Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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: BCBS Trust/PPO	$33.47
Rate for Payer: BCN Commercial	$33.47
Rate for Payer: Cash Price	$41.79
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
Rate for Payer: UHC All Payor (Choice/PPO)	$23.30

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: BCBS Trust/PPO	$33.47
Rate for Payer: BCN Commercial	$33.47
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Commercial	$36.57
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
Rate for Payer: UHC All Payor (Choice/PPO)	$23.30

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 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: BCBS Trust/PPO	$33.47
Rate for Payer: BCN Commercial	$33.47
Rate for Payer: Cash Price	$41.79
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
Rate for Payer: UHC All Payor (Choice/PPO)	$23.30

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: BCBS Trust/PPO	$33.47
Rate for Payer: BCN Commercial	$33.47
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Commercial	$36.57
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
Rate for Payer: UHC All Payor (Choice/PPO)	$23.30

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	$27.42
Rate for Payer: Aetna New Business (MI Preferred)	$35.64
Rate for Payer: BCBS Complete	$21.93
Rate for Payer: BCBS Trust/PPO	$33.47
Rate for Payer: BCN Commercial	$33.47
Rate for Payer: Cash Price	$43.86
Rate for Payer: Cash Price	$43.86
Rate for Payer: Cofinity Commercial	$47.15
Rate for Payer: Cofinity Commercial	$38.38
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
Rate for Payer: UHC All Payor (Choice/PPO)	$23.30

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: BCBS Trust/PPO	$33.47
Rate for Payer: BCN Commercial	$33.47
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cash Price	$41.79
Rate for Payer: Cofinity Commercial	$44.93
Rate for Payer: Cofinity Commercial	$36.57
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
Rate for Payer: UHC All Payor (Choice/PPO)	$23.30

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	$221.08
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	$221.08
Rate for Payer: PHP Commercial	$221.08
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	$221.08
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: BCBS Trust/PPO	$21.33
Rate for Payer: BCN Commercial	$21.33
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	$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: 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	$221.08
Rate for Payer: Nomi Health Commercial	$36.14
Rate for Payer: PACE Medicare	$22.89
Rate for Payer: PACE SWMI	$24.09
Rate for Payer: PHP Commercial	$221.08
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 HMO/PPO/Tiered Network	$24.09
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health Narrow Network	$19.27
Rate for Payer: Priority Health SBD	$163.86
Rate for Payer: Railroad Medicare Medicare	$24.09
Rate for Payer: UHC All Payor (Choice/PPO)	$28.91
Rate for Payer: UHC Core	$16.50
Rate for Payer: UHC Dual Complete DSNP	$24.09
Rate for Payer: UHC Exchange	$16.50
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	$5,000.34
Rate for Payer: Aetna Commercial	$876.47
Rate for Payer: Aetna Medicare	$1,733.45
Rate for Payer: Aetna New Business (MI Preferred)	$670.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,083.48
Rate for Payer: Amish Plain Church Group Commercial	$2,083.48
Rate for Payer: BCBS Complete	$938.06
Rate for Payer: BCBS MAPPO	$1,666.78
Rate for Payer: BCBS Trust/PPO	$4,569.52
Rate for Payer: BCN Commercial	$4,569.52
Rate for Payer: BCN Medicare Advantage	$1,666.78
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	$1,666.78
Rate for Payer: Healthscope Commercial	$928.03
Rate for Payer: Mclaren Medicaid	$893.39
Rate for Payer: Mclaren Medicare	$1,666.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,750.12
Rate for Payer: Meridian Medicaid	$938.06
Rate for Payer: MI Amish Medical Board Commercial	$1,916.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$876.47
Rate for Payer: Nomi Health Commercial	$5,000.34
Rate for Payer: PACE Medicare	$1,583.44
Rate for Payer: PACE SWMI	$1,666.78
Rate for Payer: PHP Commercial	$876.47
Rate for Payer: PHP Medicare Advantage	$1,666.78
Rate for Payer: Priority Health Choice Medicaid	$893.39
Rate for Payer: Priority Health Cigna Priority Health	$670.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,655.63
Rate for Payer: Priority Health Medicare	$1,666.78
Rate for Payer: Priority Health Narrow Network	$3,724.50
Rate for Payer: Priority Health SBD	$649.62
Rate for Payer: Railroad Medicare Medicare	$1,666.78
Rate for Payer: UHC All Payor (Choice/PPO)	$4,691.82
Rate for Payer: UHC Dual Complete DSNP	$1,666.78
Rate for Payer: UHC Medicare Advantage	$1,666.78
Rate for Payer: UHCCP Medicaid	$938.40
Rate for Payer: VA VA	$1,666.78

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

HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG

Facility

$461.04

Service Code	HCPCS J9217
Hospital Charge Code	63600147
Hospital Revenue Code	636
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$542.37
Rate for Payer: Aetna Commercial	$391.88
Rate for Payer: Aetna Medicare	$188.02
Rate for Payer: Aetna New Business (MI Preferred)	$299.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$225.99
Rate for Payer: Amish Plain Church Group Commercial	$225.99
Rate for Payer: BCBS Complete	$101.75
Rate for Payer: BCBS MAPPO	$180.79
Rate for Payer: BCBS Trust/PPO	$529.60
Rate for Payer: BCN Commercial	$529.60
Rate for Payer: BCN Medicare Advantage	$180.79
Rate for Payer: Cash Price	$368.83
Rate for Payer: Cash Price	$368.83
Rate for Payer: Cofinity Commercial	$396.49
Rate for Payer: Cofinity Commercial	$322.73
Rate for Payer: Cofinity Medicare Advantage	$322.73
Rate for Payer: Encore Health Key Benefits Commercial	$368.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$180.79
Rate for Payer: Healthscope Commercial	$414.94
Rate for Payer: Mclaren Medicaid	$96.90
Rate for Payer: Mclaren Medicare	$180.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$189.83
Rate for Payer: Meridian Medicaid	$101.75
Rate for Payer: MI Amish Medical Board Commercial	$207.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$391.88
Rate for Payer: Nomi Health Commercial	$542.37
Rate for Payer: PACE Medicare	$171.75
Rate for Payer: PACE SWMI	$180.79
Rate for Payer: PHP Commercial	$391.88
Rate for Payer: PHP Medicare Advantage	$180.79
Rate for Payer: Priority Health Choice Medicaid	$96.90
Rate for Payer: Priority Health Cigna Priority Health	$299.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$508.00
Rate for Payer: Priority Health Medicare	$180.79
Rate for Payer: Priority Health Narrow Network	$406.40
Rate for Payer: Priority Health SBD	$290.46
Rate for Payer: Railroad Medicare Medicare	$180.79
Rate for Payer: UHC All Payor (Choice/PPO)	$508.91
Rate for Payer: UHC Dual Complete DSNP	$180.79
Rate for Payer: UHC Medicare Advantage	$180.79
Rate for Payer: UHCCP Medicaid	$101.78
Rate for Payer: VA VA	$180.79

HC LEVEL 0.5 INIT 30 MIN

Facility

$939.78

Hospital Charge Code	36000060
Hospital Revenue Code	360
Min. Negotiated Rate	$592.06
Max. Negotiated Rate	$845.80
Rate for Payer: Aetna Commercial	$798.81
Rate for Payer: Aetna New Business (MI Preferred)	$610.86
Rate for Payer: Cash Price	$751.82
Rate for Payer: Cofinity Commercial	$657.85
Rate for Payer: Cofinity Commercial	$808.21
Rate for Payer: Cofinity Medicare Advantage	$657.85
Rate for Payer: Encore Health Key Benefits Commercial	$751.82
Rate for Payer: Healthscope Commercial	$845.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$798.81
Rate for Payer: PHP Commercial	$798.81
Rate for Payer: Priority Health Cigna Priority Health	$610.86
Rate for Payer: Priority Health SBD	$592.06

HC LEVEL 0.5 INIT 30 MIN

Facility

$939.78

Hospital Charge Code	36000060
Hospital Revenue Code	360
Min. Negotiated Rate	$375.91
Max. Negotiated Rate	$845.80
Rate for Payer: Aetna Commercial	$798.81
Rate for Payer: Aetna Medicare	$469.89
Rate for Payer: Aetna New Business (MI Preferred)	$610.86
Rate for Payer: BCBS Complete	$375.91
Rate for Payer: Cash Price	$751.82
Rate for Payer: Cofinity Commercial	$657.85
Rate for Payer: Cofinity Commercial	$808.21
Rate for Payer: Cofinity Medicare Advantage	$657.85
Rate for Payer: Encore Health Key Benefits Commercial	$751.82
Rate for Payer: Healthscope Commercial	$845.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$798.81
Rate for Payer: PHP Commercial	$798.81
Rate for Payer: Priority Health Cigna Priority Health	$610.86
Rate for Payer: Priority Health SBD	$592.06

HC LEVEL 0.5 SUBSQ 15 MIN

Facility

$270.72

Hospital Charge Code	36000061
Hospital Revenue Code	360
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$243.65
Rate for Payer: Aetna Commercial	$230.11
Rate for Payer: Aetna Medicare	$135.36
Rate for Payer: Aetna New Business (MI Preferred)	$175.97
Rate for Payer: BCBS Complete	$108.29
Rate for Payer: Cash Price	$216.58
Rate for Payer: Cofinity Commercial	$189.50
Rate for Payer: Cofinity Commercial	$232.82
Rate for Payer: Cofinity Medicare Advantage	$189.50
Rate for Payer: Encore Health Key Benefits Commercial	$216.58
Rate for Payer: Healthscope Commercial	$243.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.11
Rate for Payer: PHP Commercial	$230.11
Rate for Payer: Priority Health Cigna Priority Health	$175.97
Rate for Payer: Priority Health SBD	$170.55

HC LEVEL 0.5 SUBSQ 15 MIN

Facility

$270.72

Hospital Charge Code	36000061
Hospital Revenue Code	360
Min. Negotiated Rate	$170.55
Max. Negotiated Rate	$243.65
Rate for Payer: Aetna Commercial	$230.11
Rate for Payer: Aetna New Business (MI Preferred)	$175.97
Rate for Payer: Cash Price	$216.58
Rate for Payer: Cofinity Commercial	$189.50
Rate for Payer: Cofinity Commercial	$232.82
Rate for Payer: Cofinity Medicare Advantage	$189.50
Rate for Payer: Encore Health Key Benefits Commercial	$216.58
Rate for Payer: Healthscope Commercial	$243.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.11
Rate for Payer: PHP Commercial	$230.11
Rate for Payer: Priority Health Cigna Priority Health	$175.97
Rate for Payer: Priority Health SBD	$170.55

HC LEVEL 1 INIT 30 MIN

Facility

$2,074.72

Hospital Charge Code	36000062
Hospital Revenue Code	360
Min. Negotiated Rate	$829.89
Max. Negotiated Rate	$1,867.25
Rate for Payer: Aetna Commercial	$1,763.51
Rate for Payer: Aetna Medicare	$1,037.36
Rate for Payer: Aetna New Business (MI Preferred)	$1,348.57
Rate for Payer: BCBS Complete	$829.89
Rate for Payer: Cash Price	$1,659.78
Rate for Payer: Cofinity Commercial	$1,452.30
Rate for Payer: Cofinity Commercial	$1,784.26
Rate for Payer: Cofinity Medicare Advantage	$1,452.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,659.78
Rate for Payer: Healthscope Commercial	$1,867.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,763.51
Rate for Payer: PHP Commercial	$1,763.51
Rate for Payer: Priority Health Cigna Priority Health	$1,348.57
Rate for Payer: Priority Health SBD	$1,307.07

HC LEVEL 1 INIT 30 MIN

Facility

$2,074.72

Hospital Charge Code	36000062
Hospital Revenue Code	360
Min. Negotiated Rate	$1,307.07
Max. Negotiated Rate	$1,867.25
Rate for Payer: Aetna Commercial	$1,763.51
Rate for Payer: Aetna New Business (MI Preferred)	$1,348.57
Rate for Payer: Cash Price	$1,659.78
Rate for Payer: Cofinity Commercial	$1,452.30
Rate for Payer: Cofinity Commercial	$1,784.26
Rate for Payer: Cofinity Medicare Advantage	$1,452.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,659.78
Rate for Payer: Healthscope Commercial	$1,867.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,763.51
Rate for Payer: PHP Commercial	$1,763.51
Rate for Payer: Priority Health Cigna Priority Health	$1,348.57
Rate for Payer: Priority Health SBD	$1,307.07

HC LEVEL 1 SUBSQ 15 MIN

Facility

$412.97

Hospital Charge Code	36000063
Hospital Revenue Code	360
Min. Negotiated Rate	$165.19
Max. Negotiated Rate	$371.67
Rate for Payer: Aetna Commercial	$351.02
Rate for Payer: Aetna Medicare	$206.48
Rate for Payer: Aetna New Business (MI Preferred)	$268.43
Rate for Payer: BCBS Complete	$165.19
Rate for Payer: Cash Price	$330.38
Rate for Payer: Cofinity Commercial	$289.08
Rate for Payer: Cofinity Commercial	$355.15
Rate for Payer: Cofinity Medicare Advantage	$289.08
Rate for Payer: Encore Health Key Benefits Commercial	$330.38
Rate for Payer: Healthscope Commercial	$371.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$351.02
Rate for Payer: PHP Commercial	$351.02
Rate for Payer: Priority Health Cigna Priority Health	$268.43
Rate for Payer: Priority Health SBD	$260.17

HC LEVEL 1 SUBSQ 15 MIN

Facility

$412.97

Hospital Charge Code	36000063
Hospital Revenue Code	360
Min. Negotiated Rate	$260.17
Max. Negotiated Rate	$371.67
Rate for Payer: Aetna Commercial	$351.02
Rate for Payer: Aetna New Business (MI Preferred)	$268.43
Rate for Payer: Cash Price	$330.38
Rate for Payer: Cofinity Commercial	$289.08
Rate for Payer: Cofinity Commercial	$355.15
Rate for Payer: Cofinity Medicare Advantage	$289.08
Rate for Payer: Encore Health Key Benefits Commercial	$330.38
Rate for Payer: Healthscope Commercial	$371.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$351.02
Rate for Payer: PHP Commercial	$351.02
Rate for Payer: Priority Health Cigna Priority Health	$268.43
Rate for Payer: Priority Health SBD	$260.17

Know your out-of-pocket cost for care.

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