Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC VAGINAL DELIVERY (OB)

Facility

$1,792.41

Hospital Charge Code	72000006
Hospital Revenue Code	720
Min. Negotiated Rate	$716.96
Max. Negotiated Rate	$1,613.17
Rate for Payer: Aetna Commercial	$1,523.55
Rate for Payer: Aetna Medicare	$896.21
Rate for Payer: Aetna New Business (MI Preferred)	$1,165.07
Rate for Payer: BCBS Complete	$716.96
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
Rate for Payer: UHC Core	$1,326.38
Rate for Payer: UHC Exchange	$1,326.38

HC VALPROIC ACID DEPAKENE LVL

Facility

$107.51

Service Code	CPT 80164
Hospital Charge Code	30100589
Hospital Revenue Code	301
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$96.76
Rate for Payer: Aetna Commercial	$91.38
Rate for Payer: Aetna New Business (MI Preferred)	$69.88
Rate for Payer: Cash Price	$86.01
Rate for Payer: Cofinity Commercial	$75.26
Rate for Payer: Cofinity Commercial	$92.46
Rate for Payer: Cofinity Medicare Advantage	$75.26
Rate for Payer: Encore Health Key Benefits Commercial	$86.01
Rate for Payer: Healthscope Commercial	$96.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.38
Rate for Payer: PHP Commercial	$91.38
Rate for Payer: Priority Health Cigna Priority Health	$69.88
Rate for Payer: Priority Health SBD	$67.73

HC VALPROIC ACID DEPAKENE LVL

Facility

$107.51

Service Code	CPT 80164
Hospital Charge Code	30100589
Hospital Revenue Code	301
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$96.76
Rate for Payer: Aetna Commercial	$91.38
Rate for Payer: Aetna Medicare	$14.08
Rate for Payer: Aetna New Business (MI Preferred)	$69.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.93
Rate for Payer: Amish Plain Church Group Commercial	$16.93
Rate for Payer: BCBS Complete	$7.62
Rate for Payer: BCBS MAPPO	$13.54
Rate for Payer: BCN Medicare Advantage	$13.54
Rate for Payer: Cash Price	$86.01
Rate for Payer: Cash Price	$86.01
Rate for Payer: Cofinity Commercial	$92.46
Rate for Payer: Cofinity Commercial	$75.26
Rate for Payer: Cofinity Medicare Advantage	$75.26
Rate for Payer: Encore Health Key Benefits Commercial	$86.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.54
Rate for Payer: Healthscope Commercial	$96.76
Rate for Payer: Mclaren Medicaid	$7.26
Rate for Payer: Mclaren Medicare	$13.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.22
Rate for Payer: Meridian Medicaid	$7.62
Rate for Payer: MI Amish Medical Board Commercial	$15.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.38
Rate for Payer: PACE Medicare	$12.86
Rate for Payer: PACE SWMI	$13.54
Rate for Payer: PHP Commercial	$91.38
Rate for Payer: PHP Medicare Advantage	$13.54
Rate for Payer: Priority Health Choice Medicaid	$7.26
Rate for Payer: Priority Health Cigna Priority Health	$69.88
Rate for Payer: Priority Health Medicare	$13.54
Rate for Payer: Priority Health SBD	$67.73
Rate for Payer: Railroad Medicare Medicare	$13.54
Rate for Payer: UHC All Payor (Choice/PPO)	$38.11
Rate for Payer: UHC Dual Complete DSNP	$13.54
Rate for Payer: UHC Medicare Advantage	$13.54
Rate for Payer: UHCCP Medicaid	$7.62
Rate for Payer: VA VA	$13.54

HC VALVE VENT NONADJ

Facility

$52.02

Hospital Charge Code	27000277
Hospital Revenue Code	270
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC VALVE VENT NONADJ

Facility

$52.02

Hospital Charge Code	27000277
Hospital Revenue Code	270
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$44.22
Rate for Payer: Aetna Medicare	$26.01
Rate for Payer: Aetna New Business (MI Preferred)	$33.81
Rate for Payer: BCBS Complete	$20.81
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$36.41
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Cofinity Medicare Advantage	$36.41
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: PHP Commercial	$44.22
Rate for Payer: Priority Health Cigna Priority Health	$33.81
Rate for Payer: Priority Health SBD	$32.77

HC VALVE VENT ONE WAY

Facility

$42.84

Hospital Charge Code	27000662
Hospital Revenue Code	270
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$38.56
Rate for Payer: Aetna Commercial	$36.41
Rate for Payer: Aetna New Business (MI Preferred)	$27.85
Rate for Payer: Cash Price	$34.27
Rate for Payer: Cofinity Commercial	$29.99
Rate for Payer: Cofinity Commercial	$36.84
Rate for Payer: Cofinity Medicare Advantage	$29.99
Rate for Payer: Encore Health Key Benefits Commercial	$34.27
Rate for Payer: Healthscope Commercial	$38.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.41
Rate for Payer: PHP Commercial	$36.41
Rate for Payer: Priority Health Cigna Priority Health	$27.85
Rate for Payer: Priority Health SBD	$26.99

HC VALVE VENT ONE WAY

Facility

$42.84

Hospital Charge Code	27000662
Hospital Revenue Code	270
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$38.56
Rate for Payer: Aetna Commercial	$36.41
Rate for Payer: Aetna Medicare	$21.42
Rate for Payer: Aetna New Business (MI Preferred)	$27.85
Rate for Payer: BCBS Complete	$17.14
Rate for Payer: Cash Price	$34.27
Rate for Payer: Cofinity Commercial	$29.99
Rate for Payer: Cofinity Commercial	$36.84
Rate for Payer: Cofinity Medicare Advantage	$29.99
Rate for Payer: Encore Health Key Benefits Commercial	$34.27
Rate for Payer: Healthscope Commercial	$38.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.41
Rate for Payer: PHP Commercial	$36.41
Rate for Payer: Priority Health Cigna Priority Health	$27.85
Rate for Payer: Priority Health SBD	$26.99

HC VANCOMYCIN LEVEL

Facility

$138.41

Service Code	CPT 80202
Hospital Charge Code	30100051
Hospital Revenue Code	301
Min. Negotiated Rate	$87.20
Max. Negotiated Rate	$124.57
Rate for Payer: Aetna Commercial	$117.65
Rate for Payer: Aetna New Business (MI Preferred)	$89.97
Rate for Payer: Cash Price	$110.73
Rate for Payer: Cofinity Commercial	$119.03
Rate for Payer: Cofinity Commercial	$96.89
Rate for Payer: Cofinity Medicare Advantage	$96.89
Rate for Payer: Encore Health Key Benefits Commercial	$110.73
Rate for Payer: Healthscope Commercial	$124.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.65
Rate for Payer: PHP Commercial	$117.65
Rate for Payer: Priority Health Cigna Priority Health	$89.97
Rate for Payer: Priority Health SBD	$87.20

HC VANCOMYCIN LEVEL

Facility

$138.41

Service Code	CPT 80202
Hospital Charge Code	30100051
Hospital Revenue Code	301
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$124.57
Rate for Payer: Aetna Commercial	$117.65
Rate for Payer: Aetna Medicare	$14.08
Rate for Payer: Aetna New Business (MI Preferred)	$89.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.93
Rate for Payer: Amish Plain Church Group Commercial	$16.93
Rate for Payer: BCBS Complete	$7.62
Rate for Payer: BCBS MAPPO	$13.54
Rate for Payer: BCN Medicare Advantage	$13.54
Rate for Payer: Cash Price	$110.73
Rate for Payer: Cash Price	$110.73
Rate for Payer: Cofinity Commercial	$96.89
Rate for Payer: Cofinity Commercial	$119.03
Rate for Payer: Cofinity Medicare Advantage	$96.89
Rate for Payer: Encore Health Key Benefits Commercial	$110.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.54
Rate for Payer: Healthscope Commercial	$124.57
Rate for Payer: Mclaren Medicaid	$7.26
Rate for Payer: Mclaren Medicare	$13.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.22
Rate for Payer: Meridian Medicaid	$7.62
Rate for Payer: MI Amish Medical Board Commercial	$15.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.65
Rate for Payer: PACE Medicare	$12.86
Rate for Payer: PACE SWMI	$13.54
Rate for Payer: PHP Commercial	$117.65
Rate for Payer: PHP Medicare Advantage	$13.54
Rate for Payer: Priority Health Choice Medicaid	$7.26
Rate for Payer: Priority Health Cigna Priority Health	$89.97
Rate for Payer: Priority Health Medicare	$13.54
Rate for Payer: Priority Health SBD	$87.20
Rate for Payer: Railroad Medicare Medicare	$13.54
Rate for Payer: UHC All Payor (Choice/PPO)	$38.11
Rate for Payer: UHC Dual Complete DSNP	$13.54
Rate for Payer: UHC Medicare Advantage	$13.54
Rate for Payer: UHCCP Medicaid	$7.62
Rate for Payer: VA VA	$13.54

HC VAP CHOLESTEROL

Facility

$83.23

Service Code	CPT 83701
Hospital Charge Code	30100281
Hospital Revenue Code	301
Min. Negotiated Rate	$52.43
Max. Negotiated Rate	$74.91
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna New Business (MI Preferred)	$54.10
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Commercial	$58.26
Rate for Payer: Cofinity Commercial	$71.58
Rate for Payer: Cofinity Medicare Advantage	$58.26
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Healthscope Commercial	$74.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: PHP Commercial	$70.75
Rate for Payer: Priority Health Cigna Priority Health	$54.10
Rate for Payer: Priority Health SBD	$52.43

HC VAP CHOLESTEROL

Facility

$83.23

Service Code	CPT 83701
Hospital Charge Code	30100281
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$95.31
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna Medicare	$35.21
Rate for Payer: Aetna New Business (MI Preferred)	$54.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$42.33
Rate for Payer: Amish Plain Church Group Commercial	$42.33
Rate for Payer: BCBS Complete	$19.06
Rate for Payer: BCBS MAPPO	$33.86
Rate for Payer: BCN Medicare Advantage	$33.86
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Commercial	$71.58
Rate for Payer: Cofinity Commercial	$58.26
Rate for Payer: Cofinity Medicare Advantage	$58.26
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$33.86
Rate for Payer: Healthscope Commercial	$74.91
Rate for Payer: Mclaren Medicaid	$18.15
Rate for Payer: Mclaren Medicare	$33.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.55
Rate for Payer: Meridian Medicaid	$19.06
Rate for Payer: MI Amish Medical Board Commercial	$38.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: PACE Medicare	$32.17
Rate for Payer: PACE SWMI	$33.86
Rate for Payer: PHP Commercial	$70.75
Rate for Payer: PHP Medicare Advantage	$33.86
Rate for Payer: Priority Health Choice Medicaid	$18.15
Rate for Payer: Priority Health Cigna Priority Health	$54.10
Rate for Payer: Priority Health Medicare	$33.86
Rate for Payer: Priority Health SBD	$52.43
Rate for Payer: Railroad Medicare Medicare	$33.86
Rate for Payer: UHC All Payor (Choice/PPO)	$95.31
Rate for Payer: UHC Dual Complete DSNP	$33.86
Rate for Payer: UHC Medicare Advantage	$33.86
Rate for Payer: UHCCP Medicaid	$19.06
Rate for Payer: VA VA	$33.86

HC VAP CHOLESTEROL CMPT

Facility

$20.81

Service Code	CPT 84478
Hospital Charge Code	30100445
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: Aetna Medicare	$5.97
Rate for Payer: Aetna New Business (MI Preferred)	$13.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$7.17
Rate for Payer: Amish Plain Church Group Commercial	$7.17
Rate for Payer: BCBS Complete	$3.23
Rate for Payer: BCBS MAPPO	$5.74
Rate for Payer: BCN Medicare Advantage	$5.74
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Cofinity Commercial	$14.57
Rate for Payer: Cofinity Medicare Advantage	$14.57
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.74
Rate for Payer: Healthscope Commercial	$18.73
Rate for Payer: Mclaren Medicaid	$3.08
Rate for Payer: Mclaren Medicare	$5.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6.03
Rate for Payer: Meridian Medicaid	$3.23
Rate for Payer: MI Amish Medical Board Commercial	$6.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: PACE Medicare	$5.45
Rate for Payer: PACE SWMI	$5.74
Rate for Payer: PHP Commercial	$17.69
Rate for Payer: PHP Medicare Advantage	$5.74
Rate for Payer: Priority Health Choice Medicaid	$3.08
Rate for Payer: Priority Health Cigna Priority Health	$13.53
Rate for Payer: Priority Health Medicare	$5.74
Rate for Payer: Priority Health SBD	$13.11
Rate for Payer: Railroad Medicare Medicare	$5.74
Rate for Payer: UHC All Payor (Choice/PPO)	$16.16
Rate for Payer: UHC Dual Complete DSNP	$5.74
Rate for Payer: UHC Medicare Advantage	$5.74
Rate for Payer: UHCCP Medicaid	$3.23
Rate for Payer: VA VA	$5.74

HC VAP CHOLESTEROL CMPT

Facility

$20.81

Service Code	CPT 84478
Hospital Charge Code	30100445
Hospital Revenue Code	301
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: Aetna New Business (MI Preferred)	$13.53
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Commercial	$14.57
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Cofinity Medicare Advantage	$14.57
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Healthscope Commercial	$18.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: PHP Commercial	$17.69
Rate for Payer: Priority Health Cigna Priority Health	$13.53
Rate for Payer: Priority Health SBD	$13.11

HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ

Facility

$220.56

Service Code	CPT 90716
Hospital Charge Code	63600084
Hospital Revenue Code	636
Min. Negotiated Rate	$88.22
Max. Negotiated Rate	$198.50
Rate for Payer: Aetna Commercial	$187.48
Rate for Payer: Aetna Medicare	$110.28
Rate for Payer: Aetna New Business (MI Preferred)	$143.36
Rate for Payer: BCBS Complete	$88.22
Rate for Payer: Cash Price	$176.45
Rate for Payer: Cofinity Commercial	$154.39
Rate for Payer: Cofinity Commercial	$189.68
Rate for Payer: Cofinity Medicare Advantage	$154.39
Rate for Payer: Encore Health Key Benefits Commercial	$176.45
Rate for Payer: Healthscope Commercial	$198.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.48
Rate for Payer: PHP Commercial	$187.48
Rate for Payer: Priority Health Cigna Priority Health	$143.36
Rate for Payer: Priority Health SBD	$138.95

HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ

Facility

$220.56

Service Code	CPT 90716
Hospital Charge Code	63600084
Hospital Revenue Code	636
Min. Negotiated Rate	$138.95
Max. Negotiated Rate	$198.50
Rate for Payer: Aetna Commercial	$187.48
Rate for Payer: Aetna New Business (MI Preferred)	$143.36
Rate for Payer: Cash Price	$176.45
Rate for Payer: Cofinity Commercial	$154.39
Rate for Payer: Cofinity Commercial	$189.68
Rate for Payer: Cofinity Medicare Advantage	$154.39
Rate for Payer: Encore Health Key Benefits Commercial	$176.45
Rate for Payer: Healthscope Commercial	$198.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.48
Rate for Payer: PHP Commercial	$187.48
Rate for Payer: Priority Health Cigna Priority Health	$143.36
Rate for Payer: Priority Health SBD	$138.95

HC VARICELLA ZOSTER IGG

Facility

$44.74

Service Code	CPT 86787
Hospital Charge Code	30200327
Hospital Revenue Code	302
Min. Negotiated Rate	$28.19
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$38.03
Rate for Payer: Aetna New Business (MI Preferred)	$29.08
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cofinity Commercial	$31.32
Rate for Payer: Cofinity Commercial	$38.48
Rate for Payer: Cofinity Medicare Advantage	$31.32
Rate for Payer: Encore Health Key Benefits Commercial	$35.79
Rate for Payer: Healthscope Commercial	$40.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.03
Rate for Payer: PHP Commercial	$38.03
Rate for Payer: Priority Health Cigna Priority Health	$29.08
Rate for Payer: Priority Health SBD	$28.19

HC VARICELLA ZOSTER IGG

Facility

$44.74

Service Code	CPT 86787
Hospital Charge Code	30200327
Hospital Revenue Code	302
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$38.03
Rate for Payer: Aetna Medicare	$13.40
Rate for Payer: Aetna New Business (MI Preferred)	$29.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.10
Rate for Payer: Amish Plain Church Group Commercial	$16.10
Rate for Payer: BCBS Complete	$7.25
Rate for Payer: BCBS MAPPO	$12.88
Rate for Payer: BCN Medicare Advantage	$12.88
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cofinity Commercial	$38.48
Rate for Payer: Cofinity Commercial	$31.32
Rate for Payer: Cofinity Medicare Advantage	$31.32
Rate for Payer: Encore Health Key Benefits Commercial	$35.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.88
Rate for Payer: Healthscope Commercial	$40.27
Rate for Payer: Mclaren Medicaid	$6.90
Rate for Payer: Mclaren Medicare	$12.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.52
Rate for Payer: Meridian Medicaid	$7.25
Rate for Payer: MI Amish Medical Board Commercial	$14.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.03
Rate for Payer: PACE Medicare	$12.24
Rate for Payer: PACE SWMI	$12.88
Rate for Payer: PHP Commercial	$38.03
Rate for Payer: PHP Medicare Advantage	$12.88
Rate for Payer: Priority Health Choice Medicaid	$6.90
Rate for Payer: Priority Health Cigna Priority Health	$29.08
Rate for Payer: Priority Health Medicare	$12.88
Rate for Payer: Priority Health SBD	$28.19
Rate for Payer: Railroad Medicare Medicare	$12.88
Rate for Payer: UHC All Payor (Choice/PPO)	$36.26
Rate for Payer: UHC Dual Complete DSNP	$12.88
Rate for Payer: UHC Medicare Advantage	$12.88
Rate for Payer: UHCCP Medicaid	$7.25
Rate for Payer: VA VA	$12.88

HC VARICELLA ZOSTER IGM

Facility

$80.58

Service Code	CPT 86787
Hospital Charge Code	30200326
Hospital Revenue Code	302
Min. Negotiated Rate	$50.77
Max. Negotiated Rate	$72.52
Rate for Payer: Aetna Commercial	$68.49
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.30
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.46
Rate for Payer: Healthscope Commercial	$72.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.49
Rate for Payer: PHP Commercial	$68.49
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

HC VARICELLA ZOSTER IGM

Facility

$80.58

Service Code	CPT 86787
Hospital Charge Code	30200326
Hospital Revenue Code	302
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$72.52
Rate for Payer: Aetna Commercial	$68.49
Rate for Payer: Aetna Medicare	$13.40
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.10
Rate for Payer: Amish Plain Church Group Commercial	$16.10
Rate for Payer: BCBS Complete	$7.25
Rate for Payer: BCBS MAPPO	$12.88
Rate for Payer: BCN Medicare Advantage	$12.88
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cofinity Commercial	$69.30
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.88
Rate for Payer: Healthscope Commercial	$72.52
Rate for Payer: Mclaren Medicaid	$6.90
Rate for Payer: Mclaren Medicare	$12.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.52
Rate for Payer: Meridian Medicaid	$7.25
Rate for Payer: MI Amish Medical Board Commercial	$14.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.49
Rate for Payer: PACE Medicare	$12.24
Rate for Payer: PACE SWMI	$12.88
Rate for Payer: PHP Commercial	$68.49
Rate for Payer: PHP Medicare Advantage	$12.88
Rate for Payer: Priority Health Choice Medicaid	$6.90
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health Medicare	$12.88
Rate for Payer: Priority Health SBD	$50.77
Rate for Payer: Railroad Medicare Medicare	$12.88
Rate for Payer: UHC All Payor (Choice/PPO)	$36.26
Rate for Payer: UHC Dual Complete DSNP	$12.88
Rate for Payer: UHC Medicare Advantage	$12.88
Rate for Payer: UHCCP Medicaid	$7.25
Rate for Payer: VA VA	$12.88

HC VARICELLA ZOSTER PCR CSF

Facility

$109.24

Service Code	CPT 87798
Hospital Charge Code	30600167
Hospital Revenue Code	306
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$98.77
Rate for Payer: Aetna Commercial	$92.85
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$71.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$19.75
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$87.39
Rate for Payer: Cash Price	$87.39
Rate for Payer: Cofinity Commercial	$93.95
Rate for Payer: Cofinity Commercial	$76.47
Rate for Payer: Cofinity Medicare Advantage	$76.47
Rate for Payer: Encore Health Key Benefits Commercial	$87.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$98.32
Rate for Payer: Mclaren Medicaid	$18.81
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.84
Rate for Payer: Meridian Medicaid	$19.75
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.85
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$92.85
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$18.81
Rate for Payer: Priority Health Cigna Priority Health	$71.01
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$68.82
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$98.77
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Medicare Advantage	$35.09
Rate for Payer: UHCCP Medicaid	$19.76
Rate for Payer: VA VA	$35.09

HC VARICELLA ZOSTER PCR CSF

Facility

$109.24

Service Code	CPT 87798
Hospital Charge Code	30600167
Hospital Revenue Code	306
Min. Negotiated Rate	$68.82
Max. Negotiated Rate	$98.32
Rate for Payer: Aetna Commercial	$92.85
Rate for Payer: Aetna New Business (MI Preferred)	$71.01
Rate for Payer: Cash Price	$87.39
Rate for Payer: Cofinity Commercial	$76.47
Rate for Payer: Cofinity Commercial	$93.95
Rate for Payer: Cofinity Medicare Advantage	$76.47
Rate for Payer: Encore Health Key Benefits Commercial	$87.39
Rate for Payer: Healthscope Commercial	$98.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.85
Rate for Payer: PHP Commercial	$92.85
Rate for Payer: Priority Health Cigna Priority Health	$71.01
Rate for Payer: Priority Health SBD	$68.82

HC VARICELLA ZOSTER VIRUS (VZV)

Facility

$57.40

Service Code	CPT 87798
Hospital Charge Code	30600278
Hospital Revenue Code	306
Min. Negotiated Rate	$36.16
Max. Negotiated Rate	$51.66
Rate for Payer: Aetna Commercial	$48.79
Rate for Payer: Aetna New Business (MI Preferred)	$37.31
Rate for Payer: Cash Price	$45.92
Rate for Payer: Cofinity Commercial	$40.18
Rate for Payer: Cofinity Commercial	$49.36
Rate for Payer: Cofinity Medicare Advantage	$40.18
Rate for Payer: Encore Health Key Benefits Commercial	$45.92
Rate for Payer: Healthscope Commercial	$51.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.79
Rate for Payer: PHP Commercial	$48.79
Rate for Payer: Priority Health Cigna Priority Health	$37.31
Rate for Payer: Priority Health SBD	$36.16

HC VARICELLA ZOSTER VIRUS (VZV)

Facility

$57.40

Service Code	CPT 87798
Hospital Charge Code	30600278
Hospital Revenue Code	306
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$98.77
Rate for Payer: Aetna Commercial	$48.79
Rate for Payer: Aetna Medicare	$36.49
Rate for Payer: Aetna New Business (MI Preferred)	$37.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$43.86
Rate for Payer: Amish Plain Church Group Commercial	$43.86
Rate for Payer: BCBS Complete	$19.75
Rate for Payer: BCBS MAPPO	$35.09
Rate for Payer: BCN Medicare Advantage	$35.09
Rate for Payer: Cash Price	$45.92
Rate for Payer: Cash Price	$45.92
Rate for Payer: Cofinity Commercial	$49.36
Rate for Payer: Cofinity Commercial	$40.18
Rate for Payer: Cofinity Medicare Advantage	$40.18
Rate for Payer: Encore Health Key Benefits Commercial	$45.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.09
Rate for Payer: Healthscope Commercial	$51.66
Rate for Payer: Mclaren Medicaid	$18.81
Rate for Payer: Mclaren Medicare	$35.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$36.84
Rate for Payer: Meridian Medicaid	$19.75
Rate for Payer: MI Amish Medical Board Commercial	$40.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.79
Rate for Payer: PACE Medicare	$33.34
Rate for Payer: PACE SWMI	$35.09
Rate for Payer: PHP Commercial	$48.79
Rate for Payer: PHP Medicare Advantage	$35.09
Rate for Payer: Priority Health Choice Medicaid	$18.81
Rate for Payer: Priority Health Cigna Priority Health	$37.31
Rate for Payer: Priority Health Medicare	$35.09
Rate for Payer: Priority Health SBD	$36.16
Rate for Payer: Railroad Medicare Medicare	$35.09
Rate for Payer: UHC All Payor (Choice/PPO)	$98.77
Rate for Payer: UHC Dual Complete DSNP	$35.09
Rate for Payer: UHC Medicare Advantage	$35.09
Rate for Payer: UHCCP Medicaid	$19.76
Rate for Payer: VA VA	$35.09

HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING

Facility

$204.41

Service Code	CPT 36909
Hospital Charge Code	36100533
Hospital Revenue Code	361
Min. Negotiated Rate	$128.78
Max. Negotiated Rate	$183.97
Rate for Payer: Aetna Commercial	$173.75
Rate for Payer: Aetna New Business (MI Preferred)	$132.87
Rate for Payer: Cash Price	$163.53
Rate for Payer: Cofinity Commercial	$143.09
Rate for Payer: Cofinity Commercial	$175.79
Rate for Payer: Cofinity Medicare Advantage	$143.09
Rate for Payer: Encore Health Key Benefits Commercial	$163.53
Rate for Payer: Healthscope Commercial	$183.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.75
Rate for Payer: PHP Commercial	$173.75
Rate for Payer: Priority Health Cigna Priority Health	$132.87
Rate for Payer: Priority Health SBD	$128.78

HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING

Facility

$204.41

Service Code	CPT 36909
Hospital Charge Code	36100533
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$183.97
Rate for Payer: Aetna Commercial	$173.75
Rate for Payer: Aetna Medicare	$102.20
Rate for Payer: Aetna New Business (MI Preferred)	$132.87
Rate for Payer: BCBS Complete	$81.76
Rate for Payer: Cash Price	$163.53
Rate for Payer: Cofinity Commercial	$143.09
Rate for Payer: Cofinity Commercial	$175.79
Rate for Payer: Cofinity Medicare Advantage	$143.09
Rate for Payer: Encore Health Key Benefits Commercial	$163.53
Rate for Payer: Healthscope Commercial	$183.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.75
Rate for Payer: PHP Commercial	$173.75
Rate for Payer: Priority Health Cigna Priority Health	$132.87
Rate for Payer: Priority Health SBD	$128.78

Know your out-of-pocket cost for care.

All Charges