Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$310.65

Service Code	NDC 51079018020
Hospital Charge Code	10454
Hospital Revenue Code	637
Min. Negotiated Rate	$195.71
Max. Negotiated Rate	$279.58
Rate for Payer: Aetna Commercial	$264.05
Rate for Payer: Aetna New Business (MI Preferred)	$201.92
Rate for Payer: Cash Price	$248.52
Rate for Payer: Cofinity Advantage	$217.46
Rate for Payer: Cofinity Commercial	$267.16
Rate for Payer: Encore Health Key Benefits Commercial	$248.52
Rate for Payer: Healthscope Commercial	$279.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$232.99
Rate for Payer: PHP Commercial	$264.05
Rate for Payer: Priority Health SBD	$195.71

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$329.00

Service Code	NDC 64980020501
Hospital Charge Code	10454
Hospital Revenue Code	637
Min. Negotiated Rate	$207.27
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Advantage	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health SBD	$207.27

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$2.79

Service Code	NDC 68084065511
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$2.51
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: Cash Price	$2.23
Rate for Payer: Cofinity Advantage	$1.95
Rate for Payer: Cofinity Commercial	$2.40
Rate for Payer: Encore Health Key Benefits Commercial	$2.23
Rate for Payer: Healthscope Commercial	$2.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.09
Rate for Payer: PHP Commercial	$2.37
Rate for Payer: Priority Health SBD	$1.76

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$278.40

Service Code	NDC 68084065501
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$175.39
Max. Negotiated Rate	$250.56
Rate for Payer: Aetna Commercial	$236.64
Rate for Payer: Aetna New Business (MI Preferred)	$180.96
Rate for Payer: Cash Price	$222.72
Rate for Payer: Cofinity Advantage	$194.88
Rate for Payer: Cofinity Commercial	$239.42
Rate for Payer: Encore Health Key Benefits Commercial	$222.72
Rate for Payer: Healthscope Commercial	$250.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$236.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.80
Rate for Payer: PHP Commercial	$236.64
Rate for Payer: Priority Health SBD	$175.39

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$3.73

Service Code	NDC 51079014201
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna Medicare	$1.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: BCBS Complete	$1.49
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Advantage	$2.61
Rate for Payer: Cofinity Commercial	$3.21
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.36
Rate for Payer: MI Amish Medical Board Commercial	$2.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.80
Rate for Payer: PHP Commercial	$3.17
Rate for Payer: Priority Health SBD	$2.35
Rate for Payer: UHC All Payor (Choice/PPO)	$2.42
Rate for Payer: UHC Core	$1.94
Rate for Payer: UHC Exchange	$1.47

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$2.79

Service Code	NDC 68084065511
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.51
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna Medicare	$1.40
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: BCBS Complete	$1.12
Rate for Payer: Cash Price	$2.23
Rate for Payer: Cofinity Advantage	$1.95
Rate for Payer: Cofinity Commercial	$2.40
Rate for Payer: Encore Health Key Benefits Commercial	$2.23
Rate for Payer: Healthscope Commercial	$2.51
Rate for Payer: MI Amish Medical Board Commercial	$2.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.09
Rate for Payer: PHP Commercial	$2.37
Rate for Payer: Priority Health SBD	$1.76
Rate for Payer: UHC All Payor (Choice/PPO)	$1.81
Rate for Payer: UHC Core	$1.45
Rate for Payer: UHC Exchange	$1.10

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$372.40

Service Code	NDC 51079014220
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$146.35
Max. Negotiated Rate	$335.16
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare	$186.20
Rate for Payer: Aetna New Business (MI Preferred)	$242.06
Rate for Payer: BCBS Complete	$148.96
Rate for Payer: Cash Price	$297.92
Rate for Payer: Cofinity Advantage	$260.68
Rate for Payer: Cofinity Commercial	$320.26
Rate for Payer: Encore Health Key Benefits Commercial	$297.92
Rate for Payer: Healthscope Commercial	$335.16
Rate for Payer: MI Amish Medical Board Commercial	$297.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$279.30
Rate for Payer: PHP Commercial	$316.54
Rate for Payer: Priority Health SBD	$234.61
Rate for Payer: UHC All Payor (Choice/PPO)	$242.06
Rate for Payer: UHC Core	$194.02
Rate for Payer: UHC Exchange	$146.35

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$372.40

Service Code	NDC 51079014220
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$234.61
Max. Negotiated Rate	$335.16
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna New Business (MI Preferred)	$242.06
Rate for Payer: Cash Price	$297.92
Rate for Payer: Cofinity Advantage	$260.68
Rate for Payer: Cofinity Commercial	$320.26
Rate for Payer: Encore Health Key Benefits Commercial	$297.92
Rate for Payer: Healthscope Commercial	$335.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$279.30
Rate for Payer: PHP Commercial	$316.54
Rate for Payer: Priority Health SBD	$234.61

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$278.40

Service Code	NDC 68084065501
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$109.41
Max. Negotiated Rate	$250.56
Rate for Payer: Aetna Commercial	$236.64
Rate for Payer: Aetna Medicare	$139.20
Rate for Payer: Aetna New Business (MI Preferred)	$180.96
Rate for Payer: BCBS Complete	$111.36
Rate for Payer: Cash Price	$222.72
Rate for Payer: Cofinity Advantage	$194.88
Rate for Payer: Cofinity Commercial	$239.42
Rate for Payer: Encore Health Key Benefits Commercial	$222.72
Rate for Payer: Healthscope Commercial	$250.56
Rate for Payer: MI Amish Medical Board Commercial	$222.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$236.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.80
Rate for Payer: PHP Commercial	$236.64
Rate for Payer: Priority Health SBD	$175.39
Rate for Payer: UHC All Payor (Choice/PPO)	$180.96
Rate for Payer: UHC Core	$145.05
Rate for Payer: UHC Exchange	$109.41

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$262.20

Service Code	NDC 68462022401
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$103.04
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna Medicare	$131.10
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: BCBS Complete	$104.88
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Advantage	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: MI Amish Medical Board Commercial	$209.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.65
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health SBD	$165.19
Rate for Payer: UHC All Payor (Choice/PPO)	$170.43
Rate for Payer: UHC Core	$136.61
Rate for Payer: UHC Exchange	$103.04

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$262.20

Service Code	NDC 68462022401
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$165.19
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Advantage	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.65
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health SBD	$165.19

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$3.73

Service Code	NDC 51079014201
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Advantage	$2.61
Rate for Payer: Cofinity Commercial	$3.21
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.80
Rate for Payer: PHP Commercial	$3.17
Rate for Payer: Priority Health SBD	$2.35

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM)

Facility

$11,358.48

Service Code	CPT 52318
Hospital Revenue Code	360
Min. Negotiated Rate	$1,836.94
Max. Negotiated Rate	$11,358.48
Rate for Payer: Aetna Medicare	$3,652.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,390.39
Rate for Payer: Amish Plain Church Group Commercial	$4,390.39
Rate for Payer: BCBS Complete	$1,928.96
Rate for Payer: BCBS MAPPO	$3,512.31
Rate for Payer: BCBS Trust/PPO	$3,026.46
Rate for Payer: BCN Commercial	$3,026.46
Rate for Payer: BCN Medicare Advantage	$3,512.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,512.31
Rate for Payer: Mclaren Medicaid	$1,836.94
Rate for Payer: Mclaren Medicare	$3,512.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,687.93
Rate for Payer: Meridian Medicaid	$3,687.93
Rate for Payer: MI Amish Medical Board Commercial	$4,039.16
Rate for Payer: Molina Medicare/Medicaid	$3,863.54
Rate for Payer: Nomi Health Commercial	$10,536.93
Rate for Payer: PACE Medicare	$3,336.69
Rate for Payer: PACE SWMI	$3,512.31
Rate for Payer: PHP Medicare Advantage	$3,512.31
Rate for Payer: Priority Health Choice Medicaid	$1,836.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$11,358.48
Rate for Payer: Priority Health Medicare	$3,512.31
Rate for Payer: Priority Health Tiered Network	$9,086.78
Rate for Payer: Railroad Medicare Medicare	$3,512.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,512.31
Rate for Payer: UHC Medicaid	$1,836.94
Rate for Payer: UHCCP Medicaid	$1,836.94
Rate for Payer: VA VA	$3,512.31

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM)

Facility

$11,358.48

Service Code	CPT 52317
Hospital Revenue Code	360
Min. Negotiated Rate	$1,836.94
Max. Negotiated Rate	$11,358.48
Rate for Payer: Aetna Medicare	$3,652.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,390.39
Rate for Payer: Amish Plain Church Group Commercial	$4,390.39
Rate for Payer: BCBS Complete	$1,928.96
Rate for Payer: BCBS MAPPO	$3,512.31
Rate for Payer: BCBS Trust/PPO	$2,455.63
Rate for Payer: BCN Commercial	$2,455.63
Rate for Payer: BCN Medicare Advantage	$3,512.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,512.31
Rate for Payer: Mclaren Medicaid	$1,836.94
Rate for Payer: Mclaren Medicare	$3,512.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,687.93
Rate for Payer: Meridian Medicaid	$3,687.93
Rate for Payer: MI Amish Medical Board Commercial	$4,039.16
Rate for Payer: Molina Medicare/Medicaid	$3,863.54
Rate for Payer: Nomi Health Commercial	$10,536.93
Rate for Payer: PACE Medicare	$3,336.69
Rate for Payer: PACE SWMI	$3,512.31
Rate for Payer: PHP Medicare Advantage	$3,512.31
Rate for Payer: Priority Health Choice Medicaid	$1,836.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$11,358.48
Rate for Payer: Priority Health Medicare	$3,512.31
Rate for Payer: Priority Health Tiered Network	$9,086.78
Rate for Payer: Railroad Medicare Medicare	$3,512.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,512.31
Rate for Payer: UHC Medicaid	$1,836.94
Rate for Payer: UHCCP Medicaid	$1,836.94
Rate for Payer: VA VA	$3,512.31

LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE

Facility

$11,358.48

Service Code	CPT 50590
Hospital Revenue Code	360
Min. Negotiated Rate	$1,836.94
Max. Negotiated Rate	$11,358.48
Rate for Payer: Aetna Medicare	$3,652.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,390.39
Rate for Payer: Amish Plain Church Group Commercial	$4,390.39
Rate for Payer: BCBS Complete	$1,928.96
Rate for Payer: BCBS MAPPO	$3,512.31
Rate for Payer: BCBS Trust/PPO	$2,145.59
Rate for Payer: BCN Commercial	$2,145.59
Rate for Payer: BCN Medicare Advantage	$3,512.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,512.31
Rate for Payer: Mclaren Medicaid	$1,836.94
Rate for Payer: Mclaren Medicare	$3,512.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,687.93
Rate for Payer: Meridian Medicaid	$3,687.93
Rate for Payer: MI Amish Medical Board Commercial	$4,039.16
Rate for Payer: Molina Medicare/Medicaid	$3,863.54
Rate for Payer: Nomi Health Commercial	$10,536.93
Rate for Payer: PACE Medicare	$3,336.69
Rate for Payer: PACE SWMI	$3,512.31
Rate for Payer: PHP Medicare Advantage	$3,512.31
Rate for Payer: Priority Health Choice Medicaid	$1,836.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$11,358.48
Rate for Payer: Priority Health Medicare	$3,512.31
Rate for Payer: Priority Health Tiered Network	$9,086.78
Rate for Payer: Railroad Medicare Medicare	$3,512.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,512.31
Rate for Payer: UHC Medicaid	$1,836.94
Rate for Payer: UHCCP Medicaid	$1,836.94
Rate for Payer: VA VA	$3,512.31

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$216,903.21

Service Code	MSDRG 005
Min. Negotiated Rate	$76,247.84
Max. Negotiated Rate	$216,903.21
Rate for Payer: Aetna Medicare	$83,471.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$100,326.10
Rate for Payer: Amish Plain Church Group Commercial	$100,326.10
Rate for Payer: BCBS MAPPO	$80,260.88
Rate for Payer: BCBS Trust/PPO	$216,903.21
Rate for Payer: BCN Commercial	$216,903.21
Rate for Payer: BCN Medicare Advantage	$80,260.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$80,260.88
Rate for Payer: Mclaren Medicare	$80,260.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$84,273.92
Rate for Payer: MI Amish Medical Board Commercial	$92,300.01
Rate for Payer: Molina Medicare/Medicaid	$88,286.97
Rate for Payer: Nomi Health Commercial	$133,005.45
Rate for Payer: PACE Medicare	$76,247.84
Rate for Payer: PACE SWMI	$80,260.88
Rate for Payer: PHP Medicare Advantage	$80,260.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$166,227.32
Rate for Payer: Priority Health Medicare	$80,260.88
Rate for Payer: Priority Health Tiered Network	$132,981.84
Rate for Payer: Railroad Medicare Medicare	$80,260.88
Rate for Payer: VA VA	$80,260.88

LIVER TRANSPLANT WITHOUT MCC

Facility

$83,442.50

Service Code	MSDRG 006
Min. Negotiated Rate	$34,594.04
Max. Negotiated Rate	$83,442.50
Rate for Payer: Aetna Medicare	$37,871.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$45,518.47
Rate for Payer: Amish Plain Church Group Commercial	$45,518.47
Rate for Payer: BCBS MAPPO	$36,414.78
Rate for Payer: BCBS Trust/PPO	$83,442.50
Rate for Payer: BCN Commercial	$83,442.50
Rate for Payer: BCN Medicare Advantage	$36,414.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$36,414.78
Rate for Payer: Mclaren Medicare	$36,414.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$38,235.52
Rate for Payer: MI Amish Medical Board Commercial	$41,877.00
Rate for Payer: Molina Medicare/Medicaid	$40,056.26
Rate for Payer: Nomi Health Commercial	$59,817.30
Rate for Payer: PACE Medicare	$34,594.04
Rate for Payer: PACE SWMI	$36,414.78
Rate for Payer: PHP Medicare Advantage	$36,414.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$74,758.36
Rate for Payer: Priority Health Medicare	$36,414.78
Rate for Payer: Priority Health Tiered Network	$59,806.68
Rate for Payer: Railroad Medicare Medicare	$36,414.78
Rate for Payer: VA VA	$36,414.78

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$39,512.70

Service Code	MSDRG 496
Min. Negotiated Rate	$13,793.94
Max. Negotiated Rate	$39,512.70
Rate for Payer: Aetna Medicare	$15,100.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,149.92
Rate for Payer: Amish Plain Church Group Commercial	$18,149.92
Rate for Payer: BCBS MAPPO	$14,519.94
Rate for Payer: BCBS Trust/PPO	$39,512.70
Rate for Payer: BCN Commercial	$39,512.70
Rate for Payer: BCN Medicare Advantage	$14,519.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,519.94
Rate for Payer: Mclaren Medicare	$14,519.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,245.94
Rate for Payer: MI Amish Medical Board Commercial	$16,697.93
Rate for Payer: Molina Medicare/Medicaid	$15,971.93
Rate for Payer: Nomi Health Commercial	$23,270.31
Rate for Payer: PACE Medicare	$13,793.94
Rate for Payer: PACE SWMI	$14,519.94
Rate for Payer: PHP Medicare Advantage	$14,519.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$29,082.73
Rate for Payer: Priority Health Medicare	$14,519.94
Rate for Payer: Priority Health Tiered Network	$23,266.18
Rate for Payer: Railroad Medicare Medicare	$14,519.94
Rate for Payer: UHC All Payor (Choice/PPO)	$29,403.57
Rate for Payer: UHC Core	$24,599.78
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,519.94
Rate for Payer: UHC Exchange	$20,090.03
Rate for Payer: VA VA	$14,519.94

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$65,404.29

Service Code	MSDRG 495
Min. Negotiated Rate	$27,169.28
Max. Negotiated Rate	$65,404.29
Rate for Payer: Aetna Medicare	$29,743.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$35,749.05
Rate for Payer: Amish Plain Church Group Commercial	$35,749.05
Rate for Payer: BCBS MAPPO	$28,599.24
Rate for Payer: BCBS Trust/PPO	$65,404.29
Rate for Payer: BCN Commercial	$65,404.29
Rate for Payer: BCN Medicare Advantage	$28,599.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$28,599.24
Rate for Payer: Mclaren Medicare	$28,599.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30,029.20
Rate for Payer: MI Amish Medical Board Commercial	$32,889.13
Rate for Payer: Molina Medicare/Medicaid	$31,459.16
Rate for Payer: Nomi Health Commercial	$46,771.53
Rate for Payer: PACE Medicare	$27,169.28
Rate for Payer: PACE SWMI	$28,599.24
Rate for Payer: PHP Medicare Advantage	$28,599.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$58,454.04
Rate for Payer: Priority Health Medicare	$28,599.24
Rate for Payer: Priority Health Tiered Network	$46,763.23
Rate for Payer: Railroad Medicare Medicare	$28,599.24
Rate for Payer: UHC All Payor (Choice/PPO)	$59,098.91
Rate for Payer: UHC Core	$49,443.67
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$28,599.24
Rate for Payer: UHC Exchange	$40,379.42
Rate for Payer: VA VA	$28,599.24

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$25,929.04

Service Code	MSDRG 497
Min. Negotiated Rate	$9,421.18
Max. Negotiated Rate	$25,929.04
Rate for Payer: Aetna Medicare	$10,313.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,396.29
Rate for Payer: Amish Plain Church Group Commercial	$12,396.29
Rate for Payer: BCBS MAPPO	$9,917.03
Rate for Payer: BCBS Trust/PPO	$25,929.04
Rate for Payer: BCN Commercial	$25,929.04
Rate for Payer: BCN Medicare Advantage	$9,917.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,917.03
Rate for Payer: Mclaren Medicare	$9,917.03
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,412.88
Rate for Payer: MI Amish Medical Board Commercial	$11,404.58
Rate for Payer: Molina Medicare/Medicaid	$10,908.73
Rate for Payer: Nomi Health Commercial	$14,856.93
Rate for Payer: PACE Medicare	$9,421.18
Rate for Payer: PACE SWMI	$9,917.03
Rate for Payer: PHP Medicare Advantage	$9,917.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.38
Rate for Payer: Priority Health Medicare	$9,917.03
Rate for Payer: Priority Health Tiered Network	$15,584.30
Rate for Payer: Railroad Medicare Medicare	$9,917.03
Rate for Payer: UHC All Payor (Choice/PPO)	$18,772.71
Rate for Payer: UHC Core	$15,705.73
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,917.03
Rate for Payer: UHC Exchange	$12,826.48
Rate for Payer: VA VA	$9,917.03

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$51,626.34

Service Code	MSDRG 498
Min. Negotiated Rate	$22,698.84
Max. Negotiated Rate	$51,626.34
Rate for Payer: Aetna Medicare	$24,849.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$29,866.90
Rate for Payer: Amish Plain Church Group Commercial	$29,866.90
Rate for Payer: BCBS MAPPO	$23,893.52
Rate for Payer: BCBS Trust/PPO	$51,626.34
Rate for Payer: BCN Commercial	$51,626.34
Rate for Payer: BCN Medicare Advantage	$23,893.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$23,893.52
Rate for Payer: Mclaren Medicare	$23,893.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25,088.20
Rate for Payer: MI Amish Medical Board Commercial	$27,477.55
Rate for Payer: Molina Medicare/Medicaid	$26,282.87
Rate for Payer: Nomi Health Commercial	$38,916.72
Rate for Payer: PACE Medicare	$22,698.84
Rate for Payer: PACE SWMI	$23,893.52
Rate for Payer: PHP Medicare Advantage	$23,893.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$48,637.27
Rate for Payer: Priority Health Medicare	$23,893.52
Rate for Payer: Priority Health Tiered Network	$38,909.81
Rate for Payer: Railroad Medicare Medicare	$23,893.52
Rate for Payer: UHC All Payor (Choice/PPO)	$49,173.84
Rate for Payer: UHC Core	$41,140.10
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$23,893.52
Rate for Payer: UHC Exchange	$33,598.10
Rate for Payer: VA VA	$23,893.52

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$38,389.12

Service Code	MSDRG 499
Min. Negotiated Rate	$15,342.34
Max. Negotiated Rate	$38,389.12
Rate for Payer: Aetna Medicare	$16,795.82
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,187.29
Rate for Payer: Amish Plain Church Group Commercial	$20,187.29
Rate for Payer: BCBS MAPPO	$16,149.83
Rate for Payer: BCBS Trust/PPO	$38,389.12
Rate for Payer: BCN Commercial	$38,389.12
Rate for Payer: BCN Medicare Advantage	$16,149.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,149.83
Rate for Payer: Mclaren Medicare	$16,149.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,957.32
Rate for Payer: MI Amish Medical Board Commercial	$18,572.30
Rate for Payer: Molina Medicare/Medicaid	$17,764.81
Rate for Payer: Nomi Health Commercial	$25,990.92
Rate for Payer: PACE Medicare	$15,342.34
Rate for Payer: PACE SWMI	$16,149.83
Rate for Payer: PHP Medicare Advantage	$16,149.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$32,482.89
Rate for Payer: Priority Health Medicare	$16,149.83
Rate for Payer: Priority Health Tiered Network	$25,986.31
Rate for Payer: Railroad Medicare Medicare	$16,149.83
Rate for Payer: UHC All Payor (Choice/PPO)	$32,841.24
Rate for Payer: UHC Core	$27,475.83
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16,149.83
Rate for Payer: UHC Exchange	$22,438.83
Rate for Payer: VA VA	$16,149.83

LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID

Facility

$23.52

Service Code	NDC 00450013404
Hospital Charge Code	42219
Hospital Revenue Code	637
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.17
Rate for Payer: Aetna Commercial	$19.99
Rate for Payer: Aetna Medicare	$11.76
Rate for Payer: Aetna New Business (MI Preferred)	$15.29
Rate for Payer: BCBS Complete	$9.41
Rate for Payer: Cash Price	$18.82
Rate for Payer: Cofinity Advantage	$16.46
Rate for Payer: Cofinity Commercial	$20.23
Rate for Payer: Encore Health Key Benefits Commercial	$18.82
Rate for Payer: Healthscope Commercial	$21.17
Rate for Payer: MI Amish Medical Board Commercial	$18.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.64
Rate for Payer: PHP Commercial	$19.99
Rate for Payer: Priority Health SBD	$14.82
Rate for Payer: UHC All Payor (Choice/PPO)	$15.29
Rate for Payer: UHC Core	$12.25
Rate for Payer: UHC Exchange	$9.24

LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID

Facility

$23.52

Service Code	NDC 00450013404
Hospital Charge Code	42219
Hospital Revenue Code	637
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$21.17
Rate for Payer: Aetna Commercial	$19.99
Rate for Payer: Aetna New Business (MI Preferred)	$15.29
Rate for Payer: Cash Price	$18.82
Rate for Payer: Cofinity Advantage	$16.46
Rate for Payer: Cofinity Commercial	$20.23
Rate for Payer: Encore Health Key Benefits Commercial	$18.82
Rate for Payer: Healthscope Commercial	$21.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.64
Rate for Payer: PHP Commercial	$19.99
Rate for Payer: Priority Health SBD	$14.82

LOPERAMIDE 2 MG CAPSULE

Facility

$246.24

Service Code	NDC 00904747261
Hospital Charge Code	4560
Hospital Revenue Code	637
Min. Negotiated Rate	$96.77
Max. Negotiated Rate	$221.62
Rate for Payer: Aetna Commercial	$209.30
Rate for Payer: Aetna Medicare	$123.12
Rate for Payer: Aetna New Business (MI Preferred)	$160.06
Rate for Payer: BCBS Complete	$98.50
Rate for Payer: Cash Price	$196.99
Rate for Payer: Cofinity Advantage	$172.37
Rate for Payer: Cofinity Commercial	$211.77
Rate for Payer: Encore Health Key Benefits Commercial	$196.99
Rate for Payer: Healthscope Commercial	$221.62
Rate for Payer: MI Amish Medical Board Commercial	$196.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.68
Rate for Payer: PHP Commercial	$209.30
Rate for Payer: Priority Health SBD	$155.13
Rate for Payer: UHC All Payor (Choice/PPO)	$160.06
Rate for Payer: UHC Core	$128.29
Rate for Payer: UHC Exchange	$96.77

Know your out-of-pocket cost for care.

All Charges