Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL

Facility

$1,864.36

Service Code	CPT 64490
Hospital Charge Code	36100626
Hospital Revenue Code	361
Min. Negotiated Rate	$102.82
Max. Negotiated Rate	$1,677.92
Rate for Payer: Aetna Commercial	$1,584.71
Rate for Payer: Aetna Medicare	$843.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,211.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,013.79
Rate for Payer: Amish Plain Church Group Commercial	$1,013.79
Rate for Payer: BCBS Complete	$465.86
Rate for Payer: BCBS MAPPO	$811.03
Rate for Payer: BCBS Trust/PPO	$792.05
Rate for Payer: BCN Medicare Advantage	$811.03
Rate for Payer: Cash Price	$1,491.49
Rate for Payer: Cash Price	$1,491.49
Rate for Payer: Cofinity Commercial	$1,305.05
Rate for Payer: Cofinity Commercial	$1,603.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$811.03
Rate for Payer: Healthscope Commercial	$1,677.92
Rate for Payer: Mclaren Medicaid	$443.63
Rate for Payer: Mclaren Medicare	$811.03
Rate for Payer: Meridian Medicaid	$465.86
Rate for Payer: Meridian Wellcare - Medicare Advantage	$851.58
Rate for Payer: MI Amish Medical Board Commercial	$932.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,584.71
Rate for Payer: PACE Medicare	$770.48
Rate for Payer: PACE SWMI	$811.03
Rate for Payer: PHP Commercial	$1,584.71
Rate for Payer: PHP Medicare Advantage	$811.03
Rate for Payer: Priority Health Choice Medicaid	$443.63
Rate for Payer: Priority Health Cigna Priority Health	$1,305.05
Rate for Payer: Priority Health Medicare	$811.03
Rate for Payer: Priority Health SBD	$1,174.55
Rate for Payer: Railroad Medicare Medicare	$811.03
Rate for Payer: UHC All Payor (Choice/PPO)	$113.10
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$811.03
Rate for Payer: UHC Exchange	$102.82
Rate for Payer: UHC Medicare Advantage	$835.36
Rate for Payer: VA VA	$811.03

HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL

Facility

$1,864.36

Service Code	CPT 64490
Hospital Charge Code	36100626
Hospital Revenue Code	361
Min. Negotiated Rate	$1,174.55
Max. Negotiated Rate	$1,677.92
Rate for Payer: Aetna Commercial	$1,584.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,211.83
Rate for Payer: Cash Price	$1,491.49
Rate for Payer: Cofinity Commercial	$1,305.05
Rate for Payer: Cofinity Commercial	$1,603.35
Rate for Payer: Healthscope Commercial	$1,677.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,584.71
Rate for Payer: PHP Commercial	$1,584.71
Rate for Payer: Priority Health Cigna Priority Health	$1,305.05
Rate for Payer: Priority Health SBD	$1,174.55

HC INJECTION FACET JOINT C OR T 2ND LEVEL

Facility

$333.67

Service Code	CPT 64491
Hospital Charge Code	36100291
Hospital Revenue Code	361
Min. Negotiated Rate	$210.21
Max. Negotiated Rate	$300.30
Rate for Payer: Aetna Commercial	$283.62
Rate for Payer: Aetna New Business (MI Preferred)	$216.89
Rate for Payer: Cash Price	$266.94
Rate for Payer: Cofinity Commercial	$233.57
Rate for Payer: Cofinity Commercial	$286.96
Rate for Payer: Healthscope Commercial	$300.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$283.62
Rate for Payer: PHP Commercial	$283.62
Rate for Payer: Priority Health Cigna Priority Health	$233.57
Rate for Payer: Priority Health SBD	$210.21

HC INJECTION FACET JOINT C OR T 2ND LEVEL

Facility

$333.67

Service Code	CPT 64491
Hospital Charge Code	36100291
Hospital Revenue Code	361
Min. Negotiated Rate	$57.63
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$283.62
Rate for Payer: Aetna New Business (MI Preferred)	$216.89
Rate for Payer: BCBS Complete	$133.47
Rate for Payer: BCBS Trust/PPO	$186.60
Rate for Payer: Cash Price	$266.94
Rate for Payer: Cash Price	$266.94
Rate for Payer: Cofinity Commercial	$233.57
Rate for Payer: Cofinity Commercial	$286.96
Rate for Payer: Healthscope Commercial	$300.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$283.62
Rate for Payer: PHP Commercial	$283.62
Rate for Payer: Priority Health Cigna Priority Health	$233.57
Rate for Payer: Priority Health SBD	$210.21
Rate for Payer: UHC All Payor (Choice/PPO)	$63.39
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$57.63

HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL

Facility

$500.51

Service Code	CPT 64491
Hospital Charge Code	36100627
Hospital Revenue Code	361
Min. Negotiated Rate	$315.32
Max. Negotiated Rate	$450.46
Rate for Payer: Aetna Commercial	$425.43
Rate for Payer: Aetna New Business (MI Preferred)	$325.33
Rate for Payer: Cash Price	$400.41
Rate for Payer: Cofinity Commercial	$350.36
Rate for Payer: Cofinity Commercial	$430.44
Rate for Payer: Healthscope Commercial	$450.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.43
Rate for Payer: PHP Commercial	$425.43
Rate for Payer: Priority Health Cigna Priority Health	$350.36
Rate for Payer: Priority Health SBD	$315.32

HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL

Facility

$500.51

Service Code	CPT 64491
Hospital Charge Code	36100627
Hospital Revenue Code	361
Min. Negotiated Rate	$57.63
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$425.43
Rate for Payer: Aetna New Business (MI Preferred)	$325.33
Rate for Payer: BCBS Complete	$200.20
Rate for Payer: BCBS Trust/PPO	$186.60
Rate for Payer: Cash Price	$400.41
Rate for Payer: Cash Price	$400.41
Rate for Payer: Cofinity Commercial	$350.36
Rate for Payer: Cofinity Commercial	$430.44
Rate for Payer: Healthscope Commercial	$450.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.43
Rate for Payer: PHP Commercial	$425.43
Rate for Payer: Priority Health Cigna Priority Health	$350.36
Rate for Payer: Priority Health SBD	$315.32
Rate for Payer: UHC All Payor (Choice/PPO)	$63.39
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$57.63

HC INJECTION FACET JOINT C OR T 3RD + LEVEL

Facility

$333.67

Service Code	CPT 64492
Hospital Charge Code	36100292
Hospital Revenue Code	361
Min. Negotiated Rate	$58.61
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$283.62
Rate for Payer: Aetna New Business (MI Preferred)	$216.89
Rate for Payer: BCBS Complete	$133.47
Rate for Payer: BCBS Trust/PPO	$187.31
Rate for Payer: Cash Price	$266.94
Rate for Payer: Cash Price	$266.94
Rate for Payer: Cofinity Commercial	$286.96
Rate for Payer: Cofinity Commercial	$233.57
Rate for Payer: Healthscope Commercial	$300.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$283.62
Rate for Payer: PHP Commercial	$283.62
Rate for Payer: Priority Health Cigna Priority Health	$233.57
Rate for Payer: Priority Health SBD	$210.21
Rate for Payer: UHC All Payor (Choice/PPO)	$64.47
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$58.61

HC INJECTION FACET JOINT C OR T 3RD + LEVEL

Facility

$333.67

Service Code	CPT 64492
Hospital Charge Code	36100292
Hospital Revenue Code	361
Min. Negotiated Rate	$210.21
Max. Negotiated Rate	$300.30
Rate for Payer: Aetna Commercial	$283.62
Rate for Payer: Aetna New Business (MI Preferred)	$216.89
Rate for Payer: Cash Price	$266.94
Rate for Payer: Cofinity Commercial	$233.57
Rate for Payer: Cofinity Commercial	$286.96
Rate for Payer: Healthscope Commercial	$300.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$283.62
Rate for Payer: PHP Commercial	$283.62
Rate for Payer: Priority Health Cigna Priority Health	$233.57
Rate for Payer: Priority Health SBD	$210.21

HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL

Facility

$500.51

Service Code	CPT 64492
Hospital Charge Code	36100628
Hospital Revenue Code	361
Min. Negotiated Rate	$315.32
Max. Negotiated Rate	$450.46
Rate for Payer: Aetna Commercial	$425.43
Rate for Payer: Aetna New Business (MI Preferred)	$325.33
Rate for Payer: Cash Price	$400.41
Rate for Payer: Cofinity Commercial	$350.36
Rate for Payer: Cofinity Commercial	$430.44
Rate for Payer: Healthscope Commercial	$450.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.43
Rate for Payer: PHP Commercial	$425.43
Rate for Payer: Priority Health Cigna Priority Health	$350.36
Rate for Payer: Priority Health SBD	$315.32

HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL

Facility

$500.51

Service Code	CPT 64492
Hospital Charge Code	36100628
Hospital Revenue Code	361
Min. Negotiated Rate	$58.61
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$425.43
Rate for Payer: Aetna New Business (MI Preferred)	$325.33
Rate for Payer: BCBS Complete	$200.20
Rate for Payer: BCBS Trust/PPO	$187.31
Rate for Payer: Cash Price	$400.41
Rate for Payer: Cash Price	$400.41
Rate for Payer: Cofinity Commercial	$430.44
Rate for Payer: Cofinity Commercial	$350.36
Rate for Payer: Healthscope Commercial	$450.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.43
Rate for Payer: PHP Commercial	$425.43
Rate for Payer: Priority Health Cigna Priority Health	$350.36
Rate for Payer: Priority Health SBD	$315.32
Rate for Payer: UHC All Payor (Choice/PPO)	$64.47
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$58.61

HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL

Facility

$2,427.77

Service Code	CPT 64493
Hospital Charge Code	36100629
Hospital Revenue Code	361
Min. Negotiated Rate	$1,529.50
Max. Negotiated Rate	$2,184.99
Rate for Payer: Aetna Commercial	$2,063.60
Rate for Payer: Aetna New Business (MI Preferred)	$1,578.05
Rate for Payer: Cash Price	$1,942.22
Rate for Payer: Cofinity Commercial	$1,699.44
Rate for Payer: Cofinity Commercial	$2,087.88
Rate for Payer: Healthscope Commercial	$2,184.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,063.60
Rate for Payer: PHP Commercial	$2,063.60
Rate for Payer: Priority Health Cigna Priority Health	$1,699.44
Rate for Payer: Priority Health SBD	$1,529.50

HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL

Facility

$2,427.77

Service Code	CPT 64493
Hospital Charge Code	36100629
Hospital Revenue Code	361
Min. Negotiated Rate	$88.41
Max. Negotiated Rate	$2,184.99
Rate for Payer: Aetna Commercial	$2,063.60
Rate for Payer: Aetna Medicare	$843.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,578.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,013.79
Rate for Payer: Amish Plain Church Group Commercial	$1,013.79
Rate for Payer: BCBS Complete	$465.86
Rate for Payer: BCBS MAPPO	$811.03
Rate for Payer: BCBS Trust/PPO	$570.17
Rate for Payer: BCN Medicare Advantage	$811.03
Rate for Payer: Cash Price	$1,942.22
Rate for Payer: Cash Price	$1,942.22
Rate for Payer: Cofinity Commercial	$2,087.88
Rate for Payer: Cofinity Commercial	$1,699.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$811.03
Rate for Payer: Healthscope Commercial	$2,184.99
Rate for Payer: Mclaren Medicaid	$443.63
Rate for Payer: Mclaren Medicare	$811.03
Rate for Payer: Meridian Medicaid	$465.86
Rate for Payer: Meridian Wellcare - Medicare Advantage	$851.58
Rate for Payer: MI Amish Medical Board Commercial	$932.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,063.60
Rate for Payer: PACE Medicare	$770.48
Rate for Payer: PACE SWMI	$811.03
Rate for Payer: PHP Commercial	$2,063.60
Rate for Payer: PHP Medicare Advantage	$811.03
Rate for Payer: Priority Health Choice Medicaid	$443.63
Rate for Payer: Priority Health Cigna Priority Health	$1,699.44
Rate for Payer: Priority Health Medicare	$811.03
Rate for Payer: Priority Health SBD	$1,529.50
Rate for Payer: Railroad Medicare Medicare	$811.03
Rate for Payer: UHC All Payor (Choice/PPO)	$97.25
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$811.03
Rate for Payer: UHC Exchange	$88.41
Rate for Payer: UHC Medicare Advantage	$835.36
Rate for Payer: VA VA	$811.03

HC INJECTION FACET JOINT L OR S 2ND LEVEL

Facility

$403.74

Service Code	CPT 64494
Hospital Charge Code	36100294
Hospital Revenue Code	361
Min. Negotiated Rate	$254.36
Max. Negotiated Rate	$363.37
Rate for Payer: Aetna Commercial	$343.18
Rate for Payer: Aetna New Business (MI Preferred)	$262.43
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cofinity Commercial	$282.62
Rate for Payer: Cofinity Commercial	$347.22
Rate for Payer: Healthscope Commercial	$363.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.18
Rate for Payer: PHP Commercial	$343.18
Rate for Payer: Priority Health Cigna Priority Health	$282.62
Rate for Payer: Priority Health SBD	$254.36

HC INJECTION FACET JOINT L OR S 2ND LEVEL

Facility

$403.74

Service Code	CPT 64494
Hospital Charge Code	36100294
Hospital Revenue Code	361
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$343.18
Rate for Payer: Aetna New Business (MI Preferred)	$262.43
Rate for Payer: BCBS Complete	$161.50
Rate for Payer: BCBS Trust/PPO	$171.81
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cofinity Commercial	$282.62
Rate for Payer: Cofinity Commercial	$347.22
Rate for Payer: Healthscope Commercial	$363.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.18
Rate for Payer: PHP Commercial	$343.18
Rate for Payer: Priority Health Cigna Priority Health	$282.62
Rate for Payer: Priority Health SBD	$254.36
Rate for Payer: UHC All Payor (Choice/PPO)	$54.38
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$49.44

HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL

Facility

$605.60

Service Code	CPT 64494
Hospital Charge Code	36100630
Hospital Revenue Code	361
Min. Negotiated Rate	$381.53
Max. Negotiated Rate	$545.04
Rate for Payer: Aetna Commercial	$514.76
Rate for Payer: Aetna New Business (MI Preferred)	$393.64
Rate for Payer: Cash Price	$484.48
Rate for Payer: Cofinity Commercial	$423.92
Rate for Payer: Cofinity Commercial	$520.82
Rate for Payer: Healthscope Commercial	$545.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$514.76
Rate for Payer: PHP Commercial	$514.76
Rate for Payer: Priority Health Cigna Priority Health	$423.92
Rate for Payer: Priority Health SBD	$381.53

HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL

Facility

$605.60

Service Code	CPT 64494
Hospital Charge Code	36100630
Hospital Revenue Code	361
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$514.76
Rate for Payer: Aetna New Business (MI Preferred)	$393.64
Rate for Payer: BCBS Complete	$242.24
Rate for Payer: BCBS Trust/PPO	$171.81
Rate for Payer: Cash Price	$484.48
Rate for Payer: Cash Price	$484.48
Rate for Payer: Cofinity Commercial	$423.92
Rate for Payer: Cofinity Commercial	$520.82
Rate for Payer: Healthscope Commercial	$545.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$514.76
Rate for Payer: PHP Commercial	$514.76
Rate for Payer: Priority Health Cigna Priority Health	$423.92
Rate for Payer: Priority Health SBD	$381.53
Rate for Payer: UHC All Payor (Choice/PPO)	$54.38
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$49.44

HC INJECTION FACET JOINT L OR S 3RD + LE

Facility

$403.74

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$50.43
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$343.18
Rate for Payer: Aetna New Business (MI Preferred)	$262.43
Rate for Payer: BCBS Complete	$161.50
Rate for Payer: BCBS Trust/PPO	$172.52
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cofinity Commercial	$347.22
Rate for Payer: Cofinity Commercial	$282.62
Rate for Payer: Healthscope Commercial	$363.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.18
Rate for Payer: PHP Commercial	$343.18
Rate for Payer: Priority Health Cigna Priority Health	$282.62
Rate for Payer: Priority Health SBD	$254.36
Rate for Payer: UHC All Payor (Choice/PPO)	$55.47
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$50.43

HC INJECTION FACET JOINT L OR S 3RD + LE

Facility

$403.74

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$254.36
Max. Negotiated Rate	$363.37
Rate for Payer: Aetna Commercial	$343.18
Rate for Payer: Aetna New Business (MI Preferred)	$262.43
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cofinity Commercial	$282.62
Rate for Payer: Cofinity Commercial	$347.22
Rate for Payer: Healthscope Commercial	$363.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.18
Rate for Payer: PHP Commercial	$343.18
Rate for Payer: Priority Health Cigna Priority Health	$282.62
Rate for Payer: Priority Health SBD	$254.36

HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL

Facility

$605.60

Service Code	CPT 64495
Hospital Charge Code	36100631
Hospital Revenue Code	361
Min. Negotiated Rate	$50.43
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$514.76
Rate for Payer: Aetna New Business (MI Preferred)	$393.64
Rate for Payer: BCBS Complete	$242.24
Rate for Payer: BCBS Trust/PPO	$172.52
Rate for Payer: Cash Price	$484.48
Rate for Payer: Cash Price	$484.48
Rate for Payer: Cofinity Commercial	$423.92
Rate for Payer: Cofinity Commercial	$520.82
Rate for Payer: Healthscope Commercial	$545.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$514.76
Rate for Payer: PHP Commercial	$514.76
Rate for Payer: Priority Health Cigna Priority Health	$423.92
Rate for Payer: Priority Health SBD	$381.53
Rate for Payer: UHC All Payor (Choice/PPO)	$55.47
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$50.43

HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL

Facility

$605.60

Service Code	CPT 64495
Hospital Charge Code	36100631
Hospital Revenue Code	361
Min. Negotiated Rate	$381.53
Max. Negotiated Rate	$545.04
Rate for Payer: Aetna Commercial	$514.76
Rate for Payer: Aetna New Business (MI Preferred)	$393.64
Rate for Payer: Cash Price	$484.48
Rate for Payer: Cofinity Commercial	$423.92
Rate for Payer: Cofinity Commercial	$520.82
Rate for Payer: Healthscope Commercial	$545.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$514.76
Rate for Payer: PHP Commercial	$514.76
Rate for Payer: Priority Health Cigna Priority Health	$423.92
Rate for Payer: Priority Health SBD	$381.53

HC INJECTION FOR CEREBRAL SHUNT

Facility

$810.15

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$55.01
Max. Negotiated Rate	$1,932.06
Rate for Payer: Aetna Commercial	$688.63
Rate for Payer: Aetna Medicare	$639.94
Rate for Payer: Aetna New Business (MI Preferred)	$526.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$769.16
Rate for Payer: Amish Plain Church Group Commercial	$769.16
Rate for Payer: BCBS Complete	$353.45
Rate for Payer: BCBS MAPPO	$615.33
Rate for Payer: BCBS Trust/PPO	$237.92
Rate for Payer: BCN Medicare Advantage	$615.33
Rate for Payer: Cash Price	$648.12
Rate for Payer: Cash Price	$648.12
Rate for Payer: Cofinity Commercial	$696.73
Rate for Payer: Cofinity Commercial	$567.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$615.33
Rate for Payer: Healthscope Commercial	$729.14
Rate for Payer: Mclaren Medicaid	$336.59
Rate for Payer: Mclaren Medicare	$615.33
Rate for Payer: Meridian Medicaid	$353.45
Rate for Payer: Meridian Wellcare - Medicare Advantage	$646.10
Rate for Payer: MI Amish Medical Board Commercial	$707.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$688.63
Rate for Payer: PACE Medicare	$584.56
Rate for Payer: PACE SWMI	$615.33
Rate for Payer: PHP Commercial	$688.63
Rate for Payer: PHP Medicare Advantage	$615.33
Rate for Payer: Priority Health Choice Medicaid	$336.59
Rate for Payer: Priority Health Cigna Priority Health	$567.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,932.06
Rate for Payer: Priority Health Medicare	$615.33
Rate for Payer: Priority Health Narrow Network	$1,545.65
Rate for Payer: Priority Health SBD	$510.39
Rate for Payer: Railroad Medicare Medicare	$615.33
Rate for Payer: UHC All Payor (Choice/PPO)	$60.51
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$615.33
Rate for Payer: UHC Exchange	$55.01
Rate for Payer: UHC Medicare Advantage	$633.79
Rate for Payer: VA VA	$615.33

HC INJECTION FOR CEREBRAL SHUNT

Facility

$810.15

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$510.39
Max. Negotiated Rate	$729.14
Rate for Payer: Aetna Commercial	$688.63
Rate for Payer: Aetna New Business (MI Preferred)	$526.60
Rate for Payer: Cash Price	$648.12
Rate for Payer: Cofinity Commercial	$567.10
Rate for Payer: Cofinity Commercial	$696.73
Rate for Payer: Healthscope Commercial	$729.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$688.63
Rate for Payer: PHP Commercial	$688.63
Rate for Payer: Priority Health Cigna Priority Health	$567.10
Rate for Payer: Priority Health SBD	$510.39

HC INJECTION FOR HYSTEROSALPINGOGRAM

Facility

$643.62

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$579.26
Rate for Payer: Aetna Commercial	$547.08
Rate for Payer: Aetna New Business (MI Preferred)	$418.35
Rate for Payer: BCBS Complete	$257.45
Rate for Payer: BCBS Trust/PPO	$288.45
Rate for Payer: Cash Price	$514.90
Rate for Payer: Cash Price	$514.90
Rate for Payer: Cofinity Commercial	$450.53
Rate for Payer: Cofinity Commercial	$553.51
Rate for Payer: Healthscope Commercial	$579.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$547.08
Rate for Payer: PHP Commercial	$547.08
Rate for Payer: Priority Health Cigna Priority Health	$450.53
Rate for Payer: Priority Health SBD	$405.48
Rate for Payer: UHC All Payor (Choice/PPO)	$62.32
Rate for Payer: UHC Exchange	$56.65

HC INJECTION FOR HYSTEROSALPINGOGRAM

Facility

$643.62

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$405.48
Max. Negotiated Rate	$579.26
Rate for Payer: Aetna Commercial	$547.08
Rate for Payer: Aetna New Business (MI Preferred)	$418.35
Rate for Payer: Cash Price	$514.90
Rate for Payer: Cofinity Commercial	$450.53
Rate for Payer: Cofinity Commercial	$553.51
Rate for Payer: Healthscope Commercial	$579.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$547.08
Rate for Payer: PHP Commercial	$547.08
Rate for Payer: Priority Health Cigna Priority Health	$450.53
Rate for Payer: Priority Health SBD	$405.48

HC INJECTION HIP ARTHROGRAM

Facility

$1,283.57

Service Code	CPT 27093
Hospital Charge Code	36100040
Hospital Revenue Code	361
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$1,155.21
Rate for Payer: Aetna Commercial	$1,091.03
Rate for Payer: Aetna New Business (MI Preferred)	$834.32
Rate for Payer: BCBS Complete	$513.43
Rate for Payer: BCBS Trust/PPO	$240.28
Rate for Payer: Cash Price	$1,026.86
Rate for Payer: Cash Price	$1,026.86
Rate for Payer: Cofinity Commercial	$898.50
Rate for Payer: Cofinity Commercial	$1,103.87
Rate for Payer: Healthscope Commercial	$1,155.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,091.03
Rate for Payer: PHP Commercial	$1,091.03
Rate for Payer: Priority Health Cigna Priority Health	$898.50
Rate for Payer: Priority Health SBD	$808.65
Rate for Payer: UHC All Payor (Choice/PPO)	$72.40
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$65.82

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