Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION

Facility

$128.05

Service Code	NDC 48433023015
Hospital Charge Code	108150
Hospital Revenue Code	637
Min. Negotiated Rate	$50.32
Max. Negotiated Rate	$115.25
Rate for Payer: Aetna Commercial	$108.84
Rate for Payer: Aetna Medicare	$64.03
Rate for Payer: Aetna New Business (MI Preferred)	$83.23
Rate for Payer: BCBS Complete	$51.22
Rate for Payer: Cash Price	$102.44
Rate for Payer: Cofinity Advantage	$89.64
Rate for Payer: Cofinity Commercial	$110.12
Rate for Payer: Encore Health Key Benefits Commercial	$102.44
Rate for Payer: Healthscope Commercial	$115.25
Rate for Payer: MI Amish Medical Board Commercial	$102.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.04
Rate for Payer: PHP Commercial	$108.84
Rate for Payer: Priority Health SBD	$80.67
Rate for Payer: UHC All Payor (Choice/PPO)	$83.23
Rate for Payer: UHC Core	$66.71
Rate for Payer: UHC Exchange	$50.32

IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION

Facility

$61.88

Service Code	HCPCS Q9966
Hospital Charge Code	10325
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$55.69
Rate for Payer: Aetna Commercial	$52.60
Rate for Payer: Aetna Medicare	$30.94
Rate for Payer: Aetna New Business (MI Preferred)	$40.22
Rate for Payer: BCBS Complete	$24.75
Rate for Payer: BCBS Trust/PPO	$0.98
Rate for Payer: BCN Commercial	$0.98
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cofinity Advantage	$43.32
Rate for Payer: Cofinity Commercial	$53.22
Rate for Payer: Encore Health Key Benefits Commercial	$49.50
Rate for Payer: Healthscope Commercial	$55.69
Rate for Payer: MI Amish Medical Board Commercial	$49.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.41
Rate for Payer: PHP Commercial	$52.60
Rate for Payer: Priority Health SBD	$38.98
Rate for Payer: UHC All Payor (Choice/PPO)	$0.66
Rate for Payer: UHC Core	$0.66
Rate for Payer: UHC Exchange	$0.66

IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION

Facility

$61.88

Service Code	HCPCS Q9966
Hospital Charge Code	10325
Hospital Revenue Code	636
Min. Negotiated Rate	$38.98
Max. Negotiated Rate	$55.69
Rate for Payer: Aetna Commercial	$52.60
Rate for Payer: Aetna New Business (MI Preferred)	$40.22
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cofinity Advantage	$43.32
Rate for Payer: Cofinity Commercial	$53.22
Rate for Payer: Encore Health Key Benefits Commercial	$49.50
Rate for Payer: Healthscope Commercial	$55.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.41
Rate for Payer: PHP Commercial	$52.60
Rate for Payer: Priority Health SBD	$38.98

IOPAMIDOL 250 MG IODINE/ML (51 %) INTRAVENOUS SOLUTION

Facility

$4.85

Service Code	HCPCS Q9966
Hospital Charge Code	10326
Hospital Revenue Code	636
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.37
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Advantage	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$3.88
Rate for Payer: Healthscope Commercial	$4.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.64
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health SBD	$3.06

IOPAMIDOL 250 MG IODINE/ML (51 %) INTRAVENOUS SOLUTION

Facility

$4.85

Service Code	HCPCS Q9966
Hospital Charge Code	10326
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$4.37
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: BCBS Complete	$1.94
Rate for Payer: BCBS Trust/PPO	$0.98
Rate for Payer: BCN Commercial	$0.98
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Advantage	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$3.88
Rate for Payer: Healthscope Commercial	$4.37
Rate for Payer: MI Amish Medical Board Commercial	$3.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.64
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health SBD	$3.06
Rate for Payer: UHC All Payor (Choice/PPO)	$0.66
Rate for Payer: UHC Core	$0.66
Rate for Payer: UHC Exchange	$0.66

IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION

Facility

$72.90

Service Code	HCPCS Q9967
Hospital Charge Code	10327
Hospital Revenue Code	636
Min. Negotiated Rate	$45.93
Max. Negotiated Rate	$65.61
Rate for Payer: Aetna Commercial	$61.97
Rate for Payer: Aetna New Business (MI Preferred)	$47.38
Rate for Payer: Cash Price	$58.32
Rate for Payer: Cofinity Advantage	$51.03
Rate for Payer: Cofinity Commercial	$62.69
Rate for Payer: Encore Health Key Benefits Commercial	$58.32
Rate for Payer: Healthscope Commercial	$65.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.67
Rate for Payer: PHP Commercial	$61.97
Rate for Payer: Priority Health SBD	$45.93

IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION

Facility

$72.90

Service Code	HCPCS Q9967
Hospital Charge Code	10327
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$65.61
Rate for Payer: Aetna Commercial	$61.97
Rate for Payer: Aetna Medicare	$36.45
Rate for Payer: Aetna New Business (MI Preferred)	$47.38
Rate for Payer: BCBS Complete	$29.16
Rate for Payer: BCBS Trust/PPO	$0.37
Rate for Payer: BCN Commercial	$0.37
Rate for Payer: Cash Price	$58.32
Rate for Payer: Cash Price	$58.32
Rate for Payer: Cofinity Advantage	$51.03
Rate for Payer: Cofinity Commercial	$62.69
Rate for Payer: Encore Health Key Benefits Commercial	$58.32
Rate for Payer: Healthscope Commercial	$65.61
Rate for Payer: MI Amish Medical Board Commercial	$58.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.67
Rate for Payer: PHP Commercial	$61.97
Rate for Payer: Priority Health SBD	$45.93
Rate for Payer: UHC All Payor (Choice/PPO)	$0.25
Rate for Payer: UHC Core	$0.25
Rate for Payer: UHC Exchange	$0.25

IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION

Facility

$42.00

Service Code	HCPCS Q9967
Hospital Charge Code	27737
Hospital Revenue Code	636
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Advantage	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health SBD	$26.46

IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION

Facility

$42.00

Service Code	HCPCS Q9967
Hospital Charge Code	27737
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$0.37
Rate for Payer: BCN Commercial	$0.37
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Advantage	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: MI Amish Medical Board Commercial	$33.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health SBD	$26.46
Rate for Payer: UHC All Payor (Choice/PPO)	$0.25
Rate for Payer: UHC Core	$0.25
Rate for Payer: UHC Exchange	$0.25

IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION

Facility

$140.00

Service Code	HCPCS Q9967
Hospital Charge Code	10328
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: BCBS Complete	$56.00
Rate for Payer: BCBS Trust/PPO	$0.37
Rate for Payer: BCN Commercial	$0.37
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Advantage	$98.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Encore Health Key Benefits Commercial	$112.00
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: MI Amish Medical Board Commercial	$112.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.00
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: Priority Health SBD	$88.20
Rate for Payer: UHC All Payor (Choice/PPO)	$0.25
Rate for Payer: UHC Core	$0.25
Rate for Payer: UHC Exchange	$0.25

IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION

Facility

$140.00

Service Code	HCPCS Q9967
Hospital Charge Code	10328
Hospital Revenue Code	636
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Advantage	$98.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Encore Health Key Benefits Commercial	$112.00
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.00
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: Priority Health SBD	$88.20

IOPAMIDOL 61 % ORAL SOLUTION

Facility

$11.20

Service Code	HCPCS Q9967
Hospital Charge Code	180462
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna Commercial	$9.52
Rate for Payer: Aetna Medicare	$5.60
Rate for Payer: Aetna New Business (MI Preferred)	$7.28
Rate for Payer: BCBS Complete	$4.48
Rate for Payer: BCBS Trust/PPO	$0.37
Rate for Payer: BCN Commercial	$0.37
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cofinity Advantage	$7.84
Rate for Payer: Cofinity Commercial	$9.63
Rate for Payer: Encore Health Key Benefits Commercial	$8.96
Rate for Payer: Healthscope Commercial	$10.08
Rate for Payer: MI Amish Medical Board Commercial	$8.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.40
Rate for Payer: PHP Commercial	$9.52
Rate for Payer: Priority Health SBD	$7.06
Rate for Payer: UHC All Payor (Choice/PPO)	$0.25
Rate for Payer: UHC Core	$0.25
Rate for Payer: UHC Exchange	$0.25

IOPAMIDOL 61 % ORAL SOLUTION

Facility

$11.20

Service Code	HCPCS Q9967
Hospital Charge Code	180462
Hospital Revenue Code	636
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna Commercial	$9.52
Rate for Payer: Aetna New Business (MI Preferred)	$7.28
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cofinity Advantage	$7.84
Rate for Payer: Cofinity Commercial	$9.63
Rate for Payer: Encore Health Key Benefits Commercial	$8.96
Rate for Payer: Healthscope Commercial	$10.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.40
Rate for Payer: PHP Commercial	$9.52
Rate for Payer: Priority Health SBD	$7.06

IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION

Facility

$96,052.53

Service Code	HCPCS J9228
Hospital Charge Code	152408
Hospital Revenue Code	636
Min. Negotiated Rate	$97.89
Max. Negotiated Rate	$86,447.28
Rate for Payer: Aetna Commercial	$81,644.65
Rate for Payer: Aetna Medicare	$194.66
Rate for Payer: Aetna New Business (MI Preferred)	$62,434.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$233.96
Rate for Payer: Amish Plain Church Group Commercial	$233.96
Rate for Payer: BCBS Complete	$102.79
Rate for Payer: BCBS MAPPO	$187.17
Rate for Payer: BCBS Trust/PPO	$468.94
Rate for Payer: BCN Commercial	$468.94
Rate for Payer: BCN Medicare Advantage	$187.17
Rate for Payer: Cash Price	$76,842.02
Rate for Payer: Cash Price	$76,842.02
Rate for Payer: Cofinity Advantage	$67,236.77
Rate for Payer: Cofinity Commercial	$82,605.18
Rate for Payer: Encore Health Key Benefits Commercial	$76,842.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$187.17
Rate for Payer: Healthscope Commercial	$86,447.28
Rate for Payer: Mclaren Medicaid	$97.89
Rate for Payer: Mclaren Medicare	$187.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$196.53
Rate for Payer: Meridian Medicaid	$196.53
Rate for Payer: MI Amish Medical Board Commercial	$215.25
Rate for Payer: Molina Medicare/Medicaid	$205.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81,644.65
Rate for Payer: Nomi Health Commercial	$561.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$72,039.40
Rate for Payer: PACE Medicare	$177.81
Rate for Payer: PACE SWMI	$187.17
Rate for Payer: PHP Commercial	$81,644.65
Rate for Payer: PHP Medicare Advantage	$187.17
Rate for Payer: Priority Health Choice Medicaid	$97.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$578.69
Rate for Payer: Priority Health Medicare	$187.17
Rate for Payer: Priority Health SBD	$60,513.09
Rate for Payer: Priority Health Tiered Network	$462.95
Rate for Payer: Railroad Medicare Medicare	$187.17
Rate for Payer: UHC All Payor (Choice/PPO)	$308.40
Rate for Payer: UHC Core	$308.40
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$187.17
Rate for Payer: UHC Exchange	$308.40
Rate for Payer: UHC Medicaid	$97.89
Rate for Payer: UHCCP Medicaid	$97.89
Rate for Payer: VA VA	$187.17

IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION

Facility

$24,013.16

Service Code	HCPCS J9228
Hospital Charge Code	152407
Hospital Revenue Code	636
Min. Negotiated Rate	$97.89
Max. Negotiated Rate	$21,611.84
Rate for Payer: Aetna Commercial	$20,411.19
Rate for Payer: Aetna Medicare	$194.66
Rate for Payer: Aetna New Business (MI Preferred)	$15,608.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$233.96
Rate for Payer: Amish Plain Church Group Commercial	$233.96
Rate for Payer: BCBS Complete	$102.79
Rate for Payer: BCBS MAPPO	$187.17
Rate for Payer: BCBS Trust/PPO	$468.94
Rate for Payer: BCN Commercial	$468.94
Rate for Payer: BCN Medicare Advantage	$187.17
Rate for Payer: Cash Price	$19,210.53
Rate for Payer: Cash Price	$19,210.53
Rate for Payer: Cofinity Advantage	$16,809.21
Rate for Payer: Cofinity Commercial	$20,651.32
Rate for Payer: Encore Health Key Benefits Commercial	$19,210.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$187.17
Rate for Payer: Healthscope Commercial	$21,611.84
Rate for Payer: Mclaren Medicaid	$97.89
Rate for Payer: Mclaren Medicare	$187.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$196.53
Rate for Payer: Meridian Medicaid	$196.53
Rate for Payer: MI Amish Medical Board Commercial	$215.25
Rate for Payer: Molina Medicare/Medicaid	$205.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20,411.19
Rate for Payer: Nomi Health Commercial	$561.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$18,009.87
Rate for Payer: PACE Medicare	$177.81
Rate for Payer: PACE SWMI	$187.17
Rate for Payer: PHP Commercial	$20,411.19
Rate for Payer: PHP Medicare Advantage	$187.17
Rate for Payer: Priority Health Choice Medicaid	$97.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$578.69
Rate for Payer: Priority Health Medicare	$187.17
Rate for Payer: Priority Health SBD	$15,128.29
Rate for Payer: Priority Health Tiered Network	$462.95
Rate for Payer: Railroad Medicare Medicare	$187.17
Rate for Payer: UHC All Payor (Choice/PPO)	$308.40
Rate for Payer: UHC Core	$308.40
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$187.17
Rate for Payer: UHC Exchange	$308.40
Rate for Payer: UHC Medicaid	$97.89
Rate for Payer: UHCCP Medicaid	$97.89
Rate for Payer: VA VA	$187.17

IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION

Facility

$24,013.16

Service Code	HCPCS J9228
Hospital Charge Code	152407
Hospital Revenue Code	636
Min. Negotiated Rate	$15,128.29
Max. Negotiated Rate	$21,611.84
Rate for Payer: Aetna Commercial	$20,411.19
Rate for Payer: Aetna New Business (MI Preferred)	$15,608.55
Rate for Payer: Cash Price	$19,210.53
Rate for Payer: Cofinity Advantage	$16,809.21
Rate for Payer: Cofinity Commercial	$20,651.32
Rate for Payer: Encore Health Key Benefits Commercial	$19,210.53
Rate for Payer: Healthscope Commercial	$21,611.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20,411.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$18,009.87
Rate for Payer: PHP Commercial	$20,411.19
Rate for Payer: Priority Health SBD	$15,128.29

IPL CHEEKS FIRST

Professional

Both

$132.00

Hospital Revenue Code	960
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

IPL CHEST FIRST

Professional

Both

$315.00

Hospital Revenue Code	960
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

IPL CHEST SECOND

Professional

Both

$210.00

Hospital Revenue Code	960
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$84.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50

IPL FACE FIRST

Professional

Both

$237.00

Hospital Revenue Code	960
Min. Negotiated Rate	$94.80
Max. Negotiated Rate	$177.75
Rate for Payer: Aetna Medicare	$118.50
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: Cash Price	$189.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.75

IPL FACE, NECK, CHEST FIRST

Professional

Both

$420.00

Hospital Revenue Code	960
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Medicare	$210.00
Rate for Payer: BCBS Complete	$168.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.00

IPL FACE, NECK, CHEST SECOND

Professional

Both

$289.00

Hospital Revenue Code	960
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$216.75
Rate for Payer: Aetna Medicare	$144.50
Rate for Payer: BCBS Complete	$115.60
Rate for Payer: Cash Price	$231.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$216.75

IPL FACE & NECK FIRST

Professional

Both

$263.00

Hospital Revenue Code	960
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$197.25
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

IPL FACE & NECK SECOND

Professional

Both

$184.00

Hospital Revenue Code	960
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.00

IPL FACE SECOND

Professional

Both

$105.00

Hospital Revenue Code	960
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75

Know your out-of-pocket cost for care.

All Charges