Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC USTEKINUMAB AND ANTI-USTEK AB CMPT

Facility

$162.00

Service Code	CPT 80299
Hospital Charge Code	30100709
Hospital Revenue Code	301
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: Aetna Medicare	$19.39
Rate for Payer: Aetna New Business (MI Preferred)	$105.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.30
Rate for Payer: Amish Plain Church Group Commercial	$23.30
Rate for Payer: BCBS Complete	$10.71
Rate for Payer: BCBS MAPPO	$18.64
Rate for Payer: BCBS Trust/PPO	$14.60
Rate for Payer: BCN Medicare Advantage	$18.64
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cofinity Commercial	$139.32
Rate for Payer: Cofinity Commercial	$113.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.64
Rate for Payer: Healthscope Commercial	$145.80
Rate for Payer: Mclaren Medicaid	$10.20
Rate for Payer: Mclaren Medicare	$18.64
Rate for Payer: Meridian Medicaid	$10.71
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.57
Rate for Payer: MI Amish Medical Board Commercial	$21.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$137.70
Rate for Payer: PACE Medicare	$17.71
Rate for Payer: PACE SWMI	$18.64
Rate for Payer: PHP Commercial	$137.70
Rate for Payer: PHP Medicare Advantage	$18.64
Rate for Payer: Priority Health Choice Medicaid	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$113.40
Rate for Payer: Priority Health Medicare	$18.64
Rate for Payer: Priority Health SBD	$102.06
Rate for Payer: Railroad Medicare Medicare	$18.64
Rate for Payer: UHC All Payor (Choice/PPO)	$22.37
Rate for Payer: UHC Core	$23.28
Rate for Payer: UHC Dual Complete DSNP	$18.64
Rate for Payer: UHC Exchange	$18.64
Rate for Payer: UHC Medicare Advantage	$19.20
Rate for Payer: VA VA	$18.64

HC USTEKINUMAB AND ANTI-USTEK AB CMPT

Facility

$162.00

Service Code	CPT 80299
Hospital Charge Code	30100709
Hospital Revenue Code	301
Min. Negotiated Rate	$102.06
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: Aetna New Business (MI Preferred)	$105.30
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cofinity Commercial	$139.32
Rate for Payer: Cofinity Commercial	$113.40
Rate for Payer: Healthscope Commercial	$145.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$137.70
Rate for Payer: PHP Commercial	$137.70
Rate for Payer: Priority Health Cigna Priority Health	$113.40
Rate for Payer: Priority Health SBD	$102.06

HC US TRANSPLANTED KIDNEY

Facility

$500.38

Service Code	CPT 76776
Hospital Charge Code	40200013
Hospital Revenue Code	402
Min. Negotiated Rate	$315.24
Max. Negotiated Rate	$450.34
Rate for Payer: Aetna Commercial	$425.32
Rate for Payer: Aetna New Business (MI Preferred)	$325.25
Rate for Payer: Cash Price	$400.30
Rate for Payer: Cofinity Commercial	$350.27
Rate for Payer: Cofinity Commercial	$430.33
Rate for Payer: Healthscope Commercial	$450.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.32
Rate for Payer: PHP Commercial	$425.32
Rate for Payer: Priority Health Cigna Priority Health	$350.27
Rate for Payer: Priority Health SBD	$315.24

HC US TRANSPLANTED KIDNEY

Facility

$500.38

Service Code	CPT 76776
Hospital Charge Code	40200013
Hospital Revenue Code	402
Min. Negotiated Rate	$53.51
Max. Negotiated Rate	$450.34
Rate for Payer: Aetna Commercial	$425.32
Rate for Payer: Aetna Medicare	$101.73
Rate for Payer: Aetna New Business (MI Preferred)	$325.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$122.28
Rate for Payer: Amish Plain Church Group Commercial	$122.28
Rate for Payer: BCBS Complete	$56.19
Rate for Payer: BCBS MAPPO	$97.82
Rate for Payer: BCBS Trust/PPO	$186.99
Rate for Payer: BCN Medicare Advantage	$97.82
Rate for Payer: Cash Price	$400.30
Rate for Payer: Cash Price	$400.30
Rate for Payer: Cofinity Commercial	$350.27
Rate for Payer: Cofinity Commercial	$430.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$97.82
Rate for Payer: Healthscope Commercial	$450.34
Rate for Payer: Mclaren Medicaid	$53.51
Rate for Payer: Mclaren Medicare	$97.82
Rate for Payer: Meridian Medicaid	$56.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$102.71
Rate for Payer: MI Amish Medical Board Commercial	$112.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.32
Rate for Payer: PACE Medicare	$92.93
Rate for Payer: PACE SWMI	$97.82
Rate for Payer: PHP Commercial	$425.32
Rate for Payer: PHP Medicare Advantage	$97.82
Rate for Payer: Priority Health Choice Medicaid	$53.51
Rate for Payer: Priority Health Cigna Priority Health	$350.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$338.98
Rate for Payer: Priority Health Medicare	$97.82
Rate for Payer: Priority Health Narrow Network	$271.18
Rate for Payer: Priority Health SBD	$315.24
Rate for Payer: Railroad Medicare Medicare	$97.82
Rate for Payer: UHC All Payor (Choice/PPO)	$159.20
Rate for Payer: UHC Dual Complete DSNP	$97.82
Rate for Payer: UHC Exchange	$144.73
Rate for Payer: UHC Medicare Advantage	$100.75
Rate for Payer: VA VA	$97.82

HC UVULECTOMY EXCISION UVULA

Facility

$7,900.00

Service Code	CPT 42140
Hospital Charge Code	76100468
Hospital Revenue Code	761
Min. Negotiated Rate	$4,977.00
Max. Negotiated Rate	$7,110.00
Rate for Payer: Aetna Commercial	$6,715.00
Rate for Payer: Aetna New Business (MI Preferred)	$5,135.00
Rate for Payer: Cash Price	$6,320.00
Rate for Payer: Cofinity Commercial	$5,530.00
Rate for Payer: Cofinity Commercial	$6,794.00
Rate for Payer: Healthscope Commercial	$7,110.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,715.00
Rate for Payer: PHP Commercial	$6,715.00
Rate for Payer: Priority Health Cigna Priority Health	$5,530.00
Rate for Payer: Priority Health SBD	$4,977.00

HC UVULECTOMY EXCISION UVULA

Facility

$7,900.00

Service Code	CPT 42140
Hospital Charge Code	76100468
Hospital Revenue Code	761
Min. Negotiated Rate	$162.08
Max. Negotiated Rate	$7,110.00
Rate for Payer: Aetna Commercial	$6,715.00
Rate for Payer: Aetna Medicare	$2,979.38
Rate for Payer: Aetna New Business (MI Preferred)	$5,135.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,580.99
Rate for Payer: Amish Plain Church Group Commercial	$3,580.99
Rate for Payer: BCBS Complete	$1,645.54
Rate for Payer: BCBS MAPPO	$2,864.79
Rate for Payer: BCBS Trust/PPO	$952.38
Rate for Payer: BCN Medicare Advantage	$2,864.79
Rate for Payer: Cash Price	$6,320.00
Rate for Payer: Cash Price	$6,320.00
Rate for Payer: Cofinity Commercial	$6,794.00
Rate for Payer: Cofinity Commercial	$5,530.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,864.79
Rate for Payer: Healthscope Commercial	$7,110.00
Rate for Payer: Mclaren Medicaid	$1,567.04
Rate for Payer: Mclaren Medicare	$2,864.79
Rate for Payer: Meridian Medicaid	$1,645.54
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,008.03
Rate for Payer: MI Amish Medical Board Commercial	$3,294.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,715.00
Rate for Payer: PACE Medicare	$2,721.55
Rate for Payer: PACE SWMI	$2,864.79
Rate for Payer: PHP Commercial	$6,715.00
Rate for Payer: PHP Medicare Advantage	$2,864.79
Rate for Payer: Priority Health Choice Medicaid	$1,567.04
Rate for Payer: Priority Health Cigna Priority Health	$5,530.00
Rate for Payer: Priority Health Medicare	$2,864.79
Rate for Payer: Priority Health SBD	$4,977.00
Rate for Payer: Railroad Medicare Medicare	$2,864.79
Rate for Payer: UHC All Payor (Choice/PPO)	$178.29
Rate for Payer: UHC Dual Complete DSNP	$2,864.79
Rate for Payer: UHC Exchange	$162.08
Rate for Payer: UHC Medicare Advantage	$2,950.73
Rate for Payer: VA VA	$2,864.79

HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID

Facility

$60.00

Service Code	CPT V5011
Hospital Charge Code	47000008
Hospital Revenue Code	470
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID

Facility

$60.00

Service Code	CPT V5011
Hospital Charge Code	47000008
Hospital Revenue Code	470
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC V5160 DISPENSING FEE BINAURAL

Facility

$475.00

Service Code	CPT V5160
Hospital Charge Code	47000006
Hospital Revenue Code	470
Min. Negotiated Rate	$299.25
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$403.75
Rate for Payer: Aetna New Business (MI Preferred)	$308.75
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cofinity Commercial	$332.50
Rate for Payer: Cofinity Commercial	$408.50
Rate for Payer: Healthscope Commercial	$427.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$403.75
Rate for Payer: PHP Commercial	$403.75
Rate for Payer: Priority Health Cigna Priority Health	$332.50
Rate for Payer: Priority Health SBD	$299.25

HC V5160 DISPENSING FEE BINAURAL

Facility

$475.00

Service Code	CPT V5160
Hospital Charge Code	47000006
Hospital Revenue Code	470
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$403.75
Rate for Payer: Aetna New Business (MI Preferred)	$308.75
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cofinity Commercial	$332.50
Rate for Payer: Cofinity Commercial	$408.50
Rate for Payer: Healthscope Commercial	$427.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$403.75
Rate for Payer: PHP Commercial	$403.75
Rate for Payer: Priority Health Cigna Priority Health	$332.50
Rate for Payer: Priority Health SBD	$299.25

HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE

Facility

$275.00

Service Code	CPT V5241
Hospital Charge Code	47000004
Hospital Revenue Code	470
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health SBD	$173.25

HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE

Facility

$275.00

Service Code	CPT V5241
Hospital Charge Code	47000004
Hospital Revenue Code	470
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health SBD	$173.25

HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE

Facility

$70.00

Service Code	CPT V5264
Hospital Charge Code	47000005
Hospital Revenue Code	470
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE

Facility

$70.00

Service Code	CPT V5264
Hospital Charge Code	47000005
Hospital Revenue Code	470
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC VACC AIIV4 NO PRSRV 0.5ML IM

Facility

$178.26

Service Code	CPT 90694
Hospital Charge Code	63600224
Hospital Revenue Code	636
Min. Negotiated Rate	$71.30
Max. Negotiated Rate	$224.78
Rate for Payer: Aetna Commercial	$151.52
Rate for Payer: Aetna New Business (MI Preferred)	$115.87
Rate for Payer: BCBS Complete	$71.30
Rate for Payer: BCBS Trust/PPO	$224.78
Rate for Payer: Cash Price	$142.61
Rate for Payer: Cash Price	$142.61
Rate for Payer: Cofinity Commercial	$124.78
Rate for Payer: Cofinity Commercial	$153.30
Rate for Payer: Healthscope Commercial	$160.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$151.52
Rate for Payer: PHP Commercial	$151.52
Rate for Payer: Priority Health Cigna Priority Health	$124.78
Rate for Payer: Priority Health SBD	$112.30

HC VACC AIIV4 NO PRSRV 0.5ML IM

Facility

$178.26

Service Code	CPT 90694
Hospital Charge Code	63600224
Hospital Revenue Code	636
Min. Negotiated Rate	$112.30
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$151.52
Rate for Payer: Aetna New Business (MI Preferred)	$115.87
Rate for Payer: Cash Price	$142.61
Rate for Payer: Cofinity Commercial	$124.78
Rate for Payer: Cofinity Commercial	$153.30
Rate for Payer: Healthscope Commercial	$160.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$151.52
Rate for Payer: PHP Commercial	$151.52
Rate for Payer: Priority Health Cigna Priority Health	$124.78
Rate for Payer: Priority Health SBD	$112.30

HC VACC CCIIV4 ABX FREE 0.5 ML IM

Facility

$66.69

Service Code	CPT 90756
Hospital Charge Code	63600223
Hospital Revenue Code	636
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$95.89
Rate for Payer: Aetna Commercial	$56.69
Rate for Payer: Aetna New Business (MI Preferred)	$43.35
Rate for Payer: BCBS Complete	$26.68
Rate for Payer: BCBS Trust/PPO	$95.89
Rate for Payer: Cash Price	$53.35
Rate for Payer: Cash Price	$53.35
Rate for Payer: Cofinity Commercial	$46.68
Rate for Payer: Cofinity Commercial	$57.35
Rate for Payer: Healthscope Commercial	$60.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.69
Rate for Payer: PHP Commercial	$56.69
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health SBD	$42.01

HC VACC CCIIV4 ABX FREE 0.5 ML IM

Facility

$66.69

Service Code	CPT 90756
Hospital Charge Code	63600223
Hospital Revenue Code	636
Min. Negotiated Rate	$42.01
Max. Negotiated Rate	$60.02
Rate for Payer: Aetna Commercial	$56.69
Rate for Payer: Aetna New Business (MI Preferred)	$43.35
Rate for Payer: Cash Price	$53.35
Rate for Payer: Cofinity Commercial	$46.68
Rate for Payer: Cofinity Commercial	$57.35
Rate for Payer: Healthscope Commercial	$60.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.69
Rate for Payer: PHP Commercial	$56.69
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health SBD	$42.01

HC VACC CCIIV4 NO PRSV 0.5 ML IM

Facility

$71.40

Service Code	CPT 90674
Hospital Charge Code	63600222
Hospital Revenue Code	636
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$98.74
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$98.74
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$49.98
Rate for Payer: Priority Health SBD	$44.98

HC VACC CCIIV4 NO PRSV 0.5 ML IM

Facility

$71.40

Service Code	CPT 90674
Hospital Charge Code	63600222
Hospital Revenue Code	636
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$49.98
Rate for Payer: Priority Health SBD	$44.98

HC VACC RSV PREF BIVALENT IM

Facility

$823.05

Service Code	CPT 90678
Hospital Charge Code	63600226
Hospital Revenue Code	636
Min. Negotiated Rate	$518.52
Max. Negotiated Rate	$740.74
Rate for Payer: Aetna Commercial	$699.59
Rate for Payer: Aetna New Business (MI Preferred)	$534.98
Rate for Payer: Cash Price	$658.44
Rate for Payer: Cofinity Commercial	$576.14
Rate for Payer: Cofinity Commercial	$707.82
Rate for Payer: Healthscope Commercial	$740.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.59
Rate for Payer: PHP Commercial	$699.59
Rate for Payer: Priority Health Cigna Priority Health	$576.14
Rate for Payer: Priority Health SBD	$518.52

HC VACC RSV PREF BIVALENT IM

Facility

$823.05

Service Code	CPT 90678
Hospital Charge Code	63600226
Hospital Revenue Code	636
Min. Negotiated Rate	$329.22
Max. Negotiated Rate	$1,008.28
Rate for Payer: Aetna Commercial	$699.59
Rate for Payer: Aetna New Business (MI Preferred)	$534.98
Rate for Payer: BCBS Complete	$329.22
Rate for Payer: BCBS Trust/PPO	$1,008.28
Rate for Payer: Cash Price	$658.44
Rate for Payer: Cash Price	$658.44
Rate for Payer: Cofinity Commercial	$707.82
Rate for Payer: Cofinity Commercial	$576.14
Rate for Payer: Healthscope Commercial	$740.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.59
Rate for Payer: PHP Commercial	$699.59
Rate for Payer: Priority Health Cigna Priority Health	$576.14
Rate for Payer: Priority Health SBD	$518.52

HC VACC RSV PREF RECOMB ADJT IM

Facility

$781.20

Service Code	CPT 90679
Hospital Charge Code	63600225
Hospital Revenue Code	636
Min. Negotiated Rate	$492.16
Max. Negotiated Rate	$703.08
Rate for Payer: Aetna Commercial	$664.02
Rate for Payer: Aetna New Business (MI Preferred)	$507.78
Rate for Payer: Cash Price	$624.96
Rate for Payer: Cofinity Commercial	$546.84
Rate for Payer: Cofinity Commercial	$671.83
Rate for Payer: Healthscope Commercial	$703.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$664.02
Rate for Payer: PHP Commercial	$664.02
Rate for Payer: Priority Health Cigna Priority Health	$546.84
Rate for Payer: Priority Health SBD	$492.16

HC VACC RSV PREF RECOMB ADJT IM

Facility

$781.20

Service Code	CPT 90679
Hospital Charge Code	63600225
Hospital Revenue Code	636
Min. Negotiated Rate	$312.48
Max. Negotiated Rate	$829.87
Rate for Payer: Aetna Commercial	$664.02
Rate for Payer: Aetna New Business (MI Preferred)	$507.78
Rate for Payer: BCBS Complete	$312.48
Rate for Payer: BCBS Trust/PPO	$829.87
Rate for Payer: Cash Price	$624.96
Rate for Payer: Cash Price	$624.96
Rate for Payer: Cofinity Commercial	$671.83
Rate for Payer: Cofinity Commercial	$546.84
Rate for Payer: Healthscope Commercial	$703.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$664.02
Rate for Payer: PHP Commercial	$664.02
Rate for Payer: Priority Health Cigna Priority Health	$546.84
Rate for Payer: Priority Health SBD	$492.16

HC VAGINAL DELIVERY (OB)

Facility

$1,757.26

Hospital Charge Code	72000006
Hospital Revenue Code	720
Min. Negotiated Rate	$1,107.07
Max. Negotiated Rate	$1,581.53
Rate for Payer: Aetna Commercial	$1,493.67
Rate for Payer: Aetna New Business (MI Preferred)	$1,142.22
Rate for Payer: Cash Price	$1,405.81
Rate for Payer: Cofinity Commercial	$1,230.08
Rate for Payer: Cofinity Commercial	$1,511.24
Rate for Payer: Healthscope Commercial	$1,581.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,493.67
Rate for Payer: PHP Commercial	$1,493.67
Rate for Payer: Priority Health Cigna Priority Health	$1,230.08
Rate for Payer: Priority Health SBD	$1,107.07

Know your out-of-pocket cost for care.

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