Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$53.70
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Commercial	$350.04
Rate for Payer: Aetna Medicare	$205.90
Rate for Payer: Aetna New Business (MI Preferred)	$267.68
Rate for Payer: BCBS Complete	$164.72
Rate for Payer: BCBS Trust/PPO	$176.93
Rate for Payer: BCN Commercial	$176.93
Rate for Payer: Cash Price	$329.45
Rate for Payer: Cash Price	$329.45
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
Rate for Payer: UHC All Payor (Choice/PPO)	$53.70
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

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	$53.70
Max. Negotiated Rate	$940.00
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: BCBS Trust/PPO	$176.93
Rate for Payer: BCN Commercial	$176.93
Rate for Payer: Cash Price	$494.17
Rate for Payer: Cash Price	$494.17
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
Rate for Payer: UHC All Payor (Choice/PPO)	$53.70
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

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 + LE

Facility

$411.81

Service Code	CPT 64495
Hospital Charge Code	36100295
Hospital Revenue Code	361
Min. Negotiated Rate	$54.68
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Commercial	$350.04
Rate for Payer: Aetna Medicare	$205.90
Rate for Payer: Aetna New Business (MI Preferred)	$267.68
Rate for Payer: BCBS Complete	$164.72
Rate for Payer: BCBS Trust/PPO	$177.65
Rate for Payer: BCN Commercial	$177.65
Rate for Payer: Cash Price	$329.45
Rate for Payer: Cash Price	$329.45
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
Rate for Payer: UHC All Payor (Choice/PPO)	$54.68
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

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	$54.68
Max. Negotiated Rate	$940.00
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: BCBS Trust/PPO	$177.65
Rate for Payer: BCN Commercial	$177.65
Rate for Payer: Cash Price	$494.17
Rate for Payer: Cash Price	$494.17
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
Rate for Payer: UHC All Payor (Choice/PPO)	$54.68
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

HC INJECTION FOR CEREBRAL SHUNT

Facility

$826.35

Service Code	CPT 61070
Hospital Charge Code	36100270
Hospital Revenue Code	361
Min. Negotiated Rate	$59.49
Max. Negotiated Rate	$2,132.58
Rate for Payer: Aetna Commercial	$702.40
Rate for Payer: Aetna Medicare	$705.66
Rate for Payer: Aetna New Business (MI Preferred)	$537.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$848.15
Rate for Payer: Amish Plain Church Group Commercial	$848.15
Rate for Payer: BCBS Complete	$381.87
Rate for Payer: BCBS MAPPO	$678.52
Rate for Payer: BCBS Trust/PPO	$245.00
Rate for Payer: BCN Commercial	$245.00
Rate for Payer: BCN Medicare Advantage	$678.52
Rate for Payer: Cash Price	$661.08
Rate for Payer: Cash Price	$661.08
Rate for Payer: Cash Price	$661.08
Rate for Payer: Cofinity Commercial	$578.44
Rate for Payer: Cofinity Commercial	$710.66
Rate for Payer: Cofinity Medicare Advantage	$578.44
Rate for Payer: Encore Health Key Benefits Commercial	$661.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$678.52
Rate for Payer: Healthscope Commercial	$743.72
Rate for Payer: Mclaren Medicaid	$363.69
Rate for Payer: Mclaren Medicare	$678.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$712.45
Rate for Payer: Meridian Medicaid	$381.87
Rate for Payer: MI Amish Medical Board Commercial	$780.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$702.40
Rate for Payer: Nomi Health Commercial	$1,424.89
Rate for Payer: PACE Medicare	$644.59
Rate for Payer: PACE SWMI	$678.52
Rate for Payer: PHP Commercial	$702.40
Rate for Payer: PHP Medicare Advantage	$678.52
Rate for Payer: Priority Health Choice Medicaid	$363.69
Rate for Payer: Priority Health Cigna Priority Health	$537.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,132.58
Rate for Payer: Priority Health Medicare	$678.52
Rate for Payer: Priority Health Narrow Network	$1,706.06
Rate for Payer: Priority Health SBD	$520.60
Rate for Payer: Railroad Medicare Medicare	$678.52
Rate for Payer: UHC All Payor (Choice/PPO)	$59.49
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$678.52
Rate for Payer: UHC Exchange	$1,566.00
Rate for Payer: UHC Medicare Advantage	$678.52
Rate for Payer: UHCCP Medicaid	$382.01
Rate for Payer: VA VA	$678.52

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	$578.44
Rate for Payer: Cofinity Commercial	$710.66
Rate for Payer: Cofinity Medicare Advantage	$578.44
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	$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 FOR HYSTEROSALPINGOGRAM

Facility

$656.49

Service Code	CPT 58340
Hospital Charge Code	36100256
Hospital Revenue Code	761
Min. Negotiated Rate	$60.91
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$558.02
Rate for Payer: Aetna Medicare	$328.24
Rate for Payer: Aetna New Business (MI Preferred)	$426.72
Rate for Payer: BCBS Complete	$262.60
Rate for Payer: BCBS Trust/PPO	$326.08
Rate for Payer: BCN Commercial	$326.08
Rate for Payer: Cash Price	$525.19
Rate for Payer: Cash Price	$525.19
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
Rate for Payer: UHC All Payor (Choice/PPO)	$60.91
Rate for Payer: UHC Core	$878.00

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	$71.53
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: BCBS Trust/PPO	$247.43
Rate for Payer: BCN Commercial	$247.43
Rate for Payer: Cash Price	$1,047.39
Rate for Payer: Cash Price	$1,047.39
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
Rate for Payer: UHC All Payor (Choice/PPO)	$71.53
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

HC INJECTION HIP ARTHROGRAM BIL

Facility

$1,214.02

Service Code	CPT 27093
Hospital Charge Code	36100041
Hospital Revenue Code	361
Min. Negotiated Rate	$71.53
Max. Negotiated Rate	$1,092.62
Rate for Payer: Aetna Commercial	$1,031.92
Rate for Payer: Aetna Medicare	$607.01
Rate for Payer: Aetna New Business (MI Preferred)	$789.11
Rate for Payer: BCBS Complete	$485.61
Rate for Payer: BCBS Trust/PPO	$247.43
Rate for Payer: BCN Commercial	$247.43
Rate for Payer: Cash Price	$971.22
Rate for Payer: Cash Price	$971.22
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
Rate for Payer: UHC All Payor (Choice/PPO)	$71.53
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

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

HC INJECTION INTRALESIONAL UP TO 7 LESIONS

Facility

$147.11

Service Code	CPT 11900
Hospital Charge Code	76100134
Hospital Revenue Code	761
Min. Negotiated Rate	$31.44
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Commercial	$125.04
Rate for Payer: Aetna Medicare	$202.47
Rate for Payer: Aetna New Business (MI Preferred)	$95.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$243.35
Rate for Payer: Amish Plain Church Group Commercial	$243.35
Rate for Payer: BCBS Complete	$109.57
Rate for Payer: BCBS MAPPO	$194.68
Rate for Payer: BCBS Trust/PPO	$128.28
Rate for Payer: BCN Commercial	$128.28
Rate for Payer: BCN Medicare Advantage	$194.68
Rate for Payer: Cash Price	$117.69
Rate for Payer: Cash Price	$117.69
Rate for Payer: Cash Price	$117.69
Rate for Payer: Cofinity Commercial	$102.98
Rate for Payer: Cofinity Commercial	$126.51
Rate for Payer: Cofinity Medicare Advantage	$102.98
Rate for Payer: Encore Health Key Benefits Commercial	$117.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$194.68
Rate for Payer: Healthscope Commercial	$132.40
Rate for Payer: Mclaren Medicaid	$104.35
Rate for Payer: Mclaren Medicare	$194.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$204.41
Rate for Payer: Meridian Medicaid	$109.57
Rate for Payer: MI Amish Medical Board Commercial	$223.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.04
Rate for Payer: Nomi Health Commercial	$584.04
Rate for Payer: PACE Medicare	$184.95
Rate for Payer: PACE SWMI	$194.68
Rate for Payer: PHP Commercial	$125.04
Rate for Payer: PHP Medicare Advantage	$194.68
Rate for Payer: Priority Health Choice Medicaid	$104.35
Rate for Payer: Priority Health Cigna Priority Health	$95.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$611.90
Rate for Payer: Priority Health Medicare	$194.68
Rate for Payer: Priority Health Narrow Network	$489.52
Rate for Payer: Priority Health SBD	$92.68
Rate for Payer: Railroad Medicare Medicare	$194.68
Rate for Payer: UHC All Payor (Choice/PPO)	$31.44
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$194.68
Rate for Payer: UHC Medicare Advantage	$194.68
Rate for Payer: UHCCP Medicaid	$109.60
Rate for Payer: VA VA	$194.68

HC INJECTION INTRALESIONAL UP TO 7 LESIONS

Facility

$147.11

Service Code	CPT 11900
Hospital Charge Code	76100134
Hospital Revenue Code	761
Min. Negotiated Rate	$92.68
Max. Negotiated Rate	$132.40
Rate for Payer: Aetna Commercial	$125.04
Rate for Payer: Aetna New Business (MI Preferred)	$95.62
Rate for Payer: Cash Price	$117.69
Rate for Payer: Cofinity Commercial	$102.98
Rate for Payer: Cofinity Commercial	$126.51
Rate for Payer: Cofinity Medicare Advantage	$102.98
Rate for Payer: Encore Health Key Benefits Commercial	$117.69
Rate for Payer: Healthscope Commercial	$132.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.04
Rate for Payer: PHP Commercial	$125.04
Rate for Payer: Priority Health Cigna Priority Health	$95.62
Rate for Payer: Priority Health SBD	$92.68

HC INJECTION, IRON DEXTRAN, 50 MG

Facility

$62.42

Service Code	CPT J1750
Hospital Charge Code	63600097
Hospital Revenue Code	636
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$56.18
Rate for Payer: Aetna Commercial	$53.06
Rate for Payer: Aetna Medicare	$18.10
Rate for Payer: Aetna New Business (MI Preferred)	$40.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$21.75
Rate for Payer: Amish Plain Church Group Commercial	$21.75
Rate for Payer: BCBS Complete	$9.79
Rate for Payer: BCBS MAPPO	$17.40
Rate for Payer: BCBS Trust/PPO	$49.90
Rate for Payer: BCN Commercial	$49.90
Rate for Payer: BCN Medicare Advantage	$17.40
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Commercial	$53.68
Rate for Payer: Cofinity Commercial	$43.69
Rate for Payer: Cofinity Medicare Advantage	$43.69
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$17.40
Rate for Payer: Healthscope Commercial	$56.18
Rate for Payer: Mclaren Medicaid	$9.33
Rate for Payer: Mclaren Medicare	$17.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18.27
Rate for Payer: Meridian Medicaid	$9.79
Rate for Payer: MI Amish Medical Board Commercial	$20.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.06
Rate for Payer: Nomi Health Commercial	$52.20
Rate for Payer: PACE Medicare	$16.53
Rate for Payer: PACE SWMI	$17.40
Rate for Payer: PHP Commercial	$53.06
Rate for Payer: PHP Medicare Advantage	$17.40
Rate for Payer: Priority Health Choice Medicaid	$9.33
Rate for Payer: Priority Health Cigna Priority Health	$40.57
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.86
Rate for Payer: Priority Health Medicare	$17.40
Rate for Payer: Priority Health Narrow Network	$40.69
Rate for Payer: Priority Health SBD	$39.32
Rate for Payer: Railroad Medicare Medicare	$17.40
Rate for Payer: UHC All Payor (Choice/PPO)	$48.98
Rate for Payer: UHC Dual Complete DSNP	$17.40
Rate for Payer: UHC Medicare Advantage	$17.40
Rate for Payer: UHCCP Medicaid	$9.80
Rate for Payer: VA VA	$17.40

HC INJECTION, IRON DEXTRAN, 50 MG

Facility

$62.42

Service Code	CPT J1750
Hospital Charge Code	63600097
Hospital Revenue Code	636
Min. Negotiated Rate	$39.32
Max. Negotiated Rate	$56.18
Rate for Payer: Aetna Commercial	$53.06
Rate for Payer: Aetna New Business (MI Preferred)	$40.57
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Commercial	$43.69
Rate for Payer: Cofinity Commercial	$53.68
Rate for Payer: Cofinity Medicare Advantage	$43.69
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$56.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.06
Rate for Payer: PHP Commercial	$53.06
Rate for Payer: Priority Health Cigna Priority Health	$40.57
Rate for Payer: Priority Health SBD	$39.32

HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG

Facility

$20.81

Service Code	CPT J1885
Hospital Charge Code	63600098
Hospital Revenue Code	636
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: Aetna New Business (MI Preferred)	$13.53
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Commercial	$14.57
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Cofinity Medicare Advantage	$14.57
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Healthscope Commercial	$18.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: PHP Commercial	$17.69
Rate for Payer: Priority Health Cigna Priority Health	$13.53
Rate for Payer: Priority Health SBD	$13.11

HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG

Facility

$20.81

Service Code	CPT J1885
Hospital Charge Code	63600098
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: Aetna Medicare	$0.76
Rate for Payer: Aetna New Business (MI Preferred)	$13.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.91
Rate for Payer: Amish Plain Church Group Commercial	$0.91
Rate for Payer: BCBS Complete	$0.41
Rate for Payer: BCBS MAPPO	$0.73
Rate for Payer: BCBS Trust/PPO	$1.91
Rate for Payer: BCN Commercial	$1.91
Rate for Payer: BCN Medicare Advantage	$0.73
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Cofinity Commercial	$14.57
Rate for Payer: Cofinity Medicare Advantage	$14.57
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.73
Rate for Payer: Healthscope Commercial	$18.73
Rate for Payer: Mclaren Medicaid	$0.39
Rate for Payer: Mclaren Medicare	$0.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.77
Rate for Payer: Meridian Medicaid	$0.41
Rate for Payer: MI Amish Medical Board Commercial	$0.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: Nomi Health Commercial	$2.19
Rate for Payer: PACE Medicare	$0.69
Rate for Payer: PACE SWMI	$0.73
Rate for Payer: PHP Commercial	$17.69
Rate for Payer: PHP Medicare Advantage	$0.73
Rate for Payer: Priority Health Choice Medicaid	$0.39
Rate for Payer: Priority Health Cigna Priority Health	$13.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1.95
Rate for Payer: Priority Health Medicare	$0.73
Rate for Payer: Priority Health Narrow Network	$1.56
Rate for Payer: Priority Health SBD	$13.11
Rate for Payer: Railroad Medicare Medicare	$0.73
Rate for Payer: UHC All Payor (Choice/PPO)	$2.05
Rate for Payer: UHC Dual Complete DSNP	$0.73
Rate for Payer: UHC Medicare Advantage	$0.73
Rate for Payer: UHCCP Medicaid	$0.41
Rate for Payer: VA VA	$0.73

HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG

Facility

$45.78

Service Code	CPT J2010
Hospital Charge Code	63600099
Hospital Revenue Code	636
Min. Negotiated Rate	$28.84
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna New Business (MI Preferred)	$29.76
Rate for Payer: Cash Price	$36.62
Rate for Payer: Cofinity Commercial	$32.05
Rate for Payer: Cofinity Commercial	$39.37
Rate for Payer: Cofinity Medicare Advantage	$32.05
Rate for Payer: Encore Health Key Benefits Commercial	$36.62
Rate for Payer: Healthscope Commercial	$41.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.91
Rate for Payer: PHP Commercial	$38.91
Rate for Payer: Priority Health Cigna Priority Health	$29.76
Rate for Payer: Priority Health SBD	$28.84

HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG

Facility

$45.78

Service Code	CPT J2010
Hospital Charge Code	63600099
Hospital Revenue Code	636
Min. Negotiated Rate	$18.31
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare	$22.89
Rate for Payer: Aetna New Business (MI Preferred)	$29.76
Rate for Payer: BCBS Complete	$18.31
Rate for Payer: BCBS Trust/PPO	$26.42
Rate for Payer: BCN Commercial	$26.42
Rate for Payer: Cash Price	$36.62
Rate for Payer: Cash Price	$36.62
Rate for Payer: Cofinity Commercial	$32.05
Rate for Payer: Cofinity Commercial	$39.37
Rate for Payer: Cofinity Medicare Advantage	$32.05
Rate for Payer: Encore Health Key Benefits Commercial	$36.62
Rate for Payer: Healthscope Commercial	$41.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.91
Rate for Payer: PHP Commercial	$38.91
Rate for Payer: Priority Health Cigna Priority Health	$29.76
Rate for Payer: Priority Health SBD	$28.84

Know your out-of-pocket cost for care.

All Charges