Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC MASTECTOMY SLEEVE EA $40

Facility

$40.80

Service Code	HCPCS L8010
Hospital Charge Code	96000016
Hospital Revenue Code	270
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC MASTECTOMY SLEEVE EA $40

Facility

$40.80

Service Code	HCPCS L8010
Hospital Charge Code	96000016
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC MASTECTOMY SLEEVE EA $400

Facility

$408.00

Service Code	HCPCS L8010
Hospital Charge Code	96000017
Hospital Revenue Code	270
Min. Negotiated Rate	$257.04
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna Commercial	$346.80
Rate for Payer: Aetna New Business (MI Preferred)	$265.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cofinity Commercial	$285.60
Rate for Payer: Cofinity Commercial	$350.88
Rate for Payer: Cofinity Medicare Advantage	$285.60
Rate for Payer: Encore Health Key Benefits Commercial	$326.40
Rate for Payer: Healthscope Commercial	$367.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$346.80
Rate for Payer: PHP Commercial	$346.80
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: Priority Health SBD	$257.04

HC MASTECTOMY SLEEVE EA $400

Facility

$408.00

Service Code	HCPCS L8010
Hospital Charge Code	96000017
Hospital Revenue Code	270
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna Commercial	$346.80
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: Aetna New Business (MI Preferred)	$265.20
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cofinity Commercial	$285.60
Rate for Payer: Cofinity Commercial	$350.88
Rate for Payer: Cofinity Medicare Advantage	$285.60
Rate for Payer: Encore Health Key Benefits Commercial	$326.40
Rate for Payer: Healthscope Commercial	$367.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$346.80
Rate for Payer: PHP Commercial	$346.80
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: Priority Health SBD	$257.04

HC MASTECTOMY SLEEVE EA $425

Facility

$433.50

Service Code	HCPCS L8010
Hospital Charge Code	96000018
Hospital Revenue Code	270
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$390.15
Rate for Payer: Aetna Commercial	$368.48
Rate for Payer: Aetna Medicare	$216.75
Rate for Payer: Aetna New Business (MI Preferred)	$281.78
Rate for Payer: BCBS Complete	$173.40
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cofinity Commercial	$303.45
Rate for Payer: Cofinity Commercial	$372.81
Rate for Payer: Cofinity Medicare Advantage	$303.45
Rate for Payer: Encore Health Key Benefits Commercial	$346.80
Rate for Payer: Healthscope Commercial	$390.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.48
Rate for Payer: PHP Commercial	$368.48
Rate for Payer: Priority Health Cigna Priority Health	$281.78
Rate for Payer: Priority Health SBD	$273.10

HC MASTECTOMY SLEEVE EA $425

Facility

$433.50

Service Code	HCPCS L8010
Hospital Charge Code	96000018
Hospital Revenue Code	270
Min. Negotiated Rate	$273.10
Max. Negotiated Rate	$390.15
Rate for Payer: Aetna Commercial	$368.48
Rate for Payer: Aetna New Business (MI Preferred)	$281.78
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cofinity Commercial	$303.45
Rate for Payer: Cofinity Commercial	$372.81
Rate for Payer: Cofinity Medicare Advantage	$303.45
Rate for Payer: Encore Health Key Benefits Commercial	$346.80
Rate for Payer: Healthscope Commercial	$390.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.48
Rate for Payer: PHP Commercial	$368.48
Rate for Payer: Priority Health Cigna Priority Health	$281.78
Rate for Payer: Priority Health SBD	$273.10

HC MASTECTOMY SLEEVE EA $450

Facility

$459.00

Service Code	HCPCS L8010
Hospital Charge Code	96000019
Hospital Revenue Code	270
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: Aetna New Business (MI Preferred)	$298.35
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$321.30
Rate for Payer: Cofinity Commercial	$394.74
Rate for Payer: Cofinity Medicare Advantage	$321.30
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: PHP Commercial	$390.15
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health SBD	$289.17

HC MASTECTOMY SLEEVE EA $450

Facility

$459.00

Service Code	HCPCS L8010
Hospital Charge Code	96000019
Hospital Revenue Code	270
Min. Negotiated Rate	$289.17
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna New Business (MI Preferred)	$298.35
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$321.30
Rate for Payer: Cofinity Commercial	$394.74
Rate for Payer: Cofinity Medicare Advantage	$321.30
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: PHP Commercial	$390.15
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health SBD	$289.17

HC MASTECTOMY SLEEVE EA $50

Facility

$51.00

Service Code	HCPCS L8010
Hospital Charge Code	96000020
Hospital Revenue Code	270
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Medicare Advantage	$35.70
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health SBD	$32.13

HC MASTECTOMY SLEEVE EA $50

Facility

$51.00

Service Code	HCPCS L8010
Hospital Charge Code	96000020
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Medicare Advantage	$35.70
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health SBD	$32.13

HC MASTECTOMY SLEEVE EA $60

Facility

$61.20

Service Code	HCPCS L8010
Hospital Charge Code	96000021
Hospital Revenue Code	270
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna Medicare	$30.60
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: BCBS Complete	$24.48
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

HC MASTECTOMY SLEEVE EA $60

Facility

$61.20

Service Code	HCPCS L8010
Hospital Charge Code	96000021
Hospital Revenue Code	270
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

HC MASTECTOMY SLEEVE EA $70

Facility

$71.40

Service Code	HCPCS L8010
Hospital Charge Code	96000022
Hospital Revenue Code	270
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC MASTECTOMY SLEEVE EA $70

Facility

$71.40

Service Code	HCPCS L8010
Hospital Charge Code	96000022
Hospital Revenue Code	270
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC MASTECTOMY SLEEVE EA $80

Facility

$81.60

Service Code	HCPCS L8010
Hospital Charge Code	96000023
Hospital Revenue Code	270
Min. Negotiated Rate	$32.64
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$69.36
Rate for Payer: Aetna Medicare	$40.80
Rate for Payer: Aetna New Business (MI Preferred)	$53.04
Rate for Payer: BCBS Complete	$32.64
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cofinity Commercial	$57.12
Rate for Payer: Cofinity Commercial	$70.18
Rate for Payer: Cofinity Medicare Advantage	$57.12
Rate for Payer: Encore Health Key Benefits Commercial	$65.28
Rate for Payer: Healthscope Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.36
Rate for Payer: PHP Commercial	$69.36
Rate for Payer: Priority Health Cigna Priority Health	$53.04
Rate for Payer: Priority Health SBD	$51.41

HC MASTECTOMY SLEEVE EA $80

Facility

$81.60

Service Code	HCPCS L8010
Hospital Charge Code	96000023
Hospital Revenue Code	270
Min. Negotiated Rate	$51.41
Max. Negotiated Rate	$73.44
Rate for Payer: Aetna Commercial	$69.36
Rate for Payer: Aetna New Business (MI Preferred)	$53.04
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cofinity Commercial	$57.12
Rate for Payer: Cofinity Commercial	$70.18
Rate for Payer: Cofinity Medicare Advantage	$57.12
Rate for Payer: Encore Health Key Benefits Commercial	$65.28
Rate for Payer: Healthscope Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.36
Rate for Payer: PHP Commercial	$69.36
Rate for Payer: Priority Health Cigna Priority Health	$53.04
Rate for Payer: Priority Health SBD	$51.41

HC MASTECTOMY SLEEVE EA $90

Facility

$91.80

Service Code	HCPCS L8010
Hospital Charge Code	96000024
Hospital Revenue Code	270
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Cofinity Medicare Advantage	$64.26
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health SBD	$57.83

HC MASTECTOMY SLEEVE EA $90

Facility

$91.80

Service Code	HCPCS L8010
Hospital Charge Code	96000024
Hospital Revenue Code	270
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: BCBS Trust/PPO	$141.40
Rate for Payer: BCN Commercial	$141.40
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Cofinity Medicare Advantage	$64.26
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health SBD	$57.83

HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$2,142.08

Service Code	CPT 19020
Hospital Charge Code	76100281
Hospital Revenue Code	761
Min. Negotiated Rate	$333.43
Max. Negotiated Rate	$4,989.41
Rate for Payer: Aetna Commercial	$1,820.77
Rate for Payer: Aetna Medicare	$1,650.98
Rate for Payer: Aetna New Business (MI Preferred)	$1,392.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,984.35
Rate for Payer: Amish Plain Church Group Commercial	$1,984.35
Rate for Payer: BCBS Complete	$893.43
Rate for Payer: BCBS MAPPO	$1,587.48
Rate for Payer: BCBS Trust/PPO	$1,339.86
Rate for Payer: BCN Commercial	$1,339.86
Rate for Payer: BCN Medicare Advantage	$1,587.48
Rate for Payer: Cash Price	$1,713.66
Rate for Payer: Cash Price	$1,713.66
Rate for Payer: Cash Price	$1,713.66
Rate for Payer: Cofinity Commercial	$1,842.19
Rate for Payer: Cofinity Commercial	$1,499.46
Rate for Payer: Cofinity Medicare Advantage	$1,499.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,713.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,587.48
Rate for Payer: Healthscope Commercial	$1,927.87
Rate for Payer: Mclaren Medicaid	$850.89
Rate for Payer: Mclaren Medicare	$1,587.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,666.85
Rate for Payer: Meridian Medicaid	$893.43
Rate for Payer: MI Amish Medical Board Commercial	$1,825.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,820.77
Rate for Payer: Nomi Health Commercial	$3,333.71
Rate for Payer: PACE Medicare	$1,508.11
Rate for Payer: PACE SWMI	$1,587.48
Rate for Payer: PHP Commercial	$1,820.77
Rate for Payer: PHP Medicare Advantage	$1,587.48
Rate for Payer: Priority Health Choice Medicaid	$850.89
Rate for Payer: Priority Health Cigna Priority Health	$1,392.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,989.41
Rate for Payer: Priority Health Medicare	$1,587.48
Rate for Payer: Priority Health Narrow Network	$3,991.53
Rate for Payer: Priority Health SBD	$1,349.51
Rate for Payer: Railroad Medicare Medicare	$1,587.48
Rate for Payer: UHC All Payor (Choice/PPO)	$333.43
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,587.48
Rate for Payer: UHC Medicare Advantage	$1,587.48
Rate for Payer: UHCCP Medicaid	$893.75
Rate for Payer: VA VA	$1,587.48

HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$2,142.08

Service Code	CPT 19020
Hospital Charge Code	76100281
Hospital Revenue Code	761
Min. Negotiated Rate	$1,349.51
Max. Negotiated Rate	$1,927.87
Rate for Payer: Aetna Commercial	$1,820.77
Rate for Payer: Aetna New Business (MI Preferred)	$1,392.35
Rate for Payer: Cash Price	$1,713.66
Rate for Payer: Cofinity Commercial	$1,499.46
Rate for Payer: Cofinity Commercial	$1,842.19
Rate for Payer: Cofinity Medicare Advantage	$1,499.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,713.66
Rate for Payer: Healthscope Commercial	$1,927.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,820.77
Rate for Payer: PHP Commercial	$1,820.77
Rate for Payer: Priority Health Cigna Priority Health	$1,392.35
Rate for Payer: Priority Health SBD	$1,349.51

HC MATERNAL SCRN INTEGRATED SERUM 1

Facility

$112.20

Service Code	CPT 84163
Hospital Charge Code	30100641
Hospital Revenue Code	301
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$100.98
Rate for Payer: Aetna Commercial	$95.37
Rate for Payer: Aetna New Business (MI Preferred)	$72.93
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cofinity Commercial	$78.54
Rate for Payer: Cofinity Commercial	$96.49
Rate for Payer: Cofinity Medicare Advantage	$78.54
Rate for Payer: Encore Health Key Benefits Commercial	$89.76
Rate for Payer: Healthscope Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.37
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: Priority Health Cigna Priority Health	$72.93
Rate for Payer: Priority Health SBD	$70.69

HC MATERNAL SCRN INTEGRATED SERUM 1

Facility

$112.20

Service Code	CPT 84163
Hospital Charge Code	30100641
Hospital Revenue Code	301
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$100.98
Rate for Payer: Aetna Commercial	$95.37
Rate for Payer: Aetna Medicare	$15.65
Rate for Payer: Aetna New Business (MI Preferred)	$72.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.81
Rate for Payer: Amish Plain Church Group Commercial	$18.81
Rate for Payer: BCBS Complete	$8.47
Rate for Payer: BCBS MAPPO	$15.05
Rate for Payer: BCBS Trust/PPO	$13.33
Rate for Payer: BCN Commercial	$13.33
Rate for Payer: BCN Medicare Advantage	$15.05
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cofinity Commercial	$96.49
Rate for Payer: Cofinity Commercial	$78.54
Rate for Payer: Cofinity Medicare Advantage	$78.54
Rate for Payer: Encore Health Key Benefits Commercial	$89.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.05
Rate for Payer: Healthscope Commercial	$100.98
Rate for Payer: Mclaren Medicaid	$8.07
Rate for Payer: Mclaren Medicare	$15.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.80
Rate for Payer: Meridian Medicaid	$8.47
Rate for Payer: MI Amish Medical Board Commercial	$17.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.37
Rate for Payer: Nomi Health Commercial	$22.58
Rate for Payer: PACE Medicare	$14.30
Rate for Payer: PACE SWMI	$15.05
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: PHP Medicare Advantage	$15.05
Rate for Payer: Priority Health Choice Medicaid	$8.07
Rate for Payer: Priority Health Cigna Priority Health	$72.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.05
Rate for Payer: Priority Health Medicare	$15.05
Rate for Payer: Priority Health Narrow Network	$12.04
Rate for Payer: Priority Health SBD	$70.69
Rate for Payer: Railroad Medicare Medicare	$15.05
Rate for Payer: UHC All Payor (Choice/PPO)	$18.06
Rate for Payer: UHC Dual Complete DSNP	$15.05
Rate for Payer: UHC Medicare Advantage	$15.05
Rate for Payer: UHCCP Medicaid	$8.47
Rate for Payer: VA VA	$15.05

HC MATERNAL SCRN INTEGRATED SERUM 2

Facility

$242.35

Service Code	CPT 81511
Hospital Charge Code	30100654
Hospital Revenue Code	301
Min. Negotiated Rate	$82.28
Max. Negotiated Rate	$231.90
Rate for Payer: Aetna Commercial	$206.00
Rate for Payer: Aetna Medicare	$159.64
Rate for Payer: Aetna New Business (MI Preferred)	$157.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$191.88
Rate for Payer: Amish Plain Church Group Commercial	$191.88
Rate for Payer: BCBS Complete	$86.39
Rate for Payer: BCBS MAPPO	$153.50
Rate for Payer: BCBS Trust/PPO	$135.89
Rate for Payer: BCN Commercial	$135.89
Rate for Payer: BCN Medicare Advantage	$153.50
Rate for Payer: Cash Price	$193.88
Rate for Payer: Cash Price	$193.88
Rate for Payer: Cofinity Commercial	$169.64
Rate for Payer: Cofinity Commercial	$208.42
Rate for Payer: Cofinity Medicare Advantage	$169.64
Rate for Payer: Encore Health Key Benefits Commercial	$193.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$153.50
Rate for Payer: Healthscope Commercial	$218.12
Rate for Payer: Mclaren Medicaid	$82.28
Rate for Payer: Mclaren Medicare	$153.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$161.18
Rate for Payer: Meridian Medicaid	$86.39
Rate for Payer: MI Amish Medical Board Commercial	$176.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.00
Rate for Payer: Nomi Health Commercial	$230.25
Rate for Payer: PACE Medicare	$145.82
Rate for Payer: PACE SWMI	$153.50
Rate for Payer: PHP Commercial	$206.00
Rate for Payer: PHP Medicare Advantage	$153.50
Rate for Payer: Priority Health Choice Medicaid	$82.28
Rate for Payer: Priority Health Cigna Priority Health	$157.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$153.50
Rate for Payer: Priority Health Medicare	$153.50
Rate for Payer: Priority Health Narrow Network	$122.80
Rate for Payer: Priority Health SBD	$152.68
Rate for Payer: Railroad Medicare Medicare	$153.50
Rate for Payer: UHC All Payor (Choice/PPO)	$184.20
Rate for Payer: UHC Core	$231.90
Rate for Payer: UHC Dual Complete DSNP	$153.50
Rate for Payer: UHC Exchange	$231.90
Rate for Payer: UHC Medicare Advantage	$153.50
Rate for Payer: UHCCP Medicaid	$86.42
Rate for Payer: VA VA	$153.50

HC MATERNAL SCRN INTEGRATED SERUM 2

Facility

$242.35

Service Code	CPT 81511
Hospital Charge Code	30100654
Hospital Revenue Code	301
Min. Negotiated Rate	$152.68
Max. Negotiated Rate	$218.12
Rate for Payer: Aetna Commercial	$206.00
Rate for Payer: Aetna New Business (MI Preferred)	$157.53
Rate for Payer: Cash Price	$193.88
Rate for Payer: Cofinity Commercial	$169.64
Rate for Payer: Cofinity Commercial	$208.42
Rate for Payer: Cofinity Medicare Advantage	$169.64
Rate for Payer: Encore Health Key Benefits Commercial	$193.88
Rate for Payer: Healthscope Commercial	$218.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.00
Rate for Payer: PHP Commercial	$206.00
Rate for Payer: Priority Health Cigna Priority Health	$157.53
Rate for Payer: Priority Health SBD	$152.68

HC MAXIMUM VOLUNTARY VENTILATION

Facility

$122.63

Service Code	CPT 94200
Hospital Charge Code	46000022
Hospital Revenue Code	460
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$182.90
Rate for Payer: Aetna Commercial	$104.24
Rate for Payer: Aetna Medicare	$60.53
Rate for Payer: Aetna New Business (MI Preferred)	$79.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$72.75
Rate for Payer: Amish Plain Church Group Commercial	$72.75
Rate for Payer: BCBS Complete	$32.75
Rate for Payer: BCBS MAPPO	$58.20
Rate for Payer: BCBS Trust/PPO	$54.65
Rate for Payer: BCN Commercial	$54.65
Rate for Payer: BCN Medicare Advantage	$58.20
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cofinity Commercial	$85.84
Rate for Payer: Cofinity Commercial	$105.46
Rate for Payer: Cofinity Medicare Advantage	$85.84
Rate for Payer: Encore Health Key Benefits Commercial	$98.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$58.20
Rate for Payer: Healthscope Commercial	$110.37
Rate for Payer: Mclaren Medicaid	$31.20
Rate for Payer: Mclaren Medicare	$58.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$61.11
Rate for Payer: Meridian Medicaid	$32.75
Rate for Payer: MI Amish Medical Board Commercial	$66.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$104.24
Rate for Payer: Nomi Health Commercial	$174.60
Rate for Payer: PACE Medicare	$55.29
Rate for Payer: PACE SWMI	$58.20
Rate for Payer: PHP Commercial	$104.24
Rate for Payer: PHP Medicare Advantage	$58.20
Rate for Payer: Priority Health Choice Medicaid	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$79.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.90
Rate for Payer: Priority Health Medicare	$58.20
Rate for Payer: Priority Health Narrow Network	$146.32
Rate for Payer: Priority Health SBD	$77.26
Rate for Payer: Railroad Medicare Medicare	$58.20
Rate for Payer: UHC All Payor (Choice/PPO)	$15.11
Rate for Payer: UHC Dual Complete DSNP	$58.20
Rate for Payer: UHC Exchange	$90.75
Rate for Payer: UHC Medicare Advantage	$58.20
Rate for Payer: UHCCP Medicaid	$32.77
Rate for Payer: VA VA	$58.20

Know your out-of-pocket cost for care.

All Charges