Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION PLANTAR DIGIT BILATERAL

Facility

$517.14

Service Code	CPT 64455
Hospital Charge Code	76100510
Hospital Revenue Code	761
Min. Negotiated Rate	$325.80
Max. Negotiated Rate	$465.43
Rate for Payer: Aetna Commercial	$439.57
Rate for Payer: Aetna New Business (MI Preferred)	$336.14
Rate for Payer: Cash Price	$413.71
Rate for Payer: Cofinity Commercial	$362.00
Rate for Payer: Cofinity Commercial	$444.74
Rate for Payer: Healthscope Commercial	$465.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$439.57
Rate for Payer: PHP Commercial	$439.57
Rate for Payer: Priority Health Cigna Priority Health	$362.00
Rate for Payer: Priority Health SBD	$325.80

HC INJECTION PLANTAR DIGIT BILATERAL

Facility

$517.14

Service Code	CPT 64455
Hospital Charge Code	76100510
Hospital Revenue Code	761
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$465.43
Rate for Payer: Aetna Commercial	$439.57
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$336.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.42
Rate for Payer: Amish Plain Church Group Commercial	$329.42
Rate for Payer: BCBS Complete	$151.38
Rate for Payer: BCBS MAPPO	$263.54
Rate for Payer: BCBS Trust/PPO	$169.96
Rate for Payer: BCN Medicare Advantage	$263.54
Rate for Payer: Cash Price	$413.71
Rate for Payer: Cash Price	$413.71
Rate for Payer: Cofinity Commercial	$362.00
Rate for Payer: Cofinity Commercial	$444.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$465.43
Rate for Payer: Mclaren Medicaid	$144.16
Rate for Payer: Mclaren Medicare	$263.54
Rate for Payer: Meridian Medicaid	$151.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.72
Rate for Payer: MI Amish Medical Board Commercial	$303.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$439.57
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$439.57
Rate for Payer: PHP Medicare Advantage	$263.54
Rate for Payer: Priority Health Choice Medicaid	$144.16
Rate for Payer: Priority Health Cigna Priority Health	$362.00
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health SBD	$325.80
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$35.66
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$32.42
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP

Facility

$790.00

Service Code	CPT 0232T
Hospital Charge Code	76100473
Hospital Revenue Code	761
Min. Negotiated Rate	$497.70
Max. Negotiated Rate	$711.00
Rate for Payer: Aetna Commercial	$671.50
Rate for Payer: Aetna New Business (MI Preferred)	$513.50
Rate for Payer: Cash Price	$632.00
Rate for Payer: Cofinity Commercial	$553.00
Rate for Payer: Cofinity Commercial	$679.40
Rate for Payer: Healthscope Commercial	$711.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$671.50
Rate for Payer: PHP Commercial	$671.50
Rate for Payer: Priority Health Cigna Priority Health	$553.00
Rate for Payer: Priority Health SBD	$497.70

HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP

Facility

$790.00

Service Code	CPT 0232T
Hospital Charge Code	76100473
Hospital Revenue Code	761
Min. Negotiated Rate	$193.93
Max. Negotiated Rate	$1,132.15
Rate for Payer: Aetna Commercial	$671.50
Rate for Payer: Aetna Medicare	$368.71
Rate for Payer: Aetna New Business (MI Preferred)	$513.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.16
Rate for Payer: Amish Plain Church Group Commercial	$443.16
Rate for Payer: BCBS Complete	$203.64
Rate for Payer: BCBS MAPPO	$354.53
Rate for Payer: BCN Medicare Advantage	$354.53
Rate for Payer: Cash Price	$632.00
Rate for Payer: Cash Price	$632.00
Rate for Payer: Cofinity Commercial	$553.00
Rate for Payer: Cofinity Commercial	$679.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.53
Rate for Payer: Healthscope Commercial	$711.00
Rate for Payer: Mclaren Medicaid	$193.93
Rate for Payer: Mclaren Medicare	$354.53
Rate for Payer: Meridian Medicaid	$203.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.26
Rate for Payer: MI Amish Medical Board Commercial	$407.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$671.50
Rate for Payer: PACE Medicare	$336.80
Rate for Payer: PACE SWMI	$354.53
Rate for Payer: PHP Commercial	$671.50
Rate for Payer: PHP Medicare Advantage	$354.53
Rate for Payer: Priority Health Choice Medicaid	$193.93
Rate for Payer: Priority Health Cigna Priority Health	$553.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,132.15
Rate for Payer: Priority Health Medicare	$354.53
Rate for Payer: Priority Health Narrow Network	$905.72
Rate for Payer: Priority Health SBD	$497.70
Rate for Payer: Railroad Medicare Medicare	$354.53
Rate for Payer: UHC Dual Complete DSNP	$354.53
Rate for Payer: UHC Medicare Advantage	$365.17
Rate for Payer: VA VA	$354.53

HC INJECTION PROC CYSTOGRAPHY VOIDING

Facility

$1,284.65

Service Code	CPT 51600
Hospital Charge Code	36100251
Hospital Revenue Code	361
Min. Negotiated Rate	$41.91
Max. Negotiated Rate	$1,156.18
Rate for Payer: Aetna Commercial	$1,091.95
Rate for Payer: Aetna New Business (MI Preferred)	$835.02
Rate for Payer: BCBS Complete	$513.86
Rate for Payer: BCBS Trust/PPO	$305.50
Rate for Payer: Cash Price	$1,027.72
Rate for Payer: Cash Price	$1,027.72
Rate for Payer: Cofinity Commercial	$899.26
Rate for Payer: Cofinity Commercial	$1,104.80
Rate for Payer: Healthscope Commercial	$1,156.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,091.95
Rate for Payer: PHP Commercial	$1,091.95
Rate for Payer: Priority Health Cigna Priority Health	$899.26
Rate for Payer: Priority Health SBD	$809.33
Rate for Payer: UHC All Payor (Choice/PPO)	$46.10
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$41.91

HC INJECTION PROC CYSTOGRAPHY VOIDING

Facility

$1,284.65

Service Code	CPT 51600
Hospital Charge Code	36100251
Hospital Revenue Code	361
Min. Negotiated Rate	$809.33
Max. Negotiated Rate	$1,156.18
Rate for Payer: Aetna Commercial	$1,091.95
Rate for Payer: Aetna New Business (MI Preferred)	$835.02
Rate for Payer: Cash Price	$1,027.72
Rate for Payer: Cofinity Commercial	$1,104.80
Rate for Payer: Cofinity Commercial	$899.26
Rate for Payer: Healthscope Commercial	$1,156.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,091.95
Rate for Payer: PHP Commercial	$1,091.95
Rate for Payer: Priority Health Cigna Priority Health	$899.26
Rate for Payer: Priority Health SBD	$809.33

HC INJECTION PROCEDURE

Facility

$591.65

Hospital Charge Code	36000085
Hospital Revenue Code	360
Min. Negotiated Rate	$236.66
Max. Negotiated Rate	$532.48
Rate for Payer: Aetna Commercial	$502.90
Rate for Payer: Aetna New Business (MI Preferred)	$384.57
Rate for Payer: BCBS Complete	$236.66
Rate for Payer: Cash Price	$473.32
Rate for Payer: Cofinity Commercial	$414.16
Rate for Payer: Cofinity Commercial	$508.82
Rate for Payer: Healthscope Commercial	$532.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$502.90
Rate for Payer: PHP Commercial	$502.90
Rate for Payer: Priority Health Cigna Priority Health	$414.16
Rate for Payer: Priority Health SBD	$372.74

HC INJECTION PROCEDURE

Facility

$591.65

Hospital Charge Code	36000085
Hospital Revenue Code	360
Min. Negotiated Rate	$372.74
Max. Negotiated Rate	$532.48
Rate for Payer: Aetna Commercial	$502.90
Rate for Payer: Aetna New Business (MI Preferred)	$384.57
Rate for Payer: Cash Price	$473.32
Rate for Payer: Cofinity Commercial	$414.16
Rate for Payer: Cofinity Commercial	$508.82
Rate for Payer: Healthscope Commercial	$532.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$502.90
Rate for Payer: PHP Commercial	$502.90
Rate for Payer: Priority Health Cigna Priority Health	$414.16
Rate for Payer: Priority Health SBD	$372.74

HC INJECTION PROCEDURE ILEAL CONDUIT

Facility

$630.91

Service Code	CPT 50690
Hospital Charge Code	36100249
Hospital Revenue Code	361
Min. Negotiated Rate	$397.47
Max. Negotiated Rate	$567.82
Rate for Payer: Aetna Commercial	$536.27
Rate for Payer: Aetna New Business (MI Preferred)	$410.09
Rate for Payer: Cash Price	$504.73
Rate for Payer: Cofinity Commercial	$441.64
Rate for Payer: Cofinity Commercial	$542.58
Rate for Payer: Healthscope Commercial	$567.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$536.27
Rate for Payer: PHP Commercial	$536.27
Rate for Payer: Priority Health Cigna Priority Health	$441.64
Rate for Payer: Priority Health SBD	$397.47

HC INJECTION PROCEDURE ILEAL CONDUIT

Facility

$630.91

Service Code	CPT 50690
Hospital Charge Code	36100249
Hospital Revenue Code	361
Min. Negotiated Rate	$67.78
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$536.27
Rate for Payer: Aetna New Business (MI Preferred)	$410.09
Rate for Payer: BCBS Complete	$252.36
Rate for Payer: BCBS Trust/PPO	$198.58
Rate for Payer: Cash Price	$504.73
Rate for Payer: Cash Price	$504.73
Rate for Payer: Cofinity Commercial	$441.64
Rate for Payer: Cofinity Commercial	$542.58
Rate for Payer: Healthscope Commercial	$567.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$536.27
Rate for Payer: PHP Commercial	$536.27
Rate for Payer: Priority Health Cigna Priority Health	$441.64
Rate for Payer: Priority Health SBD	$397.47
Rate for Payer: UHC All Payor (Choice/PPO)	$74.56
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$67.78

HC INJECTION PROC RETROGRAD CYSTOGRAPHY

Facility

$816.16

Service Code	CPT 51610
Hospital Charge Code	36100252
Hospital Revenue Code	361
Min. Negotiated Rate	$514.18
Max. Negotiated Rate	$734.54
Rate for Payer: Aetna Commercial	$693.74
Rate for Payer: Aetna New Business (MI Preferred)	$530.50
Rate for Payer: Cash Price	$652.93
Rate for Payer: Cofinity Commercial	$571.31
Rate for Payer: Cofinity Commercial	$701.90
Rate for Payer: Healthscope Commercial	$734.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$693.74
Rate for Payer: PHP Commercial	$693.74
Rate for Payer: Priority Health Cigna Priority Health	$571.31
Rate for Payer: Priority Health SBD	$514.18

HC INJECTION PROC RETROGRAD CYSTOGRAPHY

Facility

$816.16

Service Code	CPT 51610
Hospital Charge Code	36100252
Hospital Revenue Code	361
Min. Negotiated Rate	$62.54
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$693.74
Rate for Payer: Aetna New Business (MI Preferred)	$530.50
Rate for Payer: BCBS Complete	$326.46
Rate for Payer: BCBS Trust/PPO	$276.66
Rate for Payer: Cash Price	$652.93
Rate for Payer: Cash Price	$652.93
Rate for Payer: Cofinity Commercial	$701.90
Rate for Payer: Cofinity Commercial	$571.31
Rate for Payer: Healthscope Commercial	$734.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$693.74
Rate for Payer: PHP Commercial	$693.74
Rate for Payer: Priority Health Cigna Priority Health	$571.31
Rate for Payer: Priority Health SBD	$514.18
Rate for Payer: UHC All Payor (Choice/PPO)	$68.79
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$62.54

HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG

Facility

$15.30

Service Code	CPT J2550
Hospital Charge Code	63600100
Hospital Revenue Code	636
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$13.77
Rate for Payer: Aetna Commercial	$13.00
Rate for Payer: Aetna New Business (MI Preferred)	$9.94
Rate for Payer: BCBS Complete	$6.12
Rate for Payer: BCBS Trust/PPO	$10.61
Rate for Payer: Cash Price	$12.24
Rate for Payer: Cash Price	$12.24
Rate for Payer: Cofinity Commercial	$10.71
Rate for Payer: Cofinity Commercial	$13.16
Rate for Payer: Healthscope Commercial	$13.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.00
Rate for Payer: PHP Commercial	$13.00
Rate for Payer: Priority Health Cigna Priority Health	$10.71
Rate for Payer: Priority Health SBD	$9.64

HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG

Facility

$15.30

Service Code	CPT J2550
Hospital Charge Code	63600100
Hospital Revenue Code	636
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$13.77
Rate for Payer: Aetna Commercial	$13.00
Rate for Payer: Aetna New Business (MI Preferred)	$9.94
Rate for Payer: Cash Price	$12.24
Rate for Payer: Cofinity Commercial	$10.71
Rate for Payer: Cofinity Commercial	$13.16
Rate for Payer: Healthscope Commercial	$13.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.00
Rate for Payer: PHP Commercial	$13.00
Rate for Payer: Priority Health Cigna Priority Health	$10.71
Rate for Payer: Priority Health SBD	$9.64

HC INJECTION PUDENDAL NERVE

Facility

$1,170.21

Service Code	CPT 64430
Hospital Charge Code	36100570
Hospital Revenue Code	361
Min. Negotiated Rate	$53.37
Max. Negotiated Rate	$1,463.00
Rate for Payer: Aetna Commercial	$994.68
Rate for Payer: Aetna Medicare	$843.47
Rate for Payer: Aetna New Business (MI Preferred)	$760.64
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	$492.10
Rate for Payer: BCN Medicare Advantage	$811.03
Rate for Payer: Cash Price	$936.17
Rate for Payer: Cash Price	$936.17
Rate for Payer: Cofinity Commercial	$819.15
Rate for Payer: Cofinity Commercial	$1,006.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$811.03
Rate for Payer: Healthscope Commercial	$1,053.19
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	$994.68
Rate for Payer: PACE Medicare	$770.48
Rate for Payer: PACE SWMI	$811.03
Rate for Payer: PHP Commercial	$994.68
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	$819.15
Rate for Payer: Priority Health Medicare	$811.03
Rate for Payer: Priority Health SBD	$737.23
Rate for Payer: Railroad Medicare Medicare	$811.03
Rate for Payer: UHC All Payor (Choice/PPO)	$58.71
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$811.03
Rate for Payer: UHC Exchange	$53.37
Rate for Payer: UHC Medicare Advantage	$835.36
Rate for Payer: VA VA	$811.03

HC INJECTION PUDENDAL NERVE

Facility

$1,170.21

Service Code	CPT 64430
Hospital Charge Code	36100570
Hospital Revenue Code	361
Min. Negotiated Rate	$737.23
Max. Negotiated Rate	$1,053.19
Rate for Payer: Aetna Commercial	$994.68
Rate for Payer: Aetna New Business (MI Preferred)	$760.64
Rate for Payer: Cash Price	$936.17
Rate for Payer: Cofinity Commercial	$1,006.38
Rate for Payer: Cofinity Commercial	$819.15
Rate for Payer: Healthscope Commercial	$1,053.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$994.68
Rate for Payer: PHP Commercial	$994.68
Rate for Payer: Priority Health Cigna Priority Health	$819.15
Rate for Payer: Priority Health SBD	$737.23

HC INJECTION SCLEROSING SOL MULTIPLE

Facility

$322.83

Service Code	CPT 36471
Hospital Charge Code	36100117
Hospital Revenue Code	761
Min. Negotiated Rate	$203.38
Max. Negotiated Rate	$290.55
Rate for Payer: Aetna Commercial	$274.41
Rate for Payer: Aetna New Business (MI Preferred)	$209.84
Rate for Payer: Cash Price	$258.26
Rate for Payer: Cofinity Commercial	$225.98
Rate for Payer: Cofinity Commercial	$277.63
Rate for Payer: Healthscope Commercial	$290.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.41
Rate for Payer: PHP Commercial	$274.41
Rate for Payer: Priority Health Cigna Priority Health	$225.98
Rate for Payer: Priority Health SBD	$203.38

HC INJECTION SCLEROSING SOL MULTIPLE

Facility

$322.83

Service Code	CPT 36471
Hospital Charge Code	36100117
Hospital Revenue Code	761
Min. Negotiated Rate	$73.02
Max. Negotiated Rate	$1,118.65
Rate for Payer: Aetna Commercial	$274.41
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$209.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$172.35
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$258.26
Rate for Payer: Cash Price	$258.26
Rate for Payer: Cofinity Commercial	$277.63
Rate for Payer: Cofinity Commercial	$225.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$290.55
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.41
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$274.41
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$225.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,118.65
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$894.92
Rate for Payer: Priority Health SBD	$203.38
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$80.32
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$73.02
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

HC INJECTION SCLEROSING SOL SINGLE

Facility

$245.28

Service Code	CPT 36470
Hospital Charge Code	36100116
Hospital Revenue Code	761
Min. Negotiated Rate	$154.53
Max. Negotiated Rate	$220.75
Rate for Payer: Aetna Commercial	$208.49
Rate for Payer: Aetna New Business (MI Preferred)	$159.43
Rate for Payer: Cash Price	$196.22
Rate for Payer: Cofinity Commercial	$210.94
Rate for Payer: Cofinity Commercial	$171.70
Rate for Payer: Healthscope Commercial	$220.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.49
Rate for Payer: PHP Commercial	$208.49
Rate for Payer: Priority Health Cigna Priority Health	$171.70
Rate for Payer: Priority Health SBD	$154.53

HC INJECTION SCLEROSING SOL SINGLE

Facility

$245.28

Service Code	CPT 36470
Hospital Charge Code	36100116
Hospital Revenue Code	761
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$1,118.65
Rate for Payer: Aetna Commercial	$208.49
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$159.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$76.47
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$196.22
Rate for Payer: Cash Price	$196.22
Rate for Payer: Cofinity Commercial	$171.70
Rate for Payer: Cofinity Commercial	$210.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$220.75
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.49
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$208.49
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$171.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,118.65
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$894.92
Rate for Payer: Priority Health SBD	$154.53
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$40.34
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$36.67
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

HC INJECTION SHOULDER ARTHROGRAM

Facility

$846.52

Service Code	CPT 23350
Hospital Charge Code	36100037
Hospital Revenue Code	361
Min. Negotiated Rate	$533.31
Max. Negotiated Rate	$761.87
Rate for Payer: Aetna Commercial	$719.54
Rate for Payer: Aetna New Business (MI Preferred)	$550.24
Rate for Payer: Cash Price	$677.22
Rate for Payer: Cofinity Commercial	$592.56
Rate for Payer: Cofinity Commercial	$728.01
Rate for Payer: Healthscope Commercial	$761.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$719.54
Rate for Payer: PHP Commercial	$719.54
Rate for Payer: Priority Health Cigna Priority Health	$592.56
Rate for Payer: Priority Health SBD	$533.31

HC INJECTION SHOULDER ARTHROGRAM

Facility

$846.52

Service Code	CPT 23350
Hospital Charge Code	36100037
Hospital Revenue Code	361
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$719.54
Rate for Payer: Aetna New Business (MI Preferred)	$550.24
Rate for Payer: BCBS Complete	$338.61
Rate for Payer: BCBS Trust/PPO	$176.85
Rate for Payer: Cash Price	$677.22
Rate for Payer: Cash Price	$677.22
Rate for Payer: Cofinity Commercial	$728.01
Rate for Payer: Cofinity Commercial	$592.56
Rate for Payer: Healthscope Commercial	$761.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$719.54
Rate for Payer: PHP Commercial	$719.54
Rate for Payer: Priority Health Cigna Priority Health	$592.56
Rate for Payer: Priority Health SBD	$533.31
Rate for Payer: UHC All Payor (Choice/PPO)	$52.94
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$48.13

HC INJECTION SHUNTOGRAM

Facility

$381.09

Service Code	CPT 49427
Hospital Charge Code	36100224
Hospital Revenue Code	361
Min. Negotiated Rate	$240.09
Max. Negotiated Rate	$342.98
Rate for Payer: Aetna Commercial	$323.93
Rate for Payer: Aetna New Business (MI Preferred)	$247.71
Rate for Payer: Cash Price	$304.87
Rate for Payer: Cofinity Commercial	$266.76
Rate for Payer: Cofinity Commercial	$327.74
Rate for Payer: Healthscope Commercial	$342.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$323.93
Rate for Payer: PHP Commercial	$323.93
Rate for Payer: Priority Health Cigna Priority Health	$266.76
Rate for Payer: Priority Health SBD	$240.09

HC INJECTION SHUNTOGRAM

Facility

$381.09

Service Code	CPT 49427
Hospital Charge Code	36100224
Hospital Revenue Code	361
Min. Negotiated Rate	$37.33
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$323.93
Rate for Payer: Aetna New Business (MI Preferred)	$247.71
Rate for Payer: BCBS Complete	$152.44
Rate for Payer: BCBS Trust/PPO	$93.65
Rate for Payer: Cash Price	$304.87
Rate for Payer: Cash Price	$304.87
Rate for Payer: Cofinity Commercial	$266.76
Rate for Payer: Cofinity Commercial	$327.74
Rate for Payer: Healthscope Commercial	$342.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$323.93
Rate for Payer: PHP Commercial	$323.93
Rate for Payer: Priority Health Cigna Priority Health	$266.76
Rate for Payer: Priority Health SBD	$240.09
Rate for Payer: UHC All Payor (Choice/PPO)	$41.06
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$37.33

HC INJECTION SIALOGRAM

Facility

$286.12

Service Code	CPT 42550
Hospital Charge Code	36100190
Hospital Revenue Code	361
Min. Negotiated Rate	$180.26
Max. Negotiated Rate	$257.51
Rate for Payer: Aetna Commercial	$243.20
Rate for Payer: Aetna New Business (MI Preferred)	$185.98
Rate for Payer: Cash Price	$228.90
Rate for Payer: Cofinity Commercial	$200.28
Rate for Payer: Cofinity Commercial	$246.06
Rate for Payer: Healthscope Commercial	$257.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.20
Rate for Payer: PHP Commercial	$243.20
Rate for Payer: Priority Health Cigna Priority Health	$200.28
Rate for Payer: Priority Health SBD	$180.26

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