Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE

Facility

$166.01

Service Code	NDC 00006409402
Hospital Charge Code	117263
Hospital Revenue Code	636
Min. Negotiated Rate	$66.40
Max. Negotiated Rate	$149.41
Rate for Payer: Aetna Commercial	$141.11
Rate for Payer: Aetna Medicare	$83.00
Rate for Payer: Aetna New Business (MI Preferred)	$107.91
Rate for Payer: BCBS Complete	$66.40
Rate for Payer: Cash Price	$132.81
Rate for Payer: Cofinity Advantage	$116.21
Rate for Payer: Cofinity Commercial	$142.77
Rate for Payer: Encore Health Key Benefits Commercial	$132.81
Rate for Payer: Healthscope Commercial	$149.41
Rate for Payer: MI Amish Medical Board Commercial	$132.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.51
Rate for Payer: PHP Commercial	$141.11
Rate for Payer: Priority Health SBD	$104.59
Rate for Payer: UHC All Payor (Choice/PPO)	$83.00
Rate for Payer: UHC Core	$83.00
Rate for Payer: UHC Exchange	$83.00

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE

Facility

$166.01

Service Code	NDC 00006409402
Hospital Charge Code	117263
Hospital Revenue Code	636
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$149.41
Rate for Payer: Aetna Commercial	$141.11
Rate for Payer: Aetna New Business (MI Preferred)	$107.91
Rate for Payer: Cash Price	$132.81
Rate for Payer: Cofinity Advantage	$116.21
Rate for Payer: Cofinity Commercial	$142.77
Rate for Payer: Encore Health Key Benefits Commercial	$132.81
Rate for Payer: Healthscope Commercial	$149.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.51
Rate for Payer: PHP Commercial	$141.11
Rate for Payer: Priority Health SBD	$104.59

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE

Facility

$166.01

Service Code	NDC 00006409401
Hospital Charge Code	117263
Hospital Revenue Code	636
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$149.41
Rate for Payer: Aetna Commercial	$141.11
Rate for Payer: Aetna New Business (MI Preferred)	$107.91
Rate for Payer: Cash Price	$132.81
Rate for Payer: Cofinity Advantage	$116.21
Rate for Payer: Cofinity Commercial	$142.77
Rate for Payer: Encore Health Key Benefits Commercial	$132.81
Rate for Payer: Healthscope Commercial	$149.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.51
Rate for Payer: PHP Commercial	$141.11
Rate for Payer: Priority Health SBD	$104.59

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE

Facility

$166.01

Service Code	NDC 00006409401
Hospital Charge Code	117263
Hospital Revenue Code	636
Min. Negotiated Rate	$66.40
Max. Negotiated Rate	$149.41
Rate for Payer: Aetna Commercial	$141.11
Rate for Payer: Aetna Medicare	$83.00
Rate for Payer: Aetna New Business (MI Preferred)	$107.91
Rate for Payer: BCBS Complete	$66.40
Rate for Payer: Cash Price	$132.81
Rate for Payer: Cofinity Advantage	$116.21
Rate for Payer: Cofinity Commercial	$142.77
Rate for Payer: Encore Health Key Benefits Commercial	$132.81
Rate for Payer: Healthscope Commercial	$149.41
Rate for Payer: MI Amish Medical Board Commercial	$132.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.51
Rate for Payer: PHP Commercial	$141.11
Rate for Payer: Priority Health SBD	$104.59
Rate for Payer: UHC All Payor (Choice/PPO)	$83.00
Rate for Payer: UHC Core	$83.00
Rate for Payer: UHC Exchange	$83.00

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$37,593.25

Service Code	MSDRG 421
Min. Negotiated Rate	$13,306.46
Max. Negotiated Rate	$37,593.25
Rate for Payer: Aetna Medicare	$14,567.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,508.50
Rate for Payer: Amish Plain Church Group Commercial	$17,508.50
Rate for Payer: BCBS MAPPO	$14,006.80
Rate for Payer: BCBS Trust/PPO	$37,593.25
Rate for Payer: BCN Commercial	$37,593.25
Rate for Payer: BCN Medicare Advantage	$14,006.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,006.80
Rate for Payer: Mclaren Medicare	$14,006.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,707.14
Rate for Payer: MI Amish Medical Board Commercial	$16,107.82
Rate for Payer: Molina Medicare/Medicaid	$15,407.48
Rate for Payer: Nomi Health Commercial	$22,413.75
Rate for Payer: PACE Medicare	$13,306.46
Rate for Payer: PACE SWMI	$14,006.80
Rate for Payer: PHP Medicare Advantage	$14,006.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$28,012.22
Rate for Payer: Priority Health Medicare	$14,006.80
Rate for Payer: Priority Health Tiered Network	$22,409.77
Rate for Payer: Railroad Medicare Medicare	$14,006.80
Rate for Payer: UHC All Payor (Choice/PPO)	$28,321.25
Rate for Payer: UHC Core	$23,694.29
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,006.80
Rate for Payer: UHC Exchange	$19,350.54
Rate for Payer: VA VA	$14,006.80

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$78,346.58

Service Code	MSDRG 420
Min. Negotiated Rate	$25,564.36
Max. Negotiated Rate	$78,346.58
Rate for Payer: Aetna Medicare	$27,986.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,637.31
Rate for Payer: Amish Plain Church Group Commercial	$33,637.31
Rate for Payer: BCBS MAPPO	$26,909.85
Rate for Payer: BCBS Trust/PPO	$78,346.58
Rate for Payer: BCN Commercial	$78,346.58
Rate for Payer: BCN Medicare Advantage	$26,909.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,909.85
Rate for Payer: Mclaren Medicare	$26,909.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,255.34
Rate for Payer: MI Amish Medical Board Commercial	$30,946.33
Rate for Payer: Molina Medicare/Medicaid	$29,600.83
Rate for Payer: Nomi Health Commercial	$43,951.59
Rate for Payer: PACE Medicare	$25,564.36
Rate for Payer: PACE SWMI	$26,909.85
Rate for Payer: PHP Medicare Advantage	$26,909.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$54,929.74
Rate for Payer: Priority Health Medicare	$26,909.85
Rate for Payer: Priority Health Tiered Network	$43,943.79
Rate for Payer: Railroad Medicare Medicare	$26,909.85
Rate for Payer: UHC All Payor (Choice/PPO)	$55,535.73
Rate for Payer: UHC Core	$46,462.62
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,909.85
Rate for Payer: UHC Exchange	$37,944.87
Rate for Payer: VA VA	$26,909.85

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$31,027.30

Service Code	MSDRG 422
Min. Negotiated Rate	$10,824.92
Max. Negotiated Rate	$31,027.30
Rate for Payer: Aetna Medicare	$11,850.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,243.31
Rate for Payer: Amish Plain Church Group Commercial	$14,243.31
Rate for Payer: BCBS MAPPO	$11,394.65
Rate for Payer: BCBS Trust/PPO	$31,027.30
Rate for Payer: BCN Commercial	$31,027.30
Rate for Payer: BCN Medicare Advantage	$11,394.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,394.65
Rate for Payer: Mclaren Medicare	$11,394.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,964.38
Rate for Payer: MI Amish Medical Board Commercial	$13,103.85
Rate for Payer: Molina Medicare/Medicaid	$12,534.11
Rate for Payer: Nomi Health Commercial	$18,053.55
Rate for Payer: PACE Medicare	$10,824.92
Rate for Payer: PACE SWMI	$11,394.65
Rate for Payer: PHP Medicare Advantage	$11,394.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$22,562.93
Rate for Payer: Priority Health Medicare	$11,394.65
Rate for Payer: Priority Health Tiered Network	$18,050.35
Rate for Payer: Railroad Medicare Medicare	$11,394.65
Rate for Payer: UHC All Payor (Choice/PPO)	$22,811.85
Rate for Payer: UHC Core	$19,084.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,394.65
Rate for Payer: UHC Exchange	$15,586.23
Rate for Payer: VA VA	$11,394.65

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$30,605.96

Service Code	MSDRG 354
Min. Negotiated Rate	$12,901.93
Max. Negotiated Rate	$30,605.96
Rate for Payer: Aetna Medicare	$14,124.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,976.22
Rate for Payer: Amish Plain Church Group Commercial	$16,976.22
Rate for Payer: BCBS MAPPO	$13,580.98
Rate for Payer: BCBS Trust/PPO	$30,605.96
Rate for Payer: BCN Commercial	$30,605.96
Rate for Payer: BCN Medicare Advantage	$13,580.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,580.98
Rate for Payer: Mclaren Medicare	$13,580.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,260.03
Rate for Payer: MI Amish Medical Board Commercial	$15,618.13
Rate for Payer: Molina Medicare/Medicaid	$14,939.08
Rate for Payer: Nomi Health Commercial	$21,702.96
Rate for Payer: PACE Medicare	$12,901.93
Rate for Payer: PACE SWMI	$13,580.98
Rate for Payer: PHP Medicare Advantage	$13,580.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$27,123.89
Rate for Payer: Priority Health Medicare	$13,580.98
Rate for Payer: Priority Health Tiered Network	$21,699.11
Rate for Payer: Railroad Medicare Medicare	$13,580.98
Rate for Payer: UHC All Payor (Choice/PPO)	$27,423.12
Rate for Payer: UHC Core	$22,942.89
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,580.98
Rate for Payer: UHC Exchange	$18,736.89
Rate for Payer: VA VA	$13,580.98

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$58,899.21

Service Code	MSDRG 353
Min. Negotiated Rate	$21,855.99
Max. Negotiated Rate	$58,899.21
Rate for Payer: Aetna Medicare	$23,926.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$28,757.88
Rate for Payer: Amish Plain Church Group Commercial	$28,757.88
Rate for Payer: BCBS MAPPO	$23,006.30
Rate for Payer: BCBS Trust/PPO	$58,899.21
Rate for Payer: BCN Commercial	$58,899.21
Rate for Payer: BCN Medicare Advantage	$23,006.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$23,006.30
Rate for Payer: Mclaren Medicare	$23,006.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$24,156.62
Rate for Payer: MI Amish Medical Board Commercial	$26,457.24
Rate for Payer: Molina Medicare/Medicaid	$25,306.93
Rate for Payer: Nomi Health Commercial	$37,435.80
Rate for Payer: PACE Medicare	$21,855.99
Rate for Payer: PACE SWMI	$23,006.30
Rate for Payer: PHP Medicare Advantage	$23,006.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$46,786.45
Rate for Payer: Priority Health Medicare	$23,006.30
Rate for Payer: Priority Health Tiered Network	$37,429.15
Rate for Payer: Railroad Medicare Medicare	$23,006.30
Rate for Payer: UHC All Payor (Choice/PPO)	$47,302.60
Rate for Payer: UHC Core	$39,574.57
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$23,006.30
Rate for Payer: UHC Exchange	$32,319.57
Rate for Payer: VA VA	$23,006.30

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$25,840.09

Service Code	MSDRG 355
Min. Negotiated Rate	$10,424.79
Max. Negotiated Rate	$25,840.09
Rate for Payer: Aetna Medicare	$11,412.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,716.83
Rate for Payer: Amish Plain Church Group Commercial	$13,716.83
Rate for Payer: BCBS MAPPO	$10,973.46
Rate for Payer: BCBS Trust/PPO	$25,840.09
Rate for Payer: BCN Commercial	$25,840.09
Rate for Payer: BCN Medicare Advantage	$10,973.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,973.46
Rate for Payer: Mclaren Medicare	$10,973.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,522.13
Rate for Payer: MI Amish Medical Board Commercial	$12,619.48
Rate for Payer: Molina Medicare/Medicaid	$12,070.81
Rate for Payer: Nomi Health Commercial	$17,350.50
Rate for Payer: PACE Medicare	$10,424.79
Rate for Payer: PACE SWMI	$10,973.46
Rate for Payer: PHP Medicare Advantage	$10,973.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$21,684.28
Rate for Payer: Priority Health Medicare	$10,973.46
Rate for Payer: Priority Health Tiered Network	$17,347.42
Rate for Payer: Railroad Medicare Medicare	$10,973.46
Rate for Payer: UHC All Payor (Choice/PPO)	$21,923.50
Rate for Payer: UHC Core	$18,341.76
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,973.46
Rate for Payer: UHC Exchange	$14,979.26
Rate for Payer: VA VA	$10,973.46

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$20,576.31

Service Code	APR-DRG 2274
Min. Negotiated Rate	$19,596.49
Max. Negotiated Rate	$20,576.31
Rate for Payer: BCBS Complete	$20,576.31
Rate for Payer: Mclaren Medicaid	$19,596.49
Rate for Payer: Meridian Medicaid	$20,576.31
Rate for Payer: Priority Health Choice Medicaid	$19,596.49
Rate for Payer: UHC Medicaid	$19,596.49
Rate for Payer: UHCCP Medicaid	$19,596.49

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$10,930.54

Service Code	APR-DRG 2272
Min. Negotiated Rate	$10,410.04
Max. Negotiated Rate	$10,930.54
Rate for Payer: BCBS Complete	$10,930.54
Rate for Payer: Mclaren Medicaid	$10,410.04
Rate for Payer: Meridian Medicaid	$10,930.54
Rate for Payer: Priority Health Choice Medicaid	$10,410.04
Rate for Payer: UHC Medicaid	$10,410.04
Rate for Payer: UHCCP Medicaid	$10,410.04

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$12,550.68

Service Code	APR-DRG 2273
Min. Negotiated Rate	$11,953.03
Max. Negotiated Rate	$12,550.68
Rate for Payer: BCBS Complete	$12,550.68
Rate for Payer: Mclaren Medicaid	$11,953.03
Rate for Payer: Meridian Medicaid	$12,550.68
Rate for Payer: Priority Health Choice Medicaid	$11,953.03
Rate for Payer: UHC Medicaid	$11,953.03
Rate for Payer: UHCCP Medicaid	$11,953.03

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL

Facility

$8,862.64

Service Code	APR-DRG 2271
Min. Negotiated Rate	$8,440.61
Max. Negotiated Rate	$8,862.64
Rate for Payer: BCBS Complete	$8,862.64
Rate for Payer: Mclaren Medicaid	$8,440.61
Rate for Payer: Meridian Medicaid	$8,862.64
Rate for Payer: Priority Health Choice Medicaid	$8,440.61
Rate for Payer: UHC Medicaid	$8,440.61
Rate for Payer: UHCCP Medicaid	$8,440.61

HH CATHETER LEG STRAP BARD

Facility

$12.47

Service Code	HCPCS A4334
Hospital Charge Code	27000598
Hospital Revenue Code	270
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$10.60
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Advantage	$8.73
Rate for Payer: Cofinity Commercial	$10.72
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.35
Rate for Payer: PHP Commercial	$10.60
Rate for Payer: Priority Health SBD	$7.86

HH CATHETER LEG STRAP BARD

Facility

$12.47

Service Code	HCPCS A4334
Hospital Charge Code	27000598
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$10.60
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Advantage	$8.73
Rate for Payer: Cofinity Commercial	$10.72
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.22
Rate for Payer: MI Amish Medical Board Commercial	$9.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.35
Rate for Payer: PHP Commercial	$10.60
Rate for Payer: Priority Health SBD	$7.86
Rate for Payer: UHC All Payor (Choice/PPO)	$8.11
Rate for Payer: UHC Core	$6.50
Rate for Payer: UHC Exchange	$4.90

HH DRSG MEPILEX AG FOAM 4X4 EA

Facility

$27.70

Service Code	HCPCS A6209
Hospital Charge Code	62300044
Hospital Revenue Code	623
Min. Negotiated Rate	$17.45
Max. Negotiated Rate	$24.93
Rate for Payer: Aetna Commercial	$23.55
Rate for Payer: Aetna New Business (MI Preferred)	$18.00
Rate for Payer: Cash Price	$22.16
Rate for Payer: Cofinity Advantage	$19.39
Rate for Payer: Cofinity Commercial	$23.82
Rate for Payer: Encore Health Key Benefits Commercial	$22.16
Rate for Payer: Healthscope Commercial	$24.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.77
Rate for Payer: PHP Commercial	$23.55
Rate for Payer: Priority Health SBD	$17.45

HH DRSG MEPILEX AG FOAM 4X4 EA

Facility

$27.70

Service Code	HCPCS A6209
Hospital Charge Code	62300044
Hospital Revenue Code	623
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$29.02
Rate for Payer: Aetna Commercial	$23.55
Rate for Payer: Aetna Medicare	$13.85
Rate for Payer: Aetna New Business (MI Preferred)	$18.00
Rate for Payer: BCBS Complete	$11.08
Rate for Payer: BCBS Trust/PPO	$29.02
Rate for Payer: BCN Commercial	$29.02
Rate for Payer: Cash Price	$22.16
Rate for Payer: Cash Price	$22.16
Rate for Payer: Cofinity Advantage	$19.39
Rate for Payer: Cofinity Commercial	$23.82
Rate for Payer: Encore Health Key Benefits Commercial	$22.16
Rate for Payer: Healthscope Commercial	$24.93
Rate for Payer: MI Amish Medical Board Commercial	$22.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.77
Rate for Payer: PHP Commercial	$23.55
Rate for Payer: Priority Health SBD	$17.45
Rate for Payer: UHC All Payor (Choice/PPO)	$18.00
Rate for Payer: UHC Core	$14.43
Rate for Payer: UHC Exchange	$10.89

HH DRSG MEPILEX BORDER 4X4 EA

Facility

$9.98

Service Code	HCPCS A6212
Hospital Charge Code	62300017
Hospital Revenue Code	623
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$8.98
Rate for Payer: Aetna Commercial	$8.48
Rate for Payer: Aetna New Business (MI Preferred)	$6.49
Rate for Payer: Cash Price	$7.98
Rate for Payer: Cofinity Advantage	$6.99
Rate for Payer: Cofinity Commercial	$8.58
Rate for Payer: Encore Health Key Benefits Commercial	$7.98
Rate for Payer: Healthscope Commercial	$8.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.49
Rate for Payer: PHP Commercial	$8.48
Rate for Payer: Priority Health SBD	$6.29

HH DRSG MEPILEX BORDER 4X4 EA

Facility

$9.98

Service Code	HCPCS A6212
Hospital Charge Code	62300017
Hospital Revenue Code	623
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$37.72
Rate for Payer: Aetna Commercial	$8.48
Rate for Payer: Aetna Medicare	$4.99
Rate for Payer: Aetna New Business (MI Preferred)	$6.49
Rate for Payer: BCBS Complete	$3.99
Rate for Payer: BCBS Trust/PPO	$37.72
Rate for Payer: BCN Commercial	$37.72
Rate for Payer: Cash Price	$7.98
Rate for Payer: Cash Price	$7.98
Rate for Payer: Cofinity Advantage	$6.99
Rate for Payer: Cofinity Commercial	$8.58
Rate for Payer: Encore Health Key Benefits Commercial	$7.98
Rate for Payer: Healthscope Commercial	$8.98
Rate for Payer: MI Amish Medical Board Commercial	$7.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.49
Rate for Payer: PHP Commercial	$8.48
Rate for Payer: Priority Health SBD	$6.29
Rate for Payer: UHC All Payor (Choice/PPO)	$6.49
Rate for Payer: UHC Core	$5.20
Rate for Payer: UHC Exchange	$3.92

HH DRSG MEPILEX BORDER 6X6 EA

Facility

$22.31

Service Code	HCPCS A6212
Hospital Charge Code	62300067
Hospital Revenue Code	623
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$37.72
Rate for Payer: Aetna Commercial	$18.96
Rate for Payer: Aetna Medicare	$11.15
Rate for Payer: Aetna New Business (MI Preferred)	$14.50
Rate for Payer: BCBS Complete	$8.92
Rate for Payer: BCBS Trust/PPO	$37.72
Rate for Payer: BCN Commercial	$37.72
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cofinity Advantage	$15.62
Rate for Payer: Cofinity Commercial	$19.19
Rate for Payer: Encore Health Key Benefits Commercial	$17.85
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: MI Amish Medical Board Commercial	$17.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.73
Rate for Payer: PHP Commercial	$18.96
Rate for Payer: Priority Health SBD	$14.06
Rate for Payer: UHC All Payor (Choice/PPO)	$14.50
Rate for Payer: UHC Core	$11.62
Rate for Payer: UHC Exchange	$8.77

HH DRSG MEPILEX BORDER 6X6 EA

Facility

$22.31

Service Code	HCPCS A6212
Hospital Charge Code	62300067
Hospital Revenue Code	623
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$20.08
Rate for Payer: Aetna Commercial	$18.96
Rate for Payer: Aetna New Business (MI Preferred)	$14.50
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cofinity Advantage	$15.62
Rate for Payer: Cofinity Commercial	$19.19
Rate for Payer: Encore Health Key Benefits Commercial	$17.85
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.73
Rate for Payer: PHP Commercial	$18.96
Rate for Payer: Priority Health SBD	$14.06

HH DRSG MEPILEX BORDER 6X8 EA

Facility

$22.92

Service Code	HCPCS A6213
Hospital Charge Code	62300053
Hospital Revenue Code	623
Min. Negotiated Rate	$14.44
Max. Negotiated Rate	$20.63
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna New Business (MI Preferred)	$14.90
Rate for Payer: Cash Price	$18.34
Rate for Payer: Cofinity Advantage	$16.04
Rate for Payer: Cofinity Commercial	$19.71
Rate for Payer: Encore Health Key Benefits Commercial	$18.34
Rate for Payer: Healthscope Commercial	$20.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.19
Rate for Payer: PHP Commercial	$19.48
Rate for Payer: Priority Health SBD	$14.44

HH DRSG MEPILEX BORDER 6X8 EA

Facility

$22.92

Service Code	HCPCS A6213
Hospital Charge Code	62300053
Hospital Revenue Code	623
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$50.03
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare	$11.46
Rate for Payer: Aetna New Business (MI Preferred)	$14.90
Rate for Payer: BCBS Complete	$9.17
Rate for Payer: BCBS Trust/PPO	$50.03
Rate for Payer: BCN Commercial	$50.03
Rate for Payer: Cash Price	$18.34
Rate for Payer: Cash Price	$18.34
Rate for Payer: Cofinity Advantage	$16.04
Rate for Payer: Cofinity Commercial	$19.71
Rate for Payer: Encore Health Key Benefits Commercial	$18.34
Rate for Payer: Healthscope Commercial	$20.63
Rate for Payer: MI Amish Medical Board Commercial	$18.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.19
Rate for Payer: PHP Commercial	$19.48
Rate for Payer: Priority Health SBD	$14.44
Rate for Payer: UHC All Payor (Choice/PPO)	$14.90
Rate for Payer: UHC Core	$11.94
Rate for Payer: UHC Exchange	$9.01

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM

Facility

$964.48

Service Code	CPT 97607
Hospital Charge Code	76100035
Hospital Revenue Code	761
Min. Negotiated Rate	$607.62
Max. Negotiated Rate	$868.03
Rate for Payer: Aetna Commercial	$819.81
Rate for Payer: Aetna New Business (MI Preferred)	$626.91
Rate for Payer: Cash Price	$771.58
Rate for Payer: Cofinity Advantage	$675.14
Rate for Payer: Cofinity Commercial	$829.45
Rate for Payer: Encore Health Key Benefits Commercial	$771.58
Rate for Payer: Healthscope Commercial	$868.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$819.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$723.36
Rate for Payer: PHP Commercial	$819.81
Rate for Payer: Priority Health SBD	$607.62

Know your out-of-pocket cost for care.

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