Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC 5 FR TL SOLO MAX POWER PICC

Facility

$1,065.01

Service Code	HCPCS C1751
Hospital Charge Code	27200177
Hospital Revenue Code	272
Min. Negotiated Rate	$670.96
Max. Negotiated Rate	$958.51
Rate for Payer: Aetna Commercial	$905.26
Rate for Payer: Aetna New Business (MI Preferred)	$692.26
Rate for Payer: Cash Price	$852.01
Rate for Payer: Cofinity Commercial	$745.51
Rate for Payer: Cofinity Commercial	$915.91
Rate for Payer: Cofinity Medicare Advantage	$745.51
Rate for Payer: Encore Health Key Benefits Commercial	$852.01
Rate for Payer: Healthscope Commercial	$958.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$905.26
Rate for Payer: PHP Commercial	$905.26
Rate for Payer: Priority Health Cigna Priority Health	$692.26
Rate for Payer: Priority Health SBD	$670.96

HC 6 FR SOLO 3CG POWER PICC

Facility

$1,229.00

Service Code	HCPCS C1751
Hospital Charge Code	27200168
Hospital Revenue Code	272
Min. Negotiated Rate	$774.27
Max. Negotiated Rate	$1,106.10
Rate for Payer: Aetna Commercial	$1,044.65
Rate for Payer: Aetna New Business (MI Preferred)	$798.85
Rate for Payer: Cash Price	$983.20
Rate for Payer: Cofinity Commercial	$1,056.94
Rate for Payer: Cofinity Commercial	$860.30
Rate for Payer: Cofinity Medicare Advantage	$860.30
Rate for Payer: Encore Health Key Benefits Commercial	$983.20
Rate for Payer: Healthscope Commercial	$1,106.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,044.65
Rate for Payer: PHP Commercial	$1,044.65
Rate for Payer: Priority Health Cigna Priority Health	$798.85
Rate for Payer: Priority Health SBD	$774.27

HC 6 FR SOLO 3CG POWER PICC

Facility

$1,229.00

Service Code	HCPCS C1751
Hospital Charge Code	27200168
Hospital Revenue Code	272
Min. Negotiated Rate	$491.60
Max. Negotiated Rate	$1,106.10
Rate for Payer: Aetna Commercial	$1,044.65
Rate for Payer: Aetna Medicare	$614.50
Rate for Payer: Aetna New Business (MI Preferred)	$798.85
Rate for Payer: BCBS Complete	$491.60
Rate for Payer: Cash Price	$983.20
Rate for Payer: Cofinity Commercial	$1,056.94
Rate for Payer: Cofinity Commercial	$860.30
Rate for Payer: Cofinity Medicare Advantage	$860.30
Rate for Payer: Encore Health Key Benefits Commercial	$983.20
Rate for Payer: Healthscope Commercial	$1,106.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,044.65
Rate for Payer: PHP Commercial	$1,044.65
Rate for Payer: Priority Health Cigna Priority Health	$798.85
Rate for Payer: Priority Health SBD	$774.27

HC 6FR SOLO POWER PICC

Facility

$1,065.01

Hospital Charge Code	27200109
Hospital Revenue Code	272
Min. Negotiated Rate	$670.96
Max. Negotiated Rate	$958.51
Rate for Payer: Aetna Commercial	$905.26
Rate for Payer: Aetna New Business (MI Preferred)	$692.26
Rate for Payer: Cash Price	$852.01
Rate for Payer: Cofinity Commercial	$745.51
Rate for Payer: Cofinity Commercial	$915.91
Rate for Payer: Cofinity Medicare Advantage	$745.51
Rate for Payer: Encore Health Key Benefits Commercial	$852.01
Rate for Payer: Healthscope Commercial	$958.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$905.26
Rate for Payer: PHP Commercial	$905.26
Rate for Payer: Priority Health Cigna Priority Health	$692.26
Rate for Payer: Priority Health SBD	$670.96

HC 6FR SOLO POWER PICC

Facility

$1,065.01

Hospital Charge Code	27200109
Hospital Revenue Code	272
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$958.51
Rate for Payer: Aetna Commercial	$905.26
Rate for Payer: Aetna Medicare	$532.50
Rate for Payer: Aetna New Business (MI Preferred)	$692.26
Rate for Payer: BCBS Complete	$426.00
Rate for Payer: Cash Price	$852.01
Rate for Payer: Cofinity Commercial	$745.51
Rate for Payer: Cofinity Commercial	$915.91
Rate for Payer: Cofinity Medicare Advantage	$745.51
Rate for Payer: Encore Health Key Benefits Commercial	$852.01
Rate for Payer: Healthscope Commercial	$958.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$905.26
Rate for Payer: PHP Commercial	$905.26
Rate for Payer: Priority Health Cigna Priority Health	$692.26
Rate for Payer: Priority Health SBD	$670.96

HC 8X8 WAFER

Facility

$74.04

Hospital Charge Code	27000024
Hospital Revenue Code	270
Min. Negotiated Rate	$29.62
Max. Negotiated Rate	$66.64
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna Medicare	$37.02
Rate for Payer: Aetna New Business (MI Preferred)	$48.13
Rate for Payer: BCBS Complete	$29.62
Rate for Payer: Cash Price	$59.23
Rate for Payer: Cofinity Commercial	$51.83
Rate for Payer: Cofinity Commercial	$63.67
Rate for Payer: Cofinity Medicare Advantage	$51.83
Rate for Payer: Encore Health Key Benefits Commercial	$59.23
Rate for Payer: Healthscope Commercial	$66.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.93
Rate for Payer: PHP Commercial	$62.93
Rate for Payer: Priority Health Cigna Priority Health	$48.13
Rate for Payer: Priority Health SBD	$46.65

HC 8X8 WAFER

Facility

$74.04

Hospital Charge Code	27000024
Hospital Revenue Code	270
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$66.64
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna New Business (MI Preferred)	$48.13
Rate for Payer: Cash Price	$59.23
Rate for Payer: Cofinity Commercial	$51.83
Rate for Payer: Cofinity Commercial	$63.67
Rate for Payer: Cofinity Medicare Advantage	$51.83
Rate for Payer: Encore Health Key Benefits Commercial	$59.23
Rate for Payer: Healthscope Commercial	$66.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.93
Rate for Payer: PHP Commercial	$62.93
Rate for Payer: Priority Health Cigna Priority Health	$48.13
Rate for Payer: Priority Health SBD	$46.65

HC A1AT PROTEOTYPE

Facility

$48.90

Service Code	CPT 82542
Hospital Charge Code	30100610
Hospital Revenue Code	301
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$67.81
Rate for Payer: Aetna Commercial	$41.56
Rate for Payer: Aetna Medicare	$25.05
Rate for Payer: Aetna New Business (MI Preferred)	$31.79
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	$13.56
Rate for Payer: BCBS MAPPO	$24.09
Rate for Payer: BCN Medicare Advantage	$24.09
Rate for Payer: Cash Price	$39.12
Rate for Payer: Cash Price	$39.12
Rate for Payer: Cofinity Commercial	$34.23
Rate for Payer: Cofinity Commercial	$42.05
Rate for Payer: Cofinity Medicare Advantage	$34.23
Rate for Payer: Encore Health Key Benefits Commercial	$39.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.09
Rate for Payer: Healthscope Commercial	$44.01
Rate for Payer: Mclaren Medicaid	$12.91
Rate for Payer: Mclaren Medicare	$24.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25.29
Rate for Payer: Meridian Medicaid	$13.56
Rate for Payer: MI Amish Medical Board Commercial	$27.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.56
Rate for Payer: PACE Medicare	$22.89
Rate for Payer: PACE SWMI	$24.09
Rate for Payer: PHP Commercial	$41.56
Rate for Payer: PHP Medicare Advantage	$24.09
Rate for Payer: Priority Health Choice Medicaid	$12.91
Rate for Payer: Priority Health Cigna Priority Health	$31.79
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health SBD	$30.81
Rate for Payer: Railroad Medicare Medicare	$24.09
Rate for Payer: UHC All Payor (Choice/PPO)	$67.81
Rate for Payer: UHC Dual Complete DSNP	$24.09
Rate for Payer: UHC Medicare Advantage	$24.09
Rate for Payer: UHCCP Medicaid	$13.56
Rate for Payer: VA VA	$24.09

HC A1AT PROTEOTYPE

Facility

$48.90

Service Code	CPT 82542
Hospital Charge Code	30100610
Hospital Revenue Code	301
Min. Negotiated Rate	$30.81
Max. Negotiated Rate	$44.01
Rate for Payer: Aetna Commercial	$41.56
Rate for Payer: Aetna New Business (MI Preferred)	$31.79
Rate for Payer: Cash Price	$39.12
Rate for Payer: Cofinity Commercial	$34.23
Rate for Payer: Cofinity Commercial	$42.05
Rate for Payer: Cofinity Medicare Advantage	$34.23
Rate for Payer: Encore Health Key Benefits Commercial	$39.12
Rate for Payer: Healthscope Commercial	$44.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.56
Rate for Payer: PHP Commercial	$41.56
Rate for Payer: Priority Health Cigna Priority Health	$31.79
Rate for Payer: Priority Health SBD	$30.81

HC A1AT PROTEOTYPE CMPT

Facility

$21.42

Service Code	CPT 82103
Hospital Charge Code	30100611
Hospital Revenue Code	301
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$19.28
Rate for Payer: Aetna Commercial	$18.21
Rate for Payer: Aetna New Business (MI Preferred)	$13.92
Rate for Payer: Cash Price	$17.14
Rate for Payer: Cofinity Commercial	$14.99
Rate for Payer: Cofinity Commercial	$18.42
Rate for Payer: Cofinity Medicare Advantage	$14.99
Rate for Payer: Encore Health Key Benefits Commercial	$17.14
Rate for Payer: Healthscope Commercial	$19.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.21
Rate for Payer: PHP Commercial	$18.21
Rate for Payer: Priority Health Cigna Priority Health	$13.92
Rate for Payer: Priority Health SBD	$13.49

HC A1AT PROTEOTYPE CMPT

Facility

$21.42

Service Code	CPT 82103
Hospital Charge Code	30100611
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$37.83
Rate for Payer: Aetna Commercial	$18.21
Rate for Payer: Aetna Medicare	$13.98
Rate for Payer: Aetna New Business (MI Preferred)	$13.92
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	$7.56
Rate for Payer: BCBS MAPPO	$13.44
Rate for Payer: BCN Medicare Advantage	$13.44
Rate for Payer: Cash Price	$17.14
Rate for Payer: Cash Price	$17.14
Rate for Payer: Cofinity Commercial	$18.42
Rate for Payer: Cofinity Commercial	$14.99
Rate for Payer: Cofinity Medicare Advantage	$14.99
Rate for Payer: Encore Health Key Benefits Commercial	$17.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.44
Rate for Payer: Healthscope Commercial	$19.28
Rate for Payer: Mclaren Medicaid	$7.20
Rate for Payer: Mclaren Medicare	$13.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.11
Rate for Payer: Meridian Medicaid	$7.56
Rate for Payer: MI Amish Medical Board Commercial	$15.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.21
Rate for Payer: PACE Medicare	$12.77
Rate for Payer: PACE SWMI	$13.44
Rate for Payer: PHP Commercial	$18.21
Rate for Payer: PHP Medicare Advantage	$13.44
Rate for Payer: Priority Health Choice Medicaid	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$13.92
Rate for Payer: Priority Health Medicare	$13.44
Rate for Payer: Priority Health SBD	$13.49
Rate for Payer: Railroad Medicare Medicare	$13.44
Rate for Payer: UHC All Payor (Choice/PPO)	$37.83
Rate for Payer: UHC Dual Complete DSNP	$13.44
Rate for Payer: UHC Medicare Advantage	$13.44
Rate for Payer: UHCCP Medicaid	$7.57
Rate for Payer: VA VA	$13.44

HC ABDOMINAL HYSTERECT (OB SURGER

Facility

$2,565.37

Hospital Charge Code	36000002
Hospital Revenue Code	360
Min. Negotiated Rate	$1,026.15
Max. Negotiated Rate	$2,308.83
Rate for Payer: Aetna Commercial	$2,180.56
Rate for Payer: Aetna Medicare	$1,282.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,667.49
Rate for Payer: BCBS Complete	$1,026.15
Rate for Payer: Cash Price	$2,052.30
Rate for Payer: Cofinity Commercial	$1,795.76
Rate for Payer: Cofinity Commercial	$2,206.22
Rate for Payer: Cofinity Medicare Advantage	$1,795.76
Rate for Payer: Encore Health Key Benefits Commercial	$2,052.30
Rate for Payer: Healthscope Commercial	$2,308.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,180.56
Rate for Payer: PHP Commercial	$2,180.56
Rate for Payer: Priority Health Cigna Priority Health	$1,667.49
Rate for Payer: Priority Health SBD	$1,616.18

HC ABDOMINAL HYSTERECT (OB SURGER

Facility

$2,565.37

Hospital Charge Code	36000002
Hospital Revenue Code	360
Min. Negotiated Rate	$1,616.18
Max. Negotiated Rate	$2,308.83
Rate for Payer: Aetna Commercial	$2,180.56
Rate for Payer: Aetna New Business (MI Preferred)	$1,667.49
Rate for Payer: Cash Price	$2,052.30
Rate for Payer: Cofinity Commercial	$1,795.76
Rate for Payer: Cofinity Commercial	$2,206.22
Rate for Payer: Cofinity Medicare Advantage	$1,795.76
Rate for Payer: Encore Health Key Benefits Commercial	$2,052.30
Rate for Payer: Healthscope Commercial	$2,308.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,180.56
Rate for Payer: PHP Commercial	$2,180.56
Rate for Payer: Priority Health Cigna Priority Health	$1,667.49
Rate for Payer: Priority Health SBD	$1,616.18

HC ABDOMINAL STERILIZE (OB SURGER

Facility

$1,576.94

Hospital Charge Code	36000003
Hospital Revenue Code	360
Min. Negotiated Rate	$630.78
Max. Negotiated Rate	$1,419.25
Rate for Payer: Aetna Commercial	$1,340.40
Rate for Payer: Aetna Medicare	$788.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,025.01
Rate for Payer: BCBS Complete	$630.78
Rate for Payer: Cash Price	$1,261.55
Rate for Payer: Cofinity Commercial	$1,103.86
Rate for Payer: Cofinity Commercial	$1,356.17
Rate for Payer: Cofinity Medicare Advantage	$1,103.86
Rate for Payer: Encore Health Key Benefits Commercial	$1,261.55
Rate for Payer: Healthscope Commercial	$1,419.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,340.40
Rate for Payer: PHP Commercial	$1,340.40
Rate for Payer: Priority Health Cigna Priority Health	$1,025.01
Rate for Payer: Priority Health SBD	$993.47

HC ABDOMINAL STERILIZE (OB SURGER

Facility

$1,576.94

Hospital Charge Code	36000003
Hospital Revenue Code	360
Min. Negotiated Rate	$993.47
Max. Negotiated Rate	$1,419.25
Rate for Payer: Aetna Commercial	$1,340.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,025.01
Rate for Payer: Cash Price	$1,261.55
Rate for Payer: Cofinity Commercial	$1,103.86
Rate for Payer: Cofinity Commercial	$1,356.17
Rate for Payer: Cofinity Medicare Advantage	$1,103.86
Rate for Payer: Encore Health Key Benefits Commercial	$1,261.55
Rate for Payer: Healthscope Commercial	$1,419.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,340.40
Rate for Payer: PHP Commercial	$1,340.40
Rate for Payer: Priority Health Cigna Priority Health	$1,025.01
Rate for Payer: Priority Health SBD	$993.47

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

Facility

$4,024.27

Service Code	CPT 64624
Hospital Charge Code	36100603
Hospital Revenue Code	361
Min. Negotiated Rate	$2,535.29
Max. Negotiated Rate	$3,621.84
Rate for Payer: Aetna Commercial	$3,420.63
Rate for Payer: Aetna New Business (MI Preferred)	$2,615.78
Rate for Payer: Cash Price	$3,219.42
Rate for Payer: Cofinity Commercial	$2,816.99
Rate for Payer: Cofinity Commercial	$3,460.87
Rate for Payer: Cofinity Medicare Advantage	$2,816.99
Rate for Payer: Encore Health Key Benefits Commercial	$3,219.42
Rate for Payer: Healthscope Commercial	$3,621.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,420.63
Rate for Payer: PHP Commercial	$3,420.63
Rate for Payer: Priority Health Cigna Priority Health	$2,615.78
Rate for Payer: Priority Health SBD	$2,535.29

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

Facility

$4,024.27

Service Code	CPT 64624
Hospital Charge Code	36100603
Hospital Revenue Code	361
Min. Negotiated Rate	$1,020.81
Max. Negotiated Rate	$5,360.98
Rate for Payer: Aetna Commercial	$3,420.63
Rate for Payer: Aetna Medicare	$1,980.68
Rate for Payer: Aetna New Business (MI Preferred)	$2,615.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,380.62
Rate for Payer: Amish Plain Church Group Commercial	$2,380.62
Rate for Payer: BCBS Complete	$1,071.85
Rate for Payer: BCBS MAPPO	$1,904.50
Rate for Payer: BCN Medicare Advantage	$1,904.50
Rate for Payer: Cash Price	$3,219.42
Rate for Payer: Cash Price	$3,219.42
Rate for Payer: Cofinity Commercial	$2,816.99
Rate for Payer: Cofinity Commercial	$3,460.87
Rate for Payer: Cofinity Medicare Advantage	$2,816.99
Rate for Payer: Encore Health Key Benefits Commercial	$3,219.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,904.50
Rate for Payer: Healthscope Commercial	$3,621.84
Rate for Payer: Mclaren Medicaid	$1,020.81
Rate for Payer: Mclaren Medicare	$1,904.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,999.72
Rate for Payer: Meridian Medicaid	$1,071.85
Rate for Payer: MI Amish Medical Board Commercial	$2,190.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,420.63
Rate for Payer: PACE Medicare	$1,809.28
Rate for Payer: PACE SWMI	$1,904.50
Rate for Payer: PHP Commercial	$3,420.63
Rate for Payer: PHP Medicare Advantage	$1,904.50
Rate for Payer: Priority Health Choice Medicaid	$1,020.81
Rate for Payer: Priority Health Cigna Priority Health	$2,615.78
Rate for Payer: Priority Health Medicare	$1,904.50
Rate for Payer: Priority Health SBD	$2,535.29
Rate for Payer: Railroad Medicare Medicare	$1,904.50
Rate for Payer: UHC All Payor (Choice/PPO)	$5,360.98
Rate for Payer: UHC Dual Complete DSNP	$1,904.50
Rate for Payer: UHC Medicare Advantage	$1,904.50
Rate for Payer: UHCCP Medicaid	$1,072.23
Rate for Payer: VA VA	$1,904.50

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

Facility

$2,683.19

Service Code	CPT 64624
Hospital Charge Code	36100601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,690.41
Max. Negotiated Rate	$2,414.87
Rate for Payer: Aetna Commercial	$2,280.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,744.07
Rate for Payer: Cash Price	$2,146.55
Rate for Payer: Cofinity Commercial	$1,878.23
Rate for Payer: Cofinity Commercial	$2,307.54
Rate for Payer: Cofinity Medicare Advantage	$1,878.23
Rate for Payer: Encore Health Key Benefits Commercial	$2,146.55
Rate for Payer: Healthscope Commercial	$2,414.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,280.71
Rate for Payer: PHP Commercial	$2,280.71
Rate for Payer: Priority Health Cigna Priority Health	$1,744.07
Rate for Payer: Priority Health SBD	$1,690.41

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

Facility

$2,683.19

Service Code	CPT 64624
Hospital Charge Code	36100601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,020.81
Max. Negotiated Rate	$5,360.98
Rate for Payer: Aetna Commercial	$2,280.71
Rate for Payer: Aetna Medicare	$1,980.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,744.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,380.62
Rate for Payer: Amish Plain Church Group Commercial	$2,380.62
Rate for Payer: BCBS Complete	$1,071.85
Rate for Payer: BCBS MAPPO	$1,904.50
Rate for Payer: BCN Medicare Advantage	$1,904.50
Rate for Payer: Cash Price	$2,146.55
Rate for Payer: Cash Price	$2,146.55
Rate for Payer: Cofinity Commercial	$2,307.54
Rate for Payer: Cofinity Commercial	$1,878.23
Rate for Payer: Cofinity Medicare Advantage	$1,878.23
Rate for Payer: Encore Health Key Benefits Commercial	$2,146.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,904.50
Rate for Payer: Healthscope Commercial	$2,414.87
Rate for Payer: Mclaren Medicaid	$1,020.81
Rate for Payer: Mclaren Medicare	$1,904.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,999.72
Rate for Payer: Meridian Medicaid	$1,071.85
Rate for Payer: MI Amish Medical Board Commercial	$2,190.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,280.71
Rate for Payer: PACE Medicare	$1,809.28
Rate for Payer: PACE SWMI	$1,904.50
Rate for Payer: PHP Commercial	$2,280.71
Rate for Payer: PHP Medicare Advantage	$1,904.50
Rate for Payer: Priority Health Choice Medicaid	$1,020.81
Rate for Payer: Priority Health Cigna Priority Health	$1,744.07
Rate for Payer: Priority Health Medicare	$1,904.50
Rate for Payer: Priority Health SBD	$1,690.41
Rate for Payer: Railroad Medicare Medicare	$1,904.50
Rate for Payer: UHC All Payor (Choice/PPO)	$5,360.98
Rate for Payer: UHC Dual Complete DSNP	$1,904.50
Rate for Payer: UHC Medicare Advantage	$1,904.50
Rate for Payer: UHCCP Medicaid	$1,072.23
Rate for Payer: VA VA	$1,904.50

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

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100596
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,085.35
Rate for Payer: Amish Plain Church Group Commercial	$1,085.35
Rate for Payer: BCBS Complete	$488.67
Rate for Payer: BCBS MAPPO	$868.28
Rate for Payer: BCN Medicare Advantage	$868.28
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Mclaren Medicaid	$465.40
Rate for Payer: Mclaren Medicare	$868.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$911.69
Rate for Payer: Meridian Medicaid	$488.67
Rate for Payer: MI Amish Medical Board Commercial	$998.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$798.39
Rate for Payer: Railroad Medicare Medicare	$868.28
Rate for Payer: UHC All Payor (Choice/PPO)	$2,444.12
Rate for Payer: UHC Dual Complete DSNP	$868.28
Rate for Payer: UHC Medicare Advantage	$868.28
Rate for Payer: UHCCP Medicaid	$488.84
Rate for Payer: VA VA	$868.28

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

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100596
Hospital Revenue Code	361
Min. Negotiated Rate	$798.39
Max. Negotiated Rate	$1,140.56
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health SBD	$798.39

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

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100598
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,085.35
Rate for Payer: Amish Plain Church Group Commercial	$1,085.35
Rate for Payer: BCBS Complete	$488.67
Rate for Payer: BCBS MAPPO	$868.28
Rate for Payer: BCN Medicare Advantage	$868.28
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Mclaren Medicaid	$465.40
Rate for Payer: Mclaren Medicare	$868.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$911.69
Rate for Payer: Meridian Medicaid	$488.67
Rate for Payer: MI Amish Medical Board Commercial	$998.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$798.39
Rate for Payer: Railroad Medicare Medicare	$868.28
Rate for Payer: UHC All Payor (Choice/PPO)	$2,444.12
Rate for Payer: UHC Dual Complete DSNP	$868.28
Rate for Payer: UHC Medicare Advantage	$868.28
Rate for Payer: UHCCP Medicaid	$488.84
Rate for Payer: VA VA	$868.28

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

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100598
Hospital Revenue Code	361
Min. Negotiated Rate	$798.39
Max. Negotiated Rate	$1,140.56
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health SBD	$798.39

HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP SNG NRV

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100597
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,085.35
Rate for Payer: Amish Plain Church Group Commercial	$1,085.35
Rate for Payer: BCBS Complete	$488.67
Rate for Payer: BCBS MAPPO	$868.28
Rate for Payer: BCN Medicare Advantage	$868.28
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Mclaren Medicaid	$465.40
Rate for Payer: Mclaren Medicare	$868.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$911.69
Rate for Payer: Meridian Medicaid	$488.67
Rate for Payer: MI Amish Medical Board Commercial	$998.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$798.39
Rate for Payer: Railroad Medicare Medicare	$868.28
Rate for Payer: UHC All Payor (Choice/PPO)	$2,444.12
Rate for Payer: UHC Dual Complete DSNP	$868.28
Rate for Payer: UHC Medicare Advantage	$868.28
Rate for Payer: UHCCP Medicaid	$488.84
Rate for Payer: VA VA	$868.28

HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP SNG NRV

Facility

$1,267.29

Service Code	CPT 64640
Hospital Charge Code	36100597
Hospital Revenue Code	361
Min. Negotiated Rate	$798.39
Max. Negotiated Rate	$1,140.56
Rate for Payer: Aetna Commercial	$1,077.20
Rate for Payer: Aetna New Business (MI Preferred)	$823.74
Rate for Payer: Cash Price	$1,013.83
Rate for Payer: Cofinity Commercial	$1,089.87
Rate for Payer: Cofinity Commercial	$887.10
Rate for Payer: Cofinity Medicare Advantage	$887.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,013.83
Rate for Payer: Healthscope Commercial	$1,140.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,077.20
Rate for Payer: PHP Commercial	$1,077.20
Rate for Payer: Priority Health Cigna Priority Health	$823.74
Rate for Payer: Priority Health SBD	$798.39

Know your out-of-pocket cost for care.

All Charges