Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC Z VENA CAVA FILTER

Facility

$5,871.33

Service Code	HCPCS C1880
Hospital Charge Code	27800042
Hospital Revenue Code	278
Min. Negotiated Rate	$3,698.94
Max. Negotiated Rate	$5,284.20
Rate for Payer: Aetna Commercial	$4,990.63
Rate for Payer: Aetna New Business (MI Preferred)	$3,816.36
Rate for Payer: Cash Price	$4,697.06
Rate for Payer: Cofinity Commercial	$4,109.93
Rate for Payer: Cofinity Commercial	$5,049.34
Rate for Payer: Cofinity Medicare Advantage	$4,109.93
Rate for Payer: Encore Health Key Benefits Commercial	$4,697.06
Rate for Payer: Healthscope Commercial	$5,284.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,990.63
Rate for Payer: PHP Commercial	$4,990.63
Rate for Payer: Priority Health Cigna Priority Health	$3,816.36
Rate for Payer: Priority Health SBD	$3,698.94

HEARING AID RESTOCKING FEE

Professional

Both

$133.00

Service Code	HCPCS 00663
Hospital Revenue Code	990
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$86.45
Rate for Payer: Aetna Medicare	$66.50
Rate for Payer: BCBS Complete	$53.20
Rate for Payer: Cash Price	$106.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.45
Rate for Payer: Priority Health Cigna Priority Health	$86.45

HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$28,445.28

Service Code	HCPCS J1640
Hospital Charge Code	183624
Hospital Revenue Code	636
Min. Negotiated Rate	$17,920.53
Max. Negotiated Rate	$25,600.75
Rate for Payer: Aetna Commercial	$24,178.49
Rate for Payer: Aetna New Business (MI Preferred)	$18,489.43
Rate for Payer: Cash Price	$22,756.22
Rate for Payer: Cofinity Commercial	$19,911.70
Rate for Payer: Cofinity Commercial	$24,462.94
Rate for Payer: Cofinity Medicare Advantage	$19,911.70
Rate for Payer: Encore Health Key Benefits Commercial	$22,756.22
Rate for Payer: Healthscope Commercial	$25,600.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24,178.49
Rate for Payer: PHP Commercial	$24,178.49
Rate for Payer: Priority Health Cigna Priority Health	$18,489.43
Rate for Payer: Priority Health SBD	$17,920.53

HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$28,445.28

Service Code	HCPCS J1640
Hospital Charge Code	183624
Hospital Revenue Code	636
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$25,600.75
Rate for Payer: Aetna Commercial	$24,178.49
Rate for Payer: Aetna Medicare	$35.55
Rate for Payer: Aetna New Business (MI Preferred)	$18,489.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$42.73
Rate for Payer: Amish Plain Church Group Commercial	$42.73
Rate for Payer: BCBS Complete	$19.24
Rate for Payer: BCBS MAPPO	$34.18
Rate for Payer: BCN Medicare Advantage	$34.18
Rate for Payer: Cash Price	$22,756.22
Rate for Payer: Cash Price	$22,756.22
Rate for Payer: Cofinity Commercial	$24,462.94
Rate for Payer: Cofinity Commercial	$19,911.70
Rate for Payer: Cofinity Medicare Advantage	$19,911.70
Rate for Payer: Encore Health Key Benefits Commercial	$22,756.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$34.18
Rate for Payer: Healthscope Commercial	$25,600.75
Rate for Payer: Mclaren Medicaid	$18.32
Rate for Payer: Mclaren Medicare	$34.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.89
Rate for Payer: Meridian Medicaid	$19.24
Rate for Payer: MI Amish Medical Board Commercial	$39.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24,178.49
Rate for Payer: PACE Medicare	$32.47
Rate for Payer: PACE SWMI	$34.18
Rate for Payer: PHP Commercial	$24,178.49
Rate for Payer: PHP Medicare Advantage	$34.18
Rate for Payer: Priority Health Choice Medicaid	$18.32
Rate for Payer: Priority Health Cigna Priority Health	$18,489.43
Rate for Payer: Priority Health Medicare	$34.18
Rate for Payer: Priority Health SBD	$17,920.53
Rate for Payer: Railroad Medicare Medicare	$34.18
Rate for Payer: UHC All Payor (Choice/PPO)	$96.21
Rate for Payer: UHC Dual Complete DSNP	$34.18
Rate for Payer: UHC Medicare Advantage	$34.18
Rate for Payer: UHCCP Medicaid	$19.24
Rate for Payer: VA VA	$34.18

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EACH

Facility

$8,907.47

Service Code	CPT 28160
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS

Facility

$7,528.73

Service Code	CPT 46250
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;

Facility

$7,528.73

Service Code	CPT 46260
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISSURECTOMY

Facility

$7,528.73

Service Code	CPT 46261
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISTULECTOMY, INCLUDING FISSURECTOMY, WHEN PERFORMED

Facility

$7,528.73

Service Code	CPT 46262
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;

Facility

$7,528.73

Service Code	CPT 46255
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; 2 OR MORE HEMORRHOID COLUMNS/GROUPS, WITHOUT IMAGING GUIDANCE

Facility

$7,528.73

Service Code	CPT 46946
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOID COLUMN/GROUP, WITHOUT IMAGING GUIDANCE

Facility

$7,528.73

Service Code	CPT 46945
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

HEPARIN 1,000 UNIT/ML FOR FLUSH MIXTURES

Facility

$20.16

Service Code	HCPCS J1644
Hospital Charge Code	168888
Hospital Revenue Code	636
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$18.14
Rate for Payer: Aetna Commercial	$17.14
Rate for Payer: Aetna Medicare	$10.08
Rate for Payer: Aetna New Business (MI Preferred)	$13.10
Rate for Payer: BCBS Complete	$8.06
Rate for Payer: Cash Price	$16.13
Rate for Payer: Cofinity Commercial	$17.34
Rate for Payer: Cofinity Commercial	$14.11
Rate for Payer: Cofinity Medicare Advantage	$14.11
Rate for Payer: Encore Health Key Benefits Commercial	$16.13
Rate for Payer: Healthscope Commercial	$18.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.14
Rate for Payer: PHP Commercial	$17.14
Rate for Payer: Priority Health Cigna Priority Health	$13.10
Rate for Payer: Priority Health SBD	$12.70

HEPARIN 1,000 UNIT/ML FOR FLUSH MIXTURES

Facility

$22.50

Service Code	HCPCS J1643
Hospital Charge Code	168888
Hospital Revenue Code	636
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$19.12
Rate for Payer: Aetna New Business (MI Preferred)	$14.62
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cofinity Commercial	$15.75
Rate for Payer: Cofinity Commercial	$19.35
Rate for Payer: Cofinity Medicare Advantage	$15.75
Rate for Payer: Encore Health Key Benefits Commercial	$18.00
Rate for Payer: Healthscope Commercial	$20.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.12
Rate for Payer: PHP Commercial	$19.12
Rate for Payer: Priority Health Cigna Priority Health	$14.62
Rate for Payer: Priority Health SBD	$14.18

HEPARIN 1,000 UNIT/ML FOR FLUSH MIXTURES

Facility

$20.16

Service Code	HCPCS J1644
Hospital Charge Code	168888
Hospital Revenue Code	636
Min. Negotiated Rate	$12.70
Max. Negotiated Rate	$18.14
Rate for Payer: Aetna Commercial	$17.14
Rate for Payer: Aetna New Business (MI Preferred)	$13.10
Rate for Payer: Cash Price	$16.13
Rate for Payer: Cofinity Commercial	$14.11
Rate for Payer: Cofinity Commercial	$17.34
Rate for Payer: Cofinity Medicare Advantage	$14.11
Rate for Payer: Encore Health Key Benefits Commercial	$16.13
Rate for Payer: Healthscope Commercial	$18.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.14
Rate for Payer: PHP Commercial	$17.14
Rate for Payer: Priority Health Cigna Priority Health	$13.10
Rate for Payer: Priority Health SBD	$12.70

HEPARIN 1,000 UNIT/ML FOR FLUSH MIXTURES

Facility

$22.50

Service Code	HCPCS J1643
Hospital Charge Code	168888
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$19.12
Rate for Payer: Aetna Medicare	$11.25
Rate for Payer: Aetna New Business (MI Preferred)	$14.62
Rate for Payer: BCBS Complete	$9.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cofinity Commercial	$15.75
Rate for Payer: Cofinity Commercial	$19.35
Rate for Payer: Cofinity Medicare Advantage	$15.75
Rate for Payer: Encore Health Key Benefits Commercial	$18.00
Rate for Payer: Healthscope Commercial	$20.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.12
Rate for Payer: PHP Commercial	$19.12
Rate for Payer: Priority Health Cigna Priority Health	$14.62
Rate for Payer: Priority Health SBD	$14.18

HEPARIN 1,000 UNIT/ML INJECTION-DIALYSIS BOLUS ONLY

Facility

$34.75

Service Code	HCPCS J1644
Hospital Charge Code	161558
Hospital Revenue Code	636
Min. Negotiated Rate	$21.89
Max. Negotiated Rate	$31.27
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: Aetna New Business (MI Preferred)	$31.20
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Cofinity Commercial	$33.60
Rate for Payer: Cofinity Commercial	$41.28
Rate for Payer: Cofinity Commercial	$29.89
Rate for Payer: Cofinity Medicare Advantage	$33.60
Rate for Payer: Cofinity Medicare Advantage	$24.32
Rate for Payer: Encore Health Key Benefits Commercial	$27.80
Rate for Payer: Encore Health Key Benefits Commercial	$38.40
Rate for Payer: Healthscope Commercial	$31.27
Rate for Payer: Healthscope Commercial	$43.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.80
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: PHP Commercial	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$22.59
Rate for Payer: Priority Health SBD	$30.24
Rate for Payer: Priority Health SBD	$21.89

HEPARIN 1,000 UNIT/ML INJECTION-DIALYSIS BOLUS ONLY

Facility

$76.00

Service Code	HCPCS J1643
Hospital Charge Code	161558
Hospital Revenue Code	636
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare	$38.00
Rate for Payer: Aetna New Business (MI Preferred)	$49.40
Rate for Payer: BCBS Complete	$30.40
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cofinity Commercial	$53.20
Rate for Payer: Cofinity Commercial	$65.36
Rate for Payer: Cofinity Medicare Advantage	$53.20
Rate for Payer: Encore Health Key Benefits Commercial	$60.80
Rate for Payer: Healthscope Commercial	$68.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$64.60
Rate for Payer: PHP Commercial	$64.60
Rate for Payer: Priority Health Cigna Priority Health	$49.40
Rate for Payer: Priority Health SBD	$47.88

HEPARIN 1,000 UNIT/ML INJECTION-DIALYSIS BOLUS ONLY

Facility

$76.00

Service Code	HCPCS J1643
Hospital Charge Code	161558
Hospital Revenue Code	636
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna New Business (MI Preferred)	$49.40
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cofinity Commercial	$53.20
Rate for Payer: Cofinity Commercial	$65.36
Rate for Payer: Cofinity Medicare Advantage	$53.20
Rate for Payer: Encore Health Key Benefits Commercial	$60.80
Rate for Payer: Healthscope Commercial	$68.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$64.60
Rate for Payer: PHP Commercial	$64.60
Rate for Payer: Priority Health Cigna Priority Health	$49.40
Rate for Payer: Priority Health SBD	$47.88

HEPARIN 1,000 UNIT/ML INJECTION-DIALYSIS BOLUS ONLY

Facility

$48.00

Service Code	HCPCS J1644
Hospital Charge Code	161558
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna Medicare	$17.38
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: Aetna New Business (MI Preferred)	$31.20
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: BCBS Complete	$19.20
Rate for Payer: BCBS Complete	$13.90
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cofinity Commercial	$41.28
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Cofinity Commercial	$29.89
Rate for Payer: Cofinity Commercial	$33.60
Rate for Payer: Cofinity Medicare Advantage	$24.32
Rate for Payer: Cofinity Medicare Advantage	$33.60
Rate for Payer: Encore Health Key Benefits Commercial	$27.80
Rate for Payer: Encore Health Key Benefits Commercial	$38.40
Rate for Payer: Healthscope Commercial	$43.20
Rate for Payer: Healthscope Commercial	$31.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.54
Rate for Payer: PHP Commercial	$40.80
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: Priority Health Cigna Priority Health	$22.59
Rate for Payer: Priority Health Cigna Priority Health	$31.20
Rate for Payer: Priority Health SBD	$21.89
Rate for Payer: Priority Health SBD	$30.24

HEPARIN 1,000 UNIT/ML INJECTION-DIALYSIS ONLY

Facility

$57.00

Service Code	HCPCS J1644
Hospital Charge Code	161517
Hospital Revenue Code	636
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna Medicare	$17.38
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: Aetna New Business (MI Preferred)	$37.05
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: BCBS Complete	$13.90
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Cofinity Commercial	$39.90
Rate for Payer: Cofinity Commercial	$49.02
Rate for Payer: Cofinity Commercial	$29.89
Rate for Payer: Cofinity Medicare Advantage	$39.90
Rate for Payer: Cofinity Medicare Advantage	$24.32
Rate for Payer: Encore Health Key Benefits Commercial	$27.80
Rate for Payer: Encore Health Key Benefits Commercial	$45.60
Rate for Payer: Healthscope Commercial	$31.27
Rate for Payer: Healthscope Commercial	$51.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.45
Rate for Payer: PHP Commercial	$48.45
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: Priority Health Cigna Priority Health	$22.59
Rate for Payer: Priority Health Cigna Priority Health	$37.05
Rate for Payer: Priority Health SBD	$35.91
Rate for Payer: Priority Health SBD	$21.89

HEPARIN 1,000 UNIT/ML INJECTION-DIALYSIS ONLY

Facility

$57.00

Service Code	HCPCS J1644
Hospital Charge Code	161517
Hospital Revenue Code	636
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: Aetna New Business (MI Preferred)	$37.05
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Cofinity Commercial	$39.90
Rate for Payer: Cofinity Commercial	$49.02
Rate for Payer: Cofinity Commercial	$29.89
Rate for Payer: Cofinity Medicare Advantage	$39.90
Rate for Payer: Cofinity Medicare Advantage	$24.32
Rate for Payer: Encore Health Key Benefits Commercial	$27.80
Rate for Payer: Encore Health Key Benefits Commercial	$45.60
Rate for Payer: Healthscope Commercial	$31.27
Rate for Payer: Healthscope Commercial	$51.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.45
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: PHP Commercial	$48.45
Rate for Payer: Priority Health Cigna Priority Health	$37.05
Rate for Payer: Priority Health Cigna Priority Health	$22.59
Rate for Payer: Priority Health SBD	$35.91
Rate for Payer: Priority Health SBD	$21.89

HEPARIN 30,000 UNITS IN NS 1 LITER

Facility

$95.70

Service Code	HCPCS J1644
Hospital Charge Code	180503
Hospital Revenue Code	636
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Cofinity Medicare Advantage	$66.99
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$62.20
Rate for Payer: Priority Health SBD	$60.29

HEPARIN 30,000 UNITS IN NS 1 LITER

Facility

$95.70

Service Code	HCPCS J1644
Hospital Charge Code	180503
Hospital Revenue Code	636
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna Medicare	$47.85
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: BCBS Complete	$38.28
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Cofinity Medicare Advantage	$66.99
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$62.20
Rate for Payer: Priority Health SBD	$60.29

HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION

Facility

$26.83

Service Code	HCPCS J1642
Hospital Charge Code	112939
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$24.15
Rate for Payer: Aetna Commercial	$22.81
Rate for Payer: Aetna New Business (MI Preferred)	$17.44
Rate for Payer: Cash Price	$21.46
Rate for Payer: Cofinity Commercial	$18.78
Rate for Payer: Cofinity Commercial	$23.07
Rate for Payer: Cofinity Medicare Advantage	$18.78
Rate for Payer: Encore Health Key Benefits Commercial	$21.46
Rate for Payer: Healthscope Commercial	$24.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.81
Rate for Payer: PHP Commercial	$22.81
Rate for Payer: Priority Health Cigna Priority Health	$17.44
Rate for Payer: Priority Health SBD	$16.90

Know your out-of-pocket cost for care.

All Charges