Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 2 MG TABLET

Facility

$4.26

Service Code	NDC 50268008711
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare	$2.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: BCBS Complete	$1.70
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Advantage	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: MI Amish Medical Board Commercial	$3.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.19
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health SBD	$2.68
Rate for Payer: UHC All Payor (Choice/PPO)	$2.77
Rate for Payer: UHC Core	$2.22
Rate for Payer: UHC Exchange	$1.67

ARIPIPRAZOLE 2 MG TABLET

Facility

$200.31

Service Code	NDC 60505307503
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$126.20
Max. Negotiated Rate	$180.28
Rate for Payer: Aetna Commercial	$170.26
Rate for Payer: Aetna New Business (MI Preferred)	$130.20
Rate for Payer: Cash Price	$160.25
Rate for Payer: Cofinity Advantage	$140.22
Rate for Payer: Cofinity Commercial	$172.27
Rate for Payer: Encore Health Key Benefits Commercial	$160.25
Rate for Payer: Healthscope Commercial	$180.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.23
Rate for Payer: PHP Commercial	$170.26
Rate for Payer: Priority Health SBD	$126.20

ARIPIPRAZOLE 2 MG TABLET

Facility

$2,008.88

Service Code	NDC 59148000613
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$1,265.59
Max. Negotiated Rate	$1,807.99
Rate for Payer: Aetna Commercial	$1,707.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,305.77
Rate for Payer: Cash Price	$1,607.10
Rate for Payer: Cofinity Advantage	$1,406.22
Rate for Payer: Cofinity Commercial	$1,727.64
Rate for Payer: Encore Health Key Benefits Commercial	$1,607.10
Rate for Payer: Healthscope Commercial	$1,807.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,707.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,506.66
Rate for Payer: PHP Commercial	$1,707.55
Rate for Payer: Priority Health SBD	$1,265.59

ARIPIPRAZOLE 2 MG TABLET

Facility

$93.75

Service Code	NDC 27241005103
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: Aetna Medicare	$46.88
Rate for Payer: Aetna New Business (MI Preferred)	$60.94
Rate for Payer: BCBS Complete	$37.50
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Advantage	$65.62
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: MI Amish Medical Board Commercial	$75.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.31
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health SBD	$59.06
Rate for Payer: UHC All Payor (Choice/PPO)	$60.94
Rate for Payer: UHC Core	$48.84
Rate for Payer: UHC Exchange	$36.84

ARIPIPRAZOLE 2 MG TABLET

Facility

$93.75

Service Code	NDC 27241005103
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: Aetna New Business (MI Preferred)	$60.94
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Advantage	$65.62
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.31
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health SBD	$59.06

ARIPIPRAZOLE 2 MG TABLET

Facility

$61.28

Service Code	NDC 67877043003
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$55.15
Rate for Payer: Aetna Commercial	$52.09
Rate for Payer: Aetna Medicare	$30.64
Rate for Payer: Aetna New Business (MI Preferred)	$39.83
Rate for Payer: BCBS Complete	$24.51
Rate for Payer: Cash Price	$49.02
Rate for Payer: Cofinity Advantage	$42.90
Rate for Payer: Cofinity Commercial	$52.70
Rate for Payer: Encore Health Key Benefits Commercial	$49.02
Rate for Payer: Healthscope Commercial	$55.15
Rate for Payer: MI Amish Medical Board Commercial	$49.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.96
Rate for Payer: PHP Commercial	$52.09
Rate for Payer: Priority Health SBD	$38.61
Rate for Payer: UHC All Payor (Choice/PPO)	$39.83
Rate for Payer: UHC Core	$31.93
Rate for Payer: UHC Exchange	$24.08

ARIPIPRAZOLE 2 MG TABLET

Facility

$61.28

Service Code	NDC 67877043003
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$38.61
Max. Negotiated Rate	$55.15
Rate for Payer: Aetna Commercial	$52.09
Rate for Payer: Aetna New Business (MI Preferred)	$39.83
Rate for Payer: Cash Price	$49.02
Rate for Payer: Cofinity Advantage	$42.90
Rate for Payer: Cofinity Commercial	$52.70
Rate for Payer: Encore Health Key Benefits Commercial	$49.02
Rate for Payer: Healthscope Commercial	$55.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.96
Rate for Payer: PHP Commercial	$52.09
Rate for Payer: Priority Health SBD	$38.61

ARIPIPRAZOLE 2 MG TABLET

Facility

$4.26

Service Code	NDC 50268008711
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Advantage	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.19
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health SBD	$2.68

ARIPIPRAZOLE 2 MG TABLET

Facility

$85.06

Service Code	NDC 50268008712
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$53.59
Max. Negotiated Rate	$76.55
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna New Business (MI Preferred)	$55.29
Rate for Payer: Cash Price	$68.05
Rate for Payer: Cofinity Advantage	$59.54
Rate for Payer: Cofinity Commercial	$73.15
Rate for Payer: Encore Health Key Benefits Commercial	$68.05
Rate for Payer: Healthscope Commercial	$76.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.80
Rate for Payer: PHP Commercial	$72.30
Rate for Payer: Priority Health SBD	$53.59

ARIPIPRAZOLE 2 MG TABLET

Facility

$85.06

Service Code	NDC 50268008712
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$33.43
Max. Negotiated Rate	$76.55
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna Medicare	$42.53
Rate for Payer: Aetna New Business (MI Preferred)	$55.29
Rate for Payer: BCBS Complete	$34.02
Rate for Payer: Cash Price	$68.05
Rate for Payer: Cofinity Advantage	$59.54
Rate for Payer: Cofinity Commercial	$73.15
Rate for Payer: Encore Health Key Benefits Commercial	$68.05
Rate for Payer: Healthscope Commercial	$76.55
Rate for Payer: MI Amish Medical Board Commercial	$68.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.80
Rate for Payer: PHP Commercial	$72.30
Rate for Payer: Priority Health SBD	$53.59
Rate for Payer: UHC All Payor (Choice/PPO)	$55.29
Rate for Payer: UHC Core	$44.32
Rate for Payer: UHC Exchange	$33.43

ARIPIPRAZOLE 5 MG TABLET

Facility

$213.28

Service Code	NDC 00904736706
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$134.37
Max. Negotiated Rate	$191.95
Rate for Payer: Aetna Commercial	$181.29
Rate for Payer: Aetna New Business (MI Preferred)	$138.63
Rate for Payer: Cash Price	$170.62
Rate for Payer: Cofinity Advantage	$149.30
Rate for Payer: Cofinity Commercial	$183.42
Rate for Payer: Encore Health Key Benefits Commercial	$170.62
Rate for Payer: Healthscope Commercial	$191.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.96
Rate for Payer: PHP Commercial	$181.29
Rate for Payer: Priority Health SBD	$134.37

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$719.92
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: Aetna Medicare	$915.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,190.72
Rate for Payer: BCBS Complete	$732.75
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Advantage	$1,282.31
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: MI Amish Medical Board Commercial	$1,465.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,373.90
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: Priority Health SBD	$1,154.08
Rate for Payer: UHC All Payor (Choice/PPO)	$1,190.72
Rate for Payer: UHC Core	$954.40
Rate for Payer: UHC Exchange	$719.92

ARIPIPRAZOLE 5 MG TABLET

Facility

$213.28

Service Code	NDC 00904736706
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$83.82
Max. Negotiated Rate	$191.95
Rate for Payer: Aetna Commercial	$181.29
Rate for Payer: Aetna Medicare	$106.64
Rate for Payer: Aetna New Business (MI Preferred)	$138.63
Rate for Payer: BCBS Complete	$85.31
Rate for Payer: Cash Price	$170.62
Rate for Payer: Cofinity Advantage	$149.30
Rate for Payer: Cofinity Commercial	$183.42
Rate for Payer: Encore Health Key Benefits Commercial	$170.62
Rate for Payer: Healthscope Commercial	$191.95
Rate for Payer: MI Amish Medical Board Commercial	$170.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.96
Rate for Payer: PHP Commercial	$181.29
Rate for Payer: Priority Health SBD	$134.37
Rate for Payer: UHC All Payor (Choice/PPO)	$138.63
Rate for Payer: UHC Core	$111.12
Rate for Payer: UHC Exchange	$83.82

ARIPIPRAZOLE 5 MG TABLET

Facility

$204.45

Service Code	NDC 16729027901
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$80.35
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna Medicare	$102.22
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: BCBS Complete	$81.78
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Advantage	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: MI Amish Medical Board Commercial	$163.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.34
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health SBD	$128.80
Rate for Payer: UHC All Payor (Choice/PPO)	$132.89
Rate for Payer: UHC Core	$106.52
Rate for Payer: UHC Exchange	$80.35

ARIPIPRAZOLE 5 MG TABLET

Facility

$943.87

Service Code	NDC 00904736761
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$370.94
Max. Negotiated Rate	$849.48
Rate for Payer: Aetna Commercial	$802.29
Rate for Payer: Aetna Medicare	$471.94
Rate for Payer: Aetna New Business (MI Preferred)	$613.52
Rate for Payer: BCBS Complete	$377.55
Rate for Payer: Cash Price	$755.10
Rate for Payer: Cofinity Advantage	$660.71
Rate for Payer: Cofinity Commercial	$811.73
Rate for Payer: Encore Health Key Benefits Commercial	$755.10
Rate for Payer: Healthscope Commercial	$849.48
Rate for Payer: MI Amish Medical Board Commercial	$755.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$802.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$707.90
Rate for Payer: PHP Commercial	$802.29
Rate for Payer: Priority Health SBD	$594.64
Rate for Payer: UHC All Payor (Choice/PPO)	$613.52
Rate for Payer: UHC Core	$491.76
Rate for Payer: UHC Exchange	$370.94

ARIPIPRAZOLE 5 MG TABLET

Facility

$204.45

Service Code	NDC 16729027901
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Advantage	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.34
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health SBD	$128.80

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,154.08
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: Aetna New Business (MI Preferred)	$1,190.72
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Advantage	$1,282.31
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,373.90
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: Priority Health SBD	$1,154.08

ARIPIPRAZOLE 5 MG TABLET

Facility

$943.87

Service Code	NDC 00904736761
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$594.64
Max. Negotiated Rate	$849.48
Rate for Payer: Aetna Commercial	$802.29
Rate for Payer: Aetna New Business (MI Preferred)	$613.52
Rate for Payer: Cash Price	$755.10
Rate for Payer: Cofinity Advantage	$660.71
Rate for Payer: Cofinity Commercial	$811.73
Rate for Payer: Encore Health Key Benefits Commercial	$755.10
Rate for Payer: Healthscope Commercial	$849.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$802.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$707.90
Rate for Payer: PHP Commercial	$802.29
Rate for Payer: Priority Health SBD	$594.64

ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$3,982.01

Service Code	HCPCS J9017
Hospital Charge Code	185456
Hospital Revenue Code	636
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$3,583.81
Rate for Payer: Aetna Commercial	$3,384.71
Rate for Payer: Aetna Medicare	$1,991.01
Rate for Payer: Aetna New Business (MI Preferred)	$2,588.31
Rate for Payer: BCBS Complete	$1,592.80
Rate for Payer: BCBS Trust/PPO	$18.52
Rate for Payer: BCN Commercial	$18.52
Rate for Payer: Cash Price	$3,185.61
Rate for Payer: Cash Price	$3,185.61
Rate for Payer: Cofinity Advantage	$2,787.41
Rate for Payer: Cofinity Commercial	$3,424.53
Rate for Payer: Encore Health Key Benefits Commercial	$3,185.61
Rate for Payer: Healthscope Commercial	$3,583.81
Rate for Payer: MI Amish Medical Board Commercial	$3,185.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,384.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,986.51
Rate for Payer: PHP Commercial	$3,384.71
Rate for Payer: Priority Health SBD	$2,508.67
Rate for Payer: UHC All Payor (Choice/PPO)	$12.19
Rate for Payer: UHC Core	$12.19
Rate for Payer: UHC Exchange	$12.19

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION

Facility

$17,930.33

Service Code	CPT 36819
Hospital Revenue Code	360
Min. Negotiated Rate	$2,899.76
Max. Negotiated Rate	$17,930.33
Rate for Payer: Aetna Medicare	$5,766.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,930.60
Rate for Payer: Amish Plain Church Group Commercial	$6,930.60
Rate for Payer: BCBS Complete	$3,045.03
Rate for Payer: BCBS MAPPO	$5,544.48
Rate for Payer: BCBS Trust/PPO	$4,234.36
Rate for Payer: BCN Commercial	$4,234.36
Rate for Payer: BCN Medicare Advantage	$5,544.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,544.48
Rate for Payer: Mclaren Medicaid	$2,899.76
Rate for Payer: Mclaren Medicare	$5,544.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,821.70
Rate for Payer: Meridian Medicaid	$5,821.70
Rate for Payer: MI Amish Medical Board Commercial	$6,376.15
Rate for Payer: Molina Medicare/Medicaid	$6,098.93
Rate for Payer: Nomi Health Commercial	$16,633.44
Rate for Payer: PACE Medicare	$5,267.26
Rate for Payer: PACE SWMI	$5,544.48
Rate for Payer: PHP Medicare Advantage	$5,544.48
Rate for Payer: Priority Health Choice Medicaid	$2,899.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$17,930.33
Rate for Payer: Priority Health Medicare	$5,544.48
Rate for Payer: Priority Health Tiered Network	$14,344.26
Rate for Payer: Railroad Medicare Medicare	$5,544.48
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,544.48
Rate for Payer: UHC Medicaid	$2,899.76
Rate for Payer: UHCCP Medicaid	$2,899.76
Rate for Payer: VA VA	$5,544.48

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION

Facility

$17,930.33

Service Code	CPT 36818
Hospital Revenue Code	360
Min. Negotiated Rate	$2,427.99
Max. Negotiated Rate	$17,930.33
Rate for Payer: Aetna Medicare	$5,766.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,930.60
Rate for Payer: Amish Plain Church Group Commercial	$6,930.60
Rate for Payer: BCBS Complete	$3,045.03
Rate for Payer: BCBS MAPPO	$5,544.48
Rate for Payer: BCBS Trust/PPO	$2,427.99
Rate for Payer: BCN Commercial	$2,427.99
Rate for Payer: BCN Medicare Advantage	$5,544.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,544.48
Rate for Payer: Mclaren Medicaid	$2,899.76
Rate for Payer: Mclaren Medicare	$5,544.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,821.70
Rate for Payer: Meridian Medicaid	$5,821.70
Rate for Payer: MI Amish Medical Board Commercial	$6,376.15
Rate for Payer: Molina Medicare/Medicaid	$6,098.93
Rate for Payer: Nomi Health Commercial	$16,633.44
Rate for Payer: PACE Medicare	$5,267.26
Rate for Payer: PACE SWMI	$5,544.48
Rate for Payer: PHP Medicare Advantage	$5,544.48
Rate for Payer: Priority Health Choice Medicaid	$2,899.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$17,930.33
Rate for Payer: Priority Health Medicare	$5,544.48
Rate for Payer: Priority Health Tiered Network	$14,344.26
Rate for Payer: Railroad Medicare Medicare	$5,544.48
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,544.48
Rate for Payer: UHC Medicaid	$2,899.76
Rate for Payer: UHCCP Medicaid	$2,899.76
Rate for Payer: VA VA	$5,544.48

ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)

Facility

$10,174.29

Service Code	CPT 36821
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.43
Max. Negotiated Rate	$10,174.29
Rate for Payer: Aetna Medicare	$3,271.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,932.66
Rate for Payer: Amish Plain Church Group Commercial	$3,932.66
Rate for Payer: BCBS Complete	$1,727.85
Rate for Payer: BCBS MAPPO	$3,146.13
Rate for Payer: BCBS Trust/PPO	$3,304.84
Rate for Payer: BCN Commercial	$3,304.84
Rate for Payer: BCN Medicare Advantage	$3,146.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,146.13
Rate for Payer: Mclaren Medicaid	$1,645.43
Rate for Payer: Mclaren Medicare	$3,146.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,303.44
Rate for Payer: Meridian Medicaid	$3,303.44
Rate for Payer: MI Amish Medical Board Commercial	$3,618.05
Rate for Payer: Molina Medicare/Medicaid	$3,460.74
Rate for Payer: Nomi Health Commercial	$9,438.39
Rate for Payer: PACE Medicare	$2,988.82
Rate for Payer: PACE SWMI	$3,146.13
Rate for Payer: PHP Medicare Advantage	$3,146.13
Rate for Payer: Priority Health Choice Medicaid	$1,645.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,174.29
Rate for Payer: Priority Health Medicare	$3,146.13
Rate for Payer: Priority Health Tiered Network	$8,139.43
Rate for Payer: Railroad Medicare Medicare	$3,146.13
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,146.13
Rate for Payer: UHC Medicaid	$1,645.43
Rate for Payer: UHCCP Medicaid	$1,645.43
Rate for Payer: VA VA	$3,146.13

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$989.08

Service Code	CPT 20610
Hospital Revenue Code	360
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$989.08
Rate for Payer: Aetna Medicare	$318.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$382.31
Rate for Payer: Amish Plain Church Group Commercial	$382.31
Rate for Payer: BCBS Complete	$167.97
Rate for Payer: BCBS MAPPO	$305.85
Rate for Payer: BCBS Trust/PPO	$224.17
Rate for Payer: BCN Commercial	$224.17
Rate for Payer: BCN Medicare Advantage	$305.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.85
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Mclaren Medicare	$305.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$321.14
Rate for Payer: Meridian Medicaid	$321.14
Rate for Payer: MI Amish Medical Board Commercial	$351.73
Rate for Payer: Molina Medicare/Medicaid	$336.44
Rate for Payer: Nomi Health Commercial	$917.55
Rate for Payer: PACE Medicare	$290.56
Rate for Payer: PACE SWMI	$305.85
Rate for Payer: PHP Medicare Advantage	$305.85
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.08
Rate for Payer: Priority Health Medicare	$305.85
Rate for Payer: Priority Health Tiered Network	$791.26
Rate for Payer: Railroad Medicare Medicare	$305.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$305.85
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96
Rate for Payer: VA VA	$305.85

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$989.08

Service Code	CPT 20610
Hospital Revenue Code	361
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$989.08
Rate for Payer: Aetna Medicare	$318.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$382.31
Rate for Payer: Amish Plain Church Group Commercial	$382.31
Rate for Payer: BCBS Complete	$167.97
Rate for Payer: BCBS MAPPO	$305.85
Rate for Payer: BCBS Trust/PPO	$224.17
Rate for Payer: BCN Commercial	$224.17
Rate for Payer: BCN Medicare Advantage	$305.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.85
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Mclaren Medicare	$305.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$321.14
Rate for Payer: Meridian Medicaid	$321.14
Rate for Payer: MI Amish Medical Board Commercial	$351.73
Rate for Payer: Molina Medicare/Medicaid	$336.44
Rate for Payer: Nomi Health Commercial	$917.55
Rate for Payer: PACE Medicare	$290.56
Rate for Payer: PACE SWMI	$305.85
Rate for Payer: PHP Medicare Advantage	$305.85
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.08
Rate for Payer: Priority Health Medicare	$305.85
Rate for Payer: Priority Health Tiered Network	$791.26
Rate for Payer: Railroad Medicare Medicare	$305.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$305.85
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96
Rate for Payer: VA VA	$305.85

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITH ULTRASOUND GUIDANCE, WITH PERMANENT RECORDING AND REPORTING

Facility

$989.08

Service Code	CPT 20611
Hospital Revenue Code	360
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$989.08
Rate for Payer: Aetna Medicare	$318.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$382.31
Rate for Payer: Amish Plain Church Group Commercial	$382.31
Rate for Payer: BCBS Complete	$167.97
Rate for Payer: BCBS MAPPO	$305.85
Rate for Payer: BCBS Trust/PPO	$224.17
Rate for Payer: BCN Commercial	$224.17
Rate for Payer: BCN Medicare Advantage	$305.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.85
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Mclaren Medicare	$305.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$321.14
Rate for Payer: Meridian Medicaid	$321.14
Rate for Payer: MI Amish Medical Board Commercial	$351.73
Rate for Payer: Molina Medicare/Medicaid	$336.44
Rate for Payer: Nomi Health Commercial	$917.55
Rate for Payer: PACE Medicare	$290.56
Rate for Payer: PACE SWMI	$305.85
Rate for Payer: PHP Medicare Advantage	$305.85
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.08
Rate for Payer: Priority Health Medicare	$305.85
Rate for Payer: Priority Health Tiered Network	$791.26
Rate for Payer: Railroad Medicare Medicare	$305.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$305.85
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96
Rate for Payer: VA VA	$305.85

Know your out-of-pocket cost for care.

All Charges