Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC MASTECTOMY SLEEVE EA $50

Facility

$50.00

Service Code	HCPCS L8010
Hospital Charge Code	96000020
Hospital Revenue Code	270
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$42.50
Rate for Payer: Aetna New Business (MI Preferred)	$32.50
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$35.00
Rate for Payer: Cofinity Commercial	$43.00
Rate for Payer: Healthscope Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: PHP Commercial	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health SBD	$31.50

HC MASTECTOMY SLEEVE EA $60

Facility

$60.00

Service Code	HCPCS L8010
Hospital Charge Code	96000021
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC MASTECTOMY SLEEVE EA $60

Facility

$60.00

Service Code	HCPCS L8010
Hospital Charge Code	96000021
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$148.19
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$148.19
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC MASTECTOMY SLEEVE EA $70

Facility

$70.00

Service Code	HCPCS L8010
Hospital Charge Code	96000022
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$148.19
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: BCBS Trust/PPO	$148.19
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC MASTECTOMY SLEEVE EA $70

Facility

$70.00

Service Code	HCPCS L8010
Hospital Charge Code	96000022
Hospital Revenue Code	270
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC MASTECTOMY SLEEVE EA $80

Facility

$80.00

Service Code	HCPCS L8010
Hospital Charge Code	96000023
Hospital Revenue Code	270
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$68.00
Rate for Payer: Aetna New Business (MI Preferred)	$52.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$56.00
Rate for Payer: Cofinity Commercial	$68.80
Rate for Payer: Healthscope Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: PHP Commercial	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health SBD	$50.40

HC MASTECTOMY SLEEVE EA $80

Facility

$80.00

Service Code	HCPCS L8010
Hospital Charge Code	96000023
Hospital Revenue Code	270
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$148.19
Rate for Payer: Aetna Commercial	$68.00
Rate for Payer: Aetna New Business (MI Preferred)	$52.00
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$148.19
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$68.80
Rate for Payer: Cofinity Commercial	$56.00
Rate for Payer: Healthscope Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: PHP Commercial	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health SBD	$50.40

HC MASTECTOMY SLEEVE EA $90

Facility

$90.00

Service Code	HCPCS L8010
Hospital Charge Code	96000024
Hospital Revenue Code	270
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$58.50
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$63.00
Rate for Payer: Cofinity Commercial	$77.40
Rate for Payer: Healthscope Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: PHP Commercial	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health SBD	$56.70

HC MASTECTOMY SLEEVE EA $90

Facility

$90.00

Service Code	HCPCS L8010
Hospital Charge Code	96000024
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$148.19
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$58.50
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$148.19
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$63.00
Rate for Payer: Cofinity Commercial	$77.40
Rate for Payer: Healthscope Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: PHP Commercial	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health SBD	$56.70

HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$2,100.08

Service Code	CPT 19020
Hospital Charge Code	76100281
Hospital Revenue Code	761
Min. Negotiated Rate	$1,323.05
Max. Negotiated Rate	$1,890.07
Rate for Payer: Aetna Commercial	$1,785.07
Rate for Payer: Aetna New Business (MI Preferred)	$1,365.05
Rate for Payer: Cash Price	$1,680.06
Rate for Payer: Cofinity Commercial	$1,470.06
Rate for Payer: Cofinity Commercial	$1,806.07
Rate for Payer: Healthscope Commercial	$1,890.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,785.07
Rate for Payer: PHP Commercial	$1,785.07
Rate for Payer: Priority Health Cigna Priority Health	$1,470.06
Rate for Payer: Priority Health SBD	$1,323.05

HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$2,100.08

Service Code	CPT 19020
Hospital Charge Code	76100281
Hospital Revenue Code	761
Min. Negotiated Rate	$311.72
Max. Negotiated Rate	$4,496.47
Rate for Payer: Aetna Commercial	$1,785.07
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,365.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$1,301.15
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$1,680.06
Rate for Payer: Cash Price	$1,680.06
Rate for Payer: Cofinity Commercial	$1,806.07
Rate for Payer: Cofinity Commercial	$1,470.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$1,890.07
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,785.07
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$1,785.07
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$1,470.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,496.47
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,597.18
Rate for Payer: Priority Health SBD	$1,323.05
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$342.89
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$311.72
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

HC MATERNAL SCRN INTEGRATED SERUM 1

Facility

$110.00

Service Code	CPT 84163
Hospital Charge Code	30100641
Hospital Revenue Code	301
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$93.50
Rate for Payer: Aetna Medicare	$15.65
Rate for Payer: Aetna New Business (MI Preferred)	$71.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.81
Rate for Payer: Amish Plain Church Group Commercial	$18.81
Rate for Payer: BCBS Complete	$8.64
Rate for Payer: BCBS MAPPO	$15.05
Rate for Payer: BCBS Trust/PPO	$11.79
Rate for Payer: BCN Medicare Advantage	$15.05
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$94.60
Rate for Payer: Cofinity Commercial	$77.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.05
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Mclaren Medicaid	$8.23
Rate for Payer: Mclaren Medicare	$15.05
Rate for Payer: Meridian Medicaid	$8.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15.80
Rate for Payer: MI Amish Medical Board Commercial	$17.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PACE Medicare	$14.30
Rate for Payer: PACE SWMI	$15.05
Rate for Payer: PHP Commercial	$93.50
Rate for Payer: PHP Medicare Advantage	$15.05
Rate for Payer: Priority Health Choice Medicaid	$8.23
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health Medicare	$15.05
Rate for Payer: Priority Health SBD	$69.30
Rate for Payer: Railroad Medicare Medicare	$15.05
Rate for Payer: UHC All Payor (Choice/PPO)	$18.06
Rate for Payer: UHC Core	$25.60
Rate for Payer: UHC Dual Complete DSNP	$15.05
Rate for Payer: UHC Exchange	$15.05
Rate for Payer: UHC Medicare Advantage	$15.50
Rate for Payer: VA VA	$15.05

HC MATERNAL SCRN INTEGRATED SERUM 1

Facility

$110.00

Service Code	CPT 84163
Hospital Charge Code	30100641
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$93.50
Rate for Payer: Aetna New Business (MI Preferred)	$71.50
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$77.00
Rate for Payer: Cofinity Commercial	$94.60
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PHP Commercial	$93.50
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health SBD	$69.30

HC MATERNAL SCRN INTEGRATED SERUM 2

Facility

$237.60

Service Code	CPT 81511
Hospital Charge Code	30100654
Hospital Revenue Code	301
Min. Negotiated Rate	$83.96
Max. Negotiated Rate	$213.84
Rate for Payer: Aetna Commercial	$201.96
Rate for Payer: Aetna Medicare	$159.64
Rate for Payer: Aetna New Business (MI Preferred)	$154.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$191.88
Rate for Payer: Amish Plain Church Group Commercial	$191.88
Rate for Payer: BCBS Complete	$88.17
Rate for Payer: BCBS MAPPO	$153.50
Rate for Payer: BCBS Trust/PPO	$120.21
Rate for Payer: BCN Medicare Advantage	$153.50
Rate for Payer: Cash Price	$190.08
Rate for Payer: Cash Price	$190.08
Rate for Payer: Cofinity Commercial	$204.34
Rate for Payer: Cofinity Commercial	$166.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$153.50
Rate for Payer: Healthscope Commercial	$213.84
Rate for Payer: Mclaren Medicaid	$83.96
Rate for Payer: Mclaren Medicare	$153.50
Rate for Payer: Meridian Medicaid	$88.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$161.18
Rate for Payer: MI Amish Medical Board Commercial	$176.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.96
Rate for Payer: PACE Medicare	$145.82
Rate for Payer: PACE SWMI	$153.50
Rate for Payer: PHP Commercial	$201.96
Rate for Payer: PHP Medicare Advantage	$153.50
Rate for Payer: Priority Health Choice Medicaid	$83.96
Rate for Payer: Priority Health Cigna Priority Health	$166.32
Rate for Payer: Priority Health Medicare	$153.50
Rate for Payer: Priority Health SBD	$149.69
Rate for Payer: Railroad Medicare Medicare	$153.50
Rate for Payer: UHC All Payor (Choice/PPO)	$184.20
Rate for Payer: UHC Core	$184.20
Rate for Payer: UHC Dual Complete DSNP	$153.50
Rate for Payer: UHC Exchange	$153.50
Rate for Payer: UHC Medicare Advantage	$158.10
Rate for Payer: VA VA	$153.50

HC MATERNAL SCRN INTEGRATED SERUM 2

Facility

$237.60

Service Code	CPT 81511
Hospital Charge Code	30100654
Hospital Revenue Code	301
Min. Negotiated Rate	$149.69
Max. Negotiated Rate	$213.84
Rate for Payer: Aetna Commercial	$201.96
Rate for Payer: Aetna New Business (MI Preferred)	$154.44
Rate for Payer: Cash Price	$190.08
Rate for Payer: Cofinity Commercial	$166.32
Rate for Payer: Cofinity Commercial	$204.34
Rate for Payer: Healthscope Commercial	$213.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.96
Rate for Payer: PHP Commercial	$201.96
Rate for Payer: Priority Health Cigna Priority Health	$166.32
Rate for Payer: Priority Health SBD	$149.69

HC MAXIMUM VOLUNTARY VENTILATION

Facility

$120.23

Service Code	CPT 94200
Hospital Charge Code	46000022
Hospital Revenue Code	460
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$173.33
Rate for Payer: Aetna Commercial	$102.20
Rate for Payer: Aetna Medicare	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$78.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$68.04
Rate for Payer: Amish Plain Church Group Commercial	$68.04
Rate for Payer: BCBS Complete	$31.26
Rate for Payer: BCBS MAPPO	$54.43
Rate for Payer: BCBS Trust/PPO	$55.27
Rate for Payer: BCN Medicare Advantage	$54.43
Rate for Payer: Cash Price	$96.18
Rate for Payer: Cash Price	$96.18
Rate for Payer: Cofinity Commercial	$84.16
Rate for Payer: Cofinity Commercial	$103.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$54.43
Rate for Payer: Healthscope Commercial	$108.21
Rate for Payer: Mclaren Medicaid	$29.77
Rate for Payer: Mclaren Medicare	$54.43
Rate for Payer: Meridian Medicaid	$31.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$57.15
Rate for Payer: MI Amish Medical Board Commercial	$62.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.20
Rate for Payer: PACE Medicare	$51.71
Rate for Payer: PACE SWMI	$54.43
Rate for Payer: PHP Commercial	$102.20
Rate for Payer: PHP Medicare Advantage	$54.43
Rate for Payer: Priority Health Choice Medicaid	$29.77
Rate for Payer: Priority Health Cigna Priority Health	$84.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.33
Rate for Payer: Priority Health Medicare	$54.43
Rate for Payer: Priority Health Narrow Network	$138.66
Rate for Payer: Priority Health SBD	$75.74
Rate for Payer: Railroad Medicare Medicare	$54.43
Rate for Payer: UHC All Payor (Choice/PPO)	$16.20
Rate for Payer: UHC Dual Complete DSNP	$54.43
Rate for Payer: UHC Exchange	$14.73
Rate for Payer: UHC Medicare Advantage	$56.06
Rate for Payer: VA VA	$54.43

HC MAXIMUM VOLUNTARY VENTILATION

Facility

$120.23

Service Code	CPT 94200
Hospital Charge Code	46000022
Hospital Revenue Code	460
Min. Negotiated Rate	$75.74
Max. Negotiated Rate	$108.21
Rate for Payer: Aetna Commercial	$102.20
Rate for Payer: Aetna New Business (MI Preferred)	$78.15
Rate for Payer: Cash Price	$96.18
Rate for Payer: Cofinity Commercial	$103.40
Rate for Payer: Cofinity Commercial	$84.16
Rate for Payer: Healthscope Commercial	$108.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.20
Rate for Payer: PHP Commercial	$102.20
Rate for Payer: Priority Health Cigna Priority Health	$84.16
Rate for Payer: Priority Health SBD	$75.74

HC MAYO CHROMOGENIC FACTOR 8

Facility

$331.60

Service Code	CPT 85130
Hospital Charge Code	30500105
Hospital Revenue Code	305
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$298.44
Rate for Payer: Aetna Commercial	$281.86
Rate for Payer: Aetna Medicare	$12.37
Rate for Payer: Aetna New Business (MI Preferred)	$215.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$14.86
Rate for Payer: Amish Plain Church Group Commercial	$14.86
Rate for Payer: BCBS Complete	$6.83
Rate for Payer: BCBS MAPPO	$11.89
Rate for Payer: BCBS Trust/PPO	$9.31
Rate for Payer: BCN Medicare Advantage	$11.89
Rate for Payer: Cash Price	$265.28
Rate for Payer: Cash Price	$265.28
Rate for Payer: Cofinity Commercial	$285.18
Rate for Payer: Cofinity Commercial	$232.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.89
Rate for Payer: Healthscope Commercial	$298.44
Rate for Payer: Mclaren Medicaid	$6.50
Rate for Payer: Mclaren Medicare	$11.89
Rate for Payer: Meridian Medicaid	$6.83
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.48
Rate for Payer: MI Amish Medical Board Commercial	$13.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.86
Rate for Payer: PACE Medicare	$11.30
Rate for Payer: PACE SWMI	$11.89
Rate for Payer: PHP Commercial	$281.86
Rate for Payer: PHP Medicare Advantage	$11.89
Rate for Payer: Priority Health Choice Medicaid	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$232.12
Rate for Payer: Priority Health Medicare	$11.89
Rate for Payer: Priority Health SBD	$208.91
Rate for Payer: Railroad Medicare Medicare	$11.89
Rate for Payer: UHC All Payor (Choice/PPO)	$14.27
Rate for Payer: UHC Core	$20.22
Rate for Payer: UHC Dual Complete DSNP	$11.89
Rate for Payer: UHC Exchange	$11.89
Rate for Payer: UHC Medicare Advantage	$12.25
Rate for Payer: VA VA	$11.89

HC MAYO CHROMOGENIC FACTOR 8

Facility

$331.60

Service Code	CPT 85130
Hospital Charge Code	30500105
Hospital Revenue Code	305
Min. Negotiated Rate	$208.91
Max. Negotiated Rate	$298.44
Rate for Payer: Aetna Commercial	$281.86
Rate for Payer: Aetna New Business (MI Preferred)	$215.54
Rate for Payer: Cash Price	$265.28
Rate for Payer: Cofinity Commercial	$232.12
Rate for Payer: Cofinity Commercial	$285.18
Rate for Payer: Healthscope Commercial	$298.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.86
Rate for Payer: PHP Commercial	$281.86
Rate for Payer: Priority Health Cigna Priority Health	$232.12
Rate for Payer: Priority Health SBD	$208.91

HC MAYO CHROMOGENIC FACTOR 9

Facility

$351.53

Service Code	CPT 85130
Hospital Charge Code	30500104
Hospital Revenue Code	305
Min. Negotiated Rate	$221.46
Max. Negotiated Rate	$316.38
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: Aetna New Business (MI Preferred)	$228.49
Rate for Payer: Cash Price	$281.22
Rate for Payer: Cofinity Commercial	$246.07
Rate for Payer: Cofinity Commercial	$302.32
Rate for Payer: Healthscope Commercial	$316.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$298.80
Rate for Payer: PHP Commercial	$298.80
Rate for Payer: Priority Health Cigna Priority Health	$246.07
Rate for Payer: Priority Health SBD	$221.46

HC MAYO CHROMOGENIC FACTOR 9

Facility

$351.53

Service Code	CPT 85130
Hospital Charge Code	30500104
Hospital Revenue Code	305
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$316.38
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: Aetna Medicare	$12.37
Rate for Payer: Aetna New Business (MI Preferred)	$228.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$14.86
Rate for Payer: Amish Plain Church Group Commercial	$14.86
Rate for Payer: BCBS Complete	$6.83
Rate for Payer: BCBS MAPPO	$11.89
Rate for Payer: BCBS Trust/PPO	$9.31
Rate for Payer: BCN Medicare Advantage	$11.89
Rate for Payer: Cash Price	$281.22
Rate for Payer: Cash Price	$281.22
Rate for Payer: Cofinity Commercial	$302.32
Rate for Payer: Cofinity Commercial	$246.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.89
Rate for Payer: Healthscope Commercial	$316.38
Rate for Payer: Mclaren Medicaid	$6.50
Rate for Payer: Mclaren Medicare	$11.89
Rate for Payer: Meridian Medicaid	$6.83
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.48
Rate for Payer: MI Amish Medical Board Commercial	$13.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$298.80
Rate for Payer: PACE Medicare	$11.30
Rate for Payer: PACE SWMI	$11.89
Rate for Payer: PHP Commercial	$298.80
Rate for Payer: PHP Medicare Advantage	$11.89
Rate for Payer: Priority Health Choice Medicaid	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$246.07
Rate for Payer: Priority Health Medicare	$11.89
Rate for Payer: Priority Health SBD	$221.46
Rate for Payer: Railroad Medicare Medicare	$11.89
Rate for Payer: UHC All Payor (Choice/PPO)	$14.27
Rate for Payer: UHC Core	$20.22
Rate for Payer: UHC Dual Complete DSNP	$11.89
Rate for Payer: UHC Exchange	$11.89
Rate for Payer: UHC Medicare Advantage	$12.25
Rate for Payer: VA VA	$11.89

HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS

Facility

$1,925.00

Service Code	CPT 81450
Hospital Charge Code	31000084
Hospital Revenue Code	310
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$1,732.50
Rate for Payer: Aetna Commercial	$1,636.25
Rate for Payer: Aetna Medicare	$789.91
Rate for Payer: Aetna New Business (MI Preferred)	$1,251.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$949.41
Rate for Payer: Amish Plain Church Group Commercial	$949.41
Rate for Payer: BCBS Complete	$436.27
Rate for Payer: BCBS MAPPO	$759.53
Rate for Payer: BCBS Trust/PPO	$793.03
Rate for Payer: BCN Medicare Advantage	$759.53
Rate for Payer: Cash Price	$1,540.00
Rate for Payer: Cash Price	$1,540.00
Rate for Payer: Cofinity Commercial	$1,655.50
Rate for Payer: Cofinity Commercial	$1,347.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$759.53
Rate for Payer: Healthscope Commercial	$1,732.50
Rate for Payer: Mclaren Medicaid	$415.46
Rate for Payer: Mclaren Medicare	$759.53
Rate for Payer: Meridian Medicaid	$436.27
Rate for Payer: Meridian Wellcare - Medicare Advantage	$797.51
Rate for Payer: MI Amish Medical Board Commercial	$873.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,636.25
Rate for Payer: PACE Medicare	$721.55
Rate for Payer: PACE SWMI	$759.53
Rate for Payer: PHP Commercial	$1,636.25
Rate for Payer: PHP Medicare Advantage	$759.53
Rate for Payer: Priority Health Choice Medicaid	$415.46
Rate for Payer: Priority Health Cigna Priority Health	$1,347.50
Rate for Payer: Priority Health Medicare	$759.53
Rate for Payer: Priority Health SBD	$1,212.75
Rate for Payer: Railroad Medicare Medicare	$759.53
Rate for Payer: UHC All Payor (Choice/PPO)	$911.44
Rate for Payer: UHC Core	$107.80
Rate for Payer: UHC Dual Complete DSNP	$759.53
Rate for Payer: UHC Exchange	$759.53
Rate for Payer: UHC Medicare Advantage	$782.32
Rate for Payer: VA VA	$759.53

HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS

Facility

$1,925.00

Service Code	CPT 81450
Hospital Charge Code	31000084
Hospital Revenue Code	310
Min. Negotiated Rate	$1,212.75
Max. Negotiated Rate	$1,732.50
Rate for Payer: Aetna Commercial	$1,636.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,251.25
Rate for Payer: Cash Price	$1,540.00
Rate for Payer: Cofinity Commercial	$1,347.50
Rate for Payer: Cofinity Commercial	$1,655.50
Rate for Payer: Healthscope Commercial	$1,732.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,636.25
Rate for Payer: PHP Commercial	$1,636.25
Rate for Payer: Priority Health Cigna Priority Health	$1,347.50
Rate for Payer: Priority Health SBD	$1,212.75

HC MAYO CREATININE, URINE CMPT

Facility

$10.57

Service Code	CPT 82570
Hospital Charge Code	30100734
Hospital Revenue Code	301
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$9.51
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna New Business (MI Preferred)	$6.87
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cofinity Commercial	$7.40
Rate for Payer: Cofinity Commercial	$9.09
Rate for Payer: Healthscope Commercial	$9.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.98
Rate for Payer: PHP Commercial	$8.98
Rate for Payer: Priority Health Cigna Priority Health	$7.40
Rate for Payer: Priority Health SBD	$6.66

HC MAYO CREATININE, URINE CMPT

Facility

$10.57

Service Code	CPT 82570
Hospital Charge Code	30100734
Hospital Revenue Code	301
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$9.51
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna Medicare	$5.39
Rate for Payer: Aetna New Business (MI Preferred)	$6.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.48
Rate for Payer: Amish Plain Church Group Commercial	$6.48
Rate for Payer: BCBS Complete	$2.98
Rate for Payer: BCBS MAPPO	$5.18
Rate for Payer: BCBS Trust/PPO	$4.06
Rate for Payer: BCN Medicare Advantage	$5.18
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cofinity Commercial	$9.09
Rate for Payer: Cofinity Commercial	$7.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.18
Rate for Payer: Healthscope Commercial	$9.51
Rate for Payer: Mclaren Medicaid	$2.83
Rate for Payer: Mclaren Medicare	$5.18
Rate for Payer: Meridian Medicaid	$2.98
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.44
Rate for Payer: MI Amish Medical Board Commercial	$5.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.98
Rate for Payer: PACE Medicare	$4.92
Rate for Payer: PACE SWMI	$5.18
Rate for Payer: PHP Commercial	$8.98
Rate for Payer: PHP Medicare Advantage	$5.18
Rate for Payer: Priority Health Choice Medicaid	$2.83
Rate for Payer: Priority Health Cigna Priority Health	$7.40
Rate for Payer: Priority Health Medicare	$5.18
Rate for Payer: Priority Health SBD	$6.66
Rate for Payer: Railroad Medicare Medicare	$5.18
Rate for Payer: UHC All Payor (Choice/PPO)	$6.22
Rate for Payer: UHC Core	$8.80
Rate for Payer: UHC Dual Complete DSNP	$5.18
Rate for Payer: UHC Exchange	$5.18
Rate for Payer: UHC Medicare Advantage	$5.34
Rate for Payer: VA VA	$5.18

Know your out-of-pocket cost for care.

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