Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION LUMBAR DISKOGRAPHY

Facility

$2,396.52

Service Code	CPT 62290
Hospital Charge Code	36100282
Hospital Revenue Code	361
Min. Negotiated Rate	$869.34
Max. Negotiated Rate	$2,156.87
Rate for Payer: Aetna Commercial	$2,037.04
Rate for Payer: Aetna Medicare	$1,198.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,557.74
Rate for Payer: BCBS Complete	$958.61
Rate for Payer: BCBS Trust/PPO	$869.34
Rate for Payer: BCN Commercial	$869.34
Rate for Payer: Cash Price	$1,917.22
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: MI Amish Medical Board Commercial	$1,917.22
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

HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG

Facility

$1.06

Service Code	CPT J1050
Hospital Charge Code	63600096
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna New Business (MI Preferred)	$0.69
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cofinity Advantage	$0.74
Rate for Payer: Cofinity Commercial	$0.91
Rate for Payer: Encore Health Key Benefits Commercial	$0.85
Rate for Payer: Healthscope Commercial	$0.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.80
Rate for Payer: PHP Commercial	$0.90
Rate for Payer: Priority Health SBD	$0.67

HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG

Facility

$1.06

Service Code	CPT J1050
Hospital Charge Code	63600096
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare	$0.53
Rate for Payer: Aetna New Business (MI Preferred)	$0.69
Rate for Payer: BCBS Complete	$0.42
Rate for Payer: BCBS Trust/PPO	$0.34
Rate for Payer: BCN Commercial	$0.34
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cofinity Advantage	$0.74
Rate for Payer: Cofinity Commercial	$0.91
Rate for Payer: Encore Health Key Benefits Commercial	$0.85
Rate for Payer: Healthscope Commercial	$0.95
Rate for Payer: MI Amish Medical Board Commercial	$0.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.80
Rate for Payer: PHP Commercial	$0.90
Rate for Payer: Priority Health SBD	$0.67
Rate for Payer: UHC All Payor (Choice/PPO)	$0.79
Rate for Payer: UHC Core	$0.79
Rate for Payer: UHC Exchange	$0.79

HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG

Facility

$10.61

Service Code	CPT J1020
Hospital Charge Code	63600093
Hospital Revenue Code	636
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$9.02
Rate for Payer: Aetna Medicare	$5.30
Rate for Payer: Aetna New Business (MI Preferred)	$6.90
Rate for Payer: BCBS Complete	$4.24
Rate for Payer: Cash Price	$8.49
Rate for Payer: Cofinity Advantage	$7.43
Rate for Payer: Cofinity Commercial	$9.12
Rate for Payer: Encore Health Key Benefits Commercial	$8.49
Rate for Payer: Healthscope Commercial	$9.55
Rate for Payer: MI Amish Medical Board Commercial	$8.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.96
Rate for Payer: PHP Commercial	$9.02
Rate for Payer: Priority Health SBD	$6.68
Rate for Payer: UHC All Payor (Choice/PPO)	$5.30
Rate for Payer: UHC Core	$5.30
Rate for Payer: UHC Exchange	$5.30

HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG

Facility

$10.61

Service Code	CPT J1020
Hospital Charge Code	63600093
Hospital Revenue Code	636
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$9.02
Rate for Payer: Aetna New Business (MI Preferred)	$6.90
Rate for Payer: Cash Price	$8.49
Rate for Payer: Cofinity Advantage	$7.43
Rate for Payer: Cofinity Commercial	$9.12
Rate for Payer: Encore Health Key Benefits Commercial	$8.49
Rate for Payer: Healthscope Commercial	$9.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.96
Rate for Payer: PHP Commercial	$9.02
Rate for Payer: Priority Health SBD	$6.68

HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG

Facility

$15.92

Service Code	CPT J1030
Hospital Charge Code	63600094
Hospital Revenue Code	636
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$14.33
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna New Business (MI Preferred)	$10.35
Rate for Payer: Cash Price	$12.74
Rate for Payer: Cofinity Advantage	$11.14
Rate for Payer: Cofinity Commercial	$13.69
Rate for Payer: Encore Health Key Benefits Commercial	$12.74
Rate for Payer: Healthscope Commercial	$14.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.94
Rate for Payer: PHP Commercial	$13.53
Rate for Payer: Priority Health SBD	$10.03

HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG

Facility

$15.92

Service Code	CPT J1030
Hospital Charge Code	63600094
Hospital Revenue Code	636
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$14.33
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare	$7.96
Rate for Payer: Aetna New Business (MI Preferred)	$10.35
Rate for Payer: BCBS Complete	$6.37
Rate for Payer: Cash Price	$12.74
Rate for Payer: Cofinity Advantage	$11.14
Rate for Payer: Cofinity Commercial	$13.69
Rate for Payer: Encore Health Key Benefits Commercial	$12.74
Rate for Payer: Healthscope Commercial	$14.33
Rate for Payer: MI Amish Medical Board Commercial	$12.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.94
Rate for Payer: PHP Commercial	$13.53
Rate for Payer: Priority Health SBD	$10.03
Rate for Payer: UHC All Payor (Choice/PPO)	$7.96
Rate for Payer: UHC Core	$7.96
Rate for Payer: UHC Exchange	$7.96

HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG

Facility

$26.53

Service Code	CPT J1040
Hospital Charge Code	63600095
Hospital Revenue Code	636
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$23.88
Rate for Payer: Aetna Commercial	$22.55
Rate for Payer: Aetna Medicare	$13.27
Rate for Payer: Aetna New Business (MI Preferred)	$17.24
Rate for Payer: BCBS Complete	$10.61
Rate for Payer: Cash Price	$21.22
Rate for Payer: Cofinity Advantage	$18.57
Rate for Payer: Cofinity Commercial	$22.82
Rate for Payer: Encore Health Key Benefits Commercial	$21.22
Rate for Payer: Healthscope Commercial	$23.88
Rate for Payer: MI Amish Medical Board Commercial	$21.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.90
Rate for Payer: PHP Commercial	$22.55
Rate for Payer: Priority Health SBD	$16.71
Rate for Payer: UHC All Payor (Choice/PPO)	$13.27
Rate for Payer: UHC Core	$13.27
Rate for Payer: UHC Exchange	$13.27

HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG

Facility

$26.53

Service Code	CPT J1040
Hospital Charge Code	63600095
Hospital Revenue Code	636
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$23.88
Rate for Payer: Aetna Commercial	$22.55
Rate for Payer: Aetna New Business (MI Preferred)	$17.24
Rate for Payer: Cash Price	$21.22
Rate for Payer: Cofinity Advantage	$18.57
Rate for Payer: Cofinity Commercial	$22.82
Rate for Payer: Encore Health Key Benefits Commercial	$21.22
Rate for Payer: Healthscope Commercial	$23.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.90
Rate for Payer: PHP Commercial	$22.55
Rate for Payer: Priority Health SBD	$16.71

HC INJECTION MYELOGRAM

Facility

$1,088.69

Service Code	CPT 62284
Hospital Charge Code	36100281
Hospital Revenue Code	361
Min. Negotiated Rate	$435.48
Max. Negotiated Rate	$979.82
Rate for Payer: Aetna Commercial	$925.39
Rate for Payer: Aetna Medicare	$544.35
Rate for Payer: Aetna New Business (MI Preferred)	$707.65
Rate for Payer: BCBS Complete	$435.48
Rate for Payer: BCBS Trust/PPO	$565.17
Rate for Payer: BCN Commercial	$565.17
Rate for Payer: Cash Price	$870.95
Rate for Payer: Cash Price	$870.95
Rate for Payer: Cofinity Advantage	$762.08
Rate for Payer: Cofinity Commercial	$936.27
Rate for Payer: Encore Health Key Benefits Commercial	$870.95
Rate for Payer: Healthscope Commercial	$979.82
Rate for Payer: MI Amish Medical Board Commercial	$870.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$925.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$816.52
Rate for Payer: PHP Commercial	$925.39
Rate for Payer: Priority Health SBD	$685.87

HC INJECTION MYELOGRAM

Facility

$1,088.69

Service Code	CPT 62284
Hospital Charge Code	36100281
Hospital Revenue Code	361
Min. Negotiated Rate	$685.87
Max. Negotiated Rate	$979.82
Rate for Payer: Aetna Commercial	$925.39
Rate for Payer: Aetna New Business (MI Preferred)	$707.65
Rate for Payer: Cash Price	$870.95
Rate for Payer: Cofinity Advantage	$762.08
Rate for Payer: Cofinity Commercial	$936.27
Rate for Payer: Encore Health Key Benefits Commercial	$870.95
Rate for Payer: Healthscope Commercial	$979.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$925.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$816.52
Rate for Payer: PHP Commercial	$925.39
Rate for Payer: Priority Health SBD	$685.87

HC INJECTION PLANTAR DIGIT

Facility

$358.69

Service Code	CPT 64455
Hospital Charge Code	76100263
Hospital Revenue Code	761
Min. Negotiated Rate	$140.97
Max. Negotiated Rate	$989.08
Rate for Payer: Aetna Commercial	$304.89
Rate for Payer: Aetna Medicare	$318.08
Rate for Payer: Aetna New Business (MI Preferred)	$233.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$382.31
Rate for Payer: Amish Plain Church Group Commercial	$382.31
Rate for Payer: BCBS Complete	$167.97
Rate for Payer: BCBS MAPPO	$305.85
Rate for Payer: BCBS Trust/PPO	$224.17
Rate for Payer: BCN Commercial	$224.17
Rate for Payer: BCN Medicare Advantage	$305.85
Rate for Payer: Cash Price	$286.95
Rate for Payer: Cash Price	$286.95
Rate for Payer: Cash Price	$286.95
Rate for Payer: Cofinity Advantage	$251.08
Rate for Payer: Cofinity Commercial	$308.47
Rate for Payer: Encore Health Key Benefits Commercial	$286.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.85
Rate for Payer: Healthscope Commercial	$322.82
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Mclaren Medicare	$305.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$321.14
Rate for Payer: Meridian Medicaid	$321.14
Rate for Payer: MI Amish Medical Board Commercial	$351.73
Rate for Payer: Molina Medicare/Medicaid	$336.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$304.89
Rate for Payer: Nomi Health Commercial	$917.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.02
Rate for Payer: PACE Medicare	$290.56
Rate for Payer: PACE SWMI	$305.85
Rate for Payer: PHP Commercial	$304.89
Rate for Payer: PHP Medicare Advantage	$305.85
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.08
Rate for Payer: Priority Health Medicare	$305.85
Rate for Payer: Priority Health SBD	$225.97
Rate for Payer: Priority Health Tiered Network	$791.26
Rate for Payer: Railroad Medicare Medicare	$305.85
Rate for Payer: UHC All Payor (Choice/PPO)	$233.15
Rate for Payer: UHC Core	$186.88
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$305.85
Rate for Payer: UHC Exchange	$140.97
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96
Rate for Payer: VA VA	$305.85

HC INJECTION PLANTAR DIGIT

Facility

$358.69

Service Code	CPT 64455
Hospital Charge Code	76100263
Hospital Revenue Code	761
Min. Negotiated Rate	$225.97
Max. Negotiated Rate	$322.82
Rate for Payer: Aetna Commercial	$304.89
Rate for Payer: Aetna New Business (MI Preferred)	$233.15
Rate for Payer: Cash Price	$286.95
Rate for Payer: Cofinity Advantage	$251.08
Rate for Payer: Cofinity Commercial	$308.47
Rate for Payer: Encore Health Key Benefits Commercial	$286.95
Rate for Payer: Healthscope Commercial	$322.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$304.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.02
Rate for Payer: PHP Commercial	$304.89
Rate for Payer: Priority Health SBD	$225.97

HC INJECTION PLANTAR DIGIT BILATERAL

Facility

$538.03

Service Code	CPT 64455
Hospital Charge Code	76100510
Hospital Revenue Code	761
Min. Negotiated Rate	$338.96
Max. Negotiated Rate	$484.23
Rate for Payer: Aetna Commercial	$457.33
Rate for Payer: Aetna New Business (MI Preferred)	$349.72
Rate for Payer: Cash Price	$430.42
Rate for Payer: Cofinity Advantage	$376.62
Rate for Payer: Cofinity Commercial	$462.71
Rate for Payer: Encore Health Key Benefits Commercial	$430.42
Rate for Payer: Healthscope Commercial	$484.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$403.52
Rate for Payer: PHP Commercial	$457.33
Rate for Payer: Priority Health SBD	$338.96

HC INJECTION PLANTAR DIGIT BILATERAL

Facility

$538.03

Service Code	CPT 64455
Hospital Charge Code	76100510
Hospital Revenue Code	761
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$989.08
Rate for Payer: Aetna Commercial	$457.33
Rate for Payer: Aetna Medicare	$318.08
Rate for Payer: Aetna New Business (MI Preferred)	$349.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$382.31
Rate for Payer: Amish Plain Church Group Commercial	$382.31
Rate for Payer: BCBS Complete	$167.97
Rate for Payer: BCBS MAPPO	$305.85
Rate for Payer: BCBS Trust/PPO	$224.17
Rate for Payer: BCN Commercial	$224.17
Rate for Payer: BCN Medicare Advantage	$305.85
Rate for Payer: Cash Price	$430.42
Rate for Payer: Cash Price	$430.42
Rate for Payer: Cash Price	$430.42
Rate for Payer: Cofinity Advantage	$376.62
Rate for Payer: Cofinity Commercial	$462.71
Rate for Payer: Encore Health Key Benefits Commercial	$430.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.85
Rate for Payer: Healthscope Commercial	$484.23
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Mclaren Medicare	$305.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$321.14
Rate for Payer: Meridian Medicaid	$321.14
Rate for Payer: MI Amish Medical Board Commercial	$351.73
Rate for Payer: Molina Medicare/Medicaid	$336.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.33
Rate for Payer: Nomi Health Commercial	$917.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$403.52
Rate for Payer: PACE Medicare	$290.56
Rate for Payer: PACE SWMI	$305.85
Rate for Payer: PHP Commercial	$457.33
Rate for Payer: PHP Medicare Advantage	$305.85
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.08
Rate for Payer: Priority Health Medicare	$305.85
Rate for Payer: Priority Health SBD	$338.96
Rate for Payer: Priority Health Tiered Network	$791.26
Rate for Payer: Railroad Medicare Medicare	$305.85
Rate for Payer: UHC All Payor (Choice/PPO)	$349.72
Rate for Payer: UHC Core	$280.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$305.85
Rate for Payer: UHC Exchange	$211.45
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96
Rate for Payer: VA VA	$305.85

HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP

Facility

$821.92

Service Code	CPT 0232T
Hospital Charge Code	76100473
Hospital Revenue Code	761
Min. Negotiated Rate	$232.80
Max. Negotiated Rate	$1,439.47
Rate for Payer: Aetna Commercial	$698.63
Rate for Payer: Aetna Medicare	$462.92
Rate for Payer: Aetna New Business (MI Preferred)	$534.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$556.40
Rate for Payer: Amish Plain Church Group Commercial	$556.40
Rate for Payer: BCBS Complete	$244.46
Rate for Payer: BCBS MAPPO	$445.12
Rate for Payer: BCN Medicare Advantage	$445.12
Rate for Payer: Cash Price	$657.54
Rate for Payer: Cash Price	$657.54
Rate for Payer: Cofinity Advantage	$575.34
Rate for Payer: Cofinity Commercial	$706.85
Rate for Payer: Encore Health Key Benefits Commercial	$657.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$445.12
Rate for Payer: Healthscope Commercial	$739.73
Rate for Payer: Mclaren Medicaid	$232.80
Rate for Payer: Mclaren Medicare	$445.12
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$467.38
Rate for Payer: Meridian Medicaid	$467.38
Rate for Payer: MI Amish Medical Board Commercial	$511.89
Rate for Payer: Molina Medicare/Medicaid	$489.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$698.63
Rate for Payer: Nomi Health Commercial	$1,335.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$616.44
Rate for Payer: PACE Medicare	$422.86
Rate for Payer: PACE SWMI	$445.12
Rate for Payer: PHP Commercial	$698.63
Rate for Payer: PHP Medicare Advantage	$445.12
Rate for Payer: Priority Health Choice Medicaid	$232.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,439.47
Rate for Payer: Priority Health Medicare	$445.12
Rate for Payer: Priority Health SBD	$517.81
Rate for Payer: Priority Health Tiered Network	$1,151.58
Rate for Payer: Railroad Medicare Medicare	$445.12
Rate for Payer: UHC All Payor (Choice/PPO)	$534.25
Rate for Payer: UHC Core	$428.22
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$445.12
Rate for Payer: UHC Exchange	$323.01
Rate for Payer: UHC Medicaid	$232.80
Rate for Payer: UHCCP Medicaid	$232.80
Rate for Payer: VA VA	$445.12

HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP

Facility

$821.92

Service Code	CPT 0232T
Hospital Charge Code	76100473
Hospital Revenue Code	761
Min. Negotiated Rate	$517.81
Max. Negotiated Rate	$739.73
Rate for Payer: Aetna Commercial	$698.63
Rate for Payer: Aetna New Business (MI Preferred)	$534.25
Rate for Payer: Cash Price	$657.54
Rate for Payer: Cofinity Advantage	$575.34
Rate for Payer: Cofinity Commercial	$706.85
Rate for Payer: Encore Health Key Benefits Commercial	$657.54
Rate for Payer: Healthscope Commercial	$739.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$698.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$616.44
Rate for Payer: PHP Commercial	$698.63
Rate for Payer: Priority Health SBD	$517.81

HC INJECTION PROC CYSTOGRAPHY VOIDING

Facility

$1,336.55

Service Code	CPT 51600
Hospital Charge Code	36100251
Hospital Revenue Code	361
Min. Negotiated Rate	$402.95
Max. Negotiated Rate	$1,202.89
Rate for Payer: Aetna Commercial	$1,136.07
Rate for Payer: Aetna Medicare	$668.27
Rate for Payer: Aetna New Business (MI Preferred)	$868.76
Rate for Payer: BCBS Complete	$534.62
Rate for Payer: BCBS Trust/PPO	$402.95
Rate for Payer: BCN Commercial	$402.95
Rate for Payer: Cash Price	$1,069.24
Rate for Payer: Cash Price	$1,069.24
Rate for Payer: Cofinity Advantage	$935.59
Rate for Payer: Cofinity Commercial	$1,149.43
Rate for Payer: Encore Health Key Benefits Commercial	$1,069.24
Rate for Payer: Healthscope Commercial	$1,202.89
Rate for Payer: MI Amish Medical Board Commercial	$1,069.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,136.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,002.41
Rate for Payer: PHP Commercial	$1,136.07
Rate for Payer: Priority Health SBD	$842.03

HC INJECTION PROC CYSTOGRAPHY VOIDING

Facility

$1,336.55

Service Code	CPT 51600
Hospital Charge Code	36100251
Hospital Revenue Code	361
Min. Negotiated Rate	$842.03
Max. Negotiated Rate	$1,202.89
Rate for Payer: Aetna Commercial	$1,136.07
Rate for Payer: Aetna New Business (MI Preferred)	$868.76
Rate for Payer: Cash Price	$1,069.24
Rate for Payer: Cofinity Advantage	$935.59
Rate for Payer: Cofinity Commercial	$1,149.43
Rate for Payer: Encore Health Key Benefits Commercial	$1,069.24
Rate for Payer: Healthscope Commercial	$1,202.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,136.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,002.41
Rate for Payer: PHP Commercial	$1,136.07
Rate for Payer: Priority Health SBD	$842.03

HC INJECTION PROCEDURE

Facility

$615.55

Hospital Charge Code	36000085
Hospital Revenue Code	360
Min. Negotiated Rate	$246.22
Max. Negotiated Rate	$554.00
Rate for Payer: Aetna Commercial	$523.22
Rate for Payer: Aetna Medicare	$307.77
Rate for Payer: Aetna New Business (MI Preferred)	$400.11
Rate for Payer: BCBS Complete	$246.22
Rate for Payer: Cash Price	$492.44
Rate for Payer: Cofinity Advantage	$430.88
Rate for Payer: Cofinity Commercial	$529.37
Rate for Payer: Encore Health Key Benefits Commercial	$492.44
Rate for Payer: Healthscope Commercial	$554.00
Rate for Payer: MI Amish Medical Board Commercial	$492.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$523.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$461.66
Rate for Payer: PHP Commercial	$523.22
Rate for Payer: Priority Health SBD	$387.80

HC INJECTION PROCEDURE

Facility

$615.55

Hospital Charge Code	36000085
Hospital Revenue Code	360
Min. Negotiated Rate	$387.80
Max. Negotiated Rate	$554.00
Rate for Payer: Aetna Commercial	$523.22
Rate for Payer: Aetna New Business (MI Preferred)	$400.11
Rate for Payer: Cash Price	$492.44
Rate for Payer: Cofinity Advantage	$430.88
Rate for Payer: Cofinity Commercial	$529.37
Rate for Payer: Encore Health Key Benefits Commercial	$492.44
Rate for Payer: Healthscope Commercial	$554.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$523.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$461.66
Rate for Payer: PHP Commercial	$523.22
Rate for Payer: Priority Health SBD	$387.80

HC INJECTION PROCEDURE ILEAL CONDUIT

Facility

$656.40

Service Code	CPT 50690
Hospital Charge Code	36100249
Hospital Revenue Code	361
Min. Negotiated Rate	$261.92
Max. Negotiated Rate	$590.76
Rate for Payer: Aetna Commercial	$557.94
Rate for Payer: Aetna Medicare	$328.20
Rate for Payer: Aetna New Business (MI Preferred)	$426.66
Rate for Payer: BCBS Complete	$262.56
Rate for Payer: BCBS Trust/PPO	$261.92
Rate for Payer: BCN Commercial	$261.92
Rate for Payer: Cash Price	$525.12
Rate for Payer: Cash Price	$525.12
Rate for Payer: Cofinity Advantage	$459.48
Rate for Payer: Cofinity Commercial	$564.50
Rate for Payer: Encore Health Key Benefits Commercial	$525.12
Rate for Payer: Healthscope Commercial	$590.76
Rate for Payer: MI Amish Medical Board Commercial	$525.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$557.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$492.30
Rate for Payer: PHP Commercial	$557.94
Rate for Payer: Priority Health SBD	$413.53

HC INJECTION PROCEDURE ILEAL CONDUIT

Facility

$656.40

Service Code	CPT 50690
Hospital Charge Code	36100249
Hospital Revenue Code	361
Min. Negotiated Rate	$413.53
Max. Negotiated Rate	$590.76
Rate for Payer: Aetna Commercial	$557.94
Rate for Payer: Aetna New Business (MI Preferred)	$426.66
Rate for Payer: Cash Price	$525.12
Rate for Payer: Cofinity Advantage	$459.48
Rate for Payer: Cofinity Commercial	$564.50
Rate for Payer: Encore Health Key Benefits Commercial	$525.12
Rate for Payer: Healthscope Commercial	$590.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$557.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$492.30
Rate for Payer: PHP Commercial	$557.94
Rate for Payer: Priority Health SBD	$413.53

HC INJECTION PROC RETROGRAD CYSTOGRAPHY

Facility

$874.10

Service Code	CPT 51610
Hospital Charge Code	36100252
Hospital Revenue Code	361
Min. Negotiated Rate	$349.64
Max. Negotiated Rate	$786.69
Rate for Payer: Aetna Commercial	$742.99
Rate for Payer: Aetna Medicare	$437.05
Rate for Payer: Aetna New Business (MI Preferred)	$568.16
Rate for Payer: BCBS Complete	$349.64
Rate for Payer: BCBS Trust/PPO	$364.92
Rate for Payer: BCN Commercial	$364.92
Rate for Payer: Cash Price	$699.28
Rate for Payer: Cash Price	$699.28
Rate for Payer: Cofinity Advantage	$611.87
Rate for Payer: Cofinity Commercial	$751.73
Rate for Payer: Encore Health Key Benefits Commercial	$699.28
Rate for Payer: Healthscope Commercial	$786.69
Rate for Payer: MI Amish Medical Board Commercial	$699.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$742.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$655.58
Rate for Payer: PHP Commercial	$742.99
Rate for Payer: Priority Health SBD	$550.68

HC INJECTION PROC RETROGRAD CYSTOGRAPHY

Facility

$874.10

Service Code	CPT 51610
Hospital Charge Code	36100252
Hospital Revenue Code	361
Min. Negotiated Rate	$550.68
Max. Negotiated Rate	$786.69
Rate for Payer: Aetna Commercial	$742.99
Rate for Payer: Aetna New Business (MI Preferred)	$568.16
Rate for Payer: Cash Price	$699.28
Rate for Payer: Cofinity Advantage	$611.87
Rate for Payer: Cofinity Commercial	$751.73
Rate for Payer: Encore Health Key Benefits Commercial	$699.28
Rate for Payer: Healthscope Commercial	$786.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$742.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$655.58
Rate for Payer: PHP Commercial	$742.99
Rate for Payer: Priority Health SBD	$550.68

Know your out-of-pocket cost for care.

All Charges