Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC TETANUS ANTIBODIES

Facility

$60.00

Service Code	CPT 86774
Hospital Charge Code	30200320
Hospital Revenue Code	302
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare	$15.39
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.50
Rate for Payer: Amish Plain Church Group Commercial	$18.50
Rate for Payer: BCBS Complete	$8.50
Rate for Payer: BCBS MAPPO	$14.80
Rate for Payer: BCBS Trust/PPO	$11.59
Rate for Payer: BCN Medicare Advantage	$14.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.80
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Mclaren Medicaid	$8.10
Rate for Payer: Mclaren Medicare	$14.80
Rate for Payer: Meridian Medicaid	$8.50
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15.54
Rate for Payer: MI Amish Medical Board Commercial	$17.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PACE Medicare	$14.06
Rate for Payer: PACE SWMI	$14.80
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: PHP Medicare Advantage	$14.80
Rate for Payer: Priority Health Choice Medicaid	$8.10
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health Medicare	$14.80
Rate for Payer: Priority Health SBD	$37.80
Rate for Payer: Railroad Medicare Medicare	$14.80
Rate for Payer: UHC All Payor (Choice/PPO)	$17.76
Rate for Payer: UHC Core	$25.15
Rate for Payer: UHC Dual Complete DSNP	$14.80
Rate for Payer: UHC Exchange	$14.80
Rate for Payer: UHC Medicare Advantage	$15.24
Rate for Payer: VA VA	$14.80

HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE

Facility

$122.18

Service Code	CPT 90715
Hospital Charge Code	63600022
Hospital Revenue Code	636
Min. Negotiated Rate	$76.97
Max. Negotiated Rate	$109.96
Rate for Payer: Aetna Commercial	$103.85
Rate for Payer: Aetna New Business (MI Preferred)	$79.42
Rate for Payer: Cash Price	$97.74
Rate for Payer: Cofinity Commercial	$105.07
Rate for Payer: Cofinity Commercial	$85.53
Rate for Payer: Healthscope Commercial	$109.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$103.85
Rate for Payer: PHP Commercial	$103.85
Rate for Payer: Priority Health Cigna Priority Health	$85.53
Rate for Payer: Priority Health SBD	$76.97

HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE

Facility

$122.18

Service Code	CPT 90715
Hospital Charge Code	63600022
Hospital Revenue Code	636
Min. Negotiated Rate	$48.87
Max. Negotiated Rate	$117.62
Rate for Payer: Aetna Commercial	$103.85
Rate for Payer: Aetna New Business (MI Preferred)	$79.42
Rate for Payer: BCBS Complete	$48.87
Rate for Payer: BCBS Trust/PPO	$117.62
Rate for Payer: Cash Price	$97.74
Rate for Payer: Cash Price	$97.74
Rate for Payer: Cofinity Commercial	$105.07
Rate for Payer: Cofinity Commercial	$85.53
Rate for Payer: Healthscope Commercial	$109.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$103.85
Rate for Payer: PHP Commercial	$103.85
Rate for Payer: Priority Health Cigna Priority Health	$85.53
Rate for Payer: Priority Health SBD	$76.97

HC THC URINE CONFIRM

Facility

$62.00

Service Code	CPT 80349
Hospital Charge Code	30100568
Hospital Revenue Code	301
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna Commercial	$52.70
Rate for Payer: Aetna New Business (MI Preferred)	$40.30
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Cofinity Commercial	$53.32
Rate for Payer: Healthscope Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: PHP Commercial	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health SBD	$39.06

HC THC URINE CONFIRM

Facility

$62.00

Service Code	CPT 80349
Hospital Charge Code	30100568
Hospital Revenue Code	301
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna Commercial	$52.70
Rate for Payer: Aetna New Business (MI Preferred)	$40.30
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$53.32
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Healthscope Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: PHP Commercial	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health SBD	$39.06
Rate for Payer: UHC Core	$29.32

HC THEOPHYLLINE LEVEL

Facility

$90.40

Service Code	CPT 80198
Hospital Charge Code	30100048
Hospital Revenue Code	301
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$81.36
Rate for Payer: Aetna Commercial	$76.84
Rate for Payer: Aetna Medicare	$14.71
Rate for Payer: Aetna New Business (MI Preferred)	$58.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$17.68
Rate for Payer: Amish Plain Church Group Commercial	$17.68
Rate for Payer: BCBS Complete	$8.12
Rate for Payer: BCBS MAPPO	$14.14
Rate for Payer: BCBS Trust/PPO	$11.08
Rate for Payer: BCN Medicare Advantage	$14.14
Rate for Payer: Cash Price	$72.32
Rate for Payer: Cash Price	$72.32
Rate for Payer: Cofinity Commercial	$77.74
Rate for Payer: Cofinity Commercial	$63.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.14
Rate for Payer: Healthscope Commercial	$81.36
Rate for Payer: Mclaren Medicaid	$7.73
Rate for Payer: Mclaren Medicare	$14.14
Rate for Payer: Meridian Medicaid	$8.12
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14.85
Rate for Payer: MI Amish Medical Board Commercial	$16.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.84
Rate for Payer: PACE Medicare	$13.43
Rate for Payer: PACE SWMI	$14.14
Rate for Payer: PHP Commercial	$76.84
Rate for Payer: PHP Medicare Advantage	$14.14
Rate for Payer: Priority Health Choice Medicaid	$7.73
Rate for Payer: Priority Health Cigna Priority Health	$63.28
Rate for Payer: Priority Health Medicare	$14.14
Rate for Payer: Priority Health SBD	$56.95
Rate for Payer: Railroad Medicare Medicare	$14.14
Rate for Payer: UHC All Payor (Choice/PPO)	$16.97
Rate for Payer: UHC Core	$24.05
Rate for Payer: UHC Dual Complete DSNP	$14.14
Rate for Payer: UHC Exchange	$14.14
Rate for Payer: UHC Medicare Advantage	$14.56
Rate for Payer: VA VA	$14.14

HC THEOPHYLLINE LEVEL

Facility

$90.40

Service Code	CPT 80198
Hospital Charge Code	30100048
Hospital Revenue Code	301
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$81.36
Rate for Payer: Aetna Commercial	$76.84
Rate for Payer: Aetna New Business (MI Preferred)	$58.76
Rate for Payer: Cash Price	$72.32
Rate for Payer: Cofinity Commercial	$63.28
Rate for Payer: Cofinity Commercial	$77.74
Rate for Payer: Healthscope Commercial	$81.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.84
Rate for Payer: PHP Commercial	$76.84
Rate for Payer: Priority Health Cigna Priority Health	$63.28
Rate for Payer: Priority Health SBD	$56.95

HC THERAPEUTIC ACTIVITIES EA 15 MIN

Facility

$96.90

Service Code	CPT 97530
Hospital Charge Code	42000028
Hospital Revenue Code	420
Min. Negotiated Rate	$24.79
Max. Negotiated Rate	$87.21
Rate for Payer: Aetna Commercial	$82.36
Rate for Payer: Aetna New Business (MI Preferred)	$62.98
Rate for Payer: BCBS Complete	$38.76
Rate for Payer: BCBS Trust/PPO	$24.79
Rate for Payer: Cash Price	$77.52
Rate for Payer: Cash Price	$77.52
Rate for Payer: Cofinity Commercial	$67.83
Rate for Payer: Cofinity Commercial	$83.33
Rate for Payer: Healthscope Commercial	$87.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$82.36
Rate for Payer: PHP Commercial	$82.36
Rate for Payer: Priority Health Cigna Priority Health	$67.83
Rate for Payer: Priority Health SBD	$61.05
Rate for Payer: UHC All Payor (Choice/PPO)	$39.62
Rate for Payer: UHC Exchange	$36.02

HC THERAPEUTIC ACTIVITIES EA 15 MIN

Facility

$96.90

Service Code	CPT 97530
Hospital Charge Code	42000028
Hospital Revenue Code	420
Min. Negotiated Rate	$61.05
Max. Negotiated Rate	$87.21
Rate for Payer: Aetna Commercial	$82.36
Rate for Payer: Aetna New Business (MI Preferred)	$62.98
Rate for Payer: Cash Price	$77.52
Rate for Payer: Cofinity Commercial	$67.83
Rate for Payer: Cofinity Commercial	$83.33
Rate for Payer: Healthscope Commercial	$87.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$82.36
Rate for Payer: PHP Commercial	$82.36
Rate for Payer: Priority Health Cigna Priority Health	$67.83
Rate for Payer: Priority Health SBD	$61.05

HC THERAPEUTIC APHERESIS PLASMA PHERESIS

Facility

$2,505.38

Service Code	CPT 36514
Hospital Charge Code	36100520
Hospital Revenue Code	761
Min. Negotiated Rate	$1,578.39
Max. Negotiated Rate	$2,254.84
Rate for Payer: Aetna Commercial	$2,129.57
Rate for Payer: Aetna New Business (MI Preferred)	$1,628.50
Rate for Payer: Cash Price	$2,004.30
Rate for Payer: Cofinity Commercial	$1,753.77
Rate for Payer: Cofinity Commercial	$2,154.63
Rate for Payer: Healthscope Commercial	$2,254.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,129.57
Rate for Payer: PHP Commercial	$2,129.57
Rate for Payer: Priority Health Cigna Priority Health	$1,753.77
Rate for Payer: Priority Health SBD	$1,578.39

HC THERAPEUTIC APHERESIS PLASMA PHERESIS

Facility

$2,505.38

Service Code	CPT 36514
Hospital Charge Code	36100520
Hospital Revenue Code	761
Min. Negotiated Rate	$90.05
Max. Negotiated Rate	$4,077.54
Rate for Payer: Aetna Commercial	$2,129.57
Rate for Payer: Aetna Medicare	$1,419.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,628.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,706.54
Rate for Payer: Amish Plain Church Group Commercial	$1,706.54
Rate for Payer: BCBS Complete	$784.19
Rate for Payer: BCBS MAPPO	$1,365.23
Rate for Payer: BCBS Trust/PPO	$1,089.94
Rate for Payer: BCN Medicare Advantage	$1,365.23
Rate for Payer: Cash Price	$2,004.30
Rate for Payer: Cash Price	$2,004.30
Rate for Payer: Cofinity Commercial	$1,753.77
Rate for Payer: Cofinity Commercial	$2,154.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,365.23
Rate for Payer: Healthscope Commercial	$2,254.84
Rate for Payer: Mclaren Medicaid	$746.78
Rate for Payer: Mclaren Medicare	$1,365.23
Rate for Payer: Meridian Medicaid	$784.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,433.49
Rate for Payer: MI Amish Medical Board Commercial	$1,570.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,129.57
Rate for Payer: PACE Medicare	$1,296.97
Rate for Payer: PACE SWMI	$1,365.23
Rate for Payer: PHP Commercial	$2,129.57
Rate for Payer: PHP Medicare Advantage	$1,365.23
Rate for Payer: Priority Health Choice Medicaid	$746.78
Rate for Payer: Priority Health Cigna Priority Health	$1,753.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,077.54
Rate for Payer: Priority Health Medicare	$1,365.23
Rate for Payer: Priority Health Narrow Network	$3,262.03
Rate for Payer: Priority Health SBD	$1,578.39
Rate for Payer: Railroad Medicare Medicare	$1,365.23
Rate for Payer: UHC All Payor (Choice/PPO)	$99.06
Rate for Payer: UHC Dual Complete DSNP	$1,365.23
Rate for Payer: UHC Exchange	$90.05
Rate for Payer: UHC Medicare Advantage	$1,406.19
Rate for Payer: VA VA	$1,365.23

HC THERAPEUTIC APHERESIS RED BLOOD CELLS

Facility

$2,432.40

Service Code	CPT 36512
Hospital Charge Code	76100326
Hospital Revenue Code	761
Min. Negotiated Rate	$1,532.41
Max. Negotiated Rate	$2,189.16
Rate for Payer: Aetna Commercial	$2,067.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,581.06
Rate for Payer: Cash Price	$1,945.92
Rate for Payer: Cofinity Commercial	$1,702.68
Rate for Payer: Cofinity Commercial	$2,091.86
Rate for Payer: Healthscope Commercial	$2,189.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,067.54
Rate for Payer: PHP Commercial	$2,067.54
Rate for Payer: Priority Health Cigna Priority Health	$1,702.68
Rate for Payer: Priority Health SBD	$1,532.41

HC THERAPEUTIC APHERESIS RED BLOOD CELLS

Facility

$2,432.40

Service Code	CPT 36512
Hospital Charge Code	76100326
Hospital Revenue Code	761
Min. Negotiated Rate	$102.16
Max. Negotiated Rate	$4,077.54
Rate for Payer: Aetna Commercial	$2,067.54
Rate for Payer: Aetna Medicare	$1,419.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,581.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,706.54
Rate for Payer: Amish Plain Church Group Commercial	$1,706.54
Rate for Payer: BCBS Complete	$784.19
Rate for Payer: BCBS MAPPO	$1,365.23
Rate for Payer: BCBS Trust/PPO	$634.74
Rate for Payer: BCN Medicare Advantage	$1,365.23
Rate for Payer: Cash Price	$1,945.92
Rate for Payer: Cash Price	$1,945.92
Rate for Payer: Cofinity Commercial	$2,091.86
Rate for Payer: Cofinity Commercial	$1,702.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,365.23
Rate for Payer: Healthscope Commercial	$2,189.16
Rate for Payer: Mclaren Medicaid	$746.78
Rate for Payer: Mclaren Medicare	$1,365.23
Rate for Payer: Meridian Medicaid	$784.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,433.49
Rate for Payer: MI Amish Medical Board Commercial	$1,570.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,067.54
Rate for Payer: PACE Medicare	$1,296.97
Rate for Payer: PACE SWMI	$1,365.23
Rate for Payer: PHP Commercial	$2,067.54
Rate for Payer: PHP Medicare Advantage	$1,365.23
Rate for Payer: Priority Health Choice Medicaid	$746.78
Rate for Payer: Priority Health Cigna Priority Health	$1,702.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,077.54
Rate for Payer: Priority Health Medicare	$1,365.23
Rate for Payer: Priority Health Narrow Network	$3,262.03
Rate for Payer: Priority Health SBD	$1,532.41
Rate for Payer: Railroad Medicare Medicare	$1,365.23
Rate for Payer: UHC All Payor (Choice/PPO)	$112.38
Rate for Payer: UHC Dual Complete DSNP	$1,365.23
Rate for Payer: UHC Exchange	$102.16
Rate for Payer: UHC Medicare Advantage	$1,406.19
Rate for Payer: VA VA	$1,365.23

HC THERAPEUTIC APHERESIS WHITE BLOOD CELL

Facility

$2,432.40

Service Code	CPT 36511
Hospital Charge Code	76100327
Hospital Revenue Code	761
Min. Negotiated Rate	$107.40
Max. Negotiated Rate	$4,077.54
Rate for Payer: Aetna Commercial	$2,067.54
Rate for Payer: Aetna Medicare	$1,419.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,581.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,706.54
Rate for Payer: Amish Plain Church Group Commercial	$1,706.54
Rate for Payer: BCBS Complete	$784.19
Rate for Payer: BCBS MAPPO	$1,365.23
Rate for Payer: BCBS Trust/PPO	$515.37
Rate for Payer: BCN Medicare Advantage	$1,365.23
Rate for Payer: Cash Price	$1,945.92
Rate for Payer: Cash Price	$1,945.92
Rate for Payer: Cofinity Commercial	$1,702.68
Rate for Payer: Cofinity Commercial	$2,091.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,365.23
Rate for Payer: Healthscope Commercial	$2,189.16
Rate for Payer: Mclaren Medicaid	$746.78
Rate for Payer: Mclaren Medicare	$1,365.23
Rate for Payer: Meridian Medicaid	$784.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,433.49
Rate for Payer: MI Amish Medical Board Commercial	$1,570.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,067.54
Rate for Payer: PACE Medicare	$1,296.97
Rate for Payer: PACE SWMI	$1,365.23
Rate for Payer: PHP Commercial	$2,067.54
Rate for Payer: PHP Medicare Advantage	$1,365.23
Rate for Payer: Priority Health Choice Medicaid	$746.78
Rate for Payer: Priority Health Cigna Priority Health	$1,702.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,077.54
Rate for Payer: Priority Health Medicare	$1,365.23
Rate for Payer: Priority Health Narrow Network	$3,262.03
Rate for Payer: Priority Health SBD	$1,532.41
Rate for Payer: Railroad Medicare Medicare	$1,365.23
Rate for Payer: UHC All Payor (Choice/PPO)	$118.14
Rate for Payer: UHC Dual Complete DSNP	$1,365.23
Rate for Payer: UHC Exchange	$107.40
Rate for Payer: UHC Medicare Advantage	$1,406.19
Rate for Payer: VA VA	$1,365.23

HC THERAPEUTIC APHERESIS WHITE BLOOD CELL

Facility

$2,432.40

Service Code	CPT 36511
Hospital Charge Code	76100327
Hospital Revenue Code	761
Min. Negotiated Rate	$1,532.41
Max. Negotiated Rate	$2,189.16
Rate for Payer: Aetna Commercial	$2,067.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,581.06
Rate for Payer: Cash Price	$1,945.92
Rate for Payer: Cofinity Commercial	$1,702.68
Rate for Payer: Cofinity Commercial	$2,091.86
Rate for Payer: Healthscope Commercial	$2,189.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,067.54
Rate for Payer: PHP Commercial	$2,067.54
Rate for Payer: Priority Health Cigna Priority Health	$1,702.68
Rate for Payer: Priority Health SBD	$1,532.41

HC THERAPEUTIC EX EACH 15 MIN

Facility

$112.20

Service Code	CPT 97110
Hospital Charge Code	42000020
Hospital Revenue Code	420
Min. Negotiated Rate	$19.65
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: BCBS Complete	$44.88
Rate for Payer: BCBS Trust/PPO	$19.65
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: Healthscope Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.37
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: Priority Health Cigna Priority Health	$78.54
Rate for Payer: Priority Health SBD	$70.69
Rate for Payer: UHC All Payor (Choice/PPO)	$31.69
Rate for Payer: UHC Exchange	$28.81

HC THERAPEUTIC EX EACH 15 MIN

Facility

$112.20

Service Code	CPT 97110
Hospital Charge Code	42000020
Hospital Revenue Code	420
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: Healthscope Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.37
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: Priority Health Cigna Priority Health	$78.54
Rate for Payer: Priority Health SBD	$70.69

HC THERAPEUTIC PHLEBOTOMY

Facility

$846.31

Service Code	CPT 99195
Hospital Charge Code	76100010
Hospital Revenue Code	761
Min. Negotiated Rate	$533.18
Max. Negotiated Rate	$761.68
Rate for Payer: Aetna Commercial	$719.36
Rate for Payer: Aetna New Business (MI Preferred)	$550.10
Rate for Payer: Cash Price	$677.05
Rate for Payer: Cofinity Commercial	$592.42
Rate for Payer: Cofinity Commercial	$727.83
Rate for Payer: Healthscope Commercial	$761.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$719.36
Rate for Payer: PHP Commercial	$719.36
Rate for Payer: Priority Health Cigna Priority Health	$592.42
Rate for Payer: Priority Health SBD	$533.18

HC THERAPEUTIC PHLEBOTOMY

Facility

$846.31

Service Code	CPT 99195
Hospital Charge Code	76100010
Hospital Revenue Code	761
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$761.68
Rate for Payer: Aetna Commercial	$719.36
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Aetna New Business (MI Preferred)	$550.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$435.97
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Cash Price	$677.05
Rate for Payer: Cash Price	$677.05
Rate for Payer: Cofinity Commercial	$592.42
Rate for Payer: Cofinity Commercial	$727.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Healthscope Commercial	$761.68
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$719.36
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Commercial	$719.36
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health Cigna Priority Health	$592.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Priority Health SBD	$533.18
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$103.38
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$93.98
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

HC THERASKIN PER SQ CM (116 SQ CM)

Facility

$58.26

Service Code	HCPCS Q4121
Hospital Charge Code	63600219
Hospital Revenue Code	636
Min. Negotiated Rate	$36.70
Max. Negotiated Rate	$52.43
Rate for Payer: Aetna Commercial	$49.52
Rate for Payer: Aetna New Business (MI Preferred)	$37.87
Rate for Payer: Cash Price	$46.61
Rate for Payer: Cofinity Commercial	$40.78
Rate for Payer: Cofinity Commercial	$50.10
Rate for Payer: Healthscope Commercial	$52.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.52
Rate for Payer: PHP Commercial	$49.52
Rate for Payer: Priority Health Cigna Priority Health	$40.78
Rate for Payer: Priority Health SBD	$36.70

HC THERASKIN PER SQ CM (116 SQ CM)

Facility

$58.26

Service Code	HCPCS Q4121
Hospital Charge Code	63600219
Hospital Revenue Code	636
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$52.43
Rate for Payer: Aetna Commercial	$49.52
Rate for Payer: Aetna New Business (MI Preferred)	$37.87
Rate for Payer: BCBS Complete	$23.30
Rate for Payer: BCBS Trust/PPO	$21.70
Rate for Payer: Cash Price	$46.61
Rate for Payer: Cash Price	$46.61
Rate for Payer: Cofinity Commercial	$40.78
Rate for Payer: Cofinity Commercial	$50.10
Rate for Payer: Healthscope Commercial	$52.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.52
Rate for Payer: PHP Commercial	$49.52
Rate for Payer: Priority Health Cigna Priority Health	$40.78
Rate for Payer: Priority Health SBD	$36.70

HC THERASKIN PER SQ CM (13 SQ CM)

Facility

$180.52

Service Code	CPT Q4121
Hospital Charge Code	63600064
Hospital Revenue Code	636
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$162.47
Rate for Payer: Aetna Commercial	$153.44
Rate for Payer: Aetna New Business (MI Preferred)	$117.34
Rate for Payer: BCBS Complete	$72.21
Rate for Payer: BCBS Trust/PPO	$21.70
Rate for Payer: Cash Price	$144.42
Rate for Payer: Cash Price	$144.42
Rate for Payer: Cofinity Commercial	$126.36
Rate for Payer: Cofinity Commercial	$155.25
Rate for Payer: Healthscope Commercial	$162.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.44
Rate for Payer: PHP Commercial	$153.44
Rate for Payer: Priority Health Cigna Priority Health	$126.36
Rate for Payer: Priority Health SBD	$113.73

HC THERASKIN PER SQ CM (13 SQ CM)

Facility

$180.52

Service Code	CPT Q4121
Hospital Charge Code	63600064
Hospital Revenue Code	636
Min. Negotiated Rate	$113.73
Max. Negotiated Rate	$162.47
Rate for Payer: Aetna Commercial	$153.44
Rate for Payer: Aetna New Business (MI Preferred)	$117.34
Rate for Payer: Cash Price	$144.42
Rate for Payer: Cofinity Commercial	$126.36
Rate for Payer: Cofinity Commercial	$155.25
Rate for Payer: Healthscope Commercial	$162.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.44
Rate for Payer: PHP Commercial	$153.44
Rate for Payer: Priority Health Cigna Priority Health	$126.36
Rate for Payer: Priority Health SBD	$113.73

HC THERASKIN PER SQ CM (39 SQ CM)

Facility

$82.89

Service Code	CPT Q4121
Hospital Charge Code	63600065
Hospital Revenue Code	636
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$74.60
Rate for Payer: Aetna Commercial	$70.46
Rate for Payer: Aetna New Business (MI Preferred)	$53.88
Rate for Payer: Cash Price	$66.31
Rate for Payer: Cofinity Commercial	$58.02
Rate for Payer: Cofinity Commercial	$71.29
Rate for Payer: Healthscope Commercial	$74.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.46
Rate for Payer: PHP Commercial	$70.46
Rate for Payer: Priority Health Cigna Priority Health	$58.02
Rate for Payer: Priority Health SBD	$52.22

HC THERASKIN PER SQ CM (39 SQ CM)

Facility

$82.89

Service Code	CPT Q4121
Hospital Charge Code	63600065
Hospital Revenue Code	636
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$74.60
Rate for Payer: Aetna Commercial	$70.46
Rate for Payer: Aetna New Business (MI Preferred)	$53.88
Rate for Payer: BCBS Complete	$33.16
Rate for Payer: BCBS Trust/PPO	$21.70
Rate for Payer: Cash Price	$66.31
Rate for Payer: Cash Price	$66.31
Rate for Payer: Cofinity Commercial	$58.02
Rate for Payer: Cofinity Commercial	$71.29
Rate for Payer: Healthscope Commercial	$74.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.46
Rate for Payer: PHP Commercial	$70.46
Rate for Payer: Priority Health Cigna Priority Health	$58.02
Rate for Payer: Priority Health SBD	$52.22

Know your out-of-pocket cost for care.

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