Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB

Facility

$534.77

Service Code	CPT M0243
Hospital Charge Code	77100029
Hospital Revenue Code	771
Min. Negotiated Rate	$336.91
Max. Negotiated Rate	$481.29
Rate for Payer: Aetna Commercial	$454.55
Rate for Payer: Aetna New Business (MI Preferred)	$347.60
Rate for Payer: Cash Price	$427.82
Rate for Payer: Cofinity Commercial	$374.34
Rate for Payer: Cofinity Commercial	$459.90
Rate for Payer: Cofinity Medicare Advantage	$374.34
Rate for Payer: Encore Health Key Benefits Commercial	$427.82
Rate for Payer: Healthscope Commercial	$481.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$454.55
Rate for Payer: PHP Commercial	$454.55
Rate for Payer: Priority Health Cigna Priority Health	$347.60
Rate for Payer: Priority Health SBD	$336.91

HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB

Facility

$534.77

Service Code	CPT M0243
Hospital Charge Code	77100029
Hospital Revenue Code	771
Min. Negotiated Rate	$213.91
Max. Negotiated Rate	$481.29
Rate for Payer: Aetna Commercial	$454.55
Rate for Payer: Aetna Medicare	$267.38
Rate for Payer: Aetna New Business (MI Preferred)	$347.60
Rate for Payer: BCBS Complete	$213.91
Rate for Payer: Cash Price	$427.82
Rate for Payer: Cofinity Commercial	$374.34
Rate for Payer: Cofinity Commercial	$459.90
Rate for Payer: Cofinity Medicare Advantage	$374.34
Rate for Payer: Encore Health Key Benefits Commercial	$427.82
Rate for Payer: Healthscope Commercial	$481.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$454.55
Rate for Payer: PHP Commercial	$454.55
Rate for Payer: Priority Health Cigna Priority Health	$347.60
Rate for Payer: Priority Health SBD	$336.91

HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ

Facility

$534.77

Service Code	CPT M0240
Hospital Charge Code	77100030
Hospital Revenue Code	771
Min. Negotiated Rate	$336.91
Max. Negotiated Rate	$481.29
Rate for Payer: Aetna Commercial	$454.55
Rate for Payer: Aetna New Business (MI Preferred)	$347.60
Rate for Payer: Cash Price	$427.82
Rate for Payer: Cofinity Commercial	$374.34
Rate for Payer: Cofinity Commercial	$459.90
Rate for Payer: Cofinity Medicare Advantage	$374.34
Rate for Payer: Encore Health Key Benefits Commercial	$427.82
Rate for Payer: Healthscope Commercial	$481.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$454.55
Rate for Payer: PHP Commercial	$454.55
Rate for Payer: Priority Health Cigna Priority Health	$347.60
Rate for Payer: Priority Health SBD	$336.91

HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ

Facility

$534.77

Service Code	CPT M0240
Hospital Charge Code	77100030
Hospital Revenue Code	771
Min. Negotiated Rate	$213.91
Max. Negotiated Rate	$481.29
Rate for Payer: Aetna Commercial	$454.55
Rate for Payer: Aetna Medicare	$267.38
Rate for Payer: Aetna New Business (MI Preferred)	$347.60
Rate for Payer: BCBS Complete	$213.91
Rate for Payer: Cash Price	$427.82
Rate for Payer: Cofinity Commercial	$374.34
Rate for Payer: Cofinity Commercial	$459.90
Rate for Payer: Cofinity Medicare Advantage	$374.34
Rate for Payer: Encore Health Key Benefits Commercial	$427.82
Rate for Payer: Healthscope Commercial	$481.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$454.55
Rate for Payer: PHP Commercial	$454.55
Rate for Payer: Priority Health Cigna Priority Health	$347.60
Rate for Payer: Priority Health SBD	$336.91

HC IVUS CATHETER

Facility

$2,739.36

Service Code	HCPCS C1753
Hospital Charge Code	27200052
Hospital Revenue Code	272
Min. Negotiated Rate	$1,725.80
Max. Negotiated Rate	$2,465.42
Rate for Payer: Aetna Commercial	$2,328.46
Rate for Payer: Aetna New Business (MI Preferred)	$1,780.58
Rate for Payer: Cash Price	$2,191.49
Rate for Payer: Cofinity Commercial	$1,917.55
Rate for Payer: Cofinity Commercial	$2,355.85
Rate for Payer: Cofinity Medicare Advantage	$1,917.55
Rate for Payer: Encore Health Key Benefits Commercial	$2,191.49
Rate for Payer: Healthscope Commercial	$2,465.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,328.46
Rate for Payer: PHP Commercial	$2,328.46
Rate for Payer: Priority Health Cigna Priority Health	$1,780.58
Rate for Payer: Priority Health SBD	$1,725.80

HC IVUS CATHETER

Facility

$2,739.36

Service Code	HCPCS C1753
Hospital Charge Code	27200052
Hospital Revenue Code	272
Min. Negotiated Rate	$1,095.74
Max. Negotiated Rate	$2,465.42
Rate for Payer: Aetna Commercial	$2,328.46
Rate for Payer: Aetna Medicare	$1,369.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,780.58
Rate for Payer: BCBS Complete	$1,095.74
Rate for Payer: Cash Price	$2,191.49
Rate for Payer: Cofinity Commercial	$1,917.55
Rate for Payer: Cofinity Commercial	$2,355.85
Rate for Payer: Cofinity Medicare Advantage	$1,917.55
Rate for Payer: Encore Health Key Benefits Commercial	$2,191.49
Rate for Payer: Healthscope Commercial	$2,465.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,328.46
Rate for Payer: PHP Commercial	$2,328.46
Rate for Payer: Priority Health Cigna Priority Health	$1,780.58
Rate for Payer: Priority Health SBD	$1,725.80

HC IVUS EA ADDL NON CORONARY VESSEL

Facility

$1,324.84

Service Code	CPT 37253
Hospital Charge Code	36100484
Hospital Revenue Code	361
Min. Negotiated Rate	$834.65
Max. Negotiated Rate	$1,192.36
Rate for Payer: Aetna Commercial	$1,126.11
Rate for Payer: Aetna New Business (MI Preferred)	$861.15
Rate for Payer: Cash Price	$1,059.87
Rate for Payer: Cofinity Commercial	$1,139.36
Rate for Payer: Cofinity Commercial	$927.39
Rate for Payer: Cofinity Medicare Advantage	$927.39
Rate for Payer: Encore Health Key Benefits Commercial	$1,059.87
Rate for Payer: Healthscope Commercial	$1,192.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,126.11
Rate for Payer: PHP Commercial	$1,126.11
Rate for Payer: Priority Health Cigna Priority Health	$861.15
Rate for Payer: Priority Health SBD	$834.65

HC IVUS EA ADDL NON CORONARY VESSEL

Facility

$1,324.84

Service Code	CPT 37253
Hospital Charge Code	36100484
Hospital Revenue Code	361
Min. Negotiated Rate	$529.94
Max. Negotiated Rate	$1,192.36
Rate for Payer: Aetna Commercial	$1,126.11
Rate for Payer: Aetna Medicare	$662.42
Rate for Payer: Aetna New Business (MI Preferred)	$861.15
Rate for Payer: BCBS Complete	$529.94
Rate for Payer: Cash Price	$1,059.87
Rate for Payer: Cofinity Commercial	$1,139.36
Rate for Payer: Cofinity Commercial	$927.39
Rate for Payer: Cofinity Medicare Advantage	$927.39
Rate for Payer: Encore Health Key Benefits Commercial	$1,059.87
Rate for Payer: Healthscope Commercial	$1,192.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,126.11
Rate for Payer: PHP Commercial	$1,126.11
Rate for Payer: Priority Health Cigna Priority Health	$861.15
Rate for Payer: Priority Health SBD	$834.65

HC IVUS NON CORONARY INITIAL

Facility

$7,832.55

Service Code	CPT 37252
Hospital Charge Code	36100483
Hospital Revenue Code	361
Min. Negotiated Rate	$4,934.51
Max. Negotiated Rate	$7,049.30
Rate for Payer: Aetna Commercial	$6,657.67
Rate for Payer: Aetna New Business (MI Preferred)	$5,091.16
Rate for Payer: Cash Price	$6,266.04
Rate for Payer: Cofinity Commercial	$5,482.78
Rate for Payer: Cofinity Commercial	$6,735.99
Rate for Payer: Cofinity Medicare Advantage	$5,482.78
Rate for Payer: Encore Health Key Benefits Commercial	$6,266.04
Rate for Payer: Healthscope Commercial	$7,049.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,657.67
Rate for Payer: PHP Commercial	$6,657.67
Rate for Payer: Priority Health Cigna Priority Health	$5,091.16
Rate for Payer: Priority Health SBD	$4,934.51

HC IVUS NON CORONARY INITIAL

Facility

$7,832.55

Service Code	CPT 37252
Hospital Charge Code	36100483
Hospital Revenue Code	361
Min. Negotiated Rate	$3,133.02
Max. Negotiated Rate	$7,049.30
Rate for Payer: Aetna Commercial	$6,657.67
Rate for Payer: Aetna Medicare	$3,916.28
Rate for Payer: Aetna New Business (MI Preferred)	$5,091.16
Rate for Payer: BCBS Complete	$3,133.02
Rate for Payer: Cash Price	$6,266.04
Rate for Payer: Cofinity Commercial	$5,482.78
Rate for Payer: Cofinity Commercial	$6,735.99
Rate for Payer: Cofinity Medicare Advantage	$5,482.78
Rate for Payer: Encore Health Key Benefits Commercial	$6,266.04
Rate for Payer: Healthscope Commercial	$7,049.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,657.67
Rate for Payer: PHP Commercial	$6,657.67
Rate for Payer: Priority Health Cigna Priority Health	$5,091.16
Rate for Payer: Priority Health SBD	$4,934.51

HC IVUS OR OCT EACH ADDL VESSEL

Facility

$1,532.20

Service Code	CPT 92979
Hospital Charge Code	48100107
Hospital Revenue Code	481
Min. Negotiated Rate	$965.29
Max. Negotiated Rate	$1,378.98
Rate for Payer: Aetna Commercial	$1,302.37
Rate for Payer: Aetna New Business (MI Preferred)	$995.93
Rate for Payer: Cash Price	$1,225.76
Rate for Payer: Cofinity Commercial	$1,072.54
Rate for Payer: Cofinity Commercial	$1,317.69
Rate for Payer: Cofinity Medicare Advantage	$1,072.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,225.76
Rate for Payer: Healthscope Commercial	$1,378.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,302.37
Rate for Payer: PHP Commercial	$1,302.37
Rate for Payer: Priority Health Cigna Priority Health	$995.93
Rate for Payer: Priority Health SBD	$965.29

HC IVUS OR OCT EACH ADDL VESSEL

Facility

$1,532.20

Service Code	CPT 92979
Hospital Charge Code	48100107
Hospital Revenue Code	481
Min. Negotiated Rate	$612.88
Max. Negotiated Rate	$1,378.98
Rate for Payer: Aetna Commercial	$1,302.37
Rate for Payer: Aetna Medicare	$766.10
Rate for Payer: Aetna New Business (MI Preferred)	$995.93
Rate for Payer: BCBS Complete	$612.88
Rate for Payer: Cash Price	$1,225.76
Rate for Payer: Cofinity Commercial	$1,072.54
Rate for Payer: Cofinity Commercial	$1,317.69
Rate for Payer: Cofinity Medicare Advantage	$1,072.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,225.76
Rate for Payer: Healthscope Commercial	$1,378.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,302.37
Rate for Payer: PHP Commercial	$1,302.37
Rate for Payer: Priority Health Cigna Priority Health	$995.93
Rate for Payer: Priority Health SBD	$965.29

HC IVUS OR OCT INITIAL VESSEL

Facility

$3,693.88

Service Code	CPT 92978
Hospital Charge Code	48100106
Hospital Revenue Code	481
Min. Negotiated Rate	$2,327.14
Max. Negotiated Rate	$3,324.49
Rate for Payer: Aetna Commercial	$3,139.80
Rate for Payer: Aetna New Business (MI Preferred)	$2,401.02
Rate for Payer: Cash Price	$2,955.10
Rate for Payer: Cofinity Commercial	$2,585.72
Rate for Payer: Cofinity Commercial	$3,176.74
Rate for Payer: Cofinity Medicare Advantage	$2,585.72
Rate for Payer: Encore Health Key Benefits Commercial	$2,955.10
Rate for Payer: Healthscope Commercial	$3,324.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,139.80
Rate for Payer: PHP Commercial	$3,139.80
Rate for Payer: Priority Health Cigna Priority Health	$2,401.02
Rate for Payer: Priority Health SBD	$2,327.14

HC IVUS OR OCT INITIAL VESSEL

Facility

$3,693.88

Service Code	CPT 92978
Hospital Charge Code	48100106
Hospital Revenue Code	481
Min. Negotiated Rate	$1,477.55
Max. Negotiated Rate	$3,324.49
Rate for Payer: Aetna Commercial	$3,139.80
Rate for Payer: Aetna Medicare	$1,846.94
Rate for Payer: Aetna New Business (MI Preferred)	$2,401.02
Rate for Payer: BCBS Complete	$1,477.55
Rate for Payer: Cash Price	$2,955.10
Rate for Payer: Cofinity Commercial	$2,585.72
Rate for Payer: Cofinity Commercial	$3,176.74
Rate for Payer: Cofinity Medicare Advantage	$2,585.72
Rate for Payer: Encore Health Key Benefits Commercial	$2,955.10
Rate for Payer: Healthscope Commercial	$3,324.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,139.80
Rate for Payer: PHP Commercial	$3,139.80
Rate for Payer: Priority Health Cigna Priority Health	$2,401.02
Rate for Payer: Priority Health SBD	$2,327.14

HC JAK2 EXON 12 MUTATION DETECTION

Facility

$373.32

Service Code	CPT 0027U
Hospital Charge Code	31000148
Hospital Revenue Code	310
Min. Negotiated Rate	$235.19
Max. Negotiated Rate	$335.99
Rate for Payer: Aetna Commercial	$317.32
Rate for Payer: Aetna New Business (MI Preferred)	$242.66
Rate for Payer: Cash Price	$298.66
Rate for Payer: Cofinity Commercial	$261.32
Rate for Payer: Cofinity Commercial	$321.06
Rate for Payer: Cofinity Medicare Advantage	$261.32
Rate for Payer: Encore Health Key Benefits Commercial	$298.66
Rate for Payer: Healthscope Commercial	$335.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.32
Rate for Payer: PHP Commercial	$317.32
Rate for Payer: Priority Health Cigna Priority Health	$242.66
Rate for Payer: Priority Health SBD	$235.19

HC JAK2 EXON 12 MUTATION DETECTION

Facility

$373.32

Service Code	CPT 0027U
Hospital Charge Code	31000148
Hospital Revenue Code	310
Min. Negotiated Rate	$65.34
Max. Negotiated Rate	$343.16
Rate for Payer: Aetna Commercial	$317.32
Rate for Payer: Aetna Medicare	$126.79
Rate for Payer: Aetna New Business (MI Preferred)	$242.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$152.39
Rate for Payer: Amish Plain Church Group Commercial	$152.39
Rate for Payer: BCBS Complete	$68.61
Rate for Payer: BCBS MAPPO	$121.91
Rate for Payer: BCN Medicare Advantage	$121.91
Rate for Payer: Cash Price	$298.66
Rate for Payer: Cash Price	$298.66
Rate for Payer: Cofinity Commercial	$321.06
Rate for Payer: Cofinity Commercial	$261.32
Rate for Payer: Cofinity Medicare Advantage	$261.32
Rate for Payer: Encore Health Key Benefits Commercial	$298.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$121.91
Rate for Payer: Healthscope Commercial	$335.99
Rate for Payer: Mclaren Medicaid	$65.34
Rate for Payer: Mclaren Medicare	$121.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$128.01
Rate for Payer: Meridian Medicaid	$68.61
Rate for Payer: MI Amish Medical Board Commercial	$140.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.32
Rate for Payer: PACE Medicare	$115.81
Rate for Payer: PACE SWMI	$121.91
Rate for Payer: PHP Commercial	$317.32
Rate for Payer: PHP Medicare Advantage	$121.91
Rate for Payer: Priority Health Choice Medicaid	$65.34
Rate for Payer: Priority Health Cigna Priority Health	$242.66
Rate for Payer: Priority Health Medicare	$121.91
Rate for Payer: Priority Health SBD	$235.19
Rate for Payer: Railroad Medicare Medicare	$121.91
Rate for Payer: UHC All Payor (Choice/PPO)	$343.16
Rate for Payer: UHC Dual Complete DSNP	$121.91
Rate for Payer: UHC Medicare Advantage	$121.91
Rate for Payer: UHCCP Medicaid	$68.64
Rate for Payer: VA VA	$121.91

HC JAK2 V617F MUTATION

Facility

$388.07

Service Code	CPT 81270
Hospital Charge Code	31000101
Hospital Revenue Code	310
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$349.26
Rate for Payer: Aetna Commercial	$329.86
Rate for Payer: Aetna Medicare	$95.33
Rate for Payer: Aetna New Business (MI Preferred)	$252.25
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	$51.59
Rate for Payer: BCBS MAPPO	$91.66
Rate for Payer: BCN Medicare Advantage	$91.66
Rate for Payer: Cash Price	$310.46
Rate for Payer: Cash Price	$310.46
Rate for Payer: Cofinity Commercial	$333.74
Rate for Payer: Cofinity Commercial	$271.65
Rate for Payer: Cofinity Medicare Advantage	$271.65
Rate for Payer: Encore Health Key Benefits Commercial	$310.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$91.66
Rate for Payer: Healthscope Commercial	$349.26
Rate for Payer: Mclaren Medicaid	$49.13
Rate for Payer: Mclaren Medicare	$91.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$96.24
Rate for Payer: Meridian Medicaid	$51.59
Rate for Payer: MI Amish Medical Board Commercial	$105.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.86
Rate for Payer: PACE Medicare	$87.08
Rate for Payer: PACE SWMI	$91.66
Rate for Payer: PHP Commercial	$329.86
Rate for Payer: PHP Medicare Advantage	$91.66
Rate for Payer: Priority Health Choice Medicaid	$49.13
Rate for Payer: Priority Health Cigna Priority Health	$252.25
Rate for Payer: Priority Health Medicare	$91.66
Rate for Payer: Priority Health SBD	$244.48
Rate for Payer: Railroad Medicare Medicare	$91.66
Rate for Payer: UHC All Payor (Choice/PPO)	$258.01
Rate for Payer: UHC Dual Complete DSNP	$91.66
Rate for Payer: UHC Medicare Advantage	$91.66
Rate for Payer: UHCCP Medicaid	$51.60
Rate for Payer: VA VA	$91.66

HC JAK2 V617F MUTATION

Facility

$388.07

Service Code	CPT 81270
Hospital Charge Code	31000101
Hospital Revenue Code	310
Min. Negotiated Rate	$244.48
Max. Negotiated Rate	$349.26
Rate for Payer: Aetna Commercial	$329.86
Rate for Payer: Aetna New Business (MI Preferred)	$252.25
Rate for Payer: Cash Price	$310.46
Rate for Payer: Cofinity Commercial	$271.65
Rate for Payer: Cofinity Commercial	$333.74
Rate for Payer: Cofinity Medicare Advantage	$271.65
Rate for Payer: Encore Health Key Benefits Commercial	$310.46
Rate for Payer: Healthscope Commercial	$349.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.86
Rate for Payer: PHP Commercial	$329.86
Rate for Payer: Priority Health Cigna Priority Health	$252.25
Rate for Payer: Priority Health SBD	$244.48

HC JC VIRUS, PCR, CSF

Facility

$108.12

Service Code	CPT 87798
Hospital Charge Code	30600335
Hospital Revenue Code	306
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$98.77
Rate for Payer: Aetna Commercial	$91.90
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$70.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$19.75
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cofinity Commercial	$92.98
Rate for Payer: Cofinity Commercial	$75.68
Rate for Payer: Cofinity Medicare Advantage	$75.68
Rate for Payer: Encore Health Key Benefits Commercial	$86.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$97.31
Rate for Payer: Mclaren Medicaid	$18.81
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.84
Rate for Payer: Meridian Medicaid	$19.75
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.90
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$91.90
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$18.81
Rate for Payer: Priority Health Cigna Priority Health	$70.28
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$68.12
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$98.77
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Medicare Advantage	$35.09
Rate for Payer: UHCCP Medicaid	$19.76
Rate for Payer: VA VA	$35.09

HC JC VIRUS, PCR, CSF

Facility

$108.12

Service Code	CPT 87798
Hospital Charge Code	30600335
Hospital Revenue Code	306
Min. Negotiated Rate	$68.12
Max. Negotiated Rate	$97.31
Rate for Payer: Aetna Commercial	$91.90
Rate for Payer: Aetna New Business (MI Preferred)	$70.28
Rate for Payer: Cash Price	$86.50
Rate for Payer: Cofinity Commercial	$75.68
Rate for Payer: Cofinity Commercial	$92.98
Rate for Payer: Cofinity Medicare Advantage	$75.68
Rate for Payer: Encore Health Key Benefits Commercial	$86.50
Rate for Payer: Healthscope Commercial	$97.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.90
Rate for Payer: PHP Commercial	$91.90
Rate for Payer: Priority Health Cigna Priority Health	$70.28
Rate for Payer: Priority Health SBD	$68.12

HC JET VENT INITIAL DAY

Facility

$2,576.21

Service Code	CPT 94002
Hospital Charge Code	41000057
Hospital Revenue Code	410
Min. Negotiated Rate	$345.59
Max. Negotiated Rate	$2,318.59
Rate for Payer: Aetna Commercial	$2,189.78
Rate for Payer: Aetna Medicare	$670.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,674.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$805.95
Rate for Payer: Amish Plain Church Group Commercial	$805.95
Rate for Payer: BCBS Complete	$362.87
Rate for Payer: BCBS MAPPO	$644.76
Rate for Payer: BCN Medicare Advantage	$644.76
Rate for Payer: Cash Price	$2,060.97
Rate for Payer: Cash Price	$2,060.97
Rate for Payer: Cofinity Commercial	$2,215.54
Rate for Payer: Cofinity Commercial	$1,803.35
Rate for Payer: Cofinity Medicare Advantage	$1,803.35
Rate for Payer: Encore Health Key Benefits Commercial	$2,060.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$644.76
Rate for Payer: Healthscope Commercial	$2,318.59
Rate for Payer: Mclaren Medicaid	$345.59
Rate for Payer: Mclaren Medicare	$644.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$677.00
Rate for Payer: Meridian Medicaid	$362.87
Rate for Payer: MI Amish Medical Board Commercial	$741.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,189.78
Rate for Payer: PACE Medicare	$612.52
Rate for Payer: PACE SWMI	$644.76
Rate for Payer: PHP Commercial	$2,189.78
Rate for Payer: PHP Medicare Advantage	$644.76
Rate for Payer: Priority Health Choice Medicaid	$345.59
Rate for Payer: Priority Health Cigna Priority Health	$1,674.54
Rate for Payer: Priority Health Medicare	$644.76
Rate for Payer: Priority Health SBD	$1,623.01
Rate for Payer: Railroad Medicare Medicare	$644.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1,814.93
Rate for Payer: UHC Core	$1,906.40
Rate for Payer: UHC Dual Complete DSNP	$644.76
Rate for Payer: UHC Exchange	$1,906.40
Rate for Payer: UHC Medicare Advantage	$644.76
Rate for Payer: UHCCP Medicaid	$363.00
Rate for Payer: VA VA	$644.76

HC JET VENT INITIAL DAY

Facility

$2,576.21

Service Code	CPT 94002
Hospital Charge Code	41000057
Hospital Revenue Code	410
Min. Negotiated Rate	$1,623.01
Max. Negotiated Rate	$2,318.59
Rate for Payer: Aetna Commercial	$2,189.78
Rate for Payer: Aetna New Business (MI Preferred)	$1,674.54
Rate for Payer: Cash Price	$2,060.97
Rate for Payer: Cofinity Commercial	$1,803.35
Rate for Payer: Cofinity Commercial	$2,215.54
Rate for Payer: Cofinity Medicare Advantage	$1,803.35
Rate for Payer: Encore Health Key Benefits Commercial	$2,060.97
Rate for Payer: Healthscope Commercial	$2,318.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,189.78
Rate for Payer: PHP Commercial	$2,189.78
Rate for Payer: Priority Health Cigna Priority Health	$1,674.54
Rate for Payer: Priority Health SBD	$1,623.01

HC JET VENT SUB DAY

Facility

$1,897.80

Service Code	CPT 94003
Hospital Charge Code	41000058
Hospital Revenue Code	410
Min. Negotiated Rate	$1,195.61
Max. Negotiated Rate	$1,708.02
Rate for Payer: Aetna Commercial	$1,613.13
Rate for Payer: Aetna New Business (MI Preferred)	$1,233.57
Rate for Payer: Cash Price	$1,518.24
Rate for Payer: Cofinity Commercial	$1,328.46
Rate for Payer: Cofinity Commercial	$1,632.11
Rate for Payer: Cofinity Medicare Advantage	$1,328.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,518.24
Rate for Payer: Healthscope Commercial	$1,708.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,613.13
Rate for Payer: PHP Commercial	$1,613.13
Rate for Payer: Priority Health Cigna Priority Health	$1,233.57
Rate for Payer: Priority Health SBD	$1,195.61

HC JET VENT SUB DAY

Facility

$1,897.80

Service Code	CPT 94003
Hospital Charge Code	41000058
Hospital Revenue Code	410
Min. Negotiated Rate	$345.59
Max. Negotiated Rate	$1,814.93
Rate for Payer: Aetna Commercial	$1,613.13
Rate for Payer: Aetna Medicare	$670.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,233.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$805.95
Rate for Payer: Amish Plain Church Group Commercial	$805.95
Rate for Payer: BCBS Complete	$362.87
Rate for Payer: BCBS MAPPO	$644.76
Rate for Payer: BCN Medicare Advantage	$644.76
Rate for Payer: Cash Price	$1,518.24
Rate for Payer: Cash Price	$1,518.24
Rate for Payer: Cofinity Commercial	$1,632.11
Rate for Payer: Cofinity Commercial	$1,328.46
Rate for Payer: Cofinity Medicare Advantage	$1,328.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,518.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$644.76
Rate for Payer: Healthscope Commercial	$1,708.02
Rate for Payer: Mclaren Medicaid	$345.59
Rate for Payer: Mclaren Medicare	$644.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$677.00
Rate for Payer: Meridian Medicaid	$362.87
Rate for Payer: MI Amish Medical Board Commercial	$741.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,613.13
Rate for Payer: PACE Medicare	$612.52
Rate for Payer: PACE SWMI	$644.76
Rate for Payer: PHP Commercial	$1,613.13
Rate for Payer: PHP Medicare Advantage	$644.76
Rate for Payer: Priority Health Choice Medicaid	$345.59
Rate for Payer: Priority Health Cigna Priority Health	$1,233.57
Rate for Payer: Priority Health Medicare	$644.76
Rate for Payer: Priority Health SBD	$1,195.61
Rate for Payer: Railroad Medicare Medicare	$644.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1,814.93
Rate for Payer: UHC Core	$1,404.37
Rate for Payer: UHC Dual Complete DSNP	$644.76
Rate for Payer: UHC Exchange	$1,404.37
Rate for Payer: UHC Medicare Advantage	$644.76
Rate for Payer: UHCCP Medicaid	$363.00
Rate for Payer: VA VA	$644.76

HC JO 1 ANTIBODY

Facility

$35.17

Service Code	CPT 86235
Hospital Charge Code	30200163
Hospital Revenue Code	302
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$50.47
Rate for Payer: Aetna Commercial	$29.89
Rate for Payer: Aetna Medicare	$18.65
Rate for Payer: Aetna New Business (MI Preferred)	$22.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$22.41
Rate for Payer: Amish Plain Church Group Commercial	$22.41
Rate for Payer: BCBS Complete	$10.09
Rate for Payer: BCBS MAPPO	$17.93
Rate for Payer: BCN Medicare Advantage	$17.93
Rate for Payer: Cash Price	$28.14
Rate for Payer: Cash Price	$28.14
Rate for Payer: Cofinity Commercial	$30.25
Rate for Payer: Cofinity Commercial	$24.62
Rate for Payer: Cofinity Medicare Advantage	$24.62
Rate for Payer: Encore Health Key Benefits Commercial	$28.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$17.93
Rate for Payer: Healthscope Commercial	$31.65
Rate for Payer: Mclaren Medicaid	$9.61
Rate for Payer: Mclaren Medicare	$17.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18.83
Rate for Payer: Meridian Medicaid	$10.09
Rate for Payer: MI Amish Medical Board Commercial	$20.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.89
Rate for Payer: PACE Medicare	$17.03
Rate for Payer: PACE SWMI	$17.93
Rate for Payer: PHP Commercial	$29.89
Rate for Payer: PHP Medicare Advantage	$17.93
Rate for Payer: Priority Health Choice Medicaid	$9.61
Rate for Payer: Priority Health Cigna Priority Health	$22.86
Rate for Payer: Priority Health Medicare	$17.93
Rate for Payer: Priority Health SBD	$22.16
Rate for Payer: Railroad Medicare Medicare	$17.93
Rate for Payer: UHC All Payor (Choice/PPO)	$50.47
Rate for Payer: UHC Dual Complete DSNP	$17.93
Rate for Payer: UHC Medicare Advantage	$17.93
Rate for Payer: UHCCP Medicaid	$10.09
Rate for Payer: VA VA	$17.93

Know your out-of-pocket cost for care.

All Charges