Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$9,089.10

Service Code	APR-DRG 0593
Min. Negotiated Rate	$8,656.28
Max. Negotiated Rate	$9,089.10
Rate for Payer: BCBS Complete	$9,089.10
Rate for Payer: Mclaren Medicaid	$8,656.28
Rate for Payer: Meridian Medicaid	$9,089.10
Rate for Payer: Priority Health Choice Medicaid	$8,656.28
Rate for Payer: UHC Medicaid	$8,656.28
Rate for Payer: UHCCP Medicaid	$8,656.28

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$4,390.33

Service Code	APR-DRG 0591
Min. Negotiated Rate	$4,181.27
Max. Negotiated Rate	$4,390.33
Rate for Payer: BCBS Complete	$4,390.33
Rate for Payer: Mclaren Medicaid	$4,181.27
Rate for Payer: Meridian Medicaid	$4,390.33
Rate for Payer: Priority Health Choice Medicaid	$4,181.27
Rate for Payer: UHC Medicaid	$4,181.27
Rate for Payer: UHCCP Medicaid	$4,181.27

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$7,028.66

Service Code	APR-DRG 0592
Min. Negotiated Rate	$6,693.96
Max. Negotiated Rate	$7,028.66
Rate for Payer: BCBS Complete	$7,028.66
Rate for Payer: Mclaren Medicaid	$6,693.96
Rate for Payer: Meridian Medicaid	$7,028.66
Rate for Payer: Priority Health Choice Medicaid	$6,693.96
Rate for Payer: UHC Medicaid	$6,693.96
Rate for Payer: UHCCP Medicaid	$6,693.96

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$15,010.14

Service Code	APR-DRG 0594
Min. Negotiated Rate	$14,295.37
Max. Negotiated Rate	$15,010.14
Rate for Payer: BCBS Complete	$15,010.14
Rate for Payer: Mclaren Medicaid	$14,295.37
Rate for Payer: Meridian Medicaid	$15,010.14
Rate for Payer: Priority Health Choice Medicaid	$14,295.37
Rate for Payer: UHC Medicaid	$14,295.37
Rate for Payer: UHCCP Medicaid	$14,295.37

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$15,793.84

Service Code	APR-DRG 5474
Min. Negotiated Rate	$15,041.75
Max. Negotiated Rate	$15,793.84
Rate for Payer: BCBS Complete	$15,793.84
Rate for Payer: Mclaren Medicaid	$15,041.75
Rate for Payer: Meridian Medicaid	$15,793.84
Rate for Payer: Priority Health Choice Medicaid	$15,041.75
Rate for Payer: UHC Medicaid	$15,041.75
Rate for Payer: UHCCP Medicaid	$15,041.75

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$2,883.70

Service Code	APR-DRG 5471
Min. Negotiated Rate	$2,746.38
Max. Negotiated Rate	$2,883.70
Rate for Payer: BCBS Complete	$2,883.70
Rate for Payer: Mclaren Medicaid	$2,746.38
Rate for Payer: Meridian Medicaid	$2,883.70
Rate for Payer: Priority Health Choice Medicaid	$2,746.38
Rate for Payer: UHC Medicaid	$2,746.38
Rate for Payer: UHCCP Medicaid	$2,746.38

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$8,277.88

Service Code	APR-DRG 5473
Min. Negotiated Rate	$7,883.69
Max. Negotiated Rate	$8,277.88
Rate for Payer: BCBS Complete	$8,277.88
Rate for Payer: Mclaren Medicaid	$7,883.69
Rate for Payer: Meridian Medicaid	$8,277.88
Rate for Payer: Priority Health Choice Medicaid	$7,883.69
Rate for Payer: UHC Medicaid	$7,883.69
Rate for Payer: UHCCP Medicaid	$7,883.69

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$5,464.70

Service Code	APR-DRG 5472
Min. Negotiated Rate	$5,204.47
Max. Negotiated Rate	$5,464.70
Rate for Payer: BCBS Complete	$5,464.70
Rate for Payer: Mclaren Medicaid	$5,204.47
Rate for Payer: Meridian Medicaid	$5,464.70
Rate for Payer: Priority Health Choice Medicaid	$5,204.47
Rate for Payer: UHC Medicaid	$5,204.47
Rate for Payer: UHCCP Medicaid	$5,204.47

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$2,895.16

Service Code	APR-DRG 5662
Min. Negotiated Rate	$2,757.30
Max. Negotiated Rate	$2,895.16
Rate for Payer: BCBS Complete	$2,895.16
Rate for Payer: Mclaren Medicaid	$2,757.30
Rate for Payer: Meridian Medicaid	$2,895.16
Rate for Payer: Priority Health Choice Medicaid	$2,757.30
Rate for Payer: UHC Medicaid	$2,757.30
Rate for Payer: UHCCP Medicaid	$2,757.30

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$2,016.87

Service Code	APR-DRG 5661
Min. Negotiated Rate	$1,920.83
Max. Negotiated Rate	$2,016.87
Rate for Payer: BCBS Complete	$2,016.87
Rate for Payer: Mclaren Medicaid	$1,920.83
Rate for Payer: Meridian Medicaid	$2,016.87
Rate for Payer: Priority Health Choice Medicaid	$1,920.83
Rate for Payer: UHC Medicaid	$1,920.83
Rate for Payer: UHCCP Medicaid	$1,920.83

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$5,086.32

Service Code	APR-DRG 5663
Min. Negotiated Rate	$4,844.11
Max. Negotiated Rate	$5,086.32
Rate for Payer: BCBS Complete	$5,086.32
Rate for Payer: Mclaren Medicaid	$4,844.11
Rate for Payer: Meridian Medicaid	$5,086.32
Rate for Payer: Priority Health Choice Medicaid	$4,844.11
Rate for Payer: UHC Medicaid	$4,844.11
Rate for Payer: UHCCP Medicaid	$4,844.11

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$9,732.91

Service Code	APR-DRG 5664
Min. Negotiated Rate	$9,269.44
Max. Negotiated Rate	$9,732.91
Rate for Payer: BCBS Complete	$9,732.91
Rate for Payer: Mclaren Medicaid	$9,269.44
Rate for Payer: Meridian Medicaid	$9,732.91
Rate for Payer: Priority Health Choice Medicaid	$9,269.44
Rate for Payer: UHC Medicaid	$9,269.44
Rate for Payer: UHCCP Medicaid	$9,269.44

ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED

Facility

$16,119.31

Service Code	CPT 57240
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	$2,683.29
Rate for Payer: BCN Commercial	$2,683.29
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

ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$1,989.47

Service Code	CPT 22845
Hospital Revenue Code	360
Min. Negotiated Rate	$1,989.47
Max. Negotiated Rate	$1,989.47
Rate for Payer: BCBS Trust/PPO	$1,989.47
Rate for Payer: BCN Commercial	$1,989.47

ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION

Facility

$2.72

Service Code	HCPCS J7187
Hospital Charge Code	70405
Hospital Revenue Code	636
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.45
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.90
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: PHP Commercial	$2.31
Rate for Payer: Priority Health SBD	$1.71

ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION

Facility

$2.72

Service Code	HCPCS J7187
Hospital Charge Code	70405
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare	$1.55
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.86
Rate for Payer: Amish Plain Church Group Commercial	$1.86
Rate for Payer: BCBS Complete	$0.82
Rate for Payer: BCBS MAPPO	$1.49
Rate for Payer: BCBS Trust/PPO	$3.72
Rate for Payer: BCN Commercial	$3.72
Rate for Payer: BCN Medicare Advantage	$1.49
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.90
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.49
Rate for Payer: Healthscope Commercial	$2.45
Rate for Payer: Mclaren Medicaid	$0.78
Rate for Payer: Mclaren Medicare	$1.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.56
Rate for Payer: Meridian Medicaid	$1.56
Rate for Payer: MI Amish Medical Board Commercial	$1.71
Rate for Payer: Molina Medicare/Medicaid	$1.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Nomi Health Commercial	$4.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: PACE Medicare	$1.42
Rate for Payer: PACE SWMI	$1.49
Rate for Payer: PHP Commercial	$2.31
Rate for Payer: PHP Medicare Advantage	$1.49
Rate for Payer: Priority Health Choice Medicaid	$0.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$4.70
Rate for Payer: Priority Health Medicare	$1.49
Rate for Payer: Priority Health SBD	$1.71
Rate for Payer: Priority Health Tiered Network	$3.76
Rate for Payer: Railroad Medicare Medicare	$1.49
Rate for Payer: UHC All Payor (Choice/PPO)	$2.46
Rate for Payer: UHC Core	$2.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1.49
Rate for Payer: UHC Exchange	$2.46
Rate for Payer: UHC Medicaid	$0.78
Rate for Payer: UHCCP Medicaid	$0.78
Rate for Payer: VA VA	$1.49

ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION

Facility

$2.72

Service Code	HCPCS J7187
Hospital Charge Code	70406
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare	$1.55
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.86
Rate for Payer: Amish Plain Church Group Commercial	$1.86
Rate for Payer: BCBS Complete	$0.82
Rate for Payer: BCBS MAPPO	$1.49
Rate for Payer: BCBS Trust/PPO	$3.72
Rate for Payer: BCN Commercial	$3.72
Rate for Payer: BCN Medicare Advantage	$1.49
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.90
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.49
Rate for Payer: Healthscope Commercial	$2.45
Rate for Payer: Mclaren Medicaid	$0.78
Rate for Payer: Mclaren Medicare	$1.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.56
Rate for Payer: Meridian Medicaid	$1.56
Rate for Payer: MI Amish Medical Board Commercial	$1.71
Rate for Payer: Molina Medicare/Medicaid	$1.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Nomi Health Commercial	$4.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: PACE Medicare	$1.42
Rate for Payer: PACE SWMI	$1.49
Rate for Payer: PHP Commercial	$2.31
Rate for Payer: PHP Medicare Advantage	$1.49
Rate for Payer: Priority Health Choice Medicaid	$0.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$4.70
Rate for Payer: Priority Health Medicare	$1.49
Rate for Payer: Priority Health SBD	$1.71
Rate for Payer: Priority Health Tiered Network	$3.76
Rate for Payer: Railroad Medicare Medicare	$1.49
Rate for Payer: UHC All Payor (Choice/PPO)	$2.46
Rate for Payer: UHC Core	$2.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1.49
Rate for Payer: UHC Exchange	$2.46
Rate for Payer: UHC Medicaid	$0.78
Rate for Payer: UHCCP Medicaid	$0.78
Rate for Payer: VA VA	$1.49

ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION

Facility

$2.72

Service Code	HCPCS J7187
Hospital Charge Code	70406
Hospital Revenue Code	636
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.45
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.90
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: PHP Commercial	$2.31
Rate for Payer: Priority Health SBD	$1.71

ANTIHEMOPHILIC FACTOR-VWF 600 UNIT INTRAVENOUS SOLUTION

Facility

$2.72

Service Code	HCPCS J7187
Hospital Charge Code	70404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare	$1.55
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.86
Rate for Payer: Amish Plain Church Group Commercial	$1.86
Rate for Payer: BCBS Complete	$0.82
Rate for Payer: BCBS MAPPO	$1.49
Rate for Payer: BCBS Trust/PPO	$3.72
Rate for Payer: BCN Commercial	$3.72
Rate for Payer: BCN Medicare Advantage	$1.49
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.90
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.49
Rate for Payer: Healthscope Commercial	$2.45
Rate for Payer: Mclaren Medicaid	$0.78
Rate for Payer: Mclaren Medicare	$1.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.56
Rate for Payer: Meridian Medicaid	$1.56
Rate for Payer: MI Amish Medical Board Commercial	$1.71
Rate for Payer: Molina Medicare/Medicaid	$1.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Nomi Health Commercial	$4.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: PACE Medicare	$1.42
Rate for Payer: PACE SWMI	$1.49
Rate for Payer: PHP Commercial	$2.31
Rate for Payer: PHP Medicare Advantage	$1.49
Rate for Payer: Priority Health Choice Medicaid	$0.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$4.70
Rate for Payer: Priority Health Medicare	$1.49
Rate for Payer: Priority Health SBD	$1.71
Rate for Payer: Priority Health Tiered Network	$3.76
Rate for Payer: Railroad Medicare Medicare	$1.49
Rate for Payer: UHC All Payor (Choice/PPO)	$2.46
Rate for Payer: UHC Core	$2.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1.49
Rate for Payer: UHC Exchange	$2.46
Rate for Payer: UHC Medicaid	$0.78
Rate for Payer: UHCCP Medicaid	$0.78
Rate for Payer: VA VA	$1.49

ANTIHEMOPHILIC FACTOR-VWF 600 UNIT INTRAVENOUS SOLUTION

Facility

$2.72

Service Code	HCPCS J7187
Hospital Charge Code	70404
Hospital Revenue Code	636
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.45
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.90
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: PHP Commercial	$2.31
Rate for Payer: Priority Health SBD	$1.71

ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN

Facility

$2.88

Service Code	HCPCS J7182
Hospital Charge Code	174371
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$4.84
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.76
Rate for Payer: Amish Plain Church Group Commercial	$1.76
Rate for Payer: BCBS Complete	$0.77
Rate for Payer: BCBS MAPPO	$1.41
Rate for Payer: BCBS Trust/PPO	$3.89
Rate for Payer: BCN Commercial	$3.89
Rate for Payer: BCN Medicare Advantage	$1.41
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.41
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: Mclaren Medicaid	$0.74
Rate for Payer: Mclaren Medicare	$1.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.48
Rate for Payer: Meridian Medicaid	$1.48
Rate for Payer: MI Amish Medical Board Commercial	$1.62
Rate for Payer: Molina Medicare/Medicaid	$1.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Nomi Health Commercial	$4.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PACE Medicare	$1.34
Rate for Payer: PACE SWMI	$1.41
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: PHP Medicare Advantage	$1.41
Rate for Payer: Priority Health Choice Medicaid	$0.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$4.84
Rate for Payer: Priority Health Medicare	$1.41
Rate for Payer: Priority Health SBD	$1.81
Rate for Payer: Priority Health Tiered Network	$3.87
Rate for Payer: Railroad Medicare Medicare	$1.41
Rate for Payer: UHC All Payor (Choice/PPO)	$2.56
Rate for Payer: UHC Core	$2.56
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1.41
Rate for Payer: UHC Exchange	$2.56
Rate for Payer: UHC Medicaid	$0.74
Rate for Payer: UHCCP Medicaid	$0.74
Rate for Payer: VA VA	$1.41

ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN

Facility

$2.88

Service Code	HCPCS J7182
Hospital Charge Code	174371
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: Priority Health SBD	$1.81

ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN

Facility

$2.88

Service Code	HCPCS J7182
Hospital Charge Code	174374
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$4.84
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.76
Rate for Payer: Amish Plain Church Group Commercial	$1.76
Rate for Payer: BCBS Complete	$0.77
Rate for Payer: BCBS MAPPO	$1.41
Rate for Payer: BCBS Trust/PPO	$3.89
Rate for Payer: BCN Commercial	$3.89
Rate for Payer: BCN Medicare Advantage	$1.41
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.41
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: Mclaren Medicaid	$0.74
Rate for Payer: Mclaren Medicare	$1.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.48
Rate for Payer: Meridian Medicaid	$1.48
Rate for Payer: MI Amish Medical Board Commercial	$1.62
Rate for Payer: Molina Medicare/Medicaid	$1.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Nomi Health Commercial	$4.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PACE Medicare	$1.34
Rate for Payer: PACE SWMI	$1.41
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: PHP Medicare Advantage	$1.41
Rate for Payer: Priority Health Choice Medicaid	$0.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$4.84
Rate for Payer: Priority Health Medicare	$1.41
Rate for Payer: Priority Health SBD	$1.81
Rate for Payer: Priority Health Tiered Network	$3.87
Rate for Payer: Railroad Medicare Medicare	$1.41
Rate for Payer: UHC All Payor (Choice/PPO)	$2.56
Rate for Payer: UHC Core	$2.56
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1.41
Rate for Payer: UHC Exchange	$2.56
Rate for Payer: UHC Medicaid	$0.74
Rate for Payer: UHCCP Medicaid	$0.74
Rate for Payer: VA VA	$1.41

ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN

Facility

$2.88

Service Code	HCPCS J7182
Hospital Charge Code	174374
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: Priority Health SBD	$1.81

ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN

Facility

$2.88

Service Code	HCPCS J7182
Hospital Charge Code	174369
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: Priority Health SBD	$1.81

Know your out-of-pocket cost for care.

All Charges