Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC LEVEL 3 INIT 30 MIN

Facility

$3,645.08

Hospital Charge Code	36000066
Hospital Revenue Code	360
Min. Negotiated Rate	$1,458.03
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: BCBS Complete	$1,458.03
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

HC LEVEL 3 SUBSQ 15 MIN

Facility

$1,417.04

Hospital Charge Code	36000067
Hospital Revenue Code	360
Min. Negotiated Rate	$892.74
Max. Negotiated Rate	$1,275.34
Rate for Payer: Aetna Commercial	$1,204.48
Rate for Payer: Aetna New Business (MI Preferred)	$921.08
Rate for Payer: Cash Price	$1,133.63
Rate for Payer: Cofinity Commercial	$1,218.65
Rate for Payer: Cofinity Commercial	$991.93
Rate for Payer: Healthscope Commercial	$1,275.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,204.48
Rate for Payer: PHP Commercial	$1,204.48
Rate for Payer: Priority Health Cigna Priority Health	$991.93
Rate for Payer: Priority Health SBD	$892.74

HC LEVEL 3 SUBSQ 15 MIN

Facility

$1,417.04

Hospital Charge Code	36000067
Hospital Revenue Code	360
Min. Negotiated Rate	$566.82
Max. Negotiated Rate	$1,275.34
Rate for Payer: Aetna Commercial	$1,204.48
Rate for Payer: Aetna New Business (MI Preferred)	$921.08
Rate for Payer: BCBS Complete	$566.82
Rate for Payer: Cash Price	$1,133.63
Rate for Payer: Cofinity Commercial	$1,218.65
Rate for Payer: Cofinity Commercial	$991.93
Rate for Payer: Healthscope Commercial	$1,275.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,204.48
Rate for Payer: PHP Commercial	$1,204.48
Rate for Payer: Priority Health Cigna Priority Health	$991.93
Rate for Payer: Priority Health SBD	$892.74

HC LEVEL 4 INIT 30 MIN

Facility

$4,339.52

Hospital Charge Code	36000068
Hospital Revenue Code	360
Min. Negotiated Rate	$1,735.81
Max. Negotiated Rate	$3,905.57
Rate for Payer: Aetna Commercial	$3,688.59
Rate for Payer: Aetna New Business (MI Preferred)	$2,820.69
Rate for Payer: BCBS Complete	$1,735.81
Rate for Payer: Cash Price	$3,471.62
Rate for Payer: Cofinity Commercial	$3,037.66
Rate for Payer: Cofinity Commercial	$3,731.99
Rate for Payer: Healthscope Commercial	$3,905.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,688.59
Rate for Payer: PHP Commercial	$3,688.59
Rate for Payer: Priority Health Cigna Priority Health	$3,037.66
Rate for Payer: Priority Health SBD	$2,733.90

HC LEVEL 4 INIT 30 MIN

Facility

$4,339.52

Hospital Charge Code	36000068
Hospital Revenue Code	360
Min. Negotiated Rate	$2,733.90
Max. Negotiated Rate	$3,905.57
Rate for Payer: Aetna Commercial	$3,688.59
Rate for Payer: Aetna New Business (MI Preferred)	$2,820.69
Rate for Payer: Cash Price	$3,471.62
Rate for Payer: Cofinity Commercial	$3,037.66
Rate for Payer: Cofinity Commercial	$3,731.99
Rate for Payer: Healthscope Commercial	$3,905.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,688.59
Rate for Payer: PHP Commercial	$3,688.59
Rate for Payer: Priority Health Cigna Priority Health	$3,037.66
Rate for Payer: Priority Health SBD	$2,733.90

HC LEVEL 4 SUBSQ 15 MIN

Facility

$1,579.11

Hospital Charge Code	36000069
Hospital Revenue Code	360
Min. Negotiated Rate	$631.64
Max. Negotiated Rate	$1,421.20
Rate for Payer: Aetna Commercial	$1,342.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,026.42
Rate for Payer: BCBS Complete	$631.64
Rate for Payer: Cash Price	$1,263.29
Rate for Payer: Cofinity Commercial	$1,105.38
Rate for Payer: Cofinity Commercial	$1,358.03
Rate for Payer: Healthscope Commercial	$1,421.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,342.24
Rate for Payer: PHP Commercial	$1,342.24
Rate for Payer: Priority Health Cigna Priority Health	$1,105.38
Rate for Payer: Priority Health SBD	$994.84

HC LEVEL 4 SUBSQ 15 MIN

Facility

$1,579.11

Hospital Charge Code	36000069
Hospital Revenue Code	360
Min. Negotiated Rate	$994.84
Max. Negotiated Rate	$1,421.20
Rate for Payer: Aetna Commercial	$1,342.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,026.42
Rate for Payer: Cash Price	$1,263.29
Rate for Payer: Cofinity Commercial	$1,105.38
Rate for Payer: Cofinity Commercial	$1,358.03
Rate for Payer: Healthscope Commercial	$1,421.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,342.24
Rate for Payer: PHP Commercial	$1,342.24
Rate for Payer: Priority Health Cigna Priority Health	$1,105.38
Rate for Payer: Priority Health SBD	$994.84

HC LEVEL 5 INIT 30 MIN

Facility

$4,842.31

Hospital Charge Code	36000070
Hospital Revenue Code	360
Min. Negotiated Rate	$3,050.66
Max. Negotiated Rate	$4,358.08
Rate for Payer: Aetna Commercial	$4,115.96
Rate for Payer: Aetna New Business (MI Preferred)	$3,147.50
Rate for Payer: Cash Price	$3,873.85
Rate for Payer: Cofinity Commercial	$3,389.62
Rate for Payer: Cofinity Commercial	$4,164.39
Rate for Payer: Healthscope Commercial	$4,358.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,115.96
Rate for Payer: PHP Commercial	$4,115.96
Rate for Payer: Priority Health Cigna Priority Health	$3,389.62
Rate for Payer: Priority Health SBD	$3,050.66

HC LEVEL 5 INIT 30 MIN

Facility

$4,842.31

Hospital Charge Code	36000070
Hospital Revenue Code	360
Min. Negotiated Rate	$1,936.92
Max. Negotiated Rate	$4,358.08
Rate for Payer: Aetna Commercial	$4,115.96
Rate for Payer: Aetna New Business (MI Preferred)	$3,147.50
Rate for Payer: BCBS Complete	$1,936.92
Rate for Payer: Cash Price	$3,873.85
Rate for Payer: Cofinity Commercial	$3,389.62
Rate for Payer: Cofinity Commercial	$4,164.39
Rate for Payer: Healthscope Commercial	$4,358.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,115.96
Rate for Payer: PHP Commercial	$4,115.96
Rate for Payer: Priority Health Cigna Priority Health	$3,389.62
Rate for Payer: Priority Health SBD	$3,050.66

HC LEVEL 5 SUBSQ 15 MIN

Facility

$1,979.54

Hospital Charge Code	36000071
Hospital Revenue Code	360
Min. Negotiated Rate	$1,247.11
Max. Negotiated Rate	$1,781.59
Rate for Payer: Aetna Commercial	$1,682.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,286.70
Rate for Payer: Cash Price	$1,583.63
Rate for Payer: Cofinity Commercial	$1,385.68
Rate for Payer: Cofinity Commercial	$1,702.40
Rate for Payer: Healthscope Commercial	$1,781.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,682.61
Rate for Payer: PHP Commercial	$1,682.61
Rate for Payer: Priority Health Cigna Priority Health	$1,385.68
Rate for Payer: Priority Health SBD	$1,247.11

HC LEVEL 5 SUBSQ 15 MIN

Facility

$1,979.54

Hospital Charge Code	36000071
Hospital Revenue Code	360
Min. Negotiated Rate	$791.82
Max. Negotiated Rate	$1,781.59
Rate for Payer: Aetna Commercial	$1,682.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,286.70
Rate for Payer: BCBS Complete	$791.82
Rate for Payer: Cash Price	$1,583.63
Rate for Payer: Cofinity Commercial	$1,385.68
Rate for Payer: Cofinity Commercial	$1,702.40
Rate for Payer: Healthscope Commercial	$1,781.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,682.61
Rate for Payer: PHP Commercial	$1,682.61
Rate for Payer: Priority Health Cigna Priority Health	$1,385.68
Rate for Payer: Priority Health SBD	$1,247.11

HC LEVETIRACETAM LEVEL

Facility

$75.28

Service Code	CPT 80177
Hospital Charge Code	30100057
Hospital Revenue Code	301
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$67.75
Rate for Payer: Aetna Commercial	$63.99
Rate for Payer: Aetna New Business (MI Preferred)	$48.93
Rate for Payer: Cash Price	$60.22
Rate for Payer: Cofinity Commercial	$64.74
Rate for Payer: Cofinity Commercial	$52.70
Rate for Payer: Healthscope Commercial	$67.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.99
Rate for Payer: PHP Commercial	$63.99
Rate for Payer: Priority Health Cigna Priority Health	$52.70
Rate for Payer: Priority Health SBD	$47.43

HC LEVETIRACETAM LEVEL

Facility

$75.28

Service Code	CPT 80177
Hospital Charge Code	30100057
Hospital Revenue Code	301
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$67.75
Rate for Payer: Aetna Commercial	$63.99
Rate for Payer: Aetna Medicare	$13.78
Rate for Payer: Aetna New Business (MI Preferred)	$48.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.56
Rate for Payer: Amish Plain Church Group Commercial	$16.56
Rate for Payer: BCBS Complete	$7.61
Rate for Payer: BCBS MAPPO	$13.25
Rate for Payer: BCBS Trust/PPO	$10.38
Rate for Payer: BCN Medicare Advantage	$13.25
Rate for Payer: Cash Price	$60.22
Rate for Payer: Cash Price	$60.22
Rate for Payer: Cofinity Commercial	$52.70
Rate for Payer: Cofinity Commercial	$64.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.25
Rate for Payer: Healthscope Commercial	$67.75
Rate for Payer: Mclaren Medicaid	$7.25
Rate for Payer: Mclaren Medicare	$13.25
Rate for Payer: Meridian Medicaid	$7.61
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13.91
Rate for Payer: MI Amish Medical Board Commercial	$15.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.99
Rate for Payer: PACE Medicare	$12.59
Rate for Payer: PACE SWMI	$13.25
Rate for Payer: PHP Commercial	$63.99
Rate for Payer: PHP Medicare Advantage	$13.25
Rate for Payer: Priority Health Choice Medicaid	$7.25
Rate for Payer: Priority Health Cigna Priority Health	$52.70
Rate for Payer: Priority Health Medicare	$13.25
Rate for Payer: Priority Health SBD	$47.43
Rate for Payer: Railroad Medicare Medicare	$13.25
Rate for Payer: UHC All Payor (Choice/PPO)	$15.90
Rate for Payer: UHC Core	$21.71
Rate for Payer: UHC Dual Complete DSNP	$13.25
Rate for Payer: UHC Exchange	$13.25
Rate for Payer: UHC Medicare Advantage	$13.65
Rate for Payer: VA VA	$13.25

HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR

Facility

$3,771.29

Service Code	CPT J7298
Hospital Charge Code	63600106
Hospital Revenue Code	636
Min. Negotiated Rate	$2,375.91
Max. Negotiated Rate	$3,394.16
Rate for Payer: Aetna Commercial	$3,205.60
Rate for Payer: Aetna New Business (MI Preferred)	$2,451.34
Rate for Payer: Cash Price	$3,017.03
Rate for Payer: Cofinity Commercial	$2,639.90
Rate for Payer: Cofinity Commercial	$3,243.31
Rate for Payer: Healthscope Commercial	$3,394.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,205.60
Rate for Payer: PHP Commercial	$3,205.60
Rate for Payer: Priority Health Cigna Priority Health	$2,639.90
Rate for Payer: Priority Health SBD	$2,375.91

HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR

Facility

$3,771.29

Service Code	CPT J7298
Hospital Charge Code	63600106
Hospital Revenue Code	636
Min. Negotiated Rate	$1,508.52
Max. Negotiated Rate	$3,394.16
Rate for Payer: Aetna Commercial	$3,205.60
Rate for Payer: Aetna New Business (MI Preferred)	$2,451.34
Rate for Payer: BCBS Complete	$1,508.52
Rate for Payer: BCBS Trust/PPO	$3,207.60
Rate for Payer: Cash Price	$3,017.03
Rate for Payer: Cash Price	$3,017.03
Rate for Payer: Cofinity Commercial	$3,243.31
Rate for Payer: Cofinity Commercial	$2,639.90
Rate for Payer: Healthscope Commercial	$3,394.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,205.60
Rate for Payer: PHP Commercial	$3,205.60
Rate for Payer: Priority Health Cigna Priority Health	$2,639.90
Rate for Payer: Priority Health SBD	$2,375.91

HC LH (LUTEINIZING HORMONE)

Facility

$76.50

Service Code	CPT 83002
Hospital Charge Code	30100231
Hospital Revenue Code	301
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health SBD	$48.20

HC LH (LUTEINIZING HORMONE)

Facility

$76.50

Service Code	CPT 83002
Hospital Charge Code	30100231
Hospital Revenue Code	301
Min. Negotiated Rate	$10.13
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna Medicare	$19.26
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.15
Rate for Payer: Amish Plain Church Group Commercial	$23.15
Rate for Payer: BCBS Complete	$10.64
Rate for Payer: BCBS MAPPO	$18.52
Rate for Payer: BCBS Trust/PPO	$14.50
Rate for Payer: BCN Medicare Advantage	$18.52
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.52
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$10.13
Rate for Payer: Mclaren Medicare	$18.52
Rate for Payer: Meridian Medicaid	$10.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.45
Rate for Payer: MI Amish Medical Board Commercial	$21.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$17.59
Rate for Payer: PACE SWMI	$18.52
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: PHP Medicare Advantage	$18.52
Rate for Payer: Priority Health Choice Medicaid	$10.13
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health Medicare	$18.52
Rate for Payer: Priority Health SBD	$48.20
Rate for Payer: Railroad Medicare Medicare	$18.52
Rate for Payer: UHC All Payor (Choice/PPO)	$22.22
Rate for Payer: UHC Core	$31.48
Rate for Payer: UHC Dual Complete DSNP	$18.52
Rate for Payer: UHC Exchange	$18.52
Rate for Payer: UHC Medicare Advantage	$19.08
Rate for Payer: VA VA	$18.52

HC LH PEDS, S

Facility

$180.00

Service Code	CPT 83002
Hospital Charge Code	30100738
Hospital Revenue Code	301
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health SBD	$113.40

HC LH PEDS, S

Facility

$180.00

Service Code	CPT 83002
Hospital Charge Code	30100738
Hospital Revenue Code	301
Min. Negotiated Rate	$10.13
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare	$19.26
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.15
Rate for Payer: Amish Plain Church Group Commercial	$23.15
Rate for Payer: BCBS Complete	$10.64
Rate for Payer: BCBS MAPPO	$18.52
Rate for Payer: BCBS Trust/PPO	$14.50
Rate for Payer: BCN Medicare Advantage	$18.52
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.52
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Mclaren Medicaid	$10.13
Rate for Payer: Mclaren Medicare	$18.52
Rate for Payer: Meridian Medicaid	$10.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.45
Rate for Payer: MI Amish Medical Board Commercial	$21.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.00
Rate for Payer: PACE Medicare	$17.59
Rate for Payer: PACE SWMI	$18.52
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: PHP Medicare Advantage	$18.52
Rate for Payer: Priority Health Choice Medicaid	$10.13
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health Medicare	$18.52
Rate for Payer: Priority Health SBD	$113.40
Rate for Payer: Railroad Medicare Medicare	$18.52
Rate for Payer: UHC All Payor (Choice/PPO)	$22.22
Rate for Payer: UHC Core	$31.48
Rate for Payer: UHC Dual Complete DSNP	$18.52
Rate for Payer: UHC Exchange	$18.52
Rate for Payer: UHC Medicare Advantage	$19.08
Rate for Payer: VA VA	$18.52

HC LH ULTRASENSITIVE

Facility

$77.52

Service Code	CPT 83002
Hospital Charge Code	30100232
Hospital Revenue Code	301
Min. Negotiated Rate	$10.13
Max. Negotiated Rate	$69.77
Rate for Payer: Aetna Commercial	$65.89
Rate for Payer: Aetna Medicare	$19.26
Rate for Payer: Aetna New Business (MI Preferred)	$50.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.15
Rate for Payer: Amish Plain Church Group Commercial	$23.15
Rate for Payer: BCBS Complete	$10.64
Rate for Payer: BCBS MAPPO	$18.52
Rate for Payer: BCBS Trust/PPO	$14.50
Rate for Payer: BCN Medicare Advantage	$18.52
Rate for Payer: Cash Price	$62.02
Rate for Payer: Cash Price	$62.02
Rate for Payer: Cofinity Commercial	$66.67
Rate for Payer: Cofinity Commercial	$54.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.52
Rate for Payer: Healthscope Commercial	$69.77
Rate for Payer: Mclaren Medicaid	$10.13
Rate for Payer: Mclaren Medicare	$18.52
Rate for Payer: Meridian Medicaid	$10.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.45
Rate for Payer: MI Amish Medical Board Commercial	$21.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.89
Rate for Payer: PACE Medicare	$17.59
Rate for Payer: PACE SWMI	$18.52
Rate for Payer: PHP Commercial	$65.89
Rate for Payer: PHP Medicare Advantage	$18.52
Rate for Payer: Priority Health Choice Medicaid	$10.13
Rate for Payer: Priority Health Cigna Priority Health	$54.26
Rate for Payer: Priority Health Medicare	$18.52
Rate for Payer: Priority Health SBD	$48.84
Rate for Payer: Railroad Medicare Medicare	$18.52
Rate for Payer: UHC All Payor (Choice/PPO)	$22.22
Rate for Payer: UHC Core	$31.48
Rate for Payer: UHC Dual Complete DSNP	$18.52
Rate for Payer: UHC Exchange	$18.52
Rate for Payer: UHC Medicare Advantage	$19.08
Rate for Payer: VA VA	$18.52

HC LH ULTRASENSITIVE

Facility

$77.52

Service Code	CPT 83002
Hospital Charge Code	30100232
Hospital Revenue Code	301
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$69.77
Rate for Payer: Aetna Commercial	$65.89
Rate for Payer: Aetna New Business (MI Preferred)	$50.39
Rate for Payer: Cash Price	$62.02
Rate for Payer: Cofinity Commercial	$54.26
Rate for Payer: Cofinity Commercial	$66.67
Rate for Payer: Healthscope Commercial	$69.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.89
Rate for Payer: PHP Commercial	$65.89
Rate for Payer: Priority Health Cigna Priority Health	$54.26
Rate for Payer: Priority Health SBD	$48.84

HC LIDOCAINE XYLOCAINE LEVEL

Facility

$65.00

Service Code	CPT 80176
Hospital Charge Code	30100033
Hospital Revenue Code	301
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$55.25
Rate for Payer: Aetna Medicare	$15.28
Rate for Payer: Aetna New Business (MI Preferred)	$42.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.36
Rate for Payer: Amish Plain Church Group Commercial	$18.36
Rate for Payer: BCBS Complete	$8.44
Rate for Payer: BCBS MAPPO	$14.69
Rate for Payer: BCBS Trust/PPO	$11.51
Rate for Payer: BCN Medicare Advantage	$14.69
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cofinity Commercial	$55.90
Rate for Payer: Cofinity Commercial	$45.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.69
Rate for Payer: Healthscope Commercial	$58.50
Rate for Payer: Mclaren Medicaid	$8.04
Rate for Payer: Mclaren Medicare	$14.69
Rate for Payer: Meridian Medicaid	$8.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15.42
Rate for Payer: MI Amish Medical Board Commercial	$16.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$55.25
Rate for Payer: PACE Medicare	$13.96
Rate for Payer: PACE SWMI	$14.69
Rate for Payer: PHP Commercial	$55.25
Rate for Payer: PHP Medicare Advantage	$14.69
Rate for Payer: Priority Health Choice Medicaid	$8.04
Rate for Payer: Priority Health Cigna Priority Health	$45.50
Rate for Payer: Priority Health Medicare	$14.69
Rate for Payer: Priority Health SBD	$40.95
Rate for Payer: Railroad Medicare Medicare	$14.69
Rate for Payer: UHC All Payor (Choice/PPO)	$17.63
Rate for Payer: UHC Core	$24.96
Rate for Payer: UHC Dual Complete DSNP	$14.69
Rate for Payer: UHC Exchange	$14.69
Rate for Payer: UHC Medicare Advantage	$15.13
Rate for Payer: VA VA	$14.69

HC LIDOCAINE XYLOCAINE LEVEL

Facility

$65.00

Service Code	CPT 80176
Hospital Charge Code	30100033
Hospital Revenue Code	301
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$55.25
Rate for Payer: Aetna New Business (MI Preferred)	$42.25
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cofinity Commercial	$45.50
Rate for Payer: Cofinity Commercial	$55.90
Rate for Payer: Healthscope Commercial	$58.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$55.25
Rate for Payer: PHP Commercial	$55.25
Rate for Payer: Priority Health Cigna Priority Health	$45.50
Rate for Payer: Priority Health SBD	$40.95

HC LIMITED SPECTRAL DOPPLER

Facility

$368.40

Service Code	HCPCS 93321
Hospital Charge Code	48000025
Hospital Revenue Code	480
Min. Negotiated Rate	$232.09
Max. Negotiated Rate	$331.56
Rate for Payer: Aetna Commercial	$313.14
Rate for Payer: Aetna New Business (MI Preferred)	$239.46
Rate for Payer: Cash Price	$294.72
Rate for Payer: Cofinity Commercial	$316.82
Rate for Payer: Cofinity Commercial	$257.88
Rate for Payer: Healthscope Commercial	$331.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$313.14
Rate for Payer: PHP Commercial	$313.14
Rate for Payer: Priority Health Cigna Priority Health	$257.88
Rate for Payer: Priority Health SBD	$232.09

HC LIMITED SPECTRAL DOPPLER

Facility

$368.40

Service Code	HCPCS 93321
Hospital Charge Code	48000025
Hospital Revenue Code	480
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$331.56
Rate for Payer: Aetna Commercial	$313.14
Rate for Payer: Aetna New Business (MI Preferred)	$239.46
Rate for Payer: BCBS Complete	$147.36
Rate for Payer: BCBS Trust/PPO	$82.90
Rate for Payer: Cash Price	$294.72
Rate for Payer: Cash Price	$294.72
Rate for Payer: Cofinity Commercial	$316.82
Rate for Payer: Cofinity Commercial	$257.88
Rate for Payer: Healthscope Commercial	$331.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$313.14
Rate for Payer: PHP Commercial	$313.14
Rate for Payer: Priority Health Cigna Priority Health	$257.88
Rate for Payer: Priority Health SBD	$232.09
Rate for Payer: UHC All Payor (Choice/PPO)	$27.02
Rate for Payer: UHC Exchange	$24.56

Know your out-of-pocket cost for care.

All Charges