Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC GOLD PROBE HEMOSTASIS

Facility

$600.43

Hospital Charge Code	27000080
Hospital Revenue Code	270
Min. Negotiated Rate	$240.17
Max. Negotiated Rate	$540.39
Rate for Payer: Aetna Commercial	$510.37
Rate for Payer: Aetna New Business (MI Preferred)	$390.28
Rate for Payer: BCBS Complete	$240.17
Rate for Payer: Cash Price	$480.34
Rate for Payer: Cofinity Commercial	$420.30
Rate for Payer: Cofinity Commercial	$516.37
Rate for Payer: Healthscope Commercial	$540.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$510.37
Rate for Payer: PHP Commercial	$510.37
Rate for Payer: Priority Health Cigna Priority Health	$420.30
Rate for Payer: Priority Health SBD	$378.27

HC GOLD PROBE HEMOSTASIS

Facility

$600.43

Hospital Charge Code	27000080
Hospital Revenue Code	270
Min. Negotiated Rate	$378.27
Max. Negotiated Rate	$540.39
Rate for Payer: Aetna Commercial	$510.37
Rate for Payer: Aetna New Business (MI Preferred)	$390.28
Rate for Payer: Cash Price	$480.34
Rate for Payer: Cofinity Commercial	$420.30
Rate for Payer: Cofinity Commercial	$516.37
Rate for Payer: Healthscope Commercial	$540.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$510.37
Rate for Payer: PHP Commercial	$510.37
Rate for Payer: Priority Health Cigna Priority Health	$420.30
Rate for Payer: Priority Health SBD	$378.27

HC GOOSE FEATHERS IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200087
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health SBD	$15.68

HC GOOSE FEATHERS IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200087
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$15.68
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC GRAFIX PRIME 1.5 X 2 PER SQ CM

Facility

$748.01

Service Code	HCPCS Q4133
Hospital Charge Code	63600159
Hospital Revenue Code	636
Min. Negotiated Rate	$155.21
Max. Negotiated Rate	$673.21
Rate for Payer: Aetna Commercial	$635.81
Rate for Payer: Aetna New Business (MI Preferred)	$486.21
Rate for Payer: BCBS Complete	$299.20
Rate for Payer: BCBS Trust/PPO	$155.21
Rate for Payer: Cash Price	$598.41
Rate for Payer: Cash Price	$598.41
Rate for Payer: Cofinity Commercial	$523.61
Rate for Payer: Cofinity Commercial	$643.29
Rate for Payer: Healthscope Commercial	$673.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$635.81
Rate for Payer: PHP Commercial	$635.81
Rate for Payer: Priority Health Cigna Priority Health	$523.61
Rate for Payer: Priority Health SBD	$471.25

HC GRAFIX PRIME 1.5 X 2 PER SQ CM

Facility

$748.01

Service Code	HCPCS Q4133
Hospital Charge Code	63600159
Hospital Revenue Code	636
Min. Negotiated Rate	$471.25
Max. Negotiated Rate	$673.21
Rate for Payer: Aetna Commercial	$635.81
Rate for Payer: Aetna New Business (MI Preferred)	$486.21
Rate for Payer: Cash Price	$598.41
Rate for Payer: Cofinity Commercial	$643.29
Rate for Payer: Cofinity Commercial	$523.61
Rate for Payer: Healthscope Commercial	$673.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$635.81
Rate for Payer: PHP Commercial	$635.81
Rate for Payer: Priority Health Cigna Priority Health	$523.61
Rate for Payer: Priority Health SBD	$471.25

HC GRAFIX PRIME (16 MM) DISC PER SQ CM

Facility

$757.35

Service Code	HCPCS Q4133
Hospital Charge Code	63600158
Hospital Revenue Code	636
Min. Negotiated Rate	$155.21
Max. Negotiated Rate	$681.62
Rate for Payer: Aetna Commercial	$643.75
Rate for Payer: Aetna New Business (MI Preferred)	$492.28
Rate for Payer: BCBS Complete	$302.94
Rate for Payer: BCBS Trust/PPO	$155.21
Rate for Payer: Cash Price	$605.88
Rate for Payer: Cash Price	$605.88
Rate for Payer: Cofinity Commercial	$530.14
Rate for Payer: Cofinity Commercial	$651.32
Rate for Payer: Healthscope Commercial	$681.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$643.75
Rate for Payer: PHP Commercial	$643.75
Rate for Payer: Priority Health Cigna Priority Health	$530.14
Rate for Payer: Priority Health SBD	$477.13

HC GRAFIX PRIME (16 MM) DISC PER SQ CM

Facility

$757.35

Service Code	HCPCS Q4133
Hospital Charge Code	63600158
Hospital Revenue Code	636
Min. Negotiated Rate	$477.13
Max. Negotiated Rate	$681.62
Rate for Payer: Aetna Commercial	$643.75
Rate for Payer: Aetna New Business (MI Preferred)	$492.28
Rate for Payer: Cash Price	$605.88
Rate for Payer: Cofinity Commercial	$530.14
Rate for Payer: Cofinity Commercial	$651.32
Rate for Payer: Healthscope Commercial	$681.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$643.75
Rate for Payer: PHP Commercial	$643.75
Rate for Payer: Priority Health Cigna Priority Health	$530.14
Rate for Payer: Priority Health SBD	$477.13

HC GRAFIX PRIME 2 X 3 PER SQ CM

Facility

$467.51

Service Code	HCPCS Q4133
Hospital Charge Code	63600160
Hospital Revenue Code	636
Min. Negotiated Rate	$294.53
Max. Negotiated Rate	$420.76
Rate for Payer: Aetna Commercial	$397.38
Rate for Payer: Aetna New Business (MI Preferred)	$303.88
Rate for Payer: Cash Price	$374.01
Rate for Payer: Cofinity Commercial	$327.26
Rate for Payer: Cofinity Commercial	$402.06
Rate for Payer: Healthscope Commercial	$420.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$397.38
Rate for Payer: PHP Commercial	$397.38
Rate for Payer: Priority Health Cigna Priority Health	$327.26
Rate for Payer: Priority Health SBD	$294.53

HC GRAFIX PRIME 2 X 3 PER SQ CM

Facility

$467.51

Service Code	HCPCS Q4133
Hospital Charge Code	63600160
Hospital Revenue Code	636
Min. Negotiated Rate	$155.21
Max. Negotiated Rate	$420.76
Rate for Payer: Aetna Commercial	$397.38
Rate for Payer: Aetna New Business (MI Preferred)	$303.88
Rate for Payer: BCBS Complete	$187.00
Rate for Payer: BCBS Trust/PPO	$155.21
Rate for Payer: Cash Price	$374.01
Rate for Payer: Cash Price	$374.01
Rate for Payer: Cofinity Commercial	$327.26
Rate for Payer: Cofinity Commercial	$402.06
Rate for Payer: Healthscope Commercial	$420.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$397.38
Rate for Payer: PHP Commercial	$397.38
Rate for Payer: Priority Health Cigna Priority Health	$327.26
Rate for Payer: Priority Health SBD	$294.53

HC GRAFIX PRIME 3 X 4 PER SQ CM

Facility

$272.53

Service Code	HCPCS Q4133
Hospital Charge Code	63600161
Hospital Revenue Code	636
Min. Negotiated Rate	$171.69
Max. Negotiated Rate	$245.28
Rate for Payer: Aetna Commercial	$231.65
Rate for Payer: Aetna New Business (MI Preferred)	$177.14
Rate for Payer: Cash Price	$218.02
Rate for Payer: Cofinity Commercial	$190.77
Rate for Payer: Cofinity Commercial	$234.38
Rate for Payer: Healthscope Commercial	$245.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.65
Rate for Payer: PHP Commercial	$231.65
Rate for Payer: Priority Health Cigna Priority Health	$190.77
Rate for Payer: Priority Health SBD	$171.69

HC GRAFIX PRIME 3 X 4 PER SQ CM

Facility

$272.53

Service Code	HCPCS Q4133
Hospital Charge Code	63600161
Hospital Revenue Code	636
Min. Negotiated Rate	$109.01
Max. Negotiated Rate	$245.28
Rate for Payer: Aetna Commercial	$231.65
Rate for Payer: Aetna New Business (MI Preferred)	$177.14
Rate for Payer: BCBS Complete	$109.01
Rate for Payer: BCBS Trust/PPO	$155.21
Rate for Payer: Cash Price	$218.02
Rate for Payer: Cash Price	$218.02
Rate for Payer: Cofinity Commercial	$190.77
Rate for Payer: Cofinity Commercial	$234.38
Rate for Payer: Healthscope Commercial	$245.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.65
Rate for Payer: PHP Commercial	$231.65
Rate for Payer: Priority Health Cigna Priority Health	$190.77
Rate for Payer: Priority Health SBD	$171.69

HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE

Facility

$2,410.57

Service Code	CPT 15115
Hospital Charge Code	76100067
Hospital Revenue Code	761
Min. Negotiated Rate	$1,518.66
Max. Negotiated Rate	$2,169.51
Rate for Payer: Aetna Commercial	$2,048.98
Rate for Payer: Aetna New Business (MI Preferred)	$1,566.87
Rate for Payer: Cash Price	$1,928.46
Rate for Payer: Cofinity Commercial	$2,073.09
Rate for Payer: Cofinity Commercial	$1,687.40
Rate for Payer: Healthscope Commercial	$2,169.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,048.98
Rate for Payer: PHP Commercial	$2,048.98
Rate for Payer: Priority Health Cigna Priority Health	$1,687.40
Rate for Payer: Priority Health SBD	$1,518.66

HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE

Facility

$2,410.57

Service Code	CPT 15115
Hospital Charge Code	76100067
Hospital Revenue Code	761
Min. Negotiated Rate	$684.35
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Commercial	$2,048.98
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,566.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$781.37
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Cash Price	$1,928.46
Rate for Payer: Cash Price	$1,928.46
Rate for Payer: Cofinity Commercial	$2,073.09
Rate for Payer: Cofinity Commercial	$1,687.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Healthscope Commercial	$2,169.51
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,048.98
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Commercial	$2,048.98
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health Cigna Priority Health	$1,687.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Priority Health SBD	$1,518.66
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$752.78
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$684.35
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK

Facility

$3,156.22

Service Code	CPT 15110
Hospital Charge Code	76100066
Hospital Revenue Code	761
Min. Negotiated Rate	$1,988.42
Max. Negotiated Rate	$2,840.60
Rate for Payer: Aetna Commercial	$2,682.79
Rate for Payer: Aetna New Business (MI Preferred)	$2,051.54
Rate for Payer: Cash Price	$2,524.98
Rate for Payer: Cofinity Commercial	$2,714.35
Rate for Payer: Cofinity Commercial	$2,209.35
Rate for Payer: Healthscope Commercial	$2,840.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,682.79
Rate for Payer: PHP Commercial	$2,682.79
Rate for Payer: Priority Health Cigna Priority Health	$2,209.35
Rate for Payer: Priority Health SBD	$1,988.42

HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK

Facility

$3,156.22

Service Code	CPT 15110
Hospital Charge Code	76100066
Hospital Revenue Code	761
Min. Negotiated Rate	$570.51
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Commercial	$2,682.79
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Aetna New Business (MI Preferred)	$2,051.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$570.51
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Cash Price	$2,524.98
Rate for Payer: Cash Price	$2,524.98
Rate for Payer: Cofinity Commercial	$2,714.35
Rate for Payer: Cofinity Commercial	$2,209.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Healthscope Commercial	$2,840.60
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,682.79
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Commercial	$2,682.79
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health Cigna Priority Health	$2,209.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Priority Health SBD	$1,988.42
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$773.68
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$703.35
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

HC GRAM STAIN

Facility

$50.30

Service Code	CPT 87205
Hospital Charge Code	30600104
Hospital Revenue Code	306
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$45.27
Rate for Payer: Aetna Commercial	$42.76
Rate for Payer: Aetna Medicare	$4.44
Rate for Payer: Aetna New Business (MI Preferred)	$32.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.34
Rate for Payer: Amish Plain Church Group Commercial	$5.34
Rate for Payer: BCBS Complete	$2.45
Rate for Payer: BCBS MAPPO	$4.27
Rate for Payer: BCBS Trust/PPO	$3.34
Rate for Payer: BCN Medicare Advantage	$4.27
Rate for Payer: Cash Price	$40.24
Rate for Payer: Cash Price	$40.24
Rate for Payer: Cofinity Commercial	$43.26
Rate for Payer: Cofinity Commercial	$35.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.27
Rate for Payer: Healthscope Commercial	$45.27
Rate for Payer: Mclaren Medicaid	$2.34
Rate for Payer: Mclaren Medicare	$4.27
Rate for Payer: Meridian Medicaid	$2.45
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4.48
Rate for Payer: MI Amish Medical Board Commercial	$4.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.76
Rate for Payer: PACE Medicare	$4.06
Rate for Payer: PACE SWMI	$4.27
Rate for Payer: PHP Commercial	$42.76
Rate for Payer: PHP Medicare Advantage	$4.27
Rate for Payer: Priority Health Choice Medicaid	$2.34
Rate for Payer: Priority Health Cigna Priority Health	$35.21
Rate for Payer: Priority Health Medicare	$4.27
Rate for Payer: Priority Health SBD	$31.69
Rate for Payer: Railroad Medicare Medicare	$4.27
Rate for Payer: UHC All Payor (Choice/PPO)	$5.12
Rate for Payer: UHC Core	$7.26
Rate for Payer: UHC Dual Complete DSNP	$4.27
Rate for Payer: UHC Exchange	$4.27
Rate for Payer: UHC Medicare Advantage	$4.40
Rate for Payer: VA VA	$4.27

HC GRAM STAIN

Facility

$50.30

Service Code	CPT 87205
Hospital Charge Code	30600104
Hospital Revenue Code	306
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$45.27
Rate for Payer: Aetna Commercial	$42.76
Rate for Payer: Aetna New Business (MI Preferred)	$32.70
Rate for Payer: Cash Price	$40.24
Rate for Payer: Cofinity Commercial	$35.21
Rate for Payer: Cofinity Commercial	$43.26
Rate for Payer: Healthscope Commercial	$45.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.76
Rate for Payer: PHP Commercial	$42.76
Rate for Payer: Priority Health Cigna Priority Health	$35.21
Rate for Payer: Priority Health SBD	$31.69

HC GRANULOCYTES

Facility

$1,888.00

Service Code	HCPCS P9050
Hospital Charge Code	39000057
Hospital Revenue Code	390
Min. Negotiated Rate	$755.20
Max. Negotiated Rate	$4,412.25
Rate for Payer: Aetna Commercial	$1,604.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,227.20
Rate for Payer: BCBS Complete	$755.20
Rate for Payer: BCBS Trust/PPO	$4,412.25
Rate for Payer: Cash Price	$1,510.40
Rate for Payer: Cash Price	$1,510.40
Rate for Payer: Cofinity Commercial	$1,321.60
Rate for Payer: Cofinity Commercial	$1,623.68
Rate for Payer: Healthscope Commercial	$1,699.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,604.80
Rate for Payer: PHP Commercial	$1,604.80
Rate for Payer: Priority Health Cigna Priority Health	$1,321.60
Rate for Payer: Priority Health SBD	$1,189.44

HC GRANULOCYTES

Facility

$1,888.00

Service Code	HCPCS P9050
Hospital Charge Code	39000057
Hospital Revenue Code	390
Min. Negotiated Rate	$1,189.44
Max. Negotiated Rate	$1,699.20
Rate for Payer: Aetna Commercial	$1,604.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,227.20
Rate for Payer: Cash Price	$1,510.40
Rate for Payer: Cofinity Commercial	$1,321.60
Rate for Payer: Cofinity Commercial	$1,623.68
Rate for Payer: Healthscope Commercial	$1,699.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,604.80
Rate for Payer: PHP Commercial	$1,604.80
Rate for Payer: Priority Health Cigna Priority Health	$1,321.60
Rate for Payer: Priority Health SBD	$1,189.44

HC GRASS ALLERGEN PANEL

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200122
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health SBD	$15.68

HC GRASS ALLERGEN PANEL

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200122
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$15.68
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC GREAT LAKES DISABILITY FILM(EACH)

Facility

$20.00

Hospital Charge Code	32000267
Hospital Revenue Code	320
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health SBD	$12.60

HC GREAT LAKES DISABILITY FILM(EACH)

Facility

$20.00

Hospital Charge Code	32000267
Hospital Revenue Code	320
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health SBD	$12.60
Rate for Payer: UHC Core	$14.80

HC GROIN/PSEUDO IMAGING BILATERAL

Facility

$1,415.42

Service Code	CPT 93925
Hospital Charge Code	92100027
Hospital Revenue Code	921
Min. Negotiated Rate	$119.26
Max. Negotiated Rate	$1,273.88
Rate for Payer: Aetna Commercial	$1,203.11
Rate for Payer: Aetna Medicare	$226.75
Rate for Payer: Aetna New Business (MI Preferred)	$920.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$272.54
Rate for Payer: Amish Plain Church Group Commercial	$272.54
Rate for Payer: BCBS Complete	$125.24
Rate for Payer: BCBS MAPPO	$218.03
Rate for Payer: BCBS Trust/PPO	$936.39
Rate for Payer: BCN Medicare Advantage	$218.03
Rate for Payer: Cash Price	$1,132.34
Rate for Payer: Cash Price	$1,132.34
Rate for Payer: Cofinity Commercial	$990.79
Rate for Payer: Cofinity Commercial	$1,217.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$218.03
Rate for Payer: Healthscope Commercial	$1,273.88
Rate for Payer: Mclaren Medicaid	$119.26
Rate for Payer: Mclaren Medicare	$218.03
Rate for Payer: Meridian Medicaid	$125.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$228.93
Rate for Payer: MI Amish Medical Board Commercial	$250.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,203.11
Rate for Payer: PACE Medicare	$207.13
Rate for Payer: PACE SWMI	$218.03
Rate for Payer: PHP Commercial	$1,203.11
Rate for Payer: PHP Medicare Advantage	$218.03
Rate for Payer: Priority Health Choice Medicaid	$119.26
Rate for Payer: Priority Health Cigna Priority Health	$990.79
Rate for Payer: Priority Health Medicare	$218.03
Rate for Payer: Priority Health SBD	$891.71
Rate for Payer: Railroad Medicare Medicare	$218.03
Rate for Payer: UHC All Payor (Choice/PPO)	$259.70
Rate for Payer: UHC Dual Complete DSNP	$218.03
Rate for Payer: UHC Exchange	$236.09
Rate for Payer: UHC Medicare Advantage	$224.57
Rate for Payer: VA VA	$218.03

Know your out-of-pocket cost for care.

All Charges