Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC PUNCTURE WITH INJECTION CERVICAL

Facility

$762.46

Service Code	CPT 61055
Hospital Charge Code	36100269
Hospital Revenue Code	361
Min. Negotiated Rate	$114.28
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$648.09
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$495.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.42
Rate for Payer: Amish Plain Church Group Commercial	$329.42
Rate for Payer: BCBS Complete	$151.38
Rate for Payer: BCBS MAPPO	$263.54
Rate for Payer: BCBS Trust/PPO	$276.78
Rate for Payer: BCN Medicare Advantage	$263.54
Rate for Payer: Cash Price	$609.97
Rate for Payer: Cash Price	$609.97
Rate for Payer: Cofinity Commercial	$655.72
Rate for Payer: Cofinity Commercial	$533.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$686.21
Rate for Payer: Mclaren Medicaid	$144.16
Rate for Payer: Mclaren Medicare	$263.54
Rate for Payer: Meridian Medicaid	$151.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.72
Rate for Payer: MI Amish Medical Board Commercial	$303.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$648.09
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$648.09
Rate for Payer: PHP Medicare Advantage	$263.54
Rate for Payer: Priority Health Choice Medicaid	$144.16
Rate for Payer: Priority Health Cigna Priority Health	$533.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$815.29
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health Narrow Network	$652.23
Rate for Payer: Priority Health SBD	$480.35
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$125.71
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$114.28
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

HC PUNCTURE WITH INJECTION CERVICAL

Facility

$762.46

Service Code	CPT 61055
Hospital Charge Code	36100269
Hospital Revenue Code	361
Min. Negotiated Rate	$480.35
Max. Negotiated Rate	$686.21
Rate for Payer: Aetna Commercial	$648.09
Rate for Payer: Aetna New Business (MI Preferred)	$495.60
Rate for Payer: Cash Price	$609.97
Rate for Payer: Cofinity Commercial	$533.72
Rate for Payer: Cofinity Commercial	$655.72
Rate for Payer: Healthscope Commercial	$686.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$648.09
Rate for Payer: PHP Commercial	$648.09
Rate for Payer: Priority Health Cigna Priority Health	$533.72
Rate for Payer: Priority Health SBD	$480.35

HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM

Facility

$722.93

Service Code	HCPCS Q4196
Hospital Charge Code	63600128
Hospital Revenue Code	636
Min. Negotiated Rate	$455.45
Max. Negotiated Rate	$650.64
Rate for Payer: Aetna Commercial	$614.49
Rate for Payer: Aetna New Business (MI Preferred)	$469.90
Rate for Payer: Cash Price	$578.34
Rate for Payer: Cofinity Commercial	$506.05
Rate for Payer: Cofinity Commercial	$621.72
Rate for Payer: Healthscope Commercial	$650.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$614.49
Rate for Payer: PHP Commercial	$614.49
Rate for Payer: Priority Health Cigna Priority Health	$506.05
Rate for Payer: Priority Health SBD	$455.45

HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM

Facility

$722.93

Service Code	HCPCS Q4196
Hospital Charge Code	63600128
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$650.64
Rate for Payer: Aetna Commercial	$614.49
Rate for Payer: Aetna New Business (MI Preferred)	$469.90
Rate for Payer: BCBS Complete	$289.17
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$578.34
Rate for Payer: Cash Price	$578.34
Rate for Payer: Cofinity Commercial	$621.72
Rate for Payer: Cofinity Commercial	$506.05
Rate for Payer: Healthscope Commercial	$650.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$614.49
Rate for Payer: PHP Commercial	$614.49
Rate for Payer: Priority Health Cigna Priority Health	$506.05
Rate for Payer: Priority Health SBD	$455.45

HC PURAPLY AM 2X2 PER SQ CM

Facility

$502.03

Service Code	HCPCS Q4196
Hospital Charge Code	63600115
Hospital Revenue Code	636
Min. Negotiated Rate	$316.28
Max. Negotiated Rate	$451.83
Rate for Payer: Aetna Commercial	$426.73
Rate for Payer: Aetna New Business (MI Preferred)	$326.32
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cofinity Commercial	$351.42
Rate for Payer: Cofinity Commercial	$431.75
Rate for Payer: Healthscope Commercial	$451.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$426.73
Rate for Payer: PHP Commercial	$426.73
Rate for Payer: Priority Health Cigna Priority Health	$351.42
Rate for Payer: Priority Health SBD	$316.28

HC PURAPLY AM 2X2 PER SQ CM

Facility

$502.03

Service Code	HCPCS Q4196
Hospital Charge Code	63600115
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$451.83
Rate for Payer: Aetna Commercial	$426.73
Rate for Payer: Aetna New Business (MI Preferred)	$326.32
Rate for Payer: BCBS Complete	$200.81
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cash Price	$401.62
Rate for Payer: Cofinity Commercial	$351.42
Rate for Payer: Cofinity Commercial	$431.75
Rate for Payer: Healthscope Commercial	$451.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$426.73
Rate for Payer: PHP Commercial	$426.73
Rate for Payer: Priority Health Cigna Priority Health	$351.42
Rate for Payer: Priority Health SBD	$316.28

HC PURAPLY AM 2X4 PER SQ CM

Facility

$317.95

Service Code	HCPCS Q4196
Hospital Charge Code	63600116
Hospital Revenue Code	636
Min. Negotiated Rate	$200.31
Max. Negotiated Rate	$286.16
Rate for Payer: Aetna Commercial	$270.26
Rate for Payer: Aetna New Business (MI Preferred)	$206.67
Rate for Payer: Cash Price	$254.36
Rate for Payer: Cofinity Commercial	$222.56
Rate for Payer: Cofinity Commercial	$273.44
Rate for Payer: Healthscope Commercial	$286.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$270.26
Rate for Payer: PHP Commercial	$270.26
Rate for Payer: Priority Health Cigna Priority Health	$222.56
Rate for Payer: Priority Health SBD	$200.31

HC PURAPLY AM 2X4 PER SQ CM

Facility

$317.95

Service Code	HCPCS Q4196
Hospital Charge Code	63600116
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$286.16
Rate for Payer: Aetna Commercial	$270.26
Rate for Payer: Aetna New Business (MI Preferred)	$206.67
Rate for Payer: BCBS Complete	$127.18
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$254.36
Rate for Payer: Cash Price	$254.36
Rate for Payer: Cofinity Commercial	$222.56
Rate for Payer: Cofinity Commercial	$273.44
Rate for Payer: Healthscope Commercial	$286.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$270.26
Rate for Payer: PHP Commercial	$270.26
Rate for Payer: Priority Health Cigna Priority Health	$222.56
Rate for Payer: Priority Health SBD	$200.31

HC PURAPLY AM 3X4 PER SQ CM

Facility

$265.63

Service Code	HCPCS Q4196
Hospital Charge Code	63600185
Hospital Revenue Code	636
Min. Negotiated Rate	$167.35
Max. Negotiated Rate	$239.07
Rate for Payer: Aetna Commercial	$225.79
Rate for Payer: Aetna New Business (MI Preferred)	$172.66
Rate for Payer: Cash Price	$212.50
Rate for Payer: Cofinity Commercial	$185.94
Rate for Payer: Cofinity Commercial	$228.44
Rate for Payer: Healthscope Commercial	$239.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$225.79
Rate for Payer: PHP Commercial	$225.79
Rate for Payer: Priority Health Cigna Priority Health	$185.94
Rate for Payer: Priority Health SBD	$167.35

HC PURAPLY AM 3X4 PER SQ CM

Facility

$265.63

Service Code	HCPCS Q4196
Hospital Charge Code	63600185
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$239.07
Rate for Payer: Aetna Commercial	$225.79
Rate for Payer: Aetna New Business (MI Preferred)	$172.66
Rate for Payer: BCBS Complete	$106.25
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$212.50
Rate for Payer: Cash Price	$212.50
Rate for Payer: Cofinity Commercial	$185.94
Rate for Payer: Cofinity Commercial	$228.44
Rate for Payer: Healthscope Commercial	$239.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$225.79
Rate for Payer: PHP Commercial	$225.79
Rate for Payer: Priority Health Cigna Priority Health	$185.94
Rate for Payer: Priority Health SBD	$167.35

HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED

Facility

$280.50

Service Code	HCPCS Q4196
Hospital Charge Code	63600183
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.42
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: BCBS Complete	$112.20
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$238.42
Rate for Payer: PHP Commercial	$238.42
Rate for Payer: Priority Health Cigna Priority Health	$196.35
Rate for Payer: Priority Health SBD	$176.72

HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED

Facility

$280.50

Service Code	HCPCS Q4196
Hospital Charge Code	63600183
Hospital Revenue Code	636
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.42
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$238.42
Rate for Payer: PHP Commercial	$238.42
Rate for Payer: Priority Health Cigna Priority Health	$196.35
Rate for Payer: Priority Health SBD	$176.72

HC PURAPLY AM 4X4 PER SQ CM

Facility

$220.32

Service Code	HCPCS Q4196
Hospital Charge Code	63600186
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$198.29
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: Aetna New Business (MI Preferred)	$143.21
Rate for Payer: BCBS Complete	$88.13
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cofinity Commercial	$154.22
Rate for Payer: Cofinity Commercial	$189.48
Rate for Payer: Healthscope Commercial	$198.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.27
Rate for Payer: PHP Commercial	$187.27
Rate for Payer: Priority Health Cigna Priority Health	$154.22
Rate for Payer: Priority Health SBD	$138.80

HC PURAPLY AM 4X4 PER SQ CM

Facility

$220.32

Service Code	HCPCS Q4196
Hospital Charge Code	63600186
Hospital Revenue Code	636
Min. Negotiated Rate	$138.80
Max. Negotiated Rate	$198.29
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: Aetna New Business (MI Preferred)	$143.21
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cofinity Commercial	$154.22
Rate for Payer: Cofinity Commercial	$189.48
Rate for Payer: Healthscope Commercial	$198.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.27
Rate for Payer: PHP Commercial	$187.27
Rate for Payer: Priority Health Cigna Priority Health	$154.22
Rate for Payer: Priority Health SBD	$138.80

HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED

Facility

$220.32

Service Code	HCPCS Q4196
Hospital Charge Code	63600184
Hospital Revenue Code	636
Min. Negotiated Rate	$138.80
Max. Negotiated Rate	$198.29
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: Aetna New Business (MI Preferred)	$143.21
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cofinity Commercial	$154.22
Rate for Payer: Cofinity Commercial	$189.48
Rate for Payer: Healthscope Commercial	$198.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.27
Rate for Payer: PHP Commercial	$187.27
Rate for Payer: Priority Health Cigna Priority Health	$154.22
Rate for Payer: Priority Health SBD	$138.80

HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED

Facility

$220.32

Service Code	HCPCS Q4196
Hospital Charge Code	63600184
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$198.29
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: Aetna New Business (MI Preferred)	$143.21
Rate for Payer: BCBS Complete	$88.13
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cofinity Commercial	$154.22
Rate for Payer: Cofinity Commercial	$189.48
Rate for Payer: Healthscope Commercial	$198.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.27
Rate for Payer: PHP Commercial	$187.27
Rate for Payer: Priority Health Cigna Priority Health	$154.22
Rate for Payer: Priority Health SBD	$138.80

HC PURAPLY AM 5X5 PER SQ CM

Facility

$152.57

Service Code	HCPCS Q4196
Hospital Charge Code	63600117
Hospital Revenue Code	636
Min. Negotiated Rate	$61.03
Max. Negotiated Rate	$137.31
Rate for Payer: Aetna Commercial	$129.68
Rate for Payer: Aetna New Business (MI Preferred)	$99.17
Rate for Payer: BCBS Complete	$61.03
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$122.06
Rate for Payer: Cash Price	$122.06
Rate for Payer: Cofinity Commercial	$106.80
Rate for Payer: Cofinity Commercial	$131.21
Rate for Payer: Healthscope Commercial	$137.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$129.68
Rate for Payer: PHP Commercial	$129.68
Rate for Payer: Priority Health Cigna Priority Health	$106.80
Rate for Payer: Priority Health SBD	$96.12

HC PURAPLY AM 5X5 PER SQ CM

Facility

$152.57

Service Code	HCPCS Q4196
Hospital Charge Code	63600117
Hospital Revenue Code	636
Min. Negotiated Rate	$96.12
Max. Negotiated Rate	$137.31
Rate for Payer: Aetna Commercial	$129.68
Rate for Payer: Aetna New Business (MI Preferred)	$99.17
Rate for Payer: Cash Price	$122.06
Rate for Payer: Cofinity Commercial	$106.80
Rate for Payer: Cofinity Commercial	$131.21
Rate for Payer: Healthscope Commercial	$137.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$129.68
Rate for Payer: PHP Commercial	$129.68
Rate for Payer: Priority Health Cigna Priority Health	$106.80
Rate for Payer: Priority Health SBD	$96.12

HC PURAPLY AM 6X9 PER SQ CM

Facility

$174.42

Service Code	HCPCS Q4196
Hospital Charge Code	63600118
Hospital Revenue Code	636
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$156.98
Rate for Payer: Aetna Commercial	$148.26
Rate for Payer: Aetna New Business (MI Preferred)	$113.37
Rate for Payer: BCBS Complete	$69.77
Rate for Payer: BCBS Trust/PPO	$61.57
Rate for Payer: Cash Price	$139.54
Rate for Payer: Cash Price	$139.54
Rate for Payer: Cofinity Commercial	$122.09
Rate for Payer: Cofinity Commercial	$150.00
Rate for Payer: Healthscope Commercial	$156.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.26
Rate for Payer: PHP Commercial	$148.26
Rate for Payer: Priority Health Cigna Priority Health	$122.09
Rate for Payer: Priority Health SBD	$109.88

HC PURAPLY AM 6X9 PER SQ CM

Facility

$174.42

Service Code	HCPCS Q4196
Hospital Charge Code	63600118
Hospital Revenue Code	636
Min. Negotiated Rate	$109.88
Max. Negotiated Rate	$156.98
Rate for Payer: Aetna Commercial	$148.26
Rate for Payer: Aetna New Business (MI Preferred)	$113.37
Rate for Payer: Cash Price	$139.54
Rate for Payer: Cofinity Commercial	$122.09
Rate for Payer: Cofinity Commercial	$150.00
Rate for Payer: Healthscope Commercial	$156.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.26
Rate for Payer: PHP Commercial	$148.26
Rate for Payer: Priority Health Cigna Priority Health	$122.09
Rate for Payer: Priority Health SBD	$109.88

HC PURE TONE AUDIOMETRY AIR

Facility

$162.91

Service Code	CPT 92552
Hospital Charge Code	47100009
Hospital Revenue Code	471
Min. Negotiated Rate	$37.33
Max. Negotiated Rate	$351.10
Rate for Payer: Aetna Commercial	$138.47
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$105.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$161.18
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$130.33
Rate for Payer: Cash Price	$130.33
Rate for Payer: Cofinity Commercial	$140.10
Rate for Payer: Cofinity Commercial	$114.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$146.62
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$138.47
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$138.47
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health Cigna Priority Health	$114.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Priority Health SBD	$102.63
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$41.06
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$37.33
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC PURE TONE AUDIOMETRY AIR

Facility

$162.91

Service Code	CPT 92552
Hospital Charge Code	47100009
Hospital Revenue Code	471
Min. Negotiated Rate	$102.63
Max. Negotiated Rate	$146.62
Rate for Payer: Aetna Commercial	$138.47
Rate for Payer: Aetna New Business (MI Preferred)	$105.89
Rate for Payer: Cash Price	$130.33
Rate for Payer: Cofinity Commercial	$114.04
Rate for Payer: Cofinity Commercial	$140.10
Rate for Payer: Healthscope Commercial	$146.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$138.47
Rate for Payer: PHP Commercial	$138.47
Rate for Payer: Priority Health Cigna Priority Health	$114.04
Rate for Payer: Priority Health SBD	$102.63

HC PV JAK2V617F

Facility

$323.05

Service Code	CPT 81270
Hospital Charge Code	31000147
Hospital Revenue Code	310
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$290.74
Rate for Payer: Aetna Commercial	$274.59
Rate for Payer: Aetna New Business (MI Preferred)	$209.98
Rate for Payer: Cash Price	$258.44
Rate for Payer: Cofinity Commercial	$226.14
Rate for Payer: Cofinity Commercial	$277.82
Rate for Payer: Healthscope Commercial	$290.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.59
Rate for Payer: PHP Commercial	$274.59
Rate for Payer: Priority Health Cigna Priority Health	$226.14
Rate for Payer: Priority Health SBD	$203.52

HC PV JAK2V617F

Facility

$323.05

Service Code	CPT 81270
Hospital Charge Code	31000147
Hospital Revenue Code	310
Min. Negotiated Rate	$50.14
Max. Negotiated Rate	$290.74
Rate for Payer: Aetna Commercial	$274.59
Rate for Payer: Aetna Medicare	$95.33
Rate for Payer: Aetna New Business (MI Preferred)	$209.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$114.58
Rate for Payer: Amish Plain Church Group Commercial	$114.58
Rate for Payer: BCBS Complete	$52.65
Rate for Payer: BCBS MAPPO	$91.66
Rate for Payer: BCBS Trust/PPO	$71.78
Rate for Payer: BCN Medicare Advantage	$91.66
Rate for Payer: Cash Price	$258.44
Rate for Payer: Cash Price	$258.44
Rate for Payer: Cofinity Commercial	$277.82
Rate for Payer: Cofinity Commercial	$226.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$91.66
Rate for Payer: Healthscope Commercial	$290.74
Rate for Payer: Mclaren Medicaid	$50.14
Rate for Payer: Mclaren Medicare	$91.66
Rate for Payer: Meridian Medicaid	$52.65
Rate for Payer: Meridian Wellcare - Medicare Advantage	$96.24
Rate for Payer: MI Amish Medical Board Commercial	$105.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.59
Rate for Payer: PACE Medicare	$87.08
Rate for Payer: PACE SWMI	$91.66
Rate for Payer: PHP Commercial	$274.59
Rate for Payer: PHP Medicare Advantage	$91.66
Rate for Payer: Priority Health Choice Medicaid	$50.14
Rate for Payer: Priority Health Cigna Priority Health	$226.14
Rate for Payer: Priority Health Medicare	$91.66
Rate for Payer: Priority Health SBD	$203.52
Rate for Payer: Railroad Medicare Medicare	$91.66
Rate for Payer: UHC All Payor (Choice/PPO)	$109.99
Rate for Payer: UHC Core	$150.07
Rate for Payer: UHC Dual Complete DSNP	$91.66
Rate for Payer: UHC Exchange	$91.66
Rate for Payer: UHC Medicare Advantage	$94.41
Rate for Payer: VA VA	$91.66

HC PYRUVATE KINASE RBC

Facility

$93.00

Service Code	CPT 84220
Hospital Charge Code	30100415
Hospital Revenue Code	301
Min. Negotiated Rate	$58.59
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$65.10
Rate for Payer: Priority Health SBD	$58.59

Know your out-of-pocket cost for care.

All Charges