Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PHOSPHATIDYLSERINE AUTOABS CMPT

Facility

$53.04

Service Code	CPT 86148
Hospital Charge Code	30200148
Hospital Revenue Code	302
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$47.74
Rate for Payer: Aetna Commercial	$45.08
Rate for Payer: Aetna New Business (MI Preferred)	$34.48
Rate for Payer: Cash Price	$42.43
Rate for Payer: Cofinity Commercial	$37.13
Rate for Payer: Cofinity Commercial	$45.61
Rate for Payer: Healthscope Commercial	$47.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.08
Rate for Payer: PHP Commercial	$45.08
Rate for Payer: Priority Health Cigna Priority Health	$37.13
Rate for Payer: Priority Health SBD	$33.42

HC PHOSPHOLIPASE A2 RECEPTOR

Facility

$276.60

Service Code	CPT 86255
Hospital Charge Code	30200492
Hospital Revenue Code	302
Min. Negotiated Rate	$174.26
Max. Negotiated Rate	$248.94
Rate for Payer: Aetna Commercial	$235.11
Rate for Payer: Aetna New Business (MI Preferred)	$179.79
Rate for Payer: Cash Price	$221.28
Rate for Payer: Cofinity Commercial	$193.62
Rate for Payer: Cofinity Commercial	$237.88
Rate for Payer: Healthscope Commercial	$248.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$235.11
Rate for Payer: PHP Commercial	$235.11
Rate for Payer: Priority Health Cigna Priority Health	$193.62
Rate for Payer: Priority Health SBD	$174.26

HC PHOSPHOLIPASE A2 RECEPTOR

Facility

$276.60

Service Code	CPT 86255
Hospital Charge Code	30200492
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$248.94
Rate for Payer: Aetna Commercial	$235.11
Rate for Payer: Aetna Medicare	$12.53
Rate for Payer: Aetna New Business (MI Preferred)	$179.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.06
Rate for Payer: Amish Plain Church Group Commercial	$15.06
Rate for Payer: BCBS Complete	$6.92
Rate for Payer: BCBS MAPPO	$12.05
Rate for Payer: BCBS Trust/PPO	$7.08
Rate for Payer: BCN Medicare Advantage	$12.05
Rate for Payer: Cash Price	$221.28
Rate for Payer: Cash Price	$221.28
Rate for Payer: Cofinity Commercial	$237.88
Rate for Payer: Cofinity Commercial	$193.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.05
Rate for Payer: Healthscope Commercial	$248.94
Rate for Payer: Mclaren Medicaid	$6.59
Rate for Payer: Mclaren Medicare	$12.05
Rate for Payer: Meridian Medicaid	$6.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.65
Rate for Payer: MI Amish Medical Board Commercial	$13.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$235.11
Rate for Payer: PACE Medicare	$11.45
Rate for Payer: PACE SWMI	$12.05
Rate for Payer: PHP Commercial	$235.11
Rate for Payer: PHP Medicare Advantage	$12.05
Rate for Payer: Priority Health Choice Medicaid	$6.59
Rate for Payer: Priority Health Cigna Priority Health	$193.62
Rate for Payer: Priority Health Medicare	$12.05
Rate for Payer: Priority Health SBD	$174.26
Rate for Payer: Railroad Medicare Medicare	$12.05
Rate for Payer: UHC All Payor (Choice/PPO)	$14.46
Rate for Payer: UHC Core	$20.48
Rate for Payer: UHC Dual Complete DSNP	$12.05
Rate for Payer: UHC Exchange	$12.05
Rate for Payer: UHC Medicare Advantage	$12.41
Rate for Payer: VA VA	$12.05

HC PHOSPHOLIPASE A2 SCREEN

Facility

$206.00

Service Code	CPT 86255
Hospital Charge Code	30200430
Hospital Revenue Code	302
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna Commercial	$175.10
Rate for Payer: Aetna New Business (MI Preferred)	$133.90
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cofinity Commercial	$177.16
Rate for Payer: Cofinity Commercial	$144.20
Rate for Payer: Healthscope Commercial	$185.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$175.10
Rate for Payer: PHP Commercial	$175.10
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health SBD	$129.78

HC PHOSPHOLIPASE A2 SCREEN

Facility

$206.00

Service Code	CPT 86255
Hospital Charge Code	30200430
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna Commercial	$175.10
Rate for Payer: Aetna Medicare	$12.53
Rate for Payer: Aetna New Business (MI Preferred)	$133.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.06
Rate for Payer: Amish Plain Church Group Commercial	$15.06
Rate for Payer: BCBS Complete	$6.92
Rate for Payer: BCBS MAPPO	$12.05
Rate for Payer: BCBS Trust/PPO	$7.08
Rate for Payer: BCN Medicare Advantage	$12.05
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cofinity Commercial	$177.16
Rate for Payer: Cofinity Commercial	$144.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.05
Rate for Payer: Healthscope Commercial	$185.40
Rate for Payer: Mclaren Medicaid	$6.59
Rate for Payer: Mclaren Medicare	$12.05
Rate for Payer: Meridian Medicaid	$6.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.65
Rate for Payer: MI Amish Medical Board Commercial	$13.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$175.10
Rate for Payer: PACE Medicare	$11.45
Rate for Payer: PACE SWMI	$12.05
Rate for Payer: PHP Commercial	$175.10
Rate for Payer: PHP Medicare Advantage	$12.05
Rate for Payer: Priority Health Choice Medicaid	$6.59
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health Medicare	$12.05
Rate for Payer: Priority Health SBD	$129.78
Rate for Payer: Railroad Medicare Medicare	$12.05
Rate for Payer: UHC All Payor (Choice/PPO)	$14.46
Rate for Payer: UHC Core	$20.48
Rate for Payer: UHC Dual Complete DSNP	$12.05
Rate for Payer: UHC Exchange	$12.05
Rate for Payer: UHC Medicare Advantage	$12.41
Rate for Payer: VA VA	$12.05

HC PHOSPHOLIPASE A2 TITER

Facility

$206.00

Service Code	CPT 86256
Hospital Charge Code	30200431
Hospital Revenue Code	302
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna Commercial	$175.10
Rate for Payer: Aetna New Business (MI Preferred)	$133.90
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cofinity Commercial	$144.20
Rate for Payer: Cofinity Commercial	$177.16
Rate for Payer: Healthscope Commercial	$185.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$175.10
Rate for Payer: PHP Commercial	$175.10
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health SBD	$129.78

HC PHOSPHOLIPASE A2 TITER

Facility

$206.00

Service Code	CPT 86256
Hospital Charge Code	30200431
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna Commercial	$175.10
Rate for Payer: Aetna Medicare	$12.53
Rate for Payer: Aetna New Business (MI Preferred)	$133.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.06
Rate for Payer: Amish Plain Church Group Commercial	$15.06
Rate for Payer: BCBS Complete	$6.92
Rate for Payer: BCBS MAPPO	$12.05
Rate for Payer: BCBS Trust/PPO	$7.08
Rate for Payer: BCN Medicare Advantage	$12.05
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cofinity Commercial	$177.16
Rate for Payer: Cofinity Commercial	$144.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.05
Rate for Payer: Healthscope Commercial	$185.40
Rate for Payer: Mclaren Medicaid	$6.59
Rate for Payer: Mclaren Medicare	$12.05
Rate for Payer: Meridian Medicaid	$6.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.65
Rate for Payer: MI Amish Medical Board Commercial	$13.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$175.10
Rate for Payer: PACE Medicare	$11.45
Rate for Payer: PACE SWMI	$12.05
Rate for Payer: PHP Commercial	$175.10
Rate for Payer: PHP Medicare Advantage	$12.05
Rate for Payer: Priority Health Choice Medicaid	$6.59
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health Medicare	$12.05
Rate for Payer: Priority Health SBD	$129.78
Rate for Payer: Railroad Medicare Medicare	$12.05
Rate for Payer: UHC All Payor (Choice/PPO)	$14.46
Rate for Payer: UHC Core	$20.48
Rate for Payer: UHC Dual Complete DSNP	$12.05
Rate for Payer: UHC Exchange	$12.05
Rate for Payer: UHC Medicare Advantage	$12.41
Rate for Payer: VA VA	$12.05

HC PHOSPHOROUS SERUM

Facility

$20.40

Service Code	CPT 84100
Hospital Charge Code	30100392
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna Medicare	$4.93
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.92
Rate for Payer: Amish Plain Church Group Commercial	$5.92
Rate for Payer: BCBS Complete	$2.72
Rate for Payer: BCBS MAPPO	$4.74
Rate for Payer: BCN Medicare Advantage	$4.74
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.74
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Mclaren Medicaid	$2.59
Rate for Payer: Mclaren Medicare	$4.74
Rate for Payer: Meridian Medicaid	$2.72
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4.98
Rate for Payer: MI Amish Medical Board Commercial	$5.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PACE Medicare	$4.50
Rate for Payer: PACE SWMI	$4.74
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: PHP Medicare Advantage	$4.74
Rate for Payer: Priority Health Choice Medicaid	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health Medicare	$4.74
Rate for Payer: Priority Health SBD	$12.85
Rate for Payer: Railroad Medicare Medicare	$4.74
Rate for Payer: UHC All Payor (Choice/PPO)	$5.69
Rate for Payer: UHC Core	$8.06
Rate for Payer: UHC Dual Complete DSNP	$4.74
Rate for Payer: UHC Exchange	$4.74
Rate for Payer: UHC Medicare Advantage	$4.88
Rate for Payer: VA VA	$4.74

HC PHOSPHOROUS SERUM

Facility

$20.40

Service Code	CPT 84100
Hospital Charge Code	30100392
Hospital Revenue Code	301
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$12.85

HC PHOSPHOROUS URINE

Facility

$51.90

Service Code	CPT 84105
Hospital Charge Code	30100393
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$46.71
Rate for Payer: Aetna Commercial	$44.12
Rate for Payer: Aetna Medicare	$6.01
Rate for Payer: Aetna New Business (MI Preferred)	$33.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7.22
Rate for Payer: Amish Plain Church Group Commercial	$7.22
Rate for Payer: BCBS Complete	$3.32
Rate for Payer: BCBS MAPPO	$5.78
Rate for Payer: BCBS Trust/PPO	$4.53
Rate for Payer: BCN Medicare Advantage	$5.78
Rate for Payer: Cash Price	$41.52
Rate for Payer: Cash Price	$41.52
Rate for Payer: Cofinity Commercial	$36.33
Rate for Payer: Cofinity Commercial	$44.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.78
Rate for Payer: Healthscope Commercial	$46.71
Rate for Payer: Mclaren Medicaid	$3.16
Rate for Payer: Mclaren Medicare	$5.78
Rate for Payer: Meridian Medicaid	$3.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6.07
Rate for Payer: MI Amish Medical Board Commercial	$6.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.12
Rate for Payer: PACE Medicare	$5.49
Rate for Payer: PACE SWMI	$5.78
Rate for Payer: PHP Commercial	$44.12
Rate for Payer: PHP Medicare Advantage	$5.78
Rate for Payer: Priority Health Choice Medicaid	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$36.33
Rate for Payer: Priority Health Medicare	$5.78
Rate for Payer: Priority Health SBD	$32.70
Rate for Payer: Railroad Medicare Medicare	$5.78
Rate for Payer: UHC All Payor (Choice/PPO)	$6.94
Rate for Payer: UHC Core	$8.80
Rate for Payer: UHC Dual Complete DSNP	$5.78
Rate for Payer: UHC Exchange	$5.78
Rate for Payer: UHC Medicare Advantage	$5.95
Rate for Payer: VA VA	$5.78

HC PHOSPHOROUS URINE

Facility

$51.90

Service Code	CPT 84105
Hospital Charge Code	30100393
Hospital Revenue Code	301
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$46.71
Rate for Payer: Aetna Commercial	$44.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.74
Rate for Payer: Cash Price	$41.52
Rate for Payer: Cofinity Commercial	$36.33
Rate for Payer: Cofinity Commercial	$44.63
Rate for Payer: Healthscope Commercial	$46.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.12
Rate for Payer: PHP Commercial	$44.12
Rate for Payer: Priority Health Cigna Priority Health	$36.33
Rate for Payer: Priority Health SBD	$32.70

HC PHYSICAL PERF TEST EA 15 MIN

Facility

$91.80

Service Code	CPT 97750
Hospital Charge Code	42000038
Hospital Revenue Code	420
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: BCBS Trust/PPO	$22.55
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$64.26
Rate for Payer: Priority Health SBD	$57.83
Rate for Payer: UHC All Payor (Choice/PPO)	$36.74
Rate for Payer: UHC Exchange	$33.40

HC PHYSICAL PERF TEST EA 15 MIN

Facility

$91.80

Service Code	CPT 97750
Hospital Charge Code	42000038
Hospital Revenue Code	420
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$64.26
Rate for Payer: Priority Health SBD	$57.83

HC PICC INTRODUCER

Facility

$96.39

Hospital Charge Code	27200147
Hospital Revenue Code	272
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$86.75
Rate for Payer: Aetna Commercial	$81.93
Rate for Payer: Aetna New Business (MI Preferred)	$62.65
Rate for Payer: BCBS Complete	$38.56
Rate for Payer: Cash Price	$77.11
Rate for Payer: Cofinity Commercial	$67.47
Rate for Payer: Cofinity Commercial	$82.90
Rate for Payer: Healthscope Commercial	$86.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.93
Rate for Payer: PHP Commercial	$81.93
Rate for Payer: Priority Health Cigna Priority Health	$67.47
Rate for Payer: Priority Health SBD	$60.73

HC PICC INTRODUCER

Facility

$96.39

Hospital Charge Code	27200147
Hospital Revenue Code	272
Min. Negotiated Rate	$60.73
Max. Negotiated Rate	$86.75
Rate for Payer: Aetna Commercial	$81.93
Rate for Payer: Aetna New Business (MI Preferred)	$62.65
Rate for Payer: Cash Price	$77.11
Rate for Payer: Cofinity Commercial	$67.47
Rate for Payer: Cofinity Commercial	$82.90
Rate for Payer: Healthscope Commercial	$86.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.93
Rate for Payer: PHP Commercial	$81.93
Rate for Payer: Priority Health Cigna Priority Health	$67.47
Rate for Payer: Priority Health SBD	$60.73

HC PICU 30" NITROUS OXIDE SED RECOVERY

Facility

$110.38

Hospital Charge Code	37000019
Hospital Revenue Code	370
Min. Negotiated Rate	$44.15
Max. Negotiated Rate	$99.34
Rate for Payer: Aetna Commercial	$93.82
Rate for Payer: Aetna New Business (MI Preferred)	$71.75
Rate for Payer: BCBS Complete	$44.15
Rate for Payer: Cash Price	$88.30
Rate for Payer: Cofinity Commercial	$77.27
Rate for Payer: Cofinity Commercial	$94.93
Rate for Payer: Healthscope Commercial	$99.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.82
Rate for Payer: PHP Commercial	$93.82
Rate for Payer: Priority Health Cigna Priority Health	$77.27
Rate for Payer: Priority Health SBD	$69.54

HC PICU 30" NITROUS OXIDE SED RECOVERY

Facility

$110.38

Hospital Charge Code	37000019
Hospital Revenue Code	370
Min. Negotiated Rate	$69.54
Max. Negotiated Rate	$99.34
Rate for Payer: Aetna Commercial	$93.82
Rate for Payer: Aetna New Business (MI Preferred)	$71.75
Rate for Payer: Cash Price	$88.30
Rate for Payer: Cofinity Commercial	$77.27
Rate for Payer: Cofinity Commercial	$94.93
Rate for Payer: Healthscope Commercial	$99.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.82
Rate for Payer: PHP Commercial	$93.82
Rate for Payer: Priority Health Cigna Priority Health	$77.27
Rate for Payer: Priority Health SBD	$69.54

HC PICU OBSERVATION PER HOUR

Facility

$186.06

Service Code	HCPCS G0378
Hospital Charge Code	76200017
Hospital Revenue Code	762
Min. Negotiated Rate	$117.22
Max. Negotiated Rate	$167.45
Rate for Payer: Aetna Commercial	$158.15
Rate for Payer: Aetna New Business (MI Preferred)	$120.94
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cofinity Commercial	$130.24
Rate for Payer: Cofinity Commercial	$160.01
Rate for Payer: Healthscope Commercial	$167.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$158.15
Rate for Payer: PHP Commercial	$158.15
Rate for Payer: Priority Health Cigna Priority Health	$130.24
Rate for Payer: Priority Health SBD	$117.22

HC PICU OBSERVATION PER HOUR

Facility

$186.06

Service Code	HCPCS G0378
Hospital Charge Code	76200017
Hospital Revenue Code	762
Min. Negotiated Rate	$74.42
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$158.15
Rate for Payer: Aetna New Business (MI Preferred)	$120.94
Rate for Payer: BCBS Complete	$74.42
Rate for Payer: BCBS Trust/PPO	$108.91
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cofinity Commercial	$160.01
Rate for Payer: Cofinity Commercial	$130.24
Rate for Payer: Healthscope Commercial	$167.45
Rate for Payer: Meridian Medicaid	$1,000.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$158.15
Rate for Payer: PHP Commercial	$158.15
Rate for Payer: Priority Health Cigna Priority Health	$130.24
Rate for Payer: Priority Health SBD	$117.22

HC PICU OR PED CRITICAL CARE R&B

Facility

$7,648.92

Hospital Charge Code	20300001
Hospital Revenue Code	203
Min. Negotiated Rate	$4,818.82
Max. Negotiated Rate	$6,884.03
Rate for Payer: Aetna Commercial	$6,501.58
Rate for Payer: Aetna New Business (MI Preferred)	$4,971.80
Rate for Payer: Cash Price	$6,119.14
Rate for Payer: Cofinity Commercial	$5,354.24
Rate for Payer: Cofinity Commercial	$6,578.07
Rate for Payer: Healthscope Commercial	$6,884.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,501.58
Rate for Payer: PHP Commercial	$6,501.58
Rate for Payer: Priority Health Cigna Priority Health	$5,354.24
Rate for Payer: Priority Health SBD	$4,818.82

HC PICU OR PED INTERMEDIATE CARE R&B

Facility

$6,382.60

Hospital Charge Code	20600002
Hospital Revenue Code	206
Min. Negotiated Rate	$4,021.04
Max. Negotiated Rate	$5,744.34
Rate for Payer: Aetna Commercial	$5,425.21
Rate for Payer: Aetna New Business (MI Preferred)	$4,148.69
Rate for Payer: Cash Price	$5,106.08
Rate for Payer: Cofinity Commercial	$4,467.82
Rate for Payer: Cofinity Commercial	$5,489.04
Rate for Payer: Healthscope Commercial	$5,744.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,425.21
Rate for Payer: PHP Commercial	$5,425.21
Rate for Payer: Priority Health Cigna Priority Health	$4,467.82
Rate for Payer: Priority Health SBD	$4,021.04

HC PICU/PEDS 30" SEDATION RECOVERY

Facility

$308.88

Hospital Charge Code	71000009
Hospital Revenue Code	710
Min. Negotiated Rate	$194.59
Max. Negotiated Rate	$277.99
Rate for Payer: Aetna Commercial	$262.55
Rate for Payer: Aetna New Business (MI Preferred)	$200.77
Rate for Payer: Cash Price	$247.10
Rate for Payer: Cofinity Commercial	$216.22
Rate for Payer: Cofinity Commercial	$265.64
Rate for Payer: Healthscope Commercial	$277.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$262.55
Rate for Payer: PHP Commercial	$262.55
Rate for Payer: Priority Health Cigna Priority Health	$216.22
Rate for Payer: Priority Health SBD	$194.59

HC PICU/PEDS 30" SEDATION RECOVERY

Facility

$308.88

Hospital Charge Code	71000009
Hospital Revenue Code	710
Min. Negotiated Rate	$123.55
Max. Negotiated Rate	$277.99
Rate for Payer: Aetna Commercial	$262.55
Rate for Payer: Aetna New Business (MI Preferred)	$200.77
Rate for Payer: BCBS Complete	$123.55
Rate for Payer: Cash Price	$247.10
Rate for Payer: Cofinity Commercial	$216.22
Rate for Payer: Cofinity Commercial	$265.64
Rate for Payer: Healthscope Commercial	$277.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$262.55
Rate for Payer: PHP Commercial	$262.55
Rate for Payer: Priority Health Cigna Priority Health	$216.22
Rate for Payer: Priority Health SBD	$194.59

HC PIFLUFOLASTAT PER MILLICURIE

Facility

$1,530.00

Service Code	CPT A9595
Hospital Charge Code	34300369
Hospital Revenue Code	343
Min. Negotiated Rate	$963.90
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health SBD	$963.90

HC PIFLUFOLASTAT PER MILLICURIE

Facility

$1,530.00

Service Code	CPT A9595
Hospital Charge Code	34300369
Hospital Revenue Code	343
Min. Negotiated Rate	$317.45
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna Medicare	$603.57
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$725.44
Rate for Payer: Amish Plain Church Group Commercial	$725.44
Rate for Payer: BCBS Complete	$333.35
Rate for Payer: BCBS MAPPO	$580.35
Rate for Payer: BCBS Trust/PPO	$582.64
Rate for Payer: BCN Medicare Advantage	$580.35
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$580.35
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Mclaren Medicaid	$317.45
Rate for Payer: Mclaren Medicare	$580.35
Rate for Payer: Meridian Medicaid	$333.35
Rate for Payer: Meridian Wellcare - Medicare Advantage	$609.37
Rate for Payer: MI Amish Medical Board Commercial	$667.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: PACE Medicare	$551.33
Rate for Payer: PACE SWMI	$580.35
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: PHP Medicare Advantage	$580.35
Rate for Payer: Priority Health Choice Medicaid	$317.45
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health Medicare	$580.35
Rate for Payer: Priority Health SBD	$963.90
Rate for Payer: Railroad Medicare Medicare	$580.35
Rate for Payer: UHC Dual Complete DSNP	$580.35
Rate for Payer: UHC Medicare Advantage	$597.76
Rate for Payer: VA VA	$580.35

Know your out-of-pocket cost for care.

All Charges