Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

THIOTEPA 15 MG SOLUTION FOR INJECTION

Facility

$861.90

Service Code	HCPCS J9340
Hospital Charge Code	7901
Hospital Revenue Code	636
Min. Negotiated Rate	$379.24
Max. Negotiated Rate	$775.71
Rate for Payer: Aetna American Axle	$560.24
Rate for Payer: Aetna Commercial	$732.62
Rate for Payer: Aetna New Business (MI Preferred)	$560.24
Rate for Payer: Cash Price	$689.52
Rate for Payer: Cofinity Commercial	$741.23
Rate for Payer: Cofinity Commercial	$603.33
Rate for Payer: Encore Health Key Benefits Commercial	$689.52
Rate for Payer: Healthscope Commercial	$775.71
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$603.33
Rate for Payer: Lakeland Regional Health Systems Commercial	$646.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$732.62
Rate for Payer: PHP Commercial	$732.62
Rate for Payer: Priority Health Cigna Priority Health	$603.33
Rate for Payer: Priority Health SBD	$543.00
Rate for Payer: UMR Bronson Commercial	$379.24
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$646.42

THIOTHIXENE 2 MG CAPSULE

Facility

$402.24

Service Code	NDC 70954-015-10
Hospital Charge Code	7904
Hospital Revenue Code	637
Min. Negotiated Rate	$176.99
Max. Negotiated Rate	$362.02
Rate for Payer: Aetna American Axle	$261.46
Rate for Payer: Aetna Commercial	$341.90
Rate for Payer: Aetna New Business (MI Preferred)	$261.46
Rate for Payer: Cash Price	$321.79
Rate for Payer: Cofinity Commercial	$281.57
Rate for Payer: Cofinity Commercial	$345.93
Rate for Payer: Encore Health Key Benefits Commercial	$321.79
Rate for Payer: Healthscope Commercial	$362.02
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$281.57
Rate for Payer: Lakeland Regional Health Systems Commercial	$301.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$341.90
Rate for Payer: PHP Commercial	$341.90
Rate for Payer: Priority Health Cigna Priority Health	$281.57
Rate for Payer: Priority Health SBD	$253.41
Rate for Payer: UMR Bronson Commercial	$176.99
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$301.68

THIOTHIXENE 2 MG CAPSULE

Facility

$559.68

Service Code	NDC 0378-2002-01
Hospital Charge Code	7904
Hospital Revenue Code	637
Min. Negotiated Rate	$246.26
Max. Negotiated Rate	$503.71
Rate for Payer: Aetna American Axle	$363.79
Rate for Payer: Aetna Commercial	$475.73
Rate for Payer: Aetna New Business (MI Preferred)	$363.79
Rate for Payer: Cash Price	$447.74
Rate for Payer: Cofinity Commercial	$391.78
Rate for Payer: Cofinity Commercial	$481.32
Rate for Payer: Encore Health Key Benefits Commercial	$447.74
Rate for Payer: Healthscope Commercial	$503.71
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$391.78
Rate for Payer: Lakeland Regional Health Systems Commercial	$419.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$475.73
Rate for Payer: PHP Commercial	$475.73
Rate for Payer: Priority Health Cigna Priority Health	$391.78
Rate for Payer: Priority Health SBD	$352.60
Rate for Payer: UMR Bronson Commercial	$246.26
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$419.76

THIOTHIXENE 5 MG CAPSULE

Facility

$9.90

Service Code	NDC 51079-588-01
Hospital Charge Code	7906
Hospital Revenue Code	637
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$8.91
Rate for Payer: Aetna American Axle	$6.44
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Aetna New Business (MI Preferred)	$6.44
Rate for Payer: Cash Price	$7.92
Rate for Payer: Cofinity Commercial	$6.93
Rate for Payer: Cofinity Commercial	$8.51
Rate for Payer: Encore Health Key Benefits Commercial	$7.92
Rate for Payer: Healthscope Commercial	$8.91
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$6.93
Rate for Payer: Lakeland Regional Health Systems Commercial	$7.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.42
Rate for Payer: PHP Commercial	$8.42
Rate for Payer: Priority Health Cigna Priority Health	$6.93
Rate for Payer: Priority Health SBD	$6.24
Rate for Payer: UMR Bronson Commercial	$4.36
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$7.42

THIOTHIXENE 5 MG CAPSULE

Facility

$665.76

Service Code	NDC 70954-016-10
Hospital Charge Code	7906
Hospital Revenue Code	637
Min. Negotiated Rate	$292.93
Max. Negotiated Rate	$599.18
Rate for Payer: Aetna American Axle	$432.74
Rate for Payer: Aetna Commercial	$565.90
Rate for Payer: Aetna New Business (MI Preferred)	$432.74
Rate for Payer: Cash Price	$532.61
Rate for Payer: Cofinity Commercial	$466.03
Rate for Payer: Cofinity Commercial	$572.55
Rate for Payer: Encore Health Key Benefits Commercial	$532.61
Rate for Payer: Healthscope Commercial	$599.18
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$466.03
Rate for Payer: Lakeland Regional Health Systems Commercial	$499.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$565.90
Rate for Payer: PHP Commercial	$565.90
Rate for Payer: Priority Health Cigna Priority Health	$466.03
Rate for Payer: Priority Health SBD	$419.43
Rate for Payer: UMR Bronson Commercial	$292.93
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$499.32

THIOTHIXENE 5 MG CAPSULE

Facility

$989.01

Service Code	NDC 51079-588-20
Hospital Charge Code	7906
Hospital Revenue Code	637
Min. Negotiated Rate	$435.16
Max. Negotiated Rate	$890.11
Rate for Payer: Aetna American Axle	$642.86
Rate for Payer: Aetna Commercial	$840.66
Rate for Payer: Aetna New Business (MI Preferred)	$642.86
Rate for Payer: Cash Price	$791.21
Rate for Payer: Cofinity Commercial	$692.31
Rate for Payer: Cofinity Commercial	$850.55
Rate for Payer: Encore Health Key Benefits Commercial	$791.21
Rate for Payer: Healthscope Commercial	$890.11
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$692.31
Rate for Payer: Lakeland Regional Health Systems Commercial	$741.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$840.66
Rate for Payer: PHP Commercial	$840.66
Rate for Payer: Priority Health Cigna Priority Health	$692.31
Rate for Payer: Priority Health SBD	$623.08
Rate for Payer: UMR Bronson Commercial	$435.16
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$741.76

THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE

Facility

$1,757.86

Service Code	CPT 32555
Hospital Revenue Code	361
Min. Negotiated Rate	$104.78
Max. Negotiated Rate	$1,757.86
Rate for Payer: Aetna Medicare	$580.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$698.00
Rate for Payer: Amish Plain Church Group Commercial	$698.00
Rate for Payer: BCBS Complete	$320.74
Rate for Payer: BCBS MAPPO	$558.40
Rate for Payer: BCBS Trust/PPO	$695.54
Rate for Payer: BCN Medicare Advantage	$558.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$558.40
Rate for Payer: Mclaren Medicaid	$305.44
Rate for Payer: Mclaren Medicare	$558.40
Rate for Payer: Meridian Medicaid	$320.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$586.32
Rate for Payer: MI Amish Medical Board Commercial	$642.16
Rate for Payer: PACE Medicare	$530.48
Rate for Payer: PACE SWMI	$558.40
Rate for Payer: PHP Medicare Advantage	$558.40
Rate for Payer: Priority Health Choice Medicaid	$305.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,757.86
Rate for Payer: Priority Health Medicare	$558.40
Rate for Payer: Priority Health Narrow Network	$1,406.29
Rate for Payer: Railroad Medicare Medicare	$558.40
Rate for Payer: UHC All Payor (Choice/PPO)	$115.26
Rate for Payer: UHC Core	$981.00
Rate for Payer: UHC Dual Complete DSNP	$558.40
Rate for Payer: UHC Exchange	$104.78
Rate for Payer: UHC Medicare Advantage	$575.15
Rate for Payer: VA VA	$558.40

THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY

Facility

$16,145.72

Service Code	CPT 32606
Hospital Revenue Code	360
Min. Negotiated Rate	$444.99
Max. Negotiated Rate	$16,145.72
Rate for Payer: Aetna Medicare	$5,333.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,411.01
Rate for Payer: Amish Plain Church Group Commercial	$6,411.01
Rate for Payer: BCBS Complete	$2,945.99
Rate for Payer: BCBS MAPPO	$5,128.81
Rate for Payer: BCBS Trust/PPO	$3,739.39
Rate for Payer: BCN Medicare Advantage	$5,128.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,128.81
Rate for Payer: Mclaren Medicaid	$2,805.46
Rate for Payer: Mclaren Medicare	$5,128.81
Rate for Payer: Meridian Medicaid	$2,945.99
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,385.25
Rate for Payer: MI Amish Medical Board Commercial	$5,898.13
Rate for Payer: PACE Medicare	$4,872.37
Rate for Payer: PACE SWMI	$5,128.81
Rate for Payer: PHP Medicare Advantage	$5,128.81
Rate for Payer: Priority Health Choice Medicaid	$2,805.46
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,145.72
Rate for Payer: Priority Health Medicare	$5,128.81
Rate for Payer: Priority Health Narrow Network	$12,916.58
Rate for Payer: Railroad Medicare Medicare	$5,128.81
Rate for Payer: UHC All Payor (Choice/PPO)	$489.49
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$5,128.81
Rate for Payer: UHC Exchange	$444.99
Rate for Payer: UHC Medicare Advantage	$5,282.67
Rate for Payer: VA VA	$5,128.81

THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR, OR MASS

Facility

$3,110.47

Service Code	CPT 32662
Hospital Revenue Code	360
Min. Negotiated Rate	$868.70
Max. Negotiated Rate	$3,110.47
Rate for Payer: BCBS Trust/PPO	$3,110.47
Rate for Payer: UHC All Payor (Choice/PPO)	$955.57
Rate for Payer: UHC Core	$1,879.00
Rate for Payer: UHC Exchange	$868.70

THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA

Facility

$16,145.72

Service Code	CPT 32609
Hospital Revenue Code	360
Min. Negotiated Rate	$247.22
Max. Negotiated Rate	$16,145.72
Rate for Payer: Aetna Medicare	$5,333.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,411.01
Rate for Payer: Amish Plain Church Group Commercial	$6,411.01
Rate for Payer: BCBS Complete	$2,945.99
Rate for Payer: BCBS MAPPO	$5,128.81
Rate for Payer: BCBS Trust/PPO	$3,739.39
Rate for Payer: BCN Medicare Advantage	$5,128.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,128.81
Rate for Payer: Mclaren Medicaid	$2,805.46
Rate for Payer: Mclaren Medicare	$5,128.81
Rate for Payer: Meridian Medicaid	$2,945.99
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,385.25
Rate for Payer: MI Amish Medical Board Commercial	$5,898.13
Rate for Payer: PACE Medicare	$4,872.37
Rate for Payer: PACE SWMI	$5,128.81
Rate for Payer: PHP Medicare Advantage	$5,128.81
Rate for Payer: Priority Health Choice Medicaid	$2,805.46
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,145.72
Rate for Payer: Priority Health Medicare	$5,128.81
Rate for Payer: Priority Health Narrow Network	$12,916.58
Rate for Payer: Railroad Medicare Medicare	$5,128.81
Rate for Payer: UHC All Payor (Choice/PPO)	$271.94
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$5,128.81
Rate for Payer: UHC Exchange	$247.22
Rate for Payer: UHC Medicare Advantage	$5,282.67
Rate for Payer: VA VA	$5,128.81

THORACOSCOPY; WITH DIAGNOSTIC BIOPSY(IES) OF LUNG INFILTRATE(S) (EG, WEDGE, INCISIONAL), UNILATERAL

Facility

$28,804.18

Service Code	CPT 32607
Hospital Revenue Code	360
Min. Negotiated Rate	$296.99
Max. Negotiated Rate	$28,804.18
Rate for Payer: Aetna Medicare	$9,515.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,437.32
Rate for Payer: Amish Plain Church Group Commercial	$11,437.32
Rate for Payer: BCBS Complete	$5,255.68
Rate for Payer: BCBS MAPPO	$9,149.86
Rate for Payer: BCBS Trust/PPO	$3,739.39
Rate for Payer: BCN Medicare Advantage	$9,149.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,149.86
Rate for Payer: Mclaren Medicaid	$5,004.97
Rate for Payer: Mclaren Medicare	$9,149.86
Rate for Payer: Meridian Medicaid	$5,255.68
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,607.35
Rate for Payer: MI Amish Medical Board Commercial	$10,522.34
Rate for Payer: PACE Medicare	$8,692.37
Rate for Payer: PACE SWMI	$9,149.86
Rate for Payer: PHP Medicare Advantage	$9,149.86
Rate for Payer: Priority Health Choice Medicaid	$5,004.97
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28,804.18
Rate for Payer: Priority Health Medicare	$9,149.86
Rate for Payer: Priority Health Narrow Network	$23,043.34
Rate for Payer: Railroad Medicare Medicare	$9,149.86
Rate for Payer: UHC All Payor (Choice/PPO)	$326.69
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$9,149.86
Rate for Payer: UHC Exchange	$296.99
Rate for Payer: UHC Medicare Advantage	$9,424.36
Rate for Payer: VA VA	$9,149.86

THORACOTOMY; WITH CARDIAC MASSAGE

Facility

$2,755.08

Service Code	CPT 32160
Hospital Revenue Code	360
Min. Negotiated Rate	$777.02
Max. Negotiated Rate	$2,755.08
Rate for Payer: BCBS Trust/PPO	$2,755.08
Rate for Payer: UHC All Payor (Choice/PPO)	$854.72
Rate for Payer: UHC Core	$1,879.00
Rate for Payer: UHC Exchange	$777.02

THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA);

Facility

$15,377.24

Service Code	CPT 35875
Hospital Revenue Code	360
Min. Negotiated Rate	$568.77
Max. Negotiated Rate	$15,377.24
Rate for Payer: Aetna Medicare	$5,080.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,105.86
Rate for Payer: Amish Plain Church Group Commercial	$6,105.86
Rate for Payer: BCBS Complete	$2,805.77
Rate for Payer: BCBS MAPPO	$4,884.69
Rate for Payer: BCBS Trust/PPO	$3,149.17
Rate for Payer: BCN Medicare Advantage	$4,884.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,884.69
Rate for Payer: Mclaren Medicaid	$2,671.93
Rate for Payer: Mclaren Medicare	$4,884.69
Rate for Payer: Meridian Medicaid	$2,805.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,128.92
Rate for Payer: MI Amish Medical Board Commercial	$5,617.39
Rate for Payer: PACE Medicare	$4,640.46
Rate for Payer: PACE SWMI	$4,884.69
Rate for Payer: PHP Medicare Advantage	$4,884.69
Rate for Payer: Priority Health Choice Medicaid	$2,671.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,377.24
Rate for Payer: Priority Health Medicare	$4,884.69
Rate for Payer: Priority Health Narrow Network	$12,301.79
Rate for Payer: Railroad Medicare Medicare	$4,884.69
Rate for Payer: UHC All Payor (Choice/PPO)	$625.65
Rate for Payer: UHC Core	$8,596.00
Rate for Payer: UHC Dual Complete DSNP	$4,884.69
Rate for Payer: UHC Exchange	$568.77
Rate for Payer: UHC Medicare Advantage	$5,031.23
Rate for Payer: VA VA	$4,884.69

THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)

Facility

$15,377.24

Service Code	CPT 36831
Hospital Revenue Code	360
Min. Negotiated Rate	$593.98
Max. Negotiated Rate	$15,377.24
Rate for Payer: Aetna Medicare	$5,080.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,105.86
Rate for Payer: Amish Plain Church Group Commercial	$6,105.86
Rate for Payer: BCBS Complete	$2,805.77
Rate for Payer: BCBS MAPPO	$4,884.69
Rate for Payer: BCBS Trust/PPO	$2,797.73
Rate for Payer: BCN Medicare Advantage	$4,884.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,884.69
Rate for Payer: Mclaren Medicaid	$2,671.93
Rate for Payer: Mclaren Medicare	$4,884.69
Rate for Payer: Meridian Medicaid	$2,805.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,128.92
Rate for Payer: MI Amish Medical Board Commercial	$5,617.39
Rate for Payer: PACE Medicare	$4,640.46
Rate for Payer: PACE SWMI	$4,884.69
Rate for Payer: PHP Medicare Advantage	$4,884.69
Rate for Payer: Priority Health Choice Medicaid	$2,671.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,377.24
Rate for Payer: Priority Health Medicare	$4,884.69
Rate for Payer: Priority Health Narrow Network	$12,301.79
Rate for Payer: Railroad Medicare Medicare	$4,884.69
Rate for Payer: UHC All Payor (Choice/PPO)	$653.38
Rate for Payer: UHC Core	$8,596.00
Rate for Payer: UHC Dual Complete DSNP	$4,884.69
Rate for Payer: UHC Exchange	$593.98
Rate for Payer: UHC Medicare Advantage	$5,031.23
Rate for Payer: VA VA	$4,884.69

THROMBIN 5000UNITS/EPINEPHRINE TOPICAL 30ML/NS 1L

Facility

$218.05

Service Code	NDC 9900-0002-00
Hospital Charge Code	500527
Hospital Revenue Code	250
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$196.24
Rate for Payer: Aetna American Axle	$141.73
Rate for Payer: Aetna Commercial	$185.34
Rate for Payer: Aetna New Business (MI Preferred)	$141.73
Rate for Payer: Cash Price	$174.44
Rate for Payer: Cofinity Commercial	$152.64
Rate for Payer: Cofinity Commercial	$187.52
Rate for Payer: Encore Health Key Benefits Commercial	$174.44
Rate for Payer: Healthscope Commercial	$196.24
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$152.64
Rate for Payer: Lakeland Regional Health Systems Commercial	$163.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.34
Rate for Payer: PHP Commercial	$185.34
Rate for Payer: Priority Health Cigna Priority Health	$152.64
Rate for Payer: Priority Health SBD	$137.37
Rate for Payer: UMR Bronson Commercial	$95.94
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$163.54

THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION

Facility

$694.98

Service Code	NDC 60793-217-20
Hospital Charge Code	108932
Hospital Revenue Code	250
Min. Negotiated Rate	$305.79
Max. Negotiated Rate	$625.48
Rate for Payer: Aetna American Axle	$451.74
Rate for Payer: Aetna Commercial	$590.73
Rate for Payer: Aetna New Business (MI Preferred)	$451.74
Rate for Payer: Cash Price	$555.98
Rate for Payer: Cofinity Commercial	$486.49
Rate for Payer: Cofinity Commercial	$597.68
Rate for Payer: Encore Health Key Benefits Commercial	$555.98
Rate for Payer: Healthscope Commercial	$625.48
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$486.49
Rate for Payer: Lakeland Regional Health Systems Commercial	$521.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$590.73
Rate for Payer: PHP Commercial	$590.73
Rate for Payer: Priority Health Cigna Priority Health	$486.49
Rate for Payer: Priority Health SBD	$437.84
Rate for Payer: UMR Bronson Commercial	$305.79
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$521.24

THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY

Facility

$795.39

Service Code	NDC 60793-217-22
Hospital Charge Code	108841
Hospital Revenue Code	250
Min. Negotiated Rate	$349.97
Max. Negotiated Rate	$715.85
Rate for Payer: Aetna American Axle	$517.00
Rate for Payer: Aetna Commercial	$676.08
Rate for Payer: Aetna New Business (MI Preferred)	$517.00
Rate for Payer: Cash Price	$636.31
Rate for Payer: Cofinity Commercial	$556.77
Rate for Payer: Cofinity Commercial	$684.04
Rate for Payer: Encore Health Key Benefits Commercial	$636.31
Rate for Payer: Healthscope Commercial	$715.85
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$556.77
Rate for Payer: Lakeland Regional Health Systems Commercial	$596.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$676.08
Rate for Payer: PHP Commercial	$676.08
Rate for Payer: Priority Health Cigna Priority Health	$556.77
Rate for Payer: Priority Health SBD	$501.10
Rate for Payer: UMR Bronson Commercial	$349.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$596.54

THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY

Facility

$795.39

Service Code	NDC 60793-217-21
Hospital Charge Code	108841
Hospital Revenue Code	250
Min. Negotiated Rate	$349.97
Max. Negotiated Rate	$715.85
Rate for Payer: Aetna American Axle	$517.00
Rate for Payer: Aetna Commercial	$676.08
Rate for Payer: Aetna New Business (MI Preferred)	$517.00
Rate for Payer: Cash Price	$636.31
Rate for Payer: Cofinity Commercial	$556.77
Rate for Payer: Cofinity Commercial	$684.04
Rate for Payer: Encore Health Key Benefits Commercial	$636.31
Rate for Payer: Healthscope Commercial	$715.85
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$556.77
Rate for Payer: Lakeland Regional Health Systems Commercial	$596.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$676.08
Rate for Payer: PHP Commercial	$676.08
Rate for Payer: Priority Health Cigna Priority Health	$556.77
Rate for Payer: Priority Health SBD	$501.10
Rate for Payer: UMR Bronson Commercial	$349.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$596.54

THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE

Facility

$197.38

Service Code	NDC 60793-205-05
Hospital Charge Code	161618
Hospital Revenue Code	250
Min. Negotiated Rate	$86.85
Max. Negotiated Rate	$177.64
Rate for Payer: Aetna American Axle	$128.30
Rate for Payer: Aetna Commercial	$167.77
Rate for Payer: Aetna New Business (MI Preferred)	$128.30
Rate for Payer: Cash Price	$157.90
Rate for Payer: Cofinity Commercial	$138.17
Rate for Payer: Cofinity Commercial	$169.75
Rate for Payer: Encore Health Key Benefits Commercial	$157.90
Rate for Payer: Healthscope Commercial	$177.64
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$138.17
Rate for Payer: Lakeland Regional Health Systems Commercial	$148.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$167.77
Rate for Payer: PHP Commercial	$167.77
Rate for Payer: Priority Health Cigna Priority Health	$138.17
Rate for Payer: Priority Health SBD	$124.35
Rate for Payer: UMR Bronson Commercial	$86.85
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$148.04

THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION

Facility

$176.24

Service Code	NDC 60793-215-05
Hospital Charge Code	117741
Hospital Revenue Code	250
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$158.62
Rate for Payer: Aetna American Axle	$114.56
Rate for Payer: Aetna Commercial	$149.80
Rate for Payer: Aetna New Business (MI Preferred)	$114.56
Rate for Payer: Cash Price	$140.99
Rate for Payer: Cofinity Commercial	$123.37
Rate for Payer: Cofinity Commercial	$151.57
Rate for Payer: Encore Health Key Benefits Commercial	$140.99
Rate for Payer: Healthscope Commercial	$158.62
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$123.37
Rate for Payer: Lakeland Regional Health Systems Commercial	$132.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$149.80
Rate for Payer: PHP Commercial	$149.80
Rate for Payer: Priority Health Cigna Priority Health	$123.37
Rate for Payer: Priority Health SBD	$111.03
Rate for Payer: UMR Bronson Commercial	$77.55
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$132.18

THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE

Facility

$187.98

Service Code	NDC 60793-705-05
Hospital Charge Code	87798
Hospital Revenue Code	250
Min. Negotiated Rate	$82.71
Max. Negotiated Rate	$169.18
Rate for Payer: Aetna American Axle	$122.19
Rate for Payer: Aetna Commercial	$159.78
Rate for Payer: Aetna New Business (MI Preferred)	$122.19
Rate for Payer: Cash Price	$150.38
Rate for Payer: Cofinity Commercial	$131.59
Rate for Payer: Cofinity Commercial	$161.66
Rate for Payer: Encore Health Key Benefits Commercial	$150.38
Rate for Payer: Healthscope Commercial	$169.18
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$131.59
Rate for Payer: Lakeland Regional Health Systems Commercial	$140.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$159.78
Rate for Payer: PHP Commercial	$159.78
Rate for Payer: Priority Health Cigna Priority Health	$131.59
Rate for Payer: Priority Health SBD	$118.43
Rate for Payer: UMR Bronson Commercial	$82.71
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$140.98

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION

Facility

$235.47

Service Code	NDC 0338-0322-01
Hospital Charge Code	89570
Hospital Revenue Code	250
Min. Negotiated Rate	$103.61
Max. Negotiated Rate	$211.92
Rate for Payer: Aetna American Axle	$153.06
Rate for Payer: Aetna Commercial	$200.15
Rate for Payer: Aetna New Business (MI Preferred)	$153.06
Rate for Payer: Cash Price	$188.38
Rate for Payer: Cofinity Commercial	$164.83
Rate for Payer: Cofinity Commercial	$202.50
Rate for Payer: Encore Health Key Benefits Commercial	$188.38
Rate for Payer: Healthscope Commercial	$211.92
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$164.83
Rate for Payer: Lakeland Regional Health Systems Commercial	$176.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.15
Rate for Payer: PHP Commercial	$200.15
Rate for Payer: Priority Health Cigna Priority Health	$164.83
Rate for Payer: Priority Health SBD	$148.35
Rate for Payer: UMR Bronson Commercial	$103.61
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$176.60

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION

Facility

$235.47

Service Code	NDC 0338-0324-01
Hospital Charge Code	89570
Hospital Revenue Code	250
Min. Negotiated Rate	$103.61
Max. Negotiated Rate	$211.92
Rate for Payer: Aetna American Axle	$153.06
Rate for Payer: Aetna Commercial	$200.15
Rate for Payer: Aetna New Business (MI Preferred)	$153.06
Rate for Payer: Cash Price	$188.38
Rate for Payer: Cofinity Commercial	$164.83
Rate for Payer: Cofinity Commercial	$202.50
Rate for Payer: Encore Health Key Benefits Commercial	$188.38
Rate for Payer: Healthscope Commercial	$211.92
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$164.83
Rate for Payer: Lakeland Regional Health Systems Commercial	$176.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.15
Rate for Payer: PHP Commercial	$200.15
Rate for Payer: Priority Health Cigna Priority Health	$164.83
Rate for Payer: Priority Health SBD	$148.35
Rate for Payer: UMR Bronson Commercial	$103.61
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$176.60

THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION

Facility

$947.66

Service Code	CPT 37195
Hospital Revenue Code	361
Min. Negotiated Rate	$164.66
Max. Negotiated Rate	$947.66
Rate for Payer: Aetna Medicare	$313.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$376.29
Rate for Payer: Amish Plain Church Group Commercial	$376.29
Rate for Payer: BCBS Complete	$172.91
Rate for Payer: BCBS MAPPO	$301.03
Rate for Payer: BCBS Trust/PPO	$248.86
Rate for Payer: BCN Medicare Advantage	$301.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$301.03
Rate for Payer: Mclaren Medicaid	$164.66
Rate for Payer: Mclaren Medicare	$301.03
Rate for Payer: Meridian Medicaid	$172.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$316.08
Rate for Payer: MI Amish Medical Board Commercial	$346.18
Rate for Payer: PACE Medicare	$285.98
Rate for Payer: PACE SWMI	$301.03
Rate for Payer: PHP Medicare Advantage	$301.03
Rate for Payer: Priority Health Choice Medicaid	$164.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$947.66
Rate for Payer: Priority Health Medicare	$301.03
Rate for Payer: Priority Health Narrow Network	$758.13
Rate for Payer: Railroad Medicare Medicare	$301.03
Rate for Payer: UHC Core	$700.00
Rate for Payer: UHC Dual Complete DSNP	$301.03
Rate for Payer: UHC Medicare Advantage	$310.06
Rate for Payer: VA VA	$301.03

THYMECTOMY, PARTIAL OR TOTAL; TRANSCERVICAL APPROACH (SEPARATE PROCEDURE)

Facility

$16,386.90

Service Code	CPT 60520
Hospital Revenue Code	360
Min. Negotiated Rate	$1,032.10
Max. Negotiated Rate	$16,386.90
Rate for Payer: Aetna Medicare	$5,413.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,506.78
Rate for Payer: Amish Plain Church Group Commercial	$6,506.78
Rate for Payer: BCBS Complete	$2,989.99
Rate for Payer: BCBS MAPPO	$5,205.42
Rate for Payer: BCBS Trust/PPO	$3,678.67
Rate for Payer: BCN Medicare Advantage	$5,205.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,205.42
Rate for Payer: Mclaren Medicaid	$2,847.36
Rate for Payer: Mclaren Medicare	$5,205.42
Rate for Payer: Meridian Medicaid	$2,989.99
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,465.69
Rate for Payer: MI Amish Medical Board Commercial	$5,986.23
Rate for Payer: PACE Medicare	$4,945.15
Rate for Payer: PACE SWMI	$5,205.42
Rate for Payer: PHP Medicare Advantage	$5,205.42
Rate for Payer: Priority Health Choice Medicaid	$2,847.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,386.90
Rate for Payer: Priority Health Medicare	$5,205.42
Rate for Payer: Priority Health Narrow Network	$13,109.52
Rate for Payer: Railroad Medicare Medicare	$5,205.42
Rate for Payer: UHC All Payor (Choice/PPO)	$1,135.31
Rate for Payer: UHC Core	$6,395.00
Rate for Payer: UHC Dual Complete DSNP	$5,205.42
Rate for Payer: UHC Exchange	$1,032.10
Rate for Payer: UHC Medicare Advantage	$5,361.58
Rate for Payer: VA VA	$5,205.42

Know your out-of-pocket cost for care.

All Charges