Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC TETANUS ANTIBODIES

Facility

$61.20

Service Code	CPT 86774
Hospital Charge Code	30200320
Hospital Revenue Code	302
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna Medicare	$15.39
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
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	$8.33
Rate for Payer: BCBS MAPPO	$14.80
Rate for Payer: BCN Medicare Advantage	$14.80
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.80
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Mclaren Medicaid	$7.93
Rate for Payer: Mclaren Medicare	$14.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.54
Rate for Payer: Meridian Medicaid	$8.33
Rate for Payer: MI Amish Medical Board Commercial	$17.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PACE Medicare	$14.06
Rate for Payer: PACE SWMI	$14.80
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: PHP Medicare Advantage	$14.80
Rate for Payer: Priority Health Choice Medicaid	$7.93
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health Medicare	$14.80
Rate for Payer: Priority Health SBD	$38.56
Rate for Payer: Railroad Medicare Medicare	$14.80
Rate for Payer: UHC All Payor (Choice/PPO)	$41.66
Rate for Payer: UHC Dual Complete DSNP	$14.80
Rate for Payer: UHC Medicare Advantage	$14.80
Rate for Payer: UHCCP Medicaid	$8.33
Rate for Payer: VA VA	$14.80

HC TETANUS ANTIBODIES

Facility

$61.20

Service Code	CPT 86774
Hospital Charge Code	30200320
Hospital Revenue Code	302
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 TETANUS/DIPHTHERIA/PERTUSIS VACCINE

Facility

$124.62

Service Code	CPT 90715
Hospital Charge Code	63600022
Hospital Revenue Code	636
Min. Negotiated Rate	$78.51
Max. Negotiated Rate	$112.16
Rate for Payer: Aetna Commercial	$105.93
Rate for Payer: Aetna New Business (MI Preferred)	$81.00
Rate for Payer: Cash Price	$99.70
Rate for Payer: Cofinity Commercial	$107.17
Rate for Payer: Cofinity Commercial	$87.23
Rate for Payer: Cofinity Medicare Advantage	$87.23
Rate for Payer: Encore Health Key Benefits Commercial	$99.70
Rate for Payer: Healthscope Commercial	$112.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.93
Rate for Payer: PHP Commercial	$105.93
Rate for Payer: Priority Health Cigna Priority Health	$81.00
Rate for Payer: Priority Health SBD	$78.51

HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE

Facility

$124.62

Service Code	CPT 90715
Hospital Charge Code	63600022
Hospital Revenue Code	636
Min. Negotiated Rate	$49.85
Max. Negotiated Rate	$112.16
Rate for Payer: Aetna Commercial	$105.93
Rate for Payer: Aetna Medicare	$62.31
Rate for Payer: Aetna New Business (MI Preferred)	$81.00
Rate for Payer: BCBS Complete	$49.85
Rate for Payer: Cash Price	$99.70
Rate for Payer: Cofinity Commercial	$107.17
Rate for Payer: Cofinity Commercial	$87.23
Rate for Payer: Cofinity Medicare Advantage	$87.23
Rate for Payer: Encore Health Key Benefits Commercial	$99.70
Rate for Payer: Healthscope Commercial	$112.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.93
Rate for Payer: PHP Commercial	$105.93
Rate for Payer: Priority Health Cigna Priority Health	$81.00
Rate for Payer: Priority Health SBD	$78.51

HC THC URINE CONFIRM

Facility

$63.24

Service Code	CPT 80349
Hospital Charge Code	30100568
Hospital Revenue Code	301
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna Medicare	$31.62
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: BCBS Complete	$25.30
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC THC URINE CONFIRM

Facility

$63.24

Service Code	CPT 80349
Hospital Charge Code	30100568
Hospital Revenue Code	301
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC THEOPHYLLINE LEVEL

Facility

$92.21

Service Code	CPT 80198
Hospital Charge Code	30100048
Hospital Revenue Code	301
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$82.99
Rate for Payer: Aetna Commercial	$78.38
Rate for Payer: Aetna Medicare	$14.71
Rate for Payer: Aetna New Business (MI Preferred)	$59.94
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	$7.96
Rate for Payer: BCBS MAPPO	$14.14
Rate for Payer: BCN Medicare Advantage	$14.14
Rate for Payer: Cash Price	$73.77
Rate for Payer: Cash Price	$73.77
Rate for Payer: Cofinity Commercial	$79.30
Rate for Payer: Cofinity Commercial	$64.55
Rate for Payer: Cofinity Medicare Advantage	$64.55
Rate for Payer: Encore Health Key Benefits Commercial	$73.77
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.14
Rate for Payer: Healthscope Commercial	$82.99
Rate for Payer: Mclaren Medicaid	$7.58
Rate for Payer: Mclaren Medicare	$14.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.85
Rate for Payer: Meridian Medicaid	$7.96
Rate for Payer: MI Amish Medical Board Commercial	$16.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.38
Rate for Payer: PACE Medicare	$13.43
Rate for Payer: PACE SWMI	$14.14
Rate for Payer: PHP Commercial	$78.38
Rate for Payer: PHP Medicare Advantage	$14.14
Rate for Payer: Priority Health Choice Medicaid	$7.58
Rate for Payer: Priority Health Cigna Priority Health	$59.94
Rate for Payer: Priority Health Medicare	$14.14
Rate for Payer: Priority Health SBD	$58.09
Rate for Payer: Railroad Medicare Medicare	$14.14
Rate for Payer: UHC All Payor (Choice/PPO)	$39.80
Rate for Payer: UHC Dual Complete DSNP	$14.14
Rate for Payer: UHC Medicare Advantage	$14.14
Rate for Payer: UHCCP Medicaid	$7.96
Rate for Payer: VA VA	$14.14

HC THEOPHYLLINE LEVEL

Facility

$92.21

Service Code	CPT 80198
Hospital Charge Code	30100048
Hospital Revenue Code	301
Min. Negotiated Rate	$58.09
Max. Negotiated Rate	$82.99
Rate for Payer: Aetna Commercial	$78.38
Rate for Payer: Aetna New Business (MI Preferred)	$59.94
Rate for Payer: Cash Price	$73.77
Rate for Payer: Cofinity Commercial	$64.55
Rate for Payer: Cofinity Commercial	$79.30
Rate for Payer: Cofinity Medicare Advantage	$64.55
Rate for Payer: Encore Health Key Benefits Commercial	$73.77
Rate for Payer: Healthscope Commercial	$82.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.38
Rate for Payer: PHP Commercial	$78.38
Rate for Payer: Priority Health Cigna Priority Health	$59.94
Rate for Payer: Priority Health SBD	$58.09

HC THERAPEUTIC ACTIVITIES EA 15 MIN

Facility

$98.84

Service Code	CPT 97530
Hospital Charge Code	42000028
Hospital Revenue Code	420
Min. Negotiated Rate	$39.54
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$84.01
Rate for Payer: Aetna Medicare	$49.42
Rate for Payer: Aetna New Business (MI Preferred)	$64.25
Rate for Payer: BCBS Complete	$39.54
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cofinity Commercial	$85.00
Rate for Payer: Cofinity Commercial	$69.19
Rate for Payer: Cofinity Medicare Advantage	$69.19
Rate for Payer: Encore Health Key Benefits Commercial	$79.07
Rate for Payer: Healthscope Commercial	$88.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.01
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$84.01
Rate for Payer: Priority Health Cigna Priority Health	$64.25
Rate for Payer: Priority Health SBD	$62.27
Rate for Payer: UHC Core	$73.14
Rate for Payer: UHC Exchange	$73.14

HC THERAPEUTIC ACTIVITIES EA 15 MIN

Facility

$98.84

Service Code	CPT 97530
Hospital Charge Code	42000028
Hospital Revenue Code	420
Min. Negotiated Rate	$62.27
Max. Negotiated Rate	$88.96
Rate for Payer: Aetna Commercial	$84.01
Rate for Payer: Aetna New Business (MI Preferred)	$64.25
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cofinity Commercial	$69.19
Rate for Payer: Cofinity Commercial	$85.00
Rate for Payer: Cofinity Medicare Advantage	$69.19
Rate for Payer: Encore Health Key Benefits Commercial	$79.07
Rate for Payer: Healthscope Commercial	$88.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.01
Rate for Payer: PHP Commercial	$84.01
Rate for Payer: Priority Health Cigna Priority Health	$64.25
Rate for Payer: Priority Health SBD	$62.27

HC THERAPEUTIC APHERESIS PLASMA PHERESIS

Facility

$2,555.49

Service Code	CPT 36514
Hospital Charge Code	36100520
Hospital Revenue Code	761
Min. Negotiated Rate	$856.94
Max. Negotiated Rate	$4,500.35
Rate for Payer: Aetna Commercial	$2,172.17
Rate for Payer: Aetna Medicare	$1,662.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,661.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,998.45
Rate for Payer: Amish Plain Church Group Commercial	$1,998.45
Rate for Payer: BCBS Complete	$899.78
Rate for Payer: BCBS MAPPO	$1,598.76
Rate for Payer: BCN Medicare Advantage	$1,598.76
Rate for Payer: Cash Price	$2,044.39
Rate for Payer: Cash Price	$2,044.39
Rate for Payer: Cofinity Commercial	$2,197.72
Rate for Payer: Cofinity Commercial	$1,788.84
Rate for Payer: Cofinity Medicare Advantage	$1,788.84
Rate for Payer: Encore Health Key Benefits Commercial	$2,044.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,598.76
Rate for Payer: Healthscope Commercial	$2,299.94
Rate for Payer: Mclaren Medicaid	$856.94
Rate for Payer: Mclaren Medicare	$1,598.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,678.70
Rate for Payer: Meridian Medicaid	$899.78
Rate for Payer: MI Amish Medical Board Commercial	$1,838.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,172.17
Rate for Payer: PACE Medicare	$1,518.82
Rate for Payer: PACE SWMI	$1,598.76
Rate for Payer: PHP Commercial	$2,172.17
Rate for Payer: PHP Medicare Advantage	$1,598.76
Rate for Payer: Priority Health Choice Medicaid	$856.94
Rate for Payer: Priority Health Cigna Priority Health	$1,661.07
Rate for Payer: Priority Health Medicare	$1,598.76
Rate for Payer: Priority Health SBD	$1,609.96
Rate for Payer: Railroad Medicare Medicare	$1,598.76
Rate for Payer: UHC All Payor (Choice/PPO)	$4,500.35
Rate for Payer: UHC Dual Complete DSNP	$1,598.76
Rate for Payer: UHC Medicare Advantage	$1,598.76
Rate for Payer: UHCCP Medicaid	$900.10
Rate for Payer: VA VA	$1,598.76

HC THERAPEUTIC APHERESIS PLASMA PHERESIS

Facility

$2,555.49

Service Code	CPT 36514
Hospital Charge Code	36100520
Hospital Revenue Code	761
Min. Negotiated Rate	$1,609.96
Max. Negotiated Rate	$2,299.94
Rate for Payer: Aetna Commercial	$2,172.17
Rate for Payer: Aetna New Business (MI Preferred)	$1,661.07
Rate for Payer: Cash Price	$2,044.39
Rate for Payer: Cofinity Commercial	$1,788.84
Rate for Payer: Cofinity Commercial	$2,197.72
Rate for Payer: Cofinity Medicare Advantage	$1,788.84
Rate for Payer: Encore Health Key Benefits Commercial	$2,044.39
Rate for Payer: Healthscope Commercial	$2,299.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,172.17
Rate for Payer: PHP Commercial	$2,172.17
Rate for Payer: Priority Health Cigna Priority Health	$1,661.07
Rate for Payer: Priority Health SBD	$1,609.96

HC THERAPEUTIC APHERESIS RED BLOOD CELLS

Facility

$2,481.05

Service Code	CPT 36512
Hospital Charge Code	76100326
Hospital Revenue Code	761
Min. Negotiated Rate	$1,563.06
Max. Negotiated Rate	$2,232.95
Rate for Payer: Aetna Commercial	$2,108.89
Rate for Payer: Aetna New Business (MI Preferred)	$1,612.68
Rate for Payer: Cash Price	$1,984.84
Rate for Payer: Cofinity Commercial	$1,736.73
Rate for Payer: Cofinity Commercial	$2,133.70
Rate for Payer: Cofinity Medicare Advantage	$1,736.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,984.84
Rate for Payer: Healthscope Commercial	$2,232.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,108.89
Rate for Payer: PHP Commercial	$2,108.89
Rate for Payer: Priority Health Cigna Priority Health	$1,612.68
Rate for Payer: Priority Health SBD	$1,563.06

HC THERAPEUTIC APHERESIS RED BLOOD CELLS

Facility

$2,481.05

Service Code	CPT 36512
Hospital Charge Code	76100326
Hospital Revenue Code	761
Min. Negotiated Rate	$856.94
Max. Negotiated Rate	$4,500.35
Rate for Payer: Aetna Commercial	$2,108.89
Rate for Payer: Aetna Medicare	$1,662.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,612.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,998.45
Rate for Payer: Amish Plain Church Group Commercial	$1,998.45
Rate for Payer: BCBS Complete	$899.78
Rate for Payer: BCBS MAPPO	$1,598.76
Rate for Payer: BCN Medicare Advantage	$1,598.76
Rate for Payer: Cash Price	$1,984.84
Rate for Payer: Cash Price	$1,984.84
Rate for Payer: Cofinity Commercial	$2,133.70
Rate for Payer: Cofinity Commercial	$1,736.73
Rate for Payer: Cofinity Medicare Advantage	$1,736.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,984.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,598.76
Rate for Payer: Healthscope Commercial	$2,232.95
Rate for Payer: Mclaren Medicaid	$856.94
Rate for Payer: Mclaren Medicare	$1,598.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,678.70
Rate for Payer: Meridian Medicaid	$899.78
Rate for Payer: MI Amish Medical Board Commercial	$1,838.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,108.89
Rate for Payer: PACE Medicare	$1,518.82
Rate for Payer: PACE SWMI	$1,598.76
Rate for Payer: PHP Commercial	$2,108.89
Rate for Payer: PHP Medicare Advantage	$1,598.76
Rate for Payer: Priority Health Choice Medicaid	$856.94
Rate for Payer: Priority Health Cigna Priority Health	$1,612.68
Rate for Payer: Priority Health Medicare	$1,598.76
Rate for Payer: Priority Health SBD	$1,563.06
Rate for Payer: Railroad Medicare Medicare	$1,598.76
Rate for Payer: UHC All Payor (Choice/PPO)	$4,500.35
Rate for Payer: UHC Dual Complete DSNP	$1,598.76
Rate for Payer: UHC Medicare Advantage	$1,598.76
Rate for Payer: UHCCP Medicaid	$900.10
Rate for Payer: VA VA	$1,598.76

HC THERAPEUTIC APHERESIS WHITE BLOOD CELL

Facility

$2,481.05

Service Code	CPT 36511
Hospital Charge Code	76100327
Hospital Revenue Code	761
Min. Negotiated Rate	$1,563.06
Max. Negotiated Rate	$2,232.95
Rate for Payer: Aetna Commercial	$2,108.89
Rate for Payer: Aetna New Business (MI Preferred)	$1,612.68
Rate for Payer: Cash Price	$1,984.84
Rate for Payer: Cofinity Commercial	$1,736.73
Rate for Payer: Cofinity Commercial	$2,133.70
Rate for Payer: Cofinity Medicare Advantage	$1,736.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,984.84
Rate for Payer: Healthscope Commercial	$2,232.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,108.89
Rate for Payer: PHP Commercial	$2,108.89
Rate for Payer: Priority Health Cigna Priority Health	$1,612.68
Rate for Payer: Priority Health SBD	$1,563.06

HC THERAPEUTIC APHERESIS WHITE BLOOD CELL

Facility

$2,481.05

Service Code	CPT 36511
Hospital Charge Code	76100327
Hospital Revenue Code	761
Min. Negotiated Rate	$856.94
Max. Negotiated Rate	$4,500.35
Rate for Payer: Aetna Commercial	$2,108.89
Rate for Payer: Aetna Medicare	$1,662.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,612.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,998.45
Rate for Payer: Amish Plain Church Group Commercial	$1,998.45
Rate for Payer: BCBS Complete	$899.78
Rate for Payer: BCBS MAPPO	$1,598.76
Rate for Payer: BCN Medicare Advantage	$1,598.76
Rate for Payer: Cash Price	$1,984.84
Rate for Payer: Cash Price	$1,984.84
Rate for Payer: Cofinity Commercial	$2,133.70
Rate for Payer: Cofinity Commercial	$1,736.73
Rate for Payer: Cofinity Medicare Advantage	$1,736.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,984.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,598.76
Rate for Payer: Healthscope Commercial	$2,232.95
Rate for Payer: Mclaren Medicaid	$856.94
Rate for Payer: Mclaren Medicare	$1,598.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,678.70
Rate for Payer: Meridian Medicaid	$899.78
Rate for Payer: MI Amish Medical Board Commercial	$1,838.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,108.89
Rate for Payer: PACE Medicare	$1,518.82
Rate for Payer: PACE SWMI	$1,598.76
Rate for Payer: PHP Commercial	$2,108.89
Rate for Payer: PHP Medicare Advantage	$1,598.76
Rate for Payer: Priority Health Choice Medicaid	$856.94
Rate for Payer: Priority Health Cigna Priority Health	$1,612.68
Rate for Payer: Priority Health Medicare	$1,598.76
Rate for Payer: Priority Health SBD	$1,563.06
Rate for Payer: Railroad Medicare Medicare	$1,598.76
Rate for Payer: UHC All Payor (Choice/PPO)	$4,500.35
Rate for Payer: UHC Dual Complete DSNP	$1,598.76
Rate for Payer: UHC Medicare Advantage	$1,598.76
Rate for Payer: UHCCP Medicaid	$900.10
Rate for Payer: VA VA	$1,598.76

HC THERAPEUTIC EX EACH 15 MIN

Facility

$114.44

Service Code	CPT 97110
Hospital Charge Code	42000020
Hospital Revenue Code	420
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$97.27
Rate for Payer: Aetna New Business (MI Preferred)	$74.39
Rate for Payer: Cash Price	$91.55
Rate for Payer: Cofinity Commercial	$80.11
Rate for Payer: Cofinity Commercial	$98.42
Rate for Payer: Cofinity Medicare Advantage	$80.11
Rate for Payer: Encore Health Key Benefits Commercial	$91.55
Rate for Payer: Healthscope Commercial	$103.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.27
Rate for Payer: PHP Commercial	$97.27
Rate for Payer: Priority Health Cigna Priority Health	$74.39
Rate for Payer: Priority Health SBD	$72.10

HC THERAPEUTIC EX EACH 15 MIN

Facility

$114.44

Service Code	CPT 97110
Hospital Charge Code	42000020
Hospital Revenue Code	420
Min. Negotiated Rate	$45.78
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$97.27
Rate for Payer: Aetna Medicare	$57.22
Rate for Payer: Aetna New Business (MI Preferred)	$74.39
Rate for Payer: BCBS Complete	$45.78
Rate for Payer: Cash Price	$91.55
Rate for Payer: Cash Price	$91.55
Rate for Payer: Cofinity Commercial	$98.42
Rate for Payer: Cofinity Commercial	$80.11
Rate for Payer: Cofinity Medicare Advantage	$80.11
Rate for Payer: Encore Health Key Benefits Commercial	$91.55
Rate for Payer: Healthscope Commercial	$103.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.27
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$97.27
Rate for Payer: Priority Health Cigna Priority Health	$74.39
Rate for Payer: Priority Health SBD	$72.10
Rate for Payer: UHC Core	$84.69
Rate for Payer: UHC Exchange	$84.69

HC THERAPEUTIC PHLEBOTOMY

Facility

$863.24

Service Code	CPT 99195
Hospital Charge Code	76100010
Hospital Revenue Code	761
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$776.92
Rate for Payer: Aetna Commercial	$733.75
Rate for Payer: Aetna Medicare	$130.74
Rate for Payer: Aetna New Business (MI Preferred)	$561.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$157.14
Rate for Payer: Amish Plain Church Group Commercial	$157.14
Rate for Payer: BCBS Complete	$70.75
Rate for Payer: BCBS MAPPO	$125.71
Rate for Payer: BCN Medicare Advantage	$125.71
Rate for Payer: Cash Price	$690.59
Rate for Payer: Cash Price	$690.59
Rate for Payer: Cofinity Commercial	$742.39
Rate for Payer: Cofinity Commercial	$604.27
Rate for Payer: Cofinity Medicare Advantage	$604.27
Rate for Payer: Encore Health Key Benefits Commercial	$690.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$125.71
Rate for Payer: Healthscope Commercial	$776.92
Rate for Payer: Mclaren Medicaid	$67.38
Rate for Payer: Mclaren Medicare	$125.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$132.00
Rate for Payer: Meridian Medicaid	$70.75
Rate for Payer: MI Amish Medical Board Commercial	$144.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$733.75
Rate for Payer: PACE Medicare	$119.42
Rate for Payer: PACE SWMI	$125.71
Rate for Payer: PHP Commercial	$733.75
Rate for Payer: PHP Medicare Advantage	$125.71
Rate for Payer: Priority Health Choice Medicaid	$67.38
Rate for Payer: Priority Health Cigna Priority Health	$561.11
Rate for Payer: Priority Health Medicare	$125.71
Rate for Payer: Priority Health SBD	$543.84
Rate for Payer: Railroad Medicare Medicare	$125.71
Rate for Payer: UHC All Payor (Choice/PPO)	$353.86
Rate for Payer: UHC Dual Complete DSNP	$125.71
Rate for Payer: UHC Medicare Advantage	$125.71
Rate for Payer: UHCCP Medicaid	$70.77
Rate for Payer: VA VA	$125.71

HC THERAPEUTIC PHLEBOTOMY

Facility

$863.24

Service Code	CPT 99195
Hospital Charge Code	76100010
Hospital Revenue Code	761
Min. Negotiated Rate	$543.84
Max. Negotiated Rate	$776.92
Rate for Payer: Aetna Commercial	$733.75
Rate for Payer: Aetna New Business (MI Preferred)	$561.11
Rate for Payer: Cash Price	$690.59
Rate for Payer: Cofinity Commercial	$604.27
Rate for Payer: Cofinity Commercial	$742.39
Rate for Payer: Cofinity Medicare Advantage	$604.27
Rate for Payer: Encore Health Key Benefits Commercial	$690.59
Rate for Payer: Healthscope Commercial	$776.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$733.75
Rate for Payer: PHP Commercial	$733.75
Rate for Payer: Priority Health Cigna Priority Health	$561.11
Rate for Payer: Priority Health SBD	$543.84

HC THERASKIN PER SQ CM (116 SQ CM)

Facility

$59.43

Service Code	HCPCS Q4121
Hospital Charge Code	63600219
Hospital Revenue Code	636
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$53.49
Rate for Payer: Aetna Commercial	$50.52
Rate for Payer: Aetna New Business (MI Preferred)	$38.63
Rate for Payer: Cash Price	$47.54
Rate for Payer: Cofinity Commercial	$41.60
Rate for Payer: Cofinity Commercial	$51.11
Rate for Payer: Cofinity Medicare Advantage	$41.60
Rate for Payer: Encore Health Key Benefits Commercial	$47.54
Rate for Payer: Healthscope Commercial	$53.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.52
Rate for Payer: PHP Commercial	$50.52
Rate for Payer: Priority Health Cigna Priority Health	$38.63
Rate for Payer: Priority Health SBD	$37.44

HC THERASKIN PER SQ CM (116 SQ CM)

Facility

$59.43

Service Code	HCPCS Q4121
Hospital Charge Code	63600219
Hospital Revenue Code	636
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$53.49
Rate for Payer: Aetna Commercial	$50.52
Rate for Payer: Aetna Medicare	$29.71
Rate for Payer: Aetna New Business (MI Preferred)	$38.63
Rate for Payer: BCBS Complete	$23.77
Rate for Payer: Cash Price	$47.54
Rate for Payer: Cofinity Commercial	$41.60
Rate for Payer: Cofinity Commercial	$51.11
Rate for Payer: Cofinity Medicare Advantage	$41.60
Rate for Payer: Encore Health Key Benefits Commercial	$47.54
Rate for Payer: Healthscope Commercial	$53.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.52
Rate for Payer: PHP Commercial	$50.52
Rate for Payer: Priority Health Cigna Priority Health	$38.63
Rate for Payer: Priority Health SBD	$37.44

HC THERASKIN PER SQ CM (13 SQ CM)

Facility

$184.13

Service Code	CPT Q4121
Hospital Charge Code	63600064
Hospital Revenue Code	636
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$165.72
Rate for Payer: Aetna Commercial	$156.51
Rate for Payer: Aetna New Business (MI Preferred)	$119.68
Rate for Payer: Cash Price	$147.30
Rate for Payer: Cofinity Commercial	$128.89
Rate for Payer: Cofinity Commercial	$158.35
Rate for Payer: Cofinity Medicare Advantage	$128.89
Rate for Payer: Encore Health Key Benefits Commercial	$147.30
Rate for Payer: Healthscope Commercial	$165.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.51
Rate for Payer: PHP Commercial	$156.51
Rate for Payer: Priority Health Cigna Priority Health	$119.68
Rate for Payer: Priority Health SBD	$116.00

HC THERASKIN PER SQ CM (13 SQ CM)

Facility

$184.13

Service Code	CPT Q4121
Hospital Charge Code	63600064
Hospital Revenue Code	636
Min. Negotiated Rate	$73.65
Max. Negotiated Rate	$165.72
Rate for Payer: Aetna Commercial	$156.51
Rate for Payer: Aetna Medicare	$92.06
Rate for Payer: Aetna New Business (MI Preferred)	$119.68
Rate for Payer: BCBS Complete	$73.65
Rate for Payer: Cash Price	$147.30
Rate for Payer: Cofinity Commercial	$128.89
Rate for Payer: Cofinity Commercial	$158.35
Rate for Payer: Cofinity Medicare Advantage	$128.89
Rate for Payer: Encore Health Key Benefits Commercial	$147.30
Rate for Payer: Healthscope Commercial	$165.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.51
Rate for Payer: PHP Commercial	$156.51
Rate for Payer: Priority Health Cigna Priority Health	$119.68
Rate for Payer: Priority Health SBD	$116.00

HC THERASKIN PER SQ CM (39 SQ CM)

Facility

$84.55

Service Code	CPT Q4121
Hospital Charge Code	63600065
Hospital Revenue Code	636
Min. Negotiated Rate	$53.27
Max. Negotiated Rate	$76.09
Rate for Payer: Aetna Commercial	$71.87
Rate for Payer: Aetna New Business (MI Preferred)	$54.96
Rate for Payer: Cash Price	$67.64
Rate for Payer: Cofinity Commercial	$59.19
Rate for Payer: Cofinity Commercial	$72.71
Rate for Payer: Cofinity Medicare Advantage	$59.19
Rate for Payer: Encore Health Key Benefits Commercial	$67.64
Rate for Payer: Healthscope Commercial	$76.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.87
Rate for Payer: PHP Commercial	$71.87
Rate for Payer: Priority Health Cigna Priority Health	$54.96
Rate for Payer: Priority Health SBD	$53.27

Know your out-of-pocket cost for care.

All Charges