Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC GUIDEWIRE GLIDWIRE LVL 5

Facility

$658.48

Service Code	HCPCS C1769
Hospital Charge Code	27200275
Hospital Revenue Code	272
Min. Negotiated Rate	$263.39
Max. Negotiated Rate	$592.63
Rate for Payer: Aetna Commercial	$559.71
Rate for Payer: Aetna New Business (MI Preferred)	$428.01
Rate for Payer: BCBS Complete	$263.39
Rate for Payer: Cash Price	$526.78
Rate for Payer: Cofinity Commercial	$460.94
Rate for Payer: Cofinity Commercial	$566.29
Rate for Payer: Healthscope Commercial	$592.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$559.71
Rate for Payer: PHP Commercial	$559.71
Rate for Payer: Priority Health Cigna Priority Health	$460.94
Rate for Payer: Priority Health SBD	$414.84

HC GUIDING CATHETER LVL 1

Facility

$43.03

Service Code	HCPCS C1887
Hospital Charge Code	27200022
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$38.73
Rate for Payer: Aetna Commercial	$36.58
Rate for Payer: Aetna New Business (MI Preferred)	$27.97
Rate for Payer: Cash Price	$34.42
Rate for Payer: Cofinity Commercial	$30.12
Rate for Payer: Cofinity Commercial	$37.01
Rate for Payer: Healthscope Commercial	$38.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.58
Rate for Payer: PHP Commercial	$36.58
Rate for Payer: Priority Health Cigna Priority Health	$30.12
Rate for Payer: Priority Health SBD	$27.11

HC GUIDING CATHETER LVL 1

Facility

$43.03

Service Code	HCPCS C1887
Hospital Charge Code	27200022
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$38.73
Rate for Payer: Aetna Commercial	$36.58
Rate for Payer: Aetna New Business (MI Preferred)	$27.97
Rate for Payer: BCBS Complete	$17.21
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$34.42
Rate for Payer: Cash Price	$34.42
Rate for Payer: Cofinity Commercial	$30.12
Rate for Payer: Cofinity Commercial	$37.01
Rate for Payer: Healthscope Commercial	$38.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.58
Rate for Payer: PHP Commercial	$36.58
Rate for Payer: Priority Health Cigna Priority Health	$30.12
Rate for Payer: Priority Health SBD	$27.11

HC GUIDING CATHETER LVL 17

Facility

$1,789.01

Service Code	HCPCS C1887
Hospital Charge Code	27800082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,127.08
Max. Negotiated Rate	$1,610.11
Rate for Payer: Aetna Commercial	$1,520.66
Rate for Payer: Aetna New Business (MI Preferred)	$1,162.86
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cofinity Commercial	$1,252.31
Rate for Payer: Cofinity Commercial	$1,538.55
Rate for Payer: Healthscope Commercial	$1,610.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,520.66
Rate for Payer: PHP Commercial	$1,520.66
Rate for Payer: Priority Health Cigna Priority Health	$1,252.31
Rate for Payer: Priority Health SBD	$1,127.08

HC GUIDING CATHETER LVL 17

Facility

$1,789.01

Service Code	HCPCS C1887
Hospital Charge Code	27800082
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1,610.11
Rate for Payer: Aetna Commercial	$1,520.66
Rate for Payer: Aetna New Business (MI Preferred)	$1,162.86
Rate for Payer: BCBS Complete	$715.60
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cofinity Commercial	$1,252.31
Rate for Payer: Cofinity Commercial	$1,538.55
Rate for Payer: Healthscope Commercial	$1,610.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,520.66
Rate for Payer: PHP Commercial	$1,520.66
Rate for Payer: Priority Health Cigna Priority Health	$1,252.31
Rate for Payer: Priority Health SBD	$1,127.08

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$1,246.37
Max. Negotiated Rate	$1,780.53
Rate for Payer: Aetna Commercial	$1,681.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,285.94
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,384.86
Rate for Payer: Cofinity Commercial	$1,701.40
Rate for Payer: Healthscope Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,681.61
Rate for Payer: PHP Commercial	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,384.86
Rate for Payer: Priority Health SBD	$1,246.37

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1,780.53
Rate for Payer: Aetna Commercial	$1,681.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,285.94
Rate for Payer: BCBS Complete	$791.35
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,384.86
Rate for Payer: Cofinity Commercial	$1,701.40
Rate for Payer: Healthscope Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,681.61
Rate for Payer: PHP Commercial	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,384.86
Rate for Payer: Priority Health SBD	$1,246.37

HC GUIDING CATHETER LVL 2

Facility

$280.38

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$176.64
Max. Negotiated Rate	$252.34
Rate for Payer: Aetna Commercial	$238.32
Rate for Payer: Aetna New Business (MI Preferred)	$182.25
Rate for Payer: Cash Price	$224.30
Rate for Payer: Cofinity Commercial	$196.27
Rate for Payer: Cofinity Commercial	$241.13
Rate for Payer: Healthscope Commercial	$252.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$238.32
Rate for Payer: PHP Commercial	$238.32
Rate for Payer: Priority Health Cigna Priority Health	$196.27
Rate for Payer: Priority Health SBD	$176.64

HC GUIDING CATHETER LVL 2

Facility

$280.38

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$252.34
Rate for Payer: Aetna Commercial	$238.32
Rate for Payer: Aetna New Business (MI Preferred)	$182.25
Rate for Payer: BCBS Complete	$112.15
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$224.30
Rate for Payer: Cash Price	$224.30
Rate for Payer: Cofinity Commercial	$196.27
Rate for Payer: Cofinity Commercial	$241.13
Rate for Payer: Healthscope Commercial	$252.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$238.32
Rate for Payer: PHP Commercial	$238.32
Rate for Payer: Priority Health Cigna Priority Health	$196.27
Rate for Payer: Priority Health SBD	$176.64

HC GUIDING CATHETER LVL 24

Facility

$2,429.14

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$1,530.36
Max. Negotiated Rate	$2,186.23
Rate for Payer: Aetna Commercial	$2,064.77
Rate for Payer: Aetna New Business (MI Preferred)	$1,578.94
Rate for Payer: Cash Price	$1,943.31
Rate for Payer: Cofinity Commercial	$1,700.40
Rate for Payer: Cofinity Commercial	$2,089.06
Rate for Payer: Healthscope Commercial	$2,186.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,064.77
Rate for Payer: PHP Commercial	$2,064.77
Rate for Payer: Priority Health Cigna Priority Health	$1,700.40
Rate for Payer: Priority Health SBD	$1,530.36

HC GUIDING CATHETER LVL 24

Facility

$2,429.14

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2,186.23
Rate for Payer: Aetna Commercial	$2,064.77
Rate for Payer: Aetna New Business (MI Preferred)	$1,578.94
Rate for Payer: BCBS Complete	$971.66
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$1,943.31
Rate for Payer: Cash Price	$1,943.31
Rate for Payer: Cofinity Commercial	$1,700.40
Rate for Payer: Cofinity Commercial	$2,089.06
Rate for Payer: Healthscope Commercial	$2,186.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,064.77
Rate for Payer: PHP Commercial	$2,064.77
Rate for Payer: Priority Health Cigna Priority Health	$1,700.40
Rate for Payer: Priority Health SBD	$1,530.36

HC GUIDING CATHETER LVL 3

Facility

$330.88

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$297.79
Rate for Payer: Aetna Commercial	$281.25
Rate for Payer: Aetna New Business (MI Preferred)	$215.07
Rate for Payer: BCBS Complete	$132.35
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$264.70
Rate for Payer: Cash Price	$264.70
Rate for Payer: Cofinity Commercial	$231.62
Rate for Payer: Cofinity Commercial	$284.56
Rate for Payer: Healthscope Commercial	$297.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.25
Rate for Payer: PHP Commercial	$281.25
Rate for Payer: Priority Health Cigna Priority Health	$231.62
Rate for Payer: Priority Health SBD	$208.45

HC GUIDING CATHETER LVL 3

Facility

$330.88

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$208.45
Max. Negotiated Rate	$297.79
Rate for Payer: Aetna Commercial	$281.25
Rate for Payer: Aetna New Business (MI Preferred)	$215.07
Rate for Payer: Cash Price	$264.70
Rate for Payer: Cofinity Commercial	$231.62
Rate for Payer: Cofinity Commercial	$284.56
Rate for Payer: Healthscope Commercial	$297.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.25
Rate for Payer: PHP Commercial	$281.25
Rate for Payer: Priority Health Cigna Priority Health	$231.62
Rate for Payer: Priority Health SBD	$208.45

HC GUIDING CATHETER LVL 35

Facility

$3,522.11

Service Code	HCPCS C1887
Hospital Charge Code	27800061
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.93
Max. Negotiated Rate	$3,169.90
Rate for Payer: Aetna Commercial	$2,993.79
Rate for Payer: Aetna New Business (MI Preferred)	$2,289.37
Rate for Payer: Cash Price	$2,817.69
Rate for Payer: Cofinity Commercial	$2,465.48
Rate for Payer: Cofinity Commercial	$3,029.01
Rate for Payer: Healthscope Commercial	$3,169.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,993.79
Rate for Payer: PHP Commercial	$2,993.79
Rate for Payer: Priority Health Cigna Priority Health	$2,465.48
Rate for Payer: Priority Health SBD	$2,218.93

HC GUIDING CATHETER LVL 35

Facility

$3,522.11

Service Code	HCPCS C1887
Hospital Charge Code	27800061
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3,169.90
Rate for Payer: Aetna Commercial	$2,993.79
Rate for Payer: Aetna New Business (MI Preferred)	$2,289.37
Rate for Payer: BCBS Complete	$1,408.84
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$2,817.69
Rate for Payer: Cash Price	$2,817.69
Rate for Payer: Cofinity Commercial	$3,029.01
Rate for Payer: Cofinity Commercial	$2,465.48
Rate for Payer: Healthscope Commercial	$3,169.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,993.79
Rate for Payer: PHP Commercial	$2,993.79
Rate for Payer: Priority Health Cigna Priority Health	$2,465.48
Rate for Payer: Priority Health SBD	$2,218.93

HC GUIDING CATHETER LVL 4

Facility

$480.90

Service Code	HCPCS C1887
Hospital Charge Code	27200272
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$432.81
Rate for Payer: Aetna Commercial	$408.76
Rate for Payer: Aetna New Business (MI Preferred)	$312.58
Rate for Payer: BCBS Complete	$192.36
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$384.72
Rate for Payer: Cash Price	$384.72
Rate for Payer: Cofinity Commercial	$336.63
Rate for Payer: Cofinity Commercial	$413.57
Rate for Payer: Healthscope Commercial	$432.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$408.76
Rate for Payer: PHP Commercial	$408.76
Rate for Payer: Priority Health Cigna Priority Health	$336.63
Rate for Payer: Priority Health SBD	$302.97

HC GUIDING CATHETER LVL 4

Facility

$480.90

Service Code	HCPCS C1887
Hospital Charge Code	27200272
Hospital Revenue Code	272
Min. Negotiated Rate	$302.97
Max. Negotiated Rate	$432.81
Rate for Payer: Aetna Commercial	$408.76
Rate for Payer: Aetna New Business (MI Preferred)	$312.58
Rate for Payer: Cash Price	$384.72
Rate for Payer: Cofinity Commercial	$336.63
Rate for Payer: Cofinity Commercial	$413.57
Rate for Payer: Healthscope Commercial	$432.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$408.76
Rate for Payer: PHP Commercial	$408.76
Rate for Payer: Priority Health Cigna Priority Health	$336.63
Rate for Payer: Priority Health SBD	$302.97

HC GUIDING CATHETER LVL 42

Facility

$4,295.53

Hospital Charge Code	27200130
Hospital Revenue Code	272
Min. Negotiated Rate	$1,718.21
Max. Negotiated Rate	$3,865.98
Rate for Payer: Aetna Commercial	$3,651.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,792.09
Rate for Payer: BCBS Complete	$1,718.21
Rate for Payer: Cash Price	$3,436.42
Rate for Payer: Cofinity Commercial	$3,006.87
Rate for Payer: Cofinity Commercial	$3,694.16
Rate for Payer: Healthscope Commercial	$3,865.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,651.20
Rate for Payer: PHP Commercial	$3,651.20
Rate for Payer: Priority Health Cigna Priority Health	$3,006.87
Rate for Payer: Priority Health SBD	$2,706.18

HC GUIDING CATHETER LVL 42

Facility

$4,295.53

Hospital Charge Code	27200130
Hospital Revenue Code	272
Min. Negotiated Rate	$2,706.18
Max. Negotiated Rate	$3,865.98
Rate for Payer: Aetna Commercial	$3,651.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,792.09
Rate for Payer: Cash Price	$3,436.42
Rate for Payer: Cofinity Commercial	$3,006.87
Rate for Payer: Cofinity Commercial	$3,694.16
Rate for Payer: Healthscope Commercial	$3,865.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,651.20
Rate for Payer: PHP Commercial	$3,651.20
Rate for Payer: Priority Health Cigna Priority Health	$3,006.87
Rate for Payer: Priority Health SBD	$2,706.18

HC GUIDING CATHETER LVL 57

Facility

$5,712.15

Service Code	HCPCS C1887
Hospital Charge Code	27200095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5,140.94
Rate for Payer: Aetna Commercial	$4,855.33
Rate for Payer: Aetna New Business (MI Preferred)	$3,712.90
Rate for Payer: BCBS Complete	$2,284.86
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$4,569.72
Rate for Payer: Cash Price	$4,569.72
Rate for Payer: Cofinity Commercial	$4,912.45
Rate for Payer: Cofinity Commercial	$3,998.50
Rate for Payer: Healthscope Commercial	$5,140.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,855.33
Rate for Payer: PHP Commercial	$4,855.33
Rate for Payer: Priority Health Cigna Priority Health	$3,998.50
Rate for Payer: Priority Health SBD	$3,598.65

HC GUIDING CATHETER LVL 57

Facility

$5,712.15

Service Code	HCPCS C1887
Hospital Charge Code	27200095
Hospital Revenue Code	272
Min. Negotiated Rate	$3,598.65
Max. Negotiated Rate	$5,140.94
Rate for Payer: Aetna Commercial	$4,855.33
Rate for Payer: Aetna New Business (MI Preferred)	$3,712.90
Rate for Payer: Cash Price	$4,569.72
Rate for Payer: Cofinity Commercial	$3,998.50
Rate for Payer: Cofinity Commercial	$4,912.45
Rate for Payer: Healthscope Commercial	$5,140.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,855.33
Rate for Payer: PHP Commercial	$4,855.33
Rate for Payer: Priority Health Cigna Priority Health	$3,998.50
Rate for Payer: Priority Health SBD	$3,598.65

HC HAEMOPHILUS INFLUENZAE

Facility

$51.00

Service Code	CPT 87798
Hospital Charge Code	30600269
Hospital Revenue Code	306
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health SBD	$32.13

HC HAEMOPHILUS INFLUENZAE

Facility

$51.00

Service Code	CPT 87798
Hospital Charge Code	30600269
Hospital Revenue Code	306
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$59.65
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCBS Trust/PPO	$27.48
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Mclaren Medicaid	$19.19
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36.84
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.35
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$19.19
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$32.13
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$42.11
Rate for Payer: UHC Core	$59.65
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Exchange	$35.09
Rate for Payer: UHC Medicare Advantage	$36.14
Rate for Payer: VA VA	$35.09

HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM

Facility

$32.64

Service Code	CPT 90648
Hospital Charge Code	63600069
Hospital Revenue Code	636
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$53.96
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna New Business (MI Preferred)	$21.22
Rate for Payer: BCBS Complete	$13.06
Rate for Payer: BCBS Trust/PPO	$53.96
Rate for Payer: Cash Price	$26.11
Rate for Payer: Cash Price	$26.11
Rate for Payer: Cofinity Commercial	$22.85
Rate for Payer: Cofinity Commercial	$28.07
Rate for Payer: Healthscope Commercial	$29.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.74
Rate for Payer: PHP Commercial	$27.74
Rate for Payer: Priority Health Cigna Priority Health	$22.85
Rate for Payer: Priority Health SBD	$20.56

HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM

Facility

$32.64

Service Code	CPT 90648
Hospital Charge Code	63600069
Hospital Revenue Code	636
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$29.38
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna New Business (MI Preferred)	$21.22
Rate for Payer: Cash Price	$26.11
Rate for Payer: Cofinity Commercial	$22.85
Rate for Payer: Cofinity Commercial	$28.07
Rate for Payer: Healthscope Commercial	$29.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.74
Rate for Payer: PHP Commercial	$27.74
Rate for Payer: Priority Health Cigna Priority Health	$22.85
Rate for Payer: Priority Health SBD	$20.56

Know your out-of-pocket cost for care.

All Charges