Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

THIAMINE HCL (VITAMIN B1) 100 MG TABLET

Facility

$182.13

Service Code	NDC 50268085115
Hospital Charge Code	7877
Hospital Revenue Code	637
Min. Negotiated Rate	$114.74
Max. Negotiated Rate	$163.92
Rate for Payer: Aetna Commercial	$154.81
Rate for Payer: Aetna New Business (MI Preferred)	$118.38
Rate for Payer: Cash Price	$145.70
Rate for Payer: Cofinity Commercial	$127.49
Rate for Payer: Cofinity Commercial	$156.63
Rate for Payer: Cofinity Medicare Advantage	$127.49
Rate for Payer: Encore Health Key Benefits Commercial	$145.70
Rate for Payer: Healthscope Commercial	$163.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.81
Rate for Payer: PHP Commercial	$154.81
Rate for Payer: Priority Health Cigna Priority Health	$118.38
Rate for Payer: Priority Health SBD	$114.74

THIAMINE HCL (VITAMIN B1) 100 MG TABLET

Facility

$3.65

Service Code	NDC 50268085111
Hospital Charge Code	7877
Hospital Revenue Code	637
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna Commercial	$3.10
Rate for Payer: Aetna New Business (MI Preferred)	$2.37
Rate for Payer: Cash Price	$2.92
Rate for Payer: Cofinity Commercial	$2.56
Rate for Payer: Cofinity Commercial	$3.14
Rate for Payer: Cofinity Medicare Advantage	$2.56
Rate for Payer: Encore Health Key Benefits Commercial	$2.92
Rate for Payer: Healthscope Commercial	$3.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.10
Rate for Payer: PHP Commercial	$3.10
Rate for Payer: Priority Health Cigna Priority Health	$2.37
Rate for Payer: Priority Health SBD	$2.30

THIAMINE HCL (VITAMIN B1) 100 MG TABLET

Facility

$105.75

Service Code	NDC 79854020010
Hospital Charge Code	7877
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

THIAMINE HCL (VITAMIN B1) 100 MG TABLET

Facility

$105.75

Service Code	NDC 79854020010
Hospital Charge Code	7877
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

THIAMINE HCL (VITAMIN B1) 100 MG TABLET

Facility

$182.13

Service Code	NDC 50268085115
Hospital Charge Code	7877
Hospital Revenue Code	637
Min. Negotiated Rate	$72.85
Max. Negotiated Rate	$163.92
Rate for Payer: Aetna Commercial	$154.81
Rate for Payer: Aetna Medicare	$91.06
Rate for Payer: Aetna New Business (MI Preferred)	$118.38
Rate for Payer: BCBS Complete	$72.85
Rate for Payer: Cash Price	$145.70
Rate for Payer: Cofinity Commercial	$127.49
Rate for Payer: Cofinity Commercial	$156.63
Rate for Payer: Cofinity Medicare Advantage	$127.49
Rate for Payer: Encore Health Key Benefits Commercial	$145.70
Rate for Payer: Healthscope Commercial	$163.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.81
Rate for Payer: PHP Commercial	$154.81
Rate for Payer: Priority Health Cigna Priority Health	$118.38
Rate for Payer: Priority Health SBD	$114.74

THIAMINE HCL (VITAMIN B1) 100 MG TABLET

Facility

$3.65

Service Code	NDC 50268085111
Hospital Charge Code	7877
Hospital Revenue Code	637
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna Commercial	$3.10
Rate for Payer: Aetna Medicare	$1.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.37
Rate for Payer: BCBS Complete	$1.46
Rate for Payer: Cash Price	$2.92
Rate for Payer: Cofinity Commercial	$2.56
Rate for Payer: Cofinity Commercial	$3.14
Rate for Payer: Cofinity Medicare Advantage	$2.56
Rate for Payer: Encore Health Key Benefits Commercial	$2.92
Rate for Payer: Healthscope Commercial	$3.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.10
Rate for Payer: PHP Commercial	$3.10
Rate for Payer: Priority Health Cigna Priority Health	$2.37
Rate for Payer: Priority Health SBD	$2.30

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET

Facility

$4.12

Service Code	NDC 68094011659
Hospital Charge Code	119871
Hospital Revenue Code	637
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.71
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare	$2.06
Rate for Payer: Aetna New Business (MI Preferred)	$2.68
Rate for Payer: BCBS Complete	$1.65
Rate for Payer: Cash Price	$3.30
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Commercial	$3.54
Rate for Payer: Cofinity Medicare Advantage	$2.88
Rate for Payer: Encore Health Key Benefits Commercial	$3.30
Rate for Payer: Healthscope Commercial	$3.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.50
Rate for Payer: PHP Commercial	$3.50
Rate for Payer: Priority Health Cigna Priority Health	$2.68
Rate for Payer: Priority Health SBD	$2.60

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET

Facility

$4.12

Service Code	NDC 68094011659
Hospital Charge Code	119871
Hospital Revenue Code	637
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.71
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna New Business (MI Preferred)	$2.68
Rate for Payer: Cash Price	$3.30
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Commercial	$3.54
Rate for Payer: Cofinity Medicare Advantage	$2.88
Rate for Payer: Encore Health Key Benefits Commercial	$3.30
Rate for Payer: Healthscope Commercial	$3.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.50
Rate for Payer: PHP Commercial	$3.50
Rate for Payer: Priority Health Cigna Priority Health	$2.68
Rate for Payer: Priority Health SBD	$2.60

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET

Facility

$411.25

Service Code	NDC 68094011661
Hospital Charge Code	119871
Hospital Revenue Code	637
Min. Negotiated Rate	$259.09
Max. Negotiated Rate	$370.12
Rate for Payer: Aetna Commercial	$349.56
Rate for Payer: Aetna New Business (MI Preferred)	$267.31
Rate for Payer: Cash Price	$329.00
Rate for Payer: Cofinity Commercial	$287.88
Rate for Payer: Cofinity Commercial	$353.68
Rate for Payer: Cofinity Medicare Advantage	$287.88
Rate for Payer: Encore Health Key Benefits Commercial	$329.00
Rate for Payer: Healthscope Commercial	$370.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$349.56
Rate for Payer: PHP Commercial	$349.56
Rate for Payer: Priority Health Cigna Priority Health	$267.31
Rate for Payer: Priority Health SBD	$259.09

THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET

Facility

$411.25

Service Code	NDC 68094011661
Hospital Charge Code	119871
Hospital Revenue Code	637
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$370.12
Rate for Payer: Aetna Commercial	$349.56
Rate for Payer: Aetna Medicare	$205.62
Rate for Payer: Aetna New Business (MI Preferred)	$267.31
Rate for Payer: BCBS Complete	$164.50
Rate for Payer: Cash Price	$329.00
Rate for Payer: Cofinity Commercial	$287.88
Rate for Payer: Cofinity Commercial	$353.68
Rate for Payer: Cofinity Medicare Advantage	$287.88
Rate for Payer: Encore Health Key Benefits Commercial	$329.00
Rate for Payer: Healthscope Commercial	$370.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$349.56
Rate for Payer: PHP Commercial	$349.56
Rate for Payer: Priority Health Cigna Priority Health	$267.31
Rate for Payer: Priority Health SBD	$259.09

THIORIDAZINE 100 MG TABLET

Facility

$337.44

Service Code	NDC 51079058020
Hospital Charge Code	7895
Hospital Revenue Code	637
Min. Negotiated Rate	$134.98
Max. Negotiated Rate	$303.70
Rate for Payer: Aetna Commercial	$286.82
Rate for Payer: Aetna Medicare	$168.72
Rate for Payer: Aetna New Business (MI Preferred)	$219.34
Rate for Payer: BCBS Complete	$134.98
Rate for Payer: Cash Price	$269.95
Rate for Payer: Cofinity Commercial	$236.21
Rate for Payer: Cofinity Commercial	$290.20
Rate for Payer: Cofinity Medicare Advantage	$236.21
Rate for Payer: Encore Health Key Benefits Commercial	$269.95
Rate for Payer: Healthscope Commercial	$303.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.82
Rate for Payer: PHP Commercial	$286.82
Rate for Payer: Priority Health Cigna Priority Health	$219.34
Rate for Payer: Priority Health SBD	$212.59

THIORIDAZINE 100 MG TABLET

Facility

$337.44

Service Code	NDC 51079058020
Hospital Charge Code	7895
Hospital Revenue Code	637
Min. Negotiated Rate	$212.59
Max. Negotiated Rate	$303.70
Rate for Payer: Aetna Commercial	$286.82
Rate for Payer: Aetna New Business (MI Preferred)	$219.34
Rate for Payer: Cash Price	$269.95
Rate for Payer: Cofinity Commercial	$236.21
Rate for Payer: Cofinity Commercial	$290.20
Rate for Payer: Cofinity Medicare Advantage	$236.21
Rate for Payer: Encore Health Key Benefits Commercial	$269.95
Rate for Payer: Healthscope Commercial	$303.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.82
Rate for Payer: PHP Commercial	$286.82
Rate for Payer: Priority Health Cigna Priority Health	$219.34
Rate for Payer: Priority Health SBD	$212.59

THIORIDAZINE 100 MG TABLET

Facility

$3.38

Service Code	NDC 51079058001
Hospital Charge Code	7895
Hospital Revenue Code	637
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.37
Rate for Payer: Cofinity Commercial	$2.91
Rate for Payer: Cofinity Medicare Advantage	$2.37
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.87
Rate for Payer: PHP Commercial	$2.87
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$2.13

THIORIDAZINE 100 MG TABLET

Facility

$3.38

Service Code	NDC 51079058001
Hospital Charge Code	7895
Hospital Revenue Code	637
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: BCBS Complete	$1.35
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.37
Rate for Payer: Cofinity Commercial	$2.91
Rate for Payer: Cofinity Medicare Advantage	$2.37
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.87
Rate for Payer: PHP Commercial	$2.87
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$2.13

THIORIDAZINE 100 MG TABLET

Facility

$425.76

Service Code	NDC 00378061801
Hospital Charge Code	7895
Hospital Revenue Code	637
Min. Negotiated Rate	$268.23
Max. Negotiated Rate	$383.18
Rate for Payer: Aetna Commercial	$361.90
Rate for Payer: Aetna New Business (MI Preferred)	$276.74
Rate for Payer: Cash Price	$340.61
Rate for Payer: Cofinity Commercial	$298.03
Rate for Payer: Cofinity Commercial	$366.15
Rate for Payer: Cofinity Medicare Advantage	$298.03
Rate for Payer: Encore Health Key Benefits Commercial	$340.61
Rate for Payer: Healthscope Commercial	$383.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$361.90
Rate for Payer: PHP Commercial	$361.90
Rate for Payer: Priority Health Cigna Priority Health	$276.74
Rate for Payer: Priority Health SBD	$268.23

THIORIDAZINE 100 MG TABLET

Facility

$425.76

Service Code	NDC 00378061801
Hospital Charge Code	7895
Hospital Revenue Code	637
Min. Negotiated Rate	$170.30
Max. Negotiated Rate	$383.18
Rate for Payer: Aetna Commercial	$361.90
Rate for Payer: Aetna Medicare	$212.88
Rate for Payer: Aetna New Business (MI Preferred)	$276.74
Rate for Payer: BCBS Complete	$170.30
Rate for Payer: Cash Price	$340.61
Rate for Payer: Cofinity Commercial	$298.03
Rate for Payer: Cofinity Commercial	$366.15
Rate for Payer: Cofinity Medicare Advantage	$298.03
Rate for Payer: Encore Health Key Benefits Commercial	$340.61
Rate for Payer: Healthscope Commercial	$383.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$361.90
Rate for Payer: PHP Commercial	$361.90
Rate for Payer: Priority Health Cigna Priority Health	$276.74
Rate for Payer: Priority Health SBD	$268.23

THIORIDAZINE 25 MG TABLET

Facility

$468.35

Service Code	NDC 51079056620
Hospital Charge Code	7899
Hospital Revenue Code	637
Min. Negotiated Rate	$295.06
Max. Negotiated Rate	$421.52
Rate for Payer: Aetna Commercial	$398.10
Rate for Payer: Aetna New Business (MI Preferred)	$304.43
Rate for Payer: Cash Price	$374.68
Rate for Payer: Cofinity Commercial	$327.84
Rate for Payer: Cofinity Commercial	$402.78
Rate for Payer: Cofinity Medicare Advantage	$327.84
Rate for Payer: Encore Health Key Benefits Commercial	$374.68
Rate for Payer: Healthscope Commercial	$421.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$398.10
Rate for Payer: PHP Commercial	$398.10
Rate for Payer: Priority Health Cigna Priority Health	$304.43
Rate for Payer: Priority Health SBD	$295.06

THIORIDAZINE 25 MG TABLET

Facility

$468.35

Service Code	NDC 51079056620
Hospital Charge Code	7899
Hospital Revenue Code	637
Min. Negotiated Rate	$187.34
Max. Negotiated Rate	$421.52
Rate for Payer: Aetna Commercial	$398.10
Rate for Payer: Aetna Medicare	$234.18
Rate for Payer: Aetna New Business (MI Preferred)	$304.43
Rate for Payer: BCBS Complete	$187.34
Rate for Payer: Cash Price	$374.68
Rate for Payer: Cofinity Commercial	$327.84
Rate for Payer: Cofinity Commercial	$402.78
Rate for Payer: Cofinity Medicare Advantage	$327.84
Rate for Payer: Encore Health Key Benefits Commercial	$374.68
Rate for Payer: Healthscope Commercial	$421.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$398.10
Rate for Payer: PHP Commercial	$398.10
Rate for Payer: Priority Health Cigna Priority Health	$304.43
Rate for Payer: Priority Health SBD	$295.06

THIORIDAZINE 25 MG TABLET

Facility

$299.04

Service Code	NDC 00378061401
Hospital Charge Code	7899
Hospital Revenue Code	637
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$269.14
Rate for Payer: Aetna Commercial	$254.18
Rate for Payer: Aetna Medicare	$149.52
Rate for Payer: Aetna New Business (MI Preferred)	$194.38
Rate for Payer: BCBS Complete	$119.62
Rate for Payer: Cash Price	$239.23
Rate for Payer: Cofinity Commercial	$209.33
Rate for Payer: Cofinity Commercial	$257.17
Rate for Payer: Cofinity Medicare Advantage	$209.33
Rate for Payer: Encore Health Key Benefits Commercial	$239.23
Rate for Payer: Healthscope Commercial	$269.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.18
Rate for Payer: PHP Commercial	$254.18
Rate for Payer: Priority Health Cigna Priority Health	$194.38
Rate for Payer: Priority Health SBD	$188.40

THIORIDAZINE 25 MG TABLET

Facility

$299.04

Service Code	NDC 00378061401
Hospital Charge Code	7899
Hospital Revenue Code	637
Min. Negotiated Rate	$188.40
Max. Negotiated Rate	$269.14
Rate for Payer: Aetna Commercial	$254.18
Rate for Payer: Aetna New Business (MI Preferred)	$194.38
Rate for Payer: Cash Price	$239.23
Rate for Payer: Cofinity Commercial	$209.33
Rate for Payer: Cofinity Commercial	$257.17
Rate for Payer: Cofinity Medicare Advantage	$209.33
Rate for Payer: Encore Health Key Benefits Commercial	$239.23
Rate for Payer: Healthscope Commercial	$269.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.18
Rate for Payer: PHP Commercial	$254.18
Rate for Payer: Priority Health Cigna Priority Health	$194.38
Rate for Payer: Priority Health SBD	$188.40

THIORIDAZINE 25 MG TABLET

Facility

$4.69

Service Code	NDC 51079056601
Hospital Charge Code	7899
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.22
Rate for Payer: Aetna Commercial	$3.99
Rate for Payer: Aetna New Business (MI Preferred)	$3.05
Rate for Payer: Cash Price	$3.75
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.03
Rate for Payer: Cofinity Medicare Advantage	$3.28
Rate for Payer: Encore Health Key Benefits Commercial	$3.75
Rate for Payer: Healthscope Commercial	$4.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.99
Rate for Payer: PHP Commercial	$3.99
Rate for Payer: Priority Health Cigna Priority Health	$3.05
Rate for Payer: Priority Health SBD	$2.95

THIORIDAZINE 25 MG TABLET

Facility

$4.69

Service Code	NDC 51079056601
Hospital Charge Code	7899
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$4.22
Rate for Payer: Aetna Commercial	$3.99
Rate for Payer: Aetna Medicare	$2.34
Rate for Payer: Aetna New Business (MI Preferred)	$3.05
Rate for Payer: BCBS Complete	$1.88
Rate for Payer: Cash Price	$3.75
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.03
Rate for Payer: Cofinity Medicare Advantage	$3.28
Rate for Payer: Encore Health Key Benefits Commercial	$3.75
Rate for Payer: Healthscope Commercial	$4.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.99
Rate for Payer: PHP Commercial	$3.99
Rate for Payer: Priority Health Cigna Priority Health	$3.05
Rate for Payer: Priority Health SBD	$2.95

THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE

Facility

$1,903.90

Service Code	CPT 32555
Hospital Revenue Code	361
Min. Negotiated Rate	$114.36
Max. Negotiated Rate	$1,903.90
Rate for Payer: Aetna Medicare	$629.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$757.20
Rate for Payer: Amish Plain Church Group Commercial	$757.20
Rate for Payer: BCBS Complete	$340.92
Rate for Payer: BCBS MAPPO	$605.76
Rate for Payer: BCBS Trust/PPO	$418.66
Rate for Payer: BCN Commercial	$418.66
Rate for Payer: BCN Medicare Advantage	$605.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$605.76
Rate for Payer: Mclaren Medicaid	$324.69
Rate for Payer: Mclaren Medicare	$605.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$636.05
Rate for Payer: Meridian Medicaid	$340.92
Rate for Payer: MI Amish Medical Board Commercial	$696.62
Rate for Payer: Nomi Health Commercial	$1,272.10
Rate for Payer: PACE Medicare	$575.47
Rate for Payer: PACE SWMI	$605.76
Rate for Payer: PHP Medicare Advantage	$605.76
Rate for Payer: Priority Health Choice Medicaid	$324.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,903.90
Rate for Payer: Priority Health Medicare	$605.76
Rate for Payer: Priority Health Narrow Network	$1,523.12
Rate for Payer: Railroad Medicare Medicare	$605.76
Rate for Payer: UHC All Payor (Choice/PPO)	$114.36
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$605.76
Rate for Payer: UHC Exchange	$1,566.00
Rate for Payer: UHC Medicare Advantage	$605.76
Rate for Payer: UHCCP Medicaid	$341.04
Rate for Payer: VA VA	$605.76

THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE

Facility

$1,903.90

Service Code	CPT 32554
Hospital Revenue Code	361
Min. Negotiated Rate	$93.46
Max. Negotiated Rate	$1,903.90
Rate for Payer: Aetna Medicare	$629.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$757.20
Rate for Payer: Amish Plain Church Group Commercial	$757.20
Rate for Payer: BCBS Complete	$340.92
Rate for Payer: BCBS MAPPO	$605.76
Rate for Payer: BCBS Trust/PPO	$261.30
Rate for Payer: BCN Commercial	$261.30
Rate for Payer: BCN Medicare Advantage	$605.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$605.76
Rate for Payer: Mclaren Medicaid	$324.69
Rate for Payer: Mclaren Medicare	$605.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$636.05
Rate for Payer: Meridian Medicaid	$340.92
Rate for Payer: MI Amish Medical Board Commercial	$696.62
Rate for Payer: Nomi Health Commercial	$1,272.10
Rate for Payer: PACE Medicare	$575.47
Rate for Payer: PACE SWMI	$605.76
Rate for Payer: PHP Medicare Advantage	$605.76
Rate for Payer: Priority Health Choice Medicaid	$324.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,903.90
Rate for Payer: Priority Health Medicare	$605.76
Rate for Payer: Priority Health Narrow Network	$1,523.12
Rate for Payer: Railroad Medicare Medicare	$605.76
Rate for Payer: UHC All Payor (Choice/PPO)	$93.46
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$605.76
Rate for Payer: UHC Exchange	$1,566.00
Rate for Payer: UHC Medicare Advantage	$605.76
Rate for Payer: UHCCP Medicaid	$341.04
Rate for Payer: VA VA	$605.76

THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)

Facility

$16,646.50

Service Code	CPT 36831
Hospital Revenue Code	360
Min. Negotiated Rate	$1,684.03
Max. Negotiated Rate	$16,646.50
Rate for Payer: Aetna Medicare	$5,508.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,620.50
Rate for Payer: Amish Plain Church Group Commercial	$6,620.50
Rate for Payer: BCBS Complete	$2,980.81
Rate for Payer: BCBS MAPPO	$5,296.40
Rate for Payer: BCBS Trust/PPO	$1,684.03
Rate for Payer: BCN Commercial	$1,684.03
Rate for Payer: BCN Medicare Advantage	$5,296.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,296.40
Rate for Payer: Mclaren Medicaid	$2,838.87
Rate for Payer: Mclaren Medicare	$5,296.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,561.22
Rate for Payer: Meridian Medicaid	$2,980.81
Rate for Payer: MI Amish Medical Board Commercial	$6,090.86
Rate for Payer: Nomi Health Commercial	$11,122.44
Rate for Payer: PACE Medicare	$5,031.58
Rate for Payer: PACE SWMI	$5,296.40
Rate for Payer: PHP Medicare Advantage	$5,296.40
Rate for Payer: Priority Health Choice Medicaid	$2,838.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,646.50
Rate for Payer: Priority Health Medicare	$5,296.40
Rate for Payer: Priority Health Narrow Network	$13,317.20
Rate for Payer: Railroad Medicare Medicare	$5,296.40
Rate for Payer: UHC All Payor (Choice/PPO)	$14,908.84
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,296.40
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$5,296.40
Rate for Payer: UHCCP Medicaid	$2,981.87
Rate for Payer: VA VA	$5,296.40

Know your out-of-pocket cost for care.

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