Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC US TRANSPLANTED KIDNEY

Facility

$510.39

Service Code	CPT 76776
Hospital Charge Code	40200013
Hospital Revenue Code	402
Min. Negotiated Rate	$55.59
Max. Negotiated Rate	$459.35
Rate for Payer: Aetna Commercial	$433.83
Rate for Payer: Aetna Medicare	$107.86
Rate for Payer: Aetna New Business (MI Preferred)	$331.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$129.64
Rate for Payer: Amish Plain Church Group Commercial	$129.64
Rate for Payer: BCBS Complete	$58.37
Rate for Payer: BCBS MAPPO	$103.71
Rate for Payer: BCN Medicare Advantage	$103.71
Rate for Payer: Cash Price	$408.31
Rate for Payer: Cash Price	$408.31
Rate for Payer: Cofinity Commercial	$438.94
Rate for Payer: Cofinity Commercial	$357.27
Rate for Payer: Cofinity Medicare Advantage	$357.27
Rate for Payer: Encore Health Key Benefits Commercial	$408.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$103.71
Rate for Payer: Healthscope Commercial	$459.35
Rate for Payer: Mclaren Medicaid	$55.59
Rate for Payer: Mclaren Medicare	$103.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$108.90
Rate for Payer: Meridian Medicaid	$58.37
Rate for Payer: MI Amish Medical Board Commercial	$119.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$433.83
Rate for Payer: PACE Medicare	$98.52
Rate for Payer: PACE SWMI	$103.71
Rate for Payer: PHP Commercial	$433.83
Rate for Payer: PHP Medicare Advantage	$103.71
Rate for Payer: Priority Health Choice Medicaid	$55.59
Rate for Payer: Priority Health Cigna Priority Health	$331.75
Rate for Payer: Priority Health Medicare	$103.71
Rate for Payer: Priority Health SBD	$321.55
Rate for Payer: Railroad Medicare Medicare	$103.71
Rate for Payer: UHC All Payor (Choice/PPO)	$291.93
Rate for Payer: UHC Core	$377.69
Rate for Payer: UHC Dual Complete DSNP	$103.71
Rate for Payer: UHC Exchange	$377.69
Rate for Payer: UHC Medicare Advantage	$103.71
Rate for Payer: UHCCP Medicaid	$58.39
Rate for Payer: VA VA	$103.71

HC US TRANSPLANTED KIDNEY

Facility

$510.39

Service Code	CPT 76776
Hospital Charge Code	40200013
Hospital Revenue Code	402
Min. Negotiated Rate	$321.55
Max. Negotiated Rate	$459.35
Rate for Payer: Aetna Commercial	$433.83
Rate for Payer: Aetna New Business (MI Preferred)	$331.75
Rate for Payer: Cash Price	$408.31
Rate for Payer: Cofinity Commercial	$357.27
Rate for Payer: Cofinity Commercial	$438.94
Rate for Payer: Cofinity Medicare Advantage	$357.27
Rate for Payer: Encore Health Key Benefits Commercial	$408.31
Rate for Payer: Healthscope Commercial	$459.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$433.83
Rate for Payer: PHP Commercial	$433.83
Rate for Payer: Priority Health Cigna Priority Health	$331.75
Rate for Payer: Priority Health SBD	$321.55

HC UVULECTOMY EXCISION UVULA

Facility

$8,058.00

Service Code	CPT 42140
Hospital Charge Code	76100468
Hospital Revenue Code	761
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Commercial	$6,849.30
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Aetna New Business (MI Preferred)	$5,237.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Cash Price	$6,446.40
Rate for Payer: Cash Price	$6,446.40
Rate for Payer: Cofinity Commercial	$6,929.88
Rate for Payer: Cofinity Commercial	$5,640.60
Rate for Payer: Cofinity Medicare Advantage	$5,640.60
Rate for Payer: Encore Health Key Benefits Commercial	$6,446.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Healthscope Commercial	$7,252.20
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,849.30
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Commercial	$6,849.30
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Cigna Priority Health	$5,237.70
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Priority Health SBD	$5,076.54
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,780.71
Rate for Payer: VA VA	$3,162.90

HC UVULECTOMY EXCISION UVULA

Facility

$8,058.00

Service Code	CPT 42140
Hospital Charge Code	76100468
Hospital Revenue Code	761
Min. Negotiated Rate	$5,076.54
Max. Negotiated Rate	$7,252.20
Rate for Payer: Aetna Commercial	$6,849.30
Rate for Payer: Aetna New Business (MI Preferred)	$5,237.70
Rate for Payer: Cash Price	$6,446.40
Rate for Payer: Cofinity Commercial	$5,640.60
Rate for Payer: Cofinity Commercial	$6,929.88
Rate for Payer: Cofinity Medicare Advantage	$5,640.60
Rate for Payer: Encore Health Key Benefits Commercial	$6,446.40
Rate for Payer: Healthscope Commercial	$7,252.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,849.30
Rate for Payer: PHP Commercial	$6,849.30
Rate for Payer: Priority Health Cigna Priority Health	$5,237.70
Rate for Payer: Priority Health SBD	$5,076.54

HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID

Facility

$61.20

Service Code	CPT V5011
Hospital Charge Code	47000008
Hospital Revenue Code	470
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID

Facility

$61.20

Service Code	CPT V5011
Hospital Charge Code	47000008
Hospital Revenue Code	470
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna Medicare	$30.60
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: BCBS Complete	$24.48
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56
Rate for Payer: UHC Core	$45.29
Rate for Payer: UHC Exchange	$45.29

HC V5160 DISPENSING FEE BINAURAL

Facility

$484.50

Service Code	CPT V5160
Hospital Charge Code	47000006
Hospital Revenue Code	470
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$436.05
Rate for Payer: Aetna Commercial	$411.82
Rate for Payer: Aetna Medicare	$242.25
Rate for Payer: Aetna New Business (MI Preferred)	$314.93
Rate for Payer: BCBS Complete	$193.80
Rate for Payer: Cash Price	$387.60
Rate for Payer: Cofinity Commercial	$339.15
Rate for Payer: Cofinity Commercial	$416.67
Rate for Payer: Cofinity Medicare Advantage	$339.15
Rate for Payer: Encore Health Key Benefits Commercial	$387.60
Rate for Payer: Healthscope Commercial	$436.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.82
Rate for Payer: PHP Commercial	$411.82
Rate for Payer: Priority Health Cigna Priority Health	$314.93
Rate for Payer: Priority Health SBD	$305.24
Rate for Payer: UHC Core	$358.53
Rate for Payer: UHC Exchange	$358.53

HC V5160 DISPENSING FEE BINAURAL

Facility

$484.50

Service Code	CPT V5160
Hospital Charge Code	47000006
Hospital Revenue Code	470
Min. Negotiated Rate	$305.24
Max. Negotiated Rate	$436.05
Rate for Payer: Aetna Commercial	$411.82
Rate for Payer: Aetna New Business (MI Preferred)	$314.93
Rate for Payer: Cash Price	$387.60
Rate for Payer: Cofinity Commercial	$339.15
Rate for Payer: Cofinity Commercial	$416.67
Rate for Payer: Cofinity Medicare Advantage	$339.15
Rate for Payer: Encore Health Key Benefits Commercial	$387.60
Rate for Payer: Healthscope Commercial	$436.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.82
Rate for Payer: PHP Commercial	$411.82
Rate for Payer: Priority Health Cigna Priority Health	$314.93
Rate for Payer: Priority Health SBD	$305.24

HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE

Facility

$280.50

Service Code	CPT V5241
Hospital Charge Code	47000004
Hospital Revenue Code	470
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72

HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE

Facility

$280.50

Service Code	CPT V5241
Hospital Charge Code	47000004
Hospital Revenue Code	470
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna Medicare	$140.25
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: BCBS Complete	$112.20
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72
Rate for Payer: UHC Core	$207.57
Rate for Payer: UHC Exchange	$207.57

HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE

Facility

$71.40

Service Code	CPT V5264
Hospital Charge Code	47000005
Hospital Revenue Code	470
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: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE

Facility

$71.40

Service Code	CPT V5264
Hospital Charge Code	47000005
Hospital Revenue Code	470
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98
Rate for Payer: UHC Core	$52.84
Rate for Payer: UHC Exchange	$52.84

HC VACC AIIV4 NO PRSRV 0.5ML IM

Facility

$181.83

Service Code	CPT 90694
Hospital Charge Code	63600224
Hospital Revenue Code	636
Min. Negotiated Rate	$114.55
Max. Negotiated Rate	$163.65
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna New Business (MI Preferred)	$118.19
Rate for Payer: Cash Price	$145.46
Rate for Payer: Cofinity Commercial	$127.28
Rate for Payer: Cofinity Commercial	$156.37
Rate for Payer: Cofinity Medicare Advantage	$127.28
Rate for Payer: Encore Health Key Benefits Commercial	$145.46
Rate for Payer: Healthscope Commercial	$163.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.56
Rate for Payer: PHP Commercial	$154.56
Rate for Payer: Priority Health Cigna Priority Health	$118.19
Rate for Payer: Priority Health SBD	$114.55

HC VACC AIIV4 NO PRSRV 0.5ML IM

Facility

$181.83

Service Code	CPT 90694
Hospital Charge Code	63600224
Hospital Revenue Code	636
Min. Negotiated Rate	$72.73
Max. Negotiated Rate	$163.65
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna Medicare	$90.92
Rate for Payer: Aetna New Business (MI Preferred)	$118.19
Rate for Payer: BCBS Complete	$72.73
Rate for Payer: Cash Price	$145.46
Rate for Payer: Cofinity Commercial	$127.28
Rate for Payer: Cofinity Commercial	$156.37
Rate for Payer: Cofinity Medicare Advantage	$127.28
Rate for Payer: Encore Health Key Benefits Commercial	$145.46
Rate for Payer: Healthscope Commercial	$163.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.56
Rate for Payer: PHP Commercial	$154.56
Rate for Payer: Priority Health Cigna Priority Health	$118.19
Rate for Payer: Priority Health SBD	$114.55

HC VACC CCIIV4 ABX FREE 0.5 ML IM

Facility

$68.02

Service Code	CPT 90756
Hospital Charge Code	63600223
Hospital Revenue Code	636
Min. Negotiated Rate	$27.21
Max. Negotiated Rate	$61.22
Rate for Payer: Aetna Commercial	$57.82
Rate for Payer: Aetna Medicare	$34.01
Rate for Payer: Aetna New Business (MI Preferred)	$44.21
Rate for Payer: BCBS Complete	$27.21
Rate for Payer: Cash Price	$54.42
Rate for Payer: Cofinity Commercial	$47.61
Rate for Payer: Cofinity Commercial	$58.50
Rate for Payer: Cofinity Medicare Advantage	$47.61
Rate for Payer: Encore Health Key Benefits Commercial	$54.42
Rate for Payer: Healthscope Commercial	$61.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.82
Rate for Payer: PHP Commercial	$57.82
Rate for Payer: Priority Health Cigna Priority Health	$44.21
Rate for Payer: Priority Health SBD	$42.85

HC VACC CCIIV4 ABX FREE 0.5 ML IM

Facility

$68.02

Service Code	CPT 90756
Hospital Charge Code	63600223
Hospital Revenue Code	636
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$61.22
Rate for Payer: Aetna Commercial	$57.82
Rate for Payer: Aetna New Business (MI Preferred)	$44.21
Rate for Payer: Cash Price	$54.42
Rate for Payer: Cofinity Commercial	$47.61
Rate for Payer: Cofinity Commercial	$58.50
Rate for Payer: Cofinity Medicare Advantage	$47.61
Rate for Payer: Encore Health Key Benefits Commercial	$54.42
Rate for Payer: Healthscope Commercial	$61.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.82
Rate for Payer: PHP Commercial	$57.82
Rate for Payer: Priority Health Cigna Priority Health	$44.21
Rate for Payer: Priority Health SBD	$42.85

HC VACC CCIIV4 NO PRSV 0.5 ML IM

Facility

$72.83

Service Code	CPT 90674
Hospital Charge Code	63600222
Hospital Revenue Code	636
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$61.91
Rate for Payer: Aetna Medicare	$36.41
Rate for Payer: Aetna New Business (MI Preferred)	$47.34
Rate for Payer: BCBS Complete	$29.13
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Commercial	$50.98
Rate for Payer: Cofinity Commercial	$62.63
Rate for Payer: Cofinity Medicare Advantage	$50.98
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: PHP Commercial	$61.91
Rate for Payer: Priority Health Cigna Priority Health	$47.34
Rate for Payer: Priority Health SBD	$45.88

HC VACC CCIIV4 NO PRSV 0.5 ML IM

Facility

$72.83

Service Code	CPT 90674
Hospital Charge Code	63600222
Hospital Revenue Code	636
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$61.91
Rate for Payer: Aetna New Business (MI Preferred)	$47.34
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Commercial	$50.98
Rate for Payer: Cofinity Commercial	$62.63
Rate for Payer: Cofinity Medicare Advantage	$50.98
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: PHP Commercial	$61.91
Rate for Payer: Priority Health Cigna Priority Health	$47.34
Rate for Payer: Priority Health SBD	$45.88

HC VACC RSV PREF BIVALENT IM

Facility

$839.51

Service Code	CPT 90678
Hospital Charge Code	63600226
Hospital Revenue Code	636
Min. Negotiated Rate	$335.80
Max. Negotiated Rate	$755.56
Rate for Payer: Aetna Commercial	$713.58
Rate for Payer: Aetna Medicare	$419.75
Rate for Payer: Aetna New Business (MI Preferred)	$545.68
Rate for Payer: BCBS Complete	$335.80
Rate for Payer: Cash Price	$671.61
Rate for Payer: Cofinity Commercial	$587.66
Rate for Payer: Cofinity Commercial	$721.98
Rate for Payer: Cofinity Medicare Advantage	$587.66
Rate for Payer: Encore Health Key Benefits Commercial	$671.61
Rate for Payer: Healthscope Commercial	$755.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$713.58
Rate for Payer: PHP Commercial	$713.58
Rate for Payer: Priority Health Cigna Priority Health	$545.68
Rate for Payer: Priority Health SBD	$528.89

HC VACC RSV PREF BIVALENT IM

Facility

$839.51

Service Code	CPT 90678
Hospital Charge Code	63600226
Hospital Revenue Code	636
Min. Negotiated Rate	$528.89
Max. Negotiated Rate	$755.56
Rate for Payer: Aetna Commercial	$713.58
Rate for Payer: Aetna New Business (MI Preferred)	$545.68
Rate for Payer: Cash Price	$671.61
Rate for Payer: Cofinity Commercial	$587.66
Rate for Payer: Cofinity Commercial	$721.98
Rate for Payer: Cofinity Medicare Advantage	$587.66
Rate for Payer: Encore Health Key Benefits Commercial	$671.61
Rate for Payer: Healthscope Commercial	$755.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$713.58
Rate for Payer: PHP Commercial	$713.58
Rate for Payer: Priority Health Cigna Priority Health	$545.68
Rate for Payer: Priority Health SBD	$528.89

HC VACC RSV PREF RECOMB ADJT IM

Facility

$796.82

Service Code	CPT 90679
Hospital Charge Code	63600225
Hospital Revenue Code	636
Min. Negotiated Rate	$318.73
Max. Negotiated Rate	$717.14
Rate for Payer: Aetna Commercial	$677.30
Rate for Payer: Aetna Medicare	$398.41
Rate for Payer: Aetna New Business (MI Preferred)	$517.93
Rate for Payer: BCBS Complete	$318.73
Rate for Payer: Cash Price	$637.46
Rate for Payer: Cofinity Commercial	$557.77
Rate for Payer: Cofinity Commercial	$685.27
Rate for Payer: Cofinity Medicare Advantage	$557.77
Rate for Payer: Encore Health Key Benefits Commercial	$637.46
Rate for Payer: Healthscope Commercial	$717.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$677.30
Rate for Payer: PHP Commercial	$677.30
Rate for Payer: Priority Health Cigna Priority Health	$517.93
Rate for Payer: Priority Health SBD	$502.00

HC VACC RSV PREF RECOMB ADJT IM

Facility

$796.82

Service Code	CPT 90679
Hospital Charge Code	63600225
Hospital Revenue Code	636
Min. Negotiated Rate	$502.00
Max. Negotiated Rate	$717.14
Rate for Payer: Aetna Commercial	$677.30
Rate for Payer: Aetna New Business (MI Preferred)	$517.93
Rate for Payer: Cash Price	$637.46
Rate for Payer: Cofinity Commercial	$557.77
Rate for Payer: Cofinity Commercial	$685.27
Rate for Payer: Cofinity Medicare Advantage	$557.77
Rate for Payer: Encore Health Key Benefits Commercial	$637.46
Rate for Payer: Healthscope Commercial	$717.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$677.30
Rate for Payer: PHP Commercial	$677.30
Rate for Payer: Priority Health Cigna Priority Health	$517.93
Rate for Payer: Priority Health SBD	$502.00

HC VAC WOUND PREVENA

Facility

$1,482.30

Hospital Charge Code	27000697
Hospital Revenue Code	270
Min. Negotiated Rate	$592.92
Max. Negotiated Rate	$1,334.07
Rate for Payer: Aetna Commercial	$1,259.95
Rate for Payer: Aetna Medicare	$741.15
Rate for Payer: Aetna New Business (MI Preferred)	$963.50
Rate for Payer: BCBS Complete	$592.92
Rate for Payer: Cash Price	$1,185.84
Rate for Payer: Cofinity Commercial	$1,037.61
Rate for Payer: Cofinity Commercial	$1,274.78
Rate for Payer: Cofinity Medicare Advantage	$1,037.61
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.84
Rate for Payer: Healthscope Commercial	$1,334.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.95
Rate for Payer: PHP Commercial	$1,259.95
Rate for Payer: Priority Health Cigna Priority Health	$963.50
Rate for Payer: Priority Health SBD	$933.85

HC VAC WOUND PREVENA

Facility

$1,482.30

Hospital Charge Code	27000697
Hospital Revenue Code	270
Min. Negotiated Rate	$933.85
Max. Negotiated Rate	$1,334.07
Rate for Payer: Aetna Commercial	$1,259.95
Rate for Payer: Aetna New Business (MI Preferred)	$963.50
Rate for Payer: Cash Price	$1,185.84
Rate for Payer: Cofinity Commercial	$1,037.61
Rate for Payer: Cofinity Commercial	$1,274.78
Rate for Payer: Cofinity Medicare Advantage	$1,037.61
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.84
Rate for Payer: Healthscope Commercial	$1,334.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.95
Rate for Payer: PHP Commercial	$1,259.95
Rate for Payer: Priority Health Cigna Priority Health	$963.50
Rate for Payer: Priority Health SBD	$933.85

HC VAGINAL DELIVERY (OB)

Facility

$1,792.41

Hospital Charge Code	72000006
Hospital Revenue Code	720
Min. Negotiated Rate	$1,129.22
Max. Negotiated Rate	$1,613.17
Rate for Payer: Aetna Commercial	$1,523.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,165.07
Rate for Payer: Cash Price	$1,433.93
Rate for Payer: Cofinity Commercial	$1,254.69
Rate for Payer: Cofinity Commercial	$1,541.47
Rate for Payer: Cofinity Medicare Advantage	$1,254.69
Rate for Payer: Encore Health Key Benefits Commercial	$1,433.93
Rate for Payer: Healthscope Commercial	$1,613.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,523.55
Rate for Payer: PHP Commercial	$1,523.55
Rate for Payer: Priority Health Cigna Priority Health	$1,165.07
Rate for Payer: Priority Health SBD	$1,129.22

Know your out-of-pocket cost for care.

All Charges