Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)

Facility

$60.35

Service Code	NDC 0002-8215-01
Hospital Charge Code	180910
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.32
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Healthscope Commercial	$54.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$42.24
Rate for Payer: Priority Health SBD	$38.02

INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)

Facility

$290.23

Service Code	HCPCS J1815
Hospital Charge Code	180908
Hospital Revenue Code	637
Min. Negotiated Rate	$182.84
Max. Negotiated Rate	$261.21
Rate for Payer: Aetna Commercial	$246.70
Rate for Payer: Aetna New Business (MI Preferred)	$188.65
Rate for Payer: Cash Price	$232.18
Rate for Payer: Cofinity Commercial	$203.16
Rate for Payer: Cofinity Commercial	$249.60
Rate for Payer: Healthscope Commercial	$261.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.70
Rate for Payer: PHP Commercial	$246.70
Rate for Payer: Priority Health Cigna Priority Health	$203.16
Rate for Payer: Priority Health SBD	$182.84

INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)

Facility

$46.55

Service Code	NDC 0002-7510-17
Hospital Charge Code	180914
Hospital Revenue Code	637
Min. Negotiated Rate	$29.33
Max. Negotiated Rate	$41.90
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna New Business (MI Preferred)	$30.26
Rate for Payer: Cash Price	$37.24
Rate for Payer: Cofinity Commercial	$32.58
Rate for Payer: Cofinity Commercial	$40.03
Rate for Payer: Healthscope Commercial	$41.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.57
Rate for Payer: PHP Commercial	$39.57
Rate for Payer: Priority Health Cigna Priority Health	$32.58
Rate for Payer: Priority Health SBD	$29.33

INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)

Facility

$5,065.60

Service Code	NDC 0002-8501-01
Hospital Charge Code	180916
Hospital Revenue Code	637
Min. Negotiated Rate	$3,191.33
Max. Negotiated Rate	$4,559.04
Rate for Payer: Aetna Commercial	$4,305.76
Rate for Payer: Aetna New Business (MI Preferred)	$3,292.64
Rate for Payer: Cash Price	$4,052.48
Rate for Payer: Cofinity Commercial	$3,545.92
Rate for Payer: Cofinity Commercial	$4,356.42
Rate for Payer: Healthscope Commercial	$4,559.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,305.76
Rate for Payer: PHP Commercial	$4,305.76
Rate for Payer: Priority Health Cigna Priority Health	$3,545.92
Rate for Payer: Priority Health SBD	$3,191.33

INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)

Facility

$248.94

Service Code	NDC 0169-7501-11
Hospital Charge Code	180912
Hospital Revenue Code	637
Min. Negotiated Rate	$156.83
Max. Negotiated Rate	$224.05
Rate for Payer: Aetna Commercial	$211.60
Rate for Payer: Aetna New Business (MI Preferred)	$161.81
Rate for Payer: Cash Price	$199.15
Rate for Payer: Cofinity Commercial	$174.26
Rate for Payer: Cofinity Commercial	$214.09
Rate for Payer: Healthscope Commercial	$224.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.60
Rate for Payer: PHP Commercial	$211.60
Rate for Payer: Priority Health Cigna Priority Health	$174.26
Rate for Payer: Priority Health SBD	$156.83

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$60.35

Service Code	NDC 9900-0007-58
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.32
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Healthscope Commercial	$54.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$42.24
Rate for Payer: Priority Health SBD	$38.02

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$60.35

Service Code	NDC 0002-8215-01
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.32
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Healthscope Commercial	$54.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$42.24
Rate for Payer: Priority Health SBD	$38.02

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$56.95

Service Code	NDC 0169-1833-11
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$51.26
Rate for Payer: Aetna Commercial	$48.41
Rate for Payer: Aetna New Business (MI Preferred)	$37.02
Rate for Payer: Cash Price	$45.56
Rate for Payer: Cofinity Commercial	$39.86
Rate for Payer: Cofinity Commercial	$48.98
Rate for Payer: Healthscope Commercial	$51.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.41
Rate for Payer: PHP Commercial	$48.41
Rate for Payer: Priority Health Cigna Priority Health	$39.86
Rate for Payer: Priority Health SBD	$35.88

INTERFERON BETA-1A (ALBUMIN) 44 MCG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$2,579.42

Service Code	NDC 44087-0044-3
Hospital Charge Code	22532
Hospital Revenue Code	250
Min. Negotiated Rate	$1,625.03
Max. Negotiated Rate	$2,321.48
Rate for Payer: Aetna Commercial	$2,192.51
Rate for Payer: Aetna New Business (MI Preferred)	$1,676.62
Rate for Payer: Cash Price	$2,063.54
Rate for Payer: Cofinity Commercial	$1,805.59
Rate for Payer: Cofinity Commercial	$2,218.30
Rate for Payer: Healthscope Commercial	$2,321.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,192.51
Rate for Payer: PHP Commercial	$2,192.51
Rate for Payer: Priority Health Cigna Priority Health	$1,805.59
Rate for Payer: Priority Health SBD	$1,625.03

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$18,329.18

Service Code	MS-DRG 197
Min. Negotiated Rate	$7,292.69
Max. Negotiated Rate	$18,329.18
Rate for Payer: Aetna Medicare	$7,983.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,595.65
Rate for Payer: Amish Plain Church Group Commercial	$9,595.65
Rate for Payer: BCBS MAPPO	$7,676.52
Rate for Payer: BCBS Trust/PPO	$18,329.18
Rate for Payer: BCN Medicare Advantage	$7,676.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,676.52
Rate for Payer: Mclaren Medicare	$7,676.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,060.35
Rate for Payer: MI Amish Medical Board Commercial	$8,828.00
Rate for Payer: PACE Medicare	$7,292.69
Rate for Payer: PACE SWMI	$7,676.52
Rate for Payer: PHP Medicare Advantage	$7,676.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,314.05
Rate for Payer: Priority Health Medicare	$7,676.52
Rate for Payer: Priority Health Narrow Network	$11,451.24
Rate for Payer: Railroad Medicare Medicare	$7,676.52
Rate for Payer: UHC All Payor (Choice/PPO)	$15,215.87
Rate for Payer: UHC Core	$9,336.60
Rate for Payer: UHC Dual Complete DSNP	$7,676.52
Rate for Payer: UHC Exchange	$9,999.94
Rate for Payer: UHC Medicare Advantage	$7,906.82
Rate for Payer: VA VA	$7,676.52

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$28,912.43

Service Code	MS-DRG 196
Min. Negotiated Rate	$13,435.85
Max. Negotiated Rate	$28,912.43
Rate for Payer: Aetna Medicare	$14,708.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,678.75
Rate for Payer: Amish Plain Church Group Commercial	$17,678.75
Rate for Payer: BCBS MAPPO	$14,143.00
Rate for Payer: BCBS Trust/PPO	$22,356.46
Rate for Payer: BCN Medicare Advantage	$14,143.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,143.00
Rate for Payer: Mclaren Medicare	$14,143.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,850.15
Rate for Payer: MI Amish Medical Board Commercial	$16,264.45
Rate for Payer: PACE Medicare	$13,435.85
Rate for Payer: PACE SWMI	$14,143.00
Rate for Payer: PHP Medicare Advantage	$14,143.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27,198.84
Rate for Payer: Priority Health Medicare	$14,143.00
Rate for Payer: Priority Health Narrow Network	$21,759.07
Rate for Payer: Railroad Medicare Medicare	$14,143.00
Rate for Payer: UHC All Payor (Choice/PPO)	$28,912.43
Rate for Payer: UHC Core	$17,740.94
Rate for Payer: UHC Dual Complete DSNP	$14,143.00
Rate for Payer: UHC Exchange	$19,001.39
Rate for Payer: UHC Medicare Advantage	$14,567.29
Rate for Payer: VA VA	$14,143.00

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$12,090.63

Service Code	MS-DRG 198
Min. Negotiated Rate	$5,792.32
Max. Negotiated Rate	$12,090.63
Rate for Payer: Aetna Medicare	$6,341.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,621.48
Rate for Payer: Amish Plain Church Group Commercial	$7,621.48
Rate for Payer: BCBS MAPPO	$6,097.18
Rate for Payer: BCBS Trust/PPO	$12,090.63
Rate for Payer: BCN Medicare Advantage	$6,097.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,097.18
Rate for Payer: Mclaren Medicare	$6,097.18
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,402.04
Rate for Payer: MI Amish Medical Board Commercial	$7,011.76
Rate for Payer: PACE Medicare	$5,792.32
Rate for Payer: PACE SWMI	$6,097.18
Rate for Payer: PHP Medicare Advantage	$6,097.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,167.11
Rate for Payer: Priority Health Medicare	$6,097.18
Rate for Payer: Priority Health Narrow Network	$8,933.69
Rate for Payer: Railroad Medicare Medicare	$6,097.18
Rate for Payer: UHC All Payor (Choice/PPO)	$11,870.66
Rate for Payer: UHC Core	$7,283.95
Rate for Payer: UHC Dual Complete DSNP	$6,097.18
Rate for Payer: UHC Exchange	$7,801.46
Rate for Payer: UHC Medicare Advantage	$6,280.10
Rate for Payer: VA VA	$6,097.18

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$20,478.96

Service Code	MS-DRG 065
Min. Negotiated Rate	$7,421.99
Max. Negotiated Rate	$20,478.96
Rate for Payer: Aetna Medicare	$8,125.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,765.78
Rate for Payer: Amish Plain Church Group Commercial	$9,765.78
Rate for Payer: BCBS MAPPO	$7,812.62
Rate for Payer: BCBS Trust/PPO	$20,478.96
Rate for Payer: BCN Medicare Advantage	$7,812.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,812.62
Rate for Payer: Mclaren Medicare	$7,812.62
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,203.25
Rate for Payer: MI Amish Medical Board Commercial	$8,984.51
Rate for Payer: PACE Medicare	$7,421.99
Rate for Payer: PACE SWMI	$7,812.62
Rate for Payer: PHP Medicare Advantage	$7,812.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,585.26
Rate for Payer: Priority Health Medicare	$7,812.62
Rate for Payer: Priority Health Narrow Network	$11,668.21
Rate for Payer: Railroad Medicare Medicare	$7,812.62
Rate for Payer: UHC All Payor (Choice/PPO)	$15,504.17
Rate for Payer: UHC Core	$9,513.50
Rate for Payer: UHC Dual Complete DSNP	$7,812.62
Rate for Payer: UHC Exchange	$10,189.41
Rate for Payer: UHC Medicare Advantage	$8,047.00
Rate for Payer: VA VA	$7,812.62

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$32,808.94

Service Code	MS-DRG 064
Min. Negotiated Rate	$14,172.03
Max. Negotiated Rate	$32,808.94
Rate for Payer: Aetna Medicare	$15,514.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,647.41
Rate for Payer: Amish Plain Church Group Commercial	$18,647.41
Rate for Payer: BCBS MAPPO	$14,917.93
Rate for Payer: BCBS Trust/PPO	$32,808.94
Rate for Payer: BCN Medicare Advantage	$14,917.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,917.93
Rate for Payer: Mclaren Medicare	$14,917.93
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,663.83
Rate for Payer: MI Amish Medical Board Commercial	$17,155.62
Rate for Payer: PACE Medicare	$14,172.03
Rate for Payer: PACE SWMI	$14,917.93
Rate for Payer: PHP Medicare Advantage	$14,917.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28,742.89
Rate for Payer: Priority Health Medicare	$14,917.93
Rate for Payer: Priority Health Narrow Network	$22,994.31
Rate for Payer: Railroad Medicare Medicare	$14,917.93
Rate for Payer: UHC All Payor (Choice/PPO)	$30,553.76
Rate for Payer: UHC Core	$18,748.08
Rate for Payer: UHC Dual Complete DSNP	$14,917.93
Rate for Payer: UHC Exchange	$20,080.08
Rate for Payer: UHC Medicare Advantage	$15,365.47
Rate for Payer: VA VA	$14,917.93

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$15,531.60

Service Code	MS-DRG 066
Min. Negotiated Rate	$5,171.76
Max. Negotiated Rate	$15,531.60
Rate for Payer: Aetna Medicare	$5,661.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,804.95
Rate for Payer: Amish Plain Church Group Commercial	$6,804.95
Rate for Payer: BCBS MAPPO	$5,443.96
Rate for Payer: BCBS Trust/PPO	$15,531.60
Rate for Payer: BCN Medicare Advantage	$5,443.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,443.96
Rate for Payer: Mclaren Medicare	$5,443.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,716.16
Rate for Payer: MI Amish Medical Board Commercial	$6,260.55
Rate for Payer: PACE Medicare	$5,171.76
Rate for Payer: PACE SWMI	$5,443.96
Rate for Payer: PHP Medicare Advantage	$5,443.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,865.57
Rate for Payer: Priority Health Medicare	$5,443.96
Rate for Payer: Priority Health Narrow Network	$7,892.46
Rate for Payer: Railroad Medicare Medicare	$5,443.96
Rate for Payer: UHC All Payor (Choice/PPO)	$10,487.13
Rate for Payer: UHC Core	$6,435.00
Rate for Payer: UHC Dual Complete DSNP	$5,443.96
Rate for Payer: UHC Exchange	$6,892.19
Rate for Payer: UHC Medicare Advantage	$5,607.28
Rate for Payer: VA VA	$5,443.96

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$117,873.72

Service Code	MS-DRG 021
Min. Negotiated Rate	$42,485.71
Max. Negotiated Rate	$117,873.72
Rate for Payer: Aetna Medicare	$46,510.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$55,902.25
Rate for Payer: Amish Plain Church Group Commercial	$55,902.25
Rate for Payer: BCBS MAPPO	$44,721.80
Rate for Payer: BCBS Trust/PPO	$117,873.72
Rate for Payer: BCN Medicare Advantage	$44,721.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$44,721.80
Rate for Payer: Mclaren Medicare	$44,721.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$46,957.89
Rate for Payer: MI Amish Medical Board Commercial	$51,430.07
Rate for Payer: PACE Medicare	$42,485.71
Rate for Payer: PACE SWMI	$44,721.80
Rate for Payer: PHP Medicare Advantage	$44,721.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$88,128.60
Rate for Payer: Priority Health Medicare	$44,721.80
Rate for Payer: Priority Health Narrow Network	$70,502.88
Rate for Payer: Railroad Medicare Medicare	$44,721.80
Rate for Payer: UHC All Payor (Choice/PPO)	$93,680.92
Rate for Payer: UHC Core	$57,483.50
Rate for Payer: UHC Dual Complete DSNP	$44,721.80
Rate for Payer: UHC Exchange	$61,567.54
Rate for Payer: UHC Medicare Advantage	$46,063.45
Rate for Payer: VA VA	$44,721.80

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$161,264.70

Service Code	MS-DRG 020
Min. Negotiated Rate	$58,296.90
Max. Negotiated Rate	$161,264.70
Rate for Payer: Aetna Medicare	$63,819.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$76,706.45
Rate for Payer: Amish Plain Church Group Commercial	$76,706.45
Rate for Payer: BCBS MAPPO	$61,365.16
Rate for Payer: BCBS Trust/PPO	$161,264.70
Rate for Payer: BCN Medicare Advantage	$61,365.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$61,365.16
Rate for Payer: Mclaren Medicare	$61,365.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$64,433.42
Rate for Payer: MI Amish Medical Board Commercial	$70,569.93
Rate for Payer: PACE Medicare	$58,296.90
Rate for Payer: PACE SWMI	$61,365.16
Rate for Payer: PHP Medicare Advantage	$61,365.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$121,291.26
Rate for Payer: Priority Health Medicare	$61,365.16
Rate for Payer: Priority Health Narrow Network	$97,033.01
Rate for Payer: Railroad Medicare Medicare	$61,365.16
Rate for Payer: UHC All Payor (Choice/PPO)	$128,932.91
Rate for Payer: UHC Core	$79,114.46
Rate for Payer: UHC Dual Complete DSNP	$61,365.16
Rate for Payer: UHC Exchange	$84,735.31
Rate for Payer: UHC Medicare Advantage	$63,206.11
Rate for Payer: VA VA	$61,365.16

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$76,166.99

Service Code	MS-DRG 022
Min. Negotiated Rate	$27,306.04
Max. Negotiated Rate	$76,166.99
Rate for Payer: Aetna Medicare	$29,892.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$35,929.00
Rate for Payer: Amish Plain Church Group Commercial	$35,929.00
Rate for Payer: BCBS MAPPO	$28,743.20
Rate for Payer: BCBS Trust/PPO	$76,166.99
Rate for Payer: BCN Medicare Advantage	$28,743.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$28,743.20
Rate for Payer: Mclaren Medicare	$28,743.20
Rate for Payer: Meridian Wellcare - Medicare Advantage	$30,180.36
Rate for Payer: MI Amish Medical Board Commercial	$33,054.68
Rate for Payer: PACE Medicare	$27,306.04
Rate for Payer: PACE SWMI	$28,743.20
Rate for Payer: PHP Medicare Advantage	$28,743.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49,890.37
Rate for Payer: Priority Health Medicare	$28,743.20
Rate for Payer: Priority Health Narrow Network	$39,912.30
Rate for Payer: Railroad Medicare Medicare	$28,743.20
Rate for Payer: UHC All Payor (Choice/PPO)	$53,033.58
Rate for Payer: UHC Core	$32,541.91
Rate for Payer: UHC Dual Complete DSNP	$28,743.20
Rate for Payer: UHC Exchange	$34,853.92
Rate for Payer: UHC Medicare Advantage	$29,605.50
Rate for Payer: VA VA	$28,743.20

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$27,927.02

Service Code	MS-DRG 116
Min. Negotiated Rate	$12,993.89
Max. Negotiated Rate	$27,927.02
Rate for Payer: Aetna Medicare	$14,224.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,097.22
Rate for Payer: Amish Plain Church Group Commercial	$17,097.22
Rate for Payer: BCBS MAPPO	$13,677.78
Rate for Payer: BCBS Trust/PPO	$25,292.38
Rate for Payer: BCN Medicare Advantage	$13,677.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,677.78
Rate for Payer: Mclaren Medicare	$13,677.78
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,361.67
Rate for Payer: MI Amish Medical Board Commercial	$15,729.45
Rate for Payer: PACE Medicare	$12,993.89
Rate for Payer: PACE SWMI	$13,677.78
Rate for Payer: PHP Medicare Advantage	$13,677.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26,271.83
Rate for Payer: Priority Health Medicare	$13,677.78
Rate for Payer: Priority Health Narrow Network	$21,017.46
Rate for Payer: Railroad Medicare Medicare	$13,677.78
Rate for Payer: UHC All Payor (Choice/PPO)	$27,927.02
Rate for Payer: UHC Core	$17,136.29
Rate for Payer: UHC Dual Complete DSNP	$13,677.78
Rate for Payer: UHC Exchange	$18,353.77
Rate for Payer: UHC Medicare Advantage	$14,088.11
Rate for Payer: VA VA	$13,677.78

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$21,034.53

Service Code	MS-DRG 117
Min. Negotiated Rate	$8,667.19
Max. Negotiated Rate	$21,034.53
Rate for Payer: Aetna Medicare	$9,488.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,404.20
Rate for Payer: Amish Plain Church Group Commercial	$11,404.20
Rate for Payer: BCBS MAPPO	$9,123.36
Rate for Payer: BCBS Trust/PPO	$21,034.53
Rate for Payer: BCN Medicare Advantage	$9,123.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,123.36
Rate for Payer: Mclaren Medicare	$9,123.36
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,579.53
Rate for Payer: MI Amish Medical Board Commercial	$10,491.86
Rate for Payer: PACE Medicare	$8,667.19
Rate for Payer: PACE SWMI	$9,123.36
Rate for Payer: PHP Medicare Advantage	$9,123.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,196.94
Rate for Payer: Priority Health Medicare	$9,123.36
Rate for Payer: Priority Health Narrow Network	$13,757.55
Rate for Payer: Railroad Medicare Medicare	$9,123.36
Rate for Payer: UHC All Payor (Choice/PPO)	$18,280.39
Rate for Payer: UHC Core	$11,217.02
Rate for Payer: UHC Dual Complete DSNP	$9,123.36
Rate for Payer: UHC Exchange	$12,013.96
Rate for Payer: UHC Medicare Advantage	$9,397.06
Rate for Payer: VA VA	$9,123.36

INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$878.00

Service Code	CPT 37253
Hospital Revenue Code	360
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$691.58
Rate for Payer: UHC All Payor (Choice/PPO)	$74.20
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$67.45

INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$4,687.12

Service Code	CPT 37252
Hospital Revenue Code	360
Min. Negotiated Rate	$84.81
Max. Negotiated Rate	$4,687.12
Rate for Payer: BCBS Trust/PPO	$4,687.12
Rate for Payer: UHC All Payor (Choice/PPO)	$93.29
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$84.81

INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA

Facility

$965.41

Service Code	CPT 36010
Hospital Revenue Code	360
Min. Negotiated Rate	$103.80
Max. Negotiated Rate	$965.41
Rate for Payer: BCBS Trust/PPO	$965.41
Rate for Payer: UHC All Payor (Choice/PPO)	$114.18
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$103.80

INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY

Facility

$878.00

Service Code	CPT 36140
Hospital Revenue Code	361
Min. Negotiated Rate	$85.13
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$844.30
Rate for Payer: UHC All Payor (Choice/PPO)	$93.64
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$85.13

INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY

Facility

$878.00

Service Code	CPT 36140
Hospital Revenue Code	360
Min. Negotiated Rate	$85.13
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$844.30
Rate for Payer: UHC All Payor (Choice/PPO)	$93.64
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$85.13

Know your out-of-pocket cost for care.

All Charges