07
Rate for Payer: Aetna New Business (MI Preferred)	$2,873.08
Rate for Payer: BCBS Complete	$1,768.05
Rate for Payer: Cash Price	$3,536.10
Rate for Payer: Cofinity Commercial	$3,094.09
Rate for Payer: Cofinity Commercial	$3,801.31
Rate for Payer: Cofinity Medicare Advantage	$3,094.09
Rate for Payer: Encore Health Key Benefits Commercial	$3,536.10
Rate for Payer: Healthscope Commercial	$3,978.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,757.11
Rate for Payer: PHP Commercial	$3,757.11
Rate for Payer: Priority Health Cigna Priority Health	$2,873.08
Rate for Payer: Priority Health SBD	$2,784.68

HC BARTONELLA HENSELAE CMPT

Facility

$16.66

Service Code	CPT 86611
Hospital Charge Code	30200227
Hospital Revenue Code	302
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna Commercial	$14.16
Rate for Payer: Aetna Medicare	$10.59
Rate for Payer: Aetna New Business (MI Preferred)	$10.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$12.72
Rate for Payer: Amish Plain Church Group Commercial	$12.72
Rate for Payer: BCBS Complete	$5.73
Rate for Payer: BCBS MAPPO	$10.18
Rate for Payer: BCN Medicare Advantage	$10.18
Rate for Payer: Cash Price	$13.33
Rate for Payer: Cash Price	$13.33
Rate for Payer: Cofinity Commercial	$14.33
Rate for Payer: Cofinity Commercial	$11.66
Rate for Payer: Cofinity Medicare Advantage	$11.66
Rate for Payer: Encore Health Key Benefits Commercial	$13.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$10.18
Rate for Payer: Healthscope Commercial	$14.99
Rate for Payer: Mclaren Medicaid	$5.46
Rate for Payer: Mclaren Medicare	$10.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10.69
Rate for Payer: Meridian Medicaid	$5.73
Rate for Payer: MI Amish Medical Board Commercial	$11.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.16
Rate for Payer: PACE Medicare	$9.67
Rate for Payer: PACE SWMI	$10.18
Rate for Payer: PHP Commercial	$14.16
Rate for Payer: PHP Medicare Advantage	$10.18
Rate for Payer: Priority Health Choice Medicaid	$5.46
Rate for Payer: Priority Health Cigna Priority Health	$10.83
Rate for Payer: Priority Health Medicare	$10.18
Rate for Payer: Priority Health SBD	$10.50
Rate for Payer: Railroad Medicare Medicare	$10.18
Rate for Payer: UHC All Payor (Choice/PPO)	$28.66
Rate for Payer: UHC Dual Complete DSNP	$10.18
Rate for Payer: UHC Medicare Advantage	$10.18
Rate for Payer: UHCCP Medicaid	$5.73
Rate for Payer: VA VA	$10.18

HC BARTONELLA HENSELAE CMPT

Facility

$16.66

Service Code	CPT 86611
Hospital Charge Code	30200227
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$14.99
Rate for Payer: Aetna Commercial	$14.16
Rate for Payer: Aetna New Business (MI Preferred)	$10.83
Rate for Payer: Cash Price	$13.33
Rate for Payer: Cofinity Commercial	$11.66
Rate for Payer: Cofinity Commercial	$14.33
Rate for Payer: Cofinity Medicare Advantage	$11.66
Rate for Payer: Encore Health Key Benefits Commercial	$13.33
Rate for Payer: Healthscope Commercial	$14.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.16
Rate for Payer: PHP Commercial	$14.16
Rate for Payer: Priority Health Cigna Priority Health	$10.83
Rate for Payer: Priority Health SBD	$10.50

HC BARTONELLA HENSELAE IGG IGM

Facility

$17.69

Service Code	CPT 86611
Hospital Charge Code	30200228
Hospital Revenue Code	302
Min. Negotiated Rate	$11.14
Max. Negotiated Rate	$15.92
Rate for Payer: Aetna Commercial	$15.04
Rate for Payer: Aetna New Business (MI Preferred)	$11.50
Rate for Payer: Cash Price	$14.15
Rate for Payer: Cofinity Commercial	$12.38
Rate for Payer: Cofinity Commercial	$15.21
Rate for Payer: Cofinity Medicare Advantage	$12.38
Rate for Payer: Encore Health Key Benefits Commercial	$14.15
Rate for Payer: Healthscope Commercial	$15.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.04
Rate for Payer: PHP Commercial	$15.04
Rate for Payer: Priority Health Cigna Priority Health	$11.50
Rate for Payer: Priority Health SBD	$11.14

HC BARTONELLA HENSELAE IGG IGM

Facility

$17.69

Service Code	CPT 86611
Hospital Charge Code	30200228
Hospital Revenue Code	302
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna Commercial	$15.04
Rate for Payer: Aetna Medicare	$10.59
Rate for Payer: Aetna New Business (MI Preferred)	$11.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$12.72
Rate for Payer: Amish Plain Church Group Commercial	$12.72
Rate for Payer: BCBS Complete	$5.73
Rate for Payer: BCBS MAPPO	$10.18
Rate for Payer: BCN Medicare Advantage	$10.18
Rate for Payer: Cash Price	$14.15
Rate for Payer: Cash Price	$14.15
Rate for Payer: Cofinity Commercial	$15.21
Rate for Payer: Cofinity Commercial	$12.38
Rate for Payer: Cofinity Medicare Advantage	$12.38
Rate for Payer: Encore Health Key Benefits Commercial	$14.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$10.18
Rate for Payer: Healthscope Commercial	$15.92
Rate for Payer: Mclaren Medicaid	$5.46
Rate for Payer: Mclaren Medicare	$10.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10.69
Rate for Payer: Meridian Medicaid	$5.73
Rate for Payer: MI Amish Medical Board Commercial	$11.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.04
Rate for Payer: PACE Medicare	$9.67
Rate for Payer: PACE SWMI	$10.18
Rate for Payer: PHP Commercial	$15.04
Rate for Payer: PHP Medicare Advantage	$10.18
Rate for Payer: Priority Health Choice Medicaid	$5.46
Rate for Payer: Priority Health Cigna Priority Health	$11.50
Rate for Payer: Priority Health Medicare	$10.18
Rate for Payer: Priority Health SBD	$11.14
Rate for Payer: Railroad Medicare Medicare	$10.18
Rate for Payer: UHC All Payor (Choice/PPO)	$28.66
Rate for Payer: UHC Dual Complete DSNP	$10.18
Rate for Payer: UHC Medicare Advantage	$10.18
Rate for Payer: UHCCP Medicaid	$5.73
Rate for Payer: VA VA	$10.18

HC BASIC METABOLIC PANEL

Facility

$31.84

Service Code	CPT 80048
Hospital Charge Code	30100010
Hospital Revenue Code	301
Min. Negotiated Rate	$20.06
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna New Business (MI Preferred)	$20.70
Rate for Payer: Cash Price	$25.47
Rate for Payer: Cofinity Commercial	$22.29
Rate for Payer: Cofinity Commercial	$27.38
Rate for Payer: Cofinity Medicare Advantage	$22.29
Rate for Payer: Encore Health Key Benefits Commercial	$25.47
Rate for Payer: Healthscope Commercial	$28.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.06
Rate for Payer: PHP Commercial	$27.06
Rate for Payer: Priority Health Cigna Priority Health	$20.70
Rate for Payer: Priority Health SBD	$20.06

HC BASIC METABOLIC PANEL

Facility

$31.84

Service Code	CPT 80048
Hospital Charge Code	30100010
Hospital Revenue Code	301
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$28.66
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna Medicare	$8.80
Rate for Payer: Aetna New Business (MI Preferred)	$20.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$10.57
Rate for Payer: Amish Plain Church Group Commercial	$10.57
Rate for Payer: BCBS Complete	$4.76
Rate for Payer: BCBS MAPPO	$8.46
Rate for Payer: BCN Medicare Advantage	$8.46
Rate for Payer: Cash Price	$25.47
Rate for Payer: Cash Price	$25.47
Rate for Payer: Cofinity Commercial	$27.38
Rate for Payer: Cofinity Commercial	$22.29
Rate for Payer: Cofinity Medicare Advantage	$22.29
Rate for Payer: Encore Health Key Benefits Commercial	$25.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$8.46
Rate for Payer: Healthscope Commercial	$28.66
Rate for Payer: Mclaren Medicaid	$4.53
Rate for Payer: Mclaren Medicare	$8.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.88
Rate for Payer: Meridian Medicaid	$4.76
Rate for Payer: MI Amish Medical Board Commercial	$9.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.06
Rate for Payer: PACE Medicare	$8.04
Rate for Payer: PACE SWMI	$8.46
Rate for Payer: PHP Commercial	$27.06
Rate for Payer: PHP Medicare Advantage	$8.46
Rate for Payer: Priority Health Choice Medicaid	$4.53
Rate for Payer: Priority Health Cigna Priority Health	$20.70
Rate for Payer: Priority Health Medicare	$8.46
Rate for Payer: Priority Health SBD	$20.06
Rate for Payer: Railroad Medicare Medicare	$8.46
Rate for Payer: UHC All Payor (Choice/PPO)	$23.81
Rate for Payer: UHC Dual Complete DSNP	$8.46
Rate for Payer: UHC Medicare Advantage	$8.46
Rate for Payer: UHCCP Medicaid	$4.76
Rate for Payer: VA VA	$8.46

HC BASIC METABOLIC W ION CALCIUM

Facility

$94.78

Service Code	CPT 80047
Hospital Charge Code	30100009
Hospital Revenue Code	301
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$85.30
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare	$14.28
Rate for Payer: Aetna New Business (MI Preferred)	$61.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$17.16
Rate for Payer: Amish Plain Church Group Commercial	$17.16
Rate for Payer: BCBS Complete	$7.73
Rate for Payer: BCBS MAPPO	$13.73
Rate for Payer: BCN Medicare Advantage	$13.73
Rate for Payer: Cash Price	$75.82
Rate for Payer: Cash Price	$75.82
Rate for Payer: Cofinity Commercial	$81.51
Rate for Payer: Cofinity Commercial	$66.35
Rate for Payer: Cofinity Medicare Advantage	$66.35
Rate for Payer: Encore Health Key Benefits Commercial	$75.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.73
Rate for Payer: Healthscope Commercial	$85.30
Rate for Payer: Mclaren Medicaid	$7.36
Rate for Payer: Mclaren Medicare	$13.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.42
Rate for Payer: Meridian Medicaid	$7.73
Rate for Payer: MI Amish Medical Board Commercial	$15.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.56
Rate for Payer: PACE Medicare	$13.04
Rate for Payer: PACE SWMI	$13.73
Rate for Payer: PHP Commercial	$80.56
Rate for Payer: PHP Medicare Advantage	$13.73
Rate for Payer: Priority Health Choice Medicaid	$7.36
Rate for Payer: Priority Health Cigna Priority Health	$61.61
Rate for Payer: Priority Health Medicare	$13.73
Rate for Payer: Priority Health SBD	$59.71
Rate for Payer: Railroad Medicare Medicare	$13.73
Rate for Payer: UHC All Payor (Choice/PPO)	$38.65
Rate for Payer: UHC Dual Complete DSNP	$13.73
Rate for Payer: UHC Medicare Advantage	$13.73
Rate for Payer: UHCCP Medicaid	$7.73
Rate for Payer: VA VA	$13.73

HC BASIC METABOLIC W ION CALCIUM

Facility

$94.78

Service Code	CPT 80047
Hospital Charge Code	30100009
Hospital Revenue Code	301
Min. Negotiated Rate	$59.71
Max. Negotiated Rate	$85.30
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna New Business (MI Preferred)	$61.61
Rate for Payer: Cash Price	$75.82
Rate for Payer: Cofinity Commercial	$66.35
Rate for Payer: Cofinity Commercial	$81.51
Rate for Payer: Cofinity Medicare Advantage	$66.35
Rate for Payer: Encore Health Key Benefits Commercial	$75.82
Rate for Payer: Healthscope Commercial	$85.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.56
Rate for Payer: PHP Commercial	$80.56
Rate for Payer: Priority Health Cigna Priority Health	$61.61
Rate for Payer: Priority Health SBD	$59.71

HC BASIC RAD DOSIMETRY

Facility

$431.77

Service Code	CPT 77300
Hospital Charge Code	33300005
Hospital Revenue Code	333
Min. Negotiated Rate	$272.02
Max. Negotiated Rate	$388.59
Rate for Payer: Aetna Commercial	$367.00
Rate for Payer: Aetna New Business (MI Preferred)	$280.65
Rate for Payer: Cash Price	$345.42
Rate for Payer: Cofinity Commercial	$302.24
Rate for Payer: Cofinity Commercial	$371.32
Rate for Payer: Cofinity Medicare Advantage	$302.24
Rate for Payer: Encore Health Key Benefits Commercial	$345.42
Rate for Payer: Healthscope Commercial	$388.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.00
Rate for Payer: PHP Commercial	$367.00
Rate for Payer: Priority Health Cigna Priority Health	$280.65
Rate for Payer: Priority Health SBD	$272.02

Know your out-of-pocket cost for care.

All Charges