Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION SIALOGRAM

Facility

$286.12

Service Code	CPT 42550
Hospital Charge Code	36100190
Hospital Revenue Code	361
Min. Negotiated Rate	$58.94
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$243.20
Rate for Payer: Aetna New Business (MI Preferred)	$185.98
Rate for Payer: BCBS Complete	$114.45
Rate for Payer: BCBS Trust/PPO	$272.52
Rate for Payer: Cash Price	$228.90
Rate for Payer: Cash Price	$228.90
Rate for Payer: Cofinity Commercial	$246.06
Rate for Payer: Cofinity Commercial	$200.28
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
Rate for Payer: UHC All Payor (Choice/PPO)	$64.83
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$58.94

HC INJECTION SI JOINT ANESTHESIA/STEROID

Facility

$991.42

Service Code	CPT 27096
Hospital Charge Code	36100042
Hospital Revenue Code	361
Min. Negotiated Rate	$624.59
Max. Negotiated Rate	$892.28
Rate for Payer: Aetna Commercial	$842.71
Rate for Payer: Aetna New Business (MI Preferred)	$644.42
Rate for Payer: Cash Price	$793.14
Rate for Payer: Cofinity Commercial	$693.99
Rate for Payer: Cofinity Commercial	$852.62
Rate for Payer: Healthscope Commercial	$892.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$842.71
Rate for Payer: PHP Commercial	$842.71
Rate for Payer: Priority Health Cigna Priority Health	$693.99
Rate for Payer: Priority Health SBD	$624.59

HC INJECTION SI JOINT ANESTHESIA/STEROID

Facility

$991.42

Service Code	CPT 27096
Hospital Charge Code	36100042
Hospital Revenue Code	361
Min. Negotiated Rate	$80.88
Max. Negotiated Rate	$892.28
Rate for Payer: Aetna Commercial	$842.71
Rate for Payer: Aetna New Business (MI Preferred)	$644.42
Rate for Payer: BCBS Complete	$396.57
Rate for Payer: BCBS Trust/PPO	$428.94
Rate for Payer: Cash Price	$793.14
Rate for Payer: Cash Price	$793.14
Rate for Payer: Cofinity Commercial	$852.62
Rate for Payer: Cofinity Commercial	$693.99
Rate for Payer: Healthscope Commercial	$892.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$842.71
Rate for Payer: PHP Commercial	$842.71
Rate for Payer: Priority Health Cigna Priority Health	$693.99
Rate for Payer: Priority Health SBD	$624.59
Rate for Payer: UHC All Payor (Choice/PPO)	$88.97
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$80.88

HC INJECTION SI JOINT BIL ANESTHESIA/STEROID

Facility

$1,027.30

Service Code	CPT 27096
Hospital Charge Code	36100043
Hospital Revenue Code	361
Min. Negotiated Rate	$647.20
Max. Negotiated Rate	$924.57
Rate for Payer: Aetna Commercial	$873.20
Rate for Payer: Aetna New Business (MI Preferred)	$667.74
Rate for Payer: Cash Price	$821.84
Rate for Payer: Cofinity Commercial	$719.11
Rate for Payer: Cofinity Commercial	$883.48
Rate for Payer: Healthscope Commercial	$924.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$873.20
Rate for Payer: PHP Commercial	$873.20
Rate for Payer: Priority Health Cigna Priority Health	$719.11
Rate for Payer: Priority Health SBD	$647.20

HC INJECTION SI JOINT BIL ANESTHESIA/STEROID

Facility

$1,027.30

Service Code	CPT 27096
Hospital Charge Code	36100043
Hospital Revenue Code	361
Min. Negotiated Rate	$80.88
Max. Negotiated Rate	$924.57
Rate for Payer: Aetna Commercial	$873.20
Rate for Payer: Aetna New Business (MI Preferred)	$667.74
Rate for Payer: BCBS Complete	$410.92
Rate for Payer: BCBS Trust/PPO	$428.94
Rate for Payer: Cash Price	$821.84
Rate for Payer: Cash Price	$821.84
Rate for Payer: Cofinity Commercial	$883.48
Rate for Payer: Cofinity Commercial	$719.11
Rate for Payer: Healthscope Commercial	$924.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$873.20
Rate for Payer: PHP Commercial	$873.20
Rate for Payer: Priority Health Cigna Priority Health	$719.11
Rate for Payer: Priority Health SBD	$647.20
Rate for Payer: UHC All Payor (Choice/PPO)	$88.97
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$80.88

HC INJECTION SINGLE TENDON ORIGIN/INSERTION

Facility

$273.88

Service Code	CPT 20551
Hospital Charge Code	36100519
Hospital Revenue Code	761
Min. Negotiated Rate	$172.54
Max. Negotiated Rate	$246.49
Rate for Payer: Aetna Commercial	$232.80
Rate for Payer: Aetna New Business (MI Preferred)	$178.02
Rate for Payer: Cash Price	$219.10
Rate for Payer: Cofinity Commercial	$191.72
Rate for Payer: Cofinity Commercial	$235.54
Rate for Payer: Healthscope Commercial	$246.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$232.80
Rate for Payer: PHP Commercial	$232.80
Rate for Payer: Priority Health Cigna Priority Health	$191.72
Rate for Payer: Priority Health SBD	$172.54

HC INJECTION SINGLE TENDON ORIGIN/INSERTION

Facility

$273.88

Service Code	CPT 20551
Hospital Charge Code	36100519
Hospital Revenue Code	761
Min. Negotiated Rate	$37.66
Max. Negotiated Rate	$329.42
Rate for Payer: Aetna Commercial	$232.80
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$178.02
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	$219.10
Rate for Payer: Cash Price	$219.10
Rate for Payer: Cofinity Commercial	$235.54
Rate for Payer: Cofinity Commercial	$191.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$246.49
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	$232.80
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$232.80
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	$191.72
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health SBD	$172.54
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$41.43
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$37.66
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG

Facility

$429.05

Service Code	CPT 38200
Hospital Charge Code	36100183
Hospital Revenue Code	361
Min. Negotiated Rate	$125.08
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$364.69
Rate for Payer: Aetna New Business (MI Preferred)	$278.88
Rate for Payer: BCBS Complete	$171.62
Rate for Payer: BCBS Trust/PPO	$276.04
Rate for Payer: Cash Price	$343.24
Rate for Payer: Cash Price	$343.24
Rate for Payer: Cofinity Commercial	$368.98
Rate for Payer: Cofinity Commercial	$300.34
Rate for Payer: Healthscope Commercial	$386.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$364.69
Rate for Payer: PHP Commercial	$364.69
Rate for Payer: Priority Health Cigna Priority Health	$300.34
Rate for Payer: Priority Health SBD	$270.30
Rate for Payer: UHC All Payor (Choice/PPO)	$137.59
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$125.08

HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG

Facility

$429.05

Service Code	CPT 38200
Hospital Charge Code	36100183
Hospital Revenue Code	361
Min. Negotiated Rate	$270.30
Max. Negotiated Rate	$386.14
Rate for Payer: Aetna Commercial	$364.69
Rate for Payer: Aetna New Business (MI Preferred)	$278.88
Rate for Payer: Cash Price	$343.24
Rate for Payer: Cofinity Commercial	$300.34
Rate for Payer: Cofinity Commercial	$368.98
Rate for Payer: Healthscope Commercial	$386.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$364.69
Rate for Payer: PHP Commercial	$364.69
Rate for Payer: Priority Health Cigna Priority Health	$300.34
Rate for Payer: Priority Health SBD	$270.30

HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK

Facility

$1,064.00

Service Code	CPT 36468
Hospital Charge Code	76100400
Hospital Revenue Code	761
Min. Negotiated Rate	$79.71
Max. Negotiated Rate	$1,118.65
Rate for Payer: Aetna Commercial	$904.40
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$691.60
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	$79.71
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cofinity Commercial	$744.80
Rate for Payer: Cofinity Commercial	$915.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$957.60
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	$904.40
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$904.40
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	$744.80
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	$670.32
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK

Facility

$1,064.00

Service Code	CPT 36468
Hospital Charge Code	76100400
Hospital Revenue Code	761
Min. Negotiated Rate	$670.32
Max. Negotiated Rate	$957.60
Rate for Payer: Aetna Commercial	$904.40
Rate for Payer: Aetna New Business (MI Preferred)	$691.60
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cofinity Commercial	$744.80
Rate for Payer: Cofinity Commercial	$915.04
Rate for Payer: Healthscope Commercial	$957.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$904.40
Rate for Payer: PHP Commercial	$904.40
Rate for Payer: Priority Health Cigna Priority Health	$744.80
Rate for Payer: Priority Health SBD	$670.32

HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG

Facility

$0.16

Service Code	CPT J1071
Hospital Charge Code	63600109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna Commercial	$0.14
Rate for Payer: Aetna New Business (MI Preferred)	$0.10
Rate for Payer: BCBS Complete	$0.06
Rate for Payer: BCBS Trust/PPO	$0.06
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cofinity Commercial	$0.11
Rate for Payer: Cofinity Commercial	$0.14
Rate for Payer: Healthscope Commercial	$0.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.14
Rate for Payer: PHP Commercial	$0.14
Rate for Payer: Priority Health Cigna Priority Health	$0.11
Rate for Payer: Priority Health SBD	$0.10

HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG

Facility

$0.16

Service Code	CPT J1071
Hospital Charge Code	63600109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna Commercial	$0.14
Rate for Payer: Aetna New Business (MI Preferred)	$0.10
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cofinity Commercial	$0.14
Rate for Payer: Cofinity Commercial	$0.11
Rate for Payer: Healthscope Commercial	$0.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.14
Rate for Payer: PHP Commercial	$0.14
Rate for Payer: Priority Health Cigna Priority Health	$0.11
Rate for Payer: Priority Health SBD	$0.10

HC INJECTION THERAPEUTIC SINUS TRACT

Facility

$905.55

Service Code	CPT 20500
Hospital Charge Code	36100020
Hospital Revenue Code	361
Min. Negotiated Rate	$40.49
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Commercial	$769.72
Rate for Payer: Aetna Medicare	$1,411.25
Rate for Payer: Aetna New Business (MI Preferred)	$588.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,696.21
Rate for Payer: Amish Plain Church Group Commercial	$1,696.21
Rate for Payer: BCBS Complete	$779.44
Rate for Payer: BCBS MAPPO	$1,356.97
Rate for Payer: BCBS Trust/PPO	$40.49
Rate for Payer: BCN Medicare Advantage	$1,356.97
Rate for Payer: Cash Price	$724.44
Rate for Payer: Cash Price	$724.44
Rate for Payer: Cofinity Commercial	$778.77
Rate for Payer: Cofinity Commercial	$633.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,356.97
Rate for Payer: Healthscope Commercial	$815.00
Rate for Payer: Mclaren Medicaid	$742.26
Rate for Payer: Mclaren Medicare	$1,356.97
Rate for Payer: Meridian Medicaid	$779.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,424.82
Rate for Payer: MI Amish Medical Board Commercial	$1,560.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$769.72
Rate for Payer: PACE Medicare	$1,289.12
Rate for Payer: PACE SWMI	$1,356.97
Rate for Payer: PHP Commercial	$769.72
Rate for Payer: PHP Medicare Advantage	$1,356.97
Rate for Payer: Priority Health Choice Medicaid	$742.26
Rate for Payer: Priority Health Cigna Priority Health	$633.88
Rate for Payer: Priority Health Medicare	$1,356.97
Rate for Payer: Priority Health SBD	$570.50
Rate for Payer: Railroad Medicare Medicare	$1,356.97
Rate for Payer: UHC All Payor (Choice/PPO)	$96.89
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,356.97
Rate for Payer: UHC Exchange	$88.08
Rate for Payer: UHC Medicare Advantage	$1,397.68
Rate for Payer: VA VA	$1,356.97

HC INJECTION THERAPEUTIC SINUS TRACT

Facility

$905.55

Service Code	CPT 20500
Hospital Charge Code	36100020
Hospital Revenue Code	361
Min. Negotiated Rate	$570.50
Max. Negotiated Rate	$815.00
Rate for Payer: Aetna Commercial	$769.72
Rate for Payer: Aetna New Business (MI Preferred)	$588.61
Rate for Payer: Cash Price	$724.44
Rate for Payer: Cofinity Commercial	$778.77
Rate for Payer: Cofinity Commercial	$633.88
Rate for Payer: Healthscope Commercial	$815.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$769.72
Rate for Payer: PHP Commercial	$769.72
Rate for Payer: Priority Health Cigna Priority Health	$633.88
Rate for Payer: Priority Health SBD	$570.50

HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC

Facility

$1,690.61

Service Code	CPT 64479
Hospital Charge Code	36100286
Hospital Revenue Code	361
Min. Negotiated Rate	$1,065.08
Max. Negotiated Rate	$1,521.55
Rate for Payer: Aetna Commercial	$1,437.02
Rate for Payer: Aetna New Business (MI Preferred)	$1,098.90
Rate for Payer: Cash Price	$1,352.49
Rate for Payer: Cofinity Commercial	$1,183.43
Rate for Payer: Cofinity Commercial	$1,453.92
Rate for Payer: Healthscope Commercial	$1,521.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,437.02
Rate for Payer: PHP Commercial	$1,437.02
Rate for Payer: Priority Health Cigna Priority Health	$1,183.43
Rate for Payer: Priority Health SBD	$1,065.08

HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC

Facility

$1,690.61

Service Code	CPT 64479
Hospital Charge Code	36100286
Hospital Revenue Code	361
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$1,521.55
Rate for Payer: Aetna Commercial	$1,437.02
Rate for Payer: Aetna Medicare	$843.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,098.90
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	$510.77
Rate for Payer: BCN Medicare Advantage	$811.03
Rate for Payer: Cash Price	$1,352.49
Rate for Payer: Cash Price	$1,352.49
Rate for Payer: Cofinity Commercial	$1,183.43
Rate for Payer: Cofinity Commercial	$1,453.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$811.03
Rate for Payer: Healthscope Commercial	$1,521.55
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	$1,437.02
Rate for Payer: PACE Medicare	$770.48
Rate for Payer: PACE SWMI	$811.03
Rate for Payer: PHP Commercial	$1,437.02
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	$1,183.43
Rate for Payer: Priority Health Medicare	$811.03
Rate for Payer: Priority Health SBD	$1,065.08
Rate for Payer: Railroad Medicare Medicare	$811.03
Rate for Payer: UHC All Payor (Choice/PPO)	$140.11
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$811.03
Rate for Payer: UHC Exchange	$127.37
Rate for Payer: UHC Medicare Advantage	$835.36
Rate for Payer: VA VA	$811.03

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL

Facility

$2,535.91

Service Code	CPT 64479
Hospital Charge Code	36100623
Hospital Revenue Code	361
Min. Negotiated Rate	$1,597.62
Max. Negotiated Rate	$2,282.32
Rate for Payer: Aetna Commercial	$2,155.52
Rate for Payer: Aetna New Business (MI Preferred)	$1,648.34
Rate for Payer: Cash Price	$2,028.73
Rate for Payer: Cofinity Commercial	$1,775.14
Rate for Payer: Cofinity Commercial	$2,180.88
Rate for Payer: Healthscope Commercial	$2,282.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,155.52
Rate for Payer: PHP Commercial	$2,155.52
Rate for Payer: Priority Health Cigna Priority Health	$1,775.14
Rate for Payer: Priority Health SBD	$1,597.62

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL

Facility

$2,535.91

Service Code	CPT 64479
Hospital Charge Code	36100623
Hospital Revenue Code	361
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$2,282.32
Rate for Payer: Aetna Commercial	$2,155.52
Rate for Payer: Aetna Medicare	$843.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,648.34
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	$510.77
Rate for Payer: BCN Medicare Advantage	$811.03
Rate for Payer: Cash Price	$2,028.73
Rate for Payer: Cash Price	$2,028.73
Rate for Payer: Cofinity Commercial	$1,775.14
Rate for Payer: Cofinity Commercial	$2,180.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$811.03
Rate for Payer: Healthscope Commercial	$2,282.32
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	$2,155.52
Rate for Payer: PACE Medicare	$770.48
Rate for Payer: PACE SWMI	$811.03
Rate for Payer: PHP Commercial	$2,155.52
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	$1,775.14
Rate for Payer: Priority Health Medicare	$811.03
Rate for Payer: Priority Health SBD	$1,597.62
Rate for Payer: Railroad Medicare Medicare	$811.03
Rate for Payer: UHC All Payor (Choice/PPO)	$140.11
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$811.03
Rate for Payer: UHC Exchange	$127.37
Rate for Payer: UHC Medicare Advantage	$835.36
Rate for Payer: VA VA	$811.03

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD

Facility

$893.62

Service Code	CPT 64480
Hospital Charge Code	36100287
Hospital Revenue Code	361
Min. Negotiated Rate	$59.27
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$759.58
Rate for Payer: Aetna New Business (MI Preferred)	$580.85
Rate for Payer: BCBS Complete	$357.45
Rate for Payer: BCBS Trust/PPO	$224.62
Rate for Payer: Cash Price	$714.90
Rate for Payer: Cash Price	$714.90
Rate for Payer: Cofinity Commercial	$768.51
Rate for Payer: Cofinity Commercial	$625.53
Rate for Payer: Healthscope Commercial	$804.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$759.58
Rate for Payer: PHP Commercial	$759.58
Rate for Payer: Priority Health Cigna Priority Health	$625.53
Rate for Payer: Priority Health SBD	$562.98
Rate for Payer: UHC All Payor (Choice/PPO)	$65.20
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$59.27

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD

Facility

$893.62

Service Code	CPT 64480
Hospital Charge Code	36100287
Hospital Revenue Code	361
Min. Negotiated Rate	$562.98
Max. Negotiated Rate	$804.26
Rate for Payer: Aetna Commercial	$759.58
Rate for Payer: Aetna New Business (MI Preferred)	$580.85
Rate for Payer: Cash Price	$714.90
Rate for Payer: Cofinity Commercial	$625.53
Rate for Payer: Cofinity Commercial	$768.51
Rate for Payer: Healthscope Commercial	$804.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$759.58
Rate for Payer: PHP Commercial	$759.58
Rate for Payer: Priority Health Cigna Priority Health	$625.53
Rate for Payer: Priority Health SBD	$562.98

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL

Facility

$1,340.43

Service Code	CPT 64480
Hospital Charge Code	36100624
Hospital Revenue Code	361
Min. Negotiated Rate	$844.47
Max. Negotiated Rate	$1,206.39
Rate for Payer: Aetna Commercial	$1,139.37
Rate for Payer: Aetna New Business (MI Preferred)	$871.28
Rate for Payer: Cash Price	$1,072.34
Rate for Payer: Cofinity Commercial	$938.30
Rate for Payer: Cofinity Commercial	$1,152.77
Rate for Payer: Healthscope Commercial	$1,206.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,139.37
Rate for Payer: PHP Commercial	$1,139.37
Rate for Payer: Priority Health Cigna Priority Health	$938.30
Rate for Payer: Priority Health SBD	$844.47

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL

Facility

$1,340.43

Service Code	CPT 64480
Hospital Charge Code	36100624
Hospital Revenue Code	361
Min. Negotiated Rate	$59.27
Max. Negotiated Rate	$1,206.39
Rate for Payer: Aetna Commercial	$1,139.37
Rate for Payer: Aetna New Business (MI Preferred)	$871.28
Rate for Payer: BCBS Complete	$536.17
Rate for Payer: BCBS Trust/PPO	$224.62
Rate for Payer: Cash Price	$1,072.34
Rate for Payer: Cash Price	$1,072.34
Rate for Payer: Cofinity Commercial	$1,152.77
Rate for Payer: Cofinity Commercial	$938.30
Rate for Payer: Healthscope Commercial	$1,206.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,139.37
Rate for Payer: PHP Commercial	$1,139.37
Rate for Payer: Priority Health Cigna Priority Health	$938.30
Rate for Payer: Priority Health SBD	$844.47
Rate for Payer: UHC All Payor (Choice/PPO)	$65.20
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$59.27

HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL

Facility

$953.07

Service Code	CPT 64484
Hospital Charge Code	36100289
Hospital Revenue Code	361
Min. Negotiated Rate	$600.43
Max. Negotiated Rate	$857.76
Rate for Payer: Aetna Commercial	$810.11
Rate for Payer: Aetna New Business (MI Preferred)	$619.50
Rate for Payer: Cash Price	$762.46
Rate for Payer: Cofinity Commercial	$667.15
Rate for Payer: Cofinity Commercial	$819.64
Rate for Payer: Healthscope Commercial	$857.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$810.11
Rate for Payer: PHP Commercial	$810.11
Rate for Payer: Priority Health Cigna Priority Health	$667.15
Rate for Payer: Priority Health SBD	$600.43

HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL

Facility

$953.07

Service Code	CPT 64484
Hospital Charge Code	36100289
Hospital Revenue Code	361
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$810.11
Rate for Payer: Aetna New Business (MI Preferred)	$619.50
Rate for Payer: BCBS Complete	$381.23
Rate for Payer: BCBS Trust/PPO	$174.64
Rate for Payer: Cash Price	$762.46
Rate for Payer: Cash Price	$762.46
Rate for Payer: Cofinity Commercial	$667.15
Rate for Payer: Cofinity Commercial	$819.64
Rate for Payer: Healthscope Commercial	$857.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$810.11
Rate for Payer: PHP Commercial	$810.11
Rate for Payer: Priority Health Cigna Priority Health	$667.15
Rate for Payer: Priority Health SBD	$600.43
Rate for Payer: UHC All Payor (Choice/PPO)	$55.11
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$50.10

Know your out-of-pocket cost for care.

All Charges