Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION FACET JOINT C OR T 2ND LEVEL

Facility

$340.34

Service Code	CPT 64491
Hospital Charge Code	36100291
Hospital Revenue Code	361
Min. Negotiated Rate	$214.41
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Commercial	$289.29
Rate for Payer: Aetna New Business (MI Preferred)	$221.22
Rate for Payer: Cash Price	$272.27
Rate for Payer: Cofinity Commercial	$238.24
Rate for Payer: Cofinity Commercial	$292.69
Rate for Payer: Cofinity Medicare Advantage	$238.24
Rate for Payer: Encore Health Key Benefits Commercial	$272.27
Rate for Payer: Healthscope Commercial	$306.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.29
Rate for Payer: PHP Commercial	$289.29
Rate for Payer: Priority Health Cigna Priority Health	$221.22
Rate for Payer: Priority Health SBD	$214.41

HC INJECTION FACET JOINT C OR T 2ND LEVEL

Facility

$340.34

Service Code	CPT 64491
Hospital Charge Code	36100291
Hospital Revenue Code	361
Min. Negotiated Rate	$136.14
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Commercial	$289.29
Rate for Payer: Aetna Medicare	$170.17
Rate for Payer: Aetna New Business (MI Preferred)	$221.22
Rate for Payer: BCBS Complete	$136.14
Rate for Payer: Cash Price	$272.27
Rate for Payer: Cofinity Commercial	$238.24
Rate for Payer: Cofinity Commercial	$292.69
Rate for Payer: Cofinity Medicare Advantage	$238.24
Rate for Payer: Encore Health Key Benefits Commercial	$272.27
Rate for Payer: Healthscope Commercial	$306.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.29
Rate for Payer: PHP Commercial	$289.29
Rate for Payer: Priority Health Cigna Priority Health	$221.22
Rate for Payer: Priority Health SBD	$214.41

HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL

Facility

$510.52

Service Code	CPT 64491
Hospital Charge Code	36100627
Hospital Revenue Code	361
Min. Negotiated Rate	$204.21
Max. Negotiated Rate	$459.47
Rate for Payer: Aetna Commercial	$433.94
Rate for Payer: Aetna Medicare	$255.26
Rate for Payer: Aetna New Business (MI Preferred)	$331.84
Rate for Payer: BCBS Complete	$204.21
Rate for Payer: Cash Price	$408.42
Rate for Payer: Cofinity Commercial	$357.36
Rate for Payer: Cofinity Commercial	$439.05
Rate for Payer: Cofinity Medicare Advantage	$357.36
Rate for Payer: Encore Health Key Benefits Commercial	$408.42
Rate for Payer: Healthscope Commercial	$459.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$433.94
Rate for Payer: PHP Commercial	$433.94
Rate for Payer: Priority Health Cigna Priority Health	$331.84
Rate for Payer: Priority Health SBD	$321.63

HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL

Facility

$510.52

Service Code	CPT 64491
Hospital Charge Code	36100627
Hospital Revenue Code	361
Min. Negotiated Rate	$321.63
Max. Negotiated Rate	$459.47
Rate for Payer: Aetna Commercial	$433.94
Rate for Payer: Aetna New Business (MI Preferred)	$331.84
Rate for Payer: Cash Price	$408.42
Rate for Payer: Cofinity Commercial	$357.36
Rate for Payer: Cofinity Commercial	$439.05
Rate for Payer: Cofinity Medicare Advantage	$357.36
Rate for Payer: Encore Health Key Benefits Commercial	$408.42
Rate for Payer: Healthscope Commercial	$459.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$433.94
Rate for Payer: PHP Commercial	$433.94
Rate for Payer: Priority Health Cigna Priority Health	$331.84
Rate for Payer: Priority Health SBD	$321.63

HC INJECTION FACET JOINT C OR T 3RD + LEVEL

Facility

$340.34

Service Code	CPT 64492
Hospital Charge Code	36100292
Hospital Revenue Code	361
Min. Negotiated Rate	$136.14
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Commercial	$289.29
Rate for Payer: Aetna Medicare	$170.17
Rate for Payer: Aetna New Business (MI Preferred)	$221.22
Rate for Payer: BCBS Complete	$136.14
Rate for Payer: Cash Price	$272.27
Rate for Payer: Cofinity Commercial	$238.24
Rate for Payer: Cofinity Commercial	$292.69
Rate for Payer: Cofinity Medicare Advantage	$238.24
Rate for Payer: Encore Health Key Benefits Commercial	$272.27
Rate for Payer: Healthscope Commercial	$306.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.29
Rate for Payer: PHP Commercial	$289.29
Rate for Payer: Priority Health Cigna Priority Health	$221.22
Rate for Payer: Priority Health SBD	$214.41

HC INJECTION FACET JOINT C OR T 3RD + LEVEL

Facility

$340.34

Service Code	CPT 64492
Hospital Charge Code	36100292
Hospital Revenue Code	361
Min. Negotiated Rate	$214.41
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Commercial	$289.29
Rate for Payer: Aetna New Business (MI Preferred)	$221.22
Rate for Payer: Cash Price	$272.27
Rate for Payer: Cofinity Commercial	$238.24
Rate for Payer: Cofinity Commercial	$292.69
Rate for Payer: Cofinity Medicare Advantage	$238.24
Rate for Payer: Encore Health Key Benefits Commercial	$272.27
Rate for Payer: Healthscope Commercial	$306.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.29
Rate for Payer: PHP Commercial	$289.29
Rate for Payer: Priority Health Cigna Priority Health	$221.22
Rate for Payer: Priority Health SBD	$214.41

HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL

Facility

$510.52

Service Code	CPT 64492
Hospital Charge Code	36100628
Hospital Revenue Code	361
Min. Negotiated Rate	$204.21
Max. Negotiated Rate	$459.47
Rate for Payer: Aetna Commercial	$433.94
Rate for Payer: Aetna Medicare	$255.26
Rate for Payer: Aetna New Business (MI Preferred)	$331.84
Rate for Payer: BCBS Complete	$204.21
Rate for Payer: Cash Price	$408.42
Rate for Payer: Cofinity Commercial	$357.36
Rate for Payer: Cofinity Commercial	$439.05
Rate for Payer: Cofinity Medicare Advantage	$357.36
Rate for Payer: Encore Health Key Benefits Commercial	$408.42
Rate for Payer: Healthscope Commercial	$459.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$433.94
Rate for Payer: PHP Commercial	$433.94
Rate for Payer: Priority Health Cigna Priority Health	$331.84
Rate for Payer: Priority Health SBD	$321.63

HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL

Facility

$510.52

Service Code	CPT 64492
Hospital Charge Code	36100628
Hospital Revenue Code	361
Min. Negotiated Rate	$321.63
Max. Negotiated Rate	$459.47
Rate for Payer: Aetna Commercial	$433.94
Rate for Payer: Aetna New Business (MI Preferred)	$331.84
Rate for Payer: Cash Price	$408.42
Rate for Payer: Cofinity Commercial	$357.36
Rate for Payer: Cofinity Commercial	$439.05
Rate for Payer: Cofinity Medicare Advantage	$357.36
Rate for Payer: Encore Health Key Benefits Commercial	$408.42
Rate for Payer: Healthscope Commercial	$459.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$433.94
Rate for Payer: PHP Commercial	$433.94
Rate for Payer: Priority Health Cigna Priority Health	$331.84
Rate for Payer: Priority Health SBD	$321.63

HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL

Facility

$2,476.33

Service Code	CPT 64493
Hospital Charge Code	36100629
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$2,104.88
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$1,609.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,085.35
Rate for Payer: Amish Plain Church Group Commercial	$1,085.35
Rate for Payer: BCBS Complete	$488.67
Rate for Payer: BCBS MAPPO	$868.28
Rate for Payer: BCN Medicare Advantage	$868.28
Rate for Payer: Cash Price	$1,981.06
Rate for Payer: Cash Price	$1,981.06
Rate for Payer: Cofinity Commercial	$2,129.64
Rate for Payer: Cofinity Commercial	$1,733.43
Rate for Payer: Cofinity Medicare Advantage	$1,733.43
Rate for Payer: Encore Health Key Benefits Commercial	$1,981.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$2,228.70
Rate for Payer: Mclaren Medicaid	$465.40
Rate for Payer: Mclaren Medicare	$868.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$911.69
Rate for Payer: Meridian Medicaid	$488.67
Rate for Payer: MI Amish Medical Board Commercial	$998.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,104.88
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$2,104.88
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Cigna Priority Health	$1,609.61
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$1,560.09
Rate for Payer: Railroad Medicare Medicare	$868.28
Rate for Payer: UHC All Payor (Choice/PPO)	$2,444.12
Rate for Payer: UHC Dual Complete DSNP	$868.28
Rate for Payer: UHC Medicare Advantage	$868.28
Rate for Payer: UHCCP Medicaid	$488.84
Rate for Payer: VA VA	$868.28

HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL

Facility

$2,476.33

Service Code	CPT 64493
Hospital Charge Code	36100629
Hospital Revenue Code	361
Min. Negotiated Rate	$1,560.09
Max. Negotiated Rate	$2,228.70
Rate for Payer: Aetna Commercial	$2,104.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,609.61
Rate for Payer: Cash Price	$1,981.06
Rate for Payer: Cofinity Commercial	$1,733.43
Rate for Payer: Cofinity Commercial	$2,129.64
Rate for Payer: Cofinity Medicare Advantage	$1,733.43
Rate for Payer: Encore Health Key Benefits Commercial	$1,981.06
Rate for Payer: Healthscope Commercial	$2,228.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,104.88
Rate for Payer: PHP Commercial	$2,104.88
Rate for Payer: Priority Health Cigna Priority Health	$1,609.61
Rate for Payer: Priority Health SBD	$1,560.09

HC INJECTION FACET JOINT L OR S 2ND LEVEL

Facility

$411.81

Service Code	CPT 64494
Hospital Charge Code	36100294
Hospital Revenue Code	361
Min. Negotiated Rate	$164.72
Max. Negotiated Rate	$370.63
Rate for Payer: Aetna Commercial	$350.04
Rate for Payer: Aetna Medicare	$205.91
Rate for Payer: Aetna New Business (MI Preferred)	$267.68
Rate for Payer: BCBS Complete	$164.72
Rate for Payer: Cash Price	$329.45
Rate for Payer: Cofinity Commercial	$288.27
Rate for Payer: Cofinity Commercial	$354.16
Rate for Payer: Cofinity Medicare Advantage	$288.27
Rate for Payer: Encore Health Key Benefits Commercial	$329.45
Rate for Payer: Healthscope Commercial	$370.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.04
Rate for Payer: PHP Commercial	$350.04
Rate for Payer: Priority Health Cigna Priority Health	$267.68
Rate for Payer: Priority Health SBD	$259.44

HC INJECTION FACET JOINT L OR S 2ND LEVEL

Facility

$411.81

Service Code	CPT 64494
Hospital Charge Code	36100294
Hospital Revenue Code	361
Min. Negotiated Rate	$259.44
Max. Negotiated Rate	$370.63
Rate for Payer: Aetna Commercial	$350.04
Rate for Payer: Aetna New Business (MI Preferred)	$267.68
Rate for Payer: Cash Price	$329.45
Rate for Payer: Cofinity Commercial	$288.27
Rate for Payer: Cofinity Commercial	$354.16
Rate for Payer: Cofinity Medicare Advantage	$288.27
Rate for Payer: Encore Health Key Benefits Commercial	$329.45
Rate for Payer: Healthscope Commercial	$370.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.04
Rate for Payer: PHP Commercial	$350.04
Rate for Payer: Priority Health Cigna Priority Health	$267.68
Rate for Payer: Priority Health SBD	$259.44

HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL

Facility

$617.71

Service Code	CPT 64494
Hospital Charge Code	36100630
Hospital Revenue Code	361
Min. Negotiated Rate	$389.16
Max. Negotiated Rate	$555.94
Rate for Payer: Aetna Commercial	$525.05
Rate for Payer: Aetna New Business (MI Preferred)	$401.51
Rate for Payer: Cash Price	$494.17
Rate for Payer: Cofinity Commercial	$432.40
Rate for Payer: Cofinity Commercial	$531.23
Rate for Payer: Cofinity Medicare Advantage	$432.40
Rate for Payer: Encore Health Key Benefits Commercial	$494.17
Rate for Payer: Healthscope Commercial	$555.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$525.05
Rate for Payer: PHP Commercial	$525.05
Rate for Payer: Priority Health Cigna Priority Health	$401.51
Rate for Payer: Priority Health SBD	$389.16

HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL

Facility

$617.71

Service Code	CPT 64494
Hospital Charge Code	36100630
Hospital Revenue Code	361
Min. Negotiated Rate	$247.08
Max. Negotiated Rate	$555.94
Rate for Payer: Aetna Commercial	$525.05
Rate for Payer: Aetna Medicare	$308.86
Rate for Payer: Aetna New Business (MI Preferred)	$401.51
Rate for Payer: BCBS Complete	$247.08
Rate for Payer: Cash Price	$494.17
Rate for Payer: Cofinity Commercial	$432.40
Rate for Payer: Cofinity Commercial	$531.23
Rate for Payer: Cofinity Medicare Advantage	$432.40
Rate for Payer: Encore Health Key Benefits Commercial	$494.17
Rate for Payer: Healthscope Commercial	$555.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$525.05
Rate for Payer: PHP Commercial	$525.05
Rate for Payer: Priority Health Cigna Priority Health	$401.51
Rate for Payer: Priority Health SBD	$389.16

HC INJECTION FACET JOINT L OR S 3RD + LE

Facility

$411.81

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$164.72
Max. Negotiated Rate	$370.63
Rate for Payer: Aetna Commercial	$350.04
Rate for Payer: Aetna Medicare	$205.91
Rate for Payer: Aetna New Business (MI Preferred)	$267.68
Rate for Payer: BCBS Complete	$164.72
Rate for Payer: Cash Price	$329.45
Rate for Payer: Cofinity Commercial	$288.27
Rate for Payer: Cofinity Commercial	$354.16
Rate for Payer: Cofinity Medicare Advantage	$288.27
Rate for Payer: Encore Health Key Benefits Commercial	$329.45
Rate for Payer: Healthscope Commercial	$370.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.04
Rate for Payer: PHP Commercial	$350.04
Rate for Payer: Priority Health Cigna Priority Health	$267.68
Rate for Payer: Priority Health SBD	$259.44

HC INJECTION FACET JOINT L OR S 3RD + LE

Facility

$411.81

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$259.44
Max. Negotiated Rate	$370.63
Rate for Payer: Aetna Commercial	$350.04
Rate for Payer: Aetna New Business (MI Preferred)	$267.68
Rate for Payer: Cash Price	$329.45
Rate for Payer: Cofinity Commercial	$288.27
Rate for Payer: Cofinity Commercial	$354.16
Rate for Payer: Cofinity Medicare Advantage	$288.27
Rate for Payer: Encore Health Key Benefits Commercial	$329.45
Rate for Payer: Healthscope Commercial	$370.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.04
Rate for Payer: PHP Commercial	$350.04
Rate for Payer: Priority Health Cigna Priority Health	$267.68
Rate for Payer: Priority Health SBD	$259.44

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

Facility

$617.71

Service Code	CPT 64495
Hospital Charge Code	36100631
Hospital Revenue Code	361
Min. Negotiated Rate	$389.16
Max. Negotiated Rate	$555.94
Rate for Payer: Aetna Commercial	$525.05
Rate for Payer: Aetna New Business (MI Preferred)	$401.51
Rate for Payer: Cash Price	$494.17
Rate for Payer: Cofinity Commercial	$432.40
Rate for Payer: Cofinity Commercial	$531.23
Rate for Payer: Cofinity Medicare Advantage	$432.40
Rate for Payer: Encore Health Key Benefits Commercial	$494.17
Rate for Payer: Healthscope Commercial	$555.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$525.05
Rate for Payer: PHP Commercial	$525.05
Rate for Payer: Priority Health Cigna Priority Health	$401.51
Rate for Payer: Priority Health SBD	$389.16

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

Facility

$617.71

Service Code	CPT 64495
Hospital Charge Code	36100631
Hospital Revenue Code	361
Min. Negotiated Rate	$247.08
Max. Negotiated Rate	$555.94
Rate for Payer: Aetna Commercial	$525.05
Rate for Payer: Aetna Medicare	$308.86
Rate for Payer: Aetna New Business (MI Preferred)	$401.51
Rate for Payer: BCBS Complete	$247.08
Rate for Payer: Cash Price	$494.17
Rate for Payer: Cofinity Commercial	$432.40
Rate for Payer: Cofinity Commercial	$531.23
Rate for Payer: Cofinity Medicare Advantage	$432.40
Rate for Payer: Encore Health Key Benefits Commercial	$494.17
Rate for Payer: Healthscope Commercial	$555.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$525.05
Rate for Payer: PHP Commercial	$525.05
Rate for Payer: Priority Health Cigna Priority Health	$401.51
Rate for Payer: Priority Health SBD	$389.16

HC INJECTION FOR CEREBRAL SHUNT

Facility

$826.35

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Commercial	$702.40
Rate for Payer: Aetna Medicare	$702.42
Rate for Payer: Aetna New Business (MI Preferred)	$537.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$844.25
Rate for Payer: Amish Plain Church Group Commercial	$844.25
Rate for Payer: BCBS Complete	$380.12
Rate for Payer: BCBS MAPPO	$675.40
Rate for Payer: BCN Medicare Advantage	$675.40
Rate for Payer: Cash Price	$661.08
Rate for Payer: Cash Price	$661.08
Rate for Payer: Cofinity Commercial	$710.66
Rate for Payer: Cofinity Commercial	$578.45
Rate for Payer: Cofinity Medicare Advantage	$578.45
Rate for Payer: Encore Health Key Benefits Commercial	$661.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$675.40
Rate for Payer: Healthscope Commercial	$743.72
Rate for Payer: Mclaren Medicaid	$362.01
Rate for Payer: Mclaren Medicare	$675.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$709.17
Rate for Payer: Meridian Medicaid	$380.12
Rate for Payer: MI Amish Medical Board Commercial	$776.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$702.40
Rate for Payer: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Commercial	$702.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Cigna Priority Health	$537.13
Rate for Payer: Priority Health Medicare	$675.40
Rate for Payer: Priority Health SBD	$520.60
Rate for Payer: Railroad Medicare Medicare	$675.40
Rate for Payer: UHC All Payor (Choice/PPO)	$1,901.18
Rate for Payer: UHC Dual Complete DSNP	$675.40
Rate for Payer: UHC Medicare Advantage	$675.40
Rate for Payer: UHCCP Medicaid	$380.25
Rate for Payer: VA VA	$675.40

HC INJECTION FOR CEREBRAL SHUNT

Facility

$826.35

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$520.60
Max. Negotiated Rate	$743.72
Rate for Payer: Aetna Commercial	$702.40
Rate for Payer: Aetna New Business (MI Preferred)	$537.13
Rate for Payer: Cash Price	$661.08
Rate for Payer: Cofinity Commercial	$578.45
Rate for Payer: Cofinity Commercial	$710.66
Rate for Payer: Cofinity Medicare Advantage	$578.45
Rate for Payer: Encore Health Key Benefits Commercial	$661.08
Rate for Payer: Healthscope Commercial	$743.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$702.40
Rate for Payer: PHP Commercial	$702.40
Rate for Payer: Priority Health Cigna Priority Health	$537.13
Rate for Payer: Priority Health SBD	$520.60

HC INJECTION FOR HYSTEROSALPINGOGRAM

Facility

$656.49

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$262.60
Max. Negotiated Rate	$590.84
Rate for Payer: Aetna Commercial	$558.02
Rate for Payer: Aetna Medicare	$328.25
Rate for Payer: Aetna New Business (MI Preferred)	$426.72
Rate for Payer: BCBS Complete	$262.60
Rate for Payer: Cash Price	$525.19
Rate for Payer: Cofinity Commercial	$459.54
Rate for Payer: Cofinity Commercial	$564.58
Rate for Payer: Cofinity Medicare Advantage	$459.54
Rate for Payer: Encore Health Key Benefits Commercial	$525.19
Rate for Payer: Healthscope Commercial	$590.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$558.02
Rate for Payer: PHP Commercial	$558.02
Rate for Payer: Priority Health Cigna Priority Health	$426.72
Rate for Payer: Priority Health SBD	$413.59

HC INJECTION FOR HYSTEROSALPINGOGRAM

Facility

$656.49

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$413.59
Max. Negotiated Rate	$590.84
Rate for Payer: Aetna Commercial	$558.02
Rate for Payer: Aetna New Business (MI Preferred)	$426.72
Rate for Payer: Cash Price	$525.19
Rate for Payer: Cofinity Commercial	$459.54
Rate for Payer: Cofinity Commercial	$564.58
Rate for Payer: Cofinity Medicare Advantage	$459.54
Rate for Payer: Encore Health Key Benefits Commercial	$525.19
Rate for Payer: Healthscope Commercial	$590.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$558.02
Rate for Payer: PHP Commercial	$558.02
Rate for Payer: Priority Health Cigna Priority Health	$426.72
Rate for Payer: Priority Health SBD	$413.59

HC INJECTION HIP ARTHROGRAM

Facility

$1,309.24

Service Code	CPT 27093
Hospital Charge Code	36100040
Hospital Revenue Code	361
Min. Negotiated Rate	$824.82
Max. Negotiated Rate	$1,178.32
Rate for Payer: Aetna Commercial	$1,112.85
Rate for Payer: Aetna New Business (MI Preferred)	$851.01
Rate for Payer: Cash Price	$1,047.39
Rate for Payer: Cofinity Commercial	$1,125.95
Rate for Payer: Cofinity Commercial	$916.47
Rate for Payer: Cofinity Medicare Advantage	$916.47
Rate for Payer: Encore Health Key Benefits Commercial	$1,047.39
Rate for Payer: Healthscope Commercial	$1,178.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,112.85
Rate for Payer: PHP Commercial	$1,112.85
Rate for Payer: Priority Health Cigna Priority Health	$851.01
Rate for Payer: Priority Health SBD	$824.82

HC INJECTION HIP ARTHROGRAM

Facility

$1,309.24

Service Code	CPT 27093
Hospital Charge Code	36100040
Hospital Revenue Code	361
Min. Negotiated Rate	$523.70
Max. Negotiated Rate	$1,178.32
Rate for Payer: Aetna Commercial	$1,112.85
Rate for Payer: Aetna Medicare	$654.62
Rate for Payer: Aetna New Business (MI Preferred)	$851.01
Rate for Payer: BCBS Complete	$523.70
Rate for Payer: Cash Price	$1,047.39
Rate for Payer: Cofinity Commercial	$1,125.95
Rate for Payer: Cofinity Commercial	$916.47
Rate for Payer: Cofinity Medicare Advantage	$916.47
Rate for Payer: Encore Health Key Benefits Commercial	$1,047.39
Rate for Payer: Healthscope Commercial	$1,178.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,112.85
Rate for Payer: PHP Commercial	$1,112.85
Rate for Payer: Priority Health Cigna Priority Health	$851.01
Rate for Payer: Priority Health SBD	$824.82

HC INJECTION HIP ARTHROGRAM BIL

Facility

$1,214.02

Service Code	CPT 27093
Hospital Charge Code	36100041
Hospital Revenue Code	361
Min. Negotiated Rate	$764.83
Max. Negotiated Rate	$1,092.62
Rate for Payer: Aetna Commercial	$1,031.92
Rate for Payer: Aetna New Business (MI Preferred)	$789.11
Rate for Payer: Cash Price	$971.22
Rate for Payer: Cofinity Commercial	$1,044.06
Rate for Payer: Cofinity Commercial	$849.81
Rate for Payer: Cofinity Medicare Advantage	$849.81
Rate for Payer: Encore Health Key Benefits Commercial	$971.22
Rate for Payer: Healthscope Commercial	$1,092.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,031.92
Rate for Payer: PHP Commercial	$1,031.92
Rate for Payer: Priority Health Cigna Priority Health	$789.11
Rate for Payer: Priority Health SBD	$764.83

Know your out-of-pocket cost for care.

All Charges