Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$98.31

Service Code	NDC 00338035703
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$39.32
Max. Negotiated Rate	$88.48
Rate for Payer: Aetna Commercial	$83.56
Rate for Payer: Aetna Medicare	$49.16
Rate for Payer: Aetna New Business (MI Preferred)	$63.90
Rate for Payer: BCBS Complete	$39.32
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cofinity Commercial	$68.82
Rate for Payer: Cofinity Commercial	$84.55
Rate for Payer: Cofinity Medicare Advantage	$68.82
Rate for Payer: Encore Health Key Benefits Commercial	$78.65
Rate for Payer: Healthscope Commercial	$88.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.56
Rate for Payer: PHP Commercial	$83.56
Rate for Payer: Priority Health Cigna Priority Health	$63.90
Rate for Payer: Priority Health SBD	$61.94

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$94.92

Service Code	NDC 00990771502
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Cofinity Medicare Advantage	$66.44
Rate for Payer: Encore Health Key Benefits Commercial	$75.94
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$61.70
Rate for Payer: Priority Health SBD	$59.80

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$94.92

Service Code	NDC 00990771502
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna Medicare	$47.46
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: BCBS Complete	$37.97
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Cofinity Medicare Advantage	$66.44
Rate for Payer: Encore Health Key Benefits Commercial	$75.94
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$61.70
Rate for Payer: Priority Health SBD	$59.80

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$94.92

Service Code	NDC 00990771512
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Cofinity Medicare Advantage	$66.44
Rate for Payer: Encore Health Key Benefits Commercial	$75.94
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$61.70
Rate for Payer: Priority Health SBD	$59.80

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$94.92

Service Code	NDC 00990771512
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna Medicare	$47.46
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: BCBS Complete	$37.97
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Cofinity Medicare Advantage	$66.44
Rate for Payer: Encore Health Key Benefits Commercial	$75.94
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$61.70
Rate for Payer: Priority Health SBD	$59.80

MANNITOL 25 % INTRAVENOUS SOLUTION

Facility

$90.12

Service Code	HCPCS J2150
Hospital Charge Code	4750
Hospital Revenue Code	636
Min. Negotiated Rate	$56.78
Max. Negotiated Rate	$81.11
Rate for Payer: Aetna Commercial	$76.60
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: Aetna New Business (MI Preferred)	$58.58
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cash Price	$72.10
Rate for Payer: Cofinity Commercial	$77.50
Rate for Payer: Cofinity Commercial	$63.08
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Cofinity Medicare Advantage	$42.83
Rate for Payer: Cofinity Medicare Advantage	$63.08
Rate for Payer: Encore Health Key Benefits Commercial	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$72.10
Rate for Payer: Healthscope Commercial	$81.11
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$76.60
Rate for Payer: PHP Commercial	$76.60
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$39.77
Rate for Payer: Priority Health Cigna Priority Health	$58.58
Rate for Payer: Priority Health SBD	$38.54
Rate for Payer: Priority Health SBD	$56.78

MANNITOL 25 % INTRAVENOUS SOLUTION

Facility

$61.18

Service Code	HCPCS J2150
Hospital Charge Code	4750
Hospital Revenue Code	636
Min. Negotiated Rate	$24.47
Max. Negotiated Rate	$55.06
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Commercial	$76.60
Rate for Payer: Aetna Medicare	$30.59
Rate for Payer: Aetna Medicare	$45.06
Rate for Payer: Aetna New Business (MI Preferred)	$58.58
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: BCBS Complete	$24.47
Rate for Payer: BCBS Complete	$36.05
Rate for Payer: Cash Price	$72.10
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$63.08
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$77.50
Rate for Payer: Cofinity Medicare Advantage	$63.08
Rate for Payer: Cofinity Medicare Advantage	$42.83
Rate for Payer: Encore Health Key Benefits Commercial	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$72.10
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Healthscope Commercial	$81.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$76.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.00
Rate for Payer: PHP Commercial	$76.60
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$39.77
Rate for Payer: Priority Health Cigna Priority Health	$58.58
Rate for Payer: Priority Health SBD	$38.54
Rate for Payer: Priority Health SBD	$56.78

MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST

Facility

$8,728.81

Service Code	CPT 56440
Hospital Revenue Code	360
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,745.82
Rate for Payer: VA VA	$3,100.93

MASTECTOMY FOR GYNECOMASTIA

Facility

$10,512.58

Service Code	CPT 19300
Hospital Revenue Code	360
Min. Negotiated Rate	$2,001.76
Max. Negotiated Rate	$10,512.58
Rate for Payer: Aetna Medicare	$3,884.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,668.27
Rate for Payer: Amish Plain Church Group Commercial	$4,668.27
Rate for Payer: BCBS Complete	$2,101.84
Rate for Payer: BCBS MAPPO	$3,734.62
Rate for Payer: BCN Medicare Advantage	$3,734.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,734.62
Rate for Payer: Mclaren Medicaid	$2,001.76
Rate for Payer: Mclaren Medicare	$3,734.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,921.35
Rate for Payer: Meridian Medicaid	$2,101.84
Rate for Payer: MI Amish Medical Board Commercial	$4,294.81
Rate for Payer: PACE Medicare	$3,547.89
Rate for Payer: PACE SWMI	$3,734.62
Rate for Payer: PHP Medicare Advantage	$3,734.62
Rate for Payer: Priority Health Choice Medicaid	$2,001.76
Rate for Payer: Priority Health Medicare	$3,734.62
Rate for Payer: Railroad Medicare Medicare	$3,734.62
Rate for Payer: UHC All Payor (Choice/PPO)	$10,512.58
Rate for Payer: UHC Dual Complete DSNP	$3,734.62
Rate for Payer: UHC Medicare Advantage	$3,734.62
Rate for Payer: UHCCP Medicaid	$2,102.59
Rate for Payer: VA VA	$3,734.62

MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE

Facility

$17,903.47

Service Code	CPT 19307
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.09
Max. Negotiated Rate	$17,903.47
Rate for Payer: Aetna Medicare	$6,614.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,950.31
Rate for Payer: Amish Plain Church Group Commercial	$7,950.31
Rate for Payer: BCBS Complete	$3,579.55
Rate for Payer: BCBS MAPPO	$6,360.25
Rate for Payer: BCN Medicare Advantage	$6,360.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,360.25
Rate for Payer: Mclaren Medicaid	$3,409.09
Rate for Payer: Mclaren Medicare	$6,360.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,678.26
Rate for Payer: Meridian Medicaid	$3,579.55
Rate for Payer: MI Amish Medical Board Commercial	$7,314.29
Rate for Payer: PACE Medicare	$6,042.24
Rate for Payer: PACE SWMI	$6,360.25
Rate for Payer: PHP Medicare Advantage	$6,360.25
Rate for Payer: Priority Health Choice Medicaid	$3,409.09
Rate for Payer: Priority Health Medicare	$6,360.25
Rate for Payer: Railroad Medicare Medicare	$6,360.25
Rate for Payer: UHC All Payor (Choice/PPO)	$17,903.47
Rate for Payer: UHC Dual Complete DSNP	$6,360.25
Rate for Payer: UHC Medicare Advantage	$6,360.25
Rate for Payer: UHCCP Medicaid	$3,580.82
Rate for Payer: VA VA	$6,360.25

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);

Facility

$10,512.58

Service Code	CPT 19301
Hospital Revenue Code	360
Min. Negotiated Rate	$2,001.76
Max. Negotiated Rate	$10,512.58
Rate for Payer: Aetna Medicare	$3,884.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,668.27
Rate for Payer: Amish Plain Church Group Commercial	$4,668.27
Rate for Payer: BCBS Complete	$2,101.84
Rate for Payer: BCBS MAPPO	$3,734.62
Rate for Payer: BCN Medicare Advantage	$3,734.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,734.62
Rate for Payer: Mclaren Medicaid	$2,001.76
Rate for Payer: Mclaren Medicare	$3,734.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,921.35
Rate for Payer: Meridian Medicaid	$2,101.84
Rate for Payer: MI Amish Medical Board Commercial	$4,294.81
Rate for Payer: PACE Medicare	$3,547.89
Rate for Payer: PACE SWMI	$3,734.62
Rate for Payer: PHP Medicare Advantage	$3,734.62
Rate for Payer: Priority Health Choice Medicaid	$2,001.76
Rate for Payer: Priority Health Medicare	$3,734.62
Rate for Payer: Railroad Medicare Medicare	$3,734.62
Rate for Payer: UHC All Payor (Choice/PPO)	$10,512.58
Rate for Payer: UHC Dual Complete DSNP	$3,734.62
Rate for Payer: UHC Medicare Advantage	$3,734.62
Rate for Payer: UHCCP Medicaid	$2,102.59
Rate for Payer: VA VA	$3,734.62

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY

Facility

$17,903.47

Service Code	CPT 19302
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.09
Max. Negotiated Rate	$17,903.47
Rate for Payer: Aetna Medicare	$6,614.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,950.31
Rate for Payer: Amish Plain Church Group Commercial	$7,950.31
Rate for Payer: BCBS Complete	$3,579.55
Rate for Payer: BCBS MAPPO	$6,360.25
Rate for Payer: BCN Medicare Advantage	$6,360.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,360.25
Rate for Payer: Mclaren Medicaid	$3,409.09
Rate for Payer: Mclaren Medicare	$6,360.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,678.26
Rate for Payer: Meridian Medicaid	$3,579.55
Rate for Payer: MI Amish Medical Board Commercial	$7,314.29
Rate for Payer: PACE Medicare	$6,042.24
Rate for Payer: PACE SWMI	$6,360.25
Rate for Payer: PHP Medicare Advantage	$6,360.25
Rate for Payer: Priority Health Choice Medicaid	$3,409.09
Rate for Payer: Priority Health Medicare	$6,360.25
Rate for Payer: Railroad Medicare Medicare	$6,360.25
Rate for Payer: UHC All Payor (Choice/PPO)	$17,903.47
Rate for Payer: UHC Dual Complete DSNP	$6,360.25
Rate for Payer: UHC Medicare Advantage	$6,360.25
Rate for Payer: UHCCP Medicaid	$3,580.82
Rate for Payer: VA VA	$6,360.25

MASTECTOMY, SIMPLE, COMPLETE

Facility

$17,903.47

Service Code	CPT 19303
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.09
Max. Negotiated Rate	$17,903.47
Rate for Payer: Aetna Medicare	$6,614.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,950.31
Rate for Payer: Amish Plain Church Group Commercial	$7,950.31
Rate for Payer: BCBS Complete	$3,579.55
Rate for Payer: BCBS MAPPO	$6,360.25
Rate for Payer: BCN Medicare Advantage	$6,360.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,360.25
Rate for Payer: Mclaren Medicaid	$3,409.09
Rate for Payer: Mclaren Medicare	$6,360.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,678.26
Rate for Payer: Meridian Medicaid	$3,579.55
Rate for Payer: MI Amish Medical Board Commercial	$7,314.29
Rate for Payer: PACE Medicare	$6,042.24
Rate for Payer: PACE SWMI	$6,360.25
Rate for Payer: PHP Medicare Advantage	$6,360.25
Rate for Payer: Priority Health Choice Medicaid	$3,409.09
Rate for Payer: Priority Health Medicare	$6,360.25
Rate for Payer: Railroad Medicare Medicare	$6,360.25
Rate for Payer: UHC All Payor (Choice/PPO)	$17,903.47
Rate for Payer: UHC Dual Complete DSNP	$6,360.25
Rate for Payer: UHC Medicare Advantage	$6,360.25
Rate for Payer: UHCCP Medicaid	$3,580.82
Rate for Payer: VA VA	$6,360.25

MASTOPEXY

Facility

$17,903.47

Service Code	CPT 19316
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.09
Max. Negotiated Rate	$17,903.47
Rate for Payer: Aetna Medicare	$6,614.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,950.31
Rate for Payer: Amish Plain Church Group Commercial	$7,950.31
Rate for Payer: BCBS Complete	$3,579.55
Rate for Payer: BCBS MAPPO	$6,360.25
Rate for Payer: BCN Medicare Advantage	$6,360.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,360.25
Rate for Payer: Mclaren Medicaid	$3,409.09
Rate for Payer: Mclaren Medicare	$6,360.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,678.26
Rate for Payer: Meridian Medicaid	$3,579.55
Rate for Payer: MI Amish Medical Board Commercial	$7,314.29
Rate for Payer: PACE Medicare	$6,042.24
Rate for Payer: PACE SWMI	$6,360.25
Rate for Payer: PHP Medicare Advantage	$6,360.25
Rate for Payer: Priority Health Choice Medicaid	$3,409.09
Rate for Payer: Priority Health Medicare	$6,360.25
Rate for Payer: Railroad Medicare Medicare	$6,360.25
Rate for Payer: UHC All Payor (Choice/PPO)	$17,903.47
Rate for Payer: UHC Dual Complete DSNP	$6,360.25
Rate for Payer: UHC Medicare Advantage	$6,360.25
Rate for Payer: UHCCP Medicaid	$3,580.82
Rate for Payer: VA VA	$6,360.25

MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$4,448.08

Service Code	CPT 19020
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$889.65
Rate for Payer: VA VA	$1,580.19

MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT

Facility

$299.53

Service Code	HCPCS 90707
Hospital Charge Code	10512
Hospital Revenue Code	636
Min. Negotiated Rate	$188.70
Max. Negotiated Rate	$269.58
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna New Business (MI Preferred)	$194.69
Rate for Payer: Cash Price	$239.62
Rate for Payer: Cofinity Commercial	$209.67
Rate for Payer: Cofinity Commercial	$257.60
Rate for Payer: Cofinity Medicare Advantage	$209.67
Rate for Payer: Encore Health Key Benefits Commercial	$239.62
Rate for Payer: Healthscope Commercial	$269.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.60
Rate for Payer: PHP Commercial	$254.60
Rate for Payer: Priority Health Cigna Priority Health	$194.69
Rate for Payer: Priority Health SBD	$188.70

MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT

Facility

$299.53

Service Code	HCPCS 90707
Hospital Charge Code	10512
Hospital Revenue Code	636
Min. Negotiated Rate	$119.81
Max. Negotiated Rate	$269.58
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare	$149.76
Rate for Payer: Aetna New Business (MI Preferred)	$194.69
Rate for Payer: BCBS Complete	$119.81
Rate for Payer: Cash Price	$239.62
Rate for Payer: Cofinity Commercial	$209.67
Rate for Payer: Cofinity Commercial	$257.60
Rate for Payer: Cofinity Medicare Advantage	$209.67
Rate for Payer: Encore Health Key Benefits Commercial	$239.62
Rate for Payer: Healthscope Commercial	$269.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.60
Rate for Payer: PHP Commercial	$254.60
Rate for Payer: Priority Health Cigna Priority Health	$194.69
Rate for Payer: Priority Health SBD	$188.70

MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING

Facility

$163.07

Service Code	CPT 51798
Hospital Revenue Code	361
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$163.07
Rate for Payer: Aetna Medicare	$60.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$72.41
Rate for Payer: Amish Plain Church Group Commercial	$72.41
Rate for Payer: BCBS Complete	$32.60
Rate for Payer: BCBS MAPPO	$57.93
Rate for Payer: BCN Medicare Advantage	$57.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$57.93
Rate for Payer: Mclaren Medicaid	$31.05
Rate for Payer: Mclaren Medicare	$57.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$60.83
Rate for Payer: Meridian Medicaid	$32.60
Rate for Payer: MI Amish Medical Board Commercial	$66.62
Rate for Payer: PACE Medicare	$55.03
Rate for Payer: PACE SWMI	$57.93
Rate for Payer: PHP Medicare Advantage	$57.93
Rate for Payer: Priority Health Choice Medicaid	$31.05
Rate for Payer: Priority Health Medicare	$57.93
Rate for Payer: Railroad Medicare Medicare	$57.93
Rate for Payer: UHC All Payor (Choice/PPO)	$163.07
Rate for Payer: UHC Dual Complete DSNP	$57.93
Rate for Payer: UHC Medicare Advantage	$57.93
Rate for Payer: UHCCP Medicaid	$32.61
Rate for Payer: VA VA	$57.93

MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT

Facility

$5,623.80

Service Code	CPT 53020
Hospital Revenue Code	360
Min. Negotiated Rate	$1,070.86
Max. Negotiated Rate	$5,623.80
Rate for Payer: Aetna Medicare	$2,077.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,497.34
Rate for Payer: Amish Plain Church Group Commercial	$2,497.34
Rate for Payer: BCBS Complete	$1,124.40
Rate for Payer: BCBS MAPPO	$1,997.87
Rate for Payer: BCN Medicare Advantage	$1,997.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,997.87
Rate for Payer: Mclaren Medicaid	$1,070.86
Rate for Payer: Mclaren Medicare	$1,997.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,097.76
Rate for Payer: Meridian Medicaid	$1,124.40
Rate for Payer: MI Amish Medical Board Commercial	$2,297.55
Rate for Payer: PACE Medicare	$1,897.98
Rate for Payer: PACE SWMI	$1,997.87
Rate for Payer: PHP Medicare Advantage	$1,997.87
Rate for Payer: Priority Health Choice Medicaid	$1,070.86
Rate for Payer: Priority Health Medicare	$1,997.87
Rate for Payer: Railroad Medicare Medicare	$1,997.87
Rate for Payer: UHC All Payor (Choice/PPO)	$5,623.80
Rate for Payer: UHC Dual Complete DSNP	$1,997.87
Rate for Payer: UHC Medicare Advantage	$1,997.87
Rate for Payer: UHCCP Medicaid	$1,124.80
Rate for Payer: VA VA	$1,997.87

MECLIZINE 12.5 MG TABLET

Facility

$366.70

Service Code	NDC 00904651661
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$231.02
Max. Negotiated Rate	$330.03
Rate for Payer: Aetna Commercial	$311.69
Rate for Payer: Aetna New Business (MI Preferred)	$238.35
Rate for Payer: Cash Price	$293.36
Rate for Payer: Cofinity Commercial	$256.69
Rate for Payer: Cofinity Commercial	$315.36
Rate for Payer: Cofinity Medicare Advantage	$256.69
Rate for Payer: Encore Health Key Benefits Commercial	$293.36
Rate for Payer: Healthscope Commercial	$330.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.69
Rate for Payer: PHP Commercial	$311.69
Rate for Payer: Priority Health Cigna Priority Health	$238.35
Rate for Payer: Priority Health SBD	$231.02

MECLIZINE 12.5 MG TABLET

Facility

$163.40

Service Code	NDC 50268052215
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$65.36
Max. Negotiated Rate	$147.06
Rate for Payer: Aetna Commercial	$138.89
Rate for Payer: Aetna Medicare	$81.70
Rate for Payer: Aetna New Business (MI Preferred)	$106.21
Rate for Payer: BCBS Complete	$65.36
Rate for Payer: Cash Price	$130.72
Rate for Payer: Cofinity Commercial	$114.38
Rate for Payer: Cofinity Commercial	$140.52
Rate for Payer: Cofinity Medicare Advantage	$114.38
Rate for Payer: Encore Health Key Benefits Commercial	$130.72
Rate for Payer: Healthscope Commercial	$147.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.89
Rate for Payer: PHP Commercial	$138.89
Rate for Payer: Priority Health Cigna Priority Health	$106.21
Rate for Payer: Priority Health SBD	$102.94

MECLIZINE 12.5 MG TABLET

Facility

$94.00

Service Code	NDC 00536129701
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Cofinity Medicare Advantage	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health SBD	$59.22

MECLIZINE 12.5 MG TABLET

Facility

$94.00

Service Code	NDC 00536129701
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Cofinity Medicare Advantage	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health SBD	$59.22

MECLIZINE 12.5 MG TABLET

Facility

$3.27

Service Code	NDC 50268052211
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna Commercial	$2.78
Rate for Payer: Aetna Medicare	$1.64
Rate for Payer: Aetna New Business (MI Preferred)	$2.13
Rate for Payer: BCBS Complete	$1.31
Rate for Payer: Cash Price	$2.62
Rate for Payer: Cofinity Commercial	$2.29
Rate for Payer: Cofinity Commercial	$2.81
Rate for Payer: Cofinity Medicare Advantage	$2.29
Rate for Payer: Encore Health Key Benefits Commercial	$2.62
Rate for Payer: Healthscope Commercial	$2.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.78
Rate for Payer: PHP Commercial	$2.78
Rate for Payer: Priority Health Cigna Priority Health	$2.13
Rate for Payer: Priority Health SBD	$2.06

MECLIZINE 12.5 MG TABLET

Facility

$467.40

Service Code	NDC 51079042320
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$186.96
Max. Negotiated Rate	$420.66
Rate for Payer: Aetna Commercial	$397.29
Rate for Payer: Aetna Medicare	$233.70
Rate for Payer: Aetna New Business (MI Preferred)	$303.81
Rate for Payer: BCBS Complete	$186.96
Rate for Payer: Cash Price	$373.92
Rate for Payer: Cofinity Commercial	$327.18
Rate for Payer: Cofinity Commercial	$401.96
Rate for Payer: Cofinity Medicare Advantage	$327.18
Rate for Payer: Encore Health Key Benefits Commercial	$373.92
Rate for Payer: Healthscope Commercial	$420.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.29
Rate for Payer: PHP Commercial	$397.29
Rate for Payer: Priority Health Cigna Priority Health	$303.81
Rate for Payer: Priority Health SBD	$294.46

Know your out-of-pocket cost for care.

All Charges