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Service Code NDC 47335-906-86
Hospital Charge Code 29267
Hospital Revenue Code 637
Min. Negotiated Rate $133.00
Max. Negotiated Rate $190.00
Rate for Payer: Aetna Commercial $179.44
Rate for Payer: Aetna New Business (MI Preferred) $137.22
Rate for Payer: Cash Price $168.89
Rate for Payer: Cofinity Commercial $147.78
Rate for Payer: Cofinity Commercial $181.55
Rate for Payer: Healthscope Commercial $190.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $179.44
Rate for Payer: PHP Commercial $179.44
Rate for Payer: Priority Health Cigna Priority Health $147.78
Rate for Payer: Priority Health SBD $133.00
Service Code NDC 67877-247-60
Hospital Charge Code 29267
Hospital Revenue Code 637
Min. Negotiated Rate $119.92
Max. Negotiated Rate $171.32
Rate for Payer: Aetna Commercial $161.80
Rate for Payer: Aetna New Business (MI Preferred) $123.73
Rate for Payer: Cash Price $152.28
Rate for Payer: Cofinity Commercial $133.24
Rate for Payer: Cofinity Commercial $163.70
Rate for Payer: Healthscope Commercial $171.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $161.80
Rate for Payer: PHP Commercial $161.80
Rate for Payer: Priority Health Cigna Priority Health $133.24
Rate for Payer: Priority Health SBD $119.92
Service Code NDC 0904-6642-61
Hospital Charge Code 29267
Hospital Revenue Code 637
Min. Negotiated Rate $190.92
Max. Negotiated Rate $272.74
Rate for Payer: Aetna Commercial $257.59
Rate for Payer: Aetna New Business (MI Preferred) $196.98
Rate for Payer: Cash Price $242.44
Rate for Payer: Cofinity Commercial $212.14
Rate for Payer: Cofinity Commercial $260.62
Rate for Payer: Healthscope Commercial $272.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $257.59
Rate for Payer: PHP Commercial $257.59
Rate for Payer: Priority Health Cigna Priority Health $212.14
Rate for Payer: Priority Health SBD $190.92
Service Code NDC 47335-907-88
Hospital Charge Code 70398
Hospital Revenue Code 637
Min. Negotiated Rate $260.37
Max. Negotiated Rate $371.95
Rate for Payer: Aetna Commercial $351.29
Rate for Payer: Aetna New Business (MI Preferred) $268.63
Rate for Payer: Cash Price $330.62
Rate for Payer: Cofinity Commercial $289.30
Rate for Payer: Cofinity Commercial $355.42
Rate for Payer: Healthscope Commercial $371.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $351.29
Rate for Payer: PHP Commercial $351.29
Rate for Payer: Priority Health Cigna Priority Health $289.30
Rate for Payer: Priority Health SBD $260.37
Service Code NDC 0904-6643-61
Hospital Charge Code 70398
Hospital Revenue Code 637
Min. Negotiated Rate $221.05
Max. Negotiated Rate $315.79
Rate for Payer: Aetna Commercial $298.25
Rate for Payer: Aetna New Business (MI Preferred) $228.07
Rate for Payer: Cash Price $280.70
Rate for Payer: Cofinity Commercial $245.62
Rate for Payer: Cofinity Commercial $301.76
Rate for Payer: Healthscope Commercial $315.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $298.25
Rate for Payer: PHP Commercial $298.25
Rate for Payer: Priority Health Cigna Priority Health $245.62
Rate for Payer: Priority Health SBD $221.05
Service Code NDC 0904-6639-61
Hospital Charge Code 70397
Hospital Revenue Code 637
Min. Negotiated Rate $122.69
Max. Negotiated Rate $175.28
Rate for Payer: Aetna Commercial $165.54
Rate for Payer: Aetna New Business (MI Preferred) $126.59
Rate for Payer: Cash Price $155.80
Rate for Payer: Cofinity Commercial $136.32
Rate for Payer: Cofinity Commercial $167.48
Rate for Payer: Healthscope Commercial $175.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $165.54
Rate for Payer: PHP Commercial $165.54
Rate for Payer: Priority Health Cigna Priority Health $136.32
Rate for Payer: Priority Health SBD $122.69
Service Code NDC 68180-613-07
Hospital Charge Code 96233
Hospital Revenue Code 637
Min. Negotiated Rate $80.80
Max. Negotiated Rate $115.42
Rate for Payer: Aetna Commercial $109.01
Rate for Payer: Aetna New Business (MI Preferred) $83.36
Rate for Payer: Cash Price $102.60
Rate for Payer: Cofinity Commercial $110.30
Rate for Payer: Cofinity Commercial $89.78
Rate for Payer: Healthscope Commercial $115.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $109.01
Rate for Payer: PHP Commercial $109.01
Rate for Payer: Priority Health Cigna Priority Health $89.78
Rate for Payer: Priority Health SBD $80.80
Service Code NDC 0310-0281-60
Hospital Charge Code 96233
Hospital Revenue Code 637
Min. Negotiated Rate $1,802.94
Max. Negotiated Rate $2,575.63
Rate for Payer: Aetna Commercial $2,432.54
Rate for Payer: Aetna New Business (MI Preferred) $1,860.18
Rate for Payer: Cash Price $2,289.45
Rate for Payer: Cofinity Commercial $2,003.27
Rate for Payer: Cofinity Commercial $2,461.16
Rate for Payer: Healthscope Commercial $2,575.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $2,432.54
Rate for Payer: PHP Commercial $2,432.54
Rate for Payer: Priority Health Cigna Priority Health $2,003.27
Rate for Payer: Priority Health SBD $1,802.94
Service Code NDC 0904-6802-61
Hospital Charge Code 96233
Hospital Revenue Code 637
Min. Negotiated Rate $195.35
Max. Negotiated Rate $279.07
Rate for Payer: Aetna Commercial $263.57
Rate for Payer: Aetna New Business (MI Preferred) $201.55
Rate for Payer: Cash Price $248.06
Rate for Payer: Cofinity Commercial $217.06
Rate for Payer: Cofinity Commercial $266.67
Rate for Payer: Healthscope Commercial $279.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $263.57
Rate for Payer: PHP Commercial $263.57
Rate for Payer: Priority Health Cigna Priority Health $217.06
Rate for Payer: Priority Health SBD $195.35
Service Code NDC 0310-0282-60
Hospital Charge Code 82089
Hospital Revenue Code 637
Min. Negotiated Rate $1,984.34
Max. Negotiated Rate $2,834.77
Rate for Payer: Aetna Commercial $2,677.28
Rate for Payer: Aetna New Business (MI Preferred) $2,047.33
Rate for Payer: Cash Price $2,519.79
Rate for Payer: Cofinity Commercial $2,204.82
Rate for Payer: Cofinity Commercial $2,708.78
Rate for Payer: Healthscope Commercial $2,834.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $2,677.28
Rate for Payer: PHP Commercial $2,677.28
Rate for Payer: Priority Health Cigna Priority Health $2,204.82
Rate for Payer: Priority Health SBD $1,984.34
Service Code NDC 68180-614-07
Hospital Charge Code 82089
Hospital Revenue Code 637
Min. Negotiated Rate $94.08
Max. Negotiated Rate $134.41
Rate for Payer: Aetna Commercial $126.94
Rate for Payer: Aetna New Business (MI Preferred) $97.07
Rate for Payer: Cash Price $119.47
Rate for Payer: Cofinity Commercial $104.54
Rate for Payer: Cofinity Commercial $128.43
Rate for Payer: Healthscope Commercial $134.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $126.94
Rate for Payer: PHP Commercial $126.94
Rate for Payer: Priority Health Cigna Priority Health $104.54
Rate for Payer: Priority Health SBD $94.08
Service Code NDC 16729-095-12
Hospital Charge Code 82089
Hospital Revenue Code 637
Min. Negotiated Rate $99.47
Max. Negotiated Rate $142.10
Rate for Payer: Aetna Commercial $134.21
Rate for Payer: Aetna New Business (MI Preferred) $102.63
Rate for Payer: Cash Price $126.31
Rate for Payer: Cofinity Commercial $110.52
Rate for Payer: Cofinity Commercial $135.79
Rate for Payer: Healthscope Commercial $142.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $134.21
Rate for Payer: PHP Commercial $134.21
Rate for Payer: Priority Health Cigna Priority Health $110.52
Rate for Payer: Priority Health SBD $99.47
Service Code NDC 0904-6803-61
Hospital Charge Code 82089
Hospital Revenue Code 637
Min. Negotiated Rate $270.04
Max. Negotiated Rate $385.78
Rate for Payer: Aetna Commercial $364.34
Rate for Payer: Aetna New Business (MI Preferred) $278.62
Rate for Payer: Cash Price $342.91
Rate for Payer: Cofinity Commercial $300.05
Rate for Payer: Cofinity Commercial $368.63
Rate for Payer: Healthscope Commercial $385.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $364.34
Rate for Payer: PHP Commercial $364.34
Rate for Payer: Priority Health Cigna Priority Health $300.05
Rate for Payer: Priority Health SBD $270.04
Service Code NDC 0310-0283-60
Hospital Charge Code 82090
Hospital Revenue Code 637
Min. Negotiated Rate $2,546.43
Max. Negotiated Rate $3,637.76
Rate for Payer: Aetna Commercial $3,435.67
Rate for Payer: Aetna New Business (MI Preferred) $2,627.27
Rate for Payer: Cash Price $3,233.57
Rate for Payer: Cofinity Commercial $2,829.37
Rate for Payer: Cofinity Commercial $3,476.09
Rate for Payer: Healthscope Commercial $3,637.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $3,435.67
Rate for Payer: PHP Commercial $3,435.67
Rate for Payer: Priority Health Cigna Priority Health $2,829.37
Rate for Payer: Priority Health SBD $2,546.43
Service Code NDC 0904-6804-61
Hospital Charge Code 82090
Hospital Revenue Code 637
Min. Negotiated Rate $288.79
Max. Negotiated Rate $412.56
Rate for Payer: Aetna Commercial $389.64
Rate for Payer: Aetna New Business (MI Preferred) $297.96
Rate for Payer: Cash Price $366.72
Rate for Payer: Cofinity Commercial $320.88
Rate for Payer: Cofinity Commercial $394.22
Rate for Payer: Healthscope Commercial $412.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $389.64
Rate for Payer: PHP Commercial $389.64
Rate for Payer: Priority Health Cigna Priority Health $320.88
Rate for Payer: Priority Health SBD $288.79
Service Code NDC 0904-6801-61
Hospital Charge Code 95676
Hospital Revenue Code 637
Min. Negotiated Rate $185.98
Max. Negotiated Rate $265.68
Rate for Payer: Aetna Commercial $250.92
Rate for Payer: Aetna New Business (MI Preferred) $191.88
Rate for Payer: Cash Price $236.16
Rate for Payer: Cofinity Commercial $206.64
Rate for Payer: Cofinity Commercial $253.87
Rate for Payer: Healthscope Commercial $265.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $250.92
Rate for Payer: PHP Commercial $250.92
Rate for Payer: Priority Health Cigna Priority Health $206.64
Rate for Payer: Priority Health SBD $185.98
Service Code NDC 0310-0280-60
Hospital Charge Code 95676
Hospital Revenue Code 637
Min. Negotiated Rate $1,062.80
Max. Negotiated Rate $1,518.28
Rate for Payer: Aetna Commercial $1,433.93
Rate for Payer: Aetna New Business (MI Preferred) $1,096.54
Rate for Payer: Cash Price $1,349.58
Rate for Payer: Cofinity Commercial $1,180.89
Rate for Payer: Cofinity Commercial $1,450.80
Rate for Payer: Healthscope Commercial $1,518.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,433.93
Rate for Payer: PHP Commercial $1,433.93
Rate for Payer: Priority Health Cigna Priority Health $1,180.89
Rate for Payer: Priority Health SBD $1,062.80
Service Code HCPCS 90375
Hospital Charge Code 186395
Hospital Revenue Code 636
Min. Negotiated Rate $1,269.36
Max. Negotiated Rate $1,813.36
Rate for Payer: Aetna Commercial $1,712.62
Rate for Payer: Aetna New Business (MI Preferred) $1,309.65
Rate for Payer: Cash Price $1,611.88
Rate for Payer: Cofinity Commercial $1,410.40
Rate for Payer: Cofinity Commercial $1,732.77
Rate for Payer: Healthscope Commercial $1,813.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,712.62
Rate for Payer: PHP Commercial $1,712.62
Rate for Payer: Priority Health Cigna Priority Health $1,410.40
Rate for Payer: Priority Health SBD $1,269.36
Service Code HCPCS 90675
Hospital Charge Code 11257
Hospital Revenue Code 636
Min. Negotiated Rate $621.50
Max. Negotiated Rate $887.86
Rate for Payer: Aetna Commercial $838.53
Rate for Payer: Aetna New Business (MI Preferred) $641.23
Rate for Payer: Cash Price $789.21
Rate for Payer: Cofinity Commercial $690.56
Rate for Payer: Cofinity Commercial $848.40
Rate for Payer: Healthscope Commercial $887.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $838.53
Rate for Payer: PHP Commercial $838.53
Rate for Payer: Priority Health Cigna Priority Health $690.56
Rate for Payer: Priority Health SBD $621.50
Service Code HCPCS 90675
Hospital Charge Code 22120
Hospital Revenue Code 636
Min. Negotiated Rate $764.15
Max. Negotiated Rate $1,091.64
Rate for Payer: Aetna Commercial $1,030.99
Rate for Payer: Aetna Commercial $864.36
Rate for Payer: Aetna New Business (MI Preferred) $660.98
Rate for Payer: Aetna New Business (MI Preferred) $788.40
Rate for Payer: Cash Price $813.52
Rate for Payer: Cash Price $970.34
Rate for Payer: Cofinity Commercial $1,043.12
Rate for Payer: Cofinity Commercial $849.05
Rate for Payer: Cofinity Commercial $874.53
Rate for Payer: Cofinity Commercial $711.83
Rate for Payer: Healthscope Commercial $915.21
Rate for Payer: Healthscope Commercial $1,091.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,030.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $864.36
Rate for Payer: PHP Commercial $864.36
Rate for Payer: PHP Commercial $1,030.99
Rate for Payer: Priority Health Cigna Priority Health $711.83
Rate for Payer: Priority Health Cigna Priority Health $849.05
Rate for Payer: Priority Health SBD $640.65
Rate for Payer: Priority Health SBD $764.15
Service Code NDC 0487-2784-01
Hospital Charge Code 2851
Hospital Revenue Code 637
Min. Negotiated Rate $2.34
Max. Negotiated Rate $3.35
Rate for Payer: Aetna Commercial $3.16
Rate for Payer: Aetna New Business (MI Preferred) $2.42
Rate for Payer: Cash Price $2.98
Rate for Payer: Cofinity Commercial $2.60
Rate for Payer: Cofinity Commercial $3.20
Rate for Payer: Healthscope Commercial $3.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $3.16
Rate for Payer: PHP Commercial $3.16
Rate for Payer: Priority Health Cigna Priority Health $2.60
Rate for Payer: Priority Health SBD $2.34
Service Code NDC 0487-5901-99
Hospital Charge Code 2851
Hospital Revenue Code 637
Min. Negotiated Rate $4.21
Max. Negotiated Rate $6.02
Rate for Payer: Aetna Commercial $5.69
Rate for Payer: Aetna New Business (MI Preferred) $4.35
Rate for Payer: Cash Price $5.35
Rate for Payer: Cofinity Commercial $4.68
Rate for Payer: Cofinity Commercial $5.75
Rate for Payer: Healthscope Commercial $6.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $5.69
Rate for Payer: PHP Commercial $5.69
Rate for Payer: Priority Health Cigna Priority Health $4.68
Rate for Payer: Priority Health SBD $4.21
Service Code CPT 25116
Hospital Revenue Code 360
Min. Negotiated Rate $606.10
Max. Negotiated Rate $8,817.68
Rate for Payer: Aetna Medicare $2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial $3,600.14
Rate for Payer: Amish Plain Church Group Commercial $3,600.14
Rate for Payer: BCBS Complete $1,654.34
Rate for Payer: BCBS MAPPO $2,880.11
Rate for Payer: BCBS Trust/PPO $1,234.36
Rate for Payer: BCN Medicare Advantage $2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage $2,880.11
Rate for Payer: Mclaren Medicaid $1,575.42
Rate for Payer: Mclaren Medicare $2,880.11
Rate for Payer: Meridian Medicaid $1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage $3,024.12
Rate for Payer: MI Amish Medical Board Commercial $3,312.13
Rate for Payer: PACE Medicare $2,736.10
Rate for Payer: PACE SWMI $2,880.11
Rate for Payer: PHP Medicare Advantage $2,880.11
Rate for Payer: Priority Health Choice Medicaid $1,575.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network $8,817.68
Rate for Payer: Priority Health Medicare $2,880.11
Rate for Payer: Priority Health Narrow Network $7,054.14
Rate for Payer: Railroad Medicare Medicare $2,880.11
Rate for Payer: UHC All Payor (Choice/PPO) $666.71
Rate for Payer: UHC Core $4,155.00
Rate for Payer: UHC Dual Complete DSNP $2,880.11
Rate for Payer: UHC Exchange $606.10
Rate for Payer: UHC Medicare Advantage $2,966.51
Rate for Payer: VA VA $2,880.11
Service Code MS-DRG 849
Min. Negotiated Rate $18,881.85
Max. Negotiated Rate $55,505.76
Rate for Payer: Aetna Medicare $20,670.66
Rate for Payer: Allen County Amish Medical Aid Commercial $24,844.54
Rate for Payer: Amish Plain Church Group Commercial $24,844.54
Rate for Payer: BCBS MAPPO $19,875.63
Rate for Payer: BCBS Trust/PPO $55,505.76
Rate for Payer: BCN Medicare Advantage $19,875.63
Rate for Payer: Health Alliance Plan Medicare Advantage $19,875.63
Rate for Payer: Mclaren Medicare $19,875.63
Rate for Payer: Meridian Wellcare - Medicare Advantage $20,869.41
Rate for Payer: MI Amish Medical Board Commercial $22,856.97
Rate for Payer: PACE Medicare $18,881.85
Rate for Payer: PACE SWMI $19,875.63
Rate for Payer: PHP Medicare Advantage $19,875.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network $38,621.37
Rate for Payer: Priority Health Medicare $19,875.63
Rate for Payer: Priority Health Narrow Network $30,897.10
Rate for Payer: Railroad Medicare Medicare $19,875.63
Rate for Payer: UHC All Payor (Choice/PPO) $41,054.62
Rate for Payer: UHC Core $25,191.50
Rate for Payer: UHC Dual Complete DSNP $19,875.63
Rate for Payer: UHC Exchange $26,981.29
Rate for Payer: UHC Medicare Advantage $20,471.90
Rate for Payer: VA VA $19,875.63
Service Code NDC 50268-694-11
Hospital Charge Code 22143
Hospital Revenue Code 637
Min. Negotiated Rate $6.09
Max. Negotiated Rate $8.70
Rate for Payer: Aetna Commercial $8.22
Rate for Payer: Aetna New Business (MI Preferred) $6.29
Rate for Payer: Cash Price $7.74
Rate for Payer: Cofinity Commercial $6.77
Rate for Payer: Cofinity Commercial $8.32
Rate for Payer: Healthscope Commercial $8.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $8.22
Rate for Payer: PHP Commercial $8.22
Rate for Payer: Priority Health Cigna Priority Health $6.77
Rate for Payer: Priority Health SBD $6.09