Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC TRANSSEP INTRO AGILIS

Facility

$3,621.13

Service Code	HCPCS C1766
Hospital Charge Code	27200075
Hospital Revenue Code	272
Min. Negotiated Rate	$1,448.45
Max. Negotiated Rate	$3,259.02
Rate for Payer: Aetna Commercial	$3,077.96
Rate for Payer: Aetna New Business (MI Preferred)	$2,353.73
Rate for Payer: BCBS Complete	$1,448.45
Rate for Payer: Cash Price	$2,896.90
Rate for Payer: Cofinity Commercial	$2,534.79
Rate for Payer: Cofinity Commercial	$3,114.17
Rate for Payer: Healthscope Commercial	$3,259.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,077.96
Rate for Payer: PHP Commercial	$3,077.96
Rate for Payer: Priority Health Cigna Priority Health	$2,534.79
Rate for Payer: Priority Health SBD	$2,281.31

HC TRANSSEP INTRO AGILIS

Facility

$3,621.13

Service Code	HCPCS C1766
Hospital Charge Code	27200075
Hospital Revenue Code	272
Min. Negotiated Rate	$2,281.31
Max. Negotiated Rate	$3,259.02
Rate for Payer: Aetna Commercial	$3,077.96
Rate for Payer: Aetna New Business (MI Preferred)	$2,353.73
Rate for Payer: Cash Price	$2,896.90
Rate for Payer: Cofinity Commercial	$2,534.79
Rate for Payer: Cofinity Commercial	$3,114.17
Rate for Payer: Healthscope Commercial	$3,259.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,077.96
Rate for Payer: PHP Commercial	$3,077.96
Rate for Payer: Priority Health Cigna Priority Health	$2,534.79
Rate for Payer: Priority Health SBD	$2,281.31

HC TRANSSEP PUNCTURE FOR PVI

Facility

$4,826.40

Service Code	CPT 93462
Hospital Charge Code	48100021
Hospital Revenue Code	481
Min. Negotiated Rate	$198.43
Max. Negotiated Rate	$4,343.76
Rate for Payer: Aetna Commercial	$4,102.44
Rate for Payer: Aetna New Business (MI Preferred)	$3,137.16
Rate for Payer: BCBS Complete	$1,930.56
Rate for Payer: BCBS Trust/PPO	$239.46
Rate for Payer: Cash Price	$3,861.12
Rate for Payer: Cash Price	$3,861.12
Rate for Payer: Cofinity Commercial	$4,150.70
Rate for Payer: Cofinity Commercial	$3,378.48
Rate for Payer: Healthscope Commercial	$4,343.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,102.44
Rate for Payer: PHP Commercial	$4,102.44
Rate for Payer: Priority Health Cigna Priority Health	$3,378.48
Rate for Payer: Priority Health SBD	$3,040.63
Rate for Payer: UHC All Payor (Choice/PPO)	$218.27
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$198.43

HC TRANSSEP PUNCTURE FOR PVI

Facility

$4,826.40

Service Code	CPT 93462
Hospital Charge Code	48100021
Hospital Revenue Code	481
Min. Negotiated Rate	$3,040.63
Max. Negotiated Rate	$4,343.76
Rate for Payer: Aetna Commercial	$4,102.44
Rate for Payer: Aetna New Business (MI Preferred)	$3,137.16
Rate for Payer: Cash Price	$3,861.12
Rate for Payer: Cofinity Commercial	$3,378.48
Rate for Payer: Cofinity Commercial	$4,150.70
Rate for Payer: Healthscope Commercial	$4,343.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,102.44
Rate for Payer: PHP Commercial	$4,102.44
Rate for Payer: Priority Health Cigna Priority Health	$3,378.48
Rate for Payer: Priority Health SBD	$3,040.63

HC TRANSSEPTAL INTRODUCER

Facility

$886.66

Hospital Charge Code	27200154
Hospital Revenue Code	272
Min. Negotiated Rate	$354.66
Max. Negotiated Rate	$797.99
Rate for Payer: Aetna Commercial	$753.66
Rate for Payer: Aetna New Business (MI Preferred)	$576.33
Rate for Payer: BCBS Complete	$354.66
Rate for Payer: Cash Price	$709.33
Rate for Payer: Cofinity Commercial	$620.66
Rate for Payer: Cofinity Commercial	$762.53
Rate for Payer: Healthscope Commercial	$797.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$753.66
Rate for Payer: PHP Commercial	$753.66
Rate for Payer: Priority Health Cigna Priority Health	$620.66
Rate for Payer: Priority Health SBD	$558.60

HC TRANSSEPTAL INTRODUCER

Facility

$886.66

Hospital Charge Code	27200154
Hospital Revenue Code	272
Min. Negotiated Rate	$558.60
Max. Negotiated Rate	$797.99
Rate for Payer: Aetna Commercial	$753.66
Rate for Payer: Aetna New Business (MI Preferred)	$576.33
Rate for Payer: Cash Price	$709.33
Rate for Payer: Cofinity Commercial	$620.66
Rate for Payer: Cofinity Commercial	$762.53
Rate for Payer: Healthscope Commercial	$797.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$753.66
Rate for Payer: PHP Commercial	$753.66
Rate for Payer: Priority Health Cigna Priority Health	$620.66
Rate for Payer: Priority Health SBD	$558.60

HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL

Facility

$1,530.00

Service Code	CPT 64488
Hospital Charge Code	36100576
Hospital Revenue Code	361
Min. Negotiated Rate	$66.47
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: BCBS Complete	$612.00
Rate for Payer: BCBS Trust/PPO	$812.17
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health SBD	$963.90
Rate for Payer: UHC All Payor (Choice/PPO)	$73.12
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$66.47

HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL

Facility

$1,530.00

Service Code	CPT 64488
Hospital Charge Code	36100576
Hospital Revenue Code	361
Min. Negotiated Rate	$963.90
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health SBD	$963.90

HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI

Facility

$1,170.96

Service Code	CPT 64486
Hospital Charge Code	36100575
Hospital Revenue Code	361
Min. Negotiated Rate	$53.37
Max. Negotiated Rate	$1,053.86
Rate for Payer: Aetna Commercial	$995.32
Rate for Payer: Aetna New Business (MI Preferred)	$761.12
Rate for Payer: BCBS Complete	$468.38
Rate for Payer: BCBS Trust/PPO	$242.95
Rate for Payer: Cash Price	$936.77
Rate for Payer: Cash Price	$936.77
Rate for Payer: Cofinity Commercial	$1,007.03
Rate for Payer: Cofinity Commercial	$819.67
Rate for Payer: Healthscope Commercial	$1,053.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$995.32
Rate for Payer: PHP Commercial	$995.32
Rate for Payer: Priority Health Cigna Priority Health	$819.67
Rate for Payer: Priority Health SBD	$737.70
Rate for Payer: UHC All Payor (Choice/PPO)	$58.71
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$53.37

HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI

Facility

$1,170.96

Service Code	CPT 64486
Hospital Charge Code	36100575
Hospital Revenue Code	361
Min. Negotiated Rate	$737.70
Max. Negotiated Rate	$1,053.86
Rate for Payer: Aetna Commercial	$995.32
Rate for Payer: Aetna New Business (MI Preferred)	$761.12
Rate for Payer: Cash Price	$936.77
Rate for Payer: Cofinity Commercial	$819.67
Rate for Payer: Cofinity Commercial	$1,007.03
Rate for Payer: Healthscope Commercial	$1,053.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$995.32
Rate for Payer: PHP Commercial	$995.32
Rate for Payer: Priority Health Cigna Priority Health	$819.67
Rate for Payer: Priority Health SBD	$737.70

HC TRANURETH DESTR PROST TISS RF WVT

Facility

$4,807.00

Service Code	CPT 53854
Hospital Charge Code	76100306
Hospital Revenue Code	761
Min. Negotiated Rate	$3,028.41
Max. Negotiated Rate	$4,326.30
Rate for Payer: Aetna Commercial	$4,085.95
Rate for Payer: Aetna New Business (MI Preferred)	$3,124.55
Rate for Payer: Cash Price	$3,845.60
Rate for Payer: Cofinity Commercial	$3,364.90
Rate for Payer: Cofinity Commercial	$4,134.02
Rate for Payer: Healthscope Commercial	$4,326.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,085.95
Rate for Payer: PHP Commercial	$4,085.95
Rate for Payer: Priority Health Cigna Priority Health	$3,364.90
Rate for Payer: Priority Health SBD	$3,028.41

HC TRANURETH DESTR PROST TISS RF WVT

Facility

$4,807.00

Service Code	CPT 53854
Hospital Charge Code	76100306
Hospital Revenue Code	761
Min. Negotiated Rate	$375.90
Max. Negotiated Rate	$9,610.69
Rate for Payer: Aetna Commercial	$4,085.95
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Aetna New Business (MI Preferred)	$3,124.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$757.66
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Cash Price	$3,845.60
Rate for Payer: Cash Price	$3,845.60
Rate for Payer: Cofinity Commercial	$4,134.02
Rate for Payer: Cofinity Commercial	$3,364.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Healthscope Commercial	$4,326.30
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,085.95
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Commercial	$4,085.95
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health Cigna Priority Health	$3,364.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,610.69
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,688.55
Rate for Payer: Priority Health SBD	$3,028.41
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$413.49
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$375.90
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

HC TREAT FINGER FRACTURE WITH MANIP EA

Facility

$4,160.11

Service Code	CPT 26742
Hospital Charge Code	76100386
Hospital Revenue Code	761
Min. Negotiated Rate	$341.85
Max. Negotiated Rate	$3,744.10
Rate for Payer: Aetna Commercial	$3,536.09
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Aetna New Business (MI Preferred)	$2,704.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$551.03
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Cash Price	$3,328.09
Rate for Payer: Cash Price	$3,328.09
Rate for Payer: Cofinity Commercial	$3,577.69
Rate for Payer: Cofinity Commercial	$2,912.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Healthscope Commercial	$3,744.10
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,536.09
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Commercial	$3,536.09
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health Cigna Priority Health	$2,912.08
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Priority Health SBD	$2,620.87
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$376.04
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$341.85
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

HC TREAT FINGER FRACTURE WITH MANIP EA

Facility

$4,160.11

Service Code	CPT 26742
Hospital Charge Code	76100386
Hospital Revenue Code	761
Min. Negotiated Rate	$2,620.87
Max. Negotiated Rate	$3,744.10
Rate for Payer: Aetna Commercial	$3,536.09
Rate for Payer: Aetna New Business (MI Preferred)	$2,704.07
Rate for Payer: Cash Price	$3,328.09
Rate for Payer: Cofinity Commercial	$2,912.08
Rate for Payer: Cofinity Commercial	$3,577.69
Rate for Payer: Healthscope Commercial	$3,744.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,536.09
Rate for Payer: PHP Commercial	$3,536.09
Rate for Payer: Priority Health Cigna Priority Health	$2,912.08
Rate for Payer: Priority Health SBD	$2,620.87

HC TREPONEMA PALLIDUM AB TOTAL AND RPR

Facility

$25.00

Service Code	CPT 0064U
Hospital Charge Code	30200436
Hospital Revenue Code	302
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$21.25
Rate for Payer: Aetna New Business (MI Preferred)	$16.25
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cofinity Commercial	$17.50
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Healthscope Commercial	$22.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.25
Rate for Payer: PHP Commercial	$21.25
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health SBD	$15.75

HC TREPONEMA PALLIDUM AB TOTAL AND RPR

Facility

$25.00

Service Code	CPT 0064U
Hospital Charge Code	30200436
Hospital Revenue Code	302
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$39.16
Rate for Payer: Aetna Commercial	$21.25
Rate for Payer: Aetna Medicare	$32.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$39.16
Rate for Payer: Amish Plain Church Group Commercial	$39.16
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS MAPPO	$31.33
Rate for Payer: BCBS Trust/PPO	$24.54
Rate for Payer: BCN Medicare Advantage	$31.33
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cofinity Commercial	$17.50
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.33
Rate for Payer: Healthscope Commercial	$22.50
Rate for Payer: Mclaren Medicaid	$17.14
Rate for Payer: Mclaren Medicare	$31.33
Rate for Payer: Meridian Medicaid	$18.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$32.90
Rate for Payer: MI Amish Medical Board Commercial	$36.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.25
Rate for Payer: PACE Medicare	$29.76
Rate for Payer: PACE SWMI	$31.33
Rate for Payer: PHP Commercial	$21.25
Rate for Payer: PHP Medicare Advantage	$31.33
Rate for Payer: Priority Health Choice Medicaid	$17.14
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health Medicare	$31.33
Rate for Payer: Priority Health SBD	$15.75
Rate for Payer: Railroad Medicare Medicare	$31.33
Rate for Payer: UHC All Payor (Choice/PPO)	$37.60
Rate for Payer: UHC Core	$37.60
Rate for Payer: UHC Dual Complete DSNP	$31.33
Rate for Payer: UHC Exchange	$31.33
Rate for Payer: UHC Medicare Advantage	$32.27
Rate for Payer: VA VA	$31.33

HC TREPONEMA PALLIDUM ANTIBODY

Facility

$24.00

Service Code	CPT 86780
Hospital Charge Code	30000057
Hospital Revenue Code	300
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$15.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$16.80
Rate for Payer: Cofinity Commercial	$20.64
Rate for Payer: Healthscope Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.40
Rate for Payer: PHP Commercial	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$16.80
Rate for Payer: Priority Health SBD	$15.12

HC TREPONEMA PALLIDUM ANTIBODY

Facility

$24.00

Service Code	CPT 86780
Hospital Charge Code	30000057
Hospital Revenue Code	300
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna Medicare	$13.77
Rate for Payer: Aetna New Business (MI Preferred)	$15.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.55
Rate for Payer: Amish Plain Church Group Commercial	$16.55
Rate for Payer: BCBS Complete	$7.61
Rate for Payer: BCBS MAPPO	$13.24
Rate for Payer: BCBS Trust/PPO	$10.37
Rate for Payer: BCN Medicare Advantage	$13.24
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$16.80
Rate for Payer: Cofinity Commercial	$20.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.24
Rate for Payer: Healthscope Commercial	$21.60
Rate for Payer: Mclaren Medicaid	$7.24
Rate for Payer: Mclaren Medicare	$13.24
Rate for Payer: Meridian Medicaid	$7.61
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13.90
Rate for Payer: MI Amish Medical Board Commercial	$15.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.40
Rate for Payer: PACE Medicare	$12.58
Rate for Payer: PACE SWMI	$13.24
Rate for Payer: PHP Commercial	$20.40
Rate for Payer: PHP Medicare Advantage	$13.24
Rate for Payer: Priority Health Choice Medicaid	$7.24
Rate for Payer: Priority Health Cigna Priority Health	$16.80
Rate for Payer: Priority Health Medicare	$13.24
Rate for Payer: Priority Health SBD	$15.12
Rate for Payer: Railroad Medicare Medicare	$13.24
Rate for Payer: UHC All Payor (Choice/PPO)	$15.89
Rate for Payer: UHC Core	$22.50
Rate for Payer: UHC Dual Complete DSNP	$13.24
Rate for Payer: UHC Exchange	$13.24
Rate for Payer: UHC Medicare Advantage	$13.64
Rate for Payer: VA VA	$13.24

HC TREPONEMA PALLIDUM ANTIBODY FT

Facility

$69.00

Service Code	CPT 86780
Hospital Charge Code	30200325
Hospital Revenue Code	302
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna Commercial	$58.65
Rate for Payer: Aetna New Business (MI Preferred)	$44.85
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$48.30
Rate for Payer: Cofinity Commercial	$59.34
Rate for Payer: Healthscope Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.65
Rate for Payer: PHP Commercial	$58.65
Rate for Payer: Priority Health Cigna Priority Health	$48.30
Rate for Payer: Priority Health SBD	$43.47

HC TREPONEMA PALLIDUM ANTIBODY FT

Facility

$69.00

Service Code	CPT 86780
Hospital Charge Code	30200325
Hospital Revenue Code	302
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna Commercial	$58.65
Rate for Payer: Aetna Medicare	$13.77
Rate for Payer: Aetna New Business (MI Preferred)	$44.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.55
Rate for Payer: Amish Plain Church Group Commercial	$16.55
Rate for Payer: BCBS Complete	$7.61
Rate for Payer: BCBS MAPPO	$13.24
Rate for Payer: BCBS Trust/PPO	$10.37
Rate for Payer: BCN Medicare Advantage	$13.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$59.34
Rate for Payer: Cofinity Commercial	$48.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.24
Rate for Payer: Healthscope Commercial	$62.10
Rate for Payer: Mclaren Medicaid	$7.24
Rate for Payer: Mclaren Medicare	$13.24
Rate for Payer: Meridian Medicaid	$7.61
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13.90
Rate for Payer: MI Amish Medical Board Commercial	$15.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.65
Rate for Payer: PACE Medicare	$12.58
Rate for Payer: PACE SWMI	$13.24
Rate for Payer: PHP Commercial	$58.65
Rate for Payer: PHP Medicare Advantage	$13.24
Rate for Payer: Priority Health Choice Medicaid	$7.24
Rate for Payer: Priority Health Cigna Priority Health	$48.30
Rate for Payer: Priority Health Medicare	$13.24
Rate for Payer: Priority Health SBD	$43.47
Rate for Payer: Railroad Medicare Medicare	$13.24
Rate for Payer: UHC All Payor (Choice/PPO)	$15.89
Rate for Payer: UHC Core	$22.50
Rate for Payer: UHC Dual Complete DSNP	$13.24
Rate for Payer: UHC Exchange	$13.24
Rate for Payer: UHC Medicare Advantage	$13.64
Rate for Payer: VA VA	$13.24

HC TRIAD CREAM

Facility

$27.16

Hospital Charge Code	27000605
Hospital Revenue Code	270
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$24.44
Rate for Payer: Aetna Commercial	$23.09
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cofinity Commercial	$19.01
Rate for Payer: Cofinity Commercial	$23.36
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.09
Rate for Payer: PHP Commercial	$23.09
Rate for Payer: Priority Health Cigna Priority Health	$19.01
Rate for Payer: Priority Health SBD	$17.11

HC TRIAD CREAM

Facility

$27.16

Hospital Charge Code	27000605
Hospital Revenue Code	270
Min. Negotiated Rate	$10.86
Max. Negotiated Rate	$24.44
Rate for Payer: Aetna Commercial	$23.09
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: BCBS Complete	$10.86
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cofinity Commercial	$19.01
Rate for Payer: Cofinity Commercial	$23.36
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.09
Rate for Payer: PHP Commercial	$23.09
Rate for Payer: Priority Health Cigna Priority Health	$19.01
Rate for Payer: Priority Health SBD	$17.11

HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE

Facility

$66.30

Service Code	HCPCS 87798
Hospital Charge Code	30600206
Hospital Revenue Code	306
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$59.67
Rate for Payer: Aetna Commercial	$56.36
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$43.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCBS Trust/PPO	$27.48
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Cofinity Commercial	$46.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$59.67
Rate for Payer: Mclaren Medicaid	$19.19
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36.84
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.36
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$56.36
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$19.19
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$41.77
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$42.11
Rate for Payer: UHC Core	$59.65
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Exchange	$35.09
Rate for Payer: UHC Medicare Advantage	$36.14
Rate for Payer: VA VA	$35.09

HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE

Facility

$66.30

Service Code	CPT 87661
Hospital Charge Code	30600222
Hospital Revenue Code	306
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$59.67
Rate for Payer: Aetna Commercial	$56.36
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$43.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCBS Trust/PPO	$27.48
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cofinity Commercial	$46.41
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$59.67
Rate for Payer: Mclaren Medicaid	$19.19
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36.84
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.36
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$56.36
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$19.19
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$41.77
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$42.11
Rate for Payer: UHC Core	$57.44
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Exchange	$35.09
Rate for Payer: UHC Medicare Advantage	$36.14
Rate for Payer: VA VA	$35.09

HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE

Facility

$66.30

Service Code	CPT 87661
Hospital Charge Code	30600222
Hospital Revenue Code	306
Min. Negotiated Rate	$41.77
Max. Negotiated Rate	$59.67
Rate for Payer: Aetna Commercial	$56.36
Rate for Payer: Aetna New Business (MI Preferred)	$43.10
Rate for Payer: Cash Price	$53.04
Rate for Payer: Cofinity Commercial	$46.41
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Healthscope Commercial	$59.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.36
Rate for Payer: PHP Commercial	$56.36
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$41.77

Know your out-of-pocket cost for care.

All Charges