Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

VAGINAL DELIVERY

Facility

$3,959.21

Service Code	APR-DRG 5603
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,959.21
Rate for Payer: BCBS Complete	$3,959.21
Rate for Payer: Mclaren Medicaid	$3,770.68
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$3,770.68
Rate for Payer: UHC Medicaid	$3,770.68
Rate for Payer: UHCCP Medicaid	$3,770.68

VAGINAL DELIVERY

Facility

$9,000.24

Service Code	APR-DRG 5604
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$9,000.24
Rate for Payer: BCBS Complete	$9,000.24
Rate for Payer: Mclaren Medicaid	$8,571.65
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$8,571.65
Rate for Payer: UHC Medicaid	$8,571.65
Rate for Payer: UHCCP Medicaid	$8,571.65

VAGINAL DELIVERY

Facility

$2,420.47

Service Code	APR-DRG 5601
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,420.47
Rate for Payer: BCBS Complete	$2,420.47
Rate for Payer: Mclaren Medicaid	$2,305.21
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$2,305.21
Rate for Payer: UHC Medicaid	$2,305.21
Rate for Payer: UHCCP Medicaid	$2,305.21

VAGINAL DELIVERY

Facility

$2,855.03

Service Code	APR-DRG 5602
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,855.03
Rate for Payer: BCBS Complete	$2,855.03
Rate for Payer: Mclaren Medicaid	$2,719.08
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$2,719.08
Rate for Payer: UHC Medicaid	$2,719.08
Rate for Payer: UHCCP Medicaid	$2,719.08

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$4,667.81

Service Code	APR-DRG 5423
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$4,667.81
Rate for Payer: BCBS Complete	$4,667.81
Rate for Payer: Mclaren Medicaid	$4,445.53
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$4,445.53
Rate for Payer: UHC Medicaid	$4,445.53
Rate for Payer: UHCCP Medicaid	$4,445.53

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$12,598.27

Service Code	APR-DRG 5424
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$12,598.27
Rate for Payer: BCBS Complete	$12,598.27
Rate for Payer: Mclaren Medicaid	$11,998.35
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$11,998.35
Rate for Payer: UHC Medicaid	$11,998.35
Rate for Payer: UHCCP Medicaid	$11,998.35

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$2,865.35

Service Code	APR-DRG 5421
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,865.35
Rate for Payer: BCBS Complete	$2,865.35
Rate for Payer: Mclaren Medicaid	$2,728.91
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$2,728.91
Rate for Payer: UHC Medicaid	$2,728.91
Rate for Payer: UHCCP Medicaid	$2,728.91

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$3,515.48

Service Code	APR-DRG 5422
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,515.48
Rate for Payer: BCBS Complete	$3,515.48
Rate for Payer: Mclaren Medicaid	$3,348.07
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$3,348.07
Rate for Payer: UHC Medicaid	$3,348.07
Rate for Payer: UHCCP Medicaid	$3,348.07

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$17,467.08

Service Code	MSDRG 768
Min. Negotiated Rate	$8,417.54
Max. Negotiated Rate	$17,467.08
Rate for Payer: Aetna Medicare	$9,214.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,075.71
Rate for Payer: Amish Plain Church Group Commercial	$11,075.71
Rate for Payer: BCBS MAPPO	$8,860.57
Rate for Payer: BCBS Trust/PPO	$10,936.22
Rate for Payer: BCN Commercial	$10,936.22
Rate for Payer: BCN Medicare Advantage	$8,860.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,860.57
Rate for Payer: Mclaren Medicare	$8,860.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,303.60
Rate for Payer: MI Amish Medical Board Commercial	$10,189.66
Rate for Payer: Molina Medicare/Medicaid	$9,746.63
Rate for Payer: Nomi Health Commercial	$13,823.64
Rate for Payer: PACE Medicare	$8,417.54
Rate for Payer: PACE SWMI	$8,860.57
Rate for Payer: PHP Medicare Advantage	$8,860.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$17,263.59
Rate for Payer: Priority Health Medicare	$8,860.57
Rate for Payer: Priority Health Tiered Network	$13,810.87
Rate for Payer: Railroad Medicare Medicare	$8,860.57
Rate for Payer: UHC All Payor (Choice/PPO)	$17,467.08
Rate for Payer: UHC Core	$14,613.41
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,860.57
Rate for Payer: UHC Exchange	$11,934.41
Rate for Payer: VA VA	$8,860.57

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$12,290.20

Service Code	MSDRG 806
Min. Negotiated Rate	$5,674.99
Max. Negotiated Rate	$12,290.20
Rate for Payer: Aetna Medicare	$6,662.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,007.60
Rate for Payer: Amish Plain Church Group Commercial	$8,007.60
Rate for Payer: BCBS MAPPO	$6,406.08
Rate for Payer: BCBS Trust/PPO	$9,201.68
Rate for Payer: BCN Commercial	$9,201.68
Rate for Payer: BCN Medicare Advantage	$6,406.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,406.08
Rate for Payer: Mclaren Medicare	$6,406.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,726.38
Rate for Payer: MI Amish Medical Board Commercial	$7,366.99
Rate for Payer: Molina Medicare/Medicaid	$7,046.69
Rate for Payer: Nomi Health Commercial	$9,726.60
Rate for Payer: PACE Medicare	$6,085.78
Rate for Payer: PACE SWMI	$6,406.08
Rate for Payer: PHP Medicare Advantage	$6,406.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$7,093.74
Rate for Payer: Priority Health Medicare	$6,406.08
Rate for Payer: Priority Health Tiered Network	$5,674.99
Rate for Payer: Railroad Medicare Medicare	$6,406.08
Rate for Payer: UHC All Payor (Choice/PPO)	$12,290.20
Rate for Payer: UHC Core	$10,282.30
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,406.08
Rate for Payer: UHC Exchange	$8,397.30
Rate for Payer: VA VA	$6,406.08

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$17,590.96

Service Code	MSDRG 805
Min. Negotiated Rate	$8,208.10
Max. Negotiated Rate	$17,590.96
Rate for Payer: Aetna Medicare	$9,276.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,149.12
Rate for Payer: Amish Plain Church Group Commercial	$11,149.12
Rate for Payer: BCBS MAPPO	$8,919.30
Rate for Payer: BCBS Trust/PPO	$11,008.78
Rate for Payer: BCN Commercial	$11,008.78
Rate for Payer: BCN Medicare Advantage	$8,919.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,919.30
Rate for Payer: Mclaren Medicare	$8,919.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,365.26
Rate for Payer: MI Amish Medical Board Commercial	$10,257.19
Rate for Payer: Molina Medicare/Medicaid	$9,811.23
Rate for Payer: Nomi Health Commercial	$13,921.68
Rate for Payer: PACE Medicare	$8,473.33
Rate for Payer: PACE SWMI	$8,919.30
Rate for Payer: PHP Medicare Advantage	$8,919.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,260.13
Rate for Payer: Priority Health Medicare	$8,919.30
Rate for Payer: Priority Health Tiered Network	$8,208.10
Rate for Payer: Railroad Medicare Medicare	$8,919.30
Rate for Payer: UHC All Payor (Choice/PPO)	$17,590.96
Rate for Payer: UHC Core	$14,717.05
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,919.30
Rate for Payer: UHC Exchange	$12,019.05
Rate for Payer: VA VA	$8,919.30

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$10,989.46

Service Code	MSDRG 807
Min. Negotiated Rate	$4,925.64
Max. Negotiated Rate	$10,989.46
Rate for Payer: Aetna Medicare	$6,020.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,236.71
Rate for Payer: Amish Plain Church Group Commercial	$7,236.71
Rate for Payer: BCBS MAPPO	$5,789.37
Rate for Payer: BCBS Trust/PPO	$8,176.41
Rate for Payer: BCN Commercial	$8,176.41
Rate for Payer: BCN Medicare Advantage	$5,789.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,789.37
Rate for Payer: Mclaren Medicare	$5,789.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,078.84
Rate for Payer: MI Amish Medical Board Commercial	$6,657.78
Rate for Payer: Molina Medicare/Medicaid	$6,368.31
Rate for Payer: Nomi Health Commercial	$8,697.18
Rate for Payer: PACE Medicare	$5,499.90
Rate for Payer: PACE SWMI	$5,789.37
Rate for Payer: PHP Medicare Advantage	$5,789.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$6,157.05
Rate for Payer: Priority Health Medicare	$5,789.37
Rate for Payer: Priority Health Tiered Network	$4,925.64
Rate for Payer: Railroad Medicare Medicare	$5,789.37
Rate for Payer: UHC All Payor (Choice/PPO)	$10,989.46
Rate for Payer: UHC Core	$9,194.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,789.37
Rate for Payer: UHC Exchange	$7,508.57
Rate for Payer: VA VA	$5,789.37

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$4,336.44

Service Code	APR-DRG 5412
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$4,336.44
Rate for Payer: BCBS Complete	$4,336.44
Rate for Payer: Mclaren Medicaid	$4,129.94
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$4,129.94
Rate for Payer: UHC Medicaid	$4,129.94
Rate for Payer: UHCCP Medicaid	$4,129.94

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$5,850.53

Service Code	APR-DRG 5414
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$5,850.53
Rate for Payer: BCBS Complete	$5,850.53
Rate for Payer: Mclaren Medicaid	$5,571.93
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$5,571.93
Rate for Payer: UHC Medicaid	$5,571.93
Rate for Payer: UHCCP Medicaid	$5,571.93

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$3,368.71

Service Code	APR-DRG 5411
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,368.71
Rate for Payer: BCBS Complete	$3,368.71
Rate for Payer: Mclaren Medicaid	$3,208.30
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$3,208.30
Rate for Payer: UHC Medicaid	$3,208.30
Rate for Payer: UHCCP Medicaid	$3,208.30

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$5,691.15

Service Code	APR-DRG 5413
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$5,691.15
Rate for Payer: BCBS Complete	$5,691.15
Rate for Payer: Mclaren Medicaid	$5,420.14
Rate for Payer: Meridian Medicaid	$2,100.00
Rate for Payer: Priority Health Choice Medicaid	$5,420.14
Rate for Payer: UHC Medicaid	$5,420.14
Rate for Payer: UHCCP Medicaid	$5,420.14

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$16,306.52

Service Code	MSDRG 797
Min. Negotiated Rate	$6,793.22
Max. Negotiated Rate	$16,306.52
Rate for Payer: Aetna Medicare	$8,642.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,387.89
Rate for Payer: Amish Plain Church Group Commercial	$10,387.89
Rate for Payer: BCBS MAPPO	$8,310.31
Rate for Payer: BCBS Trust/PPO	$14,482.53
Rate for Payer: BCN Commercial	$14,482.53
Rate for Payer: BCN Medicare Advantage	$8,310.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,310.31
Rate for Payer: Mclaren Medicare	$8,310.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,725.83
Rate for Payer: MI Amish Medical Board Commercial	$9,556.86
Rate for Payer: Molina Medicare/Medicaid	$9,141.34
Rate for Payer: Nomi Health Commercial	$12,905.16
Rate for Payer: PACE Medicare	$7,894.79
Rate for Payer: PACE SWMI	$8,310.31
Rate for Payer: PHP Medicare Advantage	$8,310.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$8,491.53
Rate for Payer: Priority Health Medicare	$8,310.31
Rate for Payer: Priority Health Tiered Network	$6,793.22
Rate for Payer: Railroad Medicare Medicare	$8,310.31
Rate for Payer: UHC All Payor (Choice/PPO)	$16,306.52
Rate for Payer: UHC Core	$13,642.45
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,310.31
Rate for Payer: UHC Exchange	$11,141.45
Rate for Payer: VA VA	$8,310.31

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$19,022.10

Service Code	MSDRG 796
Min. Negotiated Rate	$9,117.96
Max. Negotiated Rate	$19,022.10
Rate for Payer: Aetna Medicare	$9,981.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,997.31
Rate for Payer: Amish Plain Church Group Commercial	$11,997.31
Rate for Payer: BCBS MAPPO	$9,597.85
Rate for Payer: BCBS Trust/PPO	$17,490.46
Rate for Payer: BCN Commercial	$17,490.46
Rate for Payer: BCN Medicare Advantage	$9,597.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,597.85
Rate for Payer: Mclaren Medicare	$9,597.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,077.74
Rate for Payer: MI Amish Medical Board Commercial	$11,037.53
Rate for Payer: Molina Medicare/Medicaid	$10,557.64
Rate for Payer: Nomi Health Commercial	$15,054.30
Rate for Payer: PACE Medicare	$9,117.96
Rate for Payer: PACE SWMI	$9,597.85
Rate for Payer: PHP Medicare Advantage	$9,597.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$14,721.13
Rate for Payer: Priority Health Medicare	$9,597.85
Rate for Payer: Priority Health Tiered Network	$11,776.90
Rate for Payer: Railroad Medicare Medicare	$9,597.85
Rate for Payer: UHC All Payor (Choice/PPO)	$19,022.10
Rate for Payer: UHC Core	$15,914.38
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,597.85
Rate for Payer: UHC Exchange	$12,996.88
Rate for Payer: VA VA	$9,597.85

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

$15,600.73

Service Code	MSDRG 798
Min. Negotiated Rate	$6,793.22
Max. Negotiated Rate	$15,600.73
Rate for Payer: Aetna Medicare	$8,294.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,969.60
Rate for Payer: Amish Plain Church Group Commercial	$9,969.60
Rate for Payer: BCBS MAPPO	$7,975.68
Rate for Payer: BCBS Trust/PPO	$12,993.78
Rate for Payer: BCN Commercial	$12,993.78
Rate for Payer: BCN Medicare Advantage	$7,975.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,975.68
Rate for Payer: Mclaren Medicare	$7,975.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,374.46
Rate for Payer: MI Amish Medical Board Commercial	$9,172.03
Rate for Payer: Molina Medicare/Medicaid	$8,773.25
Rate for Payer: Nomi Health Commercial	$12,346.59
Rate for Payer: PACE Medicare	$7,576.90
Rate for Payer: PACE SWMI	$7,975.68
Rate for Payer: PHP Medicare Advantage	$7,975.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$8,491.53
Rate for Payer: Priority Health Medicare	$7,975.68
Rate for Payer: Priority Health Tiered Network	$6,793.22
Rate for Payer: Railroad Medicare Medicare	$7,975.68
Rate for Payer: UHC All Payor (Choice/PPO)	$15,600.73
Rate for Payer: UHC Core	$13,051.97
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,975.68
Rate for Payer: UHC Exchange	$10,659.22
Rate for Payer: VA VA	$7,975.68

VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$16,119.31

Service Code	CPT 58260
Hospital Revenue Code	360
Min. Negotiated Rate	$2,606.87
Max. Negotiated Rate	$16,119.31
Rate for Payer: Aetna Medicare	$5,183.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,230.57
Rate for Payer: Amish Plain Church Group Commercial	$6,230.57
Rate for Payer: BCBS Complete	$2,737.47
Rate for Payer: BCBS MAPPO	$4,984.46
Rate for Payer: BCBS Trust/PPO	$3,593.64
Rate for Payer: BCN Commercial	$3,593.64
Rate for Payer: BCN Medicare Advantage	$4,984.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,984.46
Rate for Payer: Mclaren Medicaid	$2,606.87
Rate for Payer: Mclaren Medicare	$4,984.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,233.68
Rate for Payer: Meridian Medicaid	$5,233.68
Rate for Payer: MI Amish Medical Board Commercial	$5,732.13
Rate for Payer: Molina Medicare/Medicaid	$5,482.91
Rate for Payer: Nomi Health Commercial	$14,953.38
Rate for Payer: PACE Medicare	$4,735.24
Rate for Payer: PACE SWMI	$4,984.46
Rate for Payer: PHP Medicare Advantage	$4,984.46
Rate for Payer: Priority Health Choice Medicaid	$2,606.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$16,119.31
Rate for Payer: Priority Health Medicare	$4,984.46
Rate for Payer: Priority Health Tiered Network	$12,895.45
Rate for Payer: Railroad Medicare Medicare	$4,984.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$4,984.46
Rate for Payer: UHC Medicaid	$2,606.87
Rate for Payer: UHCCP Medicaid	$2,606.87
Rate for Payer: VA VA	$4,984.46

VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)

Facility

$16,119.31

Service Code	CPT 58262
Hospital Revenue Code	360
Min. Negotiated Rate	$2,606.87
Max. Negotiated Rate	$16,119.31
Rate for Payer: Aetna Medicare	$5,183.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,230.57
Rate for Payer: Amish Plain Church Group Commercial	$6,230.57
Rate for Payer: BCBS Complete	$2,737.47
Rate for Payer: BCBS MAPPO	$4,984.46
Rate for Payer: BCBS Trust/PPO	$4,952.80
Rate for Payer: BCN Commercial	$4,952.80
Rate for Payer: BCN Medicare Advantage	$4,984.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,984.46
Rate for Payer: Mclaren Medicaid	$2,606.87
Rate for Payer: Mclaren Medicare	$4,984.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,233.68
Rate for Payer: Meridian Medicaid	$5,233.68
Rate for Payer: MI Amish Medical Board Commercial	$5,732.13
Rate for Payer: Molina Medicare/Medicaid	$5,482.91
Rate for Payer: Nomi Health Commercial	$14,953.38
Rate for Payer: PACE Medicare	$4,735.24
Rate for Payer: PACE SWMI	$4,984.46
Rate for Payer: PHP Medicare Advantage	$4,984.46
Rate for Payer: Priority Health Choice Medicaid	$2,606.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$16,119.31
Rate for Payer: Priority Health Medicare	$4,984.46
Rate for Payer: Priority Health Tiered Network	$12,895.45
Rate for Payer: Railroad Medicare Medicare	$4,984.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$4,984.46
Rate for Payer: UHC Medicaid	$2,606.87
Rate for Payer: UHCCP Medicaid	$2,606.87
Rate for Payer: VA VA	$4,984.46

VALACYCLOVIR 500 MG TABLET

Facility

$316.91

Service Code	NDC 51079009303
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$199.65
Max. Negotiated Rate	$285.22
Rate for Payer: Aetna Commercial	$269.37
Rate for Payer: Aetna New Business (MI Preferred)	$205.99
Rate for Payer: Cash Price	$253.53
Rate for Payer: Cofinity Advantage	$221.84
Rate for Payer: Cofinity Commercial	$272.54
Rate for Payer: Encore Health Key Benefits Commercial	$253.53
Rate for Payer: Healthscope Commercial	$285.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$237.68
Rate for Payer: PHP Commercial	$269.37
Rate for Payer: Priority Health SBD	$199.65

VALACYCLOVIR 500 MG TABLET

Facility

$316.91

Service Code	NDC 51079009303
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$124.55
Max. Negotiated Rate	$285.22
Rate for Payer: Aetna Commercial	$269.37
Rate for Payer: Aetna Medicare	$158.46
Rate for Payer: Aetna New Business (MI Preferred)	$205.99
Rate for Payer: BCBS Complete	$126.76
Rate for Payer: Cash Price	$253.53
Rate for Payer: Cofinity Advantage	$221.84
Rate for Payer: Cofinity Commercial	$272.54
Rate for Payer: Encore Health Key Benefits Commercial	$253.53
Rate for Payer: Healthscope Commercial	$285.22
Rate for Payer: MI Amish Medical Board Commercial	$253.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$237.68
Rate for Payer: PHP Commercial	$269.37
Rate for Payer: Priority Health SBD	$199.65
Rate for Payer: UHC All Payor (Choice/PPO)	$205.99
Rate for Payer: UHC Core	$165.11
Rate for Payer: UHC Exchange	$124.55

VALACYCLOVIR 500 MG TABLET

Facility

$624.00

Service Code	NDC 00904656561
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$393.12
Max. Negotiated Rate	$561.60
Rate for Payer: Aetna Commercial	$530.40
Rate for Payer: Aetna New Business (MI Preferred)	$405.60
Rate for Payer: Cash Price	$499.20
Rate for Payer: Cofinity Advantage	$436.80
Rate for Payer: Cofinity Commercial	$536.64
Rate for Payer: Encore Health Key Benefits Commercial	$499.20
Rate for Payer: Healthscope Commercial	$561.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$530.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$468.00
Rate for Payer: PHP Commercial	$530.40
Rate for Payer: Priority Health SBD	$393.12

VALACYCLOVIR 500 MG TABLET

Facility

$624.00

Service Code	NDC 00904656561
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$245.23
Max. Negotiated Rate	$561.60
Rate for Payer: Aetna Commercial	$530.40
Rate for Payer: Aetna Medicare	$312.00
Rate for Payer: Aetna New Business (MI Preferred)	$405.60
Rate for Payer: BCBS Complete	$249.60
Rate for Payer: Cash Price	$499.20
Rate for Payer: Cofinity Advantage	$436.80
Rate for Payer: Cofinity Commercial	$536.64
Rate for Payer: Encore Health Key Benefits Commercial	$499.20
Rate for Payer: Healthscope Commercial	$561.60
Rate for Payer: MI Amish Medical Board Commercial	$499.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$530.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$468.00
Rate for Payer: PHP Commercial	$530.40
Rate for Payer: Priority Health SBD	$393.12
Rate for Payer: UHC All Payor (Choice/PPO)	$405.60
Rate for Payer: UHC Core	$325.10
Rate for Payer: UHC Exchange	$245.23

Know your out-of-pocket cost for care.

All Charges