Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV

Facility

$63.80

Service Code	HCPCS J1644
Hospital Charge Code	118364
Hospital Revenue Code	636
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV

Facility

$63.80

Service Code	HCPCS J1644
Hospital Charge Code	118364
Hospital Revenue Code	636
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: BCBS Complete	$25.52
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN NS CONTINUOUS INFUSION CUSTOM

Facility

$63.80

Service Code	HCPCS J1644
Hospital Charge Code	300070
Hospital Revenue Code	636
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN NS CONTINUOUS INFUSION CUSTOM

Facility

$63.80

Service Code	HCPCS J1644
Hospital Charge Code	300070
Hospital Revenue Code	636
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: BCBS Complete	$25.52
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE

Facility

$17.69

Service Code	HCPCS J1644
Hospital Charge Code	116333
Hospital Revenue Code	636
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$15.92
Rate for Payer: Aetna Commercial	$15.04
Rate for Payer: Aetna Medicare	$8.85
Rate for Payer: Aetna New Business (MI Preferred)	$11.50
Rate for Payer: BCBS Complete	$7.08
Rate for Payer: Cash Price	$14.15
Rate for Payer: Cofinity Commercial	$12.38
Rate for Payer: Cofinity Commercial	$15.21
Rate for Payer: Cofinity Medicare Advantage	$12.38
Rate for Payer: Encore Health Key Benefits Commercial	$14.15
Rate for Payer: Healthscope Commercial	$15.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.04
Rate for Payer: PHP Commercial	$15.04
Rate for Payer: Priority Health Cigna Priority Health	$11.50
Rate for Payer: Priority Health SBD	$11.14

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$267.25

Service Code	HCPCS 90371
Hospital Charge Code	116881
Hospital Revenue Code	637
Min. Negotiated Rate	$168.37
Max. Negotiated Rate	$240.53
Rate for Payer: Aetna Commercial	$227.16
Rate for Payer: Aetna New Business (MI Preferred)	$173.71
Rate for Payer: Cash Price	$213.80
Rate for Payer: Cofinity Commercial	$187.07
Rate for Payer: Cofinity Commercial	$229.84
Rate for Payer: Cofinity Medicare Advantage	$187.07
Rate for Payer: Encore Health Key Benefits Commercial	$213.80
Rate for Payer: Healthscope Commercial	$240.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.16
Rate for Payer: PHP Commercial	$227.16
Rate for Payer: Priority Health Cigna Priority Health	$173.71
Rate for Payer: Priority Health SBD	$168.37

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$267.25

Service Code	HCPCS 90371
Hospital Charge Code	116881
Hospital Revenue Code	637
Min. Negotiated Rate	$71.93
Max. Negotiated Rate	$377.73
Rate for Payer: Aetna Commercial	$227.16
Rate for Payer: Aetna Medicare	$139.56
Rate for Payer: Aetna New Business (MI Preferred)	$173.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$167.74
Rate for Payer: Amish Plain Church Group Commercial	$167.74
Rate for Payer: BCBS Complete	$75.52
Rate for Payer: BCBS MAPPO	$134.19
Rate for Payer: BCN Medicare Advantage	$134.19
Rate for Payer: Cash Price	$213.80
Rate for Payer: Cash Price	$213.80
Rate for Payer: Cofinity Commercial	$229.84
Rate for Payer: Cofinity Commercial	$187.07
Rate for Payer: Cofinity Medicare Advantage	$187.07
Rate for Payer: Encore Health Key Benefits Commercial	$213.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$134.19
Rate for Payer: Healthscope Commercial	$240.53
Rate for Payer: Mclaren Medicaid	$71.93
Rate for Payer: Mclaren Medicare	$134.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$140.90
Rate for Payer: Meridian Medicaid	$75.52
Rate for Payer: MI Amish Medical Board Commercial	$154.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.16
Rate for Payer: PACE Medicare	$127.48
Rate for Payer: PACE SWMI	$134.19
Rate for Payer: PHP Commercial	$227.16
Rate for Payer: PHP Medicare Advantage	$134.19
Rate for Payer: Priority Health Choice Medicaid	$71.93
Rate for Payer: Priority Health Cigna Priority Health	$173.71
Rate for Payer: Priority Health Medicare	$134.19
Rate for Payer: Priority Health SBD	$168.37
Rate for Payer: Railroad Medicare Medicare	$134.19
Rate for Payer: UHC All Payor (Choice/PPO)	$377.73
Rate for Payer: UHC Dual Complete DSNP	$134.19
Rate for Payer: UHC Medicare Advantage	$134.19
Rate for Payer: UHCCP Medicaid	$75.55
Rate for Payer: VA VA	$134.19

HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION

Facility

$2,174.88

Service Code	HCPCS 90371
Hospital Charge Code	91047
Hospital Revenue Code	636
Min. Negotiated Rate	$71.93
Max. Negotiated Rate	$1,957.39
Rate for Payer: Aetna Commercial	$1,848.65
Rate for Payer: Aetna Medicare	$139.56
Rate for Payer: Aetna New Business (MI Preferred)	$1,413.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$167.74
Rate for Payer: Amish Plain Church Group Commercial	$167.74
Rate for Payer: BCBS Complete	$75.52
Rate for Payer: BCBS MAPPO	$134.19
Rate for Payer: BCN Medicare Advantage	$134.19
Rate for Payer: Cash Price	$1,739.90
Rate for Payer: Cash Price	$1,739.90
Rate for Payer: Cofinity Commercial	$1,870.40
Rate for Payer: Cofinity Commercial	$1,522.42
Rate for Payer: Cofinity Medicare Advantage	$1,522.42
Rate for Payer: Encore Health Key Benefits Commercial	$1,739.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$134.19
Rate for Payer: Healthscope Commercial	$1,957.39
Rate for Payer: Mclaren Medicaid	$71.93
Rate for Payer: Mclaren Medicare	$134.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$140.90
Rate for Payer: Meridian Medicaid	$75.52
Rate for Payer: MI Amish Medical Board Commercial	$154.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,848.65
Rate for Payer: PACE Medicare	$127.48
Rate for Payer: PACE SWMI	$134.19
Rate for Payer: PHP Commercial	$1,848.65
Rate for Payer: PHP Medicare Advantage	$134.19
Rate for Payer: Priority Health Choice Medicaid	$71.93
Rate for Payer: Priority Health Cigna Priority Health	$1,413.67
Rate for Payer: Priority Health Medicare	$134.19
Rate for Payer: Priority Health SBD	$1,370.17
Rate for Payer: Railroad Medicare Medicare	$134.19
Rate for Payer: UHC All Payor (Choice/PPO)	$377.73
Rate for Payer: UHC Dual Complete DSNP	$134.19
Rate for Payer: UHC Medicare Advantage	$134.19
Rate for Payer: UHCCP Medicaid	$75.55
Rate for Payer: VA VA	$134.19

HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION

Facility

$2,174.88

Service Code	HCPCS 90371
Hospital Charge Code	91047
Hospital Revenue Code	636
Min. Negotiated Rate	$1,370.17
Max. Negotiated Rate	$1,957.39
Rate for Payer: Aetna Commercial	$1,848.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,413.67
Rate for Payer: Cash Price	$1,739.90
Rate for Payer: Cofinity Commercial	$1,522.42
Rate for Payer: Cofinity Commercial	$1,870.40
Rate for Payer: Cofinity Medicare Advantage	$1,522.42
Rate for Payer: Encore Health Key Benefits Commercial	$1,739.90
Rate for Payer: Healthscope Commercial	$1,957.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,848.65
Rate for Payer: PHP Commercial	$1,848.65
Rate for Payer: Priority Health Cigna Priority Health	$1,413.67
Rate for Payer: Priority Health SBD	$1,370.17

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

Facility

$158.26

Service Code	HCPCS 90746
Hospital Charge Code	118174
Hospital Revenue Code	636
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$142.43
Rate for Payer: Aetna Commercial	$134.52
Rate for Payer: Aetna Medicare	$79.13
Rate for Payer: Aetna New Business (MI Preferred)	$102.87
Rate for Payer: BCBS Complete	$63.30
Rate for Payer: Cash Price	$126.61
Rate for Payer: Cofinity Commercial	$110.78
Rate for Payer: Cofinity Commercial	$136.10
Rate for Payer: Cofinity Medicare Advantage	$110.78
Rate for Payer: Encore Health Key Benefits Commercial	$126.61
Rate for Payer: Healthscope Commercial	$142.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.52
Rate for Payer: PHP Commercial	$134.52
Rate for Payer: Priority Health Cigna Priority Health	$102.87
Rate for Payer: Priority Health SBD	$99.70

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

Facility

$158.26

Service Code	HCPCS 90746
Hospital Charge Code	118174
Hospital Revenue Code	636
Min. Negotiated Rate	$99.70
Max. Negotiated Rate	$142.43
Rate for Payer: Aetna Commercial	$134.52
Rate for Payer: Aetna New Business (MI Preferred)	$102.87
Rate for Payer: Cash Price	$126.61
Rate for Payer: Cofinity Commercial	$110.78
Rate for Payer: Cofinity Commercial	$136.10
Rate for Payer: Cofinity Medicare Advantage	$110.78
Rate for Payer: Encore Health Key Benefits Commercial	$126.61
Rate for Payer: Healthscope Commercial	$142.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.52
Rate for Payer: PHP Commercial	$134.52
Rate for Payer: Priority Health Cigna Priority Health	$102.87
Rate for Payer: Priority Health SBD	$99.70

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 Commercial	$10.72
Rate for Payer: Cofinity Commercial	$8.73
Rate for Payer: Cofinity Medicare Advantage	$8.73
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: PHP Commercial	$10.60
Rate for Payer: Priority Health Cigna Priority Health	$8.11
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	$4.99
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 Commercial	$10.72
Rate for Payer: Cofinity Commercial	$8.73
Rate for Payer: Cofinity Medicare Advantage	$8.73
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: PHP Commercial	$10.60
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

HH DRSG MEPILEX AG FOAM 4X4 EA

Facility

$27.16

Service Code	HCPCS A6209
Hospital Charge Code	62300044
Hospital Revenue Code	623
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$24.44
Rate for Payer: Aetna Commercial	$23.09
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cofinity Commercial	$19.01
Rate for Payer: Cofinity Commercial	$23.36
Rate for Payer: Cofinity Medicare Advantage	$19.01
Rate for Payer: Encore Health Key Benefits Commercial	$21.73
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.09
Rate for Payer: PHP Commercial	$23.09
Rate for Payer: Priority Health Cigna Priority Health	$17.65
Rate for Payer: Priority Health SBD	$17.11

HH DRSG MEPILEX AG FOAM 4X4 EA

Facility

$27.16

Service Code	HCPCS A6209
Hospital Charge Code	62300044
Hospital Revenue Code	623
Min. Negotiated Rate	$10.86
Max. Negotiated Rate	$24.44
Rate for Payer: Aetna Commercial	$23.09
Rate for Payer: Aetna Medicare	$13.58
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: BCBS Complete	$10.86
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cofinity Commercial	$19.01
Rate for Payer: Cofinity Commercial	$23.36
Rate for Payer: Cofinity Medicare Advantage	$19.01
Rate for Payer: Encore Health Key Benefits Commercial	$21.73
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.09
Rate for Payer: PHP Commercial	$23.09
Rate for Payer: Priority Health Cigna Priority Health	$17.65
Rate for Payer: Priority Health SBD	$17.11

HH DRSG MEPILEX BORDER 4X4 EA

Facility

$9.78

Service Code	HCPCS A6212
Hospital Charge Code	62300017
Hospital Revenue Code	623
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$8.80
Rate for Payer: Aetna Commercial	$8.31
Rate for Payer: Aetna New Business (MI Preferred)	$6.36
Rate for Payer: Cash Price	$7.82
Rate for Payer: Cofinity Commercial	$6.85
Rate for Payer: Cofinity Commercial	$8.41
Rate for Payer: Cofinity Medicare Advantage	$6.85
Rate for Payer: Encore Health Key Benefits Commercial	$7.82
Rate for Payer: Healthscope Commercial	$8.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.31
Rate for Payer: PHP Commercial	$8.31
Rate for Payer: Priority Health Cigna Priority Health	$6.36
Rate for Payer: Priority Health SBD	$6.16

HH DRSG MEPILEX BORDER 4X4 EA

Facility

$9.78

Service Code	HCPCS A6212
Hospital Charge Code	62300017
Hospital Revenue Code	623
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$8.80
Rate for Payer: Aetna Commercial	$8.31
Rate for Payer: Aetna Medicare	$4.89
Rate for Payer: Aetna New Business (MI Preferred)	$6.36
Rate for Payer: BCBS Complete	$3.91
Rate for Payer: Cash Price	$7.82
Rate for Payer: Cofinity Commercial	$6.85
Rate for Payer: Cofinity Commercial	$8.41
Rate for Payer: Cofinity Medicare Advantage	$6.85
Rate for Payer: Encore Health Key Benefits Commercial	$7.82
Rate for Payer: Healthscope Commercial	$8.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.31
Rate for Payer: PHP Commercial	$8.31
Rate for Payer: Priority Health Cigna Priority Health	$6.36
Rate for Payer: Priority Health SBD	$6.16

HH DRSG MEPILEX BORDER 6X6 EA

Facility

$21.87

Service Code	HCPCS A6212
Hospital Charge Code	62300067
Hospital Revenue Code	623
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$19.68
Rate for Payer: Aetna Commercial	$18.59
Rate for Payer: Aetna Medicare	$10.94
Rate for Payer: Aetna New Business (MI Preferred)	$14.22
Rate for Payer: BCBS Complete	$8.75
Rate for Payer: Cash Price	$17.50
Rate for Payer: Cofinity Commercial	$15.31
Rate for Payer: Cofinity Commercial	$18.81
Rate for Payer: Cofinity Medicare Advantage	$15.31
Rate for Payer: Encore Health Key Benefits Commercial	$17.50
Rate for Payer: Healthscope Commercial	$19.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.59
Rate for Payer: PHP Commercial	$18.59
Rate for Payer: Priority Health Cigna Priority Health	$14.22
Rate for Payer: Priority Health SBD	$13.78

HH DRSG MEPILEX BORDER 6X6 EA

Facility

$21.87

Service Code	HCPCS A6212
Hospital Charge Code	62300067
Hospital Revenue Code	623
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$19.68
Rate for Payer: Aetna Commercial	$18.59
Rate for Payer: Aetna New Business (MI Preferred)	$14.22
Rate for Payer: Cash Price	$17.50
Rate for Payer: Cofinity Commercial	$15.31
Rate for Payer: Cofinity Commercial	$18.81
Rate for Payer: Cofinity Medicare Advantage	$15.31
Rate for Payer: Encore Health Key Benefits Commercial	$17.50
Rate for Payer: Healthscope Commercial	$19.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.59
Rate for Payer: PHP Commercial	$18.59
Rate for Payer: Priority Health Cigna Priority Health	$14.22
Rate for Payer: Priority Health SBD	$13.78

HH DRSG MEPILEX BORDER 6X8 EA

Facility

$22.47

Service Code	HCPCS A6213
Hospital Charge Code	62300053
Hospital Revenue Code	623
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$20.22
Rate for Payer: Aetna Commercial	$19.10
Rate for Payer: Aetna Medicare	$11.23
Rate for Payer: Aetna New Business (MI Preferred)	$14.61
Rate for Payer: BCBS Complete	$8.99
Rate for Payer: Cash Price	$17.98
Rate for Payer: Cofinity Commercial	$15.73
Rate for Payer: Cofinity Commercial	$19.32
Rate for Payer: Cofinity Medicare Advantage	$15.73
Rate for Payer: Encore Health Key Benefits Commercial	$17.98
Rate for Payer: Healthscope Commercial	$20.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.10
Rate for Payer: PHP Commercial	$19.10
Rate for Payer: Priority Health Cigna Priority Health	$14.61
Rate for Payer: Priority Health SBD	$14.16

HH DRSG MEPILEX BORDER 6X8 EA

Facility

$22.47

Service Code	HCPCS A6213
Hospital Charge Code	62300053
Hospital Revenue Code	623
Min. Negotiated Rate	$14.16
Max. Negotiated Rate	$20.22
Rate for Payer: Aetna Commercial	$19.10
Rate for Payer: Aetna New Business (MI Preferred)	$14.61
Rate for Payer: Cash Price	$17.98
Rate for Payer: Cofinity Commercial	$15.73
Rate for Payer: Cofinity Commercial	$19.32
Rate for Payer: Cofinity Medicare Advantage	$15.73
Rate for Payer: Encore Health Key Benefits Commercial	$17.98
Rate for Payer: Healthscope Commercial	$20.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.10
Rate for Payer: PHP Commercial	$19.10
Rate for Payer: Priority Health Cigna Priority Health	$14.61
Rate for Payer: Priority Health SBD	$14.16

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM

Facility

$839.87

Service Code	CPT 97607
Hospital Charge Code	76100035
Hospital Revenue Code	761
Min. Negotiated Rate	$529.12
Max. Negotiated Rate	$755.88
Rate for Payer: Aetna Commercial	$713.89
Rate for Payer: Aetna New Business (MI Preferred)	$545.92
Rate for Payer: Cash Price	$671.90
Rate for Payer: Cofinity Commercial	$587.91
Rate for Payer: Cofinity Commercial	$722.29
Rate for Payer: Cofinity Medicare Advantage	$587.91
Rate for Payer: Encore Health Key Benefits Commercial	$671.90
Rate for Payer: Healthscope Commercial	$755.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$713.89
Rate for Payer: PHP Commercial	$713.89
Rate for Payer: Priority Health Cigna Priority Health	$545.92
Rate for Payer: Priority Health SBD	$529.12

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM

Facility

$839.87

Service Code	CPT 97607
Hospital Charge Code	76100035
Hospital Revenue Code	761
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$713.89
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$545.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$671.90
Rate for Payer: Cash Price	$671.90
Rate for Payer: Cofinity Commercial	$722.29
Rate for Payer: Cofinity Commercial	$587.91
Rate for Payer: Cofinity Medicare Advantage	$587.91
Rate for Payer: Encore Health Key Benefits Commercial	$671.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$755.88
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$713.89
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$713.89
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$545.92
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$529.12
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM

Facility

$699.89

Service Code	CPT 97608
Hospital Charge Code	76100036
Hospital Revenue Code	761
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$594.91
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$454.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$559.91
Rate for Payer: Cash Price	$559.91
Rate for Payer: Cofinity Commercial	$601.91
Rate for Payer: Cofinity Commercial	$489.92
Rate for Payer: Cofinity Medicare Advantage	$489.92
Rate for Payer: Encore Health Key Benefits Commercial	$559.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$629.90
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$594.91
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$594.91
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$454.93
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$440.93
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM

Facility

$699.89

Service Code	CPT 97608
Hospital Charge Code	76100036
Hospital Revenue Code	761
Min. Negotiated Rate	$440.93
Max. Negotiated Rate	$629.90
Rate for Payer: Aetna Commercial	$594.91
Rate for Payer: Aetna New Business (MI Preferred)	$454.93
Rate for Payer: Cash Price	$559.91
Rate for Payer: Cofinity Commercial	$489.92
Rate for Payer: Cofinity Commercial	$601.91
Rate for Payer: Cofinity Medicare Advantage	$489.92
Rate for Payer: Encore Health Key Benefits Commercial	$559.91
Rate for Payer: Healthscope Commercial	$629.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$594.91
Rate for Payer: PHP Commercial	$594.91
Rate for Payer: Priority Health Cigna Priority Health	$454.93
Rate for Payer: Priority Health SBD	$440.93

Know your out-of-pocket cost for care.

All Charges