Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC SP XR INJ ARTHROGRAM ANKLE

Facility

$1,053.73

Service Code	CPT 27648
Hospital Charge Code	36100317
Hospital Revenue Code	361
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$948.36
Rate for Payer: Aetna Commercial	$895.67
Rate for Payer: Aetna New Business (MI Preferred)	$684.92
Rate for Payer: BCBS Complete	$421.49
Rate for Payer: BCBS Trust/PPO	$331.65
Rate for Payer: Cash Price	$842.98
Rate for Payer: Cash Price	$842.98
Rate for Payer: Cofinity Commercial	$906.21
Rate for Payer: Cofinity Commercial	$737.61
Rate for Payer: Healthscope Commercial	$948.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$895.67
Rate for Payer: PHP Commercial	$895.67
Rate for Payer: Priority Health Cigna Priority Health	$737.61
Rate for Payer: Priority Health SBD	$663.85
Rate for Payer: UHC All Payor (Choice/PPO)	$55.11
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$50.10

HC SP XR INJ ARTHROGRAM ANKLE

Facility

$1,053.73

Service Code	CPT 27648
Hospital Charge Code	36100317
Hospital Revenue Code	361
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$948.36
Rate for Payer: Aetna Commercial	$895.67
Rate for Payer: Aetna New Business (MI Preferred)	$684.92
Rate for Payer: Cash Price	$842.98
Rate for Payer: Cofinity Commercial	$737.61
Rate for Payer: Cofinity Commercial	$906.21
Rate for Payer: Healthscope Commercial	$948.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$895.67
Rate for Payer: PHP Commercial	$895.67
Rate for Payer: Priority Health Cigna Priority Health	$737.61
Rate for Payer: Priority Health SBD	$663.85

HC SPYGLASS CHOLANGIOSCOPY

Facility

$6,140.07

Hospital Charge Code	36000086
Hospital Revenue Code	360
Min. Negotiated Rate	$3,868.24
Max. Negotiated Rate	$5,526.06
Rate for Payer: Aetna Commercial	$5,219.06
Rate for Payer: Aetna New Business (MI Preferred)	$3,991.05
Rate for Payer: Cash Price	$4,912.06
Rate for Payer: Cofinity Commercial	$4,298.05
Rate for Payer: Cofinity Commercial	$5,280.46
Rate for Payer: Healthscope Commercial	$5,526.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,219.06
Rate for Payer: PHP Commercial	$5,219.06
Rate for Payer: Priority Health Cigna Priority Health	$4,298.05
Rate for Payer: Priority Health SBD	$3,868.24

HC SPYGLASS CHOLANGIOSCOPY

Facility

$6,140.07

Hospital Charge Code	36000086
Hospital Revenue Code	360
Min. Negotiated Rate	$2,456.03
Max. Negotiated Rate	$5,526.06
Rate for Payer: Aetna Commercial	$5,219.06
Rate for Payer: Aetna New Business (MI Preferred)	$3,991.05
Rate for Payer: BCBS Complete	$2,456.03
Rate for Payer: Cash Price	$4,912.06
Rate for Payer: Cofinity Commercial	$4,298.05
Rate for Payer: Cofinity Commercial	$5,280.46
Rate for Payer: Healthscope Commercial	$5,526.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,219.06
Rate for Payer: PHP Commercial	$5,219.06
Rate for Payer: Priority Health Cigna Priority Health	$4,298.05
Rate for Payer: Priority Health SBD	$3,868.24

HC SPYGLASS FORCEPS

Facility

$2,396.89

Hospital Charge Code	27200151
Hospital Revenue Code	272
Min. Negotiated Rate	$958.76
Max. Negotiated Rate	$2,157.20
Rate for Payer: Aetna Commercial	$2,037.36
Rate for Payer: Aetna New Business (MI Preferred)	$1,557.98
Rate for Payer: BCBS Complete	$958.76
Rate for Payer: Cash Price	$1,917.51
Rate for Payer: Cofinity Commercial	$1,677.82
Rate for Payer: Cofinity Commercial	$2,061.33
Rate for Payer: Healthscope Commercial	$2,157.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,037.36
Rate for Payer: PHP Commercial	$2,037.36
Rate for Payer: Priority Health Cigna Priority Health	$1,677.82
Rate for Payer: Priority Health SBD	$1,510.04

HC SPYGLASS FORCEPS

Facility

$2,396.89

Hospital Charge Code	27200151
Hospital Revenue Code	272
Min. Negotiated Rate	$1,510.04
Max. Negotiated Rate	$2,157.20
Rate for Payer: Aetna Commercial	$2,037.36
Rate for Payer: Aetna New Business (MI Preferred)	$1,557.98
Rate for Payer: Cash Price	$1,917.51
Rate for Payer: Cofinity Commercial	$1,677.82
Rate for Payer: Cofinity Commercial	$2,061.33
Rate for Payer: Healthscope Commercial	$2,157.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,037.36
Rate for Payer: PHP Commercial	$2,037.36
Rate for Payer: Priority Health Cigna Priority Health	$1,677.82
Rate for Payer: Priority Health SBD	$1,510.04

HC SP Z ANGIO SUPERSEL ECT RENAL BIL

Facility

$3,774.00

Service Code	CPT 36254
Hospital Charge Code	36100350
Hospital Revenue Code	361
Min. Negotiated Rate	$398.17
Max. Negotiated Rate	$8,913.25
Rate for Payer: Aetna Commercial	$3,207.90
Rate for Payer: Aetna Medicare	$2,949.65
Rate for Payer: Aetna New Business (MI Preferred)	$2,453.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,545.25
Rate for Payer: Amish Plain Church Group Commercial	$3,545.25
Rate for Payer: BCBS Complete	$1,629.11
Rate for Payer: BCBS MAPPO	$2,836.20
Rate for Payer: BCBS Trust/PPO	$1,228.77
Rate for Payer: BCN Medicare Advantage	$2,836.20
Rate for Payer: Cash Price	$3,019.20
Rate for Payer: Cash Price	$3,019.20
Rate for Payer: Cofinity Commercial	$3,245.64
Rate for Payer: Cofinity Commercial	$2,641.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,836.20
Rate for Payer: Healthscope Commercial	$3,396.60
Rate for Payer: Mclaren Medicaid	$1,551.40
Rate for Payer: Mclaren Medicare	$2,836.20
Rate for Payer: Meridian Medicaid	$1,629.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,978.01
Rate for Payer: MI Amish Medical Board Commercial	$3,261.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,207.90
Rate for Payer: PACE Medicare	$2,694.39
Rate for Payer: PACE SWMI	$2,836.20
Rate for Payer: PHP Commercial	$3,207.90
Rate for Payer: PHP Medicare Advantage	$2,836.20
Rate for Payer: Priority Health Choice Medicaid	$1,551.40
Rate for Payer: Priority Health Cigna Priority Health	$2,641.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,913.25
Rate for Payer: Priority Health Medicare	$2,836.20
Rate for Payer: Priority Health Narrow Network	$7,130.60
Rate for Payer: Priority Health SBD	$2,377.62
Rate for Payer: Railroad Medicare Medicare	$2,836.20
Rate for Payer: UHC All Payor (Choice/PPO)	$437.99
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,836.20
Rate for Payer: UHC Exchange	$398.17
Rate for Payer: UHC Medicare Advantage	$2,921.29
Rate for Payer: VA VA	$2,836.20

HC SP Z ANGIO SUPERSEL ECT RENAL BIL

Facility

$3,774.00

Service Code	CPT 36254
Hospital Charge Code	36100350
Hospital Revenue Code	361
Min. Negotiated Rate	$2,377.62
Max. Negotiated Rate	$3,396.60
Rate for Payer: Aetna Commercial	$3,207.90
Rate for Payer: Aetna New Business (MI Preferred)	$2,453.10
Rate for Payer: Cash Price	$3,019.20
Rate for Payer: Cofinity Commercial	$2,641.80
Rate for Payer: Cofinity Commercial	$3,245.64
Rate for Payer: Healthscope Commercial	$3,396.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,207.90
Rate for Payer: PHP Commercial	$3,207.90
Rate for Payer: Priority Health Cigna Priority Health	$2,641.80
Rate for Payer: Priority Health SBD	$2,377.62

HC SP Z ANGIO SUPERSELECT RENAL UNI

Facility

$3,774.00

Service Code	CPT 36253
Hospital Charge Code	36100349
Hospital Revenue Code	361
Min. Negotiated Rate	$336.94
Max. Negotiated Rate	$15,411.76
Rate for Payer: Aetna Commercial	$3,207.90
Rate for Payer: Aetna Medicare	$5,085.31
Rate for Payer: Aetna New Business (MI Preferred)	$2,453.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,112.15
Rate for Payer: Amish Plain Church Group Commercial	$6,112.15
Rate for Payer: BCBS Complete	$2,808.66
Rate for Payer: BCBS MAPPO	$4,889.72
Rate for Payer: BCBS Trust/PPO	$1,533.20
Rate for Payer: BCN Medicare Advantage	$4,889.72
Rate for Payer: Cash Price	$3,019.20
Rate for Payer: Cash Price	$3,019.20
Rate for Payer: Cofinity Commercial	$2,641.80
Rate for Payer: Cofinity Commercial	$3,245.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,889.72
Rate for Payer: Healthscope Commercial	$3,396.60
Rate for Payer: Mclaren Medicaid	$2,674.68
Rate for Payer: Mclaren Medicare	$4,889.72
Rate for Payer: Meridian Medicaid	$2,808.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,134.21
Rate for Payer: MI Amish Medical Board Commercial	$5,623.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,207.90
Rate for Payer: PACE Medicare	$4,645.23
Rate for Payer: PACE SWMI	$4,889.72
Rate for Payer: PHP Commercial	$3,207.90
Rate for Payer: PHP Medicare Advantage	$4,889.72
Rate for Payer: Priority Health Choice Medicaid	$2,674.68
Rate for Payer: Priority Health Cigna Priority Health	$2,641.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,411.76
Rate for Payer: Priority Health Medicare	$4,889.72
Rate for Payer: Priority Health Narrow Network	$12,329.41
Rate for Payer: Priority Health SBD	$2,377.62
Rate for Payer: Railroad Medicare Medicare	$4,889.72
Rate for Payer: UHC All Payor (Choice/PPO)	$370.63
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$4,889.72
Rate for Payer: UHC Exchange	$336.94
Rate for Payer: UHC Medicare Advantage	$5,036.41
Rate for Payer: VA VA	$4,889.72

HC SP Z ANGIO SUPERSELECT RENAL UNI

Facility

$3,774.00

Service Code	CPT 36253
Hospital Charge Code	36100349
Hospital Revenue Code	361
Min. Negotiated Rate	$2,377.62
Max. Negotiated Rate	$3,396.60
Rate for Payer: Aetna Commercial	$3,207.90
Rate for Payer: Aetna New Business (MI Preferred)	$2,453.10
Rate for Payer: Cash Price	$3,019.20
Rate for Payer: Cofinity Commercial	$2,641.80
Rate for Payer: Cofinity Commercial	$3,245.64
Rate for Payer: Healthscope Commercial	$3,396.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,207.90
Rate for Payer: PHP Commercial	$3,207.90
Rate for Payer: Priority Health Cigna Priority Health	$2,641.80
Rate for Payer: Priority Health SBD	$2,377.62

HC SP Z EMBOLIZATION COIL BODY

Facility

$406.40

Hospital Charge Code	27800058
Hospital Revenue Code	278
Min. Negotiated Rate	$162.56
Max. Negotiated Rate	$365.76
Rate for Payer: Aetna Commercial	$345.44
Rate for Payer: Aetna New Business (MI Preferred)	$264.16
Rate for Payer: BCBS Complete	$162.56
Rate for Payer: Cash Price	$325.12
Rate for Payer: Cofinity Commercial	$284.48
Rate for Payer: Cofinity Commercial	$349.50
Rate for Payer: Healthscope Commercial	$365.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$345.44
Rate for Payer: PHP Commercial	$345.44
Rate for Payer: Priority Health Cigna Priority Health	$284.48
Rate for Payer: Priority Health SBD	$256.03

HC SP Z EMBOLIZATION COIL BODY

Facility

$406.40

Hospital Charge Code	27800058
Hospital Revenue Code	278
Min. Negotiated Rate	$256.03
Max. Negotiated Rate	$365.76
Rate for Payer: Aetna Commercial	$345.44
Rate for Payer: Aetna New Business (MI Preferred)	$264.16
Rate for Payer: Cash Price	$325.12
Rate for Payer: Cofinity Commercial	$284.48
Rate for Payer: Cofinity Commercial	$349.50
Rate for Payer: Healthscope Commercial	$365.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$345.44
Rate for Payer: PHP Commercial	$345.44
Rate for Payer: Priority Health Cigna Priority Health	$284.48
Rate for Payer: Priority Health SBD	$256.03

HC SP Z EMBOLIZATION SPHERES

Facility

$1,004.03

Hospital Charge Code	27800057
Hospital Revenue Code	278
Min. Negotiated Rate	$632.54
Max. Negotiated Rate	$903.63
Rate for Payer: Aetna Commercial	$853.43
Rate for Payer: Aetna New Business (MI Preferred)	$652.62
Rate for Payer: Cash Price	$803.22
Rate for Payer: Cofinity Commercial	$702.82
Rate for Payer: Cofinity Commercial	$863.47
Rate for Payer: Healthscope Commercial	$903.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$853.43
Rate for Payer: PHP Commercial	$853.43
Rate for Payer: Priority Health Cigna Priority Health	$702.82
Rate for Payer: Priority Health SBD	$632.54

HC SP Z EMBOLIZATION SPHERES

Facility

$1,004.03

Hospital Charge Code	27800057
Hospital Revenue Code	278
Min. Negotiated Rate	$401.61
Max. Negotiated Rate	$903.63
Rate for Payer: Aetna Commercial	$853.43
Rate for Payer: Aetna New Business (MI Preferred)	$652.62
Rate for Payer: BCBS Complete	$401.61
Rate for Payer: Cash Price	$803.22
Rate for Payer: Cofinity Commercial	$702.82
Rate for Payer: Cofinity Commercial	$863.47
Rate for Payer: Healthscope Commercial	$903.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$853.43
Rate for Payer: PHP Commercial	$853.43
Rate for Payer: Priority Health Cigna Priority Health	$702.82
Rate for Payer: Priority Health SBD	$632.54

HC SP Z SEL CATH SEG SUBSEG PULM ART

Facility

$1,252.58

Service Code	CPT 36015
Hospital Charge Code	36100318
Hospital Revenue Code	361
Min. Negotiated Rate	$163.39
Max. Negotiated Rate	$1,719.58
Rate for Payer: Aetna Commercial	$1,064.69
Rate for Payer: Aetna New Business (MI Preferred)	$814.18
Rate for Payer: BCBS Complete	$501.03
Rate for Payer: BCBS Trust/PPO	$1,719.58
Rate for Payer: Cash Price	$1,002.06
Rate for Payer: Cash Price	$1,002.06
Rate for Payer: Cofinity Commercial	$876.81
Rate for Payer: Cofinity Commercial	$1,077.22
Rate for Payer: Healthscope Commercial	$1,127.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,064.69
Rate for Payer: PHP Commercial	$1,064.69
Rate for Payer: Priority Health Cigna Priority Health	$876.81
Rate for Payer: Priority Health SBD	$789.13
Rate for Payer: UHC All Payor (Choice/PPO)	$179.73
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$163.39

HC SP Z SEL CATH SEG SUBSEG PULM ART

Facility

$1,252.58

Service Code	CPT 36015
Hospital Charge Code	36100318
Hospital Revenue Code	361
Min. Negotiated Rate	$789.13
Max. Negotiated Rate	$1,127.32
Rate for Payer: Aetna Commercial	$1,064.69
Rate for Payer: Aetna New Business (MI Preferred)	$814.18
Rate for Payer: Cash Price	$1,002.06
Rate for Payer: Cofinity Commercial	$876.81
Rate for Payer: Cofinity Commercial	$1,077.22
Rate for Payer: Healthscope Commercial	$1,127.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,064.69
Rate for Payer: PHP Commercial	$1,064.69
Rate for Payer: Priority Health Cigna Priority Health	$876.81
Rate for Payer: Priority Health SBD	$789.13

HC SP Z TRUE FILL

Facility

$6,624.52

Hospital Charge Code	27800059
Hospital Revenue Code	278
Min. Negotiated Rate	$4,173.45
Max. Negotiated Rate	$5,962.07
Rate for Payer: Aetna Commercial	$5,630.84
Rate for Payer: Aetna New Business (MI Preferred)	$4,305.94
Rate for Payer: Cash Price	$5,299.62
Rate for Payer: Cofinity Commercial	$4,637.16
Rate for Payer: Cofinity Commercial	$5,697.09
Rate for Payer: Healthscope Commercial	$5,962.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,630.84
Rate for Payer: PHP Commercial	$5,630.84
Rate for Payer: Priority Health Cigna Priority Health	$4,637.16
Rate for Payer: Priority Health SBD	$4,173.45

HC SP Z TRUE FILL

Facility

$6,624.52

Hospital Charge Code	27800059
Hospital Revenue Code	278
Min. Negotiated Rate	$2,649.81
Max. Negotiated Rate	$5,962.07
Rate for Payer: Aetna Commercial	$5,630.84
Rate for Payer: Aetna New Business (MI Preferred)	$4,305.94
Rate for Payer: BCBS Complete	$2,649.81
Rate for Payer: Cash Price	$5,299.62
Rate for Payer: Cofinity Commercial	$4,637.16
Rate for Payer: Cofinity Commercial	$5,697.09
Rate for Payer: Healthscope Commercial	$5,962.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,630.84
Rate for Payer: PHP Commercial	$5,630.84
Rate for Payer: Priority Health Cigna Priority Health	$4,637.16
Rate for Payer: Priority Health SBD	$4,173.45

HC SQ ICD

Facility

$55,312.00

Service Code	HCPCS C1722
Hospital Charge Code	27800122
Hospital Revenue Code	278
Min. Negotiated Rate	$22,124.80
Max. Negotiated Rate	$49,780.80
Rate for Payer: Aetna Commercial	$47,015.20
Rate for Payer: Aetna New Business (MI Preferred)	$35,952.80
Rate for Payer: BCBS Complete	$22,124.80
Rate for Payer: Cash Price	$44,249.60
Rate for Payer: Cofinity Commercial	$38,718.40
Rate for Payer: Cofinity Commercial	$47,568.32
Rate for Payer: Healthscope Commercial	$49,780.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47,015.20
Rate for Payer: PHP Commercial	$47,015.20
Rate for Payer: Priority Health Cigna Priority Health	$38,718.40
Rate for Payer: Priority Health SBD	$34,846.56

HC SQ ICD

Facility

$55,312.00

Service Code	HCPCS C1722
Hospital Charge Code	27800122
Hospital Revenue Code	278
Min. Negotiated Rate	$34,846.56
Max. Negotiated Rate	$49,780.80
Rate for Payer: Aetna Commercial	$47,015.20
Rate for Payer: Aetna New Business (MI Preferred)	$35,952.80
Rate for Payer: Cash Price	$44,249.60
Rate for Payer: Cofinity Commercial	$38,718.40
Rate for Payer: Cofinity Commercial	$47,568.32
Rate for Payer: Healthscope Commercial	$49,780.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47,015.20
Rate for Payer: PHP Commercial	$47,015.20
Rate for Payer: Priority Health Cigna Priority Health	$38,718.40
Rate for Payer: Priority Health SBD	$34,846.56

HC SQ ICD LEAD

Facility

$14,375.00

Service Code	HCPCS C1896
Hospital Charge Code	27800123
Hospital Revenue Code	278
Min. Negotiated Rate	$5,750.00
Max. Negotiated Rate	$12,937.50
Rate for Payer: Aetna Commercial	$12,218.75
Rate for Payer: Aetna New Business (MI Preferred)	$9,343.75
Rate for Payer: BCBS Complete	$5,750.00
Rate for Payer: Cash Price	$11,500.00
Rate for Payer: Cofinity Commercial	$10,062.50
Rate for Payer: Cofinity Commercial	$12,362.50
Rate for Payer: Healthscope Commercial	$12,937.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12,218.75
Rate for Payer: PHP Commercial	$12,218.75
Rate for Payer: Priority Health Cigna Priority Health	$10,062.50
Rate for Payer: Priority Health SBD	$9,056.25

HC SQ ICD LEAD

Facility

$14,375.00

Service Code	HCPCS C1896
Hospital Charge Code	27800123
Hospital Revenue Code	278
Min. Negotiated Rate	$9,056.25
Max. Negotiated Rate	$12,937.50
Rate for Payer: Aetna Commercial	$12,218.75
Rate for Payer: Aetna New Business (MI Preferred)	$9,343.75
Rate for Payer: Cash Price	$11,500.00
Rate for Payer: Cofinity Commercial	$10,062.50
Rate for Payer: Cofinity Commercial	$12,362.50
Rate for Payer: Healthscope Commercial	$12,937.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12,218.75
Rate for Payer: PHP Commercial	$12,218.75
Rate for Payer: Priority Health Cigna Priority Health	$10,062.50
Rate for Payer: Priority Health SBD	$9,056.25

HC SQ IM CHEMO HORMONAL

Facility

$226.16

Service Code	CPT 96402
Hospital Charge Code	33100002
Hospital Revenue Code	331
Min. Negotiated Rate	$142.48
Max. Negotiated Rate	$203.54
Rate for Payer: Aetna Commercial	$192.24
Rate for Payer: Aetna New Business (MI Preferred)	$147.00
Rate for Payer: Cash Price	$180.93
Rate for Payer: Cofinity Commercial	$158.31
Rate for Payer: Cofinity Commercial	$194.50
Rate for Payer: Healthscope Commercial	$203.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.24
Rate for Payer: PHP Commercial	$192.24
Rate for Payer: Priority Health Cigna Priority Health	$158.31
Rate for Payer: Priority Health SBD	$142.48

HC SQ IM CHEMO HORMONAL

Facility

$226.16

Service Code	CPT 96402
Hospital Charge Code	33100002
Hospital Revenue Code	331
Min. Negotiated Rate	$34.29
Max. Negotiated Rate	$203.54
Rate for Payer: Aetna Commercial	$192.24
Rate for Payer: Aetna Medicare	$65.19
Rate for Payer: Aetna New Business (MI Preferred)	$147.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$78.35
Rate for Payer: Amish Plain Church Group Commercial	$78.35
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS MAPPO	$62.68
Rate for Payer: BCBS Trust/PPO	$138.01
Rate for Payer: BCN Medicare Advantage	$62.68
Rate for Payer: Cash Price	$180.93
Rate for Payer: Cash Price	$180.93
Rate for Payer: Cofinity Commercial	$194.50
Rate for Payer: Cofinity Commercial	$158.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.68
Rate for Payer: Healthscope Commercial	$203.54
Rate for Payer: Mclaren Medicaid	$34.29
Rate for Payer: Mclaren Medicare	$62.68
Rate for Payer: Meridian Medicaid	$36.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$65.81
Rate for Payer: MI Amish Medical Board Commercial	$72.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.24
Rate for Payer: PACE Medicare	$59.55
Rate for Payer: PACE SWMI	$62.68
Rate for Payer: PHP Commercial	$192.24
Rate for Payer: PHP Medicare Advantage	$62.68
Rate for Payer: Priority Health Choice Medicaid	$34.29
Rate for Payer: Priority Health Cigna Priority Health	$158.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$193.04
Rate for Payer: Priority Health Medicare	$62.68
Rate for Payer: Priority Health Narrow Network	$154.43
Rate for Payer: Priority Health SBD	$142.48
Rate for Payer: Railroad Medicare Medicare	$62.68
Rate for Payer: UHC All Payor (Choice/PPO)	$38.18
Rate for Payer: UHC Dual Complete DSNP	$62.68
Rate for Payer: UHC Exchange	$34.71
Rate for Payer: UHC Medicare Advantage	$64.56
Rate for Payer: VA VA	$62.68

HC SQ IM CHEMO NON-HORMONAL

Facility

$470.70

Service Code	CPT 96401
Hospital Charge Code	33100001
Hospital Revenue Code	331
Min. Negotiated Rate	$296.54
Max. Negotiated Rate	$423.63
Rate for Payer: Aetna Commercial	$400.10
Rate for Payer: Aetna New Business (MI Preferred)	$305.96
Rate for Payer: Cash Price	$376.56
Rate for Payer: Cofinity Commercial	$329.49
Rate for Payer: Cofinity Commercial	$404.80
Rate for Payer: Healthscope Commercial	$423.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$400.10
Rate for Payer: PHP Commercial	$400.10
Rate for Payer: Priority Health Cigna Priority Health	$329.49
Rate for Payer: Priority Health SBD	$296.54

Know your out-of-pocket cost for care.

All Charges