Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$275.60

Service Code	NDC 40985022368
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$110.24
Max. Negotiated Rate	$248.04
Rate for Payer: Aetna Commercial	$234.26
Rate for Payer: Aetna Medicare	$137.80
Rate for Payer: Aetna New Business (MI Preferred)	$179.14
Rate for Payer: BCBS Complete	$110.24
Rate for Payer: Cash Price	$220.48
Rate for Payer: Cofinity Commercial	$192.92
Rate for Payer: Cofinity Commercial	$237.02
Rate for Payer: Cofinity Medicare Advantage	$192.92
Rate for Payer: Encore Health Key Benefits Commercial	$220.48
Rate for Payer: Healthscope Commercial	$248.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.26
Rate for Payer: PHP Commercial	$234.26
Rate for Payer: Priority Health Cigna Priority Health	$179.14
Rate for Payer: Priority Health SBD	$173.63

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$180.00

Service Code	NDC 00904549261
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Cofinity Medicare Advantage	$126.00
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health SBD	$113.40

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$187.20

Service Code	NDC 80681016000
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$117.94
Max. Negotiated Rate	$168.48
Rate for Payer: Aetna Commercial	$159.12
Rate for Payer: Aetna New Business (MI Preferred)	$121.68
Rate for Payer: Cash Price	$149.76
Rate for Payer: Cofinity Commercial	$131.04
Rate for Payer: Cofinity Commercial	$160.99
Rate for Payer: Cofinity Medicare Advantage	$131.04
Rate for Payer: Encore Health Key Benefits Commercial	$149.76
Rate for Payer: Healthscope Commercial	$168.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.12
Rate for Payer: PHP Commercial	$159.12
Rate for Payer: Priority Health Cigna Priority Health	$121.68
Rate for Payer: Priority Health SBD	$117.94

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$275.60

Service Code	NDC 40985022368
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$173.63
Max. Negotiated Rate	$248.04
Rate for Payer: Aetna Commercial	$234.26
Rate for Payer: Aetna New Business (MI Preferred)	$179.14
Rate for Payer: Cash Price	$220.48
Rate for Payer: Cofinity Commercial	$192.92
Rate for Payer: Cofinity Commercial	$237.02
Rate for Payer: Cofinity Medicare Advantage	$192.92
Rate for Payer: Encore Health Key Benefits Commercial	$220.48
Rate for Payer: Healthscope Commercial	$248.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.26
Rate for Payer: PHP Commercial	$234.26
Rate for Payer: Priority Health Cigna Priority Health	$179.14
Rate for Payer: Priority Health SBD	$173.63

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$2.06

Service Code	NDC 77333086125
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna Commercial	$1.75
Rate for Payer: Aetna New Business (MI Preferred)	$1.34
Rate for Payer: Cash Price	$1.65
Rate for Payer: Cofinity Commercial	$1.44
Rate for Payer: Cofinity Commercial	$1.77
Rate for Payer: Cofinity Medicare Advantage	$1.44
Rate for Payer: Encore Health Key Benefits Commercial	$1.65
Rate for Payer: Healthscope Commercial	$1.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.75
Rate for Payer: PHP Commercial	$1.75
Rate for Payer: Priority Health Cigna Priority Health	$1.34
Rate for Payer: Priority Health SBD	$1.30

MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET

Facility

$208.00

Service Code	NDC 96295012782
Hospital Charge Code	196928
Hospital Revenue Code	637
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$187.20
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna New Business (MI Preferred)	$135.20
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cofinity Commercial	$145.60
Rate for Payer: Cofinity Commercial	$178.88
Rate for Payer: Cofinity Medicare Advantage	$145.60
Rate for Payer: Encore Health Key Benefits Commercial	$166.40
Rate for Payer: Healthscope Commercial	$187.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.80
Rate for Payer: PHP Commercial	$176.80
Rate for Payer: Priority Health Cigna Priority Health	$135.20
Rate for Payer: Priority Health SBD	$131.04

MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET

Facility

$208.00

Service Code	NDC 96295012782
Hospital Charge Code	196928
Hospital Revenue Code	637
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$187.20
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna Medicare	$104.00
Rate for Payer: Aetna New Business (MI Preferred)	$135.20
Rate for Payer: BCBS Complete	$83.20
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cofinity Commercial	$145.60
Rate for Payer: Cofinity Commercial	$178.88
Rate for Payer: Cofinity Medicare Advantage	$145.60
Rate for Payer: Encore Health Key Benefits Commercial	$166.40
Rate for Payer: Healthscope Commercial	$187.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.80
Rate for Payer: PHP Commercial	$176.80
Rate for Payer: Priority Health Cigna Priority Health	$135.20
Rate for Payer: Priority Health SBD	$131.04

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$21.95

Service Code	NDC 09900000800
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$18.66
Rate for Payer: Aetna New Business (MI Preferred)	$14.27
Rate for Payer: Cash Price	$17.56
Rate for Payer: Cofinity Commercial	$15.37
Rate for Payer: Cofinity Commercial	$18.88
Rate for Payer: Cofinity Medicare Advantage	$15.37
Rate for Payer: Encore Health Key Benefits Commercial	$17.56
Rate for Payer: Healthscope Commercial	$19.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.66
Rate for Payer: PHP Commercial	$18.66
Rate for Payer: Priority Health Cigna Priority Health	$14.27
Rate for Payer: Priority Health SBD	$13.83

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$21.95

Service Code	NDC 09900000800
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$18.66
Rate for Payer: Aetna Medicare	$10.97
Rate for Payer: Aetna New Business (MI Preferred)	$14.27
Rate for Payer: BCBS Complete	$8.78
Rate for Payer: Cash Price	$17.56
Rate for Payer: Cofinity Commercial	$15.37
Rate for Payer: Cofinity Commercial	$18.88
Rate for Payer: Cofinity Medicare Advantage	$15.37
Rate for Payer: Encore Health Key Benefits Commercial	$17.56
Rate for Payer: Healthscope Commercial	$19.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.66
Rate for Payer: PHP Commercial	$18.66
Rate for Payer: Priority Health Cigna Priority Health	$14.27
Rate for Payer: Priority Health SBD	$13.83

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$24.60

Service Code	NDC 00005434462
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$22.14
Rate for Payer: Aetna Commercial	$20.91
Rate for Payer: Aetna Medicare	$12.30
Rate for Payer: Aetna New Business (MI Preferred)	$15.99
Rate for Payer: BCBS Complete	$9.84
Rate for Payer: Cash Price	$19.68
Rate for Payer: Cofinity Commercial	$17.22
Rate for Payer: Cofinity Commercial	$21.16
Rate for Payer: Cofinity Medicare Advantage	$17.22
Rate for Payer: Encore Health Key Benefits Commercial	$19.68
Rate for Payer: Healthscope Commercial	$22.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.91
Rate for Payer: PHP Commercial	$20.91
Rate for Payer: Priority Health Cigna Priority Health	$15.99
Rate for Payer: Priority Health SBD	$15.50

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$24.60

Service Code	NDC 00005434462
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$22.14
Rate for Payer: Aetna Commercial	$20.91
Rate for Payer: Aetna New Business (MI Preferred)	$15.99
Rate for Payer: Cash Price	$19.68
Rate for Payer: Cofinity Commercial	$17.22
Rate for Payer: Cofinity Commercial	$21.16
Rate for Payer: Cofinity Medicare Advantage	$17.22
Rate for Payer: Encore Health Key Benefits Commercial	$19.68
Rate for Payer: Healthscope Commercial	$22.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.91
Rate for Payer: PHP Commercial	$20.91
Rate for Payer: Priority Health Cigna Priority Health	$15.99
Rate for Payer: Priority Health SBD	$15.50

MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID

Facility

$46.89

Service Code	NDC 81033050150
Hospital Charge Code	162541
Hospital Revenue Code	637
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$42.20
Rate for Payer: Aetna Commercial	$39.86
Rate for Payer: Aetna New Business (MI Preferred)	$30.48
Rate for Payer: Cash Price	$37.51
Rate for Payer: Cofinity Commercial	$32.82
Rate for Payer: Cofinity Commercial	$40.33
Rate for Payer: Cofinity Medicare Advantage	$32.82
Rate for Payer: Encore Health Key Benefits Commercial	$37.51
Rate for Payer: Healthscope Commercial	$42.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.86
Rate for Payer: PHP Commercial	$39.86
Rate for Payer: Priority Health Cigna Priority Health	$30.48
Rate for Payer: Priority Health SBD	$29.54

MULTIVIT-MINS-FERROUS GLUCONATE 9 MG IRON/15 ML (15 ML) ORAL LIQUID

Facility

$46.89

Service Code	NDC 81033050150
Hospital Charge Code	162541
Hospital Revenue Code	637
Min. Negotiated Rate	$18.76
Max. Negotiated Rate	$42.20
Rate for Payer: Aetna Commercial	$39.86
Rate for Payer: Aetna Medicare	$23.45
Rate for Payer: Aetna New Business (MI Preferred)	$30.48
Rate for Payer: BCBS Complete	$18.76
Rate for Payer: Cash Price	$37.51
Rate for Payer: Cofinity Commercial	$32.82
Rate for Payer: Cofinity Commercial	$40.33
Rate for Payer: Cofinity Medicare Advantage	$32.82
Rate for Payer: Encore Health Key Benefits Commercial	$37.51
Rate for Payer: Healthscope Commercial	$42.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.86
Rate for Payer: PHP Commercial	$39.86
Rate for Payer: Priority Health Cigna Priority Health	$30.48
Rate for Payer: Priority Health SBD	$29.54

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.96

Service Code	NDC 45802011222
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.47
Rate for Payer: Aetna New Business (MI Preferred)	$19.47
Rate for Payer: Cash Price	$23.97
Rate for Payer: Cofinity Commercial	$20.97
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Medicare Advantage	$20.97
Rate for Payer: Encore Health Key Benefits Commercial	$23.97
Rate for Payer: Healthscope Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.47
Rate for Payer: PHP Commercial	$25.47
Rate for Payer: Priority Health Cigna Priority Health	$19.47
Rate for Payer: Priority Health SBD	$18.87

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.96

Service Code	NDC 68462018022
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.47
Rate for Payer: Aetna Medicare	$14.98
Rate for Payer: Aetna New Business (MI Preferred)	$19.47
Rate for Payer: BCBS Complete	$11.98
Rate for Payer: Cash Price	$23.97
Rate for Payer: Cofinity Commercial	$20.97
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Medicare Advantage	$20.97
Rate for Payer: Encore Health Key Benefits Commercial	$23.97
Rate for Payer: Healthscope Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.47
Rate for Payer: PHP Commercial	$25.47
Rate for Payer: Priority Health Cigna Priority Health	$19.47
Rate for Payer: Priority Health SBD	$18.87

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$20.79

Service Code	NDC 51672131200
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$18.71
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna New Business (MI Preferred)	$13.51
Rate for Payer: Cash Price	$16.63
Rate for Payer: Cofinity Commercial	$14.55
Rate for Payer: Cofinity Commercial	$17.88
Rate for Payer: Cofinity Medicare Advantage	$14.55
Rate for Payer: Encore Health Key Benefits Commercial	$16.63
Rate for Payer: Healthscope Commercial	$18.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.67
Rate for Payer: PHP Commercial	$17.67
Rate for Payer: Priority Health Cigna Priority Health	$13.51
Rate for Payer: Priority Health SBD	$13.10

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.96

Service Code	NDC 45802011222
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.47
Rate for Payer: Aetna Medicare	$14.98
Rate for Payer: Aetna New Business (MI Preferred)	$19.47
Rate for Payer: BCBS Complete	$11.98
Rate for Payer: Cash Price	$23.97
Rate for Payer: Cofinity Commercial	$20.97
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Medicare Advantage	$20.97
Rate for Payer: Encore Health Key Benefits Commercial	$23.97
Rate for Payer: Healthscope Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.47
Rate for Payer: PHP Commercial	$25.47
Rate for Payer: Priority Health Cigna Priority Health	$19.47
Rate for Payer: Priority Health SBD	$18.87

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.65

Service Code	NDC 00093101042
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$26.68
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Aetna New Business (MI Preferred)	$19.27
Rate for Payer: Cash Price	$23.72
Rate for Payer: Cofinity Commercial	$20.75
Rate for Payer: Cofinity Commercial	$25.50
Rate for Payer: Cofinity Medicare Advantage	$20.75
Rate for Payer: Encore Health Key Benefits Commercial	$23.72
Rate for Payer: Healthscope Commercial	$26.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.20
Rate for Payer: PHP Commercial	$25.20
Rate for Payer: Priority Health Cigna Priority Health	$19.27
Rate for Payer: Priority Health SBD	$18.68

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.65

Service Code	NDC 00093101042
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$26.68
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Aetna Medicare	$14.82
Rate for Payer: Aetna New Business (MI Preferred)	$19.27
Rate for Payer: BCBS Complete	$11.86
Rate for Payer: Cash Price	$23.72
Rate for Payer: Cofinity Commercial	$20.75
Rate for Payer: Cofinity Commercial	$25.50
Rate for Payer: Cofinity Medicare Advantage	$20.75
Rate for Payer: Encore Health Key Benefits Commercial	$23.72
Rate for Payer: Healthscope Commercial	$26.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.20
Rate for Payer: PHP Commercial	$25.20
Rate for Payer: Priority Health Cigna Priority Health	$19.27
Rate for Payer: Priority Health SBD	$18.68

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$20.79

Service Code	NDC 51672131200
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$18.71
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare	$10.39
Rate for Payer: Aetna New Business (MI Preferred)	$13.51
Rate for Payer: BCBS Complete	$8.32
Rate for Payer: Cash Price	$16.63
Rate for Payer: Cofinity Commercial	$14.55
Rate for Payer: Cofinity Commercial	$17.88
Rate for Payer: Cofinity Medicare Advantage	$14.55
Rate for Payer: Encore Health Key Benefits Commercial	$16.63
Rate for Payer: Healthscope Commercial	$18.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.67
Rate for Payer: PHP Commercial	$17.67
Rate for Payer: Priority Health Cigna Priority Health	$13.51
Rate for Payer: Priority Health SBD	$13.10

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.96

Service Code	NDC 68462018022
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.47
Rate for Payer: Aetna New Business (MI Preferred)	$19.47
Rate for Payer: Cash Price	$23.97
Rate for Payer: Cofinity Commercial	$20.97
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Medicare Advantage	$20.97
Rate for Payer: Encore Health Key Benefits Commercial	$23.97
Rate for Payer: Healthscope Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.47
Rate for Payer: PHP Commercial	$25.47
Rate for Payer: Priority Health Cigna Priority Health	$19.47
Rate for Payer: Priority Health SBD	$18.87

MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK WITH NAMED VASCULAR PEDICLE (IE, BUCCINATORS, GENIOGLOSSUS, TEMPORALIS, MASSETER, STERNOCLEIDOMASTOID, LEVATOR SCAPULAE)

Facility

$10,050.52

Service Code	CPT 15733
Hospital Revenue Code	360
Min. Negotiated Rate	$1,913.77
Max. Negotiated Rate	$10,050.52
Rate for Payer: Aetna Medicare	$3,713.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,463.09
Rate for Payer: Amish Plain Church Group Commercial	$4,463.09
Rate for Payer: BCBS Complete	$2,009.46
Rate for Payer: BCBS MAPPO	$3,570.47
Rate for Payer: BCN Medicare Advantage	$3,570.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,570.47
Rate for Payer: Mclaren Medicaid	$1,913.77
Rate for Payer: Mclaren Medicare	$3,570.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,748.99
Rate for Payer: Meridian Medicaid	$2,009.46
Rate for Payer: MI Amish Medical Board Commercial	$4,106.04
Rate for Payer: PACE Medicare	$3,391.95
Rate for Payer: PACE SWMI	$3,570.47
Rate for Payer: PHP Medicare Advantage	$3,570.47
Rate for Payer: Priority Health Choice Medicaid	$1,913.77
Rate for Payer: Priority Health Medicare	$3,570.47
Rate for Payer: Railroad Medicare Medicare	$3,570.47
Rate for Payer: UHC All Payor (Choice/PPO)	$10,050.52
Rate for Payer: UHC Dual Complete DSNP	$3,570.47
Rate for Payer: UHC Medicare Advantage	$3,570.47
Rate for Payer: UHCCP Medicaid	$2,010.17
Rate for Payer: VA VA	$3,570.47

MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY

Facility

$10,050.52

Service Code	CPT 15738
Hospital Revenue Code	360
Min. Negotiated Rate	$1,913.77
Max. Negotiated Rate	$10,050.52
Rate for Payer: Aetna Medicare	$3,713.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,463.09
Rate for Payer: Amish Plain Church Group Commercial	$4,463.09
Rate for Payer: BCBS Complete	$2,009.46
Rate for Payer: BCBS MAPPO	$3,570.47
Rate for Payer: BCN Medicare Advantage	$3,570.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,570.47
Rate for Payer: Mclaren Medicaid	$1,913.77
Rate for Payer: Mclaren Medicare	$3,570.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,748.99
Rate for Payer: Meridian Medicaid	$2,009.46
Rate for Payer: MI Amish Medical Board Commercial	$4,106.04
Rate for Payer: PACE Medicare	$3,391.95
Rate for Payer: PACE SWMI	$3,570.47
Rate for Payer: PHP Medicare Advantage	$3,570.47
Rate for Payer: Priority Health Choice Medicaid	$1,913.77
Rate for Payer: Priority Health Medicare	$3,570.47
Rate for Payer: Railroad Medicare Medicare	$3,570.47
Rate for Payer: UHC All Payor (Choice/PPO)	$10,050.52
Rate for Payer: UHC Dual Complete DSNP	$3,570.47
Rate for Payer: UHC Medicare Advantage	$3,570.47
Rate for Payer: UHCCP Medicaid	$2,010.17
Rate for Payer: VA VA	$3,570.47

MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK

Facility

$10,050.52

Service Code	CPT 15734
Hospital Revenue Code	360
Min. Negotiated Rate	$1,913.77
Max. Negotiated Rate	$10,050.52
Rate for Payer: Aetna Medicare	$3,713.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,463.09
Rate for Payer: Amish Plain Church Group Commercial	$4,463.09
Rate for Payer: BCBS Complete	$2,009.46
Rate for Payer: BCBS MAPPO	$3,570.47
Rate for Payer: BCN Medicare Advantage	$3,570.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,570.47
Rate for Payer: Mclaren Medicaid	$1,913.77
Rate for Payer: Mclaren Medicare	$3,570.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,748.99
Rate for Payer: Meridian Medicaid	$2,009.46
Rate for Payer: MI Amish Medical Board Commercial	$4,106.04
Rate for Payer: PACE Medicare	$3,391.95
Rate for Payer: PACE SWMI	$3,570.47
Rate for Payer: PHP Medicare Advantage	$3,570.47
Rate for Payer: Priority Health Choice Medicaid	$1,913.77
Rate for Payer: Priority Health Medicare	$3,570.47
Rate for Payer: Railroad Medicare Medicare	$3,570.47
Rate for Payer: UHC All Payor (Choice/PPO)	$10,050.52
Rate for Payer: UHC Dual Complete DSNP	$3,570.47
Rate for Payer: UHC Medicare Advantage	$3,570.47
Rate for Payer: UHCCP Medicaid	$2,010.17
Rate for Payer: VA VA	$3,570.47

MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION

Facility

$47.17

Service Code	NDC 54643564901
Hospital Charge Code	161578
Hospital Revenue Code	250
Min. Negotiated Rate	$29.72
Max. Negotiated Rate	$42.45
Rate for Payer: Aetna Commercial	$40.09
Rate for Payer: Aetna New Business (MI Preferred)	$30.66
Rate for Payer: Cash Price	$37.74
Rate for Payer: Cofinity Commercial	$33.02
Rate for Payer: Cofinity Commercial	$40.57
Rate for Payer: Cofinity Medicare Advantage	$33.02
Rate for Payer: Encore Health Key Benefits Commercial	$37.74
Rate for Payer: Healthscope Commercial	$42.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.09
Rate for Payer: PHP Commercial	$40.09
Rate for Payer: Priority Health Cigna Priority Health	$30.66
Rate for Payer: Priority Health SBD	$29.72

Know your out-of-pocket cost for care.

All Charges