Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ISOVUE 370 PER ML

Facility

$1.86

Service Code	HCPCS Q9967
Hospital Charge Code	63600013
Hospital Revenue Code	636
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna New Business (MI Preferred)	$1.21
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cofinity Commercial	$1.30
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Healthscope Commercial	$1.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.58
Rate for Payer: PHP Commercial	$1.58
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: Priority Health SBD	$1.17

HC ISOVUE 370 PER ML

Facility

$1.86

Service Code	HCPCS Q9967
Hospital Charge Code	63600013
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna New Business (MI Preferred)	$1.21
Rate for Payer: BCBS Complete	$0.74
Rate for Payer: BCBS Trust/PPO	$0.13
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cofinity Commercial	$1.30
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Healthscope Commercial	$1.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.58
Rate for Payer: PHP Commercial	$1.58
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: Priority Health SBD	$1.17

HC IUD REMOVAL

Facility

$307.84

Service Code	HCPCS 58301
Hospital Charge Code	45000086
Hospital Revenue Code	761
Min. Negotiated Rate	$193.94
Max. Negotiated Rate	$277.06
Rate for Payer: Aetna Commercial	$261.66
Rate for Payer: Aetna New Business (MI Preferred)	$200.10
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cofinity Commercial	$215.49
Rate for Payer: Cofinity Commercial	$264.74
Rate for Payer: Healthscope Commercial	$277.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.66
Rate for Payer: PHP Commercial	$261.66
Rate for Payer: Priority Health Cigna Priority Health	$215.49
Rate for Payer: Priority Health SBD	$193.94

HC IUD REMOVAL

Facility

$307.84

Service Code	HCPCS 58301
Hospital Charge Code	45000086
Hospital Revenue Code	761
Min. Negotiated Rate	$64.83
Max. Negotiated Rate	$356.81
Rate for Payer: Aetna Commercial	$261.66
Rate for Payer: Aetna Medicare	$296.87
Rate for Payer: Aetna New Business (MI Preferred)	$200.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$356.81
Rate for Payer: Amish Plain Church Group Commercial	$356.81
Rate for Payer: BCBS Complete	$163.96
Rate for Payer: BCBS MAPPO	$285.45
Rate for Payer: BCBS Trust/PPO	$97.31
Rate for Payer: BCN Medicare Advantage	$285.45
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cofinity Commercial	$215.49
Rate for Payer: Cofinity Commercial	$264.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$285.45
Rate for Payer: Healthscope Commercial	$277.06
Rate for Payer: Mclaren Medicaid	$156.14
Rate for Payer: Mclaren Medicare	$285.45
Rate for Payer: Meridian Medicaid	$163.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$299.72
Rate for Payer: MI Amish Medical Board Commercial	$328.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.66
Rate for Payer: PACE Medicare	$271.18
Rate for Payer: PACE SWMI	$285.45
Rate for Payer: PHP Commercial	$261.66
Rate for Payer: PHP Medicare Advantage	$285.45
Rate for Payer: Priority Health Choice Medicaid	$156.14
Rate for Payer: Priority Health Cigna Priority Health	$215.49
Rate for Payer: Priority Health Medicare	$285.45
Rate for Payer: Priority Health SBD	$193.94
Rate for Payer: Railroad Medicare Medicare	$285.45
Rate for Payer: UHC All Payor (Choice/PPO)	$71.31
Rate for Payer: UHC Dual Complete DSNP	$285.45
Rate for Payer: UHC Exchange	$64.83
Rate for Payer: UHC Medicare Advantage	$294.01
Rate for Payer: VA VA	$285.45

HC IUPC ASSIST

Facility

$117.37

Hospital Charge Code	27000120
Hospital Revenue Code	272
Min. Negotiated Rate	$73.94
Max. Negotiated Rate	$105.63
Rate for Payer: Aetna Commercial	$99.76
Rate for Payer: Aetna New Business (MI Preferred)	$76.29
Rate for Payer: Cash Price	$93.90
Rate for Payer: Cofinity Commercial	$100.94
Rate for Payer: Cofinity Commercial	$82.16
Rate for Payer: Healthscope Commercial	$105.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.76
Rate for Payer: PHP Commercial	$99.76
Rate for Payer: Priority Health Cigna Priority Health	$82.16
Rate for Payer: Priority Health SBD	$73.94

HC IUPC ASSIST

Facility

$117.37

Hospital Charge Code	27000120
Hospital Revenue Code	272
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$105.63
Rate for Payer: Aetna Commercial	$99.76
Rate for Payer: Aetna New Business (MI Preferred)	$76.29
Rate for Payer: BCBS Complete	$46.95
Rate for Payer: Cash Price	$93.90
Rate for Payer: Cofinity Commercial	$100.94
Rate for Payer: Cofinity Commercial	$82.16
Rate for Payer: Healthscope Commercial	$105.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.76
Rate for Payer: PHP Commercial	$99.76
Rate for Payer: Priority Health Cigna Priority Health	$82.16
Rate for Payer: Priority Health SBD	$73.94

HC IV 0.45% NS 1000

Facility

$83.74

Hospital Charge Code	25000010
Hospital Revenue Code	250
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$75.37
Rate for Payer: Aetna Commercial	$71.18
Rate for Payer: Aetna New Business (MI Preferred)	$54.43
Rate for Payer: Cash Price	$66.99
Rate for Payer: Cofinity Commercial	$58.62
Rate for Payer: Cofinity Commercial	$72.02
Rate for Payer: Healthscope Commercial	$75.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.18
Rate for Payer: PHP Commercial	$71.18
Rate for Payer: Priority Health Cigna Priority Health	$58.62
Rate for Payer: Priority Health SBD	$52.76

HC IV 0.45% NS 1000

Facility

$83.74

Hospital Charge Code	25000010
Hospital Revenue Code	250
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$75.37
Rate for Payer: Aetna Commercial	$71.18
Rate for Payer: Aetna New Business (MI Preferred)	$54.43
Rate for Payer: BCBS Complete	$33.50
Rate for Payer: Cash Price	$66.99
Rate for Payer: Cofinity Commercial	$58.62
Rate for Payer: Cofinity Commercial	$72.02
Rate for Payer: Healthscope Commercial	$75.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.18
Rate for Payer: PHP Commercial	$71.18
Rate for Payer: Priority Health Cigna Priority Health	$58.62
Rate for Payer: Priority Health SBD	$52.76

HC IV HYDRATION ONLY, EACH ADDL HR

Facility

$199.58

Service Code	CPT 96361
Hospital Charge Code	26000002
Hospital Revenue Code	260
Min. Negotiated Rate	$125.74
Max. Negotiated Rate	$179.62
Rate for Payer: Aetna Commercial	$169.64
Rate for Payer: Aetna New Business (MI Preferred)	$129.73
Rate for Payer: Cash Price	$159.66
Rate for Payer: Cofinity Commercial	$139.71
Rate for Payer: Cofinity Commercial	$171.64
Rate for Payer: Healthscope Commercial	$179.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$169.64
Rate for Payer: PHP Commercial	$169.64
Rate for Payer: Priority Health Cigna Priority Health	$139.71
Rate for Payer: Priority Health SBD	$125.74

HC IV HYDRATION ONLY, EACH ADDL HR

Facility

$199.58

Service Code	CPT 96361
Hospital Charge Code	26000002
Hospital Revenue Code	260
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$179.62
Rate for Payer: Aetna Commercial	$169.64
Rate for Payer: Aetna Medicare	$43.96
Rate for Payer: Aetna New Business (MI Preferred)	$129.73
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	$51.93
Rate for Payer: BCN Medicare Advantage	$42.27
Rate for Payer: Cash Price	$159.66
Rate for Payer: Cash Price	$159.66
Rate for Payer: Cofinity Commercial	$139.71
Rate for Payer: Cofinity Commercial	$171.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$42.27
Rate for Payer: Healthscope Commercial	$179.62
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	$169.64
Rate for Payer: PACE Medicare	$40.16
Rate for Payer: PACE SWMI	$42.27
Rate for Payer: PHP Commercial	$169.64
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	$139.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$124.59
Rate for Payer: Priority Health Medicare	$42.27
Rate for Payer: Priority Health Narrow Network	$99.67
Rate for Payer: Priority Health SBD	$125.74
Rate for Payer: Railroad Medicare Medicare	$42.27
Rate for Payer: UHC All Payor (Choice/PPO)	$13.33
Rate for Payer: UHC Dual Complete DSNP	$42.27
Rate for Payer: UHC Exchange	$12.12
Rate for Payer: UHC Medicare Advantage	$43.54
Rate for Payer: VA VA	$42.27

HC IV HYDRATION ONLY,INITIAL HR

Facility

$500.24

Service Code	CPT 96360
Hospital Charge Code	26000001
Hospital Revenue Code	260
Min. Negotiated Rate	$31.76
Max. Negotiated Rate	$636.96
Rate for Payer: Aetna Commercial	$425.20
Rate for Payer: Aetna Medicare	$198.35
Rate for Payer: Aetna New Business (MI Preferred)	$325.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$238.40
Rate for Payer: Amish Plain Church Group Commercial	$238.40
Rate for Payer: BCBS Complete	$109.55
Rate for Payer: BCBS MAPPO	$190.72
Rate for Payer: BCBS Trust/PPO	$132.55
Rate for Payer: BCN Medicare Advantage	$190.72
Rate for Payer: Cash Price	$400.19
Rate for Payer: Cash Price	$400.19
Rate for Payer: Cofinity Commercial	$350.17
Rate for Payer: Cofinity Commercial	$430.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$190.72
Rate for Payer: Healthscope Commercial	$450.22
Rate for Payer: Mclaren Medicaid	$104.32
Rate for Payer: Mclaren Medicare	$190.72
Rate for Payer: Meridian Medicaid	$109.55
Rate for Payer: Meridian Wellcare - Medicare Advantage	$200.26
Rate for Payer: MI Amish Medical Board Commercial	$219.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.20
Rate for Payer: PACE Medicare	$181.18
Rate for Payer: PACE SWMI	$190.72
Rate for Payer: PHP Commercial	$425.20
Rate for Payer: PHP Medicare Advantage	$190.72
Rate for Payer: Priority Health Choice Medicaid	$104.32
Rate for Payer: Priority Health Cigna Priority Health	$350.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$636.96
Rate for Payer: Priority Health Medicare	$190.72
Rate for Payer: Priority Health Narrow Network	$509.57
Rate for Payer: Priority Health SBD	$315.15
Rate for Payer: Railroad Medicare Medicare	$190.72
Rate for Payer: UHC All Payor (Choice/PPO)	$34.94
Rate for Payer: UHC Dual Complete DSNP	$190.72
Rate for Payer: UHC Exchange	$31.76
Rate for Payer: UHC Medicare Advantage	$196.44
Rate for Payer: VA VA	$190.72

HC IV HYDRATION ONLY,INITIAL HR

Facility

$500.24

Service Code	CPT 96360
Hospital Charge Code	26000001
Hospital Revenue Code	260
Min. Negotiated Rate	$315.15
Max. Negotiated Rate	$450.22
Rate for Payer: Aetna Commercial	$425.20
Rate for Payer: Aetna New Business (MI Preferred)	$325.16
Rate for Payer: Cash Price	$400.19
Rate for Payer: Cofinity Commercial	$350.17
Rate for Payer: Cofinity Commercial	$430.21
Rate for Payer: Healthscope Commercial	$450.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.20
Rate for Payer: PHP Commercial	$425.20
Rate for Payer: Priority Health Cigna Priority Health	$350.17
Rate for Payer: Priority Health SBD	$315.15

HC IV HYDRATION W/OBS, EACH ADDL HR

Facility

$126.49

Service Code	CPT 96361
Hospital Charge Code	26000011
Hospital Revenue Code	260
Min. Negotiated Rate	$79.69
Max. Negotiated Rate	$113.84
Rate for Payer: Aetna Commercial	$107.52
Rate for Payer: Aetna New Business (MI Preferred)	$82.22
Rate for Payer: Cash Price	$101.19
Rate for Payer: Cofinity Commercial	$108.78
Rate for Payer: Cofinity Commercial	$88.54
Rate for Payer: Healthscope Commercial	$113.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$107.52
Rate for Payer: PHP Commercial	$107.52
Rate for Payer: Priority Health Cigna Priority Health	$88.54
Rate for Payer: Priority Health SBD	$79.69

HC IV HYDRATION W/OBS, EACH ADDL HR

Facility

$126.49

Service Code	CPT 96361
Hospital Charge Code	26000011
Hospital Revenue Code	260
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$124.59
Rate for Payer: Aetna Commercial	$107.52
Rate for Payer: Aetna Medicare	$43.96
Rate for Payer: Aetna New Business (MI Preferred)	$82.22
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	$51.93
Rate for Payer: BCN Medicare Advantage	$42.27
Rate for Payer: Cash Price	$101.19
Rate for Payer: Cash Price	$101.19
Rate for Payer: Cofinity Commercial	$108.78
Rate for Payer: Cofinity Commercial	$88.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$42.27
Rate for Payer: Healthscope Commercial	$113.84
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	$107.52
Rate for Payer: PACE Medicare	$40.16
Rate for Payer: PACE SWMI	$42.27
Rate for Payer: PHP Commercial	$107.52
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	$88.54
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$124.59
Rate for Payer: Priority Health Medicare	$42.27
Rate for Payer: Priority Health Narrow Network	$99.67
Rate for Payer: Priority Health SBD	$79.69
Rate for Payer: Railroad Medicare Medicare	$42.27
Rate for Payer: UHC All Payor (Choice/PPO)	$13.33
Rate for Payer: UHC Dual Complete DSNP	$42.27
Rate for Payer: UHC Exchange	$12.12
Rate for Payer: UHC Medicare Advantage	$43.54
Rate for Payer: VA VA	$42.27

HC IV HYDRATION W/OBS, INITIAL HR

Facility

$265.62

Service Code	CPT 96360
Hospital Charge Code	26000010
Hospital Revenue Code	260
Min. Negotiated Rate	$167.34
Max. Negotiated Rate	$239.06
Rate for Payer: Aetna Commercial	$225.78
Rate for Payer: Aetna New Business (MI Preferred)	$172.65
Rate for Payer: Cash Price	$212.50
Rate for Payer: Cofinity Commercial	$185.93
Rate for Payer: Cofinity Commercial	$228.43
Rate for Payer: Healthscope Commercial	$239.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$225.78
Rate for Payer: PHP Commercial	$225.78
Rate for Payer: Priority Health Cigna Priority Health	$185.93
Rate for Payer: Priority Health SBD	$167.34

HC IV HYDRATION W/OBS, INITIAL HR

Facility

$265.62

Service Code	CPT 96360
Hospital Charge Code	26000010
Hospital Revenue Code	260
Min. Negotiated Rate	$31.76
Max. Negotiated Rate	$636.96
Rate for Payer: Aetna Commercial	$225.78
Rate for Payer: Aetna Medicare	$198.35
Rate for Payer: Aetna New Business (MI Preferred)	$172.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$238.40
Rate for Payer: Amish Plain Church Group Commercial	$238.40
Rate for Payer: BCBS Complete	$109.55
Rate for Payer: BCBS MAPPO	$190.72
Rate for Payer: BCBS Trust/PPO	$132.55
Rate for Payer: BCN Medicare Advantage	$190.72
Rate for Payer: Cash Price	$212.50
Rate for Payer: Cash Price	$212.50
Rate for Payer: Cofinity Commercial	$185.93
Rate for Payer: Cofinity Commercial	$228.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$190.72
Rate for Payer: Healthscope Commercial	$239.06
Rate for Payer: Mclaren Medicaid	$104.32
Rate for Payer: Mclaren Medicare	$190.72
Rate for Payer: Meridian Medicaid	$109.55
Rate for Payer: Meridian Wellcare - Medicare Advantage	$200.26
Rate for Payer: MI Amish Medical Board Commercial	$219.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$225.78
Rate for Payer: PACE Medicare	$181.18
Rate for Payer: PACE SWMI	$190.72
Rate for Payer: PHP Commercial	$225.78
Rate for Payer: PHP Medicare Advantage	$190.72
Rate for Payer: Priority Health Choice Medicaid	$104.32
Rate for Payer: Priority Health Cigna Priority Health	$185.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$636.96
Rate for Payer: Priority Health Medicare	$190.72
Rate for Payer: Priority Health Narrow Network	$509.57
Rate for Payer: Priority Health SBD	$167.34
Rate for Payer: Railroad Medicare Medicare	$190.72
Rate for Payer: UHC All Payor (Choice/PPO)	$34.94
Rate for Payer: UHC Dual Complete DSNP	$190.72
Rate for Payer: UHC Exchange	$31.76
Rate for Payer: UHC Medicare Advantage	$196.44
Rate for Payer: VA VA	$190.72

HC IVIG INFUSION FIRST HOUR

Facility

$674.68

Service Code	CPT 96365
Hospital Charge Code	26000004
Hospital Revenue Code	260
Min. Negotiated Rate	$425.05
Max. Negotiated Rate	$607.21
Rate for Payer: Aetna Commercial	$573.48
Rate for Payer: Aetna New Business (MI Preferred)	$438.54
Rate for Payer: Cash Price	$539.74
Rate for Payer: Cofinity Commercial	$472.28
Rate for Payer: Cofinity Commercial	$580.22
Rate for Payer: Healthscope Commercial	$607.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$573.48
Rate for Payer: PHP Commercial	$573.48
Rate for Payer: Priority Health Cigna Priority Health	$472.28
Rate for Payer: Priority Health SBD	$425.05

HC IVIG INFUSION FIRST HOUR

Facility

$674.68

Service Code	CPT 96365
Hospital Charge Code	26000004
Hospital Revenue Code	260
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$636.96
Rate for Payer: Aetna Commercial	$573.48
Rate for Payer: Aetna Medicare	$198.35
Rate for Payer: Aetna New Business (MI Preferred)	$438.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$238.40
Rate for Payer: Amish Plain Church Group Commercial	$238.40
Rate for Payer: BCBS Complete	$109.55
Rate for Payer: BCBS MAPPO	$190.72
Rate for Payer: BCBS Trust/PPO	$260.99
Rate for Payer: BCN Medicare Advantage	$190.72
Rate for Payer: Cash Price	$539.74
Rate for Payer: Cash Price	$539.74
Rate for Payer: Cofinity Commercial	$472.28
Rate for Payer: Cofinity Commercial	$580.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$190.72
Rate for Payer: Healthscope Commercial	$607.21
Rate for Payer: Mclaren Medicaid	$104.32
Rate for Payer: Mclaren Medicare	$190.72
Rate for Payer: Meridian Medicaid	$109.55
Rate for Payer: Meridian Wellcare - Medicare Advantage	$200.26
Rate for Payer: MI Amish Medical Board Commercial	$219.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$573.48
Rate for Payer: PACE Medicare	$181.18
Rate for Payer: PACE SWMI	$190.72
Rate for Payer: PHP Commercial	$573.48
Rate for Payer: PHP Medicare Advantage	$190.72
Rate for Payer: Priority Health Choice Medicaid	$104.32
Rate for Payer: Priority Health Cigna Priority Health	$472.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$636.96
Rate for Payer: Priority Health Medicare	$190.72
Rate for Payer: Priority Health Narrow Network	$509.57
Rate for Payer: Priority Health SBD	$425.05
Rate for Payer: Railroad Medicare Medicare	$190.72
Rate for Payer: UHC All Payor (Choice/PPO)	$67.72
Rate for Payer: UHC Dual Complete DSNP	$190.72
Rate for Payer: UHC Exchange	$61.56
Rate for Payer: UHC Medicare Advantage	$196.44
Rate for Payer: VA VA	$190.72

HC IV INF BAMLANIVIMAB/ETESEVIMAB

Facility

$524.28

Service Code	CPT M0245
Hospital Charge Code	77100031
Hospital Revenue Code	771
Min. Negotiated Rate	$230.13
Max. Negotiated Rate	$525.89
Rate for Payer: Aetna Commercial	$445.64
Rate for Payer: Aetna Medicare	$437.54
Rate for Payer: Aetna New Business (MI Preferred)	$340.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$525.89
Rate for Payer: Amish Plain Church Group Commercial	$525.89
Rate for Payer: BCBS Complete	$241.66
Rate for Payer: BCBS MAPPO	$420.71
Rate for Payer: BCN Medicare Advantage	$420.71
Rate for Payer: Cash Price	$419.42
Rate for Payer: Cash Price	$419.42
Rate for Payer: Cofinity Commercial	$367.00
Rate for Payer: Cofinity Commercial	$450.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$420.71
Rate for Payer: Healthscope Commercial	$471.85
Rate for Payer: Mclaren Medicaid	$230.13
Rate for Payer: Mclaren Medicare	$420.71
Rate for Payer: Meridian Medicaid	$241.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$441.75
Rate for Payer: MI Amish Medical Board Commercial	$483.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$445.64
Rate for Payer: PACE Medicare	$399.67
Rate for Payer: PACE SWMI	$420.71
Rate for Payer: PHP Commercial	$445.64
Rate for Payer: PHP Medicare Advantage	$420.71
Rate for Payer: Priority Health Choice Medicaid	$230.13
Rate for Payer: Priority Health Cigna Priority Health	$367.00
Rate for Payer: Priority Health Medicare	$420.71
Rate for Payer: Priority Health SBD	$330.30
Rate for Payer: Railroad Medicare Medicare	$420.71
Rate for Payer: UHC Dual Complete DSNP	$420.71
Rate for Payer: UHC Medicare Advantage	$433.33
Rate for Payer: VA VA	$420.71

HC IV INF BAMLANIVIMAB/ETESEVIMAB

Facility

$524.28

Service Code	CPT M0245
Hospital Charge Code	77100031
Hospital Revenue Code	771
Min. Negotiated Rate	$330.30
Max. Negotiated Rate	$471.85
Rate for Payer: Aetna Commercial	$445.64
Rate for Payer: Aetna New Business (MI Preferred)	$340.78
Rate for Payer: Cash Price	$419.42
Rate for Payer: Cofinity Commercial	$367.00
Rate for Payer: Cofinity Commercial	$450.88
Rate for Payer: Healthscope Commercial	$471.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$445.64
Rate for Payer: PHP Commercial	$445.64
Rate for Payer: Priority Health Cigna Priority Health	$367.00
Rate for Payer: Priority Health SBD	$330.30

HC IV INF SOTROVIMAB

Facility

$524.28

Service Code	HCPCS M0247
Hospital Charge Code	77100032
Hospital Revenue Code	771
Min. Negotiated Rate	$330.30
Max. Negotiated Rate	$471.85
Rate for Payer: Aetna Commercial	$445.64
Rate for Payer: Aetna New Business (MI Preferred)	$340.78
Rate for Payer: Cash Price	$419.42
Rate for Payer: Cofinity Commercial	$367.00
Rate for Payer: Cofinity Commercial	$450.88
Rate for Payer: Healthscope Commercial	$471.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$445.64
Rate for Payer: PHP Commercial	$445.64
Rate for Payer: Priority Health Cigna Priority Health	$367.00
Rate for Payer: Priority Health SBD	$330.30

HC IV INF SOTROVIMAB

Facility

$524.28

Service Code	HCPCS M0247
Hospital Charge Code	77100032
Hospital Revenue Code	771
Min. Negotiated Rate	$230.13
Max. Negotiated Rate	$525.89
Rate for Payer: Aetna Commercial	$445.64
Rate for Payer: Aetna Medicare	$437.54
Rate for Payer: Aetna New Business (MI Preferred)	$340.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$525.89
Rate for Payer: Amish Plain Church Group Commercial	$525.89
Rate for Payer: BCBS Complete	$241.66
Rate for Payer: BCBS MAPPO	$420.71
Rate for Payer: BCN Medicare Advantage	$420.71
Rate for Payer: Cash Price	$419.42
Rate for Payer: Cash Price	$419.42
Rate for Payer: Cofinity Commercial	$367.00
Rate for Payer: Cofinity Commercial	$450.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$420.71
Rate for Payer: Healthscope Commercial	$471.85
Rate for Payer: Mclaren Medicaid	$230.13
Rate for Payer: Mclaren Medicare	$420.71
Rate for Payer: Meridian Medicaid	$241.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$441.75
Rate for Payer: MI Amish Medical Board Commercial	$483.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$445.64
Rate for Payer: PACE Medicare	$399.67
Rate for Payer: PACE SWMI	$420.71
Rate for Payer: PHP Commercial	$445.64
Rate for Payer: PHP Medicare Advantage	$420.71
Rate for Payer: Priority Health Choice Medicaid	$230.13
Rate for Payer: Priority Health Cigna Priority Health	$367.00
Rate for Payer: Priority Health Medicare	$420.71
Rate for Payer: Priority Health SBD	$330.30
Rate for Payer: Railroad Medicare Medicare	$420.71
Rate for Payer: UHC Dual Complete DSNP	$420.71
Rate for Payer: UHC Medicare Advantage	$433.33
Rate for Payer: VA VA	$420.71

HC IV INFUSION CONCURRENT

Facility

$170.26

Service Code	CPT 96368
Hospital Charge Code	26000007
Hospital Revenue Code	260
Min. Negotiated Rate	$19.32
Max. Negotiated Rate	$153.23
Rate for Payer: Aetna Commercial	$144.72
Rate for Payer: Aetna New Business (MI Preferred)	$110.67
Rate for Payer: BCBS Complete	$68.10
Rate for Payer: BCBS Trust/PPO	$80.62
Rate for Payer: Cash Price	$136.21
Rate for Payer: Cash Price	$136.21
Rate for Payer: Cofinity Commercial	$119.18
Rate for Payer: Cofinity Commercial	$146.42
Rate for Payer: Healthscope Commercial	$153.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$144.72
Rate for Payer: PHP Commercial	$144.72
Rate for Payer: Priority Health Cigna Priority Health	$119.18
Rate for Payer: Priority Health SBD	$107.26
Rate for Payer: UHC All Payor (Choice/PPO)	$21.25
Rate for Payer: UHC Exchange	$19.32

HC IV INFUSION CONCURRENT

Facility

$170.26

Service Code	CPT 96368
Hospital Charge Code	26000007
Hospital Revenue Code	260
Min. Negotiated Rate	$107.26
Max. Negotiated Rate	$153.23
Rate for Payer: Aetna Commercial	$144.72
Rate for Payer: Aetna New Business (MI Preferred)	$110.67
Rate for Payer: Cash Price	$136.21
Rate for Payer: Cofinity Commercial	$119.18
Rate for Payer: Cofinity Commercial	$146.42
Rate for Payer: Healthscope Commercial	$153.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$144.72
Rate for Payer: PHP Commercial	$144.72
Rate for Payer: Priority Health Cigna Priority Health	$119.18
Rate for Payer: Priority Health SBD	$107.26

HC IV INFUSION THERAPY EACH ADD HR

Facility

$190.73

Service Code	CPT 96366
Hospital Charge Code	26000005
Hospital Revenue Code	260
Min. Negotiated Rate	$120.16
Max. Negotiated Rate	$171.66
Rate for Payer: Aetna Commercial	$162.12
Rate for Payer: Aetna New Business (MI Preferred)	$123.97
Rate for Payer: Cash Price	$152.58
Rate for Payer: Cofinity Commercial	$133.51
Rate for Payer: Cofinity Commercial	$164.03
Rate for Payer: Healthscope Commercial	$171.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$162.12
Rate for Payer: PHP Commercial	$162.12
Rate for Payer: Priority Health Cigna Priority Health	$133.51
Rate for Payer: Priority Health SBD	$120.16

Know your out-of-pocket cost for care.

All Charges