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Service Code NDC 68462029201
Hospital Charge Code 11639
Hospital Revenue Code 637
Min. Negotiated Rate $80.64
Max. Negotiated Rate $184.68
Rate for Payer: Aetna Commercial $174.42
Rate for Payer: Aetna Medicare $102.60
Rate for Payer: Aetna New Business (MI Preferred) $133.38
Rate for Payer: BCBS Complete $82.08
Rate for Payer: Cash Price $164.16
Rate for Payer: Cofinity Advantage $143.64
Rate for Payer: Cofinity Commercial $176.47
Rate for Payer: Encore Health Key Benefits Commercial $164.16
Rate for Payer: Healthscope Commercial $184.68
Rate for Payer: MI Amish Medical Board Commercial $164.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial $174.42
Rate for Payer: Opus (Opus Packaging Group) HMA $153.90
Rate for Payer: PHP Commercial $174.42
Rate for Payer: Priority Health SBD $129.28
Rate for Payer: UHC All Payor (Choice/PPO) $133.38
Rate for Payer: UHC Core $106.91
Rate for Payer: UHC Exchange $80.64
Service Code NDC 68462029201
Hospital Charge Code 11639
Hospital Revenue Code 637
Min. Negotiated Rate $129.28
Max. Negotiated Rate $184.68
Rate for Payer: Aetna Commercial $174.42
Rate for Payer: Aetna New Business (MI Preferred) $133.38
Rate for Payer: Cash Price $164.16
Rate for Payer: Cofinity Advantage $143.64
Rate for Payer: Cofinity Commercial $176.47
Rate for Payer: Encore Health Key Benefits Commercial $164.16
Rate for Payer: Healthscope Commercial $184.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial $174.42
Rate for Payer: Opus (Opus Packaging Group) HMA $153.90
Rate for Payer: PHP Commercial $174.42
Rate for Payer: Priority Health SBD $129.28
Service Code NDC 60687049301
Hospital Charge Code 11639
Hospital Revenue Code 637
Min. Negotiated Rate $206.18
Max. Negotiated Rate $472.18
Rate for Payer: Aetna Commercial $445.94
Rate for Payer: Aetna Medicare $262.32
Rate for Payer: Aetna New Business (MI Preferred) $341.02
Rate for Payer: BCBS Complete $209.86
Rate for Payer: Cash Price $419.71
Rate for Payer: Cofinity Advantage $367.25
Rate for Payer: Cofinity Commercial $451.19
Rate for Payer: Encore Health Key Benefits Commercial $419.71
Rate for Payer: Healthscope Commercial $472.18
Rate for Payer: MI Amish Medical Board Commercial $419.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial $445.94
Rate for Payer: Opus (Opus Packaging Group) HMA $393.48
Rate for Payer: PHP Commercial $445.94
Rate for Payer: Priority Health SBD $330.52
Rate for Payer: UHC All Payor (Choice/PPO) $341.02
Rate for Payer: UHC Core $273.34
Rate for Payer: UHC Exchange $206.18
Service Code NDC 60687049311
Hospital Charge Code 11639
Hospital Revenue Code 637
Min. Negotiated Rate $2.06
Max. Negotiated Rate $4.72
Rate for Payer: Aetna Commercial $4.46
Rate for Payer: Aetna Medicare $2.62
Rate for Payer: Aetna New Business (MI Preferred) $3.41
Rate for Payer: BCBS Complete $2.10
Rate for Payer: Cash Price $4.20
Rate for Payer: Cofinity Advantage $3.67
Rate for Payer: Cofinity Commercial $4.51
Rate for Payer: Encore Health Key Benefits Commercial $4.20
Rate for Payer: Healthscope Commercial $4.72
Rate for Payer: MI Amish Medical Board Commercial $4.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.46
Rate for Payer: Opus (Opus Packaging Group) HMA $3.94
Rate for Payer: PHP Commercial $4.46
Rate for Payer: Priority Health SBD $3.31
Rate for Payer: UHC All Payor (Choice/PPO) $3.41
Rate for Payer: UHC Core $2.74
Rate for Payer: UHC Exchange $2.06
Service Code NDC 60687049311
Hospital Charge Code 11639
Hospital Revenue Code 637
Min. Negotiated Rate $3.31
Max. Negotiated Rate $4.72
Rate for Payer: Aetna Commercial $4.46
Rate for Payer: Aetna New Business (MI Preferred) $3.41
Rate for Payer: Cash Price $4.20
Rate for Payer: Cofinity Advantage $3.67
Rate for Payer: Cofinity Commercial $4.51
Rate for Payer: Encore Health Key Benefits Commercial $4.20
Rate for Payer: Healthscope Commercial $4.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.46
Rate for Payer: Opus (Opus Packaging Group) HMA $3.94
Rate for Payer: PHP Commercial $4.46
Rate for Payer: Priority Health SBD $3.31
Service Code NDC 75834015801
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $134.66
Max. Negotiated Rate $192.38
Rate for Payer: Aetna Commercial $181.69
Rate for Payer: Aetna New Business (MI Preferred) $138.94
Rate for Payer: Cash Price $171.00
Rate for Payer: Cofinity Advantage $149.62
Rate for Payer: Cofinity Commercial $183.82
Rate for Payer: Encore Health Key Benefits Commercial $171.00
Rate for Payer: Healthscope Commercial $192.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial $181.69
Rate for Payer: Opus (Opus Packaging Group) HMA $160.31
Rate for Payer: PHP Commercial $181.69
Rate for Payer: Priority Health SBD $134.66
Service Code NDC 68462029305
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $789.64
Max. Negotiated Rate $1,808.33
Rate for Payer: Aetna Commercial $1,707.86
Rate for Payer: Aetna Medicare $1,004.62
Rate for Payer: Aetna New Business (MI Preferred) $1,306.01
Rate for Payer: BCBS Complete $803.70
Rate for Payer: Cash Price $1,607.40
Rate for Payer: Cofinity Advantage $1,406.47
Rate for Payer: Cofinity Commercial $1,727.95
Rate for Payer: Encore Health Key Benefits Commercial $1,607.40
Rate for Payer: Healthscope Commercial $1,808.33
Rate for Payer: MI Amish Medical Board Commercial $1,607.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,707.86
Rate for Payer: Opus (Opus Packaging Group) HMA $1,506.94
Rate for Payer: PHP Commercial $1,707.86
Rate for Payer: Priority Health SBD $1,265.83
Rate for Payer: UHC All Payor (Choice/PPO) $1,306.01
Rate for Payer: UHC Core $1,046.82
Rate for Payer: UHC Exchange $789.64
Service Code NDC 60687050411
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $3.54
Max. Negotiated Rate $5.06
Rate for Payer: Aetna Commercial $4.78
Rate for Payer: Aetna New Business (MI Preferred) $3.65
Rate for Payer: Cash Price $4.50
Rate for Payer: Cofinity Advantage $3.93
Rate for Payer: Cofinity Commercial $4.83
Rate for Payer: Encore Health Key Benefits Commercial $4.50
Rate for Payer: Healthscope Commercial $5.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.78
Rate for Payer: Opus (Opus Packaging Group) HMA $4.21
Rate for Payer: PHP Commercial $4.78
Rate for Payer: Priority Health SBD $3.54
Service Code NDC 68462029301
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $276.85
Max. Negotiated Rate $395.50
Rate for Payer: Aetna Commercial $373.53
Rate for Payer: Aetna New Business (MI Preferred) $285.64
Rate for Payer: Cash Price $351.56
Rate for Payer: Cofinity Advantage $307.62
Rate for Payer: Cofinity Commercial $377.93
Rate for Payer: Encore Health Key Benefits Commercial $351.56
Rate for Payer: Healthscope Commercial $395.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial $373.53
Rate for Payer: Opus (Opus Packaging Group) HMA $329.59
Rate for Payer: PHP Commercial $373.53
Rate for Payer: Priority Health SBD $276.85
Service Code NDC 75834015801
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $84.00
Max. Negotiated Rate $192.38
Rate for Payer: Aetna Commercial $181.69
Rate for Payer: Aetna Medicare $106.88
Rate for Payer: Aetna New Business (MI Preferred) $138.94
Rate for Payer: BCBS Complete $85.50
Rate for Payer: Cash Price $171.00
Rate for Payer: Cofinity Advantage $149.62
Rate for Payer: Cofinity Commercial $183.82
Rate for Payer: Encore Health Key Benefits Commercial $171.00
Rate for Payer: Healthscope Commercial $192.38
Rate for Payer: MI Amish Medical Board Commercial $171.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial $181.69
Rate for Payer: Opus (Opus Packaging Group) HMA $160.31
Rate for Payer: PHP Commercial $181.69
Rate for Payer: Priority Health SBD $134.66
Rate for Payer: UHC All Payor (Choice/PPO) $138.94
Rate for Payer: UHC Core $111.36
Rate for Payer: UHC Exchange $84.00
Service Code NDC 68462029305
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $1,265.83
Max. Negotiated Rate $1,808.33
Rate for Payer: Aetna Commercial $1,707.86
Rate for Payer: Aetna New Business (MI Preferred) $1,306.01
Rate for Payer: Cash Price $1,607.40
Rate for Payer: Cofinity Advantage $1,406.47
Rate for Payer: Cofinity Commercial $1,727.95
Rate for Payer: Encore Health Key Benefits Commercial $1,607.40
Rate for Payer: Healthscope Commercial $1,808.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,707.86
Rate for Payer: Opus (Opus Packaging Group) HMA $1,506.94
Rate for Payer: PHP Commercial $1,707.86
Rate for Payer: Priority Health SBD $1,265.83
Service Code NDC 60687050401
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $353.81
Max. Negotiated Rate $505.44
Rate for Payer: Aetna Commercial $477.36
Rate for Payer: Aetna New Business (MI Preferred) $365.04
Rate for Payer: Cash Price $449.28
Rate for Payer: Cofinity Advantage $393.12
Rate for Payer: Cofinity Commercial $482.98
Rate for Payer: Encore Health Key Benefits Commercial $449.28
Rate for Payer: Healthscope Commercial $505.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial $477.36
Rate for Payer: Opus (Opus Packaging Group) HMA $421.20
Rate for Payer: PHP Commercial $477.36
Rate for Payer: Priority Health SBD $353.81
Service Code NDC 68462029301
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $172.70
Max. Negotiated Rate $395.50
Rate for Payer: Aetna Commercial $373.53
Rate for Payer: Aetna Medicare $219.72
Rate for Payer: Aetna New Business (MI Preferred) $285.64
Rate for Payer: BCBS Complete $175.78
Rate for Payer: Cash Price $351.56
Rate for Payer: Cofinity Advantage $307.62
Rate for Payer: Cofinity Commercial $377.93
Rate for Payer: Encore Health Key Benefits Commercial $351.56
Rate for Payer: Healthscope Commercial $395.50
Rate for Payer: MI Amish Medical Board Commercial $351.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial $373.53
Rate for Payer: Opus (Opus Packaging Group) HMA $329.59
Rate for Payer: PHP Commercial $373.53
Rate for Payer: Priority Health SBD $276.85
Rate for Payer: UHC All Payor (Choice/PPO) $285.64
Rate for Payer: UHC Core $228.95
Rate for Payer: UHC Exchange $172.70
Service Code NDC 60687050411
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $2.21
Max. Negotiated Rate $5.06
Rate for Payer: Aetna Commercial $4.78
Rate for Payer: Aetna Medicare $2.81
Rate for Payer: Aetna New Business (MI Preferred) $3.65
Rate for Payer: BCBS Complete $2.25
Rate for Payer: Cash Price $4.50
Rate for Payer: Cofinity Advantage $3.93
Rate for Payer: Cofinity Commercial $4.83
Rate for Payer: Encore Health Key Benefits Commercial $4.50
Rate for Payer: Healthscope Commercial $5.06
Rate for Payer: MI Amish Medical Board Commercial $4.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.78
Rate for Payer: Opus (Opus Packaging Group) HMA $4.21
Rate for Payer: PHP Commercial $4.78
Rate for Payer: Priority Health SBD $3.54
Rate for Payer: UHC All Payor (Choice/PPO) $3.65
Rate for Payer: UHC Core $2.93
Rate for Payer: UHC Exchange $2.21
Service Code NDC 60687050401
Hospital Charge Code 11640
Hospital Revenue Code 637
Min. Negotiated Rate $220.71
Max. Negotiated Rate $505.44
Rate for Payer: Aetna Commercial $477.36
Rate for Payer: Aetna Medicare $280.80
Rate for Payer: Aetna New Business (MI Preferred) $365.04
Rate for Payer: BCBS Complete $224.64
Rate for Payer: Cash Price $449.28
Rate for Payer: Cofinity Advantage $393.12
Rate for Payer: Cofinity Commercial $482.98
Rate for Payer: Encore Health Key Benefits Commercial $449.28
Rate for Payer: Healthscope Commercial $505.44
Rate for Payer: MI Amish Medical Board Commercial $449.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial $477.36
Rate for Payer: Opus (Opus Packaging Group) HMA $421.20
Rate for Payer: PHP Commercial $477.36
Rate for Payer: Priority Health SBD $353.81
Rate for Payer: UHC All Payor (Choice/PPO) $365.04
Rate for Payer: UHC Core $292.59
Rate for Payer: UHC Exchange $220.71
Service Code APR-DRG 3104
Min. Negotiated Rate $26,850.10
Max. Negotiated Rate $28,192.60
Rate for Payer: UHC Medicaid $26,850.10
Rate for Payer: BCBS Complete $28,192.60
Rate for Payer: Mclaren Medicaid $26,850.10
Rate for Payer: Meridian Medicaid $28,192.60
Rate for Payer: Priority Health Choice Medicaid $26,850.10
Rate for Payer: UHCCP Medicaid $26,850.10
Service Code APR-DRG 3102
Min. Negotiated Rate $12,306.29
Max. Negotiated Rate $12,921.61
Rate for Payer: BCBS Complete $12,921.61
Rate for Payer: Mclaren Medicaid $12,306.29
Rate for Payer: Meridian Medicaid $12,921.61
Rate for Payer: Priority Health Choice Medicaid $12,306.29
Rate for Payer: UHC Medicaid $12,306.29
Rate for Payer: UHCCP Medicaid $12,306.29
Service Code APR-DRG 3101
Min. Negotiated Rate $8,229.86
Max. Negotiated Rate $8,641.35
Rate for Payer: BCBS Complete $8,641.35
Rate for Payer: Mclaren Medicaid $8,229.86
Rate for Payer: Meridian Medicaid $8,641.35
Rate for Payer: Priority Health Choice Medicaid $8,229.86
Rate for Payer: UHC Medicaid $8,229.86
Rate for Payer: UHCCP Medicaid $8,229.86
Service Code APR-DRG 3103
Min. Negotiated Rate $19,541.34
Max. Negotiated Rate $20,518.41
Rate for Payer: BCBS Complete $20,518.41
Rate for Payer: Mclaren Medicaid $19,541.34
Rate for Payer: Meridian Medicaid $20,518.41
Rate for Payer: Priority Health Choice Medicaid $19,541.34
Rate for Payer: UHC Medicaid $19,541.34
Rate for Payer: UHCCP Medicaid $19,541.34
Service Code APR-DRG 1114
Min. Negotiated Rate $8,532.34
Max. Negotiated Rate $8,958.96
Rate for Payer: BCBS Complete $8,958.96
Rate for Payer: Mclaren Medicaid $8,532.34
Rate for Payer: Meridian Medicaid $8,958.96
Rate for Payer: Priority Health Choice Medicaid $8,532.34
Rate for Payer: UHC Medicaid $8,532.34
Rate for Payer: UHCCP Medicaid $8,532.34
Service Code APR-DRG 1111
Min. Negotiated Rate $3,954.13
Max. Negotiated Rate $4,151.84
Rate for Payer: BCBS Complete $4,151.84
Rate for Payer: Mclaren Medicaid $3,954.13
Rate for Payer: Meridian Medicaid $4,151.84
Rate for Payer: Priority Health Choice Medicaid $3,954.13
Rate for Payer: UHC Medicaid $3,954.13
Rate for Payer: UHCCP Medicaid $3,954.13
Service Code APR-DRG 1112
Min. Negotiated Rate $4,567.29
Max. Negotiated Rate $4,795.65
Rate for Payer: BCBS Complete $4,795.65
Rate for Payer: Mclaren Medicaid $4,567.29
Rate for Payer: Meridian Medicaid $4,795.65
Rate for Payer: Priority Health Choice Medicaid $4,567.29
Rate for Payer: UHC Medicaid $4,567.29
Rate for Payer: UHCCP Medicaid $4,567.29
Service Code APR-DRG 1113
Min. Negotiated Rate $5,672.94
Max. Negotiated Rate $5,956.59
Rate for Payer: BCBS Complete $5,956.59
Rate for Payer: Mclaren Medicaid $5,672.94
Rate for Payer: Meridian Medicaid $5,956.59
Rate for Payer: Priority Health Choice Medicaid $5,672.94
Rate for Payer: UHC Medicaid $5,672.94
Rate for Payer: UHCCP Medicaid $5,672.94
Service Code NDC 00456112030
Hospital Charge Code 152700
Hospital Revenue Code 637
Min. Negotiated Rate $517.76
Max. Negotiated Rate $1,185.71
Rate for Payer: Aetna Commercial $1,119.84
Rate for Payer: Aetna Medicare $658.73
Rate for Payer: Aetna New Business (MI Preferred) $856.35
Rate for Payer: BCBS Complete $526.98
Rate for Payer: Cash Price $1,053.97
Rate for Payer: Cofinity Advantage $922.22
Rate for Payer: Cofinity Commercial $1,133.02
Rate for Payer: Encore Health Key Benefits Commercial $1,053.97
Rate for Payer: Healthscope Commercial $1,185.71
Rate for Payer: MI Amish Medical Board Commercial $1,053.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,119.84
Rate for Payer: Opus (Opus Packaging Group) HMA $988.10
Rate for Payer: PHP Commercial $1,119.84
Rate for Payer: Priority Health SBD $830.00
Rate for Payer: UHC All Payor (Choice/PPO) $856.35
Rate for Payer: UHC Core $686.40
Rate for Payer: UHC Exchange $517.76
Service Code NDC 62332023330
Hospital Charge Code 152700
Hospital Revenue Code 637
Min. Negotiated Rate $213.10
Max. Negotiated Rate $488.02
Rate for Payer: Aetna Commercial $460.90
Rate for Payer: Aetna Medicare $271.12
Rate for Payer: Aetna New Business (MI Preferred) $352.46
Rate for Payer: BCBS Complete $216.90
Rate for Payer: Cash Price $433.79
Rate for Payer: Cofinity Advantage $379.57
Rate for Payer: Cofinity Commercial $466.33
Rate for Payer: Encore Health Key Benefits Commercial $433.79
Rate for Payer: Healthscope Commercial $488.02
Rate for Payer: MI Amish Medical Board Commercial $433.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial $460.90
Rate for Payer: Opus (Opus Packaging Group) HMA $406.68
Rate for Payer: PHP Commercial $460.90
Rate for Payer: Priority Health SBD $341.61
Rate for Payer: UHC All Payor (Choice/PPO) $352.46
Rate for Payer: UHC Core $282.51
Rate for Payer: UHC Exchange $213.10