Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC LEGIONELLA PNEUMOPHILA AB

Facility

$48.96

Service Code	CPT 86713
Hospital Charge Code	30200301
Hospital Revenue Code	302
Min. Negotiated Rate	$30.84
Max. Negotiated Rate	$44.06
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna New Business (MI Preferred)	$31.82
Rate for Payer: Cash Price	$39.17
Rate for Payer: Cofinity Commercial	$34.27
Rate for Payer: Cofinity Commercial	$42.11
Rate for Payer: Cofinity Medicare Advantage	$34.27
Rate for Payer: Encore Health Key Benefits Commercial	$39.17
Rate for Payer: Healthscope Commercial	$44.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.62
Rate for Payer: PHP Commercial	$41.62
Rate for Payer: Priority Health Cigna Priority Health	$31.82
Rate for Payer: Priority Health SBD	$30.84

HC LEGIONELLA PNEUMOPHILA AB

Facility

$48.96

Service Code	CPT 86713
Hospital Charge Code	30200301
Hospital Revenue Code	302
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$44.06
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$31.82
Rate for Payer: Allen County Amish Medical Aid Commercial	$19.12
Rate for Payer: Amish Plain Church Group Commercial	$19.12
Rate for Payer: BCBS Complete	$8.61
Rate for Payer: BCBS MAPPO	$15.30
Rate for Payer: BCN Medicare Advantage	$15.30
Rate for Payer: Cash Price	$39.17
Rate for Payer: Cash Price	$39.17
Rate for Payer: Cofinity Commercial	$42.11
Rate for Payer: Cofinity Commercial	$34.27
Rate for Payer: Cofinity Medicare Advantage	$34.27
Rate for Payer: Encore Health Key Benefits Commercial	$39.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.30
Rate for Payer: Healthscope Commercial	$44.06
Rate for Payer: Mclaren Medicaid	$8.20
Rate for Payer: Mclaren Medicare	$15.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.07
Rate for Payer: Meridian Medicaid	$8.61
Rate for Payer: MI Amish Medical Board Commercial	$17.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.62
Rate for Payer: PACE Medicare	$14.54
Rate for Payer: PACE SWMI	$15.30
Rate for Payer: PHP Commercial	$41.62
Rate for Payer: PHP Medicare Advantage	$15.30
Rate for Payer: Priority Health Choice Medicaid	$8.20
Rate for Payer: Priority Health Cigna Priority Health	$31.82
Rate for Payer: Priority Health Medicare	$15.30
Rate for Payer: Priority Health SBD	$30.84
Rate for Payer: Railroad Medicare Medicare	$15.30
Rate for Payer: UHC All Payor (Choice/PPO)	$43.07
Rate for Payer: UHC Dual Complete DSNP	$15.30
Rate for Payer: UHC Medicare Advantage	$15.30
Rate for Payer: UHCCP Medicaid	$8.61
Rate for Payer: VA VA	$15.30

HC LEPTOSPIRA ANTIBODY

Facility

$68.34

Service Code	CPT 86720
Hospital Charge Code	30200303
Hospital Revenue Code	302
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$61.51
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare	$16.85
Rate for Payer: Aetna New Business (MI Preferred)	$44.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$20.25
Rate for Payer: Amish Plain Church Group Commercial	$20.25
Rate for Payer: BCBS Complete	$9.12
Rate for Payer: BCBS MAPPO	$16.20
Rate for Payer: BCN Medicare Advantage	$16.20
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cofinity Commercial	$58.77
Rate for Payer: Cofinity Commercial	$47.84
Rate for Payer: Cofinity Medicare Advantage	$47.84
Rate for Payer: Encore Health Key Benefits Commercial	$54.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$16.20
Rate for Payer: Healthscope Commercial	$61.51
Rate for Payer: Mclaren Medicaid	$8.68
Rate for Payer: Mclaren Medicare	$16.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17.01
Rate for Payer: Meridian Medicaid	$9.12
Rate for Payer: MI Amish Medical Board Commercial	$18.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.09
Rate for Payer: PACE Medicare	$15.39
Rate for Payer: PACE SWMI	$16.20
Rate for Payer: PHP Commercial	$58.09
Rate for Payer: PHP Medicare Advantage	$16.20
Rate for Payer: Priority Health Choice Medicaid	$8.68
Rate for Payer: Priority Health Cigna Priority Health	$44.42
Rate for Payer: Priority Health Medicare	$16.20
Rate for Payer: Priority Health SBD	$43.05
Rate for Payer: Railroad Medicare Medicare	$16.20
Rate for Payer: UHC All Payor (Choice/PPO)	$45.60
Rate for Payer: UHC Dual Complete DSNP	$16.20
Rate for Payer: UHC Medicare Advantage	$16.20
Rate for Payer: UHCCP Medicaid	$9.12
Rate for Payer: VA VA	$16.20

HC LEPTOSPIRA ANTIBODY

Facility

$68.34

Service Code	CPT 86720
Hospital Charge Code	30200303
Hospital Revenue Code	302
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$61.51
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna New Business (MI Preferred)	$44.42
Rate for Payer: Cash Price	$54.67
Rate for Payer: Cofinity Commercial	$47.84
Rate for Payer: Cofinity Commercial	$58.77
Rate for Payer: Cofinity Medicare Advantage	$47.84
Rate for Payer: Encore Health Key Benefits Commercial	$54.67
Rate for Payer: Healthscope Commercial	$61.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.09
Rate for Payer: PHP Commercial	$58.09
Rate for Payer: Priority Health Cigna Priority Health	$44.42
Rate for Payer: Priority Health SBD	$43.05

HC LEUKEMIA LYMPHOMA IMM T PANEL

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100014
Hospital Revenue Code	311
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUKEMIA LYMPHOMA IMM T PANEL

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100014
Hospital Revenue Code	311
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$26.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: BCBS Complete	$20.90
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUKEMIA LYMPHOMA IMMUNOPH GLL

Facility

$54.83

Service Code	CPT 88185
Hospital Charge Code	31100010
Hospital Revenue Code	311
Min. Negotiated Rate	$34.54
Max. Negotiated Rate	$49.35
Rate for Payer: Aetna Commercial	$46.61
Rate for Payer: Aetna New Business (MI Preferred)	$35.64
Rate for Payer: Cash Price	$43.86
Rate for Payer: Cofinity Commercial	$38.38
Rate for Payer: Cofinity Commercial	$47.15
Rate for Payer: Cofinity Medicare Advantage	$38.38
Rate for Payer: Encore Health Key Benefits Commercial	$43.86
Rate for Payer: Healthscope Commercial	$49.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.61
Rate for Payer: PHP Commercial	$46.61
Rate for Payer: Priority Health Cigna Priority Health	$35.64
Rate for Payer: Priority Health SBD	$34.54

HC LEUKEMIA LYMPHOMA IMMUNOPH GLL

Facility

$54.83

Service Code	CPT 88185
Hospital Charge Code	31100010
Hospital Revenue Code	311
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$49.35
Rate for Payer: Aetna Commercial	$46.61
Rate for Payer: Aetna Medicare	$27.41
Rate for Payer: Aetna New Business (MI Preferred)	$35.64
Rate for Payer: BCBS Complete	$21.93
Rate for Payer: Cash Price	$43.86
Rate for Payer: Cofinity Commercial	$38.38
Rate for Payer: Cofinity Commercial	$47.15
Rate for Payer: Cofinity Medicare Advantage	$38.38
Rate for Payer: Encore Health Key Benefits Commercial	$43.86
Rate for Payer: Healthscope Commercial	$49.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.61
Rate for Payer: PHP Commercial	$46.61
Rate for Payer: Priority Health Cigna Priority Health	$35.64
Rate for Payer: Priority Health SBD	$34.54

HC LEUKEMIA LYMPHOMA IMMUNOPH TCR

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100009
Hospital Revenue Code	311
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUKEMIA LYMPHOMA IMMUNOPH TCR

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100009
Hospital Revenue Code	311
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$26.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: BCBS Complete	$20.90
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUKEMIA LYMPHOMA PLASMA CELL

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100013
Hospital Revenue Code	311
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUKEMIA LYMPHOMA PLASMA CELL

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100013
Hospital Revenue Code	311
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$26.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: BCBS Complete	$20.90
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUK/LYMPH IMMUNOPHENO CMPT B

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31000008
Hospital Revenue Code	310
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$26.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: BCBS Complete	$20.90
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUK/LYMPH IMMUNOPHENO CMPT B

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31000008
Hospital Revenue Code	310
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUK/LYMPH IMMUNOPHENO CMPT C

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31000009
Hospital Revenue Code	310
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$26.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: BCBS Complete	$20.90
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUK/LYMPH IMMUNOPHENO CMPT C

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31000009
Hospital Revenue Code	310
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUK/LYMPH IMMUNOPHENO CMPT D

Facility

$54.83

Service Code	CPT 88185
Hospital Charge Code	31000010
Hospital Revenue Code	310
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$49.35
Rate for Payer: Aetna Commercial	$46.61
Rate for Payer: Aetna Medicare	$27.41
Rate for Payer: Aetna New Business (MI Preferred)	$35.64
Rate for Payer: BCBS Complete	$21.93
Rate for Payer: Cash Price	$43.86
Rate for Payer: Cofinity Commercial	$38.38
Rate for Payer: Cofinity Commercial	$47.15
Rate for Payer: Cofinity Medicare Advantage	$38.38
Rate for Payer: Encore Health Key Benefits Commercial	$43.86
Rate for Payer: Healthscope Commercial	$49.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.61
Rate for Payer: PHP Commercial	$46.61
Rate for Payer: Priority Health Cigna Priority Health	$35.64
Rate for Payer: Priority Health SBD	$34.54

HC LEUK/LYMPH IMMUNOPHENO CMPT D

Facility

$54.83

Service Code	CPT 88185
Hospital Charge Code	31000010
Hospital Revenue Code	310
Min. Negotiated Rate	$34.54
Max. Negotiated Rate	$49.35
Rate for Payer: Aetna Commercial	$46.61
Rate for Payer: Aetna New Business (MI Preferred)	$35.64
Rate for Payer: Cash Price	$43.86
Rate for Payer: Cofinity Commercial	$38.38
Rate for Payer: Cofinity Commercial	$47.15
Rate for Payer: Cofinity Medicare Advantage	$38.38
Rate for Payer: Encore Health Key Benefits Commercial	$43.86
Rate for Payer: Healthscope Commercial	$49.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.61
Rate for Payer: PHP Commercial	$46.61
Rate for Payer: Priority Health Cigna Priority Health	$35.64
Rate for Payer: Priority Health SBD	$34.54

HC LEUK LYMPHOMA IMMUNOPHEN TISSUE

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100015
Hospital Revenue Code	311
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$26.12
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: BCBS Complete	$20.90
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUK LYMPHOMA IMMUNOPHEN TISSUE

Facility

$52.24

Service Code	CPT 88185
Hospital Charge Code	31100015
Hospital Revenue Code	311
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$47.02
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna New Business (MI Preferred)	$33.96
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$36.57
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Medicare Advantage	$36.57
Rate for Payer: Encore Health Key Benefits Commercial	$41.79
Rate for Payer: Healthscope Commercial	$47.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.40
Rate for Payer: PHP Commercial	$44.40
Rate for Payer: Priority Health Cigna Priority Health	$33.96
Rate for Payer: Priority Health SBD	$32.91

HC LEUKOTRIENE E4, U

Facility

$260.10

Service Code	CPT 82542
Hospital Charge Code	30100715
Hospital Revenue Code	301
Min. Negotiated Rate	$163.86
Max. Negotiated Rate	$234.09
Rate for Payer: Aetna Commercial	$221.09
Rate for Payer: Aetna New Business (MI Preferred)	$169.06
Rate for Payer: Cash Price	$208.08
Rate for Payer: Cofinity Commercial	$182.07
Rate for Payer: Cofinity Commercial	$223.69
Rate for Payer: Cofinity Medicare Advantage	$182.07
Rate for Payer: Encore Health Key Benefits Commercial	$208.08
Rate for Payer: Healthscope Commercial	$234.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.09
Rate for Payer: PHP Commercial	$221.09
Rate for Payer: Priority Health Cigna Priority Health	$169.06
Rate for Payer: Priority Health SBD	$163.86

HC LEUKOTRIENE E4, U

Facility

$260.10

Service Code	CPT 82542
Hospital Charge Code	30100715
Hospital Revenue Code	301
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$234.09
Rate for Payer: Aetna Commercial	$221.09
Rate for Payer: Aetna Medicare	$25.05
Rate for Payer: Aetna New Business (MI Preferred)	$169.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$30.11
Rate for Payer: Amish Plain Church Group Commercial	$30.11
Rate for Payer: BCBS Complete	$13.56
Rate for Payer: BCBS MAPPO	$24.09
Rate for Payer: BCN Medicare Advantage	$24.09
Rate for Payer: Cash Price	$208.08
Rate for Payer: Cash Price	$208.08
Rate for Payer: Cofinity Commercial	$223.69
Rate for Payer: Cofinity Commercial	$182.07
Rate for Payer: Cofinity Medicare Advantage	$182.07
Rate for Payer: Encore Health Key Benefits Commercial	$208.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.09
Rate for Payer: Healthscope Commercial	$234.09
Rate for Payer: Mclaren Medicaid	$12.91
Rate for Payer: Mclaren Medicare	$24.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25.29
Rate for Payer: Meridian Medicaid	$13.56
Rate for Payer: MI Amish Medical Board Commercial	$27.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.09
Rate for Payer: PACE Medicare	$22.89
Rate for Payer: PACE SWMI	$24.09
Rate for Payer: PHP Commercial	$221.09
Rate for Payer: PHP Medicare Advantage	$24.09
Rate for Payer: Priority Health Choice Medicaid	$12.91
Rate for Payer: Priority Health Cigna Priority Health	$169.06
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health SBD	$163.86
Rate for Payer: Railroad Medicare Medicare	$24.09
Rate for Payer: UHC All Payor (Choice/PPO)	$67.81
Rate for Payer: UHC Dual Complete DSNP	$24.09
Rate for Payer: UHC Medicare Advantage	$24.09
Rate for Payer: UHCCP Medicaid	$13.56
Rate for Payer: VA VA	$24.09

HC LEUPROLIDE ACETATE 3.75MG

Facility

$1,031.14

Service Code	HCPCS J1950
Hospital Charge Code	63600142
Hospital Revenue Code	636
Min. Negotiated Rate	$649.62
Max. Negotiated Rate	$928.03
Rate for Payer: Aetna Commercial	$876.47
Rate for Payer: Aetna New Business (MI Preferred)	$670.24
Rate for Payer: Cash Price	$824.91
Rate for Payer: Cofinity Commercial	$721.80
Rate for Payer: Cofinity Commercial	$886.78
Rate for Payer: Cofinity Medicare Advantage	$721.80
Rate for Payer: Encore Health Key Benefits Commercial	$824.91
Rate for Payer: Healthscope Commercial	$928.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$876.47
Rate for Payer: PHP Commercial	$876.47
Rate for Payer: Priority Health Cigna Priority Health	$670.24
Rate for Payer: Priority Health SBD	$649.62

HC LEUPROLIDE ACETATE 3.75MG

Facility

$1,031.14

Service Code	HCPCS J1950
Hospital Charge Code	63600142
Hospital Revenue Code	636
Min. Negotiated Rate	$649.62
Max. Negotiated Rate	$4,870.68
Rate for Payer: Aetna Commercial	$876.47
Rate for Payer: Aetna Medicare	$1,799.53
Rate for Payer: Aetna New Business (MI Preferred)	$670.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,162.90
Rate for Payer: Amish Plain Church Group Commercial	$2,162.90
Rate for Payer: BCBS Complete	$973.82
Rate for Payer: BCBS MAPPO	$1,730.32
Rate for Payer: BCN Medicare Advantage	$1,730.32
Rate for Payer: Cash Price	$824.91
Rate for Payer: Cash Price	$824.91
Rate for Payer: Cofinity Commercial	$886.78
Rate for Payer: Cofinity Commercial	$721.80
Rate for Payer: Cofinity Medicare Advantage	$721.80
Rate for Payer: Encore Health Key Benefits Commercial	$824.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,730.32
Rate for Payer: Healthscope Commercial	$928.03
Rate for Payer: Mclaren Medicaid	$927.45
Rate for Payer: Mclaren Medicare	$1,730.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,816.84
Rate for Payer: Meridian Medicaid	$973.82
Rate for Payer: MI Amish Medical Board Commercial	$1,989.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$876.47
Rate for Payer: PACE Medicare	$1,643.80
Rate for Payer: PACE SWMI	$1,730.32
Rate for Payer: PHP Commercial	$876.47
Rate for Payer: PHP Medicare Advantage	$1,730.32
Rate for Payer: Priority Health Choice Medicaid	$927.45
Rate for Payer: Priority Health Cigna Priority Health	$670.24
Rate for Payer: Priority Health Medicare	$1,730.32
Rate for Payer: Priority Health SBD	$649.62
Rate for Payer: Railroad Medicare Medicare	$1,730.32
Rate for Payer: UHC All Payor (Choice/PPO)	$4,870.68
Rate for Payer: UHC Dual Complete DSNP	$1,730.32
Rate for Payer: UHC Medicare Advantage	$1,730.32
Rate for Payer: UHCCP Medicaid	$974.17
Rate for Payer: VA VA	$1,730.32

HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG

Facility

$461.04

Service Code	HCPCS J9217
Hospital Charge Code	63600147
Hospital Revenue Code	636
Min. Negotiated Rate	$290.46
Max. Negotiated Rate	$414.94
Rate for Payer: Aetna Commercial	$391.88
Rate for Payer: Aetna New Business (MI Preferred)	$299.68
Rate for Payer: Cash Price	$368.83
Rate for Payer: Cofinity Commercial	$322.73
Rate for Payer: Cofinity Commercial	$396.49
Rate for Payer: Cofinity Medicare Advantage	$322.73
Rate for Payer: Encore Health Key Benefits Commercial	$368.83
Rate for Payer: Healthscope Commercial	$414.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$391.88
Rate for Payer: PHP Commercial	$391.88
Rate for Payer: Priority Health Cigna Priority Health	$299.68
Rate for Payer: Priority Health SBD	$290.46

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