Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC LEUK/LYMPH IMMUNOPHENO CMPT C

Facility

$51.22

Service Code	CPT 88185
Hospital Charge Code	31000009
Hospital Revenue Code	310
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$46.10
Rate for Payer: Aetna Commercial	$43.54
Rate for Payer: Aetna New Business (MI Preferred)	$33.29
Rate for Payer: BCBS Complete	$20.49
Rate for Payer: BCBS Trust/PPO	$29.37
Rate for Payer: Cash Price	$40.98
Rate for Payer: Cash Price	$40.98
Rate for Payer: Cofinity Commercial	$44.05
Rate for Payer: Cofinity Commercial	$35.85
Rate for Payer: Healthscope Commercial	$46.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.54
Rate for Payer: PHP Commercial	$43.54
Rate for Payer: Priority Health Cigna Priority Health	$35.85
Rate for Payer: Priority Health SBD	$32.27
Rate for Payer: UHC All Payor (Choice/PPO)	$25.58
Rate for Payer: UHC Core	$20.50
Rate for Payer: UHC Exchange	$23.25

HC LEUK/LYMPH IMMUNOPHENO CMPT C

Facility

$51.22

Service Code	CPT 88185
Hospital Charge Code	31000009
Hospital Revenue Code	310
Min. Negotiated Rate	$32.27
Max. Negotiated Rate	$46.10
Rate for Payer: Aetna Commercial	$43.54
Rate for Payer: Aetna New Business (MI Preferred)	$33.29
Rate for Payer: Cash Price	$40.98
Rate for Payer: Cofinity Commercial	$35.85
Rate for Payer: Cofinity Commercial	$44.05
Rate for Payer: Healthscope Commercial	$46.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.54
Rate for Payer: PHP Commercial	$43.54
Rate for Payer: Priority Health Cigna Priority Health	$35.85
Rate for Payer: Priority Health SBD	$32.27

HC LEUK/LYMPH IMMUNOPHENO CMPT D

Facility

$53.75

Service Code	CPT 88185
Hospital Charge Code	31000010
Hospital Revenue Code	310
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$48.38
Rate for Payer: Aetna Commercial	$45.69
Rate for Payer: Aetna New Business (MI Preferred)	$34.94
Rate for Payer: BCBS Complete	$21.50
Rate for Payer: BCBS Trust/PPO	$29.37
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cofinity Commercial	$46.22
Rate for Payer: Cofinity Commercial	$37.62
Rate for Payer: Healthscope Commercial	$48.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.69
Rate for Payer: PHP Commercial	$45.69
Rate for Payer: Priority Health Cigna Priority Health	$37.62
Rate for Payer: Priority Health SBD	$33.86
Rate for Payer: UHC All Payor (Choice/PPO)	$25.58
Rate for Payer: UHC Core	$20.50
Rate for Payer: UHC Exchange	$23.25

HC LEUK/LYMPH IMMUNOPHENO CMPT D

Facility

$53.75

Service Code	CPT 88185
Hospital Charge Code	31000010
Hospital Revenue Code	310
Min. Negotiated Rate	$33.86
Max. Negotiated Rate	$48.38
Rate for Payer: Aetna Commercial	$45.69
Rate for Payer: Aetna New Business (MI Preferred)	$34.94
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cofinity Commercial	$37.62
Rate for Payer: Cofinity Commercial	$46.22
Rate for Payer: Healthscope Commercial	$48.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.69
Rate for Payer: PHP Commercial	$45.69
Rate for Payer: Priority Health Cigna Priority Health	$37.62
Rate for Payer: Priority Health SBD	$33.86

HC LEUK LYMPHOMA IMMUNOPHEN TISSUE

Facility

$51.22

Service Code	CPT 88185
Hospital Charge Code	31100015
Hospital Revenue Code	311
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$46.10
Rate for Payer: Aetna Commercial	$43.54
Rate for Payer: Aetna New Business (MI Preferred)	$33.29
Rate for Payer: BCBS Complete	$20.49
Rate for Payer: BCBS Trust/PPO	$29.37
Rate for Payer: Cash Price	$40.98
Rate for Payer: Cash Price	$40.98
Rate for Payer: Cofinity Commercial	$44.05
Rate for Payer: Cofinity Commercial	$35.85
Rate for Payer: Healthscope Commercial	$46.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.54
Rate for Payer: PHP Commercial	$43.54
Rate for Payer: Priority Health Cigna Priority Health	$35.85
Rate for Payer: Priority Health SBD	$32.27
Rate for Payer: UHC All Payor (Choice/PPO)	$25.58
Rate for Payer: UHC Core	$20.50
Rate for Payer: UHC Exchange	$23.25

HC LEUK LYMPHOMA IMMUNOPHEN TISSUE

Facility

$51.22

Service Code	CPT 88185
Hospital Charge Code	31100015
Hospital Revenue Code	311
Min. Negotiated Rate	$32.27
Max. Negotiated Rate	$46.10
Rate for Payer: Aetna Commercial	$43.54
Rate for Payer: Aetna New Business (MI Preferred)	$33.29
Rate for Payer: Cash Price	$40.98
Rate for Payer: Cofinity Commercial	$35.85
Rate for Payer: Cofinity Commercial	$44.05
Rate for Payer: Healthscope Commercial	$46.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.54
Rate for Payer: PHP Commercial	$43.54
Rate for Payer: Priority Health Cigna Priority Health	$35.85
Rate for Payer: Priority Health SBD	$32.27

HC LEUKOTRIENE E4, U

Facility

$255.00

Service Code	CPT 82542
Hospital Charge Code	30100715
Hospital Revenue Code	301
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna Medicare	$25.05
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$30.11
Rate for Payer: Amish Plain Church Group Commercial	$30.11
Rate for Payer: BCBS Complete	$13.84
Rate for Payer: BCBS MAPPO	$24.09
Rate for Payer: BCBS Trust/PPO	$18.87
Rate for Payer: BCN Medicare Advantage	$24.09
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.09
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Mclaren Medicaid	$13.18
Rate for Payer: Mclaren Medicare	$24.09
Rate for Payer: Meridian Medicaid	$13.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$25.29
Rate for Payer: MI Amish Medical Board Commercial	$27.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$216.75
Rate for Payer: PACE Medicare	$22.89
Rate for Payer: PACE SWMI	$24.09
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: PHP Medicare Advantage	$24.09
Rate for Payer: Priority Health Choice Medicaid	$13.18
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health SBD	$160.65
Rate for Payer: Railroad Medicare Medicare	$24.09
Rate for Payer: UHC All Payor (Choice/PPO)	$28.91
Rate for Payer: UHC Core	$30.68
Rate for Payer: UHC Dual Complete DSNP	$24.09
Rate for Payer: UHC Exchange	$24.09
Rate for Payer: UHC Medicare Advantage	$24.81
Rate for Payer: VA VA	$24.09

HC LEUKOTRIENE E4, U

Facility

$255.00

Service Code	CPT 82542
Hospital Charge Code	30100715
Hospital Revenue Code	301
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: Priority Health SBD	$160.65

HC LEUPROLIDE ACETATE 3.75MG

Facility

$1,010.92

Service Code	HCPCS J1950
Hospital Charge Code	63600142
Hospital Revenue Code	636
Min. Negotiated Rate	$636.88
Max. Negotiated Rate	$909.83
Rate for Payer: Aetna Commercial	$859.28
Rate for Payer: Aetna New Business (MI Preferred)	$657.10
Rate for Payer: Cash Price	$808.74
Rate for Payer: Cofinity Commercial	$707.64
Rate for Payer: Cofinity Commercial	$869.39
Rate for Payer: Healthscope Commercial	$909.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$859.28
Rate for Payer: PHP Commercial	$859.28
Rate for Payer: Priority Health Cigna Priority Health	$707.64
Rate for Payer: Priority Health SBD	$636.88

HC LEUPROLIDE ACETATE 3.75MG

Facility

$1,010.92

Service Code	HCPCS J1950
Hospital Charge Code	63600142
Hospital Revenue Code	636
Min. Negotiated Rate	$636.88
Max. Negotiated Rate	$4,632.03
Rate for Payer: Aetna Commercial	$859.28
Rate for Payer: Aetna Medicare	$1,627.19
Rate for Payer: Aetna New Business (MI Preferred)	$657.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,955.76
Rate for Payer: Amish Plain Church Group Commercial	$1,955.76
Rate for Payer: BCBS Complete	$898.71
Rate for Payer: BCBS MAPPO	$1,564.60
Rate for Payer: BCBS Trust/PPO	$4,632.03
Rate for Payer: BCN Medicare Advantage	$1,564.60
Rate for Payer: Cash Price	$808.74
Rate for Payer: Cash Price	$808.74
Rate for Payer: Cofinity Commercial	$869.39
Rate for Payer: Cofinity Commercial	$707.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,564.60
Rate for Payer: Healthscope Commercial	$909.83
Rate for Payer: Mclaren Medicaid	$855.84
Rate for Payer: Mclaren Medicare	$1,564.60
Rate for Payer: Meridian Medicaid	$898.71
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,642.83
Rate for Payer: MI Amish Medical Board Commercial	$1,799.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$859.28
Rate for Payer: PACE Medicare	$1,486.37
Rate for Payer: PACE SWMI	$1,564.60
Rate for Payer: PHP Commercial	$859.28
Rate for Payer: PHP Medicare Advantage	$1,564.60
Rate for Payer: Priority Health Choice Medicaid	$855.84
Rate for Payer: Priority Health Cigna Priority Health	$707.64
Rate for Payer: Priority Health Medicare	$1,564.60
Rate for Payer: Priority Health SBD	$636.88
Rate for Payer: Railroad Medicare Medicare	$1,564.60
Rate for Payer: UHC Dual Complete DSNP	$1,564.60
Rate for Payer: UHC Medicare Advantage	$1,611.54
Rate for Payer: VA VA	$1,564.60

HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG

Facility

$452.00

Service Code	HCPCS J9217
Hospital Charge Code	63600147
Hospital Revenue Code	636
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$556.62
Rate for Payer: Aetna Commercial	$384.20
Rate for Payer: Aetna Medicare	$188.55
Rate for Payer: Aetna New Business (MI Preferred)	$293.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$226.63
Rate for Payer: Amish Plain Church Group Commercial	$226.63
Rate for Payer: BCBS Complete	$104.14
Rate for Payer: BCBS MAPPO	$181.30
Rate for Payer: BCBS Trust/PPO	$556.62
Rate for Payer: BCN Medicare Advantage	$181.30
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cofinity Commercial	$388.72
Rate for Payer: Cofinity Commercial	$316.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$181.30
Rate for Payer: Healthscope Commercial	$406.80
Rate for Payer: Mclaren Medicaid	$99.17
Rate for Payer: Mclaren Medicare	$181.30
Rate for Payer: Meridian Medicaid	$104.14
Rate for Payer: Meridian Wellcare - Medicare Advantage	$190.37
Rate for Payer: MI Amish Medical Board Commercial	$208.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$384.20
Rate for Payer: PACE Medicare	$172.24
Rate for Payer: PACE SWMI	$181.30
Rate for Payer: PHP Commercial	$384.20
Rate for Payer: PHP Medicare Advantage	$181.30
Rate for Payer: Priority Health Choice Medicaid	$99.17
Rate for Payer: Priority Health Cigna Priority Health	$316.40
Rate for Payer: Priority Health Medicare	$181.30
Rate for Payer: Priority Health SBD	$284.76
Rate for Payer: Railroad Medicare Medicare	$181.30
Rate for Payer: UHC Dual Complete DSNP	$181.30
Rate for Payer: UHC Medicare Advantage	$186.74
Rate for Payer: VA VA	$181.30

HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG

Facility

$452.00

Service Code	HCPCS J9217
Hospital Charge Code	63600147
Hospital Revenue Code	636
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$406.80
Rate for Payer: Aetna Commercial	$384.20
Rate for Payer: Aetna New Business (MI Preferred)	$293.80
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cofinity Commercial	$316.40
Rate for Payer: Cofinity Commercial	$388.72
Rate for Payer: Healthscope Commercial	$406.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$384.20
Rate for Payer: PHP Commercial	$384.20
Rate for Payer: Priority Health Cigna Priority Health	$316.40
Rate for Payer: Priority Health SBD	$284.76

HC LEVEL 0.5 INIT 30 MIN

Facility

$895.03

Hospital Charge Code	36000060
Hospital Revenue Code	360
Min. Negotiated Rate	$358.01
Max. Negotiated Rate	$805.53
Rate for Payer: Aetna Commercial	$760.78
Rate for Payer: Aetna New Business (MI Preferred)	$581.77
Rate for Payer: BCBS Complete	$358.01
Rate for Payer: Cash Price	$716.02
Rate for Payer: Cofinity Commercial	$626.52
Rate for Payer: Cofinity Commercial	$769.73
Rate for Payer: Healthscope Commercial	$805.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$760.78
Rate for Payer: PHP Commercial	$760.78
Rate for Payer: Priority Health Cigna Priority Health	$626.52
Rate for Payer: Priority Health SBD	$563.87

HC LEVEL 0.5 INIT 30 MIN

Facility

$895.03

Hospital Charge Code	36000060
Hospital Revenue Code	360
Min. Negotiated Rate	$563.87
Max. Negotiated Rate	$805.53
Rate for Payer: Aetna Commercial	$760.78
Rate for Payer: Aetna New Business (MI Preferred)	$581.77
Rate for Payer: Cash Price	$716.02
Rate for Payer: Cofinity Commercial	$626.52
Rate for Payer: Cofinity Commercial	$769.73
Rate for Payer: Healthscope Commercial	$805.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$760.78
Rate for Payer: PHP Commercial	$760.78
Rate for Payer: Priority Health Cigna Priority Health	$626.52
Rate for Payer: Priority Health SBD	$563.87

HC LEVEL 0.5 SUBSQ 15 MIN

Facility

$257.83

Hospital Charge Code	36000061
Hospital Revenue Code	360
Min. Negotiated Rate	$103.13
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Commercial	$219.16
Rate for Payer: Aetna New Business (MI Preferred)	$167.59
Rate for Payer: BCBS Complete	$103.13
Rate for Payer: Cash Price	$206.26
Rate for Payer: Cofinity Commercial	$180.48
Rate for Payer: Cofinity Commercial	$221.73
Rate for Payer: Healthscope Commercial	$232.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.16
Rate for Payer: PHP Commercial	$219.16
Rate for Payer: Priority Health Cigna Priority Health	$180.48
Rate for Payer: Priority Health SBD	$162.43

HC LEVEL 0.5 SUBSQ 15 MIN

Facility

$257.83

Hospital Charge Code	36000061
Hospital Revenue Code	360
Min. Negotiated Rate	$162.43
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Commercial	$219.16
Rate for Payer: Aetna New Business (MI Preferred)	$167.59
Rate for Payer: Cash Price	$206.26
Rate for Payer: Cofinity Commercial	$180.48
Rate for Payer: Cofinity Commercial	$221.73
Rate for Payer: Healthscope Commercial	$232.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.16
Rate for Payer: PHP Commercial	$219.16
Rate for Payer: Priority Health Cigna Priority Health	$180.48
Rate for Payer: Priority Health SBD	$162.43

HC LEVEL 1 INIT 30 MIN

Facility

$1,975.92

Hospital Charge Code	36000062
Hospital Revenue Code	360
Min. Negotiated Rate	$790.37
Max. Negotiated Rate	$1,778.33
Rate for Payer: Aetna Commercial	$1,679.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,284.35
Rate for Payer: BCBS Complete	$790.37
Rate for Payer: Cash Price	$1,580.74
Rate for Payer: Cofinity Commercial	$1,383.14
Rate for Payer: Cofinity Commercial	$1,699.29
Rate for Payer: Healthscope Commercial	$1,778.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,679.53
Rate for Payer: PHP Commercial	$1,679.53
Rate for Payer: Priority Health Cigna Priority Health	$1,383.14
Rate for Payer: Priority Health SBD	$1,244.83

HC LEVEL 1 INIT 30 MIN

Facility

$1,975.92

Hospital Charge Code	36000062
Hospital Revenue Code	360
Min. Negotiated Rate	$1,244.83
Max. Negotiated Rate	$1,778.33
Rate for Payer: Aetna Commercial	$1,679.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,284.35
Rate for Payer: Cash Price	$1,580.74
Rate for Payer: Cofinity Commercial	$1,383.14
Rate for Payer: Cofinity Commercial	$1,699.29
Rate for Payer: Healthscope Commercial	$1,778.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,679.53
Rate for Payer: PHP Commercial	$1,679.53
Rate for Payer: Priority Health Cigna Priority Health	$1,383.14
Rate for Payer: Priority Health SBD	$1,244.83

HC LEVEL 1 SUBSQ 15 MIN

Facility

$393.30

Hospital Charge Code	36000063
Hospital Revenue Code	360
Min. Negotiated Rate	$157.32
Max. Negotiated Rate	$353.97
Rate for Payer: Aetna Commercial	$334.30
Rate for Payer: Aetna New Business (MI Preferred)	$255.64
Rate for Payer: BCBS Complete	$157.32
Rate for Payer: Cash Price	$314.64
Rate for Payer: Cofinity Commercial	$275.31
Rate for Payer: Cofinity Commercial	$338.24
Rate for Payer: Healthscope Commercial	$353.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$334.30
Rate for Payer: PHP Commercial	$334.30
Rate for Payer: Priority Health Cigna Priority Health	$275.31
Rate for Payer: Priority Health SBD	$247.78

HC LEVEL 1 SUBSQ 15 MIN

Facility

$393.30

Hospital Charge Code	36000063
Hospital Revenue Code	360
Min. Negotiated Rate	$247.78
Max. Negotiated Rate	$353.97
Rate for Payer: Aetna Commercial	$334.30
Rate for Payer: Aetna New Business (MI Preferred)	$255.64
Rate for Payer: Cash Price	$314.64
Rate for Payer: Cofinity Commercial	$275.31
Rate for Payer: Cofinity Commercial	$338.24
Rate for Payer: Healthscope Commercial	$353.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$334.30
Rate for Payer: PHP Commercial	$334.30
Rate for Payer: Priority Health Cigna Priority Health	$275.31
Rate for Payer: Priority Health SBD	$247.78

HC LEVEL 2 INIT 30 MIN

Facility

$3,073.19

Hospital Charge Code	36000064
Hospital Revenue Code	360
Min. Negotiated Rate	$1,936.11
Max. Negotiated Rate	$2,765.87
Rate for Payer: Aetna Commercial	$2,612.21
Rate for Payer: Aetna New Business (MI Preferred)	$1,997.57
Rate for Payer: Cash Price	$2,458.55
Rate for Payer: Cofinity Commercial	$2,151.23
Rate for Payer: Cofinity Commercial	$2,642.94
Rate for Payer: Healthscope Commercial	$2,765.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,612.21
Rate for Payer: PHP Commercial	$2,612.21
Rate for Payer: Priority Health Cigna Priority Health	$2,151.23
Rate for Payer: Priority Health SBD	$1,936.11

HC LEVEL 2 INIT 30 MIN

Facility

$3,073.19

Hospital Charge Code	36000064
Hospital Revenue Code	360
Min. Negotiated Rate	$1,229.28
Max. Negotiated Rate	$2,765.87
Rate for Payer: Aetna Commercial	$2,612.21
Rate for Payer: Aetna New Business (MI Preferred)	$1,997.57
Rate for Payer: BCBS Complete	$1,229.28
Rate for Payer: Cash Price	$2,458.55
Rate for Payer: Cofinity Commercial	$2,151.23
Rate for Payer: Cofinity Commercial	$2,642.94
Rate for Payer: Healthscope Commercial	$2,765.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,612.21
Rate for Payer: PHP Commercial	$2,612.21
Rate for Payer: Priority Health Cigna Priority Health	$2,151.23
Rate for Payer: Priority Health SBD	$1,936.11

HC LEVEL 2 SUBSQ 15 MIN

Facility

$1,178.99

Hospital Charge Code	36000065
Hospital Revenue Code	360
Min. Negotiated Rate	$471.60
Max. Negotiated Rate	$1,061.09
Rate for Payer: Aetna Commercial	$1,002.14
Rate for Payer: Aetna New Business (MI Preferred)	$766.34
Rate for Payer: BCBS Complete	$471.60
Rate for Payer: Cash Price	$943.19
Rate for Payer: Cofinity Commercial	$1,013.93
Rate for Payer: Cofinity Commercial	$825.29
Rate for Payer: Healthscope Commercial	$1,061.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,002.14
Rate for Payer: PHP Commercial	$1,002.14
Rate for Payer: Priority Health Cigna Priority Health	$825.29
Rate for Payer: Priority Health SBD	$742.76

HC LEVEL 2 SUBSQ 15 MIN

Facility

$1,178.99

Hospital Charge Code	36000065
Hospital Revenue Code	360
Min. Negotiated Rate	$742.76
Max. Negotiated Rate	$1,061.09
Rate for Payer: Aetna Commercial	$1,002.14
Rate for Payer: Aetna New Business (MI Preferred)	$766.34
Rate for Payer: Cash Price	$943.19
Rate for Payer: Cofinity Commercial	$1,013.93
Rate for Payer: Cofinity Commercial	$825.29
Rate for Payer: Healthscope Commercial	$1,061.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,002.14
Rate for Payer: PHP Commercial	$1,002.14
Rate for Payer: Priority Health Cigna Priority Health	$825.29
Rate for Payer: Priority Health SBD	$742.76

HC LEVEL 3 INIT 30 MIN

Facility

$3,645.08

Hospital Charge Code	36000066
Hospital Revenue Code	360
Min. Negotiated Rate	$2,296.40
Max. Negotiated Rate	$3,280.57
Rate for Payer: Aetna Commercial	$3,098.32
Rate for Payer: Aetna New Business (MI Preferred)	$2,369.30
Rate for Payer: Cash Price	$2,916.06
Rate for Payer: Cofinity Commercial	$2,551.56
Rate for Payer: Cofinity Commercial	$3,134.77
Rate for Payer: Healthscope Commercial	$3,280.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,098.32
Rate for Payer: PHP Commercial	$3,098.32
Rate for Payer: Priority Health Cigna Priority Health	$2,551.56
Rate for Payer: Priority Health SBD	$2,296.40

Know your out-of-pocket cost for care.

All Charges