Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$192.85

Service Code	NDC 0904-6474-61
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Commercial	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$163.92
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health Cigna Priority Health	$135.00
Rate for Payer: Priority Health SBD	$121.50

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$1,386.50

Service Code	NDC 65862-560-99
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$873.50
Max. Negotiated Rate	$1,247.85
Rate for Payer: Aetna Commercial	$1,178.52
Rate for Payer: Aetna New Business (MI Preferred)	$901.22
Rate for Payer: Cash Price	$1,109.20
Rate for Payer: Cofinity Commercial	$1,192.39
Rate for Payer: Cofinity Commercial	$970.55
Rate for Payer: Healthscope Commercial	$1,247.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,178.52
Rate for Payer: PHP Commercial	$1,178.52
Rate for Payer: Priority Health Cigna Priority Health	$970.55
Rate for Payer: Priority Health SBD	$873.50

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$199.50

Service Code	NDC 51079-051-20
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$125.68
Max. Negotiated Rate	$179.55
Rate for Payer: Aetna Commercial	$169.58
Rate for Payer: Aetna New Business (MI Preferred)	$129.68
Rate for Payer: Cash Price	$159.60
Rate for Payer: Cofinity Commercial	$139.65
Rate for Payer: Cofinity Commercial	$171.57
Rate for Payer: Healthscope Commercial	$179.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$169.58
Rate for Payer: PHP Commercial	$169.58
Rate for Payer: Priority Health Cigna Priority Health	$139.65
Rate for Payer: Priority Health SBD	$125.68

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$319.60

Service Code	NDC 68084-813-09
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$201.35
Max. Negotiated Rate	$287.64
Rate for Payer: Aetna Commercial	$271.66
Rate for Payer: Aetna New Business (MI Preferred)	$207.74
Rate for Payer: Cash Price	$255.68
Rate for Payer: Cofinity Commercial	$223.72
Rate for Payer: Cofinity Commercial	$274.86
Rate for Payer: Healthscope Commercial	$287.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$271.66
Rate for Payer: PHP Commercial	$271.66
Rate for Payer: Priority Health Cigna Priority Health	$223.72
Rate for Payer: Priority Health SBD	$201.35

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$149.23

Service Code	NDC 50268-639-15
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$94.01
Max. Negotiated Rate	$134.31
Rate for Payer: Aetna Commercial	$126.85
Rate for Payer: Aetna New Business (MI Preferred)	$97.00
Rate for Payer: Cash Price	$119.38
Rate for Payer: Cofinity Commercial	$104.46
Rate for Payer: Cofinity Commercial	$128.34
Rate for Payer: Healthscope Commercial	$134.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$126.85
Rate for Payer: PHP Commercial	$126.85
Rate for Payer: Priority Health Cigna Priority Health	$104.46
Rate for Payer: Priority Health SBD	$94.01

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$254.60

Service Code	NDC 63739-564-10
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$160.40
Max. Negotiated Rate	$229.14
Rate for Payer: Aetna Commercial	$216.41
Rate for Payer: Aetna New Business (MI Preferred)	$165.49
Rate for Payer: Cash Price	$203.68
Rate for Payer: Cofinity Commercial	$178.22
Rate for Payer: Cofinity Commercial	$218.96
Rate for Payer: Healthscope Commercial	$229.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$216.41
Rate for Payer: PHP Commercial	$216.41
Rate for Payer: Priority Health Cigna Priority Health	$178.22
Rate for Payer: Priority Health SBD	$160.40

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$120.56

Service Code	NDC 65862-560-90
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$75.95
Max. Negotiated Rate	$108.50
Rate for Payer: Aetna Commercial	$102.48
Rate for Payer: Aetna New Business (MI Preferred)	$78.36
Rate for Payer: Cash Price	$96.45
Rate for Payer: Cofinity Commercial	$103.68
Rate for Payer: Cofinity Commercial	$84.39
Rate for Payer: Healthscope Commercial	$108.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.48
Rate for Payer: PHP Commercial	$102.48
Rate for Payer: Priority Health Cigna Priority Health	$84.39
Rate for Payer: Priority Health SBD	$75.95

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$4,482.85

Service Code	NDC 0008-0841-81
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$2,824.20
Max. Negotiated Rate	$4,034.56
Rate for Payer: Aetna Commercial	$3,810.42
Rate for Payer: Aetna New Business (MI Preferred)	$2,913.85
Rate for Payer: Cash Price	$3,586.28
Rate for Payer: Cofinity Commercial	$3,138.00
Rate for Payer: Cofinity Commercial	$3,855.25
Rate for Payer: Healthscope Commercial	$4,034.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,810.42
Rate for Payer: PHP Commercial	$3,810.42
Rate for Payer: Priority Health Cigna Priority Health	$3,138.00
Rate for Payer: Priority Health SBD	$2,824.20

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$207.10

Service Code	NDC 35573-428-80
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$186.39
Rate for Payer: Aetna Commercial	$176.04
Rate for Payer: Aetna New Business (MI Preferred)	$134.62
Rate for Payer: Cash Price	$165.68
Rate for Payer: Cofinity Commercial	$144.97
Rate for Payer: Cofinity Commercial	$178.11
Rate for Payer: Healthscope Commercial	$186.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$176.04
Rate for Payer: PHP Commercial	$176.04
Rate for Payer: Priority Health Cigna Priority Health	$144.97
Rate for Payer: Priority Health SBD	$130.47

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$272.84

Service Code	NDC 62175-617-46
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$171.89
Max. Negotiated Rate	$245.56
Rate for Payer: Aetna Commercial	$231.91
Rate for Payer: Aetna New Business (MI Preferred)	$177.35
Rate for Payer: Cash Price	$218.27
Rate for Payer: Cofinity Commercial	$190.99
Rate for Payer: Cofinity Commercial	$234.64
Rate for Payer: Healthscope Commercial	$245.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.91
Rate for Payer: PHP Commercial	$231.91
Rate for Payer: Priority Health Cigna Priority Health	$190.99
Rate for Payer: Priority Health SBD	$171.89

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$2.00

Service Code	NDC 51079-051-01
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.80
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna New Business (MI Preferred)	$1.30
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cofinity Commercial	$1.40
Rate for Payer: Cofinity Commercial	$1.72
Rate for Payer: Healthscope Commercial	$1.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.70
Rate for Payer: PHP Commercial	$1.70
Rate for Payer: Priority Health Cigna Priority Health	$1.40
Rate for Payer: Priority Health SBD	$1.26

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$4.00

Service Code	NDC 68084-813-11
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Aetna New Business (MI Preferred)	$2.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cofinity Commercial	$2.80
Rate for Payer: Cofinity Commercial	$3.44
Rate for Payer: Healthscope Commercial	$3.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.40
Rate for Payer: PHP Commercial	$3.40
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: Priority Health SBD	$2.52

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$378.59

Service Code	NDC 55111-333-90
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$238.51
Max. Negotiated Rate	$340.73
Rate for Payer: Aetna Commercial	$321.80
Rate for Payer: Aetna New Business (MI Preferred)	$246.08
Rate for Payer: Cash Price	$302.87
Rate for Payer: Cofinity Commercial	$265.01
Rate for Payer: Cofinity Commercial	$325.59
Rate for Payer: Healthscope Commercial	$340.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$321.80
Rate for Payer: PHP Commercial	$321.80
Rate for Payer: Priority Health Cigna Priority Health	$265.01
Rate for Payer: Priority Health SBD	$238.51

PAPAVERINE 30 MG/ML INJECTION SOLUTION

Facility

$68.81

Service Code	HCPCS J2440
Hospital Charge Code	6030
Hospital Revenue Code	636
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$61.93
Rate for Payer: Aetna Commercial	$58.49
Rate for Payer: Aetna New Business (MI Preferred)	$44.73
Rate for Payer: Cash Price	$55.05
Rate for Payer: Cofinity Commercial	$59.18
Rate for Payer: Cofinity Commercial	$48.17
Rate for Payer: Healthscope Commercial	$61.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.49
Rate for Payer: PHP Commercial	$58.49
Rate for Payer: Priority Health Cigna Priority Health	$48.17
Rate for Payer: Priority Health SBD	$43.35

PARABEN-CETYL ALCOHOL-STEARYL ALCOHOL-PROPY GLYCOL-SLS TOPICAL CLEANER

Facility

$38.08

Service Code	NDC 299392116
Hospital Charge Code	113943
Hospital Revenue Code	637
Min. Negotiated Rate	$23.99
Max. Negotiated Rate	$34.27
Rate for Payer: Aetna Commercial	$32.37
Rate for Payer: Aetna New Business (MI Preferred)	$24.75
Rate for Payer: Cash Price	$30.46
Rate for Payer: Cofinity Commercial	$26.66
Rate for Payer: Cofinity Commercial	$32.75
Rate for Payer: Healthscope Commercial	$34.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.37
Rate for Payer: PHP Commercial	$32.37
Rate for Payer: Priority Health Cigna Priority Health	$26.66
Rate for Payer: Priority Health SBD	$23.99

PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION

Facility

$40.60

Service Code	NDC 0338-0644-06
Hospital Charge Code	117996
Hospital Revenue Code	250
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$36.54
Rate for Payer: Aetna Commercial	$34.51
Rate for Payer: Aetna New Business (MI Preferred)	$26.39
Rate for Payer: Cash Price	$32.48
Rate for Payer: Cofinity Commercial	$28.42
Rate for Payer: Cofinity Commercial	$34.92
Rate for Payer: Healthscope Commercial	$36.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.51
Rate for Payer: PHP Commercial	$34.51
Rate for Payer: Priority Health Cigna Priority Health	$28.42
Rate for Payer: Priority Health SBD	$25.58

PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION

Facility

$72.50

Service Code	NDC 0338-0502-06
Hospital Charge Code	188047
Hospital Revenue Code	250
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$65.25
Rate for Payer: Aetna Commercial	$61.62
Rate for Payer: Aetna New Business (MI Preferred)	$47.12
Rate for Payer: Cash Price	$58.00
Rate for Payer: Cofinity Commercial	$50.75
Rate for Payer: Cofinity Commercial	$62.35
Rate for Payer: Healthscope Commercial	$65.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.62
Rate for Payer: PHP Commercial	$61.62
Rate for Payer: Priority Health Cigna Priority Health	$50.75
Rate for Payer: Priority Health SBD	$45.68

PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION

Facility

$86.28

Service Code	NDC 0338-0502-03
Hospital Charge Code	188047
Hospital Revenue Code	250
Min. Negotiated Rate	$54.36
Max. Negotiated Rate	$77.65
Rate for Payer: Aetna Commercial	$73.34
Rate for Payer: Aetna New Business (MI Preferred)	$56.08
Rate for Payer: Cash Price	$69.02
Rate for Payer: Cofinity Commercial	$60.40
Rate for Payer: Cofinity Commercial	$74.20
Rate for Payer: Healthscope Commercial	$77.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$73.34
Rate for Payer: PHP Commercial	$73.34
Rate for Payer: Priority Health Cigna Priority Health	$60.40
Rate for Payer: Priority Health SBD	$54.36

PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION

Facility

$16.25

Service Code	HCPCS J2501
Hospital Charge Code	31688
Hospital Revenue Code	636
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$14.62
Rate for Payer: Aetna Commercial	$13.81
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Aetna New Business (MI Preferred)	$10.56
Rate for Payer: Aetna New Business (MI Preferred)	$17.89
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$22.02
Rate for Payer: Cofinity Commercial	$11.38
Rate for Payer: Cofinity Commercial	$13.98
Rate for Payer: Cofinity Commercial	$23.68
Rate for Payer: Cofinity Commercial	$19.27
Rate for Payer: Healthscope Commercial	$24.78
Rate for Payer: Healthscope Commercial	$14.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.40
Rate for Payer: PHP Commercial	$13.81
Rate for Payer: PHP Commercial	$23.40
Rate for Payer: Priority Health Cigna Priority Health	$19.27
Rate for Payer: Priority Health Cigna Priority Health	$11.38
Rate for Payer: Priority Health SBD	$10.24
Rate for Payer: Priority Health SBD	$17.34

PAROXETINE 20 MG TABLET

Facility

$392.45

Service Code	NDC 0904-5677-61
Hospital Charge Code	10855
Hospital Revenue Code	637
Min. Negotiated Rate	$247.24
Max. Negotiated Rate	$353.20
Rate for Payer: Aetna Commercial	$333.58
Rate for Payer: Aetna New Business (MI Preferred)	$255.09
Rate for Payer: Cash Price	$313.96
Rate for Payer: Cofinity Commercial	$274.72
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Healthscope Commercial	$353.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$333.58
Rate for Payer: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$274.72
Rate for Payer: Priority Health SBD	$247.24

PAROXETINE 20 MG TABLET

Facility

$408.90

Service Code	NDC 63739-963-10
Hospital Charge Code	10855
Hospital Revenue Code	637
Min. Negotiated Rate	$257.61
Max. Negotiated Rate	$368.01
Rate for Payer: Aetna Commercial	$347.56
Rate for Payer: Aetna New Business (MI Preferred)	$265.78
Rate for Payer: Cash Price	$327.12
Rate for Payer: Cofinity Commercial	$286.23
Rate for Payer: Cofinity Commercial	$351.65
Rate for Payer: Healthscope Commercial	$368.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$347.56
Rate for Payer: PHP Commercial	$347.56
Rate for Payer: Priority Health Cigna Priority Health	$286.23
Rate for Payer: Priority Health SBD	$257.61

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER

Facility

$4,301.45

Service Code	CPT 26236
Hospital Revenue Code	360
Min. Negotiated Rate	$444.34
Max. Negotiated Rate	$4,301.45
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$779.80
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,301.45
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Priority Health Narrow Network	$3,441.16
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$488.77
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$444.34
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); PROXIMAL OR MIDDLE PHALANX OF FINGER

Facility

$4,301.45

Service Code	CPT 26235
Hospital Revenue Code	360
Min. Negotiated Rate	$494.76
Max. Negotiated Rate	$4,301.45
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$804.96
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,301.45
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Priority Health Narrow Network	$3,441.16
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$544.24
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$494.76
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS

Facility

$8,925.64

Service Code	CPT 28120
Hospital Revenue Code	360
Min. Negotiated Rate	$491.49
Max. Negotiated Rate	$8,925.64
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,889.48
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,925.64
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health Narrow Network	$7,140.51
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$540.64
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$491.49
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS

Facility

$8,925.64

Service Code	CPT 28122
Hospital Revenue Code	360
Min. Negotiated Rate	$435.50
Max. Negotiated Rate	$8,925.64
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,544.90
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,925.64
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health Narrow Network	$7,140.51
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$479.05
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$435.50
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

Know your out-of-pocket cost for care.

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