Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG

Facility

$461.04

Service Code	HCPCS J9217
Hospital Charge Code	63600147
Hospital Revenue Code	636
Min. Negotiated Rate	$94.58
Max. Negotiated Rate	$496.69
Rate for Payer: Aetna Commercial	$391.88
Rate for Payer: Aetna Medicare	$183.51
Rate for Payer: Aetna New Business (MI Preferred)	$299.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$220.56
Rate for Payer: Amish Plain Church Group Commercial	$220.56
Rate for Payer: BCBS Complete	$99.31
Rate for Payer: BCBS MAPPO	$176.45
Rate for Payer: BCN Medicare Advantage	$176.45
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	$176.45
Rate for Payer: Healthscope Commercial	$414.94
Rate for Payer: Mclaren Medicaid	$94.58
Rate for Payer: Mclaren Medicare	$176.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$185.27
Rate for Payer: Meridian Medicaid	$99.31
Rate for Payer: MI Amish Medical Board Commercial	$202.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$391.88
Rate for Payer: PACE Medicare	$167.63
Rate for Payer: PACE SWMI	$176.45
Rate for Payer: PHP Commercial	$391.88
Rate for Payer: PHP Medicare Advantage	$176.45
Rate for Payer: Priority Health Choice Medicaid	$94.58
Rate for Payer: Priority Health Cigna Priority Health	$299.68
Rate for Payer: Priority Health Medicare	$176.45
Rate for Payer: Priority Health SBD	$290.46
Rate for Payer: Railroad Medicare Medicare	$176.45
Rate for Payer: UHC All Payor (Choice/PPO)	$496.69
Rate for Payer: UHC Dual Complete DSNP	$176.45
Rate for Payer: UHC Medicare Advantage	$176.45
Rate for Payer: UHCCP Medicaid	$99.34
Rate for Payer: VA VA	$176.45

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 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 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 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 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	$206.49
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

HC LEVEL 2 INIT 30 MIN

Facility

$3,226.85

Hospital Charge Code	36000064
Hospital Revenue Code	360
Min. Negotiated Rate	$2,032.92
Max. Negotiated Rate	$2,904.16
Rate for Payer: Aetna Commercial	$2,742.82
Rate for Payer: Aetna New Business (MI Preferred)	$2,097.45
Rate for Payer: Cash Price	$2,581.48
Rate for Payer: Cofinity Commercial	$2,258.80
Rate for Payer: Cofinity Commercial	$2,775.09
Rate for Payer: Cofinity Medicare Advantage	$2,258.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,581.48
Rate for Payer: Healthscope Commercial	$2,904.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,742.82
Rate for Payer: PHP Commercial	$2,742.82
Rate for Payer: Priority Health Cigna Priority Health	$2,097.45
Rate for Payer: Priority Health SBD	$2,032.92

HC LEVEL 2 INIT 30 MIN

Facility

$3,226.85

Hospital Charge Code	36000064
Hospital Revenue Code	360
Min. Negotiated Rate	$1,290.74
Max. Negotiated Rate	$2,904.16
Rate for Payer: Aetna Commercial	$2,742.82
Rate for Payer: Aetna Medicare	$1,613.42
Rate for Payer: Aetna New Business (MI Preferred)	$2,097.45
Rate for Payer: BCBS Complete	$1,290.74
Rate for Payer: Cash Price	$2,581.48
Rate for Payer: Cofinity Commercial	$2,258.80
Rate for Payer: Cofinity Commercial	$2,775.09
Rate for Payer: Cofinity Medicare Advantage	$2,258.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,581.48
Rate for Payer: Healthscope Commercial	$2,904.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,742.82
Rate for Payer: PHP Commercial	$2,742.82
Rate for Payer: Priority Health Cigna Priority Health	$2,097.45
Rate for Payer: Priority Health SBD	$2,032.92

HC LEVEL 2 SUBSQ 15 MIN

Facility

$1,237.94

Hospital Charge Code	36000065
Hospital Revenue Code	360
Min. Negotiated Rate	$495.18
Max. Negotiated Rate	$1,114.15
Rate for Payer: Aetna Commercial	$1,052.25
Rate for Payer: Aetna Medicare	$618.97
Rate for Payer: Aetna New Business (MI Preferred)	$804.66
Rate for Payer: BCBS Complete	$495.18
Rate for Payer: Cash Price	$990.35
Rate for Payer: Cofinity Commercial	$1,064.63
Rate for Payer: Cofinity Commercial	$866.56
Rate for Payer: Cofinity Medicare Advantage	$866.56
Rate for Payer: Encore Health Key Benefits Commercial	$990.35
Rate for Payer: Healthscope Commercial	$1,114.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,052.25
Rate for Payer: PHP Commercial	$1,052.25
Rate for Payer: Priority Health Cigna Priority Health	$804.66
Rate for Payer: Priority Health SBD	$779.90

HC LEVEL 2 SUBSQ 15 MIN

Facility

$1,237.94

Hospital Charge Code	36000065
Hospital Revenue Code	360
Min. Negotiated Rate	$779.90
Max. Negotiated Rate	$1,114.15
Rate for Payer: Aetna Commercial	$1,052.25
Rate for Payer: Aetna New Business (MI Preferred)	$804.66
Rate for Payer: Cash Price	$990.35
Rate for Payer: Cofinity Commercial	$1,064.63
Rate for Payer: Cofinity Commercial	$866.56
Rate for Payer: Cofinity Medicare Advantage	$866.56
Rate for Payer: Encore Health Key Benefits Commercial	$990.35
Rate for Payer: Healthscope Commercial	$1,114.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,052.25
Rate for Payer: PHP Commercial	$1,052.25
Rate for Payer: Priority Health Cigna Priority Health	$804.66
Rate for Payer: Priority Health SBD	$779.90

HC LEVEL 3 INIT 30 MIN

Facility

$3,827.33

Hospital Charge Code	36000066
Hospital Revenue Code	360
Min. Negotiated Rate	$2,411.22
Max. Negotiated Rate	$3,444.60
Rate for Payer: Aetna Commercial	$3,253.23
Rate for Payer: Aetna New Business (MI Preferred)	$2,487.76
Rate for Payer: Cash Price	$3,061.86
Rate for Payer: Cofinity Commercial	$2,679.13
Rate for Payer: Cofinity Commercial	$3,291.50
Rate for Payer: Cofinity Medicare Advantage	$2,679.13
Rate for Payer: Encore Health Key Benefits Commercial	$3,061.86
Rate for Payer: Healthscope Commercial	$3,444.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,253.23
Rate for Payer: PHP Commercial	$3,253.23
Rate for Payer: Priority Health Cigna Priority Health	$2,487.76
Rate for Payer: Priority Health SBD	$2,411.22

HC LEVEL 3 INIT 30 MIN

Facility

$3,827.33

Hospital Charge Code	36000066
Hospital Revenue Code	360
Min. Negotiated Rate	$1,530.93
Max. Negotiated Rate	$3,444.60
Rate for Payer: Aetna Commercial	$3,253.23
Rate for Payer: Aetna Medicare	$1,913.66
Rate for Payer: Aetna New Business (MI Preferred)	$2,487.76
Rate for Payer: BCBS Complete	$1,530.93
Rate for Payer: Cash Price	$3,061.86
Rate for Payer: Cofinity Commercial	$2,679.13
Rate for Payer: Cofinity Commercial	$3,291.50
Rate for Payer: Cofinity Medicare Advantage	$2,679.13
Rate for Payer: Encore Health Key Benefits Commercial	$3,061.86
Rate for Payer: Healthscope Commercial	$3,444.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,253.23
Rate for Payer: PHP Commercial	$3,253.23
Rate for Payer: Priority Health Cigna Priority Health	$2,487.76
Rate for Payer: Priority Health SBD	$2,411.22

HC LEVEL 3 SUBSQ 15 MIN

Facility

$1,487.89

Hospital Charge Code	36000067
Hospital Revenue Code	360
Min. Negotiated Rate	$937.37
Max. Negotiated Rate	$1,339.10
Rate for Payer: Aetna Commercial	$1,264.71
Rate for Payer: Aetna New Business (MI Preferred)	$967.13
Rate for Payer: Cash Price	$1,190.31
Rate for Payer: Cofinity Commercial	$1,041.52
Rate for Payer: Cofinity Commercial	$1,279.59
Rate for Payer: Cofinity Medicare Advantage	$1,041.52
Rate for Payer: Encore Health Key Benefits Commercial	$1,190.31
Rate for Payer: Healthscope Commercial	$1,339.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,264.71
Rate for Payer: PHP Commercial	$1,264.71
Rate for Payer: Priority Health Cigna Priority Health	$967.13
Rate for Payer: Priority Health SBD	$937.37

HC LEVEL 3 SUBSQ 15 MIN

Facility

$1,487.89

Hospital Charge Code	36000067
Hospital Revenue Code	360
Min. Negotiated Rate	$595.16
Max. Negotiated Rate	$1,339.10
Rate for Payer: Aetna Commercial	$1,264.71
Rate for Payer: Aetna Medicare	$743.95
Rate for Payer: Aetna New Business (MI Preferred)	$967.13
Rate for Payer: BCBS Complete	$595.16
Rate for Payer: Cash Price	$1,190.31
Rate for Payer: Cofinity Commercial	$1,041.52
Rate for Payer: Cofinity Commercial	$1,279.59
Rate for Payer: Cofinity Medicare Advantage	$1,041.52
Rate for Payer: Encore Health Key Benefits Commercial	$1,190.31
Rate for Payer: Healthscope Commercial	$1,339.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,264.71
Rate for Payer: PHP Commercial	$1,264.71
Rate for Payer: Priority Health Cigna Priority Health	$967.13
Rate for Payer: Priority Health SBD	$937.37

HC LEVEL 4 INIT 30 MIN

Facility

$4,556.50

Hospital Charge Code	36000068
Hospital Revenue Code	360
Min. Negotiated Rate	$1,822.60
Max. Negotiated Rate	$4,100.85
Rate for Payer: Aetna Commercial	$3,873.03
Rate for Payer: Aetna Medicare	$2,278.25
Rate for Payer: Aetna New Business (MI Preferred)	$2,961.72
Rate for Payer: BCBS Complete	$1,822.60
Rate for Payer: Cash Price	$3,645.20
Rate for Payer: Cofinity Commercial	$3,189.55
Rate for Payer: Cofinity Commercial	$3,918.59
Rate for Payer: Cofinity Medicare Advantage	$3,189.55
Rate for Payer: Encore Health Key Benefits Commercial	$3,645.20
Rate for Payer: Healthscope Commercial	$4,100.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,873.03
Rate for Payer: PHP Commercial	$3,873.03
Rate for Payer: Priority Health Cigna Priority Health	$2,961.72
Rate for Payer: Priority Health SBD	$2,870.59

HC LEVEL 4 INIT 30 MIN

Facility

$4,556.50

Hospital Charge Code	36000068
Hospital Revenue Code	360
Min. Negotiated Rate	$2,870.59
Max. Negotiated Rate	$4,100.85
Rate for Payer: Aetna Commercial	$3,873.03
Rate for Payer: Aetna New Business (MI Preferred)	$2,961.72
Rate for Payer: Cash Price	$3,645.20
Rate for Payer: Cofinity Commercial	$3,189.55
Rate for Payer: Cofinity Commercial	$3,918.59
Rate for Payer: Cofinity Medicare Advantage	$3,189.55
Rate for Payer: Encore Health Key Benefits Commercial	$3,645.20
Rate for Payer: Healthscope Commercial	$4,100.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,873.03
Rate for Payer: PHP Commercial	$3,873.03
Rate for Payer: Priority Health Cigna Priority Health	$2,961.72
Rate for Payer: Priority Health SBD	$2,870.59

HC LEVEL 4 SUBSQ 15 MIN

Facility

$1,658.07

Hospital Charge Code	36000069
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.58
Max. Negotiated Rate	$1,492.26
Rate for Payer: Aetna Commercial	$1,409.36
Rate for Payer: Aetna New Business (MI Preferred)	$1,077.75
Rate for Payer: Cash Price	$1,326.46
Rate for Payer: Cofinity Commercial	$1,160.65
Rate for Payer: Cofinity Commercial	$1,425.94
Rate for Payer: Cofinity Medicare Advantage	$1,160.65
Rate for Payer: Encore Health Key Benefits Commercial	$1,326.46
Rate for Payer: Healthscope Commercial	$1,492.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,409.36
Rate for Payer: PHP Commercial	$1,409.36
Rate for Payer: Priority Health Cigna Priority Health	$1,077.75
Rate for Payer: Priority Health SBD	$1,044.58

HC LEVEL 4 SUBSQ 15 MIN

Facility

$1,658.07

Hospital Charge Code	36000069
Hospital Revenue Code	360
Min. Negotiated Rate	$663.23
Max. Negotiated Rate	$1,492.26
Rate for Payer: Aetna Commercial	$1,409.36
Rate for Payer: Aetna Medicare	$829.03
Rate for Payer: Aetna New Business (MI Preferred)	$1,077.75
Rate for Payer: BCBS Complete	$663.23
Rate for Payer: Cash Price	$1,326.46
Rate for Payer: Cofinity Commercial	$1,160.65
Rate for Payer: Cofinity Commercial	$1,425.94
Rate for Payer: Cofinity Medicare Advantage	$1,160.65
Rate for Payer: Encore Health Key Benefits Commercial	$1,326.46
Rate for Payer: Healthscope Commercial	$1,492.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,409.36
Rate for Payer: PHP Commercial	$1,409.36
Rate for Payer: Priority Health Cigna Priority Health	$1,077.75
Rate for Payer: Priority Health SBD	$1,044.58

HC LEVEL 5 INIT 30 MIN

Facility

$5,084.43

Hospital Charge Code	36000070
Hospital Revenue Code	360
Min. Negotiated Rate	$3,203.19
Max. Negotiated Rate	$4,575.99
Rate for Payer: Aetna Commercial	$4,321.77
Rate for Payer: Aetna New Business (MI Preferred)	$3,304.88
Rate for Payer: Cash Price	$4,067.54
Rate for Payer: Cofinity Commercial	$3,559.10
Rate for Payer: Cofinity Commercial	$4,372.61
Rate for Payer: Cofinity Medicare Advantage	$3,559.10
Rate for Payer: Encore Health Key Benefits Commercial	$4,067.54
Rate for Payer: Healthscope Commercial	$4,575.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,321.77
Rate for Payer: PHP Commercial	$4,321.77
Rate for Payer: Priority Health Cigna Priority Health	$3,304.88
Rate for Payer: Priority Health SBD	$3,203.19

HC LEVEL 5 INIT 30 MIN

Facility

$5,084.43

Hospital Charge Code	36000070
Hospital Revenue Code	360
Min. Negotiated Rate	$2,033.77
Max. Negotiated Rate	$4,575.99
Rate for Payer: Aetna Commercial	$4,321.77
Rate for Payer: Aetna Medicare	$2,542.22
Rate for Payer: Aetna New Business (MI Preferred)	$3,304.88
Rate for Payer: BCBS Complete	$2,033.77
Rate for Payer: Cash Price	$4,067.54
Rate for Payer: Cofinity Commercial	$3,559.10
Rate for Payer: Cofinity Commercial	$4,372.61
Rate for Payer: Cofinity Medicare Advantage	$3,559.10
Rate for Payer: Encore Health Key Benefits Commercial	$4,067.54
Rate for Payer: Healthscope Commercial	$4,575.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,321.77
Rate for Payer: PHP Commercial	$4,321.77
Rate for Payer: Priority Health Cigna Priority Health	$3,304.88
Rate for Payer: Priority Health SBD	$3,203.19

HC LEVEL 5 SUBSQ 15 MIN

Facility

$2,078.52

Hospital Charge Code	36000071
Hospital Revenue Code	360
Min. Negotiated Rate	$1,309.47
Max. Negotiated Rate	$1,870.67
Rate for Payer: Aetna Commercial	$1,766.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,351.04
Rate for Payer: Cash Price	$1,662.82
Rate for Payer: Cofinity Commercial	$1,454.96
Rate for Payer: Cofinity Commercial	$1,787.53
Rate for Payer: Cofinity Medicare Advantage	$1,454.96
Rate for Payer: Encore Health Key Benefits Commercial	$1,662.82
Rate for Payer: Healthscope Commercial	$1,870.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,766.74
Rate for Payer: PHP Commercial	$1,766.74
Rate for Payer: Priority Health Cigna Priority Health	$1,351.04
Rate for Payer: Priority Health SBD	$1,309.47

HC LEVEL 5 SUBSQ 15 MIN

Facility

$2,078.52

Hospital Charge Code	36000071
Hospital Revenue Code	360
Min. Negotiated Rate	$831.41
Max. Negotiated Rate	$1,870.67
Rate for Payer: Aetna Commercial	$1,766.74
Rate for Payer: Aetna Medicare	$1,039.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,351.04
Rate for Payer: BCBS Complete	$831.41
Rate for Payer: Cash Price	$1,662.82
Rate for Payer: Cofinity Commercial	$1,454.96
Rate for Payer: Cofinity Commercial	$1,787.53
Rate for Payer: Cofinity Medicare Advantage	$1,454.96
Rate for Payer: Encore Health Key Benefits Commercial	$1,662.82
Rate for Payer: Healthscope Commercial	$1,870.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,766.74
Rate for Payer: PHP Commercial	$1,766.74
Rate for Payer: Priority Health Cigna Priority Health	$1,351.04
Rate for Payer: Priority Health SBD	$1,309.47

Know your out-of-pocket cost for care.

All Charges