Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INDUCTION OF ARRHYTHMIA

Facility

$3,679.65

Service Code	CPT 93618
Hospital Charge Code	48100036
Hospital Revenue Code	481
Min. Negotiated Rate	$579.26
Max. Negotiated Rate	$3,311.68
Rate for Payer: Aetna Commercial	$3,127.70
Rate for Payer: Aetna Medicare	$1,101.33
Rate for Payer: Aetna New Business (MI Preferred)	$2,391.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,323.71
Rate for Payer: Amish Plain Church Group Commercial	$1,323.71
Rate for Payer: BCBS Complete	$608.27
Rate for Payer: BCBS MAPPO	$1,058.97
Rate for Payer: BCBS Trust/PPO	$3,245.84
Rate for Payer: BCN Medicare Advantage	$1,058.97
Rate for Payer: Cash Price	$2,943.72
Rate for Payer: Cash Price	$2,943.72
Rate for Payer: Cofinity Commercial	$3,164.50
Rate for Payer: Cofinity Commercial	$2,575.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,058.97
Rate for Payer: Healthscope Commercial	$3,311.68
Rate for Payer: Mclaren Medicaid	$579.26
Rate for Payer: Mclaren Medicare	$1,058.97
Rate for Payer: Meridian Medicaid	$608.27
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,111.92
Rate for Payer: MI Amish Medical Board Commercial	$1,217.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,127.70
Rate for Payer: PACE Medicare	$1,006.02
Rate for Payer: PACE SWMI	$1,058.97
Rate for Payer: PHP Commercial	$3,127.70
Rate for Payer: PHP Medicare Advantage	$1,058.97
Rate for Payer: Priority Health Choice Medicaid	$579.26
Rate for Payer: Priority Health Cigna Priority Health	$2,575.76
Rate for Payer: Priority Health Medicare	$1,058.97
Rate for Payer: Priority Health SBD	$2,318.18
Rate for Payer: Railroad Medicare Medicare	$1,058.97
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,058.97
Rate for Payer: UHC Medicare Advantage	$1,090.74
Rate for Payer: VA VA	$1,058.97

HC INDUCTION OF ARRHYTHMIA

Facility

$3,679.65

Service Code	CPT 93618
Hospital Charge Code	48100036
Hospital Revenue Code	481
Min. Negotiated Rate	$2,318.18
Max. Negotiated Rate	$3,311.68
Rate for Payer: Aetna Commercial	$3,127.70
Rate for Payer: Aetna New Business (MI Preferred)	$2,391.77
Rate for Payer: Cash Price	$2,943.72
Rate for Payer: Cofinity Commercial	$2,575.76
Rate for Payer: Cofinity Commercial	$3,164.50
Rate for Payer: Healthscope Commercial	$3,311.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,127.70
Rate for Payer: PHP Commercial	$3,127.70
Rate for Payer: Priority Health Cigna Priority Health	$2,575.76
Rate for Payer: Priority Health SBD	$2,318.18

HC INDWELLING PORT

Facility

$1,334.80

Service Code	HCPCS C1788
Hospital Charge Code	27800015
Hospital Revenue Code	278
Min. Negotiated Rate	$840.92
Max. Negotiated Rate	$1,201.32
Rate for Payer: Aetna Commercial	$1,134.58
Rate for Payer: Aetna New Business (MI Preferred)	$867.62
Rate for Payer: Cash Price	$1,067.84
Rate for Payer: Cofinity Commercial	$1,147.93
Rate for Payer: Cofinity Commercial	$934.36
Rate for Payer: Healthscope Commercial	$1,201.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,134.58
Rate for Payer: PHP Commercial	$1,134.58
Rate for Payer: Priority Health Cigna Priority Health	$934.36
Rate for Payer: Priority Health SBD	$840.92

HC INDWELLING PORT

Facility

$1,334.80

Service Code	HCPCS C1788
Hospital Charge Code	27800015
Hospital Revenue Code	278
Min. Negotiated Rate	$533.92
Max. Negotiated Rate	$1,201.32
Rate for Payer: Aetna Commercial	$1,134.58
Rate for Payer: Aetna New Business (MI Preferred)	$867.62
Rate for Payer: BCBS Complete	$533.92
Rate for Payer: Cash Price	$1,067.84
Rate for Payer: Cofinity Commercial	$1,147.93
Rate for Payer: Cofinity Commercial	$934.36
Rate for Payer: Healthscope Commercial	$1,201.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,134.58
Rate for Payer: PHP Commercial	$1,134.58
Rate for Payer: Priority Health Cigna Priority Health	$934.36
Rate for Payer: Priority Health SBD	$840.92

HC INFANT COOLING SYSTEM

Facility

$657.75

Hospital Charge Code	27000644
Hospital Revenue Code	270
Min. Negotiated Rate	$263.10
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$559.09
Rate for Payer: Aetna New Business (MI Preferred)	$427.54
Rate for Payer: BCBS Complete	$263.10
Rate for Payer: Cash Price	$526.20
Rate for Payer: Cofinity Commercial	$460.42
Rate for Payer: Cofinity Commercial	$565.66
Rate for Payer: Healthscope Commercial	$591.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$559.09
Rate for Payer: PHP Commercial	$559.09
Rate for Payer: Priority Health Cigna Priority Health	$460.42
Rate for Payer: Priority Health SBD	$414.38

HC INFANT COOLING SYSTEM

Facility

$657.75

Hospital Charge Code	27000644
Hospital Revenue Code	270
Min. Negotiated Rate	$414.38
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$559.09
Rate for Payer: Aetna New Business (MI Preferred)	$427.54
Rate for Payer: Cash Price	$526.20
Rate for Payer: Cofinity Commercial	$460.42
Rate for Payer: Cofinity Commercial	$565.66
Rate for Payer: Healthscope Commercial	$591.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$559.09
Rate for Payer: PHP Commercial	$559.09
Rate for Payer: Priority Health Cigna Priority Health	$460.42
Rate for Payer: Priority Health SBD	$414.38

HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES

Facility

$153.00

Service Code	CPT 87502
Hospital Charge Code	30000171
Hospital Revenue Code	300
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health SBD	$96.39

HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES

Facility

$153.00

Service Code	CPT 87502
Hospital Charge Code	30000171
Hospital Revenue Code	300
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$144.62
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna Medicare	$99.63
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$119.75
Rate for Payer: Amish Plain Church Group Commercial	$119.75
Rate for Payer: BCBS Complete	$55.03
Rate for Payer: BCBS MAPPO	$95.80
Rate for Payer: BCBS Trust/PPO	$75.02
Rate for Payer: BCN Medicare Advantage	$95.80
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$95.80
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Mclaren Medicaid	$52.40
Rate for Payer: Mclaren Medicare	$95.80
Rate for Payer: Meridian Medicaid	$55.03
Rate for Payer: Meridian Wellcare - Medicare Advantage	$100.59
Rate for Payer: MI Amish Medical Board Commercial	$110.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.05
Rate for Payer: PACE Medicare	$91.01
Rate for Payer: PACE SWMI	$95.80
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: PHP Medicare Advantage	$95.80
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health Medicare	$95.80
Rate for Payer: Priority Health SBD	$96.39
Rate for Payer: Railroad Medicare Medicare	$95.80
Rate for Payer: UHC All Payor (Choice/PPO)	$114.96
Rate for Payer: UHC Core	$144.62
Rate for Payer: UHC Dual Complete DSNP	$95.80
Rate for Payer: UHC Exchange	$95.80
Rate for Payer: UHC Medicare Advantage	$98.67
Rate for Payer: VA VA	$95.80

HC INFLIXIMAB AB

Facility

$185.00

Service Code	CPT 82397
Hospital Charge Code	30100662
Hospital Revenue Code	301
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$157.25
Rate for Payer: Aetna Medicare	$14.68
Rate for Payer: Aetna New Business (MI Preferred)	$120.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$17.65
Rate for Payer: Amish Plain Church Group Commercial	$17.65
Rate for Payer: BCBS Complete	$8.11
Rate for Payer: BCBS MAPPO	$14.12
Rate for Payer: BCBS Trust/PPO	$11.06
Rate for Payer: BCN Medicare Advantage	$14.12
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cofinity Commercial	$159.10
Rate for Payer: Cofinity Commercial	$129.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.12
Rate for Payer: Healthscope Commercial	$166.50
Rate for Payer: Mclaren Medicaid	$7.72
Rate for Payer: Mclaren Medicare	$14.12
Rate for Payer: Meridian Medicaid	$8.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14.83
Rate for Payer: MI Amish Medical Board Commercial	$16.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$157.25
Rate for Payer: PACE Medicare	$13.41
Rate for Payer: PACE SWMI	$14.12
Rate for Payer: PHP Commercial	$157.25
Rate for Payer: PHP Medicare Advantage	$14.12
Rate for Payer: Priority Health Choice Medicaid	$7.72
Rate for Payer: Priority Health Cigna Priority Health	$129.50
Rate for Payer: Priority Health Medicare	$14.12
Rate for Payer: Priority Health SBD	$116.55
Rate for Payer: Railroad Medicare Medicare	$14.12
Rate for Payer: UHC All Payor (Choice/PPO)	$16.94
Rate for Payer: UHC Core	$24.01
Rate for Payer: UHC Dual Complete DSNP	$14.12
Rate for Payer: UHC Exchange	$14.12
Rate for Payer: UHC Medicare Advantage	$14.54
Rate for Payer: VA VA	$14.12

HC INFLIXIMAB AB

Facility

$185.00

Service Code	CPT 82397
Hospital Charge Code	30100662
Hospital Revenue Code	301
Min. Negotiated Rate	$116.55
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$157.25
Rate for Payer: Aetna New Business (MI Preferred)	$120.25
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cofinity Commercial	$129.50
Rate for Payer: Cofinity Commercial	$159.10
Rate for Payer: Healthscope Commercial	$166.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$157.25
Rate for Payer: PHP Commercial	$157.25
Rate for Payer: Priority Health Cigna Priority Health	$129.50
Rate for Payer: Priority Health SBD	$116.55

HC INFLIXIMAB, S

Facility

$245.00

Service Code	CPT 80230
Hospital Charge Code	30100705
Hospital Revenue Code	301
Min. Negotiated Rate	$21.10
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$208.25
Rate for Payer: Aetna Medicare	$40.11
Rate for Payer: Aetna New Business (MI Preferred)	$159.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$48.21
Rate for Payer: Amish Plain Church Group Commercial	$48.21
Rate for Payer: BCBS Complete	$22.15
Rate for Payer: BCBS MAPPO	$38.57
Rate for Payer: BCBS Trust/PPO	$30.21
Rate for Payer: BCN Medicare Advantage	$38.57
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cofinity Commercial	$210.70
Rate for Payer: Cofinity Commercial	$171.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$38.57
Rate for Payer: Healthscope Commercial	$220.50
Rate for Payer: Mclaren Medicaid	$21.10
Rate for Payer: Mclaren Medicare	$38.57
Rate for Payer: Meridian Medicaid	$22.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$40.50
Rate for Payer: MI Amish Medical Board Commercial	$44.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.25
Rate for Payer: PACE Medicare	$36.64
Rate for Payer: PACE SWMI	$38.57
Rate for Payer: PHP Commercial	$208.25
Rate for Payer: PHP Medicare Advantage	$38.57
Rate for Payer: Priority Health Choice Medicaid	$21.10
Rate for Payer: Priority Health Cigna Priority Health	$171.50
Rate for Payer: Priority Health Medicare	$38.57
Rate for Payer: Priority Health SBD	$154.35
Rate for Payer: Railroad Medicare Medicare	$38.57
Rate for Payer: UHC All Payor (Choice/PPO)	$46.28
Rate for Payer: UHC Core	$46.28
Rate for Payer: UHC Dual Complete DSNP	$38.57
Rate for Payer: UHC Exchange	$38.57
Rate for Payer: UHC Medicare Advantage	$39.73
Rate for Payer: VA VA	$38.57

HC INFLIXIMAB, S

Facility

$245.00

Service Code	CPT 80230
Hospital Charge Code	30100705
Hospital Revenue Code	301
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$208.25
Rate for Payer: Aetna New Business (MI Preferred)	$159.25
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cofinity Commercial	$171.50
Rate for Payer: Cofinity Commercial	$210.70
Rate for Payer: Healthscope Commercial	$220.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.25
Rate for Payer: PHP Commercial	$208.25
Rate for Payer: Priority Health Cigna Priority Health	$171.50
Rate for Payer: Priority Health SBD	$154.35

HC INFLUENZA A AND B PCR

Facility

$212.70

Service Code	CPT 87631
Hospital Charge Code	30600207
Hospital Revenue Code	306
Min. Negotiated Rate	$78.02
Max. Negotiated Rate	$211.61
Rate for Payer: Aetna Commercial	$180.80
Rate for Payer: Aetna Medicare	$148.34
Rate for Payer: Aetna New Business (MI Preferred)	$138.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$178.29
Rate for Payer: Amish Plain Church Group Commercial	$178.29
Rate for Payer: BCBS Complete	$81.93
Rate for Payer: BCBS MAPPO	$142.63
Rate for Payer: BCBS Trust/PPO	$111.69
Rate for Payer: BCN Medicare Advantage	$142.63
Rate for Payer: Cash Price	$170.16
Rate for Payer: Cash Price	$170.16
Rate for Payer: Cofinity Commercial	$182.92
Rate for Payer: Cofinity Commercial	$148.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$142.63
Rate for Payer: Healthscope Commercial	$191.43
Rate for Payer: Mclaren Medicaid	$78.02
Rate for Payer: Mclaren Medicare	$142.63
Rate for Payer: Meridian Medicaid	$81.93
Rate for Payer: Meridian Wellcare - Medicare Advantage	$149.76
Rate for Payer: MI Amish Medical Board Commercial	$164.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$180.80
Rate for Payer: PACE Medicare	$135.50
Rate for Payer: PACE SWMI	$142.63
Rate for Payer: PHP Commercial	$180.80
Rate for Payer: PHP Medicare Advantage	$142.63
Rate for Payer: Priority Health Choice Medicaid	$78.02
Rate for Payer: Priority Health Cigna Priority Health	$148.89
Rate for Payer: Priority Health Medicare	$142.63
Rate for Payer: Priority Health SBD	$134.00
Rate for Payer: Railroad Medicare Medicare	$142.63
Rate for Payer: UHC All Payor (Choice/PPO)	$171.16
Rate for Payer: UHC Core	$211.61
Rate for Payer: UHC Dual Complete DSNP	$142.63
Rate for Payer: UHC Exchange	$142.63
Rate for Payer: UHC Medicare Advantage	$146.91
Rate for Payer: VA VA	$142.63

HC INFLUENZA A AND B PCR

Facility

$212.70

Service Code	CPT 87631
Hospital Charge Code	30600207
Hospital Revenue Code	306
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$191.43
Rate for Payer: Aetna Commercial	$180.80
Rate for Payer: Aetna New Business (MI Preferred)	$138.26
Rate for Payer: Cash Price	$170.16
Rate for Payer: Cofinity Commercial	$148.89
Rate for Payer: Cofinity Commercial	$182.92
Rate for Payer: Healthscope Commercial	$191.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$180.80
Rate for Payer: PHP Commercial	$180.80
Rate for Payer: Priority Health Cigna Priority Health	$148.89
Rate for Payer: Priority Health SBD	$134.00

HC INFLUENZA A/B DNA AMP PROBE

Facility

$142.87

Service Code	CPT 87502
Hospital Charge Code	30600314
Hospital Revenue Code	306
Min. Negotiated Rate	$90.01
Max. Negotiated Rate	$128.58
Rate for Payer: Aetna Commercial	$121.44
Rate for Payer: Aetna New Business (MI Preferred)	$92.87
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cofinity Commercial	$100.01
Rate for Payer: Cofinity Commercial	$122.87
Rate for Payer: Healthscope Commercial	$128.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$121.44
Rate for Payer: PHP Commercial	$121.44
Rate for Payer: Priority Health Cigna Priority Health	$100.01
Rate for Payer: Priority Health SBD	$90.01

HC INFLUENZA A/B DNA AMP PROBE

Facility

$142.87

Service Code	CPT 87502
Hospital Charge Code	30600314
Hospital Revenue Code	306
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$144.62
Rate for Payer: Aetna Commercial	$121.44
Rate for Payer: Aetna Medicare	$99.63
Rate for Payer: Aetna New Business (MI Preferred)	$92.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$119.75
Rate for Payer: Amish Plain Church Group Commercial	$119.75
Rate for Payer: BCBS Complete	$55.03
Rate for Payer: BCBS MAPPO	$95.80
Rate for Payer: BCBS Trust/PPO	$75.02
Rate for Payer: BCN Medicare Advantage	$95.80
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cofinity Commercial	$122.87
Rate for Payer: Cofinity Commercial	$100.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$95.80
Rate for Payer: Healthscope Commercial	$128.58
Rate for Payer: Mclaren Medicaid	$52.40
Rate for Payer: Mclaren Medicare	$95.80
Rate for Payer: Meridian Medicaid	$55.03
Rate for Payer: Meridian Wellcare - Medicare Advantage	$100.59
Rate for Payer: MI Amish Medical Board Commercial	$110.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$121.44
Rate for Payer: PACE Medicare	$91.01
Rate for Payer: PACE SWMI	$95.80
Rate for Payer: PHP Commercial	$121.44
Rate for Payer: PHP Medicare Advantage	$95.80
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health	$100.01
Rate for Payer: Priority Health Medicare	$95.80
Rate for Payer: Priority Health SBD	$90.01
Rate for Payer: Railroad Medicare Medicare	$95.80
Rate for Payer: UHC All Payor (Choice/PPO)	$114.96
Rate for Payer: UHC Core	$144.62
Rate for Payer: UHC Dual Complete DSNP	$95.80
Rate for Payer: UHC Exchange	$95.80
Rate for Payer: UHC Medicare Advantage	$98.67
Rate for Payer: VA VA	$95.80

HC INFLUENZA AND RSV BY PCR

Facility

$218.96

Service Code	CPT 87631
Hospital Charge Code	30600213
Hospital Revenue Code	306
Min. Negotiated Rate	$78.02
Max. Negotiated Rate	$211.61
Rate for Payer: Aetna Commercial	$186.12
Rate for Payer: Aetna Medicare	$148.34
Rate for Payer: Aetna New Business (MI Preferred)	$142.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$178.29
Rate for Payer: Amish Plain Church Group Commercial	$178.29
Rate for Payer: BCBS Complete	$81.93
Rate for Payer: BCBS MAPPO	$142.63
Rate for Payer: BCBS Trust/PPO	$111.69
Rate for Payer: BCN Medicare Advantage	$142.63
Rate for Payer: Cash Price	$175.17
Rate for Payer: Cash Price	$175.17
Rate for Payer: Cofinity Commercial	$188.31
Rate for Payer: Cofinity Commercial	$153.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$142.63
Rate for Payer: Healthscope Commercial	$197.06
Rate for Payer: Mclaren Medicaid	$78.02
Rate for Payer: Mclaren Medicare	$142.63
Rate for Payer: Meridian Medicaid	$81.93
Rate for Payer: Meridian Wellcare - Medicare Advantage	$149.76
Rate for Payer: MI Amish Medical Board Commercial	$164.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$186.12
Rate for Payer: PACE Medicare	$135.50
Rate for Payer: PACE SWMI	$142.63
Rate for Payer: PHP Commercial	$186.12
Rate for Payer: PHP Medicare Advantage	$142.63
Rate for Payer: Priority Health Choice Medicaid	$78.02
Rate for Payer: Priority Health Cigna Priority Health	$153.27
Rate for Payer: Priority Health Medicare	$142.63
Rate for Payer: Priority Health SBD	$137.94
Rate for Payer: Railroad Medicare Medicare	$142.63
Rate for Payer: UHC All Payor (Choice/PPO)	$171.16
Rate for Payer: UHC Core	$211.61
Rate for Payer: UHC Dual Complete DSNP	$142.63
Rate for Payer: UHC Exchange	$142.63
Rate for Payer: UHC Medicare Advantage	$146.91
Rate for Payer: VA VA	$142.63

HC INFLUENZA AND RSV BY PCR

Facility

$218.96

Service Code	CPT 87631
Hospital Charge Code	30600213
Hospital Revenue Code	306
Min. Negotiated Rate	$137.94
Max. Negotiated Rate	$197.06
Rate for Payer: Aetna Commercial	$186.12
Rate for Payer: Aetna New Business (MI Preferred)	$142.32
Rate for Payer: Cash Price	$175.17
Rate for Payer: Cofinity Commercial	$153.27
Rate for Payer: Cofinity Commercial	$188.31
Rate for Payer: Healthscope Commercial	$197.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$186.12
Rate for Payer: PHP Commercial	$186.12
Rate for Payer: Priority Health Cigna Priority Health	$153.27
Rate for Payer: Priority Health SBD	$137.94

HC INFLUENZA INJECTION

Facility

$30.00

Service Code	HCPCS G0008
Hospital Charge Code	77100009
Hospital Revenue Code	771
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$127.06
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna Medicare	$43.96
Rate for Payer: Aetna New Business (MI Preferred)	$19.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$52.84
Rate for Payer: Amish Plain Church Group Commercial	$52.84
Rate for Payer: BCBS Complete	$24.28
Rate for Payer: BCBS MAPPO	$42.27
Rate for Payer: BCBS Trust/PPO	$61.17
Rate for Payer: BCN Medicare Advantage	$42.27
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cofinity Commercial	$25.80
Rate for Payer: Cofinity Commercial	$21.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$42.27
Rate for Payer: Healthscope Commercial	$27.00
Rate for Payer: Mclaren Medicaid	$23.12
Rate for Payer: Mclaren Medicare	$42.27
Rate for Payer: Meridian Medicaid	$24.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$44.38
Rate for Payer: MI Amish Medical Board Commercial	$48.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.50
Rate for Payer: PACE Medicare	$40.16
Rate for Payer: PACE SWMI	$42.27
Rate for Payer: PHP Commercial	$25.50
Rate for Payer: PHP Medicare Advantage	$42.27
Rate for Payer: Priority Health Choice Medicaid	$23.12
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$127.06
Rate for Payer: Priority Health Medicare	$42.27
Rate for Payer: Priority Health Narrow Network	$101.65
Rate for Payer: Priority Health SBD	$18.90
Rate for Payer: Railroad Medicare Medicare	$42.27
Rate for Payer: UHC Dual Complete DSNP	$42.27
Rate for Payer: UHC Medicare Advantage	$43.54
Rate for Payer: VA VA	$42.27

HC INFLUENZA INJECTION

Facility

$30.00

Service Code	HCPCS G0008
Hospital Charge Code	77100009
Hospital Revenue Code	771
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$19.50
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cofinity Commercial	$21.00
Rate for Payer: Cofinity Commercial	$25.80
Rate for Payer: Healthscope Commercial	$27.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.50
Rate for Payer: PHP Commercial	$25.50
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health SBD	$18.90

HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM

Facility

$69.36

Service Code	CPT 90662
Hospital Charge Code	63600073
Hospital Revenue Code	636
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.96
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: Priority Health Cigna Priority Health	$48.55
Rate for Payer: Priority Health SBD	$43.70

HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM

Facility

$69.36

Service Code	CPT 90662
Hospital Charge Code	63600073
Hospital Revenue Code	636
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$213.92
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: BCBS Complete	$27.74
Rate for Payer: BCBS Trust/PPO	$213.92
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.96
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: Priority Health Cigna Priority Health	$48.55
Rate for Payer: Priority Health SBD	$43.70

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM

Facility

$25.50

Service Code	CPT 90688
Hospital Charge Code	63600079
Hospital Revenue Code	636
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$62.65
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Aetna New Business (MI Preferred)	$16.58
Rate for Payer: BCBS Complete	$10.20
Rate for Payer: BCBS Trust/PPO	$62.65
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$21.93
Rate for Payer: Cofinity Commercial	$17.85
Rate for Payer: Healthscope Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.68
Rate for Payer: PHP Commercial	$21.68
Rate for Payer: Priority Health Cigna Priority Health	$17.85
Rate for Payer: Priority Health SBD	$16.06

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM

Facility

$25.50

Service Code	CPT 90688
Hospital Charge Code	63600079
Hospital Revenue Code	636
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$22.95
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Aetna New Business (MI Preferred)	$16.58
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$17.85
Rate for Payer: Cofinity Commercial	$21.93
Rate for Payer: Healthscope Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.68
Rate for Payer: PHP Commercial	$21.68
Rate for Payer: Priority Health Cigna Priority Health	$17.85
Rate for Payer: Priority Health SBD	$16.06

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL

Facility

$31.62

Service Code	CPT 90672
Hospital Charge Code	63600075
Hospital Revenue Code	636
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$28.46
Rate for Payer: Aetna Commercial	$26.88
Rate for Payer: Aetna New Business (MI Preferred)	$20.55
Rate for Payer: Cash Price	$25.30
Rate for Payer: Cofinity Commercial	$22.13
Rate for Payer: Cofinity Commercial	$27.19
Rate for Payer: Healthscope Commercial	$28.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.88
Rate for Payer: PHP Commercial	$26.88
Rate for Payer: Priority Health Cigna Priority Health	$22.13
Rate for Payer: Priority Health SBD	$19.92

Know your out-of-pocket cost for care.

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