Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC 5 FR TL 3CG MAX POWER PICC

Facility

$1,204.90

Service Code	HCPCS C1751
Hospital Charge Code	27200178
Hospital Revenue Code	272
Min. Negotiated Rate	$481.96
Max. Negotiated Rate	$1,084.41
Rate for Payer: Aetna Commercial	$1,024.16
Rate for Payer: Aetna New Business (MI Preferred)	$783.18
Rate for Payer: BCBS Complete	$481.96
Rate for Payer: Cash Price	$963.92
Rate for Payer: Cofinity Commercial	$1,036.21
Rate for Payer: Cofinity Commercial	$843.43
Rate for Payer: Healthscope Commercial	$1,084.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,024.16
Rate for Payer: PHP Commercial	$1,024.16
Rate for Payer: Priority Health Cigna Priority Health	$843.43
Rate for Payer: Priority Health SBD	$759.09

HC 5 FR TL 3CG MAX POWER PICC

Facility

$1,204.90

Service Code	HCPCS C1751
Hospital Charge Code	27200178
Hospital Revenue Code	272
Min. Negotiated Rate	$759.09
Max. Negotiated Rate	$1,084.41
Rate for Payer: Aetna Commercial	$1,024.16
Rate for Payer: Aetna New Business (MI Preferred)	$783.18
Rate for Payer: Cash Price	$963.92
Rate for Payer: Cofinity Commercial	$1,036.21
Rate for Payer: Cofinity Commercial	$843.43
Rate for Payer: Healthscope Commercial	$1,084.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,024.16
Rate for Payer: PHP Commercial	$1,024.16
Rate for Payer: Priority Health Cigna Priority Health	$843.43
Rate for Payer: Priority Health SBD	$759.09

HC 5 FR TL SOLO MAX POWER PICC

Facility

$1,044.13

Service Code	HCPCS C1751
Hospital Charge Code	27200177
Hospital Revenue Code	272
Min. Negotiated Rate	$417.65
Max. Negotiated Rate	$939.72
Rate for Payer: Aetna Commercial	$887.51
Rate for Payer: Aetna New Business (MI Preferred)	$678.68
Rate for Payer: BCBS Complete	$417.65
Rate for Payer: Cash Price	$835.30
Rate for Payer: Cofinity Commercial	$730.89
Rate for Payer: Cofinity Commercial	$897.95
Rate for Payer: Healthscope Commercial	$939.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$887.51
Rate for Payer: PHP Commercial	$887.51
Rate for Payer: Priority Health Cigna Priority Health	$730.89
Rate for Payer: Priority Health SBD	$657.80

HC 5 FR TL SOLO MAX POWER PICC

Facility

$1,044.13

Service Code	HCPCS C1751
Hospital Charge Code	27200177
Hospital Revenue Code	272
Min. Negotiated Rate	$657.80
Max. Negotiated Rate	$939.72
Rate for Payer: Aetna Commercial	$887.51
Rate for Payer: Aetna New Business (MI Preferred)	$678.68
Rate for Payer: Cash Price	$835.30
Rate for Payer: Cofinity Commercial	$730.89
Rate for Payer: Cofinity Commercial	$897.95
Rate for Payer: Healthscope Commercial	$939.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$887.51
Rate for Payer: PHP Commercial	$887.51
Rate for Payer: Priority Health Cigna Priority Health	$730.89
Rate for Payer: Priority Health SBD	$657.80

HC 6 FR SOLO 3CG POWER PICC

Facility

$1,204.90

Service Code	HCPCS C1751
Hospital Charge Code	27200168
Hospital Revenue Code	272
Min. Negotiated Rate	$759.09
Max. Negotiated Rate	$1,084.41
Rate for Payer: Aetna Commercial	$1,024.16
Rate for Payer: Aetna New Business (MI Preferred)	$783.18
Rate for Payer: Cash Price	$963.92
Rate for Payer: Cofinity Commercial	$1,036.21
Rate for Payer: Cofinity Commercial	$843.43
Rate for Payer: Healthscope Commercial	$1,084.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,024.16
Rate for Payer: PHP Commercial	$1,024.16
Rate for Payer: Priority Health Cigna Priority Health	$843.43
Rate for Payer: Priority Health SBD	$759.09

HC 6 FR SOLO 3CG POWER PICC

Facility

$1,204.90

Service Code	HCPCS C1751
Hospital Charge Code	27200168
Hospital Revenue Code	272
Min. Negotiated Rate	$481.96
Max. Negotiated Rate	$1,084.41
Rate for Payer: Aetna Commercial	$1,024.16
Rate for Payer: Aetna New Business (MI Preferred)	$783.18
Rate for Payer: BCBS Complete	$481.96
Rate for Payer: Cash Price	$963.92
Rate for Payer: Cofinity Commercial	$1,036.21
Rate for Payer: Cofinity Commercial	$843.43
Rate for Payer: Healthscope Commercial	$1,084.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,024.16
Rate for Payer: PHP Commercial	$1,024.16
Rate for Payer: Priority Health Cigna Priority Health	$843.43
Rate for Payer: Priority Health SBD	$759.09

HC 6FR SOLO POWER PICC

Facility

$1,044.13

Hospital Charge Code	27200109
Hospital Revenue Code	272
Min. Negotiated Rate	$417.65
Max. Negotiated Rate	$939.72
Rate for Payer: Aetna Commercial	$887.51
Rate for Payer: Aetna New Business (MI Preferred)	$678.68
Rate for Payer: BCBS Complete	$417.65
Rate for Payer: Cash Price	$835.30
Rate for Payer: Cofinity Commercial	$730.89
Rate for Payer: Cofinity Commercial	$897.95
Rate for Payer: Healthscope Commercial	$939.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$887.51
Rate for Payer: PHP Commercial	$887.51
Rate for Payer: Priority Health Cigna Priority Health	$730.89
Rate for Payer: Priority Health SBD	$657.80

HC 6FR SOLO POWER PICC

Facility

$1,044.13

Hospital Charge Code	27200109
Hospital Revenue Code	272
Min. Negotiated Rate	$657.80
Max. Negotiated Rate	$939.72
Rate for Payer: Aetna Commercial	$887.51
Rate for Payer: Aetna New Business (MI Preferred)	$678.68
Rate for Payer: Cash Price	$835.30
Rate for Payer: Cofinity Commercial	$897.95
Rate for Payer: Cofinity Commercial	$730.89
Rate for Payer: Healthscope Commercial	$939.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$887.51
Rate for Payer: PHP Commercial	$887.51
Rate for Payer: Priority Health Cigna Priority Health	$730.89
Rate for Payer: Priority Health SBD	$657.80

HC 8X8 WAFER

Facility

$72.59

Hospital Charge Code	27000024
Hospital Revenue Code	270
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$65.33
Rate for Payer: Aetna Commercial	$61.70
Rate for Payer: Aetna New Business (MI Preferred)	$47.18
Rate for Payer: BCBS Complete	$29.04
Rate for Payer: Cash Price	$58.07
Rate for Payer: Cofinity Commercial	$50.81
Rate for Payer: Cofinity Commercial	$62.43
Rate for Payer: Healthscope Commercial	$65.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.70
Rate for Payer: PHP Commercial	$61.70
Rate for Payer: Priority Health Cigna Priority Health	$50.81
Rate for Payer: Priority Health SBD	$45.73

HC 8X8 WAFER

Facility

$72.59

Hospital Charge Code	27000024
Hospital Revenue Code	270
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$65.33
Rate for Payer: Aetna Commercial	$61.70
Rate for Payer: Aetna New Business (MI Preferred)	$47.18
Rate for Payer: Cash Price	$58.07
Rate for Payer: Cofinity Commercial	$50.81
Rate for Payer: Cofinity Commercial	$62.43
Rate for Payer: Healthscope Commercial	$65.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.70
Rate for Payer: PHP Commercial	$61.70
Rate for Payer: Priority Health Cigna Priority Health	$50.81
Rate for Payer: Priority Health SBD	$45.73

HC A1AT PROTEOTYPE

Facility

$47.94

Service Code	CPT 82542
Hospital Charge Code	30100610
Hospital Revenue Code	301
Min. Negotiated Rate	$30.20
Max. Negotiated Rate	$43.15
Rate for Payer: Aetna Commercial	$40.75
Rate for Payer: Aetna New Business (MI Preferred)	$31.16
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Cofinity Commercial	$41.23
Rate for Payer: Healthscope Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.75
Rate for Payer: PHP Commercial	$40.75
Rate for Payer: Priority Health Cigna Priority Health	$33.56
Rate for Payer: Priority Health SBD	$30.20

HC A1AT PROTEOTYPE

Facility

$47.94

Service Code	CPT 82542
Hospital Charge Code	30100610
Hospital Revenue Code	301
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$43.15
Rate for Payer: Aetna Commercial	$40.75
Rate for Payer: Aetna Medicare	$25.05
Rate for Payer: Aetna New Business (MI Preferred)	$31.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$30.11
Rate for Payer: Amish Plain Church Group Commercial	$30.11
Rate for Payer: BCBS Complete	$13.84
Rate for Payer: BCBS MAPPO	$24.09
Rate for Payer: BCBS Trust/PPO	$18.87
Rate for Payer: BCN Medicare Advantage	$24.09
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$41.23
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.09
Rate for Payer: Healthscope Commercial	$43.15
Rate for Payer: Mclaren Medicaid	$13.18
Rate for Payer: Mclaren Medicare	$24.09
Rate for Payer: Meridian Medicaid	$13.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$25.29
Rate for Payer: MI Amish Medical Board Commercial	$27.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.75
Rate for Payer: PACE Medicare	$22.89
Rate for Payer: PACE SWMI	$24.09
Rate for Payer: PHP Commercial	$40.75
Rate for Payer: PHP Medicare Advantage	$24.09
Rate for Payer: Priority Health Choice Medicaid	$13.18
Rate for Payer: Priority Health Cigna Priority Health	$33.56
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health SBD	$30.20
Rate for Payer: Railroad Medicare Medicare	$24.09
Rate for Payer: UHC All Payor (Choice/PPO)	$28.91
Rate for Payer: UHC Core	$30.68
Rate for Payer: UHC Dual Complete DSNP	$24.09
Rate for Payer: UHC Exchange	$24.09
Rate for Payer: UHC Medicare Advantage	$24.81
Rate for Payer: VA VA	$24.09

HC A1AT PROTEOTYPE CMPT

Facility

$21.00

Service Code	CPT 82103
Hospital Charge Code	30100611
Hospital Revenue Code	301
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$17.85
Rate for Payer: Aetna New Business (MI Preferred)	$13.65
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$14.70
Rate for Payer: Cofinity Commercial	$18.06
Rate for Payer: Healthscope Commercial	$18.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.85
Rate for Payer: PHP Commercial	$17.85
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health SBD	$13.23

HC A1AT PROTEOTYPE CMPT

Facility

$21.00

Service Code	CPT 82103
Hospital Charge Code	30100611
Hospital Revenue Code	301
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$22.84
Rate for Payer: Aetna Commercial	$17.85
Rate for Payer: Aetna Medicare	$13.98
Rate for Payer: Aetna New Business (MI Preferred)	$13.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.80
Rate for Payer: Amish Plain Church Group Commercial	$16.80
Rate for Payer: BCBS Complete	$7.72
Rate for Payer: BCBS MAPPO	$13.44
Rate for Payer: BCBS Trust/PPO	$10.52
Rate for Payer: BCN Medicare Advantage	$13.44
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$14.70
Rate for Payer: Cofinity Commercial	$18.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.44
Rate for Payer: Healthscope Commercial	$18.90
Rate for Payer: Mclaren Medicaid	$7.35
Rate for Payer: Mclaren Medicare	$13.44
Rate for Payer: Meridian Medicaid	$7.72
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14.11
Rate for Payer: MI Amish Medical Board Commercial	$15.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.85
Rate for Payer: PACE Medicare	$12.77
Rate for Payer: PACE SWMI	$13.44
Rate for Payer: PHP Commercial	$17.85
Rate for Payer: PHP Medicare Advantage	$13.44
Rate for Payer: Priority Health Choice Medicaid	$7.35
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health Medicare	$13.44
Rate for Payer: Priority Health SBD	$13.23
Rate for Payer: Railroad Medicare Medicare	$13.44
Rate for Payer: UHC All Payor (Choice/PPO)	$16.13
Rate for Payer: UHC Core	$22.84
Rate for Payer: UHC Dual Complete DSNP	$13.44
Rate for Payer: UHC Exchange	$13.44
Rate for Payer: UHC Medicare Advantage	$13.84
Rate for Payer: VA VA	$13.44

HC ABBY RETRACTOR

Facility

$259.95

Hospital Charge Code	27000643
Hospital Revenue Code	270
Min. Negotiated Rate	$163.77
Max. Negotiated Rate	$233.96
Rate for Payer: Aetna Commercial	$220.96
Rate for Payer: Aetna New Business (MI Preferred)	$168.97
Rate for Payer: Cash Price	$207.96
Rate for Payer: Cofinity Commercial	$181.96
Rate for Payer: Cofinity Commercial	$223.56
Rate for Payer: Healthscope Commercial	$233.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$220.96
Rate for Payer: PHP Commercial	$220.96
Rate for Payer: Priority Health Cigna Priority Health	$181.96
Rate for Payer: Priority Health SBD	$163.77

HC ABBY RETRACTOR

Facility

$259.95

Hospital Charge Code	27000643
Hospital Revenue Code	270
Min. Negotiated Rate	$103.98
Max. Negotiated Rate	$233.96
Rate for Payer: Aetna Commercial	$220.96
Rate for Payer: Aetna New Business (MI Preferred)	$168.97
Rate for Payer: BCBS Complete	$103.98
Rate for Payer: Cash Price	$207.96
Rate for Payer: Cofinity Commercial	$181.96
Rate for Payer: Cofinity Commercial	$223.56
Rate for Payer: Healthscope Commercial	$233.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$220.96
Rate for Payer: PHP Commercial	$220.96
Rate for Payer: Priority Health Cigna Priority Health	$181.96
Rate for Payer: Priority Health SBD	$163.77

HC ABDOMINAL HYSTERECT (OB SURGER

Facility

$2,515.07

Hospital Charge Code	36000002
Hospital Revenue Code	360
Min. Negotiated Rate	$1,006.03
Max. Negotiated Rate	$2,263.56
Rate for Payer: Aetna Commercial	$2,137.81
Rate for Payer: Aetna New Business (MI Preferred)	$1,634.80
Rate for Payer: BCBS Complete	$1,006.03
Rate for Payer: Cash Price	$2,012.06
Rate for Payer: Cofinity Commercial	$1,760.55
Rate for Payer: Cofinity Commercial	$2,162.96
Rate for Payer: Healthscope Commercial	$2,263.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,137.81
Rate for Payer: PHP Commercial	$2,137.81
Rate for Payer: Priority Health Cigna Priority Health	$1,760.55
Rate for Payer: Priority Health SBD	$1,584.49

HC ABDOMINAL HYSTERECT (OB SURGER

Facility

$2,515.07

Hospital Charge Code	36000002
Hospital Revenue Code	360
Min. Negotiated Rate	$1,584.49
Max. Negotiated Rate	$2,263.56
Rate for Payer: Aetna Commercial	$2,137.81
Rate for Payer: Aetna New Business (MI Preferred)	$1,634.80
Rate for Payer: Cash Price	$2,012.06
Rate for Payer: Cofinity Commercial	$2,162.96
Rate for Payer: Cofinity Commercial	$1,760.55
Rate for Payer: Healthscope Commercial	$2,263.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,137.81
Rate for Payer: PHP Commercial	$2,137.81
Rate for Payer: Priority Health Cigna Priority Health	$1,760.55
Rate for Payer: Priority Health SBD	$1,584.49

HC ABDOMINAL STERILIZE (OB SURGER

Facility

$1,546.02

Hospital Charge Code	36000003
Hospital Revenue Code	360
Min. Negotiated Rate	$973.99
Max. Negotiated Rate	$1,391.42
Rate for Payer: Aetna Commercial	$1,314.12
Rate for Payer: Aetna New Business (MI Preferred)	$1,004.91
Rate for Payer: Cash Price	$1,236.82
Rate for Payer: Cofinity Commercial	$1,082.21
Rate for Payer: Cofinity Commercial	$1,329.58
Rate for Payer: Healthscope Commercial	$1,391.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,314.12
Rate for Payer: PHP Commercial	$1,314.12
Rate for Payer: Priority Health Cigna Priority Health	$1,082.21
Rate for Payer: Priority Health SBD	$973.99

HC ABDOMINAL STERILIZE (OB SURGER

Facility

$1,546.02

Hospital Charge Code	36000003
Hospital Revenue Code	360
Min. Negotiated Rate	$618.41
Max. Negotiated Rate	$1,391.42
Rate for Payer: Aetna Commercial	$1,314.12
Rate for Payer: Aetna New Business (MI Preferred)	$1,004.91
Rate for Payer: BCBS Complete	$618.41
Rate for Payer: Cash Price	$1,236.82
Rate for Payer: Cofinity Commercial	$1,082.21
Rate for Payer: Cofinity Commercial	$1,329.58
Rate for Payer: Healthscope Commercial	$1,391.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,314.12
Rate for Payer: PHP Commercial	$1,314.12
Rate for Payer: Priority Health Cigna Priority Health	$1,082.21
Rate for Payer: Priority Health SBD	$973.99

HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV BIL KNEE 3 OR MORE NRVS

Facility

$3,945.36

Service Code	CPT 64624
Hospital Charge Code	36100603
Hospital Revenue Code	361
Min. Negotiated Rate	$2,485.58
Max. Negotiated Rate	$3,550.82
Rate for Payer: Aetna Commercial	$3,353.56
Rate for Payer: Aetna New Business (MI Preferred)	$2,564.48
Rate for Payer: Cash Price	$3,156.29
Rate for Payer: Cofinity Commercial	$2,761.75
Rate for Payer: Cofinity Commercial	$3,393.01
Rate for Payer: Healthscope Commercial	$3,550.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,353.56
Rate for Payer: PHP Commercial	$3,353.56
Rate for Payer: Priority Health Cigna Priority Health	$2,761.75
Rate for Payer: Priority Health SBD	$2,485.58

HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV BIL KNEE 3 OR MORE NRVS

Facility

$3,945.36

Service Code	CPT 64624
Hospital Charge Code	36100603
Hospital Revenue Code	361
Min. Negotiated Rate	$142.76
Max. Negotiated Rate	$5,467.25
Rate for Payer: Aetna Commercial	$3,353.56
Rate for Payer: Aetna Medicare	$1,786.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,564.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,147.49
Rate for Payer: Amish Plain Church Group Commercial	$2,147.49
Rate for Payer: BCBS Complete	$986.81
Rate for Payer: BCBS MAPPO	$1,717.99
Rate for Payer: BCN Medicare Advantage	$1,717.99
Rate for Payer: Cash Price	$3,156.29
Rate for Payer: Cash Price	$3,156.29
Rate for Payer: Cofinity Commercial	$2,761.75
Rate for Payer: Cofinity Commercial	$3,393.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,717.99
Rate for Payer: Healthscope Commercial	$3,550.82
Rate for Payer: Mclaren Medicaid	$939.74
Rate for Payer: Mclaren Medicare	$1,717.99
Rate for Payer: Meridian Medicaid	$986.81
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,803.89
Rate for Payer: MI Amish Medical Board Commercial	$1,975.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,353.56
Rate for Payer: PACE Medicare	$1,632.09
Rate for Payer: PACE SWMI	$1,717.99
Rate for Payer: PHP Commercial	$3,353.56
Rate for Payer: PHP Medicare Advantage	$1,717.99
Rate for Payer: Priority Health Choice Medicaid	$939.74
Rate for Payer: Priority Health Cigna Priority Health	$2,761.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,467.25
Rate for Payer: Priority Health Medicare	$1,717.99
Rate for Payer: Priority Health Narrow Network	$4,373.80
Rate for Payer: Priority Health SBD	$2,485.58
Rate for Payer: Railroad Medicare Medicare	$1,717.99
Rate for Payer: UHC All Payor (Choice/PPO)	$157.04
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,717.99
Rate for Payer: UHC Exchange	$142.76
Rate for Payer: UHC Medicare Advantage	$1,769.53
Rate for Payer: VA VA	$1,717.99

HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV KNEE 3 OR MORE NRVS

Facility

$2,630.58

Service Code	CPT 64624
Hospital Charge Code	36100601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,657.27
Max. Negotiated Rate	$2,367.52
Rate for Payer: Aetna Commercial	$2,235.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,709.88
Rate for Payer: Cash Price	$2,104.46
Rate for Payer: Cofinity Commercial	$2,262.30
Rate for Payer: Cofinity Commercial	$1,841.41
Rate for Payer: Healthscope Commercial	$2,367.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,235.99
Rate for Payer: PHP Commercial	$2,235.99
Rate for Payer: Priority Health Cigna Priority Health	$1,841.41
Rate for Payer: Priority Health SBD	$1,657.27

HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV KNEE 3 OR MORE NRVS

Facility

$2,630.58

Service Code	CPT 64624
Hospital Charge Code	36100601
Hospital Revenue Code	361
Min. Negotiated Rate	$142.76
Max. Negotiated Rate	$5,467.25
Rate for Payer: Aetna Commercial	$2,235.99
Rate for Payer: Aetna Medicare	$1,786.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,709.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,147.49
Rate for Payer: Amish Plain Church Group Commercial	$2,147.49
Rate for Payer: BCBS Complete	$986.81
Rate for Payer: BCBS MAPPO	$1,717.99
Rate for Payer: BCN Medicare Advantage	$1,717.99
Rate for Payer: Cash Price	$2,104.46
Rate for Payer: Cash Price	$2,104.46
Rate for Payer: Cofinity Commercial	$2,262.30
Rate for Payer: Cofinity Commercial	$1,841.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,717.99
Rate for Payer: Healthscope Commercial	$2,367.52
Rate for Payer: Mclaren Medicaid	$939.74
Rate for Payer: Mclaren Medicare	$1,717.99
Rate for Payer: Meridian Medicaid	$986.81
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,803.89
Rate for Payer: MI Amish Medical Board Commercial	$1,975.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,235.99
Rate for Payer: PACE Medicare	$1,632.09
Rate for Payer: PACE SWMI	$1,717.99
Rate for Payer: PHP Commercial	$2,235.99
Rate for Payer: PHP Medicare Advantage	$1,717.99
Rate for Payer: Priority Health Choice Medicaid	$939.74
Rate for Payer: Priority Health Cigna Priority Health	$1,841.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,467.25
Rate for Payer: Priority Health Medicare	$1,717.99
Rate for Payer: Priority Health Narrow Network	$4,373.80
Rate for Payer: Priority Health SBD	$1,657.27
Rate for Payer: Railroad Medicare Medicare	$1,717.99
Rate for Payer: UHC All Payor (Choice/PPO)	$157.04
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,717.99
Rate for Payer: UHC Exchange	$142.76
Rate for Payer: UHC Medicare Advantage	$1,769.53
Rate for Payer: VA VA	$1,717.99

HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NR OR BRANCH SHOULDER EA ADDL NRV

Facility

$1,242.44

Service Code	CPT 64640
Hospital Charge Code	36100596
Hospital Revenue Code	361
Min. Negotiated Rate	$782.74
Max. Negotiated Rate	$1,118.20
Rate for Payer: Aetna Commercial	$1,056.07
Rate for Payer: Aetna New Business (MI Preferred)	$807.59
Rate for Payer: Cash Price	$993.95
Rate for Payer: Cofinity Commercial	$869.71
Rate for Payer: Cofinity Commercial	$1,068.50
Rate for Payer: Healthscope Commercial	$1,118.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,056.07
Rate for Payer: PHP Commercial	$1,056.07
Rate for Payer: Priority Health Cigna Priority Health	$869.71
Rate for Payer: Priority Health SBD	$782.74

Know your out-of-pocket cost for care.

All Charges