Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION

Facility

$54,778.00

Service Code	HCPCS J9042
Hospital Charge Code	153416
Hospital Revenue Code	636
Min. Negotiated Rate	$34,510.14
Max. Negotiated Rate	$49,300.20
Rate for Payer: Aetna Commercial	$46,561.30
Rate for Payer: Aetna New Business (MI Preferred)	$35,605.70
Rate for Payer: Cash Price	$43,822.40
Rate for Payer: Cofinity Commercial	$38,344.60
Rate for Payer: Cofinity Commercial	$47,109.08
Rate for Payer: Cofinity Medicare Advantage	$38,344.60
Rate for Payer: Encore Health Key Benefits Commercial	$43,822.40
Rate for Payer: Healthscope Commercial	$49,300.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46,561.30
Rate for Payer: PHP Commercial	$46,561.30
Rate for Payer: Priority Health Cigna Priority Health	$35,605.70
Rate for Payer: Priority Health SBD	$34,510.14

BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION

Facility

$54,778.00

Service Code	HCPCS J9042
Hospital Charge Code	153416
Hospital Revenue Code	636
Min. Negotiated Rate	$138.63
Max. Negotiated Rate	$49,300.20
Rate for Payer: Aetna Commercial	$46,561.30
Rate for Payer: Aetna Medicare	$268.99
Rate for Payer: Aetna New Business (MI Preferred)	$35,605.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$323.30
Rate for Payer: Amish Plain Church Group Commercial	$323.30
Rate for Payer: BCBS Complete	$145.56
Rate for Payer: BCBS MAPPO	$258.64
Rate for Payer: BCN Medicare Advantage	$258.64
Rate for Payer: Cash Price	$43,822.40
Rate for Payer: Cash Price	$43,822.40
Rate for Payer: Cofinity Commercial	$38,344.60
Rate for Payer: Cofinity Commercial	$47,109.08
Rate for Payer: Cofinity Medicare Advantage	$38,344.60
Rate for Payer: Encore Health Key Benefits Commercial	$43,822.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$258.64
Rate for Payer: Healthscope Commercial	$49,300.20
Rate for Payer: Mclaren Medicaid	$138.63
Rate for Payer: Mclaren Medicare	$258.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$271.57
Rate for Payer: Meridian Medicaid	$145.56
Rate for Payer: MI Amish Medical Board Commercial	$297.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46,561.30
Rate for Payer: PACE Medicare	$245.71
Rate for Payer: PACE SWMI	$258.64
Rate for Payer: PHP Commercial	$46,561.30
Rate for Payer: PHP Medicare Advantage	$258.64
Rate for Payer: Priority Health Choice Medicaid	$138.63
Rate for Payer: Priority Health Cigna Priority Health	$35,605.70
Rate for Payer: Priority Health Medicare	$258.64
Rate for Payer: Priority Health SBD	$34,510.14
Rate for Payer: Railroad Medicare Medicare	$258.64
Rate for Payer: UHC All Payor (Choice/PPO)	$728.05
Rate for Payer: UHC Dual Complete DSNP	$258.64
Rate for Payer: UHC Medicare Advantage	$258.64
Rate for Payer: UHCCP Medicaid	$145.61
Rate for Payer: VA VA	$258.64

BREXPIPRAZOLE 3 MG TABLET

Facility

$5,215.45

Service Code	NDC 59148003913
Hospital Charge Code	174668
Hospital Revenue Code	637
Min. Negotiated Rate	$2,086.18
Max. Negotiated Rate	$4,693.90
Rate for Payer: Aetna Commercial	$4,433.13
Rate for Payer: Aetna Medicare	$2,607.72
Rate for Payer: Aetna New Business (MI Preferred)	$3,390.04
Rate for Payer: BCBS Complete	$2,086.18
Rate for Payer: Cash Price	$4,172.36
Rate for Payer: Cofinity Commercial	$3,650.82
Rate for Payer: Cofinity Commercial	$4,485.29
Rate for Payer: Cofinity Medicare Advantage	$3,650.82
Rate for Payer: Encore Health Key Benefits Commercial	$4,172.36
Rate for Payer: Healthscope Commercial	$4,693.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,433.13
Rate for Payer: PHP Commercial	$4,433.13
Rate for Payer: Priority Health Cigna Priority Health	$3,390.04
Rate for Payer: Priority Health SBD	$3,285.73

BREXPIPRAZOLE 3 MG TABLET

Facility

$5,215.45

Service Code	NDC 59148003913
Hospital Charge Code	174668
Hospital Revenue Code	637
Min. Negotiated Rate	$3,285.73
Max. Negotiated Rate	$4,693.90
Rate for Payer: Aetna Commercial	$4,433.13
Rate for Payer: Aetna New Business (MI Preferred)	$3,390.04
Rate for Payer: Cash Price	$4,172.36
Rate for Payer: Cofinity Commercial	$3,650.82
Rate for Payer: Cofinity Commercial	$4,485.29
Rate for Payer: Cofinity Medicare Advantage	$3,650.82
Rate for Payer: Encore Health Key Benefits Commercial	$4,172.36
Rate for Payer: Healthscope Commercial	$4,693.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,433.13
Rate for Payer: PHP Commercial	$4,433.13
Rate for Payer: Priority Health Cigna Priority Health	$3,390.04
Rate for Payer: Priority Health SBD	$3,285.73

BRIMONIDINE 0.15 % EYE DROPS

Facility

$499.17

Service Code	NDC 61314014405
Hospital Charge Code	31158
Hospital Revenue Code	637
Min. Negotiated Rate	$199.67
Max. Negotiated Rate	$449.25
Rate for Payer: Aetna Commercial	$424.29
Rate for Payer: Aetna Medicare	$249.59
Rate for Payer: Aetna New Business (MI Preferred)	$324.46
Rate for Payer: BCBS Complete	$199.67
Rate for Payer: Cash Price	$399.34
Rate for Payer: Cofinity Commercial	$349.42
Rate for Payer: Cofinity Commercial	$429.29
Rate for Payer: Cofinity Medicare Advantage	$349.42
Rate for Payer: Encore Health Key Benefits Commercial	$399.34
Rate for Payer: Healthscope Commercial	$449.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$424.29
Rate for Payer: PHP Commercial	$424.29
Rate for Payer: Priority Health Cigna Priority Health	$324.46
Rate for Payer: Priority Health SBD	$314.48

BRIMONIDINE 0.15 % EYE DROPS

Facility

$674.73

Service Code	NDC 00023917705
Hospital Charge Code	31158
Hospital Revenue Code	637
Min. Negotiated Rate	$269.89
Max. Negotiated Rate	$607.26
Rate for Payer: Aetna Commercial	$573.52
Rate for Payer: Aetna Medicare	$337.37
Rate for Payer: Aetna New Business (MI Preferred)	$438.57
Rate for Payer: BCBS Complete	$269.89
Rate for Payer: Cash Price	$539.78
Rate for Payer: Cofinity Commercial	$472.31
Rate for Payer: Cofinity Commercial	$580.27
Rate for Payer: Cofinity Medicare Advantage	$472.31
Rate for Payer: Encore Health Key Benefits Commercial	$539.78
Rate for Payer: Healthscope Commercial	$607.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$573.52
Rate for Payer: PHP Commercial	$573.52
Rate for Payer: Priority Health Cigna Priority Health	$438.57
Rate for Payer: Priority Health SBD	$425.08

BRIMONIDINE 0.15 % EYE DROPS

Facility

$674.73

Service Code	NDC 00023917705
Hospital Charge Code	31158
Hospital Revenue Code	637
Min. Negotiated Rate	$425.08
Max. Negotiated Rate	$607.26
Rate for Payer: Aetna Commercial	$573.52
Rate for Payer: Aetna New Business (MI Preferred)	$438.57
Rate for Payer: Cash Price	$539.78
Rate for Payer: Cofinity Commercial	$472.31
Rate for Payer: Cofinity Commercial	$580.27
Rate for Payer: Cofinity Medicare Advantage	$472.31
Rate for Payer: Encore Health Key Benefits Commercial	$539.78
Rate for Payer: Healthscope Commercial	$607.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$573.52
Rate for Payer: PHP Commercial	$573.52
Rate for Payer: Priority Health Cigna Priority Health	$438.57
Rate for Payer: Priority Health SBD	$425.08

BRIMONIDINE 0.15 % EYE DROPS

Facility

$349.37

Service Code	NDC 82182077305
Hospital Charge Code	31158
Hospital Revenue Code	637
Min. Negotiated Rate	$139.75
Max. Negotiated Rate	$314.43
Rate for Payer: Aetna Commercial	$296.96
Rate for Payer: Aetna Medicare	$174.69
Rate for Payer: Aetna New Business (MI Preferred)	$227.09
Rate for Payer: BCBS Complete	$139.75
Rate for Payer: Cash Price	$279.50
Rate for Payer: Cofinity Commercial	$244.56
Rate for Payer: Cofinity Commercial	$300.46
Rate for Payer: Cofinity Medicare Advantage	$244.56
Rate for Payer: Encore Health Key Benefits Commercial	$279.50
Rate for Payer: Healthscope Commercial	$314.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.96
Rate for Payer: PHP Commercial	$296.96
Rate for Payer: Priority Health Cigna Priority Health	$227.09
Rate for Payer: Priority Health SBD	$220.10

BRIMONIDINE 0.15 % EYE DROPS

Facility

$349.37

Service Code	NDC 82182077305
Hospital Charge Code	31158
Hospital Revenue Code	637
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$314.43
Rate for Payer: Aetna Commercial	$296.96
Rate for Payer: Aetna New Business (MI Preferred)	$227.09
Rate for Payer: Cash Price	$279.50
Rate for Payer: Cofinity Commercial	$244.56
Rate for Payer: Cofinity Commercial	$300.46
Rate for Payer: Cofinity Medicare Advantage	$244.56
Rate for Payer: Encore Health Key Benefits Commercial	$279.50
Rate for Payer: Healthscope Commercial	$314.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.96
Rate for Payer: PHP Commercial	$296.96
Rate for Payer: Priority Health Cigna Priority Health	$227.09
Rate for Payer: Priority Health SBD	$220.10

BRIMONIDINE 0.15 % EYE DROPS

Facility

$499.17

Service Code	NDC 61314014405
Hospital Charge Code	31158
Hospital Revenue Code	637
Min. Negotiated Rate	$314.48
Max. Negotiated Rate	$449.25
Rate for Payer: Aetna Commercial	$424.29
Rate for Payer: Aetna New Business (MI Preferred)	$324.46
Rate for Payer: Cash Price	$399.34
Rate for Payer: Cofinity Commercial	$349.42
Rate for Payer: Cofinity Commercial	$429.29
Rate for Payer: Cofinity Medicare Advantage	$349.42
Rate for Payer: Encore Health Key Benefits Commercial	$399.34
Rate for Payer: Healthscope Commercial	$449.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$424.29
Rate for Payer: PHP Commercial	$424.29
Rate for Payer: Priority Health Cigna Priority Health	$324.46
Rate for Payer: Priority Health SBD	$314.48

BRIVARACETAM 10 MG/ML ORAL SOLUTION

Facility

$5,068.26

Service Code	NDC 50474087015
Hospital Charge Code	178914
Hospital Revenue Code	637
Min. Negotiated Rate	$2,027.30
Max. Negotiated Rate	$4,561.43
Rate for Payer: Aetna Commercial	$4,308.02
Rate for Payer: Aetna Medicare	$2,534.13
Rate for Payer: Aetna New Business (MI Preferred)	$3,294.37
Rate for Payer: BCBS Complete	$2,027.30
Rate for Payer: Cash Price	$4,054.61
Rate for Payer: Cofinity Commercial	$3,547.78
Rate for Payer: Cofinity Commercial	$4,358.70
Rate for Payer: Cofinity Medicare Advantage	$3,547.78
Rate for Payer: Encore Health Key Benefits Commercial	$4,054.61
Rate for Payer: Healthscope Commercial	$4,561.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,308.02
Rate for Payer: PHP Commercial	$4,308.02
Rate for Payer: Priority Health Cigna Priority Health	$3,294.37
Rate for Payer: Priority Health SBD	$3,193.00

BRIVARACETAM 10 MG/ML ORAL SOLUTION

Facility

$5,068.26

Service Code	NDC 50474087015
Hospital Charge Code	178914
Hospital Revenue Code	637
Min. Negotiated Rate	$3,193.00
Max. Negotiated Rate	$4,561.43
Rate for Payer: Aetna Commercial	$4,308.02
Rate for Payer: Aetna New Business (MI Preferred)	$3,294.37
Rate for Payer: Cash Price	$4,054.61
Rate for Payer: Cofinity Commercial	$3,547.78
Rate for Payer: Cofinity Commercial	$4,358.70
Rate for Payer: Cofinity Medicare Advantage	$3,547.78
Rate for Payer: Encore Health Key Benefits Commercial	$4,054.61
Rate for Payer: Healthscope Commercial	$4,561.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,308.02
Rate for Payer: PHP Commercial	$4,308.02
Rate for Payer: Priority Health Cigna Priority Health	$3,294.37
Rate for Payer: Priority Health SBD	$3,193.00

BROMOCRIPTINE 2.5 MG TABLET

Facility

$636.48

Service Code	NDC 60687028621
Hospital Charge Code	9297
Hospital Revenue Code	637
Min. Negotiated Rate	$254.59
Max. Negotiated Rate	$572.83
Rate for Payer: Aetna Commercial	$541.01
Rate for Payer: Aetna Medicare	$318.24
Rate for Payer: Aetna New Business (MI Preferred)	$413.71
Rate for Payer: BCBS Complete	$254.59
Rate for Payer: Cash Price	$509.18
Rate for Payer: Cofinity Commercial	$445.54
Rate for Payer: Cofinity Commercial	$547.37
Rate for Payer: Cofinity Medicare Advantage	$445.54
Rate for Payer: Encore Health Key Benefits Commercial	$509.18
Rate for Payer: Healthscope Commercial	$572.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$541.01
Rate for Payer: PHP Commercial	$541.01
Rate for Payer: Priority Health Cigna Priority Health	$413.71
Rate for Payer: Priority Health SBD	$400.98

BROMOCRIPTINE 2.5 MG TABLET

Facility

$636.48

Service Code	NDC 60687028621
Hospital Charge Code	9297
Hospital Revenue Code	637
Min. Negotiated Rate	$400.98
Max. Negotiated Rate	$572.83
Rate for Payer: Aetna Commercial	$541.01
Rate for Payer: Aetna New Business (MI Preferred)	$413.71
Rate for Payer: Cash Price	$509.18
Rate for Payer: Cofinity Commercial	$445.54
Rate for Payer: Cofinity Commercial	$547.37
Rate for Payer: Cofinity Medicare Advantage	$445.54
Rate for Payer: Encore Health Key Benefits Commercial	$509.18
Rate for Payer: Healthscope Commercial	$572.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$541.01
Rate for Payer: PHP Commercial	$541.01
Rate for Payer: Priority Health Cigna Priority Health	$413.71
Rate for Payer: Priority Health SBD	$400.98

BROMOCRIPTINE 2.5 MG TABLET

Facility

$21.22

Service Code	NDC 60687028611
Hospital Charge Code	9297
Hospital Revenue Code	637
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$19.10
Rate for Payer: Aetna Commercial	$18.04
Rate for Payer: Aetna Medicare	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$13.79
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cofinity Commercial	$14.85
Rate for Payer: Cofinity Commercial	$18.25
Rate for Payer: Cofinity Medicare Advantage	$14.85
Rate for Payer: Encore Health Key Benefits Commercial	$16.98
Rate for Payer: Healthscope Commercial	$19.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.04
Rate for Payer: PHP Commercial	$18.04
Rate for Payer: Priority Health Cigna Priority Health	$13.79
Rate for Payer: Priority Health SBD	$13.37

BROMOCRIPTINE 2.5 MG TABLET

Facility

$202.76

Service Code	NDC 00574010603
Hospital Charge Code	9297
Hospital Revenue Code	637
Min. Negotiated Rate	$81.10
Max. Negotiated Rate	$182.48
Rate for Payer: Aetna Commercial	$172.35
Rate for Payer: Aetna Medicare	$101.38
Rate for Payer: Aetna New Business (MI Preferred)	$131.79
Rate for Payer: BCBS Complete	$81.10
Rate for Payer: Cash Price	$162.21
Rate for Payer: Cofinity Commercial	$141.93
Rate for Payer: Cofinity Commercial	$174.37
Rate for Payer: Cofinity Medicare Advantage	$141.93
Rate for Payer: Encore Health Key Benefits Commercial	$162.21
Rate for Payer: Healthscope Commercial	$182.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.35
Rate for Payer: PHP Commercial	$172.35
Rate for Payer: Priority Health Cigna Priority Health	$131.79
Rate for Payer: Priority Health SBD	$127.74

BROMOCRIPTINE 2.5 MG TABLET

Facility

$202.76

Service Code	NDC 00574010603
Hospital Charge Code	9297
Hospital Revenue Code	637
Min. Negotiated Rate	$127.74
Max. Negotiated Rate	$182.48
Rate for Payer: Aetna Commercial	$172.35
Rate for Payer: Aetna New Business (MI Preferred)	$131.79
Rate for Payer: Cash Price	$162.21
Rate for Payer: Cofinity Commercial	$141.93
Rate for Payer: Cofinity Commercial	$174.37
Rate for Payer: Cofinity Medicare Advantage	$141.93
Rate for Payer: Encore Health Key Benefits Commercial	$162.21
Rate for Payer: Healthscope Commercial	$182.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.35
Rate for Payer: PHP Commercial	$172.35
Rate for Payer: Priority Health Cigna Priority Health	$131.79
Rate for Payer: Priority Health SBD	$127.74

BROMOCRIPTINE 2.5 MG TABLET

Facility

$21.22

Service Code	NDC 60687028611
Hospital Charge Code	9297
Hospital Revenue Code	637
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$19.10
Rate for Payer: Aetna Commercial	$18.04
Rate for Payer: Aetna New Business (MI Preferred)	$13.79
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cofinity Commercial	$14.85
Rate for Payer: Cofinity Commercial	$18.25
Rate for Payer: Cofinity Medicare Advantage	$14.85
Rate for Payer: Encore Health Key Benefits Commercial	$16.98
Rate for Payer: Healthscope Commercial	$19.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.04
Rate for Payer: PHP Commercial	$18.04
Rate for Payer: Priority Health Cigna Priority Health	$13.79
Rate for Payer: Priority Health SBD	$13.37

BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID

Facility

$644.70

Service Code	NDC 00485020616
Hospital Charge Code	29801
Hospital Revenue Code	637
Min. Negotiated Rate	$257.88
Max. Negotiated Rate	$580.23
Rate for Payer: Aetna Commercial	$548.00
Rate for Payer: Aetna Medicare	$322.35
Rate for Payer: Aetna New Business (MI Preferred)	$419.06
Rate for Payer: BCBS Complete	$257.88
Rate for Payer: Cash Price	$515.76
Rate for Payer: Cofinity Commercial	$451.29
Rate for Payer: Cofinity Commercial	$554.44
Rate for Payer: Cofinity Medicare Advantage	$451.29
Rate for Payer: Encore Health Key Benefits Commercial	$515.76
Rate for Payer: Healthscope Commercial	$580.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$548.00
Rate for Payer: PHP Commercial	$548.00
Rate for Payer: Priority Health Cigna Priority Health	$419.06
Rate for Payer: Priority Health SBD	$406.16

BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID

Facility

$644.70

Service Code	NDC 00485020616
Hospital Charge Code	29801
Hospital Revenue Code	637
Min. Negotiated Rate	$406.16
Max. Negotiated Rate	$580.23
Rate for Payer: Aetna Commercial	$548.00
Rate for Payer: Aetna New Business (MI Preferred)	$419.06
Rate for Payer: Cash Price	$515.76
Rate for Payer: Cofinity Commercial	$451.29
Rate for Payer: Cofinity Commercial	$554.44
Rate for Payer: Cofinity Medicare Advantage	$451.29
Rate for Payer: Encore Health Key Benefits Commercial	$515.76
Rate for Payer: Healthscope Commercial	$580.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$548.00
Rate for Payer: PHP Commercial	$548.00
Rate for Payer: Priority Health Cigna Priority Health	$419.06
Rate for Payer: Priority Health SBD	$406.16

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$4,734.21

Service Code	CPT 31622
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE

Facility

$4,734.21

Service Code	CPT 31624
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES

Facility

$4,734.21

Service Code	CPT 31625
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS

Facility

$4,734.21

Service Code	CPT 31623
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES

Facility

$10,121.85

Service Code	CPT 31653
Hospital Revenue Code	360
Min. Negotiated Rate	$1,927.35
Max. Negotiated Rate	$10,121.85
Rate for Payer: Aetna Medicare	$3,739.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,494.76
Rate for Payer: Amish Plain Church Group Commercial	$4,494.76
Rate for Payer: BCBS Complete	$2,023.72
Rate for Payer: BCBS MAPPO	$3,595.81
Rate for Payer: BCN Medicare Advantage	$3,595.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,595.81
Rate for Payer: Mclaren Medicaid	$1,927.35
Rate for Payer: Mclaren Medicare	$3,595.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,775.60
Rate for Payer: Meridian Medicaid	$2,023.72
Rate for Payer: MI Amish Medical Board Commercial	$4,135.18
Rate for Payer: PACE Medicare	$3,416.02
Rate for Payer: PACE SWMI	$3,595.81
Rate for Payer: PHP Medicare Advantage	$3,595.81
Rate for Payer: Priority Health Choice Medicaid	$1,927.35
Rate for Payer: Priority Health Medicare	$3,595.81
Rate for Payer: Railroad Medicare Medicare	$3,595.81
Rate for Payer: UHC All Payor (Choice/PPO)	$10,121.85
Rate for Payer: UHC Dual Complete DSNP	$3,595.81
Rate for Payer: UHC Medicare Advantage	$3,595.81
Rate for Payer: UHCCP Medicaid	$2,024.44
Rate for Payer: VA VA	$3,595.81

Know your out-of-pocket cost for care.

All Charges