Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC TC-99M AUTOL WBC DIAG PER DOSE

Facility

$1,745.01

Service Code	HCPCS A9569
Hospital Charge Code	34300027
Hospital Revenue Code	343
Min. Negotiated Rate	$1,099.36
Max. Negotiated Rate	$1,570.51
Rate for Payer: Aetna Commercial	$1,483.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,134.26
Rate for Payer: Cash Price	$1,396.01
Rate for Payer: Cofinity Commercial	$1,500.71
Rate for Payer: Cofinity Commercial	$1,221.51
Rate for Payer: Healthscope Commercial	$1,570.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,483.26
Rate for Payer: PHP Commercial	$1,483.26
Rate for Payer: Priority Health Cigna Priority Health	$1,221.51
Rate for Payer: Priority Health SBD	$1,099.36

HC TC-99M AUTOL WBC DIAG PER DOSE

Facility

$1,745.01

Service Code	HCPCS A9569
Hospital Charge Code	34300027
Hospital Revenue Code	343
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$1,570.51
Rate for Payer: Aetna Commercial	$1,483.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,134.26
Rate for Payer: BCBS Complete	$698.00
Rate for Payer: BCBS Trust/PPO	$3.38
Rate for Payer: Cash Price	$1,396.01
Rate for Payer: Cash Price	$1,396.01
Rate for Payer: Cofinity Commercial	$1,221.51
Rate for Payer: Cofinity Commercial	$1,500.71
Rate for Payer: Healthscope Commercial	$1,570.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,483.26
Rate for Payer: PHP Commercial	$1,483.26
Rate for Payer: Priority Health Cigna Priority Health	$1,221.51
Rate for Payer: Priority Health SBD	$1,099.36

HC TC99M DTPA AEROSOL <=75 MCI

Facility

$131.39

Service Code	HCPCS A9567
Hospital Charge Code	34300030
Hospital Revenue Code	343
Min. Negotiated Rate	$52.56
Max. Negotiated Rate	$118.25
Rate for Payer: Aetna Commercial	$111.68
Rate for Payer: Aetna New Business (MI Preferred)	$85.40
Rate for Payer: BCBS Complete	$52.56
Rate for Payer: BCBS Trust/PPO	$67.10
Rate for Payer: Cash Price	$105.11
Rate for Payer: Cash Price	$105.11
Rate for Payer: Cofinity Commercial	$113.00
Rate for Payer: Cofinity Commercial	$91.97
Rate for Payer: Healthscope Commercial	$118.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.68
Rate for Payer: PHP Commercial	$111.68
Rate for Payer: Priority Health Cigna Priority Health	$91.97
Rate for Payer: Priority Health SBD	$82.78

HC TC99M DTPA AEROSOL <=75 MCI

Facility

$131.39

Service Code	HCPCS A9567
Hospital Charge Code	34300030
Hospital Revenue Code	343
Min. Negotiated Rate	$82.78
Max. Negotiated Rate	$118.25
Rate for Payer: Aetna Commercial	$111.68
Rate for Payer: Aetna New Business (MI Preferred)	$85.40
Rate for Payer: Cash Price	$105.11
Rate for Payer: Cofinity Commercial	$113.00
Rate for Payer: Cofinity Commercial	$91.97
Rate for Payer: Healthscope Commercial	$118.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.68
Rate for Payer: PHP Commercial	$111.68
Rate for Payer: Priority Health Cigna Priority Health	$91.97
Rate for Payer: Priority Health SBD	$82.78

HC TC 99M MAA PER STUDY

Facility

$124.80

Service Code	HCPCS A9540
Hospital Charge Code	34300017
Hospital Revenue Code	343
Min. Negotiated Rate	$78.62
Max. Negotiated Rate	$112.32
Rate for Payer: Aetna Commercial	$106.08
Rate for Payer: Aetna New Business (MI Preferred)	$81.12
Rate for Payer: Cash Price	$99.84
Rate for Payer: Cofinity Commercial	$107.33
Rate for Payer: Cofinity Commercial	$87.36
Rate for Payer: Healthscope Commercial	$112.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.08
Rate for Payer: PHP Commercial	$106.08
Rate for Payer: Priority Health Cigna Priority Health	$87.36
Rate for Payer: Priority Health SBD	$78.62

HC TC 99M MAA PER STUDY

Facility

$124.80

Service Code	HCPCS A9540
Hospital Charge Code	34300017
Hospital Revenue Code	343
Min. Negotiated Rate	$49.92
Max. Negotiated Rate	$112.32
Rate for Payer: Aetna Commercial	$106.08
Rate for Payer: Aetna New Business (MI Preferred)	$81.12
Rate for Payer: BCBS Complete	$49.92
Rate for Payer: BCBS Trust/PPO	$65.89
Rate for Payer: Cash Price	$99.84
Rate for Payer: Cash Price	$99.84
Rate for Payer: Cofinity Commercial	$107.33
Rate for Payer: Cofinity Commercial	$87.36
Rate for Payer: Healthscope Commercial	$112.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.08
Rate for Payer: PHP Commercial	$106.08
Rate for Payer: Priority Health Cigna Priority Health	$87.36
Rate for Payer: Priority Health SBD	$78.62

HC TC 99M MDP PER STUDY

Facility

$140.03

Service Code	HCPCS A9503
Hospital Charge Code	34300018
Hospital Revenue Code	343
Min. Negotiated Rate	$36.54
Max. Negotiated Rate	$126.03
Rate for Payer: Aetna Commercial	$119.03
Rate for Payer: Aetna New Business (MI Preferred)	$91.02
Rate for Payer: BCBS Complete	$56.01
Rate for Payer: BCBS Trust/PPO	$36.54
Rate for Payer: Cash Price	$112.02
Rate for Payer: Cash Price	$112.02
Rate for Payer: Cofinity Commercial	$120.43
Rate for Payer: Cofinity Commercial	$98.02
Rate for Payer: Healthscope Commercial	$126.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.03
Rate for Payer: PHP Commercial	$119.03
Rate for Payer: Priority Health Cigna Priority Health	$98.02
Rate for Payer: Priority Health SBD	$88.22

HC TC 99M MDP PER STUDY

Facility

$140.03

Service Code	HCPCS A9503
Hospital Charge Code	34300018
Hospital Revenue Code	343
Min. Negotiated Rate	$88.22
Max. Negotiated Rate	$126.03
Rate for Payer: Aetna Commercial	$119.03
Rate for Payer: Aetna New Business (MI Preferred)	$91.02
Rate for Payer: Cash Price	$112.02
Rate for Payer: Cofinity Commercial	$120.43
Rate for Payer: Cofinity Commercial	$98.02
Rate for Payer: Healthscope Commercial	$126.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.03
Rate for Payer: PHP Commercial	$119.03
Rate for Payer: Priority Health Cigna Priority Health	$98.02
Rate for Payer: Priority Health SBD	$88.22

HC TC 99M PERTECHNETATE PER MCI

Facility

$46.68

Service Code	HCPCS A9512
Hospital Charge Code	34300029
Hospital Revenue Code	343
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$42.01
Rate for Payer: Aetna Commercial	$39.68
Rate for Payer: Aetna New Business (MI Preferred)	$30.34
Rate for Payer: BCBS Complete	$18.67
Rate for Payer: BCBS Trust/PPO	$3.13
Rate for Payer: Cash Price	$37.34
Rate for Payer: Cash Price	$37.34
Rate for Payer: Cofinity Commercial	$32.68
Rate for Payer: Cofinity Commercial	$40.14
Rate for Payer: Healthscope Commercial	$42.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.68
Rate for Payer: PHP Commercial	$39.68
Rate for Payer: Priority Health Cigna Priority Health	$32.68
Rate for Payer: Priority Health SBD	$29.41

HC TC 99M PERTECHNETATE PER MCI

Facility

$46.68

Service Code	HCPCS A9512
Hospital Charge Code	34300029
Hospital Revenue Code	343
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$42.01
Rate for Payer: Aetna Commercial	$39.68
Rate for Payer: Aetna New Business (MI Preferred)	$30.34
Rate for Payer: Cash Price	$37.34
Rate for Payer: Cofinity Commercial	$32.68
Rate for Payer: Cofinity Commercial	$40.14
Rate for Payer: Healthscope Commercial	$42.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.68
Rate for Payer: PHP Commercial	$39.68
Rate for Payer: Priority Health Cigna Priority Health	$32.68
Rate for Payer: Priority Health SBD	$29.41

HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES

Facility

$231.54

Service Code	CPT A9538
Hospital Charge Code	34300037
Hospital Revenue Code	343
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$208.39
Rate for Payer: Aetna Commercial	$196.81
Rate for Payer: Aetna New Business (MI Preferred)	$150.50
Rate for Payer: BCBS Complete	$92.62
Rate for Payer: BCBS Trust/PPO	$36.05
Rate for Payer: Cash Price	$185.23
Rate for Payer: Cash Price	$185.23
Rate for Payer: Cofinity Commercial	$162.08
Rate for Payer: Cofinity Commercial	$199.12
Rate for Payer: Healthscope Commercial	$208.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$196.81
Rate for Payer: PHP Commercial	$196.81
Rate for Payer: Priority Health Cigna Priority Health	$162.08
Rate for Payer: Priority Health SBD	$145.87

HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES

Facility

$231.54

Service Code	CPT A9538
Hospital Charge Code	34300037
Hospital Revenue Code	343
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$208.39
Rate for Payer: Aetna Commercial	$196.81
Rate for Payer: Aetna New Business (MI Preferred)	$150.50
Rate for Payer: Cash Price	$185.23
Rate for Payer: Cofinity Commercial	$162.08
Rate for Payer: Cofinity Commercial	$199.12
Rate for Payer: Healthscope Commercial	$208.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$196.81
Rate for Payer: PHP Commercial	$196.81
Rate for Payer: Priority Health Cigna Priority Health	$162.08
Rate for Payer: Priority Health SBD	$145.87

HC TC 99M SULFUR COLLOID PER STUDY

Facility

$245.38

Service Code	HCPCS A9541
Hospital Charge Code	34300020
Hospital Revenue Code	343
Min. Negotiated Rate	$85.38
Max. Negotiated Rate	$220.84
Rate for Payer: Aetna Commercial	$208.57
Rate for Payer: Aetna New Business (MI Preferred)	$159.50
Rate for Payer: BCBS Complete	$98.15
Rate for Payer: BCBS Trust/PPO	$85.38
Rate for Payer: Cash Price	$196.30
Rate for Payer: Cash Price	$196.30
Rate for Payer: Cofinity Commercial	$211.03
Rate for Payer: Cofinity Commercial	$171.77
Rate for Payer: Healthscope Commercial	$220.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.57
Rate for Payer: PHP Commercial	$208.57
Rate for Payer: Priority Health Cigna Priority Health	$171.77
Rate for Payer: Priority Health SBD	$154.59

HC TC 99M SULFUR COLLOID PER STUDY

Facility

$245.38

Service Code	HCPCS A9541
Hospital Charge Code	34300020
Hospital Revenue Code	343
Min. Negotiated Rate	$154.59
Max. Negotiated Rate	$220.84
Rate for Payer: Aetna Commercial	$208.57
Rate for Payer: Aetna New Business (MI Preferred)	$159.50
Rate for Payer: Cash Price	$196.30
Rate for Payer: Cofinity Commercial	$171.77
Rate for Payer: Cofinity Commercial	$211.03
Rate for Payer: Healthscope Commercial	$220.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.57
Rate for Payer: PHP Commercial	$208.57
Rate for Payer: Priority Health Cigna Priority Health	$171.77
Rate for Payer: Priority Health SBD	$154.59

HC T CELL ACUTE LYMPH LEUK

Facility

$35.00

Service Code	CPT 88271
Hospital Charge Code	31000133
Hospital Revenue Code	310
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$36.40
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna Medicare	$22.28
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.78
Rate for Payer: Amish Plain Church Group Commercial	$26.78
Rate for Payer: BCBS Complete	$12.30
Rate for Payer: BCBS MAPPO	$21.42
Rate for Payer: BCBS Trust/PPO	$16.78
Rate for Payer: BCN Medicare Advantage	$21.42
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.42
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Mclaren Medicaid	$11.72
Rate for Payer: Mclaren Medicare	$21.42
Rate for Payer: Meridian Medicaid	$12.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.49
Rate for Payer: MI Amish Medical Board Commercial	$24.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.75
Rate for Payer: PACE Medicare	$20.35
Rate for Payer: PACE SWMI	$21.42
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: PHP Medicare Advantage	$21.42
Rate for Payer: Priority Health Choice Medicaid	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health Medicare	$21.42
Rate for Payer: Priority Health SBD	$22.05
Rate for Payer: Railroad Medicare Medicare	$21.42
Rate for Payer: UHC All Payor (Choice/PPO)	$25.70
Rate for Payer: UHC Core	$36.40
Rate for Payer: UHC Dual Complete DSNP	$21.42
Rate for Payer: UHC Exchange	$21.42
Rate for Payer: UHC Medicare Advantage	$22.06
Rate for Payer: VA VA	$21.42

HC T CELL ACUTE LYMPH LEUK

Facility

$35.00

Service Code	CPT 88271
Hospital Charge Code	31000133
Hospital Revenue Code	310
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health SBD	$22.05

HC T CELL ACUTE LYMPH LEUK CMPT1

Facility

$116.28

Service Code	CPT 88275
Hospital Charge Code	31000040
Hospital Revenue Code	310
Min. Negotiated Rate	$73.26
Max. Negotiated Rate	$104.65
Rate for Payer: Aetna Commercial	$98.84
Rate for Payer: Aetna New Business (MI Preferred)	$75.58
Rate for Payer: Cash Price	$93.02
Rate for Payer: Cofinity Commercial	$81.40
Rate for Payer: Cofinity Commercial	$100.00
Rate for Payer: Healthscope Commercial	$104.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.84
Rate for Payer: PHP Commercial	$98.84
Rate for Payer: Priority Health Cigna Priority Health	$81.40
Rate for Payer: Priority Health SBD	$73.26

HC T CELL ACUTE LYMPH LEUK CMPT1

Facility

$116.28

Service Code	CPT 88275
Hospital Charge Code	31000040
Hospital Revenue Code	310
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$104.65
Rate for Payer: Aetna Commercial	$98.84
Rate for Payer: Aetna Medicare	$53.24
Rate for Payer: Aetna New Business (MI Preferred)	$75.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$63.99
Rate for Payer: Amish Plain Church Group Commercial	$63.99
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: BCBS MAPPO	$51.19
Rate for Payer: BCBS Trust/PPO	$40.08
Rate for Payer: BCN Medicare Advantage	$51.19
Rate for Payer: Cash Price	$93.02
Rate for Payer: Cash Price	$93.02
Rate for Payer: Cofinity Commercial	$81.40
Rate for Payer: Cofinity Commercial	$100.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.19
Rate for Payer: Healthscope Commercial	$104.65
Rate for Payer: Mclaren Medicaid	$28.00
Rate for Payer: Mclaren Medicare	$51.19
Rate for Payer: Meridian Medicaid	$29.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$53.75
Rate for Payer: MI Amish Medical Board Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.84
Rate for Payer: PACE Medicare	$48.63
Rate for Payer: PACE SWMI	$51.19
Rate for Payer: PHP Commercial	$98.84
Rate for Payer: PHP Medicare Advantage	$51.19
Rate for Payer: Priority Health Choice Medicaid	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$81.40
Rate for Payer: Priority Health Medicare	$51.19
Rate for Payer: Priority Health SBD	$73.26
Rate for Payer: Railroad Medicare Medicare	$51.19
Rate for Payer: UHC All Payor (Choice/PPO)	$61.43
Rate for Payer: UHC Core	$68.26
Rate for Payer: UHC Dual Complete DSNP	$51.19
Rate for Payer: UHC Exchange	$51.19
Rate for Payer: UHC Medicare Advantage	$52.73
Rate for Payer: VA VA	$51.19

HC T CELL ACUTE LYMPH LEUK CMPT2

Facility

$103.02

Service Code	CPT 88271
Hospital Charge Code	31000029
Hospital Revenue Code	310
Min. Negotiated Rate	$64.90
Max. Negotiated Rate	$92.72
Rate for Payer: Aetna Commercial	$87.57
Rate for Payer: Aetna New Business (MI Preferred)	$66.96
Rate for Payer: Cash Price	$82.42
Rate for Payer: Cofinity Commercial	$72.11
Rate for Payer: Cofinity Commercial	$88.60
Rate for Payer: Healthscope Commercial	$92.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$87.57
Rate for Payer: PHP Commercial	$87.57
Rate for Payer: Priority Health Cigna Priority Health	$72.11
Rate for Payer: Priority Health SBD	$64.90

HC T CELL ACUTE LYMPH LEUK CMPT2

Facility

$103.02

Service Code	CPT 88271
Hospital Charge Code	31000029
Hospital Revenue Code	310
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$92.72
Rate for Payer: Aetna Commercial	$87.57
Rate for Payer: Aetna Medicare	$22.28
Rate for Payer: Aetna New Business (MI Preferred)	$66.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.78
Rate for Payer: Amish Plain Church Group Commercial	$26.78
Rate for Payer: BCBS Complete	$12.30
Rate for Payer: BCBS MAPPO	$21.42
Rate for Payer: BCBS Trust/PPO	$16.78
Rate for Payer: BCN Medicare Advantage	$21.42
Rate for Payer: Cash Price	$82.42
Rate for Payer: Cash Price	$82.42
Rate for Payer: Cofinity Commercial	$72.11
Rate for Payer: Cofinity Commercial	$88.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.42
Rate for Payer: Healthscope Commercial	$92.72
Rate for Payer: Mclaren Medicaid	$11.72
Rate for Payer: Mclaren Medicare	$21.42
Rate for Payer: Meridian Medicaid	$12.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.49
Rate for Payer: MI Amish Medical Board Commercial	$24.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$87.57
Rate for Payer: PACE Medicare	$20.35
Rate for Payer: PACE SWMI	$21.42
Rate for Payer: PHP Commercial	$87.57
Rate for Payer: PHP Medicare Advantage	$21.42
Rate for Payer: Priority Health Choice Medicaid	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$72.11
Rate for Payer: Priority Health Medicare	$21.42
Rate for Payer: Priority Health SBD	$64.90
Rate for Payer: Railroad Medicare Medicare	$21.42
Rate for Payer: UHC All Payor (Choice/PPO)	$25.70
Rate for Payer: UHC Core	$36.40
Rate for Payer: UHC Dual Complete DSNP	$21.42
Rate for Payer: UHC Exchange	$21.42
Rate for Payer: UHC Medicare Advantage	$22.06
Rate for Payer: VA VA	$21.42

HC T CELL ACUTE LYMPH LEUK FISH

Facility

$83.00

Service Code	CPT 88275
Hospital Charge Code	31000039
Hospital Revenue Code	310
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$70.55
Rate for Payer: Aetna Medicare	$53.24
Rate for Payer: Aetna New Business (MI Preferred)	$53.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$63.99
Rate for Payer: Amish Plain Church Group Commercial	$63.99
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: BCBS MAPPO	$51.19
Rate for Payer: BCBS Trust/PPO	$40.08
Rate for Payer: BCN Medicare Advantage	$51.19
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$58.10
Rate for Payer: Cofinity Commercial	$71.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.19
Rate for Payer: Healthscope Commercial	$74.70
Rate for Payer: Mclaren Medicaid	$28.00
Rate for Payer: Mclaren Medicare	$51.19
Rate for Payer: Meridian Medicaid	$29.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$53.75
Rate for Payer: MI Amish Medical Board Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.55
Rate for Payer: PACE Medicare	$48.63
Rate for Payer: PACE SWMI	$51.19
Rate for Payer: PHP Commercial	$70.55
Rate for Payer: PHP Medicare Advantage	$51.19
Rate for Payer: Priority Health Choice Medicaid	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: Priority Health Medicare	$51.19
Rate for Payer: Priority Health SBD	$52.29
Rate for Payer: Railroad Medicare Medicare	$51.19
Rate for Payer: UHC All Payor (Choice/PPO)	$61.43
Rate for Payer: UHC Core	$68.26
Rate for Payer: UHC Dual Complete DSNP	$51.19
Rate for Payer: UHC Exchange	$51.19
Rate for Payer: UHC Medicare Advantage	$52.73
Rate for Payer: VA VA	$51.19

HC T CELL ACUTE LYMPH LEUK FISH

Facility

$83.00

Service Code	CPT 88275
Hospital Charge Code	31000039
Hospital Revenue Code	310
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$70.55
Rate for Payer: Aetna New Business (MI Preferred)	$53.95
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$58.10
Rate for Payer: Cofinity Commercial	$71.38
Rate for Payer: Healthscope Commercial	$74.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.55
Rate for Payer: PHP Commercial	$70.55
Rate for Payer: Priority Health Cigna Priority Health	$58.10
Rate for Payer: Priority Health SBD	$52.29

HC T CELLS CD4 CD8 COUNT

Facility

$74.23

Service Code	CPT 86360
Hospital Charge Code	30200207
Hospital Revenue Code	302
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$79.86
Rate for Payer: Aetna Commercial	$63.10
Rate for Payer: Aetna Medicare	$48.86
Rate for Payer: Aetna New Business (MI Preferred)	$48.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$58.72
Rate for Payer: Amish Plain Church Group Commercial	$58.72
Rate for Payer: BCBS Complete	$26.99
Rate for Payer: BCBS MAPPO	$46.98
Rate for Payer: BCBS Trust/PPO	$36.79
Rate for Payer: BCN Medicare Advantage	$46.98
Rate for Payer: Cash Price	$59.38
Rate for Payer: Cash Price	$59.38
Rate for Payer: Cofinity Commercial	$51.96
Rate for Payer: Cofinity Commercial	$63.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$46.98
Rate for Payer: Healthscope Commercial	$66.81
Rate for Payer: Mclaren Medicaid	$25.70
Rate for Payer: Mclaren Medicare	$46.98
Rate for Payer: Meridian Medicaid	$26.99
Rate for Payer: Meridian Wellcare - Medicare Advantage	$49.33
Rate for Payer: MI Amish Medical Board Commercial	$54.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.10
Rate for Payer: PACE Medicare	$44.63
Rate for Payer: PACE SWMI	$46.98
Rate for Payer: PHP Commercial	$63.10
Rate for Payer: PHP Medicare Advantage	$46.98
Rate for Payer: Priority Health Choice Medicaid	$25.70
Rate for Payer: Priority Health Cigna Priority Health	$51.96
Rate for Payer: Priority Health Medicare	$46.98
Rate for Payer: Priority Health SBD	$46.76
Rate for Payer: Railroad Medicare Medicare	$46.98
Rate for Payer: UHC All Payor (Choice/PPO)	$56.38
Rate for Payer: UHC Core	$79.86
Rate for Payer: UHC Dual Complete DSNP	$46.98
Rate for Payer: UHC Exchange	$46.98
Rate for Payer: UHC Medicare Advantage	$48.39
Rate for Payer: VA VA	$46.98

HC T CELLS CD4 CD8 COUNT

Facility

$74.23

Service Code	CPT 86360
Hospital Charge Code	30200207
Hospital Revenue Code	302
Min. Negotiated Rate	$46.76
Max. Negotiated Rate	$66.81
Rate for Payer: Aetna Commercial	$63.10
Rate for Payer: Aetna New Business (MI Preferred)	$48.25
Rate for Payer: Cash Price	$59.38
Rate for Payer: Cofinity Commercial	$51.96
Rate for Payer: Cofinity Commercial	$63.84
Rate for Payer: Healthscope Commercial	$66.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.10
Rate for Payer: PHP Commercial	$63.10
Rate for Payer: Priority Health Cigna Priority Health	$51.96
Rate for Payer: Priority Health SBD	$46.76

HC T CELL TOTAL

Facility

$59.60

Service Code	CPT 86359
Hospital Charge Code	30200205
Hospital Revenue Code	302
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$64.12
Rate for Payer: Aetna Commercial	$50.66
Rate for Payer: Aetna Medicare	$39.24
Rate for Payer: Aetna New Business (MI Preferred)	$38.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$47.16
Rate for Payer: Amish Plain Church Group Commercial	$47.16
Rate for Payer: BCBS Complete	$21.67
Rate for Payer: BCBS MAPPO	$37.73
Rate for Payer: BCBS Trust/PPO	$29.55
Rate for Payer: BCN Medicare Advantage	$37.73
Rate for Payer: Cash Price	$47.68
Rate for Payer: Cash Price	$47.68
Rate for Payer: Cofinity Commercial	$41.72
Rate for Payer: Cofinity Commercial	$51.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$37.73
Rate for Payer: Healthscope Commercial	$53.64
Rate for Payer: Mclaren Medicaid	$20.64
Rate for Payer: Mclaren Medicare	$37.73
Rate for Payer: Meridian Medicaid	$21.67
Rate for Payer: Meridian Wellcare - Medicare Advantage	$39.62
Rate for Payer: MI Amish Medical Board Commercial	$43.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.66
Rate for Payer: PACE Medicare	$35.84
Rate for Payer: PACE SWMI	$37.73
Rate for Payer: PHP Commercial	$50.66
Rate for Payer: PHP Medicare Advantage	$37.73
Rate for Payer: Priority Health Choice Medicaid	$20.64
Rate for Payer: Priority Health Cigna Priority Health	$41.72
Rate for Payer: Priority Health Medicare	$37.73
Rate for Payer: Priority Health SBD	$37.55
Rate for Payer: Railroad Medicare Medicare	$37.73
Rate for Payer: UHC All Payor (Choice/PPO)	$45.28
Rate for Payer: UHC Core	$64.12
Rate for Payer: UHC Dual Complete DSNP	$37.73
Rate for Payer: UHC Exchange	$37.73
Rate for Payer: UHC Medicare Advantage	$38.86
Rate for Payer: VA VA	$37.73

Know your out-of-pocket cost for care.

All Charges