Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INTRINSIC FACTOR ANTIBODIES

Facility

$48.00

Service Code	CPT 86340
Hospital Charge Code	30200200
Hospital Revenue Code	302
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Medicare	$15.68
Rate for Payer: Aetna New Business (MI Preferred)	$31.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.85
Rate for Payer: Amish Plain Church Group Commercial	$18.85
Rate for Payer: BCBS Complete	$8.66
Rate for Payer: BCBS MAPPO	$15.08
Rate for Payer: BCBS Trust/PPO	$11.81
Rate for Payer: BCN Medicare Advantage	$15.08
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cofinity Commercial	$41.28
Rate for Payer: Cofinity Commercial	$33.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.08
Rate for Payer: Healthscope Commercial	$43.20
Rate for Payer: Mclaren Medicaid	$8.25
Rate for Payer: Mclaren Medicare	$15.08
Rate for Payer: Meridian Medicaid	$8.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15.83
Rate for Payer: MI Amish Medical Board Commercial	$17.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.80
Rate for Payer: PACE Medicare	$14.33
Rate for Payer: PACE SWMI	$15.08
Rate for Payer: PHP Commercial	$40.80
Rate for Payer: PHP Medicare Advantage	$15.08
Rate for Payer: Priority Health Choice Medicaid	$8.25
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health Medicare	$15.08
Rate for Payer: Priority Health SBD	$30.24
Rate for Payer: Railroad Medicare Medicare	$15.08
Rate for Payer: UHC All Payor (Choice/PPO)	$18.10
Rate for Payer: UHC Core	$25.62
Rate for Payer: UHC Dual Complete DSNP	$15.08
Rate for Payer: UHC Exchange	$15.08
Rate for Payer: UHC Medicare Advantage	$15.53
Rate for Payer: VA VA	$15.08

HC INTRO AORTA TRANSLUMBAR

Facility

$3,672.00

Service Code	CPT 36160
Hospital Charge Code	36100621
Hospital Revenue Code	361
Min. Negotiated Rate	$117.55
Max. Negotiated Rate	$3,304.80
Rate for Payer: Aetna Commercial	$3,121.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,386.80
Rate for Payer: BCBS Complete	$1,468.80
Rate for Payer: BCBS Trust/PPO	$980.91
Rate for Payer: Cash Price	$2,937.60
Rate for Payer: Cash Price	$2,937.60
Rate for Payer: Cofinity Commercial	$3,157.92
Rate for Payer: Cofinity Commercial	$2,570.40
Rate for Payer: Healthscope Commercial	$3,304.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,121.20
Rate for Payer: PHP Commercial	$3,121.20
Rate for Payer: Priority Health Cigna Priority Health	$2,570.40
Rate for Payer: Priority Health SBD	$2,313.36
Rate for Payer: UHC All Payor (Choice/PPO)	$129.30
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$117.55

HC INTRO AORTA TRANSLUMBAR

Facility

$3,672.00

Service Code	CPT 36160
Hospital Charge Code	36100621
Hospital Revenue Code	361
Min. Negotiated Rate	$2,313.36
Max. Negotiated Rate	$3,304.80
Rate for Payer: Aetna Commercial	$3,121.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,386.80
Rate for Payer: Cash Price	$2,937.60
Rate for Payer: Cofinity Commercial	$2,570.40
Rate for Payer: Cofinity Commercial	$3,157.92
Rate for Payer: Healthscope Commercial	$3,304.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,121.20
Rate for Payer: PHP Commercial	$3,121.20
Rate for Payer: Priority Health Cigna Priority Health	$2,570.40
Rate for Payer: Priority Health SBD	$2,313.36

HC INTRODUCER

Facility

$293.71

Service Code	HCPCS C1894
Hospital Charge Code	27200049
Hospital Revenue Code	272
Min. Negotiated Rate	$185.04
Max. Negotiated Rate	$264.34
Rate for Payer: Aetna Commercial	$249.65
Rate for Payer: Aetna New Business (MI Preferred)	$190.91
Rate for Payer: Cash Price	$234.97
Rate for Payer: Cofinity Commercial	$205.60
Rate for Payer: Cofinity Commercial	$252.59
Rate for Payer: Healthscope Commercial	$264.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$249.65
Rate for Payer: PHP Commercial	$249.65
Rate for Payer: Priority Health Cigna Priority Health	$205.60
Rate for Payer: Priority Health SBD	$185.04

HC INTRODUCER

Facility

$293.71

Service Code	HCPCS C1894
Hospital Charge Code	27200049
Hospital Revenue Code	272
Min. Negotiated Rate	$117.48
Max. Negotiated Rate	$264.34
Rate for Payer: Aetna Commercial	$249.65
Rate for Payer: Aetna New Business (MI Preferred)	$190.91
Rate for Payer: BCBS Complete	$117.48
Rate for Payer: Cash Price	$234.97
Rate for Payer: Cofinity Commercial	$252.59
Rate for Payer: Cofinity Commercial	$205.60
Rate for Payer: Healthscope Commercial	$264.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$249.65
Rate for Payer: PHP Commercial	$249.65
Rate for Payer: Priority Health Cigna Priority Health	$205.60
Rate for Payer: Priority Health SBD	$185.04

HC INTRODUCER LONG

Facility

$249.93

Service Code	HCPCS C1894
Hospital Charge Code	27200050
Hospital Revenue Code	272
Min. Negotiated Rate	$99.97
Max. Negotiated Rate	$224.94
Rate for Payer: Aetna Commercial	$212.44
Rate for Payer: Aetna New Business (MI Preferred)	$162.45
Rate for Payer: BCBS Complete	$99.97
Rate for Payer: Cash Price	$199.94
Rate for Payer: Cofinity Commercial	$174.95
Rate for Payer: Cofinity Commercial	$214.94
Rate for Payer: Healthscope Commercial	$224.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.44
Rate for Payer: PHP Commercial	$212.44
Rate for Payer: Priority Health Cigna Priority Health	$174.95
Rate for Payer: Priority Health SBD	$157.46

HC INTRODUCER LONG

Facility

$249.93

Service Code	HCPCS C1894
Hospital Charge Code	27200050
Hospital Revenue Code	272
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$224.94
Rate for Payer: Aetna Commercial	$212.44
Rate for Payer: Aetna New Business (MI Preferred)	$162.45
Rate for Payer: Cash Price	$199.94
Rate for Payer: Cofinity Commercial	$174.95
Rate for Payer: Cofinity Commercial	$214.94
Rate for Payer: Healthscope Commercial	$224.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.44
Rate for Payer: PHP Commercial	$212.44
Rate for Payer: Priority Health Cigna Priority Health	$174.95
Rate for Payer: Priority Health SBD	$157.46

HC INTRODUCER REGULAR

Facility

$92.82

Service Code	HCPCS C1893
Hospital Charge Code	27200051
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$83.54
Rate for Payer: Aetna Commercial	$78.90
Rate for Payer: Aetna New Business (MI Preferred)	$60.33
Rate for Payer: BCBS Complete	$37.13
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$74.26
Rate for Payer: Cash Price	$74.26
Rate for Payer: Cofinity Commercial	$64.97
Rate for Payer: Cofinity Commercial	$79.83
Rate for Payer: Healthscope Commercial	$83.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.90
Rate for Payer: PHP Commercial	$78.90
Rate for Payer: Priority Health Cigna Priority Health	$64.97
Rate for Payer: Priority Health SBD	$58.48

HC INTRODUCER REGULAR

Facility

$92.82

Service Code	HCPCS C1893
Hospital Charge Code	27200051
Hospital Revenue Code	272
Min. Negotiated Rate	$58.48
Max. Negotiated Rate	$83.54
Rate for Payer: Aetna Commercial	$78.90
Rate for Payer: Aetna New Business (MI Preferred)	$60.33
Rate for Payer: Cash Price	$74.26
Rate for Payer: Cofinity Commercial	$64.97
Rate for Payer: Cofinity Commercial	$79.83
Rate for Payer: Healthscope Commercial	$83.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.90
Rate for Payer: PHP Commercial	$78.90
Rate for Payer: Priority Health Cigna Priority Health	$64.97
Rate for Payer: Priority Health SBD	$58.48

HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY

Facility

$3,389.80

Service Code	CPT 50553
Hospital Charge Code	36100246
Hospital Revenue Code	361
Min. Negotiated Rate	$2,135.57
Max. Negotiated Rate	$3,050.82
Rate for Payer: Aetna Commercial	$2,881.33
Rate for Payer: Aetna New Business (MI Preferred)	$2,203.37
Rate for Payer: Cash Price	$2,711.84
Rate for Payer: Cofinity Commercial	$2,372.86
Rate for Payer: Cofinity Commercial	$2,915.23
Rate for Payer: Healthscope Commercial	$3,050.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,881.33
Rate for Payer: PHP Commercial	$2,881.33
Rate for Payer: Priority Health Cigna Priority Health	$2,372.86
Rate for Payer: Priority Health SBD	$2,135.57

HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY

Facility

$3,389.80

Service Code	CPT 50553
Hospital Charge Code	36100246
Hospital Revenue Code	361
Min. Negotiated Rate	$303.21
Max. Negotiated Rate	$13,737.10
Rate for Payer: Aetna Commercial	$2,881.33
Rate for Payer: Aetna Medicare	$4,788.26
Rate for Payer: Aetna New Business (MI Preferred)	$2,203.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,755.12
Rate for Payer: Amish Plain Church Group Commercial	$5,755.12
Rate for Payer: BCBS Complete	$2,644.60
Rate for Payer: BCBS MAPPO	$4,604.10
Rate for Payer: BCBS Trust/PPO	$1,510.65
Rate for Payer: BCN Medicare Advantage	$4,604.10
Rate for Payer: Cash Price	$2,711.84
Rate for Payer: Cash Price	$2,711.84
Rate for Payer: Cofinity Commercial	$2,372.86
Rate for Payer: Cofinity Commercial	$2,915.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,604.10
Rate for Payer: Healthscope Commercial	$3,050.82
Rate for Payer: Mclaren Medicaid	$2,518.44
Rate for Payer: Mclaren Medicare	$4,604.10
Rate for Payer: Meridian Medicaid	$2,644.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,834.30
Rate for Payer: MI Amish Medical Board Commercial	$5,294.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,881.33
Rate for Payer: PACE Medicare	$4,373.90
Rate for Payer: PACE SWMI	$4,604.10
Rate for Payer: PHP Commercial	$2,881.33
Rate for Payer: PHP Medicare Advantage	$4,604.10
Rate for Payer: Priority Health Choice Medicaid	$2,518.44
Rate for Payer: Priority Health Cigna Priority Health	$2,372.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,737.10
Rate for Payer: Priority Health Medicare	$4,604.10
Rate for Payer: Priority Health Narrow Network	$10,989.68
Rate for Payer: Priority Health SBD	$2,135.57
Rate for Payer: Railroad Medicare Medicare	$4,604.10
Rate for Payer: UHC All Payor (Choice/PPO)	$333.53
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$4,604.10
Rate for Payer: UHC Exchange	$303.21
Rate for Payer: UHC Medicare Advantage	$4,742.22
Rate for Payer: VA VA	$4,604.10

HC INTRO SHEATH NON GUIDE LVL 1

Facility

$40.95

Service Code	HCPCS C1894
Hospital Charge Code	27200276
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$36.86
Rate for Payer: Aetna Commercial	$34.81
Rate for Payer: Aetna New Business (MI Preferred)	$26.62
Rate for Payer: Cash Price	$32.76
Rate for Payer: Cofinity Commercial	$28.66
Rate for Payer: Cofinity Commercial	$35.22
Rate for Payer: Healthscope Commercial	$36.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.81
Rate for Payer: PHP Commercial	$34.81
Rate for Payer: Priority Health Cigna Priority Health	$28.66
Rate for Payer: Priority Health SBD	$25.80

HC INTRO SHEATH NON GUIDE LVL 1

Facility

$40.95

Service Code	HCPCS C1894
Hospital Charge Code	27200276
Hospital Revenue Code	272
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$36.86
Rate for Payer: Aetna Commercial	$34.81
Rate for Payer: Aetna New Business (MI Preferred)	$26.62
Rate for Payer: BCBS Complete	$16.38
Rate for Payer: Cash Price	$32.76
Rate for Payer: Cofinity Commercial	$28.66
Rate for Payer: Cofinity Commercial	$35.22
Rate for Payer: Healthscope Commercial	$36.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.81
Rate for Payer: PHP Commercial	$34.81
Rate for Payer: Priority Health Cigna Priority Health	$28.66
Rate for Payer: Priority Health SBD	$25.80

HC INTRO SHEATH NON GUIDE LVL 11

Facility

$1,195.00

Service Code	HCPCS C1894
Hospital Charge Code	27200322
Hospital Revenue Code	272
Min. Negotiated Rate	$478.00
Max. Negotiated Rate	$1,075.50
Rate for Payer: Aetna Commercial	$1,015.75
Rate for Payer: Aetna New Business (MI Preferred)	$776.75
Rate for Payer: BCBS Complete	$478.00
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cofinity Commercial	$1,027.70
Rate for Payer: Cofinity Commercial	$836.50
Rate for Payer: Healthscope Commercial	$1,075.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,015.75
Rate for Payer: PHP Commercial	$1,015.75
Rate for Payer: Priority Health Cigna Priority Health	$836.50
Rate for Payer: Priority Health SBD	$752.85

HC INTRO SHEATH NON GUIDE LVL 11

Facility

$1,195.00

Service Code	HCPCS C1894
Hospital Charge Code	27200322
Hospital Revenue Code	272
Min. Negotiated Rate	$752.85
Max. Negotiated Rate	$1,075.50
Rate for Payer: Aetna Commercial	$1,015.75
Rate for Payer: Aetna New Business (MI Preferred)	$776.75
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cofinity Commercial	$1,027.70
Rate for Payer: Cofinity Commercial	$836.50
Rate for Payer: Healthscope Commercial	$1,075.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,015.75
Rate for Payer: PHP Commercial	$1,015.75
Rate for Payer: Priority Health Cigna Priority Health	$836.50
Rate for Payer: Priority Health SBD	$752.85

HC INTRO SHEATH NON GUIDE LVL 2

Facility

$159.12

Service Code	HCPCS C1894
Hospital Charge Code	27200020
Hospital Revenue Code	272
Min. Negotiated Rate	$63.65
Max. Negotiated Rate	$143.21
Rate for Payer: Aetna Commercial	$135.25
Rate for Payer: Aetna New Business (MI Preferred)	$103.43
Rate for Payer: BCBS Complete	$63.65
Rate for Payer: Cash Price	$127.30
Rate for Payer: Cofinity Commercial	$111.38
Rate for Payer: Cofinity Commercial	$136.84
Rate for Payer: Healthscope Commercial	$143.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$135.25
Rate for Payer: PHP Commercial	$135.25
Rate for Payer: Priority Health Cigna Priority Health	$111.38
Rate for Payer: Priority Health SBD	$100.25

HC INTRO SHEATH NON GUIDE LVL 2

Facility

$159.12

Service Code	HCPCS C1894
Hospital Charge Code	27200020
Hospital Revenue Code	272
Min. Negotiated Rate	$100.25
Max. Negotiated Rate	$143.21
Rate for Payer: Aetna Commercial	$135.25
Rate for Payer: Aetna New Business (MI Preferred)	$103.43
Rate for Payer: Cash Price	$127.30
Rate for Payer: Cofinity Commercial	$111.38
Rate for Payer: Cofinity Commercial	$136.84
Rate for Payer: Healthscope Commercial	$143.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$135.25
Rate for Payer: PHP Commercial	$135.25
Rate for Payer: Priority Health Cigna Priority Health	$111.38
Rate for Payer: Priority Health SBD	$100.25

HC INTRO SHEATH NON GUIDE LVL 3

Facility

$330.88

Service Code	HCPCS C1894
Hospital Charge Code	27200042
Hospital Revenue Code	272
Min. Negotiated Rate	$208.45
Max. Negotiated Rate	$297.79
Rate for Payer: Aetna Commercial	$281.25
Rate for Payer: Aetna New Business (MI Preferred)	$215.07
Rate for Payer: Cash Price	$264.70
Rate for Payer: Cofinity Commercial	$231.62
Rate for Payer: Cofinity Commercial	$284.56
Rate for Payer: Healthscope Commercial	$297.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.25
Rate for Payer: PHP Commercial	$281.25
Rate for Payer: Priority Health Cigna Priority Health	$231.62
Rate for Payer: Priority Health SBD	$208.45

HC INTRO SHEATH NON GUIDE LVL 3

Facility

$330.88

Service Code	HCPCS C1894
Hospital Charge Code	27200042
Hospital Revenue Code	272
Min. Negotiated Rate	$132.35
Max. Negotiated Rate	$297.79
Rate for Payer: Aetna Commercial	$281.25
Rate for Payer: Aetna New Business (MI Preferred)	$215.07
Rate for Payer: BCBS Complete	$132.35
Rate for Payer: Cash Price	$264.70
Rate for Payer: Cofinity Commercial	$231.62
Rate for Payer: Cofinity Commercial	$284.56
Rate for Payer: Healthscope Commercial	$297.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.25
Rate for Payer: PHP Commercial	$281.25
Rate for Payer: Priority Health Cigna Priority Health	$231.62
Rate for Payer: Priority Health SBD	$208.45

HC INTRO SHEATH NON GUIDE LVL 4

Facility

$475.65

Service Code	HCPCS C1894
Hospital Charge Code	27200277
Hospital Revenue Code	272
Min. Negotiated Rate	$190.26
Max. Negotiated Rate	$428.08
Rate for Payer: Aetna Commercial	$404.30
Rate for Payer: Aetna New Business (MI Preferred)	$309.17
Rate for Payer: BCBS Complete	$190.26
Rate for Payer: Cash Price	$380.52
Rate for Payer: Cofinity Commercial	$332.96
Rate for Payer: Cofinity Commercial	$409.06
Rate for Payer: Healthscope Commercial	$428.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$404.30
Rate for Payer: PHP Commercial	$404.30
Rate for Payer: Priority Health Cigna Priority Health	$332.96
Rate for Payer: Priority Health SBD	$299.66

HC INTRO SHEATH NON GUIDE LVL 4

Facility

$475.65

Service Code	HCPCS C1894
Hospital Charge Code	27200277
Hospital Revenue Code	272
Min. Negotiated Rate	$299.66
Max. Negotiated Rate	$428.08
Rate for Payer: Aetna Commercial	$404.30
Rate for Payer: Aetna New Business (MI Preferred)	$309.17
Rate for Payer: Cash Price	$380.52
Rate for Payer: Cofinity Commercial	$332.96
Rate for Payer: Cofinity Commercial	$409.06
Rate for Payer: Healthscope Commercial	$428.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$404.30
Rate for Payer: PHP Commercial	$404.30
Rate for Payer: Priority Health Cigna Priority Health	$332.96
Rate for Payer: Priority Health SBD	$299.66

HC IODINE, S

Facility

$61.20

Service Code	CPT 83789
Hospital Charge Code	30100687
Hospital Revenue Code	301
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$42.84
Rate for Payer: Priority Health SBD	$38.56

HC IODINE, S

Facility

$61.20

Service Code	CPT 83789
Hospital Charge Code	30100687
Hospital Revenue Code	301
Min. Negotiated Rate	$13.19
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna Medicare	$25.07
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$30.14
Rate for Payer: Amish Plain Church Group Commercial	$30.14
Rate for Payer: BCBS Complete	$13.85
Rate for Payer: BCBS MAPPO	$24.11
Rate for Payer: BCBS Trust/PPO	$18.88
Rate for Payer: BCN Medicare Advantage	$24.11
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.11
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Mclaren Medicaid	$13.19
Rate for Payer: Mclaren Medicare	$24.11
Rate for Payer: Meridian Medicaid	$13.85
Rate for Payer: Meridian Wellcare - Medicare Advantage	$25.32
Rate for Payer: MI Amish Medical Board Commercial	$27.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.02
Rate for Payer: PACE Medicare	$22.90
Rate for Payer: PACE SWMI	$24.11
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: PHP Medicare Advantage	$24.11
Rate for Payer: Priority Health Choice Medicaid	$13.19
Rate for Payer: Priority Health Cigna Priority Health	$42.84
Rate for Payer: Priority Health Medicare	$24.11
Rate for Payer: Priority Health SBD	$38.56
Rate for Payer: Railroad Medicare Medicare	$24.11
Rate for Payer: UHC All Payor (Choice/PPO)	$28.93
Rate for Payer: UHC Core	$30.68
Rate for Payer: UHC Dual Complete DSNP	$24.11
Rate for Payer: UHC Exchange	$24.11
Rate for Payer: UHC Medicare Advantage	$24.83
Rate for Payer: VA VA	$24.11

HC IOFLUPANE I-123 PER STUDY

Facility

$5,330.03

Service Code	HCPCS A9584
Hospital Charge Code	34300035
Hospital Revenue Code	343
Min. Negotiated Rate	$3,357.92
Max. Negotiated Rate	$4,797.03
Rate for Payer: Aetna Commercial	$4,530.53
Rate for Payer: Aetna New Business (MI Preferred)	$3,464.52
Rate for Payer: Cash Price	$4,264.02
Rate for Payer: Cofinity Commercial	$3,731.02
Rate for Payer: Cofinity Commercial	$4,583.83
Rate for Payer: Healthscope Commercial	$4,797.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,530.53
Rate for Payer: PHP Commercial	$4,530.53
Rate for Payer: Priority Health Cigna Priority Health	$3,731.02
Rate for Payer: Priority Health SBD	$3,357.92

HC IOFLUPANE I-123 PER STUDY

Facility

$5,330.03

Service Code	HCPCS A9584
Hospital Charge Code	34300035
Hospital Revenue Code	343
Min. Negotiated Rate	$1,190.78
Max. Negotiated Rate	$4,797.03
Rate for Payer: Aetna Commercial	$4,530.53
Rate for Payer: Aetna New Business (MI Preferred)	$3,464.52
Rate for Payer: BCBS Complete	$2,132.01
Rate for Payer: BCBS Trust/PPO	$1,190.78
Rate for Payer: Cash Price	$4,264.02
Rate for Payer: Cash Price	$4,264.02
Rate for Payer: Cofinity Commercial	$4,583.83
Rate for Payer: Cofinity Commercial	$3,731.02
Rate for Payer: Healthscope Commercial	$4,797.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,530.53
Rate for Payer: PHP Commercial	$4,530.53
Rate for Payer: Priority Health Cigna Priority Health	$3,731.02
Rate for Payer: Priority Health SBD	$3,357.92

Know your out-of-pocket cost for care.

All Charges