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Charge Type Setting Price  
Service Code HCPCS 38740
Min. Negotiated Rate $681.81
Max. Negotiated Rate $1,366.95
Rate for Payer: Aetna Commercial $913.63
Rate for Payer: Aetna Medicare $709.08
Rate for Payer: Aetna New Business (MI Preferred) $981.81
Rate for Payer: Aetna New Business (MI Preferred) $913.63
Rate for Payer: BCBS Complete $841.20
Rate for Payer: BCBS MAPPO $681.81
Rate for Payer: BCN Medicare Advantage $681.81
Rate for Payer: Cash Price $1,682.40
Rate for Payer: Cash Price $1,682.40
Rate for Payer: Cofinity Commercial $981.81
Rate for Payer: Cofinity Commercial $913.63
Rate for Payer: Health Alliance Plan Medicare Advantage $681.81
Rate for Payer: Healthscope Commercial $1,090.90
Rate for Payer: Healthscope Commercial $1,261.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage $715.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,366.95
Rate for Payer: Nomi Health Commercial $818.17
Rate for Payer: PACE SWMI $681.81
Rate for Payer: PHP Medicare Advantage $681.81
Rate for Payer: Priority Health Cigna Priority Health $1,366.95
Rate for Payer: Priority Health Medicare $681.81
Rate for Payer: UHC Dual Complete DSNP $681.81
Rate for Payer: UHC Medicare Advantage $681.81
Service Code NDC 68084099611
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $2.04
Max. Negotiated Rate $4.58
Rate for Payer: Aetna Commercial $4.33
Rate for Payer: Aetna Medicare $2.54
Rate for Payer: Aetna New Business (MI Preferred) $3.31
Rate for Payer: BCBS Complete $2.04
Rate for Payer: Cash Price $4.07
Rate for Payer: Cofinity Commercial $3.56
Rate for Payer: Cofinity Commercial $4.38
Rate for Payer: Cofinity Medicare Advantage $3.56
Rate for Payer: Encore Health Key Benefits Commercial $4.07
Rate for Payer: Healthscope Commercial $4.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.33
Rate for Payer: PHP Commercial $4.33
Rate for Payer: Priority Health Cigna Priority Health $3.31
Rate for Payer: Priority Health SBD $3.21
Service Code NDC 68084099601
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $320.54
Max. Negotiated Rate $457.92
Rate for Payer: Aetna Commercial $432.48
Rate for Payer: Aetna New Business (MI Preferred) $330.72
Rate for Payer: Cash Price $407.04
Rate for Payer: Cofinity Commercial $356.16
Rate for Payer: Cofinity Commercial $437.57
Rate for Payer: Cofinity Medicare Advantage $356.16
Rate for Payer: Encore Health Key Benefits Commercial $407.04
Rate for Payer: Healthscope Commercial $457.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial $432.48
Rate for Payer: PHP Commercial $432.48
Rate for Payer: Priority Health Cigna Priority Health $330.72
Rate for Payer: Priority Health SBD $320.54
Service Code NDC 51079063001
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $4.32
Max. Negotiated Rate $6.17
Rate for Payer: Aetna Commercial $5.83
Rate for Payer: Aetna New Business (MI Preferred) $4.46
Rate for Payer: Cash Price $5.49
Rate for Payer: Cofinity Commercial $4.80
Rate for Payer: Cofinity Commercial $5.90
Rate for Payer: Cofinity Medicare Advantage $4.80
Rate for Payer: Encore Health Key Benefits Commercial $5.49
Rate for Payer: Healthscope Commercial $6.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial $5.83
Rate for Payer: PHP Commercial $5.83
Rate for Payer: Priority Health Cigna Priority Health $4.46
Rate for Payer: Priority Health SBD $4.32
Service Code NDC 00093406701
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $156.18
Max. Negotiated Rate $351.40
Rate for Payer: Aetna Commercial $331.88
Rate for Payer: Aetna Medicare $195.22
Rate for Payer: Aetna New Business (MI Preferred) $253.79
Rate for Payer: BCBS Complete $156.18
Rate for Payer: Cash Price $312.36
Rate for Payer: Cofinity Commercial $273.31
Rate for Payer: Cofinity Commercial $335.79
Rate for Payer: Cofinity Medicare Advantage $273.31
Rate for Payer: Encore Health Key Benefits Commercial $312.36
Rate for Payer: Healthscope Commercial $351.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial $331.88
Rate for Payer: PHP Commercial $331.88
Rate for Payer: Priority Health Cigna Priority Health $253.79
Rate for Payer: Priority Health SBD $245.98
Service Code NDC 51079063001
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $2.74
Max. Negotiated Rate $6.17
Rate for Payer: Aetna Commercial $5.83
Rate for Payer: Aetna Medicare $3.43
Rate for Payer: Aetna New Business (MI Preferred) $4.46
Rate for Payer: BCBS Complete $2.74
Rate for Payer: Cash Price $5.49
Rate for Payer: Cofinity Commercial $4.80
Rate for Payer: Cofinity Commercial $5.90
Rate for Payer: Cofinity Medicare Advantage $4.80
Rate for Payer: Encore Health Key Benefits Commercial $5.49
Rate for Payer: Healthscope Commercial $6.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial $5.83
Rate for Payer: PHP Commercial $5.83
Rate for Payer: Priority Health Cigna Priority Health $4.46
Rate for Payer: Priority Health SBD $4.32
Service Code NDC 51079063020
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $432.13
Max. Negotiated Rate $617.33
Rate for Payer: Aetna Commercial $583.03
Rate for Payer: Aetna New Business (MI Preferred) $445.85
Rate for Payer: Cash Price $548.74
Rate for Payer: Cofinity Commercial $480.14
Rate for Payer: Cofinity Commercial $589.89
Rate for Payer: Cofinity Medicare Advantage $480.14
Rate for Payer: Encore Health Key Benefits Commercial $548.74
Rate for Payer: Healthscope Commercial $617.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial $583.03
Rate for Payer: PHP Commercial $583.03
Rate for Payer: Priority Health Cigna Priority Health $445.85
Rate for Payer: Priority Health SBD $432.13
Service Code NDC 00093406701
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $245.98
Max. Negotiated Rate $351.40
Rate for Payer: Aetna Commercial $331.88
Rate for Payer: Aetna New Business (MI Preferred) $253.79
Rate for Payer: Cash Price $312.36
Rate for Payer: Cofinity Commercial $273.31
Rate for Payer: Cofinity Commercial $335.79
Rate for Payer: Cofinity Medicare Advantage $273.31
Rate for Payer: Encore Health Key Benefits Commercial $312.36
Rate for Payer: Healthscope Commercial $351.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial $331.88
Rate for Payer: PHP Commercial $331.88
Rate for Payer: Priority Health Cigna Priority Health $253.79
Rate for Payer: Priority Health SBD $245.98
Service Code NDC 51079063020
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $274.37
Max. Negotiated Rate $617.33
Rate for Payer: Aetna Commercial $583.03
Rate for Payer: Aetna Medicare $342.96
Rate for Payer: Aetna New Business (MI Preferred) $445.85
Rate for Payer: BCBS Complete $274.37
Rate for Payer: Cash Price $548.74
Rate for Payer: Cofinity Commercial $480.14
Rate for Payer: Cofinity Commercial $589.89
Rate for Payer: Cofinity Medicare Advantage $480.14
Rate for Payer: Encore Health Key Benefits Commercial $548.74
Rate for Payer: Healthscope Commercial $617.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial $583.03
Rate for Payer: PHP Commercial $583.03
Rate for Payer: Priority Health Cigna Priority Health $445.85
Rate for Payer: Priority Health SBD $432.13
Service Code NDC 68084099601
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $203.52
Max. Negotiated Rate $457.92
Rate for Payer: Aetna Commercial $432.48
Rate for Payer: Aetna Medicare $254.40
Rate for Payer: Aetna New Business (MI Preferred) $330.72
Rate for Payer: BCBS Complete $203.52
Rate for Payer: Cash Price $407.04
Rate for Payer: Cofinity Commercial $356.16
Rate for Payer: Cofinity Commercial $437.57
Rate for Payer: Cofinity Medicare Advantage $356.16
Rate for Payer: Encore Health Key Benefits Commercial $407.04
Rate for Payer: Healthscope Commercial $457.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial $432.48
Rate for Payer: PHP Commercial $432.48
Rate for Payer: Priority Health Cigna Priority Health $330.72
Rate for Payer: Priority Health SBD $320.54
Service Code NDC 68084099611
Hospital Charge Code 6468
Hospital Revenue Code 637
Min. Negotiated Rate $3.21
Max. Negotiated Rate $4.58
Rate for Payer: Aetna Commercial $4.33
Rate for Payer: Aetna New Business (MI Preferred) $3.31
Rate for Payer: Cash Price $4.07
Rate for Payer: Cofinity Commercial $3.56
Rate for Payer: Cofinity Commercial $4.38
Rate for Payer: Cofinity Medicare Advantage $3.56
Rate for Payer: Encore Health Key Benefits Commercial $4.07
Rate for Payer: Healthscope Commercial $4.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.33
Rate for Payer: PHP Commercial $4.33
Rate for Payer: Priority Health Cigna Priority Health $3.31
Rate for Payer: Priority Health SBD $3.21
Service Code NDC 51079063120
Hospital Charge Code 6469
Hospital Revenue Code 637
Min. Negotiated Rate $311.24
Max. Negotiated Rate $700.30
Rate for Payer: Aetna Commercial $661.39
Rate for Payer: Aetna Medicare $389.06
Rate for Payer: Aetna New Business (MI Preferred) $505.77
Rate for Payer: BCBS Complete $311.24
Rate for Payer: Cash Price $622.49
Rate for Payer: Cofinity Commercial $544.68
Rate for Payer: Cofinity Commercial $669.17
Rate for Payer: Cofinity Medicare Advantage $544.68
Rate for Payer: Encore Health Key Benefits Commercial $622.49
Rate for Payer: Healthscope Commercial $700.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial $661.39
Rate for Payer: PHP Commercial $661.39
Rate for Payer: Priority Health Cigna Priority Health $505.77
Rate for Payer: Priority Health SBD $490.21
Service Code NDC 51079063101
Hospital Charge Code 6469
Hospital Revenue Code 637
Min. Negotiated Rate $4.91
Max. Negotiated Rate $7.01
Rate for Payer: Aetna Commercial $6.62
Rate for Payer: Aetna New Business (MI Preferred) $5.06
Rate for Payer: Cash Price $6.23
Rate for Payer: Cofinity Commercial $5.45
Rate for Payer: Cofinity Commercial $6.70
Rate for Payer: Cofinity Medicare Advantage $5.45
Rate for Payer: Encore Health Key Benefits Commercial $6.23
Rate for Payer: Healthscope Commercial $7.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial $6.62
Rate for Payer: PHP Commercial $6.62
Rate for Payer: Priority Health Cigna Priority Health $5.06
Rate for Payer: Priority Health SBD $4.91
Service Code NDC 51079063120
Hospital Charge Code 6469
Hospital Revenue Code 637
Min. Negotiated Rate $490.21
Max. Negotiated Rate $700.30
Rate for Payer: Aetna Commercial $661.39
Rate for Payer: Aetna New Business (MI Preferred) $505.77
Rate for Payer: Cash Price $622.49
Rate for Payer: Cofinity Commercial $544.68
Rate for Payer: Cofinity Commercial $669.17
Rate for Payer: Cofinity Medicare Advantage $544.68
Rate for Payer: Encore Health Key Benefits Commercial $622.49
Rate for Payer: Healthscope Commercial $700.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial $661.39
Rate for Payer: PHP Commercial $661.39
Rate for Payer: Priority Health Cigna Priority Health $505.77
Rate for Payer: Priority Health SBD $490.21
Service Code NDC 00904702161
Hospital Charge Code 6469
Hospital Revenue Code 637
Min. Negotiated Rate $255.36
Max. Negotiated Rate $574.56
Rate for Payer: Aetna Commercial $542.64
Rate for Payer: Aetna Medicare $319.20
Rate for Payer: Aetna New Business (MI Preferred) $414.96
Rate for Payer: BCBS Complete $255.36
Rate for Payer: Cash Price $510.72
Rate for Payer: Cofinity Commercial $446.88
Rate for Payer: Cofinity Commercial $549.02
Rate for Payer: Cofinity Medicare Advantage $446.88
Rate for Payer: Encore Health Key Benefits Commercial $510.72
Rate for Payer: Healthscope Commercial $574.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial $542.64
Rate for Payer: PHP Commercial $542.64
Rate for Payer: Priority Health Cigna Priority Health $414.96
Rate for Payer: Priority Health SBD $402.19
Service Code NDC 51079063101
Hospital Charge Code 6469
Hospital Revenue Code 637
Min. Negotiated Rate $3.12
Max. Negotiated Rate $7.01
Rate for Payer: Aetna Commercial $6.62
Rate for Payer: Aetna Medicare $3.90
Rate for Payer: Aetna New Business (MI Preferred) $5.06
Rate for Payer: BCBS Complete $3.12
Rate for Payer: Cash Price $6.23
Rate for Payer: Cofinity Commercial $5.45
Rate for Payer: Cofinity Commercial $6.70
Rate for Payer: Cofinity Medicare Advantage $5.45
Rate for Payer: Encore Health Key Benefits Commercial $6.23
Rate for Payer: Healthscope Commercial $7.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial $6.62
Rate for Payer: PHP Commercial $6.62
Rate for Payer: Priority Health Cigna Priority Health $5.06
Rate for Payer: Priority Health SBD $4.91
Service Code NDC 00904702161
Hospital Charge Code 6469
Hospital Revenue Code 637
Min. Negotiated Rate $402.19
Max. Negotiated Rate $574.56
Rate for Payer: Aetna Commercial $542.64
Rate for Payer: Aetna New Business (MI Preferred) $414.96
Rate for Payer: Cash Price $510.72
Rate for Payer: Cofinity Commercial $446.88
Rate for Payer: Cofinity Commercial $549.02
Rate for Payer: Cofinity Medicare Advantage $446.88
Rate for Payer: Encore Health Key Benefits Commercial $510.72
Rate for Payer: Healthscope Commercial $574.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial $542.64
Rate for Payer: PHP Commercial $542.64
Rate for Payer: Priority Health Cigna Priority Health $414.96
Rate for Payer: Priority Health SBD $402.19
Service Code NDC 59762535001
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $130.64
Max. Negotiated Rate $293.95
Rate for Payer: Aetna Commercial $277.62
Rate for Payer: Aetna Medicare $163.31
Rate for Payer: Aetna New Business (MI Preferred) $212.30
Rate for Payer: BCBS Complete $130.64
Rate for Payer: Cash Price $261.29
Rate for Payer: Cofinity Commercial $228.63
Rate for Payer: Cofinity Commercial $280.88
Rate for Payer: Cofinity Medicare Advantage $228.63
Rate for Payer: Encore Health Key Benefits Commercial $261.29
Rate for Payer: Healthscope Commercial $293.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial $277.62
Rate for Payer: PHP Commercial $277.62
Rate for Payer: Priority Health Cigna Priority Health $212.30
Rate for Payer: Priority Health SBD $205.76
Service Code NDC 51079063201
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $8.32
Max. Negotiated Rate $11.88
Rate for Payer: Aetna Commercial $11.22
Rate for Payer: Aetna New Business (MI Preferred) $8.58
Rate for Payer: Cash Price $10.56
Rate for Payer: Cofinity Commercial $11.35
Rate for Payer: Cofinity Commercial $9.24
Rate for Payer: Cofinity Medicare Advantage $9.24
Rate for Payer: Encore Health Key Benefits Commercial $10.56
Rate for Payer: Healthscope Commercial $11.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial $11.22
Rate for Payer: PHP Commercial $11.22
Rate for Payer: Priority Health Cigna Priority Health $8.58
Rate for Payer: Priority Health SBD $8.32
Service Code NDC 51079063220
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $527.77
Max. Negotiated Rate $1,187.48
Rate for Payer: Aetna Commercial $1,121.51
Rate for Payer: Aetna Medicare $659.71
Rate for Payer: Aetna New Business (MI Preferred) $857.62
Rate for Payer: BCBS Complete $527.77
Rate for Payer: Cash Price $1,055.54
Rate for Payer: Cofinity Commercial $1,134.70
Rate for Payer: Cofinity Commercial $923.59
Rate for Payer: Cofinity Medicare Advantage $923.59
Rate for Payer: Encore Health Key Benefits Commercial $1,055.54
Rate for Payer: Healthscope Commercial $1,187.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,121.51
Rate for Payer: PHP Commercial $1,121.51
Rate for Payer: Priority Health Cigna Priority Health $857.62
Rate for Payer: Priority Health SBD $831.23
Service Code NDC 51079063201
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $5.28
Max. Negotiated Rate $11.88
Rate for Payer: Aetna Commercial $11.22
Rate for Payer: Aetna Medicare $6.60
Rate for Payer: Aetna New Business (MI Preferred) $8.58
Rate for Payer: BCBS Complete $5.28
Rate for Payer: Cash Price $10.56
Rate for Payer: Cofinity Commercial $11.35
Rate for Payer: Cofinity Commercial $9.24
Rate for Payer: Cofinity Medicare Advantage $9.24
Rate for Payer: Encore Health Key Benefits Commercial $10.56
Rate for Payer: Healthscope Commercial $11.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial $11.22
Rate for Payer: PHP Commercial $11.22
Rate for Payer: Priority Health Cigna Priority Health $8.58
Rate for Payer: Priority Health SBD $8.32
Service Code NDC 51079063220
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $831.23
Max. Negotiated Rate $1,187.48
Rate for Payer: Aetna Commercial $1,121.51
Rate for Payer: Aetna New Business (MI Preferred) $857.62
Rate for Payer: Cash Price $1,055.54
Rate for Payer: Cofinity Commercial $1,134.70
Rate for Payer: Cofinity Commercial $923.59
Rate for Payer: Cofinity Medicare Advantage $923.59
Rate for Payer: Encore Health Key Benefits Commercial $1,055.54
Rate for Payer: Healthscope Commercial $1,187.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,121.51
Rate for Payer: PHP Commercial $1,121.51
Rate for Payer: Priority Health Cigna Priority Health $857.62
Rate for Payer: Priority Health SBD $831.23
Service Code NDC 00904702261
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $755.71
Max. Negotiated Rate $1,079.59
Rate for Payer: Aetna Commercial $1,019.61
Rate for Payer: Aetna New Business (MI Preferred) $779.70
Rate for Payer: Cash Price $959.63
Rate for Payer: Cofinity Commercial $1,031.60
Rate for Payer: Cofinity Commercial $839.68
Rate for Payer: Cofinity Medicare Advantage $839.68
Rate for Payer: Encore Health Key Benefits Commercial $959.63
Rate for Payer: Healthscope Commercial $1,079.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,019.61
Rate for Payer: PHP Commercial $1,019.61
Rate for Payer: Priority Health Cigna Priority Health $779.70
Rate for Payer: Priority Health SBD $755.71
Service Code NDC 59762535001
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $205.76
Max. Negotiated Rate $293.95
Rate for Payer: Aetna Commercial $277.62
Rate for Payer: Aetna New Business (MI Preferred) $212.30
Rate for Payer: Cash Price $261.29
Rate for Payer: Cofinity Commercial $228.63
Rate for Payer: Cofinity Commercial $280.88
Rate for Payer: Cofinity Medicare Advantage $228.63
Rate for Payer: Encore Health Key Benefits Commercial $261.29
Rate for Payer: Healthscope Commercial $293.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial $277.62
Rate for Payer: PHP Commercial $277.62
Rate for Payer: Priority Health Cigna Priority Health $212.30
Rate for Payer: Priority Health SBD $205.76
Service Code NDC 00904702261
Hospital Charge Code 6470
Hospital Revenue Code 637
Min. Negotiated Rate $479.82
Max. Negotiated Rate $1,079.59
Rate for Payer: Aetna Commercial $1,019.61
Rate for Payer: Aetna Medicare $599.77
Rate for Payer: Aetna New Business (MI Preferred) $779.70
Rate for Payer: BCBS Complete $479.82
Rate for Payer: Cash Price $959.63
Rate for Payer: Cofinity Commercial $1,031.60
Rate for Payer: Cofinity Commercial $839.68
Rate for Payer: Cofinity Medicare Advantage $839.68
Rate for Payer: Encore Health Key Benefits Commercial $959.63
Rate for Payer: Healthscope Commercial $1,079.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,019.61
Rate for Payer: PHP Commercial $1,019.61
Rate for Payer: Priority Health Cigna Priority Health $779.70
Rate for Payer: Priority Health SBD $755.71