Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM

Facility

$25.50

Service Code	CPT 90687
Hospital Charge Code	63600126
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 VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM

Facility

$25.50

Service Code	CPT 90687
Hospital Charge Code	63600126
Hospital Revenue Code	636
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$31.32
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	$31.32
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM

Facility

$25.50

Service Code	CPT 90686
Hospital Charge Code	63600078
Hospital Revenue Code	636
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$65.81
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	$65.81
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM

Facility

$25.50

Service Code	CPT 90686
Hospital Charge Code	63600078
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM

Facility

$25.50

Service Code	CPT 90685
Hospital Charge Code	63600077
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM

Facility

$25.50

Service Code	CPT 90685
Hospital Charge Code	63600077
Hospital Revenue Code	636
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$64.07
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	$64.07
Rate for Payer: Cash Price	$20.40
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 VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM

Facility

$24.48

Service Code	CPT 90656
Hospital Charge Code	63600072
Hospital Revenue Code	636
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$49.40
Rate for Payer: Aetna Commercial	$20.81
Rate for Payer: Aetna New Business (MI Preferred)	$15.91
Rate for Payer: BCBS Complete	$9.79
Rate for Payer: BCBS Trust/PPO	$49.40
Rate for Payer: Cash Price	$19.58
Rate for Payer: Cash Price	$19.58
Rate for Payer: Cofinity Commercial	$21.05
Rate for Payer: Cofinity Commercial	$17.14
Rate for Payer: Healthscope Commercial	$22.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.81
Rate for Payer: PHP Commercial	$20.81
Rate for Payer: Priority Health Cigna Priority Health	$17.14
Rate for Payer: Priority Health SBD	$15.42

HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM

Facility

$24.48

Service Code	CPT 90656
Hospital Charge Code	63600072
Hospital Revenue Code	636
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$22.03
Rate for Payer: Aetna Commercial	$20.81
Rate for Payer: Aetna New Business (MI Preferred)	$15.91
Rate for Payer: Cash Price	$19.58
Rate for Payer: Cofinity Commercial	$21.05
Rate for Payer: Cofinity Commercial	$17.14
Rate for Payer: Healthscope Commercial	$22.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.81
Rate for Payer: PHP Commercial	$20.81
Rate for Payer: Priority Health Cigna Priority Health	$17.14
Rate for Payer: Priority Health SBD	$15.42

HC INF PUMP PROGRAMMABLE LVL 6

Facility

$690.00

Service Code	HCPCS C1772
Hospital Charge Code	27800141
Hospital Revenue Code	278
Min. Negotiated Rate	$276.00
Max. Negotiated Rate	$621.00
Rate for Payer: Aetna Commercial	$586.50
Rate for Payer: Aetna New Business (MI Preferred)	$448.50
Rate for Payer: BCBS Complete	$276.00
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cofinity Commercial	$483.00
Rate for Payer: Cofinity Commercial	$593.40
Rate for Payer: Healthscope Commercial	$621.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$586.50
Rate for Payer: PHP Commercial	$586.50
Rate for Payer: Priority Health Cigna Priority Health	$483.00
Rate for Payer: Priority Health SBD	$434.70

HC INF PUMP PROGRAMMABLE LVL 6

Facility

$690.00

Service Code	HCPCS C1772
Hospital Charge Code	27800141
Hospital Revenue Code	278
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$621.00
Rate for Payer: Aetna Commercial	$586.50
Rate for Payer: Aetna New Business (MI Preferred)	$448.50
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cofinity Commercial	$483.00
Rate for Payer: Cofinity Commercial	$593.40
Rate for Payer: Healthscope Commercial	$621.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$586.50
Rate for Payer: PHP Commercial	$586.50
Rate for Payer: Priority Health Cigna Priority Health	$483.00
Rate for Payer: Priority Health SBD	$434.70

HC INFRARED THERAPY

Facility

$57.48

Service Code	CPT 97026
Hospital Charge Code	42000013
Hospital Revenue Code	420
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$51.73
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna New Business (MI Preferred)	$37.36
Rate for Payer: BCBS Complete	$22.99
Rate for Payer: BCBS Trust/PPO	$4.46
Rate for Payer: Cash Price	$45.98
Rate for Payer: Cash Price	$45.98
Rate for Payer: Cofinity Commercial	$40.24
Rate for Payer: Cofinity Commercial	$49.43
Rate for Payer: Healthscope Commercial	$51.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.86
Rate for Payer: PHP Commercial	$48.86
Rate for Payer: Priority Health Cigna Priority Health	$40.24
Rate for Payer: Priority Health SBD	$36.21
Rate for Payer: UHC All Payor (Choice/PPO)	$7.20
Rate for Payer: UHC Exchange	$6.55

HC INFRARED THERAPY

Facility

$57.48

Service Code	CPT 97026
Hospital Charge Code	42000013
Hospital Revenue Code	420
Min. Negotiated Rate	$36.21
Max. Negotiated Rate	$51.73
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna New Business (MI Preferred)	$37.36
Rate for Payer: Cash Price	$45.98
Rate for Payer: Cofinity Commercial	$40.24
Rate for Payer: Cofinity Commercial	$49.43
Rate for Payer: Healthscope Commercial	$51.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.86
Rate for Payer: PHP Commercial	$48.86
Rate for Payer: Priority Health Cigna Priority Health	$40.24
Rate for Payer: Priority Health SBD	$36.21

HC INFUSION CATHETER LVL 1

Facility

$157.50

Service Code	HCPCS C1751
Hospital Charge Code	27200278
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$141.75
Rate for Payer: Aetna Commercial	$133.88
Rate for Payer: Aetna New Business (MI Preferred)	$102.38
Rate for Payer: BCBS Complete	$63.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cofinity Commercial	$110.25
Rate for Payer: Cofinity Commercial	$135.45
Rate for Payer: Healthscope Commercial	$141.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$133.88
Rate for Payer: PHP Commercial	$133.88
Rate for Payer: Priority Health Cigna Priority Health	$110.25
Rate for Payer: Priority Health SBD	$99.22

HC INFUSION CATHETER LVL 1

Facility

$157.50

Service Code	HCPCS C1751
Hospital Charge Code	27200278
Hospital Revenue Code	272
Min. Negotiated Rate	$99.22
Max. Negotiated Rate	$141.75
Rate for Payer: Aetna Commercial	$133.88
Rate for Payer: Aetna New Business (MI Preferred)	$102.38
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cofinity Commercial	$110.25
Rate for Payer: Cofinity Commercial	$135.45
Rate for Payer: Healthscope Commercial	$141.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$133.88
Rate for Payer: PHP Commercial	$133.88
Rate for Payer: Priority Health Cigna Priority Health	$110.25
Rate for Payer: Priority Health SBD	$99.22

HC INFUSION CATHETER LVL 2

Facility

$237.12

Service Code	HCPCS C1751
Hospital Charge Code	27200005
Hospital Revenue Code	272
Min. Negotiated Rate	$149.39
Max. Negotiated Rate	$213.41
Rate for Payer: Aetna Commercial	$201.55
Rate for Payer: Aetna New Business (MI Preferred)	$154.13
Rate for Payer: Cash Price	$189.70
Rate for Payer: Cofinity Commercial	$165.98
Rate for Payer: Cofinity Commercial	$203.92
Rate for Payer: Healthscope Commercial	$213.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.55
Rate for Payer: PHP Commercial	$201.55
Rate for Payer: Priority Health Cigna Priority Health	$165.98
Rate for Payer: Priority Health SBD	$149.39

HC INFUSION CATHETER LVL 2

Facility

$237.12

Service Code	HCPCS C1751
Hospital Charge Code	27200005
Hospital Revenue Code	272
Min. Negotiated Rate	$94.85
Max. Negotiated Rate	$213.41
Rate for Payer: Aetna Commercial	$201.55
Rate for Payer: Aetna New Business (MI Preferred)	$154.13
Rate for Payer: BCBS Complete	$94.85
Rate for Payer: Cash Price	$189.70
Rate for Payer: Cofinity Commercial	$165.98
Rate for Payer: Cofinity Commercial	$203.92
Rate for Payer: Healthscope Commercial	$213.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.55
Rate for Payer: PHP Commercial	$201.55
Rate for Payer: Priority Health Cigna Priority Health	$165.98
Rate for Payer: Priority Health SBD	$149.39

HC INFUSION CATHETER LVL 3

Facility

$396.90

Service Code	HCPCS C1751
Hospital Charge Code	27200265
Hospital Revenue Code	272
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$357.21
Rate for Payer: Aetna Commercial	$337.36
Rate for Payer: Aetna New Business (MI Preferred)	$257.98
Rate for Payer: BCBS Complete	$158.76
Rate for Payer: Cash Price	$317.52
Rate for Payer: Cofinity Commercial	$277.83
Rate for Payer: Cofinity Commercial	$341.33
Rate for Payer: Healthscope Commercial	$357.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$337.36
Rate for Payer: PHP Commercial	$337.36
Rate for Payer: Priority Health Cigna Priority Health	$277.83
Rate for Payer: Priority Health SBD	$250.05

HC INFUSION CATHETER LVL 3

Facility

$396.90

Service Code	HCPCS C1751
Hospital Charge Code	27200265
Hospital Revenue Code	272
Min. Negotiated Rate	$250.05
Max. Negotiated Rate	$357.21
Rate for Payer: Aetna Commercial	$337.36
Rate for Payer: Aetna New Business (MI Preferred)	$257.98
Rate for Payer: Cash Price	$317.52
Rate for Payer: Cofinity Commercial	$277.83
Rate for Payer: Cofinity Commercial	$341.33
Rate for Payer: Healthscope Commercial	$357.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$337.36
Rate for Payer: PHP Commercial	$337.36
Rate for Payer: Priority Health Cigna Priority Health	$277.83
Rate for Payer: Priority Health SBD	$250.05

HC INFUSION CATHETER LVL 6

Facility

$662.86

Service Code	HCPCS C1751
Hospital Charge Code	27200280
Hospital Revenue Code	272
Min. Negotiated Rate	$265.14
Max. Negotiated Rate	$596.57
Rate for Payer: Aetna Commercial	$563.43
Rate for Payer: Aetna New Business (MI Preferred)	$430.86
Rate for Payer: BCBS Complete	$265.14
Rate for Payer: Cash Price	$530.29
Rate for Payer: Cofinity Commercial	$464.00
Rate for Payer: Cofinity Commercial	$570.06
Rate for Payer: Healthscope Commercial	$596.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$563.43
Rate for Payer: PHP Commercial	$563.43
Rate for Payer: Priority Health Cigna Priority Health	$464.00
Rate for Payer: Priority Health SBD	$417.60

HC INFUSION CATHETER LVL 6

Facility

$662.86

Service Code	HCPCS C1751
Hospital Charge Code	27200280
Hospital Revenue Code	272
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$596.57
Rate for Payer: Aetna Commercial	$563.43
Rate for Payer: Aetna New Business (MI Preferred)	$430.86
Rate for Payer: Cash Price	$530.29
Rate for Payer: Cofinity Commercial	$464.00
Rate for Payer: Cofinity Commercial	$570.06
Rate for Payer: Healthscope Commercial	$596.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$563.43
Rate for Payer: PHP Commercial	$563.43
Rate for Payer: Priority Health Cigna Priority Health	$464.00
Rate for Payer: Priority Health SBD	$417.60

HC INFUSION CATHETER LVL 7

Facility

$740.38

Service Code	HCPCS C1751
Hospital Charge Code	27200003
Hospital Revenue Code	272
Min. Negotiated Rate	$466.44
Max. Negotiated Rate	$666.34
Rate for Payer: Aetna Commercial	$629.32
Rate for Payer: Aetna New Business (MI Preferred)	$481.25
Rate for Payer: Cash Price	$592.30
Rate for Payer: Cofinity Commercial	$518.27
Rate for Payer: Cofinity Commercial	$636.73
Rate for Payer: Healthscope Commercial	$666.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$629.32
Rate for Payer: PHP Commercial	$629.32
Rate for Payer: Priority Health Cigna Priority Health	$518.27
Rate for Payer: Priority Health SBD	$466.44

HC INFUSION CATHETER LVL 7

Facility

$740.38

Service Code	HCPCS C1751
Hospital Charge Code	27200003
Hospital Revenue Code	272
Min. Negotiated Rate	$296.15
Max. Negotiated Rate	$666.34
Rate for Payer: Aetna Commercial	$629.32
Rate for Payer: Aetna New Business (MI Preferred)	$481.25
Rate for Payer: BCBS Complete	$296.15
Rate for Payer: Cash Price	$592.30
Rate for Payer: Cofinity Commercial	$518.27
Rate for Payer: Cofinity Commercial	$636.73
Rate for Payer: Healthscope Commercial	$666.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$629.32
Rate for Payer: PHP Commercial	$629.32
Rate for Payer: Priority Health Cigna Priority Health	$518.27
Rate for Payer: Priority Health SBD	$466.44

HC INFUSION CATHETER LVL 9

Facility

$904.18

Service Code	HCPCS C1751
Hospital Charge Code	27200170
Hospital Revenue Code	272
Min. Negotiated Rate	$361.67
Max. Negotiated Rate	$813.76
Rate for Payer: Aetna Commercial	$768.55
Rate for Payer: Aetna New Business (MI Preferred)	$587.72
Rate for Payer: BCBS Complete	$361.67
Rate for Payer: Cash Price	$723.34
Rate for Payer: Cofinity Commercial	$632.93
Rate for Payer: Cofinity Commercial	$777.59
Rate for Payer: Healthscope Commercial	$813.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$768.55
Rate for Payer: PHP Commercial	$768.55
Rate for Payer: Priority Health Cigna Priority Health	$632.93
Rate for Payer: Priority Health SBD	$569.63

HC INFUSION CATHETER LVL 9

Facility

$904.18

Service Code	HCPCS C1751
Hospital Charge Code	27200170
Hospital Revenue Code	272
Min. Negotiated Rate	$569.63
Max. Negotiated Rate	$813.76
Rate for Payer: Aetna Commercial	$768.55
Rate for Payer: Aetna New Business (MI Preferred)	$587.72
Rate for Payer: Cash Price	$723.34
Rate for Payer: Cofinity Commercial	$632.93
Rate for Payer: Cofinity Commercial	$777.59
Rate for Payer: Healthscope Commercial	$813.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$768.55
Rate for Payer: PHP Commercial	$768.55
Rate for Payer: Priority Health Cigna Priority Health	$632.93
Rate for Payer: Priority Health SBD	$569.63

Know your out-of-pocket cost for care.

All Charges