Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJ ENZYME PALMAR FASCIAL CORD

Facility

$332.99

Service Code	CPT 20527
Hospital Charge Code	76100305
Hospital Revenue Code	761
Min. Negotiated Rate	$209.78
Max. Negotiated Rate	$299.69
Rate for Payer: Aetna Commercial	$283.04
Rate for Payer: Aetna New Business (MI Preferred)	$216.44
Rate for Payer: Cash Price	$266.39
Rate for Payer: Cofinity Commercial	$286.37
Rate for Payer: Cofinity Commercial	$233.09
Rate for Payer: Healthscope Commercial	$299.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$283.04
Rate for Payer: PHP Commercial	$283.04
Rate for Payer: Priority Health Cigna Priority Health	$233.09
Rate for Payer: Priority Health SBD	$209.78

HC INJ HEPARIN SODIUM PER 1000U

Facility

$1.02

Service Code	HCPCS J1644
Hospital Charge Code	63600140
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.87
Rate for Payer: Aetna New Business (MI Preferred)	$0.66
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Commercial	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Healthscope Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.87
Rate for Payer: PHP Commercial	$0.87
Rate for Payer: Priority Health Cigna Priority Health	$0.71
Rate for Payer: Priority Health SBD	$0.64

HC INJ HEPARIN SODIUM PER 1000U

Facility

$1.02

Service Code	HCPCS J1644
Hospital Charge Code	63600140
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.87
Rate for Payer: Aetna New Business (MI Preferred)	$0.66
Rate for Payer: BCBS Complete	$0.41
Rate for Payer: BCBS Trust/PPO	$0.78
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Commercial	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Healthscope Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.87
Rate for Payer: PHP Commercial	$0.87
Rate for Payer: Priority Health Cigna Priority Health	$0.71
Rate for Payer: Priority Health SBD	$0.64

HC INJ KNEE ARTHROGRAM CT/MRI

Facility

$542.10

Service Code	CPT 27369
Hospital Charge Code	36100562
Hospital Revenue Code	361
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$460.78
Rate for Payer: Aetna New Business (MI Preferred)	$352.36
Rate for Payer: BCBS Complete	$216.84
Rate for Payer: BCBS Trust/PPO	$295.44
Rate for Payer: Cash Price	$433.68
Rate for Payer: Cash Price	$433.68
Rate for Payer: Cofinity Commercial	$466.21
Rate for Payer: Cofinity Commercial	$379.47
Rate for Payer: Healthscope Commercial	$487.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$460.78
Rate for Payer: PHP Commercial	$460.78
Rate for Payer: Priority Health Cigna Priority Health	$379.47
Rate for Payer: Priority Health SBD	$341.52
Rate for Payer: UHC All Payor (Choice/PPO)	$42.87
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$38.97

HC INJ KNEE ARTHROGRAM CT/MRI

Facility

$542.10

Service Code	CPT 27369
Hospital Charge Code	36100562
Hospital Revenue Code	361
Min. Negotiated Rate	$341.52
Max. Negotiated Rate	$487.89
Rate for Payer: Aetna Commercial	$460.78
Rate for Payer: Aetna New Business (MI Preferred)	$352.36
Rate for Payer: Cash Price	$433.68
Rate for Payer: Cofinity Commercial	$379.47
Rate for Payer: Cofinity Commercial	$466.21
Rate for Payer: Healthscope Commercial	$487.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$460.78
Rate for Payer: PHP Commercial	$460.78
Rate for Payer: Priority Health Cigna Priority Health	$379.47
Rate for Payer: Priority Health SBD	$341.52

HC INJ LUMB W MYELO 2+REG SAME MD

Facility

$2,055.83

Service Code	CPT 62305
Hospital Charge Code	36100463
Hospital Revenue Code	361
Min. Negotiated Rate	$117.88
Max. Negotiated Rate	$2,221.16
Rate for Payer: Aetna Commercial	$1,747.46
Rate for Payer: Aetna Medicare	$740.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,336.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$890.55
Rate for Payer: Amish Plain Church Group Commercial	$890.55
Rate for Payer: BCBS Complete	$409.23
Rate for Payer: BCBS MAPPO	$712.44
Rate for Payer: BCBS Trust/PPO	$922.07
Rate for Payer: BCN Medicare Advantage	$712.44
Rate for Payer: Cash Price	$1,644.66
Rate for Payer: Cash Price	$1,644.66
Rate for Payer: Cofinity Commercial	$1,439.08
Rate for Payer: Cofinity Commercial	$1,768.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$712.44
Rate for Payer: Healthscope Commercial	$1,850.25
Rate for Payer: Mclaren Medicaid	$389.70
Rate for Payer: Mclaren Medicare	$712.44
Rate for Payer: Meridian Medicaid	$409.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$748.06
Rate for Payer: MI Amish Medical Board Commercial	$819.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,747.46
Rate for Payer: PACE Medicare	$676.82
Rate for Payer: PACE SWMI	$712.44
Rate for Payer: PHP Commercial	$1,747.46
Rate for Payer: PHP Medicare Advantage	$712.44
Rate for Payer: Priority Health Choice Medicaid	$389.70
Rate for Payer: Priority Health Cigna Priority Health	$1,439.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,221.16
Rate for Payer: Priority Health Medicare	$712.44
Rate for Payer: Priority Health Narrow Network	$1,776.93
Rate for Payer: Priority Health SBD	$1,295.17
Rate for Payer: Railroad Medicare Medicare	$712.44
Rate for Payer: UHC All Payor (Choice/PPO)	$129.67
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$712.44
Rate for Payer: UHC Exchange	$117.88
Rate for Payer: UHC Medicare Advantage	$733.81
Rate for Payer: VA VA	$712.44

HC INJ LUMB W MYELO 2+REG SAME MD

Facility

$2,055.83

Service Code	CPT 62305
Hospital Charge Code	36100463
Hospital Revenue Code	361
Min. Negotiated Rate	$1,295.17
Max. Negotiated Rate	$1,850.25
Rate for Payer: Aetna Commercial	$1,747.46
Rate for Payer: Aetna New Business (MI Preferred)	$1,336.29
Rate for Payer: Cash Price	$1,644.66
Rate for Payer: Cofinity Commercial	$1,439.08
Rate for Payer: Cofinity Commercial	$1,768.01
Rate for Payer: Healthscope Commercial	$1,850.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,747.46
Rate for Payer: PHP Commercial	$1,747.46
Rate for Payer: Priority Health Cigna Priority Health	$1,439.08
Rate for Payer: Priority Health SBD	$1,295.17

HC INJ LUMB W MYELO CERV SAME MD

Facility

$2,161.30

Service Code	CPT 62302
Hospital Charge Code	36100460
Hospital Revenue Code	361
Min. Negotiated Rate	$114.93
Max. Negotiated Rate	$2,221.16
Rate for Payer: Aetna Commercial	$1,837.10
Rate for Payer: Aetna Medicare	$740.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,404.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$890.55
Rate for Payer: Amish Plain Church Group Commercial	$890.55
Rate for Payer: BCBS Complete	$409.23
Rate for Payer: BCBS MAPPO	$712.44
Rate for Payer: BCBS Trust/PPO	$733.04
Rate for Payer: BCN Medicare Advantage	$712.44
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cofinity Commercial	$1,512.91
Rate for Payer: Cofinity Commercial	$1,858.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$712.44
Rate for Payer: Healthscope Commercial	$1,945.17
Rate for Payer: Mclaren Medicaid	$389.70
Rate for Payer: Mclaren Medicare	$712.44
Rate for Payer: Meridian Medicaid	$409.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$748.06
Rate for Payer: MI Amish Medical Board Commercial	$819.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,837.10
Rate for Payer: PACE Medicare	$676.82
Rate for Payer: PACE SWMI	$712.44
Rate for Payer: PHP Commercial	$1,837.10
Rate for Payer: PHP Medicare Advantage	$712.44
Rate for Payer: Priority Health Choice Medicaid	$389.70
Rate for Payer: Priority Health Cigna Priority Health	$1,512.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,221.16
Rate for Payer: Priority Health Medicare	$712.44
Rate for Payer: Priority Health Narrow Network	$1,776.93
Rate for Payer: Priority Health SBD	$1,361.62
Rate for Payer: Railroad Medicare Medicare	$712.44
Rate for Payer: UHC All Payor (Choice/PPO)	$126.42
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$712.44
Rate for Payer: UHC Exchange	$114.93
Rate for Payer: UHC Medicare Advantage	$733.81
Rate for Payer: VA VA	$712.44

HC INJ LUMB W MYELO CERV SAME MD

Facility

$2,161.30

Service Code	CPT 62302
Hospital Charge Code	36100460
Hospital Revenue Code	361
Min. Negotiated Rate	$1,361.62
Max. Negotiated Rate	$1,945.17
Rate for Payer: Aetna Commercial	$1,837.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,404.84
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cofinity Commercial	$1,512.91
Rate for Payer: Cofinity Commercial	$1,858.72
Rate for Payer: Healthscope Commercial	$1,945.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,837.10
Rate for Payer: PHP Commercial	$1,837.10
Rate for Payer: Priority Health Cigna Priority Health	$1,512.91
Rate for Payer: Priority Health SBD	$1,361.62

HC INJ LUMB W MYELO LS SAME MD

Facility

$2,161.30

Service Code	CPT 62304
Hospital Charge Code	36100462
Hospital Revenue Code	361
Min. Negotiated Rate	$113.62
Max. Negotiated Rate	$2,221.16
Rate for Payer: Aetna Commercial	$1,837.10
Rate for Payer: Aetna Medicare	$740.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,404.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$890.55
Rate for Payer: Amish Plain Church Group Commercial	$890.55
Rate for Payer: BCBS Complete	$409.23
Rate for Payer: BCBS MAPPO	$712.44
Rate for Payer: BCBS Trust/PPO	$750.06
Rate for Payer: BCN Medicare Advantage	$712.44
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cofinity Commercial	$1,512.91
Rate for Payer: Cofinity Commercial	$1,858.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$712.44
Rate for Payer: Healthscope Commercial	$1,945.17
Rate for Payer: Mclaren Medicaid	$389.70
Rate for Payer: Mclaren Medicare	$712.44
Rate for Payer: Meridian Medicaid	$409.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$748.06
Rate for Payer: MI Amish Medical Board Commercial	$819.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,837.10
Rate for Payer: PACE Medicare	$676.82
Rate for Payer: PACE SWMI	$712.44
Rate for Payer: PHP Commercial	$1,837.10
Rate for Payer: PHP Medicare Advantage	$712.44
Rate for Payer: Priority Health Choice Medicaid	$389.70
Rate for Payer: Priority Health Cigna Priority Health	$1,512.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,221.16
Rate for Payer: Priority Health Medicare	$712.44
Rate for Payer: Priority Health Narrow Network	$1,776.93
Rate for Payer: Priority Health SBD	$1,361.62
Rate for Payer: Railroad Medicare Medicare	$712.44
Rate for Payer: UHC All Payor (Choice/PPO)	$124.98
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$712.44
Rate for Payer: UHC Exchange	$113.62
Rate for Payer: UHC Medicare Advantage	$733.81
Rate for Payer: VA VA	$712.44

HC INJ LUMB W MYELO LS SAME MD

Facility

$2,161.30

Service Code	CPT 62304
Hospital Charge Code	36100462
Hospital Revenue Code	361
Min. Negotiated Rate	$1,361.62
Max. Negotiated Rate	$1,945.17
Rate for Payer: Aetna Commercial	$1,837.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,404.84
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cofinity Commercial	$1,512.91
Rate for Payer: Cofinity Commercial	$1,858.72
Rate for Payer: Healthscope Commercial	$1,945.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,837.10
Rate for Payer: PHP Commercial	$1,837.10
Rate for Payer: Priority Health Cigna Priority Health	$1,512.91
Rate for Payer: Priority Health SBD	$1,361.62

HC INJ LUMB W MYELO THOR SAME MD

Facility

$2,161.30

Service Code	CPT 62303
Hospital Charge Code	36100461
Hospital Revenue Code	361
Min. Negotiated Rate	$114.93
Max. Negotiated Rate	$2,221.16
Rate for Payer: Aetna Commercial	$1,837.10
Rate for Payer: Aetna Medicare	$740.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,404.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$890.55
Rate for Payer: Amish Plain Church Group Commercial	$890.55
Rate for Payer: BCBS Complete	$409.23
Rate for Payer: BCBS MAPPO	$712.44
Rate for Payer: BCBS Trust/PPO	$390.97
Rate for Payer: BCN Medicare Advantage	$712.44
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cofinity Commercial	$1,858.72
Rate for Payer: Cofinity Commercial	$1,512.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$712.44
Rate for Payer: Healthscope Commercial	$1,945.17
Rate for Payer: Mclaren Medicaid	$389.70
Rate for Payer: Mclaren Medicare	$712.44
Rate for Payer: Meridian Medicaid	$409.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$748.06
Rate for Payer: MI Amish Medical Board Commercial	$819.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,837.10
Rate for Payer: PACE Medicare	$676.82
Rate for Payer: PACE SWMI	$712.44
Rate for Payer: PHP Commercial	$1,837.10
Rate for Payer: PHP Medicare Advantage	$712.44
Rate for Payer: Priority Health Choice Medicaid	$389.70
Rate for Payer: Priority Health Cigna Priority Health	$1,512.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,221.16
Rate for Payer: Priority Health Medicare	$712.44
Rate for Payer: Priority Health Narrow Network	$1,776.93
Rate for Payer: Priority Health SBD	$1,361.62
Rate for Payer: Railroad Medicare Medicare	$712.44
Rate for Payer: UHC All Payor (Choice/PPO)	$126.42
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$712.44
Rate for Payer: UHC Exchange	$114.93
Rate for Payer: UHC Medicare Advantage	$733.81
Rate for Payer: VA VA	$712.44

HC INJ LUMB W MYELO THOR SAME MD

Facility

$2,161.30

Service Code	CPT 62303
Hospital Charge Code	36100461
Hospital Revenue Code	361
Min. Negotiated Rate	$1,361.62
Max. Negotiated Rate	$1,945.17
Rate for Payer: Aetna Commercial	$1,837.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,404.84
Rate for Payer: Cash Price	$1,729.04
Rate for Payer: Cofinity Commercial	$1,512.91
Rate for Payer: Cofinity Commercial	$1,858.72
Rate for Payer: Healthscope Commercial	$1,945.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,837.10
Rate for Payer: PHP Commercial	$1,837.10
Rate for Payer: Priority Health Cigna Priority Health	$1,512.91
Rate for Payer: Priority Health SBD	$1,361.62

HC INJ LYMPHANGIOGRAPHY

Facility

$1,279.58

Service Code	CPT 38790
Hospital Charge Code	36100445
Hospital Revenue Code	361
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$1,151.62
Rate for Payer: Aetna Commercial	$1,087.64
Rate for Payer: Aetna New Business (MI Preferred)	$831.73
Rate for Payer: BCBS Complete	$511.83
Rate for Payer: BCBS Trust/PPO	$169.00
Rate for Payer: Cash Price	$1,023.66
Rate for Payer: Cash Price	$1,023.66
Rate for Payer: Cofinity Commercial	$1,100.44
Rate for Payer: Cofinity Commercial	$895.71
Rate for Payer: Healthscope Commercial	$1,151.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,087.64
Rate for Payer: PHP Commercial	$1,087.64
Rate for Payer: Priority Health Cigna Priority Health	$895.71
Rate for Payer: Priority Health SBD	$806.14
Rate for Payer: UHC All Payor (Choice/PPO)	$87.89
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$79.90

HC INJ LYMPHANGIOGRAPHY

Facility

$1,279.58

Service Code	CPT 38790
Hospital Charge Code	36100445
Hospital Revenue Code	361
Min. Negotiated Rate	$806.14
Max. Negotiated Rate	$1,151.62
Rate for Payer: Aetna Commercial	$1,087.64
Rate for Payer: Aetna New Business (MI Preferred)	$831.73
Rate for Payer: Cash Price	$1,023.66
Rate for Payer: Cofinity Commercial	$1,100.44
Rate for Payer: Cofinity Commercial	$895.71
Rate for Payer: Healthscope Commercial	$1,151.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,087.64
Rate for Payer: PHP Commercial	$1,087.64
Rate for Payer: Priority Health Cigna Priority Health	$895.71
Rate for Payer: Priority Health SBD	$806.14

HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG

Facility

$25.50

Service Code	CPT J2930
Hospital Charge Code	63600102
Hospital Revenue Code	636
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$22.95
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Aetna New Business (MI Preferred)	$16.58
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$17.85
Rate for Payer: Cofinity Commercial	$21.93
Rate for Payer: Healthscope Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.68
Rate for Payer: PHP Commercial	$21.68
Rate for Payer: Priority Health Cigna Priority Health	$17.85
Rate for Payer: Priority Health SBD	$16.06

HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG

Facility

$25.50

Service Code	CPT J2930
Hospital Charge Code	63600102
Hospital Revenue Code	636
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$22.95
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Aetna New Business (MI Preferred)	$16.58
Rate for Payer: BCBS Complete	$10.20
Rate for Payer: BCBS Trust/PPO	$17.41
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$17.85
Rate for Payer: Cofinity Commercial	$21.93
Rate for Payer: Healthscope Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.68
Rate for Payer: PHP Commercial	$21.68
Rate for Payer: Priority Health Cigna Priority Health	$17.85
Rate for Payer: Priority Health SBD	$16.06

HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG

Facility

$20.40

Service Code	CPT J2920
Hospital Charge Code	63600101
Hospital Revenue Code	636
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: BCBS Complete	$8.16
Rate for Payer: BCBS Trust/PPO	$12.38
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$12.85

HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG

Facility

$20.40

Service Code	CPT J2920
Hospital Charge Code	63600101
Hospital Revenue Code	636
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$12.85

HC INJ NERV BLOCK GREAT OCCIPTL

Facility

$259.20

Service Code	CPT 64405
Hospital Charge Code	36100545
Hospital Revenue Code	761
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$329.42
Rate for Payer: Aetna Commercial	$220.32
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$168.48
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	$207.36
Rate for Payer: Cash Price	$207.36
Rate for Payer: Cofinity Commercial	$181.44
Rate for Payer: Cofinity Commercial	$222.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$233.28
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	$220.32
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$220.32
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	$181.44
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health SBD	$163.30
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$56.91
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$51.74
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

HC INJ NERV BLOCK GREAT OCCIPTL

Facility

$259.20

Service Code	CPT 64405
Hospital Charge Code	36100545
Hospital Revenue Code	761
Min. Negotiated Rate	$163.30
Max. Negotiated Rate	$233.28
Rate for Payer: Aetna Commercial	$220.32
Rate for Payer: Aetna New Business (MI Preferred)	$168.48
Rate for Payer: Cash Price	$207.36
Rate for Payer: Cofinity Commercial	$181.44
Rate for Payer: Cofinity Commercial	$222.91
Rate for Payer: Healthscope Commercial	$233.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$220.32
Rate for Payer: PHP Commercial	$220.32
Rate for Payer: Priority Health Cigna Priority Health	$181.44
Rate for Payer: Priority Health SBD	$163.30

HC INJ ONABOTULINUMTOXINA PER 1 UNIT

Facility

$8.00

Service Code	HCPCS J0585
Hospital Charge Code	63600114
Hospital Revenue Code	636
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna New Business (MI Preferred)	$5.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cofinity Commercial	$5.60
Rate for Payer: Cofinity Commercial	$6.88
Rate for Payer: Healthscope Commercial	$7.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.80
Rate for Payer: PHP Commercial	$6.80
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: Priority Health SBD	$5.04

HC INJ ONABOTULINUMTOXINA PER 1 UNIT

Facility

$8.00

Service Code	HCPCS J0585
Hospital Charge Code	63600114
Hospital Revenue Code	636
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$18.71
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare	$6.58
Rate for Payer: Aetna New Business (MI Preferred)	$5.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$7.91
Rate for Payer: Amish Plain Church Group Commercial	$7.91
Rate for Payer: BCBS Complete	$3.63
Rate for Payer: BCBS MAPPO	$6.33
Rate for Payer: BCBS Trust/PPO	$18.71
Rate for Payer: BCN Medicare Advantage	$6.33
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cofinity Commercial	$6.88
Rate for Payer: Cofinity Commercial	$5.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.33
Rate for Payer: Healthscope Commercial	$7.20
Rate for Payer: Mclaren Medicaid	$3.46
Rate for Payer: Mclaren Medicare	$6.33
Rate for Payer: Meridian Medicaid	$3.63
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6.64
Rate for Payer: MI Amish Medical Board Commercial	$7.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.80
Rate for Payer: PACE Medicare	$6.01
Rate for Payer: PACE SWMI	$6.33
Rate for Payer: PHP Commercial	$6.80
Rate for Payer: PHP Medicare Advantage	$6.33
Rate for Payer: Priority Health Choice Medicaid	$3.46
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: Priority Health Medicare	$6.33
Rate for Payer: Priority Health SBD	$5.04
Rate for Payer: Railroad Medicare Medicare	$6.33
Rate for Payer: UHC Dual Complete DSNP	$6.33
Rate for Payer: UHC Medicare Advantage	$6.52
Rate for Payer: VA VA	$6.33

HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS

Facility

$16.84

Service Code	HCPCS J0561
Hospital Charge Code	63600162
Hospital Revenue Code	636
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$64.33
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna Medicare	$22.60
Rate for Payer: Aetna New Business (MI Preferred)	$10.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$27.16
Rate for Payer: Amish Plain Church Group Commercial	$27.16
Rate for Payer: BCBS Complete	$12.48
Rate for Payer: BCBS MAPPO	$21.73
Rate for Payer: BCBS Trust/PPO	$64.33
Rate for Payer: BCN Medicare Advantage	$21.73
Rate for Payer: Cash Price	$13.47
Rate for Payer: Cash Price	$13.47
Rate for Payer: Cofinity Commercial	$14.48
Rate for Payer: Cofinity Commercial	$11.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.73
Rate for Payer: Healthscope Commercial	$15.16
Rate for Payer: Mclaren Medicaid	$11.89
Rate for Payer: Mclaren Medicare	$21.73
Rate for Payer: Meridian Medicaid	$12.48
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.82
Rate for Payer: MI Amish Medical Board Commercial	$24.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.31
Rate for Payer: PACE Medicare	$20.64
Rate for Payer: PACE SWMI	$21.73
Rate for Payer: PHP Commercial	$14.31
Rate for Payer: PHP Medicare Advantage	$21.73
Rate for Payer: Priority Health Choice Medicaid	$11.89
Rate for Payer: Priority Health Cigna Priority Health	$11.79
Rate for Payer: Priority Health Medicare	$21.73
Rate for Payer: Priority Health SBD	$10.61
Rate for Payer: Railroad Medicare Medicare	$21.73
Rate for Payer: UHC Dual Complete DSNP	$21.73
Rate for Payer: UHC Medicare Advantage	$22.38
Rate for Payer: VA VA	$21.73

HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS

Facility

$16.84

Service Code	HCPCS J0561
Hospital Charge Code	63600162
Hospital Revenue Code	636
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$15.16
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna New Business (MI Preferred)	$10.95
Rate for Payer: Cash Price	$13.47
Rate for Payer: Cofinity Commercial	$11.79
Rate for Payer: Cofinity Commercial	$14.48
Rate for Payer: Healthscope Commercial	$15.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.31
Rate for Payer: PHP Commercial	$14.31
Rate for Payer: Priority Health Cigna Priority Health	$11.79
Rate for Payer: Priority Health SBD	$10.61

Know your out-of-pocket cost for care.

All Charges