Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 15 MG TABLET

Facility

$591.52

Service Code	NDC 00904651204
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$372.66
Max. Negotiated Rate	$532.37
Rate for Payer: Aetna Commercial	$502.79
Rate for Payer: Aetna New Business (MI Preferred)	$384.49
Rate for Payer: Cash Price	$473.22
Rate for Payer: Cofinity Commercial	$414.06
Rate for Payer: Cofinity Commercial	$508.71
Rate for Payer: Cofinity Medicare Advantage	$414.06
Rate for Payer: Encore Health Key Benefits Commercial	$473.22
Rate for Payer: Healthscope Commercial	$532.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$502.79
Rate for Payer: PHP Commercial	$502.79
Rate for Payer: Priority Health Cigna Priority Health	$384.49
Rate for Payer: Priority Health SBD	$372.66

ARIPIPRAZOLE 15 MG TABLET

Facility

$591.52

Service Code	NDC 00904651204
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$236.61
Max. Negotiated Rate	$532.37
Rate for Payer: Aetna Commercial	$502.79
Rate for Payer: Aetna Medicare	$295.76
Rate for Payer: Aetna New Business (MI Preferred)	$384.49
Rate for Payer: BCBS Complete	$236.61
Rate for Payer: Cash Price	$473.22
Rate for Payer: Cofinity Commercial	$414.06
Rate for Payer: Cofinity Commercial	$508.71
Rate for Payer: Cofinity Medicare Advantage	$414.06
Rate for Payer: Encore Health Key Benefits Commercial	$473.22
Rate for Payer: Healthscope Commercial	$532.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$502.79
Rate for Payer: PHP Commercial	$502.79
Rate for Payer: Priority Health Cigna Priority Health	$384.49
Rate for Payer: Priority Health SBD	$372.66

ARIPIPRAZOLE 2 MG TABLET

Facility

$93.75

Service Code	NDC 27241005103
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: Aetna Medicare	$46.88
Rate for Payer: Aetna New Business (MI Preferred)	$60.94
Rate for Payer: BCBS Complete	$37.50
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Commercial	$65.62
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Cofinity Medicare Advantage	$65.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health Cigna Priority Health	$60.94
Rate for Payer: Priority Health SBD	$59.06

ARIPIPRAZOLE 2 MG TABLET

Facility

$2,008.88

Service Code	NDC 59148000613
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$1,265.59
Max. Negotiated Rate	$1,807.99
Rate for Payer: Aetna Commercial	$1,707.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,305.77
Rate for Payer: Cash Price	$1,607.10
Rate for Payer: Cofinity Commercial	$1,406.22
Rate for Payer: Cofinity Commercial	$1,727.64
Rate for Payer: Cofinity Medicare Advantage	$1,406.22
Rate for Payer: Encore Health Key Benefits Commercial	$1,607.10
Rate for Payer: Healthscope Commercial	$1,807.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,707.55
Rate for Payer: PHP Commercial	$1,707.55
Rate for Payer: Priority Health Cigna Priority Health	$1,305.77
Rate for Payer: Priority Health SBD	$1,265.59

ARIPIPRAZOLE 2 MG TABLET

Facility

$62.70

Service Code	NDC 65162089603
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$25.08
Max. Negotiated Rate	$56.43
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna Medicare	$31.35
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: BCBS Complete	$25.08
Rate for Payer: Cash Price	$50.16
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Commercial	$53.92
Rate for Payer: Cofinity Medicare Advantage	$43.89
Rate for Payer: Encore Health Key Benefits Commercial	$50.16
Rate for Payer: Healthscope Commercial	$56.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$39.50

ARIPIPRAZOLE 2 MG TABLET

Facility

$93.75

Service Code	NDC 27241005103
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: Aetna New Business (MI Preferred)	$60.94
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Commercial	$65.62
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Cofinity Medicare Advantage	$65.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health Cigna Priority Health	$60.94
Rate for Payer: Priority Health SBD	$59.06

ARIPIPRAZOLE 2 MG TABLET

Facility

$62.70

Service Code	NDC 65162089603
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$56.43
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: Cash Price	$50.16
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Commercial	$53.92
Rate for Payer: Cofinity Medicare Advantage	$43.89
Rate for Payer: Encore Health Key Benefits Commercial	$50.16
Rate for Payer: Healthscope Commercial	$56.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$39.50

ARIPIPRAZOLE 2 MG TABLET

Facility

$200.31

Service Code	NDC 60505307503
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$80.12
Max. Negotiated Rate	$180.28
Rate for Payer: Aetna Commercial	$170.26
Rate for Payer: Aetna Medicare	$100.16
Rate for Payer: Aetna New Business (MI Preferred)	$130.20
Rate for Payer: BCBS Complete	$80.12
Rate for Payer: Cash Price	$160.25
Rate for Payer: Cofinity Commercial	$140.22
Rate for Payer: Cofinity Commercial	$172.27
Rate for Payer: Cofinity Medicare Advantage	$140.22
Rate for Payer: Encore Health Key Benefits Commercial	$160.25
Rate for Payer: Healthscope Commercial	$180.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.26
Rate for Payer: PHP Commercial	$170.26
Rate for Payer: Priority Health Cigna Priority Health	$130.20
Rate for Payer: Priority Health SBD	$126.20

ARIPIPRAZOLE 2 MG TABLET

Facility

$62.70

Service Code	NDC 67877043003
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$25.08
Max. Negotiated Rate	$56.43
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna Medicare	$31.35
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: BCBS Complete	$25.08
Rate for Payer: Cash Price	$50.16
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Commercial	$53.92
Rate for Payer: Cofinity Medicare Advantage	$43.89
Rate for Payer: Encore Health Key Benefits Commercial	$50.16
Rate for Payer: Healthscope Commercial	$56.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$39.50

ARIPIPRAZOLE 2 MG TABLET

Facility

$2,008.88

Service Code	NDC 59148000613
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$803.55
Max. Negotiated Rate	$1,807.99
Rate for Payer: Aetna Commercial	$1,707.55
Rate for Payer: Aetna Medicare	$1,004.44
Rate for Payer: Aetna New Business (MI Preferred)	$1,305.77
Rate for Payer: BCBS Complete	$803.55
Rate for Payer: Cash Price	$1,607.10
Rate for Payer: Cofinity Commercial	$1,406.22
Rate for Payer: Cofinity Commercial	$1,727.64
Rate for Payer: Cofinity Medicare Advantage	$1,406.22
Rate for Payer: Encore Health Key Benefits Commercial	$1,607.10
Rate for Payer: Healthscope Commercial	$1,807.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,707.55
Rate for Payer: PHP Commercial	$1,707.55
Rate for Payer: Priority Health Cigna Priority Health	$1,305.77
Rate for Payer: Priority Health SBD	$1,265.59

ARIPIPRAZOLE 2 MG TABLET

Facility

$200.31

Service Code	NDC 60505307503
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$126.20
Max. Negotiated Rate	$180.28
Rate for Payer: Aetna Commercial	$170.26
Rate for Payer: Aetna New Business (MI Preferred)	$130.20
Rate for Payer: Cash Price	$160.25
Rate for Payer: Cofinity Commercial	$140.22
Rate for Payer: Cofinity Commercial	$172.27
Rate for Payer: Cofinity Medicare Advantage	$140.22
Rate for Payer: Encore Health Key Benefits Commercial	$160.25
Rate for Payer: Healthscope Commercial	$180.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.26
Rate for Payer: PHP Commercial	$170.26
Rate for Payer: Priority Health Cigna Priority Health	$130.20
Rate for Payer: Priority Health SBD	$126.20

ARIPIPRAZOLE 2 MG TABLET

Facility

$62.70

Service Code	NDC 67877043003
Hospital Charge Code	70306
Hospital Revenue Code	637
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$56.43
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: Cash Price	$50.16
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Commercial	$53.92
Rate for Payer: Cofinity Medicare Advantage	$43.89
Rate for Payer: Encore Health Key Benefits Commercial	$50.16
Rate for Payer: Healthscope Commercial	$56.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$39.50

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,821.51

Service Code	NDC 00904736761
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,147.55
Max. Negotiated Rate	$1,639.36
Rate for Payer: Aetna Commercial	$1,548.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,183.98
Rate for Payer: Cash Price	$1,457.21
Rate for Payer: Cofinity Commercial	$1,275.06
Rate for Payer: Cofinity Commercial	$1,566.50
Rate for Payer: Cofinity Medicare Advantage	$1,275.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,457.21
Rate for Payer: Healthscope Commercial	$1,639.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,548.28
Rate for Payer: PHP Commercial	$1,548.28
Rate for Payer: Priority Health Cigna Priority Health	$1,183.98
Rate for Payer: Priority Health SBD	$1,147.55

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,821.51

Service Code	NDC 00904736761
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$728.60
Max. Negotiated Rate	$1,639.36
Rate for Payer: Aetna Commercial	$1,548.28
Rate for Payer: Aetna Medicare	$910.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,183.98
Rate for Payer: BCBS Complete	$728.60
Rate for Payer: Cash Price	$1,457.21
Rate for Payer: Cofinity Commercial	$1,275.06
Rate for Payer: Cofinity Commercial	$1,566.50
Rate for Payer: Cofinity Medicare Advantage	$1,275.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,457.21
Rate for Payer: Healthscope Commercial	$1,639.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,548.28
Rate for Payer: PHP Commercial	$1,548.28
Rate for Payer: Priority Health Cigna Priority Health	$1,183.98
Rate for Payer: Priority Health SBD	$1,147.55

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,154.08
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: Aetna New Business (MI Preferred)	$1,190.72
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Commercial	$1,282.31
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Cofinity Medicare Advantage	$1,282.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: Priority Health Cigna Priority Health	$1,190.72
Rate for Payer: Priority Health SBD	$1,154.08

ARIPIPRAZOLE 5 MG TABLET

Facility

$204.45

Service Code	NDC 16729027901
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$81.78
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna Medicare	$102.22
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: BCBS Complete	$81.78
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$732.75
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: Aetna Medicare	$915.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,190.72
Rate for Payer: BCBS Complete	$732.75
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Commercial	$1,282.31
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Cofinity Medicare Advantage	$1,282.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: Priority Health Cigna Priority Health	$1,190.72
Rate for Payer: Priority Health SBD	$1,154.08

ARIPIPRAZOLE 5 MG TABLET

Facility

$204.45

Service Code	NDC 16729027901
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$3,982.01

Service Code	HCPCS J9017
Hospital Charge Code	185456
Hospital Revenue Code	636
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3,583.81
Rate for Payer: Aetna Commercial	$3,384.71
Rate for Payer: Aetna Medicare	$4.87
Rate for Payer: Aetna New Business (MI Preferred)	$2,588.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.85
Rate for Payer: Amish Plain Church Group Commercial	$5.85
Rate for Payer: BCBS Complete	$2.63
Rate for Payer: BCBS MAPPO	$4.68
Rate for Payer: BCBS Trust/PPO	$20.32
Rate for Payer: BCN Commercial	$20.32
Rate for Payer: BCN Medicare Advantage	$4.68
Rate for Payer: Cash Price	$3,185.61
Rate for Payer: Cash Price	$3,185.61
Rate for Payer: Cofinity Commercial	$3,424.53
Rate for Payer: Cofinity Commercial	$2,787.41
Rate for Payer: Cofinity Medicare Advantage	$2,787.41
Rate for Payer: Encore Health Key Benefits Commercial	$3,185.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.68
Rate for Payer: Healthscope Commercial	$3,583.81
Rate for Payer: Mclaren Medicaid	$2.51
Rate for Payer: Mclaren Medicare	$4.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.91
Rate for Payer: Meridian Medicaid	$2.63
Rate for Payer: MI Amish Medical Board Commercial	$5.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,384.71
Rate for Payer: Nomi Health Commercial	$14.04
Rate for Payer: PACE Medicare	$4.45
Rate for Payer: PACE SWMI	$4.68
Rate for Payer: PHP Commercial	$3,384.71
Rate for Payer: PHP Medicare Advantage	$4.68
Rate for Payer: Priority Health Choice Medicaid	$2.51
Rate for Payer: Priority Health Cigna Priority Health	$2,588.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.71
Rate for Payer: Priority Health Medicare	$4.68
Rate for Payer: Priority Health Narrow Network	$16.57
Rate for Payer: Priority Health SBD	$2,508.67
Rate for Payer: Railroad Medicare Medicare	$4.68
Rate for Payer: UHC All Payor (Choice/PPO)	$13.17
Rate for Payer: UHC Dual Complete DSNP	$4.68
Rate for Payer: UHC Medicare Advantage	$4.68
Rate for Payer: UHCCP Medicaid	$2.63
Rate for Payer: VA VA	$4.68

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION

Facility

$16,646.50

Service Code	CPT 36820
Hospital Revenue Code	360
Min. Negotiated Rate	$772.61
Max. Negotiated Rate	$16,646.50
Rate for Payer: Aetna Medicare	$5,508.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,620.50
Rate for Payer: Amish Plain Church Group Commercial	$6,620.50
Rate for Payer: BCBS Complete	$2,980.81
Rate for Payer: BCBS MAPPO	$5,296.40
Rate for Payer: BCBS Trust/PPO	$1,684.03
Rate for Payer: BCN Commercial	$1,684.03
Rate for Payer: BCN Medicare Advantage	$5,296.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,296.40
Rate for Payer: Mclaren Medicaid	$2,838.87
Rate for Payer: Mclaren Medicare	$5,296.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,561.22
Rate for Payer: Meridian Medicaid	$2,980.81
Rate for Payer: MI Amish Medical Board Commercial	$6,090.86
Rate for Payer: Nomi Health Commercial	$11,122.44
Rate for Payer: PACE Medicare	$5,031.58
Rate for Payer: PACE SWMI	$5,296.40
Rate for Payer: PHP Medicare Advantage	$5,296.40
Rate for Payer: Priority Health Choice Medicaid	$2,838.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,646.50
Rate for Payer: Priority Health Medicare	$5,296.40
Rate for Payer: Priority Health Narrow Network	$13,317.20
Rate for Payer: Railroad Medicare Medicare	$5,296.40
Rate for Payer: UHC All Payor (Choice/PPO)	$772.61
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,296.40
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$5,296.40
Rate for Payer: UHCCP Medicaid	$2,981.87
Rate for Payer: VA VA	$5,296.40

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION

Facility

$16,646.50

Service Code	CPT 36819
Hospital Revenue Code	360
Min. Negotiated Rate	$777.68
Max. Negotiated Rate	$16,646.50
Rate for Payer: Aetna Medicare	$5,508.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,620.50
Rate for Payer: Amish Plain Church Group Commercial	$6,620.50
Rate for Payer: BCBS Complete	$2,980.81
Rate for Payer: BCBS MAPPO	$5,296.40
Rate for Payer: BCBS Trust/PPO	$3,305.83
Rate for Payer: BCN Commercial	$3,305.83
Rate for Payer: BCN Medicare Advantage	$5,296.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,296.40
Rate for Payer: Mclaren Medicaid	$2,838.87
Rate for Payer: Mclaren Medicare	$5,296.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,561.22
Rate for Payer: Meridian Medicaid	$2,980.81
Rate for Payer: MI Amish Medical Board Commercial	$6,090.86
Rate for Payer: Nomi Health Commercial	$11,122.44
Rate for Payer: PACE Medicare	$5,031.58
Rate for Payer: PACE SWMI	$5,296.40
Rate for Payer: PHP Medicare Advantage	$5,296.40
Rate for Payer: Priority Health Choice Medicaid	$2,838.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,646.50
Rate for Payer: Priority Health Medicare	$5,296.40
Rate for Payer: Priority Health Narrow Network	$13,317.20
Rate for Payer: Railroad Medicare Medicare	$5,296.40
Rate for Payer: UHC All Payor (Choice/PPO)	$777.68
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,296.40
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$5,296.40
Rate for Payer: UHCCP Medicaid	$2,981.87
Rate for Payer: VA VA	$5,296.40

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION

Facility

$16,646.50

Service Code	CPT 36818
Hospital Revenue Code	360
Min. Negotiated Rate	$733.29
Max. Negotiated Rate	$16,646.50
Rate for Payer: Aetna Medicare	$5,508.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,620.50
Rate for Payer: Amish Plain Church Group Commercial	$6,620.50
Rate for Payer: BCBS Complete	$2,980.81
Rate for Payer: BCBS MAPPO	$5,296.40
Rate for Payer: BCBS Trust/PPO	$1,895.57
Rate for Payer: BCN Commercial	$1,895.57
Rate for Payer: BCN Medicare Advantage	$5,296.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,296.40
Rate for Payer: Mclaren Medicaid	$2,838.87
Rate for Payer: Mclaren Medicare	$5,296.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,561.22
Rate for Payer: Meridian Medicaid	$2,980.81
Rate for Payer: MI Amish Medical Board Commercial	$6,090.86
Rate for Payer: Nomi Health Commercial	$11,122.44
Rate for Payer: PACE Medicare	$5,031.58
Rate for Payer: PACE SWMI	$5,296.40
Rate for Payer: PHP Medicare Advantage	$5,296.40
Rate for Payer: Priority Health Choice Medicaid	$2,838.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,646.50
Rate for Payer: Priority Health Medicare	$5,296.40
Rate for Payer: Priority Health Narrow Network	$13,317.20
Rate for Payer: Railroad Medicare Medicare	$5,296.40
Rate for Payer: UHC All Payor (Choice/PPO)	$733.29
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,296.40
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$5,296.40
Rate for Payer: UHCCP Medicaid	$2,981.87
Rate for Payer: VA VA	$5,296.40

ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)

Facility

$9,692.51

Service Code	CPT 36821
Hospital Revenue Code	360
Min. Negotiated Rate	$702.04
Max. Negotiated Rate	$9,692.51
Rate for Payer: Aetna Medicare	$3,207.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,854.82
Rate for Payer: Amish Plain Church Group Commercial	$3,854.82
Rate for Payer: BCBS Complete	$1,735.60
Rate for Payer: BCBS MAPPO	$3,083.86
Rate for Payer: BCBS Trust/PPO	$2,580.14
Rate for Payer: BCN Commercial	$2,580.14
Rate for Payer: BCN Medicare Advantage	$3,083.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,083.86
Rate for Payer: Mclaren Medicaid	$1,652.95
Rate for Payer: Mclaren Medicare	$3,083.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,238.05
Rate for Payer: Meridian Medicaid	$1,735.60
Rate for Payer: MI Amish Medical Board Commercial	$3,546.44
Rate for Payer: Nomi Health Commercial	$6,476.11
Rate for Payer: PACE Medicare	$2,929.67
Rate for Payer: PACE SWMI	$3,083.86
Rate for Payer: PHP Medicare Advantage	$3,083.86
Rate for Payer: Priority Health Choice Medicaid	$1,652.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,692.51
Rate for Payer: Priority Health Medicare	$3,083.86
Rate for Payer: Priority Health Narrow Network	$7,754.01
Rate for Payer: Railroad Medicare Medicare	$3,083.86
Rate for Payer: UHC All Payor (Choice/PPO)	$702.04
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,083.86
Rate for Payer: UHC Exchange	$5,811.00
Rate for Payer: UHC Medicare Advantage	$3,083.86
Rate for Payer: UHCCP Medicaid	$1,736.21
Rate for Payer: VA VA	$3,083.86

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$940.00

Service Code	CPT 20605
Hospital Revenue Code	360
Min. Negotiated Rate	$39.13
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Medicare	$300.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$361.52
Rate for Payer: Amish Plain Church Group Commercial	$361.52
Rate for Payer: BCBS Complete	$162.77
Rate for Payer: BCBS MAPPO	$289.22
Rate for Payer: BCBS Trust/PPO	$175.02
Rate for Payer: BCN Commercial	$175.02
Rate for Payer: BCN Medicare Advantage	$289.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$289.22
Rate for Payer: Mclaren Medicaid	$155.02
Rate for Payer: Mclaren Medicare	$289.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$303.68
Rate for Payer: Meridian Medicaid	$162.77
Rate for Payer: MI Amish Medical Board Commercial	$332.60
Rate for Payer: Nomi Health Commercial	$607.36
Rate for Payer: PACE Medicare	$274.76
Rate for Payer: PACE SWMI	$289.22
Rate for Payer: PHP Medicare Advantage	$289.22
Rate for Payer: Priority Health Choice Medicaid	$155.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$909.03
Rate for Payer: Priority Health Medicare	$289.22
Rate for Payer: Priority Health Narrow Network	$727.22
Rate for Payer: Railroad Medicare Medicare	$289.22
Rate for Payer: UHC All Payor (Choice/PPO)	$39.13
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$289.22
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$289.22
Rate for Payer: UHCCP Medicaid	$162.83
Rate for Payer: VA VA	$289.22

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$940.00

Service Code	CPT 20610
Hospital Revenue Code	361
Min. Negotiated Rate	$48.39
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Medicare	$300.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$361.52
Rate for Payer: Amish Plain Church Group Commercial	$361.52
Rate for Payer: BCBS Complete	$162.77
Rate for Payer: BCBS MAPPO	$289.22
Rate for Payer: BCBS Trust/PPO	$175.02
Rate for Payer: BCN Commercial	$175.02
Rate for Payer: BCN Medicare Advantage	$289.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$289.22
Rate for Payer: Mclaren Medicaid	$155.02
Rate for Payer: Mclaren Medicare	$289.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$303.68
Rate for Payer: Meridian Medicaid	$162.77
Rate for Payer: MI Amish Medical Board Commercial	$332.60
Rate for Payer: Nomi Health Commercial	$607.36
Rate for Payer: PACE Medicare	$274.76
Rate for Payer: PACE SWMI	$289.22
Rate for Payer: PHP Medicare Advantage	$289.22
Rate for Payer: Priority Health Choice Medicaid	$155.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$909.03
Rate for Payer: Priority Health Medicare	$289.22
Rate for Payer: Priority Health Narrow Network	$727.22
Rate for Payer: Railroad Medicare Medicare	$289.22
Rate for Payer: UHC All Payor (Choice/PPO)	$48.39
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$289.22
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$289.22
Rate for Payer: UHCCP Medicaid	$162.83
Rate for Payer: VA VA	$289.22

Know your out-of-pocket cost for care.

All Charges