Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC HYSTEROSCOPY ENDOMETR ABLATION

Facility

$13,091.70

Service Code	CPT 58563
Hospital Charge Code	76100340
Hospital Revenue Code	761
Min. Negotiated Rate	$240.67
Max. Negotiated Rate	$11,782.53
Rate for Payer: Aetna Commercial	$11,127.94
Rate for Payer: Aetna Medicare	$4,602.78
Rate for Payer: Aetna New Business (MI Preferred)	$8,509.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,532.19
Rate for Payer: Amish Plain Church Group Commercial	$5,532.19
Rate for Payer: BCBS Complete	$2,542.15
Rate for Payer: BCBS MAPPO	$4,425.75
Rate for Payer: BCBS Trust/PPO	$1,983.85
Rate for Payer: BCN Medicare Advantage	$4,425.75
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cofinity Commercial	$11,258.86
Rate for Payer: Cofinity Commercial	$9,164.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,425.75
Rate for Payer: Healthscope Commercial	$11,782.53
Rate for Payer: Mclaren Medicaid	$2,420.89
Rate for Payer: Mclaren Medicare	$4,425.75
Rate for Payer: Meridian Medicaid	$2,542.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,647.04
Rate for Payer: MI Amish Medical Board Commercial	$5,089.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,127.94
Rate for Payer: PACE Medicare	$4,204.46
Rate for Payer: PACE SWMI	$4,425.75
Rate for Payer: PHP Commercial	$11,127.94
Rate for Payer: PHP Medicare Advantage	$4,425.75
Rate for Payer: Priority Health Choice Medicaid	$2,420.89
Rate for Payer: Priority Health Cigna Priority Health	$9,164.19
Rate for Payer: Priority Health Medicare	$4,425.75
Rate for Payer: Priority Health SBD	$8,247.77
Rate for Payer: Railroad Medicare Medicare	$4,425.75
Rate for Payer: UHC All Payor (Choice/PPO)	$264.74
Rate for Payer: UHC Dual Complete DSNP	$4,425.75
Rate for Payer: UHC Exchange	$240.67
Rate for Payer: UHC Medicare Advantage	$4,558.52
Rate for Payer: VA VA	$4,425.75

HC HYSTEROSCOPY REMOVE FB

Facility

$7,789.74

Service Code	CPT 58562
Hospital Charge Code	76100339
Hospital Revenue Code	761
Min. Negotiated Rate	$217.09
Max. Negotiated Rate	$7,010.77
Rate for Payer: Aetna Commercial	$6,621.28
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$5,063.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$1,505.59
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$6,231.79
Rate for Payer: Cash Price	$6,231.79
Rate for Payer: Cofinity Commercial	$6,699.18
Rate for Payer: Cofinity Commercial	$5,452.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$7,010.77
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,621.28
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$6,621.28
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$5,452.82
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$4,907.54
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$238.80
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$217.09
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

HC HYSTEROSCOPY REMOVE FB

Facility

$7,789.74

Service Code	CPT 58562
Hospital Charge Code	76100339
Hospital Revenue Code	761
Min. Negotiated Rate	$4,907.54
Max. Negotiated Rate	$7,010.77
Rate for Payer: Aetna Commercial	$6,621.28
Rate for Payer: Aetna New Business (MI Preferred)	$5,063.33
Rate for Payer: Cash Price	$6,231.79
Rate for Payer: Cofinity Commercial	$5,452.82
Rate for Payer: Cofinity Commercial	$6,699.18
Rate for Payer: Healthscope Commercial	$7,010.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,621.28
Rate for Payer: PHP Commercial	$6,621.28
Rate for Payer: Priority Health Cigna Priority Health	$5,452.82
Rate for Payer: Priority Health SBD	$4,907.54

HC HYSTEROSCOPY REMOVE MYOMA

Facility

$13,091.70

Service Code	CPT 58561
Hospital Charge Code	76100338
Hospital Revenue Code	761
Min. Negotiated Rate	$8,247.77
Max. Negotiated Rate	$11,782.53
Rate for Payer: Aetna Commercial	$11,127.94
Rate for Payer: Aetna New Business (MI Preferred)	$8,509.60
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cofinity Commercial	$11,258.86
Rate for Payer: Cofinity Commercial	$9,164.19
Rate for Payer: Healthscope Commercial	$11,782.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,127.94
Rate for Payer: PHP Commercial	$11,127.94
Rate for Payer: Priority Health Cigna Priority Health	$9,164.19
Rate for Payer: Priority Health SBD	$8,247.77

HC HYSTEROSCOPY REMOVE MYOMA

Facility

$13,091.70

Service Code	CPT 58561
Hospital Charge Code	76100338
Hospital Revenue Code	761
Min. Negotiated Rate	$350.36
Max. Negotiated Rate	$11,782.53
Rate for Payer: Aetna Commercial	$11,127.94
Rate for Payer: Aetna Medicare	$4,602.78
Rate for Payer: Aetna New Business (MI Preferred)	$8,509.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,532.19
Rate for Payer: Amish Plain Church Group Commercial	$5,532.19
Rate for Payer: BCBS Complete	$2,542.15
Rate for Payer: BCBS MAPPO	$4,425.75
Rate for Payer: BCBS Trust/PPO	$2,395.50
Rate for Payer: BCN Medicare Advantage	$4,425.75
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cofinity Commercial	$9,164.19
Rate for Payer: Cofinity Commercial	$11,258.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,425.75
Rate for Payer: Healthscope Commercial	$11,782.53
Rate for Payer: Mclaren Medicaid	$2,420.89
Rate for Payer: Mclaren Medicare	$4,425.75
Rate for Payer: Meridian Medicaid	$2,542.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,647.04
Rate for Payer: MI Amish Medical Board Commercial	$5,089.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,127.94
Rate for Payer: PACE Medicare	$4,204.46
Rate for Payer: PACE SWMI	$4,425.75
Rate for Payer: PHP Commercial	$11,127.94
Rate for Payer: PHP Medicare Advantage	$4,425.75
Rate for Payer: Priority Health Choice Medicaid	$2,420.89
Rate for Payer: Priority Health Cigna Priority Health	$9,164.19
Rate for Payer: Priority Health Medicare	$4,425.75
Rate for Payer: Priority Health SBD	$8,247.77
Rate for Payer: Railroad Medicare Medicare	$4,425.75
Rate for Payer: UHC All Payor (Choice/PPO)	$385.40
Rate for Payer: UHC Dual Complete DSNP	$4,425.75
Rate for Payer: UHC Exchange	$350.36
Rate for Payer: UHC Medicare Advantage	$4,558.52
Rate for Payer: VA VA	$4,425.75

HC HYSTEROSCOPY RESECT SEPTUM

Facility

$13,091.70

Service Code	CPT 58560
Hospital Charge Code	76100337
Hospital Revenue Code	761
Min. Negotiated Rate	$306.16
Max. Negotiated Rate	$11,782.53
Rate for Payer: Aetna Commercial	$11,127.94
Rate for Payer: Aetna Medicare	$4,602.78
Rate for Payer: Aetna New Business (MI Preferred)	$8,509.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,532.19
Rate for Payer: Amish Plain Church Group Commercial	$5,532.19
Rate for Payer: BCBS Complete	$2,542.15
Rate for Payer: BCBS MAPPO	$4,425.75
Rate for Payer: BCBS Trust/PPO	$1,819.45
Rate for Payer: BCN Medicare Advantage	$4,425.75
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cofinity Commercial	$9,164.19
Rate for Payer: Cofinity Commercial	$11,258.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,425.75
Rate for Payer: Healthscope Commercial	$11,782.53
Rate for Payer: Mclaren Medicaid	$2,420.89
Rate for Payer: Mclaren Medicare	$4,425.75
Rate for Payer: Meridian Medicaid	$2,542.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,647.04
Rate for Payer: MI Amish Medical Board Commercial	$5,089.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,127.94
Rate for Payer: PACE Medicare	$4,204.46
Rate for Payer: PACE SWMI	$4,425.75
Rate for Payer: PHP Commercial	$11,127.94
Rate for Payer: PHP Medicare Advantage	$4,425.75
Rate for Payer: Priority Health Choice Medicaid	$2,420.89
Rate for Payer: Priority Health Cigna Priority Health	$9,164.19
Rate for Payer: Priority Health Medicare	$4,425.75
Rate for Payer: Priority Health SBD	$8,247.77
Rate for Payer: Railroad Medicare Medicare	$4,425.75
Rate for Payer: UHC All Payor (Choice/PPO)	$336.78
Rate for Payer: UHC Dual Complete DSNP	$4,425.75
Rate for Payer: UHC Exchange	$306.16
Rate for Payer: UHC Medicare Advantage	$4,558.52
Rate for Payer: VA VA	$4,425.75

HC HYSTEROSCOPY RESECT SEPTUM

Facility

$13,091.70

Service Code	CPT 58560
Hospital Charge Code	76100337
Hospital Revenue Code	761
Min. Negotiated Rate	$8,247.77
Max. Negotiated Rate	$11,782.53
Rate for Payer: Aetna Commercial	$11,127.94
Rate for Payer: Aetna New Business (MI Preferred)	$8,509.60
Rate for Payer: Cash Price	$10,473.36
Rate for Payer: Cofinity Commercial	$11,258.86
Rate for Payer: Cofinity Commercial	$9,164.19
Rate for Payer: Healthscope Commercial	$11,782.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,127.94
Rate for Payer: PHP Commercial	$11,127.94
Rate for Payer: Priority Health Cigna Priority Health	$9,164.19
Rate for Payer: Priority Health SBD	$8,247.77

HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C

Facility

$4,013.52

Service Code	CPT 58558
Hospital Charge Code	76100304
Hospital Revenue Code	761
Min. Negotiated Rate	$2,528.52
Max. Negotiated Rate	$3,612.17
Rate for Payer: Aetna Commercial	$3,411.49
Rate for Payer: Aetna New Business (MI Preferred)	$2,608.79
Rate for Payer: Cash Price	$3,210.82
Rate for Payer: Cofinity Commercial	$2,809.46
Rate for Payer: Cofinity Commercial	$3,451.63
Rate for Payer: Healthscope Commercial	$3,612.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,411.49
Rate for Payer: PHP Commercial	$3,411.49
Rate for Payer: Priority Health Cigna Priority Health	$2,809.46
Rate for Payer: Priority Health SBD	$2,528.52

HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C

Facility

$4,013.52

Service Code	CPT 58558
Hospital Charge Code	76100304
Hospital Revenue Code	761
Min. Negotiated Rate	$226.59
Max. Negotiated Rate	$3,612.17
Rate for Payer: Aetna Commercial	$3,411.49
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$2,608.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$1,799.23
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$3,210.82
Rate for Payer: Cash Price	$3,210.82
Rate for Payer: Cofinity Commercial	$3,451.63
Rate for Payer: Cofinity Commercial	$2,809.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$3,612.17
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,411.49
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$3,411.49
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$2,809.46
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$2,528.52
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$249.25
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$226.59
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

HC I-123 CAPSULE PER 100 UCI

Facility

$103.60

Service Code	HCPCS A9516
Hospital Charge Code	34300009
Hospital Revenue Code	343
Min. Negotiated Rate	$65.27
Max. Negotiated Rate	$93.24
Rate for Payer: Aetna Commercial	$88.06
Rate for Payer: Aetna New Business (MI Preferred)	$67.34
Rate for Payer: Cash Price	$82.88
Rate for Payer: Cofinity Commercial	$72.52
Rate for Payer: Cofinity Commercial	$89.10
Rate for Payer: Healthscope Commercial	$93.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.06
Rate for Payer: PHP Commercial	$88.06
Rate for Payer: Priority Health Cigna Priority Health	$72.52
Rate for Payer: Priority Health SBD	$65.27

HC I-123 CAPSULE PER 100 UCI

Facility

$103.60

Service Code	HCPCS A9516
Hospital Charge Code	34300009
Hospital Revenue Code	343
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$93.24
Rate for Payer: Aetna Commercial	$88.06
Rate for Payer: Aetna New Business (MI Preferred)	$67.34
Rate for Payer: BCBS Complete	$41.44
Rate for Payer: BCBS Trust/PPO	$60.17
Rate for Payer: Cash Price	$82.88
Rate for Payer: Cash Price	$82.88
Rate for Payer: Cofinity Commercial	$72.52
Rate for Payer: Cofinity Commercial	$89.10
Rate for Payer: Healthscope Commercial	$93.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.06
Rate for Payer: PHP Commercial	$88.06
Rate for Payer: Priority Health Cigna Priority Health	$72.52
Rate for Payer: Priority Health SBD	$65.27

HC I-123 MIBG PER STUDY

Facility

$11,938.04

Service Code	HCPCS A9582
Hospital Charge Code	34300010
Hospital Revenue Code	343
Min. Negotiated Rate	$7,520.97
Max. Negotiated Rate	$10,744.24
Rate for Payer: Aetna Commercial	$10,147.33
Rate for Payer: Aetna New Business (MI Preferred)	$7,759.73
Rate for Payer: Cash Price	$9,550.43
Rate for Payer: Cofinity Commercial	$10,266.71
Rate for Payer: Cofinity Commercial	$8,356.63
Rate for Payer: Healthscope Commercial	$10,744.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10,147.33
Rate for Payer: PHP Commercial	$10,147.33
Rate for Payer: Priority Health Cigna Priority Health	$8,356.63
Rate for Payer: Priority Health SBD	$7,520.97

HC I-123 MIBG PER STUDY

Facility

$11,938.04

Service Code	HCPCS A9582
Hospital Charge Code	34300010
Hospital Revenue Code	343
Min. Negotiated Rate	$4,775.22
Max. Negotiated Rate	$10,744.24
Rate for Payer: Aetna Commercial	$10,147.33
Rate for Payer: Aetna New Business (MI Preferred)	$7,759.73
Rate for Payer: BCBS Complete	$4,775.22
Rate for Payer: BCBS Trust/PPO	$6,164.55
Rate for Payer: Cash Price	$9,550.43
Rate for Payer: Cash Price	$9,550.43
Rate for Payer: Cofinity Commercial	$10,266.71
Rate for Payer: Cofinity Commercial	$8,356.63
Rate for Payer: Healthscope Commercial	$10,744.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10,147.33
Rate for Payer: PHP Commercial	$10,147.33
Rate for Payer: Priority Health Cigna Priority Health	$8,356.63
Rate for Payer: Priority Health SBD	$7,520.97

HC I-131 CAP (DX) PER MCI

Facility

$73.47

Service Code	HCPCS A9528
Hospital Charge Code	34300011
Hospital Revenue Code	343
Min. Negotiated Rate	$46.29
Max. Negotiated Rate	$66.12
Rate for Payer: Aetna Commercial	$62.45
Rate for Payer: Aetna New Business (MI Preferred)	$47.76
Rate for Payer: Cash Price	$58.78
Rate for Payer: Cofinity Commercial	$51.43
Rate for Payer: Cofinity Commercial	$63.18
Rate for Payer: Healthscope Commercial	$66.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$62.45
Rate for Payer: PHP Commercial	$62.45
Rate for Payer: Priority Health Cigna Priority Health	$51.43
Rate for Payer: Priority Health SBD	$46.29

HC I-131 CAP (DX) PER MCI

Facility

$73.47

Service Code	HCPCS A9528
Hospital Charge Code	34300011
Hospital Revenue Code	343
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$130.51
Rate for Payer: Aetna Commercial	$62.45
Rate for Payer: Aetna New Business (MI Preferred)	$47.76
Rate for Payer: BCBS Complete	$29.39
Rate for Payer: BCBS Trust/PPO	$130.51
Rate for Payer: Cash Price	$58.78
Rate for Payer: Cash Price	$58.78
Rate for Payer: Cofinity Commercial	$63.18
Rate for Payer: Cofinity Commercial	$51.43
Rate for Payer: Healthscope Commercial	$66.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$62.45
Rate for Payer: PHP Commercial	$62.45
Rate for Payer: Priority Health Cigna Priority Health	$51.43
Rate for Payer: Priority Health SBD	$46.29

HC I-131 CAP (TX) PER MCI

Facility

$66.79

Service Code	HCPCS A9517
Hospital Charge Code	34400001
Hospital Revenue Code	344
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$60.11
Rate for Payer: Aetna Commercial	$56.77
Rate for Payer: Aetna New Business (MI Preferred)	$43.41
Rate for Payer: Cash Price	$53.43
Rate for Payer: Cofinity Commercial	$46.75
Rate for Payer: Cofinity Commercial	$57.44
Rate for Payer: Healthscope Commercial	$60.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.77
Rate for Payer: PHP Commercial	$56.77
Rate for Payer: Priority Health Cigna Priority Health	$46.75
Rate for Payer: Priority Health SBD	$42.08

HC I-131 CAP (TX) PER MCI

Facility

$66.79

Service Code	HCPCS A9517
Hospital Charge Code	34400001
Hospital Revenue Code	344
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$60.11
Rate for Payer: Aetna Commercial	$56.77
Rate for Payer: Aetna Medicare	$22.19
Rate for Payer: Aetna New Business (MI Preferred)	$43.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.68
Rate for Payer: Amish Plain Church Group Commercial	$26.68
Rate for Payer: BCBS Complete	$12.26
Rate for Payer: BCBS MAPPO	$21.34
Rate for Payer: BCBS Trust/PPO	$24.78
Rate for Payer: BCN Medicare Advantage	$21.34
Rate for Payer: Cash Price	$53.43
Rate for Payer: Cash Price	$53.43
Rate for Payer: Cofinity Commercial	$57.44
Rate for Payer: Cofinity Commercial	$46.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.34
Rate for Payer: Healthscope Commercial	$60.11
Rate for Payer: Mclaren Medicaid	$11.67
Rate for Payer: Mclaren Medicare	$21.34
Rate for Payer: Meridian Medicaid	$12.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.41
Rate for Payer: MI Amish Medical Board Commercial	$24.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.77
Rate for Payer: PACE Medicare	$20.27
Rate for Payer: PACE SWMI	$21.34
Rate for Payer: PHP Commercial	$56.77
Rate for Payer: PHP Medicare Advantage	$21.34
Rate for Payer: Priority Health Choice Medicaid	$11.67
Rate for Payer: Priority Health Cigna Priority Health	$46.75
Rate for Payer: Priority Health Medicare	$21.34
Rate for Payer: Priority Health SBD	$42.08
Rate for Payer: Railroad Medicare Medicare	$21.34
Rate for Payer: UHC Dual Complete DSNP	$21.34
Rate for Payer: UHC Medicare Advantage	$21.98
Rate for Payer: VA VA	$21.34

HC I-131 SOD IODIDE DIAG PER UCI

Facility

$46.92

Service Code	HCPCS A9531
Hospital Charge Code	34300031
Hospital Revenue Code	343
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$42.23
Rate for Payer: Aetna Commercial	$39.88
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: BCBS Complete	$18.77
Rate for Payer: BCBS Trust/PPO	$11.02
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.84
Rate for Payer: Cofinity Commercial	$40.35
Rate for Payer: Healthscope Commercial	$42.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.88
Rate for Payer: PHP Commercial	$39.88
Rate for Payer: Priority Health Cigna Priority Health	$32.84
Rate for Payer: Priority Health SBD	$29.56

HC I-131 SOD IODIDE DIAG PER UCI

Facility

$46.92

Service Code	HCPCS A9531
Hospital Charge Code	34300031
Hospital Revenue Code	343
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$42.23
Rate for Payer: Aetna Commercial	$39.88
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.84
Rate for Payer: Cofinity Commercial	$40.35
Rate for Payer: Healthscope Commercial	$42.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.88
Rate for Payer: PHP Commercial	$39.88
Rate for Payer: Priority Health Cigna Priority Health	$32.84
Rate for Payer: Priority Health SBD	$29.56

HC I-131 SOL (DX) PER MCI

Facility

$46.93

Service Code	HCPCS A9529
Hospital Charge Code	34300012
Hospital Revenue Code	343
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$42.24
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: BCBS Complete	$18.77
Rate for Payer: BCBS Trust/PPO	$7.11
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.85
Rate for Payer: Cofinity Commercial	$40.36
Rate for Payer: Healthscope Commercial	$42.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.89
Rate for Payer: PHP Commercial	$39.89
Rate for Payer: Priority Health Cigna Priority Health	$32.85
Rate for Payer: Priority Health SBD	$29.57

HC I-131 SOL (DX) PER MCI

Facility

$46.93

Service Code	HCPCS A9529
Hospital Charge Code	34300012
Hospital Revenue Code	343
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$42.24
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.85
Rate for Payer: Cofinity Commercial	$40.36
Rate for Payer: Healthscope Commercial	$42.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.89
Rate for Payer: PHP Commercial	$39.89
Rate for Payer: Priority Health Cigna Priority Health	$32.85
Rate for Payer: Priority Health SBD	$29.57

HC I-131 SOL (TX) PER MCI

Facility

$46.93

Service Code	HCPCS A9530
Hospital Charge Code	34400002
Hospital Revenue Code	344
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$42.24
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$32.85
Rate for Payer: Cofinity Commercial	$40.36
Rate for Payer: Healthscope Commercial	$42.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.89
Rate for Payer: PHP Commercial	$39.89
Rate for Payer: Priority Health Cigna Priority Health	$32.85
Rate for Payer: Priority Health SBD	$29.57

HC I-131 SOL (TX) PER MCI

Facility

$46.93

Service Code	HCPCS A9530
Hospital Charge Code	34400002
Hospital Revenue Code	344
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$42.24
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna Medicare	$21.22
Rate for Payer: Aetna New Business (MI Preferred)	$30.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$25.50
Rate for Payer: Amish Plain Church Group Commercial	$25.50
Rate for Payer: BCBS Complete	$11.72
Rate for Payer: BCBS MAPPO	$20.40
Rate for Payer: BCBS Trust/PPO	$23.71
Rate for Payer: BCN Medicare Advantage	$20.40
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cash Price	$37.54
Rate for Payer: Cofinity Commercial	$40.36
Rate for Payer: Cofinity Commercial	$32.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.40
Rate for Payer: Healthscope Commercial	$42.24
Rate for Payer: Mclaren Medicaid	$11.16
Rate for Payer: Mclaren Medicare	$20.40
Rate for Payer: Meridian Medicaid	$11.72
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21.42
Rate for Payer: MI Amish Medical Board Commercial	$23.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.89
Rate for Payer: PACE Medicare	$19.38
Rate for Payer: PACE SWMI	$20.40
Rate for Payer: PHP Commercial	$39.89
Rate for Payer: PHP Medicare Advantage	$20.40
Rate for Payer: Priority Health Choice Medicaid	$11.16
Rate for Payer: Priority Health Cigna Priority Health	$32.85
Rate for Payer: Priority Health Medicare	$20.40
Rate for Payer: Priority Health SBD	$29.57
Rate for Payer: Railroad Medicare Medicare	$20.40
Rate for Payer: UHC Dual Complete DSNP	$20.40
Rate for Payer: UHC Medicare Advantage	$21.01
Rate for Payer: VA VA	$20.40

HC IAPB MONITORING SERVICES HOURL

Facility

$400.66

Hospital Charge Code	27000118
Hospital Revenue Code	270
Min. Negotiated Rate	$160.26
Max. Negotiated Rate	$360.59
Rate for Payer: Aetna Commercial	$340.56
Rate for Payer: Aetna New Business (MI Preferred)	$260.43
Rate for Payer: BCBS Complete	$160.26
Rate for Payer: Cash Price	$320.53
Rate for Payer: Cofinity Commercial	$280.46
Rate for Payer: Cofinity Commercial	$344.57
Rate for Payer: Healthscope Commercial	$360.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.56
Rate for Payer: PHP Commercial	$340.56
Rate for Payer: Priority Health Cigna Priority Health	$280.46
Rate for Payer: Priority Health SBD	$252.42

HC IAPB MONITORING SERVICES HOURL

Facility

$400.66

Hospital Charge Code	27000118
Hospital Revenue Code	270
Min. Negotiated Rate	$252.42
Max. Negotiated Rate	$360.59
Rate for Payer: Aetna Commercial	$340.56
Rate for Payer: Aetna New Business (MI Preferred)	$260.43
Rate for Payer: Cash Price	$320.53
Rate for Payer: Cofinity Commercial	$280.46
Rate for Payer: Cofinity Commercial	$344.57
Rate for Payer: Healthscope Commercial	$360.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.56
Rate for Payer: PHP Commercial	$340.56
Rate for Payer: Priority Health Cigna Priority Health	$280.46
Rate for Payer: Priority Health SBD	$252.42

Know your out-of-pocket cost for care.

All Charges