Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION FACET JOINT L OR S 2ND LEVEL

Facility

$420.05

Service Code	CPT 64494
Hospital Charge Code	36100294
Hospital Revenue Code	361
Min. Negotiated Rate	$168.02
Max. Negotiated Rate	$378.05
Rate for Payer: Aetna Commercial	$357.04
Rate for Payer: Aetna Medicare	$210.03
Rate for Payer: Aetna New Business (MI Preferred)	$273.03
Rate for Payer: BCBS Complete	$168.02
Rate for Payer: BCBS Trust/PPO	$226.62
Rate for Payer: BCN Commercial	$226.62
Rate for Payer: Cash Price	$336.04
Rate for Payer: Cash Price	$336.04
Rate for Payer: Cofinity Advantage	$294.04
Rate for Payer: Cofinity Commercial	$361.24
Rate for Payer: Encore Health Key Benefits Commercial	$336.04
Rate for Payer: Healthscope Commercial	$378.05
Rate for Payer: MI Amish Medical Board Commercial	$336.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.04
Rate for Payer: PHP Commercial	$357.04
Rate for Payer: Priority Health SBD	$264.63

HC INJECTION FACET JOINT L OR S 2ND LEVEL

Facility

$420.05

Service Code	CPT 64494
Hospital Charge Code	36100294
Hospital Revenue Code	361
Min. Negotiated Rate	$264.63
Max. Negotiated Rate	$378.05
Rate for Payer: Aetna Commercial	$357.04
Rate for Payer: Aetna New Business (MI Preferred)	$273.03
Rate for Payer: Cash Price	$336.04
Rate for Payer: Cofinity Advantage	$294.04
Rate for Payer: Cofinity Commercial	$361.24
Rate for Payer: Encore Health Key Benefits Commercial	$336.04
Rate for Payer: Healthscope Commercial	$378.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.04
Rate for Payer: PHP Commercial	$357.04
Rate for Payer: Priority Health SBD	$264.63

HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL

Facility

$630.06

Service Code	CPT 64494
Hospital Charge Code	36100630
Hospital Revenue Code	361
Min. Negotiated Rate	$226.62
Max. Negotiated Rate	$567.05
Rate for Payer: Aetna Commercial	$535.55
Rate for Payer: Aetna Medicare	$315.03
Rate for Payer: Aetna New Business (MI Preferred)	$409.54
Rate for Payer: BCBS Complete	$252.02
Rate for Payer: BCBS Trust/PPO	$226.62
Rate for Payer: BCN Commercial	$226.62
Rate for Payer: Cash Price	$504.05
Rate for Payer: Cash Price	$504.05
Rate for Payer: Cofinity Advantage	$441.04
Rate for Payer: Cofinity Commercial	$541.85
Rate for Payer: Encore Health Key Benefits Commercial	$504.05
Rate for Payer: Healthscope Commercial	$567.05
Rate for Payer: MI Amish Medical Board Commercial	$504.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$535.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.55
Rate for Payer: PHP Commercial	$535.55
Rate for Payer: Priority Health SBD	$396.94

HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL

Facility

$630.06

Service Code	CPT 64494
Hospital Charge Code	36100630
Hospital Revenue Code	361
Min. Negotiated Rate	$396.94
Max. Negotiated Rate	$567.05
Rate for Payer: Aetna Commercial	$535.55
Rate for Payer: Aetna New Business (MI Preferred)	$409.54
Rate for Payer: Cash Price	$504.05
Rate for Payer: Cofinity Advantage	$441.04
Rate for Payer: Cofinity Commercial	$541.85
Rate for Payer: Encore Health Key Benefits Commercial	$504.05
Rate for Payer: Healthscope Commercial	$567.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$535.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.55
Rate for Payer: PHP Commercial	$535.55
Rate for Payer: Priority Health SBD	$396.94

HC INJECTION FACET JOINT L OR S 3RD + LE

Facility

$420.05

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$168.02
Max. Negotiated Rate	$378.05
Rate for Payer: Aetna Commercial	$357.04
Rate for Payer: Aetna Medicare	$210.03
Rate for Payer: Aetna New Business (MI Preferred)	$273.03
Rate for Payer: BCBS Complete	$168.02
Rate for Payer: BCBS Trust/PPO	$227.55
Rate for Payer: BCN Commercial	$227.55
Rate for Payer: Cash Price	$336.04
Rate for Payer: Cash Price	$336.04
Rate for Payer: Cofinity Advantage	$294.04
Rate for Payer: Cofinity Commercial	$361.24
Rate for Payer: Encore Health Key Benefits Commercial	$336.04
Rate for Payer: Healthscope Commercial	$378.05
Rate for Payer: MI Amish Medical Board Commercial	$336.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.04
Rate for Payer: PHP Commercial	$357.04
Rate for Payer: Priority Health SBD	$264.63

HC INJECTION FACET JOINT L OR S 3RD + LE

Facility

$420.05

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$264.63
Max. Negotiated Rate	$378.05
Rate for Payer: Aetna Commercial	$357.04
Rate for Payer: Aetna New Business (MI Preferred)	$273.03
Rate for Payer: Cash Price	$336.04
Rate for Payer: Cofinity Advantage	$294.04
Rate for Payer: Cofinity Commercial	$361.24
Rate for Payer: Encore Health Key Benefits Commercial	$336.04
Rate for Payer: Healthscope Commercial	$378.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.04
Rate for Payer: PHP Commercial	$357.04
Rate for Payer: Priority Health SBD	$264.63

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

Facility

$630.06

Service Code	CPT 64495
Hospital Charge Code	36100631
Hospital Revenue Code	361
Min. Negotiated Rate	$396.94
Max. Negotiated Rate	$567.05
Rate for Payer: Aetna Commercial	$535.55
Rate for Payer: Aetna New Business (MI Preferred)	$409.54
Rate for Payer: Cash Price	$504.05
Rate for Payer: Cofinity Advantage	$441.04
Rate for Payer: Cofinity Commercial	$541.85
Rate for Payer: Encore Health Key Benefits Commercial	$504.05
Rate for Payer: Healthscope Commercial	$567.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$535.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.55
Rate for Payer: PHP Commercial	$535.55
Rate for Payer: Priority Health SBD	$396.94

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

Facility

$630.06

Service Code	CPT 64495
Hospital Charge Code	36100631
Hospital Revenue Code	361
Min. Negotiated Rate	$227.55
Max. Negotiated Rate	$567.05
Rate for Payer: Aetna Commercial	$535.55
Rate for Payer: Aetna Medicare	$315.03
Rate for Payer: Aetna New Business (MI Preferred)	$409.54
Rate for Payer: BCBS Complete	$252.02
Rate for Payer: BCBS Trust/PPO	$227.55
Rate for Payer: BCN Commercial	$227.55
Rate for Payer: Cash Price	$504.05
Rate for Payer: Cash Price	$504.05
Rate for Payer: Cofinity Advantage	$441.04
Rate for Payer: Cofinity Commercial	$541.85
Rate for Payer: Encore Health Key Benefits Commercial	$504.05
Rate for Payer: Healthscope Commercial	$567.05
Rate for Payer: MI Amish Medical Board Commercial	$504.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$535.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.55
Rate for Payer: PHP Commercial	$535.55
Rate for Payer: Priority Health SBD	$396.94

HC INJECTION FOR CEREBRAL SHUNT

Facility

$842.88

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$531.01
Max. Negotiated Rate	$758.59
Rate for Payer: Aetna Commercial	$716.45
Rate for Payer: Aetna New Business (MI Preferred)	$547.87
Rate for Payer: Cash Price	$674.30
Rate for Payer: Cofinity Advantage	$590.02
Rate for Payer: Cofinity Commercial	$724.88
Rate for Payer: Encore Health Key Benefits Commercial	$674.30
Rate for Payer: Healthscope Commercial	$758.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$632.16
Rate for Payer: PHP Commercial	$716.45
Rate for Payer: Priority Health SBD	$531.01

HC INJECTION FOR CEREBRAL SHUNT

Facility

$842.88

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$313.81
Max. Negotiated Rate	$2,274.56
Rate for Payer: Aetna Commercial	$716.45
Rate for Payer: Aetna Medicare	$731.47
Rate for Payer: Aetna New Business (MI Preferred)	$547.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$879.17
Rate for Payer: Amish Plain Church Group Commercial	$879.17
Rate for Payer: BCBS Complete	$386.27
Rate for Payer: BCBS MAPPO	$703.34
Rate for Payer: BCBS Trust/PPO	$313.81
Rate for Payer: BCN Commercial	$313.81
Rate for Payer: BCN Medicare Advantage	$703.34
Rate for Payer: Cash Price	$674.30
Rate for Payer: Cash Price	$674.30
Rate for Payer: Cash Price	$674.30
Rate for Payer: Cofinity Advantage	$590.02
Rate for Payer: Cofinity Commercial	$724.88
Rate for Payer: Encore Health Key Benefits Commercial	$674.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$703.34
Rate for Payer: Healthscope Commercial	$758.59
Rate for Payer: Mclaren Medicaid	$367.85
Rate for Payer: Mclaren Medicare	$703.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$738.51
Rate for Payer: Meridian Medicaid	$738.51
Rate for Payer: MI Amish Medical Board Commercial	$808.84
Rate for Payer: Molina Medicare/Medicaid	$773.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.45
Rate for Payer: Nomi Health Commercial	$2,110.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$632.16
Rate for Payer: PACE Medicare	$668.17
Rate for Payer: PACE SWMI	$703.34
Rate for Payer: PHP Commercial	$716.45
Rate for Payer: PHP Medicare Advantage	$703.34
Rate for Payer: Priority Health Choice Medicaid	$367.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2,274.56
Rate for Payer: Priority Health Medicare	$703.34
Rate for Payer: Priority Health SBD	$531.01
Rate for Payer: Priority Health Tiered Network	$1,819.65
Rate for Payer: Railroad Medicare Medicare	$703.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$703.34
Rate for Payer: UHC Medicaid	$367.85
Rate for Payer: UHCCP Medicaid	$367.85
Rate for Payer: VA VA	$703.34

HC INJECTION FOR HYSTEROSALPINGOGRAM

Facility

$669.62

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$421.86
Max. Negotiated Rate	$602.66
Rate for Payer: Aetna Commercial	$569.18
Rate for Payer: Aetna New Business (MI Preferred)	$435.25
Rate for Payer: Cash Price	$535.70
Rate for Payer: Cofinity Advantage	$468.73
Rate for Payer: Cofinity Commercial	$575.87
Rate for Payer: Encore Health Key Benefits Commercial	$535.70
Rate for Payer: Healthscope Commercial	$602.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$569.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$502.21
Rate for Payer: PHP Commercial	$569.18
Rate for Payer: Priority Health SBD	$421.86

HC INJECTION FOR HYSTEROSALPINGOGRAM

Facility

$669.62

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$227.78
Max. Negotiated Rate	$602.66
Rate for Payer: Aetna Commercial	$569.18
Rate for Payer: Aetna Medicare	$334.81
Rate for Payer: Aetna New Business (MI Preferred)	$435.25
Rate for Payer: BCBS Complete	$267.85
Rate for Payer: BCBS Trust/PPO	$227.78
Rate for Payer: BCN Commercial	$227.78
Rate for Payer: Cash Price	$535.70
Rate for Payer: Cash Price	$535.70
Rate for Payer: Cofinity Advantage	$468.73
Rate for Payer: Cofinity Commercial	$575.87
Rate for Payer: Encore Health Key Benefits Commercial	$535.70
Rate for Payer: Healthscope Commercial	$602.66
Rate for Payer: MI Amish Medical Board Commercial	$535.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$569.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$502.21
Rate for Payer: PHP Commercial	$569.18
Rate for Payer: Priority Health SBD	$421.86
Rate for Payer: UHC All Payor (Choice/PPO)	$435.25
Rate for Payer: UHC Core	$348.87
Rate for Payer: UHC Exchange	$263.16

HC INJECTION HIP ARTHROGRAM

Facility

$1,335.42

Service Code	CPT 27093
Hospital Charge Code	36100040
Hospital Revenue Code	361
Min. Negotiated Rate	$316.93
Max. Negotiated Rate	$1,201.88
Rate for Payer: Aetna Commercial	$1,135.11
Rate for Payer: Aetna Medicare	$667.71
Rate for Payer: Aetna New Business (MI Preferred)	$868.02
Rate for Payer: BCBS Complete	$534.17
Rate for Payer: BCBS Trust/PPO	$316.93
Rate for Payer: BCN Commercial	$316.93
Rate for Payer: Cash Price	$1,068.34
Rate for Payer: Cash Price	$1,068.34
Rate for Payer: Cofinity Advantage	$934.79
Rate for Payer: Cofinity Commercial	$1,148.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,068.34
Rate for Payer: Healthscope Commercial	$1,201.88
Rate for Payer: MI Amish Medical Board Commercial	$1,068.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,135.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,001.57
Rate for Payer: PHP Commercial	$1,135.11
Rate for Payer: Priority Health SBD	$841.31

HC INJECTION HIP ARTHROGRAM

Facility

$1,335.42

Service Code	CPT 27093
Hospital Charge Code	36100040
Hospital Revenue Code	361
Min. Negotiated Rate	$841.31
Max. Negotiated Rate	$1,201.88
Rate for Payer: Aetna Commercial	$1,135.11
Rate for Payer: Aetna New Business (MI Preferred)	$868.02
Rate for Payer: Cash Price	$1,068.34
Rate for Payer: Cofinity Advantage	$934.79
Rate for Payer: Cofinity Commercial	$1,148.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,068.34
Rate for Payer: Healthscope Commercial	$1,201.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,135.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,001.57
Rate for Payer: PHP Commercial	$1,135.11
Rate for Payer: Priority Health SBD	$841.31

HC INJECTION HIP ARTHROGRAM BIL

Facility

$1,238.30

Service Code	CPT 27093
Hospital Charge Code	36100041
Hospital Revenue Code	361
Min. Negotiated Rate	$316.93
Max. Negotiated Rate	$1,114.47
Rate for Payer: Aetna Commercial	$1,052.56
Rate for Payer: Aetna Medicare	$619.15
Rate for Payer: Aetna New Business (MI Preferred)	$804.89
Rate for Payer: BCBS Complete	$495.32
Rate for Payer: BCBS Trust/PPO	$316.93
Rate for Payer: BCN Commercial	$316.93
Rate for Payer: Cash Price	$990.64
Rate for Payer: Cash Price	$990.64
Rate for Payer: Cofinity Advantage	$866.81
Rate for Payer: Cofinity Commercial	$1,064.94
Rate for Payer: Encore Health Key Benefits Commercial	$990.64
Rate for Payer: Healthscope Commercial	$1,114.47
Rate for Payer: MI Amish Medical Board Commercial	$990.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,052.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$928.73
Rate for Payer: PHP Commercial	$1,052.56
Rate for Payer: Priority Health SBD	$780.13

HC INJECTION HIP ARTHROGRAM BIL

Facility

$1,238.30

Service Code	CPT 27093
Hospital Charge Code	36100041
Hospital Revenue Code	361
Min. Negotiated Rate	$780.13
Max. Negotiated Rate	$1,114.47
Rate for Payer: Aetna Commercial	$1,052.56
Rate for Payer: Aetna New Business (MI Preferred)	$804.89
Rate for Payer: Cash Price	$990.64
Rate for Payer: Cofinity Advantage	$866.81
Rate for Payer: Cofinity Commercial	$1,064.94
Rate for Payer: Encore Health Key Benefits Commercial	$990.64
Rate for Payer: Healthscope Commercial	$1,114.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,052.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$928.73
Rate for Payer: PHP Commercial	$1,052.56
Rate for Payer: Priority Health SBD	$780.13

HC INJECTION INTRALESIONAL UP TO 7 LESIONS

Facility

$150.05

Service Code	CPT 11900
Hospital Charge Code	76100134
Hospital Revenue Code	761
Min. Negotiated Rate	$94.53
Max. Negotiated Rate	$135.04
Rate for Payer: Aetna Commercial	$127.54
Rate for Payer: Aetna New Business (MI Preferred)	$97.53
Rate for Payer: Cash Price	$120.04
Rate for Payer: Cofinity Advantage	$105.03
Rate for Payer: Cofinity Commercial	$129.04
Rate for Payer: Encore Health Key Benefits Commercial	$120.04
Rate for Payer: Healthscope Commercial	$135.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.54
Rate for Payer: PHP Commercial	$127.54
Rate for Payer: Priority Health SBD	$94.53

HC INJECTION INTRALESIONAL UP TO 7 LESIONS

Facility

$150.05

Service Code	CPT 11900
Hospital Charge Code	76100134
Hospital Revenue Code	761
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$127.54
Rate for Payer: Aetna Medicare	$207.91
Rate for Payer: Aetna New Business (MI Preferred)	$97.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$249.89
Rate for Payer: Amish Plain Church Group Commercial	$249.89
Rate for Payer: BCBS Complete	$109.79
Rate for Payer: BCBS MAPPO	$199.91
Rate for Payer: BCBS Trust/PPO	$164.31
Rate for Payer: BCN Commercial	$164.31
Rate for Payer: BCN Medicare Advantage	$199.91
Rate for Payer: Cash Price	$120.04
Rate for Payer: Cash Price	$120.04
Rate for Payer: Cash Price	$120.04
Rate for Payer: Cofinity Advantage	$105.03
Rate for Payer: Cofinity Commercial	$129.04
Rate for Payer: Encore Health Key Benefits Commercial	$120.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$199.91
Rate for Payer: Healthscope Commercial	$135.04
Rate for Payer: Mclaren Medicaid	$104.55
Rate for Payer: Mclaren Medicare	$199.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$209.91
Rate for Payer: Meridian Medicaid	$209.91
Rate for Payer: MI Amish Medical Board Commercial	$229.90
Rate for Payer: Molina Medicare/Medicaid	$219.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.54
Rate for Payer: Nomi Health Commercial	$599.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.54
Rate for Payer: PACE Medicare	$189.91
Rate for Payer: PACE SWMI	$199.91
Rate for Payer: PHP Commercial	$127.54
Rate for Payer: PHP Medicare Advantage	$199.91
Rate for Payer: Priority Health Choice Medicaid	$104.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$646.50
Rate for Payer: Priority Health Medicare	$199.91
Rate for Payer: Priority Health SBD	$94.53
Rate for Payer: Priority Health Tiered Network	$517.20
Rate for Payer: Railroad Medicare Medicare	$199.91
Rate for Payer: UHC All Payor (Choice/PPO)	$97.53
Rate for Payer: UHC Core	$78.18
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$199.91
Rate for Payer: UHC Exchange	$58.97
Rate for Payer: UHC Medicaid	$104.55
Rate for Payer: UHCCP Medicaid	$104.55
Rate for Payer: VA VA	$199.91

HC INJECTION, IRON DEXTRAN, 50 MG

Facility

$63.67

Service Code	CPT J1750
Hospital Charge Code	63600097
Hospital Revenue Code	636
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$57.30
Rate for Payer: Aetna Commercial	$54.12
Rate for Payer: Aetna Medicare	$18.83
Rate for Payer: Aetna New Business (MI Preferred)	$41.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$22.64
Rate for Payer: Amish Plain Church Group Commercial	$22.64
Rate for Payer: BCBS Complete	$9.95
Rate for Payer: BCBS MAPPO	$18.11
Rate for Payer: BCBS Trust/PPO	$45.36
Rate for Payer: BCN Commercial	$45.36
Rate for Payer: BCN Medicare Advantage	$18.11
Rate for Payer: Cash Price	$50.94
Rate for Payer: Cash Price	$50.94
Rate for Payer: Cofinity Advantage	$44.57
Rate for Payer: Cofinity Commercial	$54.76
Rate for Payer: Encore Health Key Benefits Commercial	$50.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.11
Rate for Payer: Healthscope Commercial	$57.30
Rate for Payer: Mclaren Medicaid	$9.47
Rate for Payer: Mclaren Medicare	$18.11
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19.02
Rate for Payer: Meridian Medicaid	$19.02
Rate for Payer: MI Amish Medical Board Commercial	$20.83
Rate for Payer: Molina Medicare/Medicaid	$19.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.12
Rate for Payer: Nomi Health Commercial	$54.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.75
Rate for Payer: PACE Medicare	$17.20
Rate for Payer: PACE SWMI	$18.11
Rate for Payer: PHP Commercial	$54.12
Rate for Payer: PHP Medicare Advantage	$18.11
Rate for Payer: Priority Health Choice Medicaid	$9.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$57.12
Rate for Payer: Priority Health Medicare	$18.11
Rate for Payer: Priority Health SBD	$40.11
Rate for Payer: Priority Health Tiered Network	$45.70
Rate for Payer: Railroad Medicare Medicare	$18.11
Rate for Payer: UHC All Payor (Choice/PPO)	$29.83
Rate for Payer: UHC Core	$29.83
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18.11
Rate for Payer: UHC Exchange	$29.83
Rate for Payer: UHC Medicaid	$9.47
Rate for Payer: UHCCP Medicaid	$9.47
Rate for Payer: VA VA	$18.11

HC INJECTION, IRON DEXTRAN, 50 MG

Facility

$63.67

Service Code	CPT J1750
Hospital Charge Code	63600097
Hospital Revenue Code	636
Min. Negotiated Rate	$40.11
Max. Negotiated Rate	$57.30
Rate for Payer: Aetna Commercial	$54.12
Rate for Payer: Aetna New Business (MI Preferred)	$41.39
Rate for Payer: Cash Price	$50.94
Rate for Payer: Cofinity Advantage	$44.57
Rate for Payer: Cofinity Commercial	$54.76
Rate for Payer: Encore Health Key Benefits Commercial	$50.94
Rate for Payer: Healthscope Commercial	$57.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.75
Rate for Payer: PHP Commercial	$54.12
Rate for Payer: Priority Health SBD	$40.11

HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG

Facility

$21.23

Service Code	CPT J1885
Hospital Charge Code	63600098
Hospital Revenue Code	636
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$19.11
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna New Business (MI Preferred)	$13.80
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cofinity Advantage	$14.86
Rate for Payer: Cofinity Commercial	$18.26
Rate for Payer: Encore Health Key Benefits Commercial	$16.98
Rate for Payer: Healthscope Commercial	$19.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.92
Rate for Payer: PHP Commercial	$18.05
Rate for Payer: Priority Health SBD	$13.37

HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG

Facility

$21.23

Service Code	CPT J1885
Hospital Charge Code	63600098
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$19.11
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare	$0.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.41
Rate for Payer: Amish Plain Church Group Commercial	$0.41
Rate for Payer: BCBS Complete	$0.18
Rate for Payer: BCBS MAPPO	$0.33
Rate for Payer: BCBS Trust/PPO	$0.81
Rate for Payer: BCN Commercial	$0.81
Rate for Payer: BCN Medicare Advantage	$0.33
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cofinity Advantage	$14.86
Rate for Payer: Cofinity Commercial	$18.26
Rate for Payer: Encore Health Key Benefits Commercial	$16.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.33
Rate for Payer: Healthscope Commercial	$19.11
Rate for Payer: Mclaren Medicaid	$0.17
Rate for Payer: Mclaren Medicare	$0.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.35
Rate for Payer: Meridian Medicaid	$0.35
Rate for Payer: MI Amish Medical Board Commercial	$0.38
Rate for Payer: Molina Medicare/Medicaid	$0.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.05
Rate for Payer: Nomi Health Commercial	$0.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.92
Rate for Payer: PACE Medicare	$0.31
Rate for Payer: PACE SWMI	$0.33
Rate for Payer: PHP Commercial	$18.05
Rate for Payer: PHP Medicare Advantage	$0.33
Rate for Payer: Priority Health Choice Medicaid	$0.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$0.95
Rate for Payer: Priority Health Medicare	$0.33
Rate for Payer: Priority Health SBD	$13.37
Rate for Payer: Priority Health Tiered Network	$0.76
Rate for Payer: Railroad Medicare Medicare	$0.33
Rate for Payer: UHC All Payor (Choice/PPO)	$0.54
Rate for Payer: UHC Core	$0.54
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$0.33
Rate for Payer: UHC Exchange	$0.54
Rate for Payer: UHC Medicaid	$0.17
Rate for Payer: UHCCP Medicaid	$0.17
Rate for Payer: VA VA	$0.33

HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG

Facility

$46.70

Service Code	CPT J2010
Hospital Charge Code	63600099
Hospital Revenue Code	636
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$42.03
Rate for Payer: Aetna Commercial	$39.70
Rate for Payer: Aetna Medicare	$23.35
Rate for Payer: Aetna New Business (MI Preferred)	$30.36
Rate for Payer: BCBS Complete	$18.68
Rate for Payer: BCBS Trust/PPO	$13.54
Rate for Payer: BCN Commercial	$13.54
Rate for Payer: Cash Price	$37.36
Rate for Payer: Cash Price	$37.36
Rate for Payer: Cofinity Advantage	$32.69
Rate for Payer: Cofinity Commercial	$40.16
Rate for Payer: Encore Health Key Benefits Commercial	$37.36
Rate for Payer: Healthscope Commercial	$42.03
Rate for Payer: MI Amish Medical Board Commercial	$37.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.02
Rate for Payer: PHP Commercial	$39.70
Rate for Payer: Priority Health SBD	$29.42
Rate for Payer: UHC All Payor (Choice/PPO)	$8.91
Rate for Payer: UHC Core	$8.91
Rate for Payer: UHC Exchange	$8.91

HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG

Facility

$46.70

Service Code	CPT J2010
Hospital Charge Code	63600099
Hospital Revenue Code	636
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$42.03
Rate for Payer: Aetna Commercial	$39.70
Rate for Payer: Aetna New Business (MI Preferred)	$30.36
Rate for Payer: Cash Price	$37.36
Rate for Payer: Cofinity Advantage	$32.69
Rate for Payer: Cofinity Commercial	$40.16
Rate for Payer: Encore Health Key Benefits Commercial	$37.36
Rate for Payer: Healthscope Commercial	$42.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.02
Rate for Payer: PHP Commercial	$39.70
Rate for Payer: Priority Health SBD	$29.42

HC INJECTION LUMBAR DISKOGRAPHY

Facility

$2,396.52

Service Code	CPT 62290
Hospital Charge Code	36100282
Hospital Revenue Code	361
Min. Negotiated Rate	$1,509.81
Max. Negotiated Rate	$2,156.87
Rate for Payer: Aetna Commercial	$2,037.04
Rate for Payer: Aetna New Business (MI Preferred)	$1,557.74
Rate for Payer: Cash Price	$1,917.22
Rate for Payer: Cofinity Advantage	$1,677.56
Rate for Payer: Cofinity Commercial	$2,061.01
Rate for Payer: Encore Health Key Benefits Commercial	$1,917.22
Rate for Payer: Healthscope Commercial	$2,156.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,037.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,797.39
Rate for Payer: PHP Commercial	$2,037.04
Rate for Payer: Priority Health SBD	$1,509.81

Know your out-of-pocket cost for care.

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