Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INFUSION CATH LVL 12

Facility

$1,272.93

Service Code	HCPCS C1751
Hospital Charge Code	27200312
Hospital Revenue Code	272
Min. Negotiated Rate	$509.17
Max. Negotiated Rate	$1,145.64
Rate for Payer: Aetna Commercial	$1,081.99
Rate for Payer: Aetna Medicare	$636.47
Rate for Payer: Aetna New Business (MI Preferred)	$827.40
Rate for Payer: BCBS Complete	$509.17
Rate for Payer: Cash Price	$1,018.34
Rate for Payer: Cofinity Commercial	$1,094.72
Rate for Payer: Cofinity Commercial	$891.05
Rate for Payer: Cofinity Medicare Advantage	$891.05
Rate for Payer: Encore Health Key Benefits Commercial	$1,018.34
Rate for Payer: Healthscope Commercial	$1,145.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,081.99
Rate for Payer: PHP Commercial	$1,081.99
Rate for Payer: Priority Health Cigna Priority Health	$827.40
Rate for Payer: Priority Health SBD	$801.95

HC INFUSION CATH LVL 12

Facility

$1,272.93

Service Code	HCPCS C1751
Hospital Charge Code	27200312
Hospital Revenue Code	272
Min. Negotiated Rate	$801.95
Max. Negotiated Rate	$1,145.64
Rate for Payer: Aetna Commercial	$1,081.99
Rate for Payer: Aetna New Business (MI Preferred)	$827.40
Rate for Payer: Cash Price	$1,018.34
Rate for Payer: Cofinity Commercial	$1,094.72
Rate for Payer: Cofinity Commercial	$891.05
Rate for Payer: Cofinity Medicare Advantage	$891.05
Rate for Payer: Encore Health Key Benefits Commercial	$1,018.34
Rate for Payer: Healthscope Commercial	$1,145.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,081.99
Rate for Payer: PHP Commercial	$1,081.99
Rate for Payer: Priority Health Cigna Priority Health	$827.40
Rate for Payer: Priority Health SBD	$801.95

HC INFUSION CATH LVL 13

Facility

$1,380.06

Service Code	HCPCS C1751
Hospital Charge Code	27200313
Hospital Revenue Code	272
Min. Negotiated Rate	$869.44
Max. Negotiated Rate	$1,242.05
Rate for Payer: Aetna Commercial	$1,173.05
Rate for Payer: Aetna New Business (MI Preferred)	$897.04
Rate for Payer: Cash Price	$1,104.05
Rate for Payer: Cofinity Commercial	$1,186.85
Rate for Payer: Cofinity Commercial	$966.04
Rate for Payer: Cofinity Medicare Advantage	$966.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.05
Rate for Payer: Healthscope Commercial	$1,242.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.05
Rate for Payer: PHP Commercial	$1,173.05
Rate for Payer: Priority Health Cigna Priority Health	$897.04
Rate for Payer: Priority Health SBD	$869.44

HC INFUSION CATH LVL 13

Facility

$1,380.06

Service Code	HCPCS C1751
Hospital Charge Code	27200313
Hospital Revenue Code	272
Min. Negotiated Rate	$552.02
Max. Negotiated Rate	$1,242.05
Rate for Payer: Aetna Commercial	$1,173.05
Rate for Payer: Aetna Medicare	$690.03
Rate for Payer: Aetna New Business (MI Preferred)	$897.04
Rate for Payer: BCBS Complete	$552.02
Rate for Payer: Cash Price	$1,104.05
Rate for Payer: Cofinity Commercial	$1,186.85
Rate for Payer: Cofinity Commercial	$966.04
Rate for Payer: Cofinity Medicare Advantage	$966.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.05
Rate for Payer: Healthscope Commercial	$1,242.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.05
Rate for Payer: PHP Commercial	$1,173.05
Rate for Payer: Priority Health Cigna Priority Health	$897.04
Rate for Payer: Priority Health SBD	$869.44

HC INFUSION CATH LVL 14

Facility

$1,475.84

Service Code	HCPCS C1751
Hospital Charge Code	27200267
Hospital Revenue Code	272
Min. Negotiated Rate	$929.78
Max. Negotiated Rate	$1,328.26
Rate for Payer: Aetna Commercial	$1,254.46
Rate for Payer: Aetna New Business (MI Preferred)	$959.30
Rate for Payer: Cash Price	$1,180.67
Rate for Payer: Cofinity Commercial	$1,033.09
Rate for Payer: Cofinity Commercial	$1,269.22
Rate for Payer: Cofinity Medicare Advantage	$1,033.09
Rate for Payer: Encore Health Key Benefits Commercial	$1,180.67
Rate for Payer: Healthscope Commercial	$1,328.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,254.46
Rate for Payer: PHP Commercial	$1,254.46
Rate for Payer: Priority Health Cigna Priority Health	$959.30
Rate for Payer: Priority Health SBD	$929.78

HC INFUSION CATH LVL 14

Facility

$1,475.84

Service Code	HCPCS C1751
Hospital Charge Code	27200267
Hospital Revenue Code	272
Min. Negotiated Rate	$590.34
Max. Negotiated Rate	$1,328.26
Rate for Payer: Aetna Commercial	$1,254.46
Rate for Payer: Aetna Medicare	$737.92
Rate for Payer: Aetna New Business (MI Preferred)	$959.30
Rate for Payer: BCBS Complete	$590.34
Rate for Payer: Cash Price	$1,180.67
Rate for Payer: Cofinity Commercial	$1,033.09
Rate for Payer: Cofinity Commercial	$1,269.22
Rate for Payer: Cofinity Medicare Advantage	$1,033.09
Rate for Payer: Encore Health Key Benefits Commercial	$1,180.67
Rate for Payer: Healthscope Commercial	$1,328.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,254.46
Rate for Payer: PHP Commercial	$1,254.46
Rate for Payer: Priority Health Cigna Priority Health	$959.30
Rate for Payer: Priority Health SBD	$929.78

HC INFUSION CATH LVL 4

Facility

$459.00

Service Code	HCPCS C1751
Hospital Charge Code	27200093
Hospital Revenue Code	272
Min. Negotiated Rate	$289.17
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna New Business (MI Preferred)	$298.35
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$321.30
Rate for Payer: Cofinity Commercial	$394.74
Rate for Payer: Cofinity Medicare Advantage	$321.30
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: PHP Commercial	$390.15
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health SBD	$289.17

HC INFUSION CATH LVL 4

Facility

$459.00

Service Code	HCPCS C1751
Hospital Charge Code	27200093
Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: Aetna New Business (MI Preferred)	$298.35
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$321.30
Rate for Payer: Cofinity Commercial	$394.74
Rate for Payer: Cofinity Medicare Advantage	$321.30
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: PHP Commercial	$390.15
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health SBD	$289.17

HC INFUSION CATH LVL 5

Facility

$595.35

Service Code	CPT C1751
Hospital Charge Code	27200296
Hospital Revenue Code	272
Min. Negotiated Rate	$375.07
Max. Negotiated Rate	$535.82
Rate for Payer: Aetna Commercial	$506.05
Rate for Payer: Aetna New Business (MI Preferred)	$386.98
Rate for Payer: Cash Price	$476.28
Rate for Payer: Cofinity Commercial	$416.75
Rate for Payer: Cofinity Commercial	$512.00
Rate for Payer: Cofinity Medicare Advantage	$416.75
Rate for Payer: Encore Health Key Benefits Commercial	$476.28
Rate for Payer: Healthscope Commercial	$535.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$506.05
Rate for Payer: PHP Commercial	$506.05
Rate for Payer: Priority Health Cigna Priority Health	$386.98
Rate for Payer: Priority Health SBD	$375.07

HC INFUSION CATH LVL 5

Facility

$595.35

Service Code	CPT C1751
Hospital Charge Code	27200296
Hospital Revenue Code	272
Min. Negotiated Rate	$238.14
Max. Negotiated Rate	$535.82
Rate for Payer: Aetna Commercial	$506.05
Rate for Payer: Aetna Medicare	$297.68
Rate for Payer: Aetna New Business (MI Preferred)	$386.98
Rate for Payer: BCBS Complete	$238.14
Rate for Payer: Cash Price	$476.28
Rate for Payer: Cofinity Commercial	$416.75
Rate for Payer: Cofinity Commercial	$512.00
Rate for Payer: Cofinity Medicare Advantage	$416.75
Rate for Payer: Encore Health Key Benefits Commercial	$476.28
Rate for Payer: Healthscope Commercial	$535.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$506.05
Rate for Payer: PHP Commercial	$506.05
Rate for Payer: Priority Health Cigna Priority Health	$386.98
Rate for Payer: Priority Health SBD	$375.07

HC INFUSION CATH LVL 8

Facility

$843.51

Service Code	CPT C1751
Hospital Charge Code	27200309
Hospital Revenue Code	272
Min. Negotiated Rate	$531.41
Max. Negotiated Rate	$759.16
Rate for Payer: Aetna Commercial	$716.98
Rate for Payer: Aetna New Business (MI Preferred)	$548.28
Rate for Payer: Cash Price	$674.81
Rate for Payer: Cofinity Commercial	$590.46
Rate for Payer: Cofinity Commercial	$725.42
Rate for Payer: Cofinity Medicare Advantage	$590.46
Rate for Payer: Encore Health Key Benefits Commercial	$674.81
Rate for Payer: Healthscope Commercial	$759.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.98
Rate for Payer: PHP Commercial	$716.98
Rate for Payer: Priority Health Cigna Priority Health	$548.28
Rate for Payer: Priority Health SBD	$531.41

HC INFUSION CATH LVL 8

Facility

$843.51

Service Code	CPT C1751
Hospital Charge Code	27200309
Hospital Revenue Code	272
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$759.16
Rate for Payer: Aetna Commercial	$716.98
Rate for Payer: Aetna Medicare	$421.75
Rate for Payer: Aetna New Business (MI Preferred)	$548.28
Rate for Payer: BCBS Complete	$337.40
Rate for Payer: Cash Price	$674.81
Rate for Payer: Cofinity Commercial	$590.46
Rate for Payer: Cofinity Commercial	$725.42
Rate for Payer: Cofinity Medicare Advantage	$590.46
Rate for Payer: Encore Health Key Benefits Commercial	$674.81
Rate for Payer: Healthscope Commercial	$759.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.98
Rate for Payer: PHP Commercial	$716.98
Rate for Payer: Priority Health Cigna Priority Health	$548.28
Rate for Payer: Priority Health SBD	$531.41

HC INGESTION CHALLENGE TEST EA ADDL 60 MIN

Facility

$224.40

Service Code	CPT 95079
Hospital Charge Code	51000115
Hospital Revenue Code	510
Min. Negotiated Rate	$141.37
Max. Negotiated Rate	$201.96
Rate for Payer: Aetna Commercial	$190.74
Rate for Payer: Aetna New Business (MI Preferred)	$145.86
Rate for Payer: Cash Price	$179.52
Rate for Payer: Cofinity Commercial	$157.08
Rate for Payer: Cofinity Commercial	$192.98
Rate for Payer: Cofinity Medicare Advantage	$157.08
Rate for Payer: Encore Health Key Benefits Commercial	$179.52
Rate for Payer: Healthscope Commercial	$201.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.74
Rate for Payer: PHP Commercial	$190.74
Rate for Payer: Priority Health Cigna Priority Health	$145.86
Rate for Payer: Priority Health SBD	$141.37

HC INGESTION CHALLENGE TEST EA ADDL 60 MIN

Facility

$224.40

Service Code	CPT 95079
Hospital Charge Code	51000115
Hospital Revenue Code	510
Min. Negotiated Rate	$89.76
Max. Negotiated Rate	$201.96
Rate for Payer: Aetna Commercial	$190.74
Rate for Payer: Aetna Medicare	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$145.86
Rate for Payer: BCBS Complete	$89.76
Rate for Payer: Cash Price	$179.52
Rate for Payer: Cofinity Commercial	$157.08
Rate for Payer: Cofinity Commercial	$192.98
Rate for Payer: Cofinity Medicare Advantage	$157.08
Rate for Payer: Encore Health Key Benefits Commercial	$179.52
Rate for Payer: Healthscope Commercial	$201.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.74
Rate for Payer: PHP Commercial	$190.74
Rate for Payer: Priority Health Cigna Priority Health	$145.86
Rate for Payer: Priority Health SBD	$141.37

HC INGESTION CHALLENGE TEST INIT 120 MIN

Facility

$1,429.99

Service Code	CPT 95076
Hospital Charge Code	51000114
Hospital Revenue Code	510
Min. Negotiated Rate	$900.89
Max. Negotiated Rate	$1,286.99
Rate for Payer: Aetna Commercial	$1,215.49
Rate for Payer: Aetna New Business (MI Preferred)	$929.49
Rate for Payer: Cash Price	$1,143.99
Rate for Payer: Cofinity Commercial	$1,000.99
Rate for Payer: Cofinity Commercial	$1,229.79
Rate for Payer: Cofinity Medicare Advantage	$1,000.99
Rate for Payer: Encore Health Key Benefits Commercial	$1,143.99
Rate for Payer: Healthscope Commercial	$1,286.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,215.49
Rate for Payer: PHP Commercial	$1,215.49
Rate for Payer: Priority Health Cigna Priority Health	$929.49
Rate for Payer: Priority Health SBD	$900.89

HC INGESTION CHALLENGE TEST INIT 120 MIN

Facility

$1,429.99

Service Code	CPT 95076
Hospital Charge Code	51000114
Hospital Revenue Code	510
Min. Negotiated Rate	$277.37
Max. Negotiated Rate	$1,456.65
Rate for Payer: Aetna Commercial	$1,215.49
Rate for Payer: Aetna Medicare	$538.18
Rate for Payer: Aetna New Business (MI Preferred)	$929.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$646.85
Rate for Payer: Amish Plain Church Group Commercial	$646.85
Rate for Payer: BCBS Complete	$291.24
Rate for Payer: BCBS MAPPO	$517.48
Rate for Payer: BCN Medicare Advantage	$517.48
Rate for Payer: Cash Price	$1,143.99
Rate for Payer: Cash Price	$1,143.99
Rate for Payer: Cofinity Commercial	$1,000.99
Rate for Payer: Cofinity Commercial	$1,229.79
Rate for Payer: Cofinity Medicare Advantage	$1,000.99
Rate for Payer: Encore Health Key Benefits Commercial	$1,143.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$517.48
Rate for Payer: Healthscope Commercial	$1,286.99
Rate for Payer: Mclaren Medicaid	$277.37
Rate for Payer: Mclaren Medicare	$517.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$543.35
Rate for Payer: Meridian Medicaid	$291.24
Rate for Payer: MI Amish Medical Board Commercial	$595.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,215.49
Rate for Payer: PACE Medicare	$491.61
Rate for Payer: PACE SWMI	$517.48
Rate for Payer: PHP Commercial	$1,215.49
Rate for Payer: PHP Medicare Advantage	$517.48
Rate for Payer: Priority Health Choice Medicaid	$277.37
Rate for Payer: Priority Health Cigna Priority Health	$929.49
Rate for Payer: Priority Health Medicare	$517.48
Rate for Payer: Priority Health SBD	$900.89
Rate for Payer: Railroad Medicare Medicare	$517.48
Rate for Payer: UHC All Payor (Choice/PPO)	$1,456.65
Rate for Payer: UHC Dual Complete DSNP	$517.48
Rate for Payer: UHC Medicare Advantage	$517.48
Rate for Payer: UHCCP Medicaid	$291.34
Rate for Payer: VA VA	$517.48

HC INHALATION BRONCHIAL CHALLENGE TESTING

Facility

$495.05

Service Code	CPT 95070
Hospital Charge Code	46000028
Hospital Revenue Code	460
Min. Negotiated Rate	$277.37
Max. Negotiated Rate	$1,456.65
Rate for Payer: Aetna Commercial	$420.79
Rate for Payer: Aetna Medicare	$538.18
Rate for Payer: Aetna New Business (MI Preferred)	$321.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$646.85
Rate for Payer: Amish Plain Church Group Commercial	$646.85
Rate for Payer: BCBS Complete	$291.24
Rate for Payer: BCBS MAPPO	$517.48
Rate for Payer: BCN Medicare Advantage	$517.48
Rate for Payer: Cash Price	$396.04
Rate for Payer: Cash Price	$396.04
Rate for Payer: Cofinity Commercial	$425.74
Rate for Payer: Cofinity Commercial	$346.54
Rate for Payer: Cofinity Medicare Advantage	$346.54
Rate for Payer: Encore Health Key Benefits Commercial	$396.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$517.48
Rate for Payer: Healthscope Commercial	$445.55
Rate for Payer: Mclaren Medicaid	$277.37
Rate for Payer: Mclaren Medicare	$517.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$543.35
Rate for Payer: Meridian Medicaid	$291.24
Rate for Payer: MI Amish Medical Board Commercial	$595.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.79
Rate for Payer: PACE Medicare	$491.61
Rate for Payer: PACE SWMI	$517.48
Rate for Payer: PHP Commercial	$420.79
Rate for Payer: PHP Medicare Advantage	$517.48
Rate for Payer: Priority Health Choice Medicaid	$277.37
Rate for Payer: Priority Health Cigna Priority Health	$321.78
Rate for Payer: Priority Health Medicare	$517.48
Rate for Payer: Priority Health SBD	$311.88
Rate for Payer: Railroad Medicare Medicare	$517.48
Rate for Payer: UHC All Payor (Choice/PPO)	$1,456.65
Rate for Payer: UHC Core	$366.34
Rate for Payer: UHC Dual Complete DSNP	$517.48
Rate for Payer: UHC Exchange	$366.34
Rate for Payer: UHC Medicare Advantage	$517.48
Rate for Payer: UHCCP Medicaid	$291.34
Rate for Payer: VA VA	$517.48

HC INHALATION BRONCHIAL CHALLENGE TESTING

Facility

$495.05

Service Code	CPT 95070
Hospital Charge Code	46000028
Hospital Revenue Code	460
Min. Negotiated Rate	$311.88
Max. Negotiated Rate	$445.55
Rate for Payer: Aetna Commercial	$420.79
Rate for Payer: Aetna New Business (MI Preferred)	$321.78
Rate for Payer: Cash Price	$396.04
Rate for Payer: Cofinity Commercial	$346.54
Rate for Payer: Cofinity Commercial	$425.74
Rate for Payer: Cofinity Medicare Advantage	$346.54
Rate for Payer: Encore Health Key Benefits Commercial	$396.04
Rate for Payer: Healthscope Commercial	$445.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.79
Rate for Payer: PHP Commercial	$420.79
Rate for Payer: Priority Health Cigna Priority Health	$321.78
Rate for Payer: Priority Health SBD	$311.88

HC INHIBIN A, TUMOR MARKER, S

Facility

$73.44

Service Code	CPT 86336
Hospital Charge Code	30200460
Hospital Revenue Code	302
Min. Negotiated Rate	$46.27
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cofinity Commercial	$51.41
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Medicare Advantage	$51.41
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health SBD	$46.27

HC INHIBIN A, TUMOR MARKER, S

Facility

$73.44

Service Code	CPT 86336
Hospital Charge Code	30200460
Hospital Revenue Code	302
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Medicare	$16.21
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$19.49
Rate for Payer: Amish Plain Church Group Commercial	$19.49
Rate for Payer: BCBS Complete	$8.77
Rate for Payer: BCBS MAPPO	$15.59
Rate for Payer: BCN Medicare Advantage	$15.59
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Commercial	$51.41
Rate for Payer: Cofinity Medicare Advantage	$51.41
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.59
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Mclaren Medicaid	$8.36
Rate for Payer: Mclaren Medicare	$15.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.37
Rate for Payer: Meridian Medicaid	$8.77
Rate for Payer: MI Amish Medical Board Commercial	$17.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: PACE Medicare	$14.81
Rate for Payer: PACE SWMI	$15.59
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: PHP Medicare Advantage	$15.59
Rate for Payer: Priority Health Choice Medicaid	$8.36
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health Medicare	$15.59
Rate for Payer: Priority Health SBD	$46.27
Rate for Payer: Railroad Medicare Medicare	$15.59
Rate for Payer: UHC All Payor (Choice/PPO)	$43.88
Rate for Payer: UHC Dual Complete DSNP	$15.59
Rate for Payer: UHC Medicare Advantage	$15.59
Rate for Payer: UHCCP Medicaid	$8.78
Rate for Payer: VA VA	$15.59

HC INHIBIN B, CMPT

Facility

$49.94

Service Code	CPT 83520
Hospital Charge Code	30100693
Hospital Revenue Code	301
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$44.95
Rate for Payer: Aetna Commercial	$42.45
Rate for Payer: Aetna New Business (MI Preferred)	$32.46
Rate for Payer: Cash Price	$39.95
Rate for Payer: Cofinity Commercial	$34.96
Rate for Payer: Cofinity Commercial	$42.95
Rate for Payer: Cofinity Medicare Advantage	$34.96
Rate for Payer: Encore Health Key Benefits Commercial	$39.95
Rate for Payer: Healthscope Commercial	$44.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.45
Rate for Payer: PHP Commercial	$42.45
Rate for Payer: Priority Health Cigna Priority Health	$32.46
Rate for Payer: Priority Health SBD	$31.46

HC INHIBIN B, CMPT

Facility

$49.94

Service Code	CPT 83520
Hospital Charge Code	30100693
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$48.61
Rate for Payer: Aetna Commercial	$42.45
Rate for Payer: Aetna Medicare	$17.96
Rate for Payer: Aetna New Business (MI Preferred)	$32.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$21.59
Rate for Payer: Amish Plain Church Group Commercial	$21.59
Rate for Payer: BCBS Complete	$9.72
Rate for Payer: BCBS MAPPO	$17.27
Rate for Payer: BCN Medicare Advantage	$17.27
Rate for Payer: Cash Price	$39.95
Rate for Payer: Cash Price	$39.95
Rate for Payer: Cofinity Commercial	$42.95
Rate for Payer: Cofinity Commercial	$34.96
Rate for Payer: Cofinity Medicare Advantage	$34.96
Rate for Payer: Encore Health Key Benefits Commercial	$39.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$17.27
Rate for Payer: Healthscope Commercial	$44.95
Rate for Payer: Mclaren Medicaid	$9.26
Rate for Payer: Mclaren Medicare	$17.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18.13
Rate for Payer: Meridian Medicaid	$9.72
Rate for Payer: MI Amish Medical Board Commercial	$19.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.45
Rate for Payer: PACE Medicare	$16.41
Rate for Payer: PACE SWMI	$17.27
Rate for Payer: PHP Commercial	$42.45
Rate for Payer: PHP Medicare Advantage	$17.27
Rate for Payer: Priority Health Choice Medicaid	$9.26
Rate for Payer: Priority Health Cigna Priority Health	$32.46
Rate for Payer: Priority Health Medicare	$17.27
Rate for Payer: Priority Health SBD	$31.46
Rate for Payer: Railroad Medicare Medicare	$17.27
Rate for Payer: UHC All Payor (Choice/PPO)	$48.61
Rate for Payer: UHC Dual Complete DSNP	$17.27
Rate for Payer: UHC Medicare Advantage	$17.27
Rate for Payer: UHCCP Medicaid	$9.72
Rate for Payer: VA VA	$17.27

HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT

Facility

$180.93

Service Code	CPT G0402
Hospital Charge Code	51000096
Hospital Revenue Code	510
Min. Negotiated Rate	$67.36
Max. Negotiated Rate	$353.78
Rate for Payer: Aetna Commercial	$153.79
Rate for Payer: Aetna Medicare	$130.71
Rate for Payer: Aetna New Business (MI Preferred)	$117.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$157.10
Rate for Payer: Amish Plain Church Group Commercial	$157.10
Rate for Payer: BCBS Complete	$70.73
Rate for Payer: BCBS MAPPO	$125.68
Rate for Payer: BCN Medicare Advantage	$125.68
Rate for Payer: Cash Price	$144.74
Rate for Payer: Cash Price	$144.74
Rate for Payer: Cofinity Commercial	$155.60
Rate for Payer: Cofinity Commercial	$126.65
Rate for Payer: Cofinity Medicare Advantage	$126.65
Rate for Payer: Encore Health Key Benefits Commercial	$144.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$125.68
Rate for Payer: Healthscope Commercial	$162.84
Rate for Payer: Mclaren Medicaid	$67.36
Rate for Payer: Mclaren Medicare	$125.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$131.96
Rate for Payer: Meridian Medicaid	$70.73
Rate for Payer: MI Amish Medical Board Commercial	$144.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.79
Rate for Payer: PACE Medicare	$119.40
Rate for Payer: PACE SWMI	$125.68
Rate for Payer: PHP Commercial	$153.79
Rate for Payer: PHP Medicare Advantage	$125.68
Rate for Payer: Priority Health Choice Medicaid	$67.36
Rate for Payer: Priority Health Cigna Priority Health	$117.60
Rate for Payer: Priority Health Medicare	$125.68
Rate for Payer: Priority Health SBD	$113.99
Rate for Payer: Railroad Medicare Medicare	$125.68
Rate for Payer: UHC All Payor (Choice/PPO)	$353.78
Rate for Payer: UHC Dual Complete DSNP	$125.68
Rate for Payer: UHC Medicare Advantage	$125.68
Rate for Payer: UHCCP Medicaid	$70.76
Rate for Payer: VA VA	$125.68

HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT

Facility

$180.93

Service Code	CPT G0402
Hospital Charge Code	51000096
Hospital Revenue Code	510
Min. Negotiated Rate	$113.99
Max. Negotiated Rate	$162.84
Rate for Payer: Aetna Commercial	$153.79
Rate for Payer: Aetna New Business (MI Preferred)	$117.60
Rate for Payer: Cash Price	$144.74
Rate for Payer: Cofinity Commercial	$126.65
Rate for Payer: Cofinity Commercial	$155.60
Rate for Payer: Cofinity Medicare Advantage	$126.65
Rate for Payer: Encore Health Key Benefits Commercial	$144.74
Rate for Payer: Healthscope Commercial	$162.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.79
Rate for Payer: PHP Commercial	$153.79
Rate for Payer: Priority Health Cigna Priority Health	$117.60
Rate for Payer: Priority Health SBD	$113.99

HC INITIATION PROLONGED INFUSION REQUIRING PUMP

Facility

$579.68

Service Code	HCPCS C8957
Hospital Charge Code	26000012
Hospital Revenue Code	260
Min. Negotiated Rate	$365.20
Max. Negotiated Rate	$521.71
Rate for Payer: Aetna Commercial	$492.73
Rate for Payer: Aetna New Business (MI Preferred)	$376.79
Rate for Payer: Cash Price	$463.74
Rate for Payer: Cofinity Commercial	$405.78
Rate for Payer: Cofinity Commercial	$498.52
Rate for Payer: Cofinity Medicare Advantage	$405.78
Rate for Payer: Encore Health Key Benefits Commercial	$463.74
Rate for Payer: Healthscope Commercial	$521.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$492.73
Rate for Payer: PHP Commercial	$492.73
Rate for Payer: Priority Health Cigna Priority Health	$376.79
Rate for Payer: Priority Health SBD	$365.20

Know your out-of-pocket cost for care.

All Charges