Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP

Facility

$805.80

Service Code	CPT 0232T
Hospital Charge Code	76100473
Hospital Revenue Code	761
Min. Negotiated Rate	$507.65
Max. Negotiated Rate	$725.22
Rate for Payer: Aetna Commercial	$684.93
Rate for Payer: Aetna New Business (MI Preferred)	$523.77
Rate for Payer: Cash Price	$644.64
Rate for Payer: Cofinity Commercial	$564.06
Rate for Payer: Cofinity Commercial	$692.99
Rate for Payer: Cofinity Medicare Advantage	$564.06
Rate for Payer: Encore Health Key Benefits Commercial	$644.64
Rate for Payer: Healthscope Commercial	$725.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$684.93
Rate for Payer: PHP Commercial	$684.93
Rate for Payer: Priority Health Cigna Priority Health	$523.77
Rate for Payer: Priority Health SBD	$507.65

HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP

Facility

$805.80

Service Code	CPT 0232T
Hospital Charge Code	76100473
Hospital Revenue Code	761
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$1,095.50
Rate for Payer: Aetna Commercial	$684.93
Rate for Payer: Aetna Medicare	$404.75
Rate for Payer: Aetna New Business (MI Preferred)	$523.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$486.48
Rate for Payer: Amish Plain Church Group Commercial	$486.48
Rate for Payer: BCBS Complete	$219.03
Rate for Payer: BCBS MAPPO	$389.18
Rate for Payer: BCN Medicare Advantage	$389.18
Rate for Payer: Cash Price	$644.64
Rate for Payer: Cash Price	$644.64
Rate for Payer: Cofinity Commercial	$692.99
Rate for Payer: Cofinity Commercial	$564.06
Rate for Payer: Cofinity Medicare Advantage	$564.06
Rate for Payer: Encore Health Key Benefits Commercial	$644.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.18
Rate for Payer: Healthscope Commercial	$725.22
Rate for Payer: Mclaren Medicaid	$208.60
Rate for Payer: Mclaren Medicare	$389.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$408.64
Rate for Payer: Meridian Medicaid	$219.03
Rate for Payer: MI Amish Medical Board Commercial	$447.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$684.93
Rate for Payer: PACE Medicare	$369.72
Rate for Payer: PACE SWMI	$389.18
Rate for Payer: PHP Commercial	$684.93
Rate for Payer: PHP Medicare Advantage	$389.18
Rate for Payer: Priority Health Choice Medicaid	$208.60
Rate for Payer: Priority Health Cigna Priority Health	$523.77
Rate for Payer: Priority Health Medicare	$389.18
Rate for Payer: Priority Health SBD	$507.65
Rate for Payer: Railroad Medicare Medicare	$389.18
Rate for Payer: UHC All Payor (Choice/PPO)	$1,095.50
Rate for Payer: UHC Dual Complete DSNP	$389.18
Rate for Payer: UHC Medicare Advantage	$389.18
Rate for Payer: UHCCP Medicaid	$219.11
Rate for Payer: VA VA	$389.18

HC INJECTION PROC CYSTOGRAPHY VOIDING

Facility

$1,310.34

Service Code	CPT 51600
Hospital Charge Code	36100251
Hospital Revenue Code	361
Min. Negotiated Rate	$825.51
Max. Negotiated Rate	$1,179.31
Rate for Payer: Aetna Commercial	$1,113.79
Rate for Payer: Aetna New Business (MI Preferred)	$851.72
Rate for Payer: Cash Price	$1,048.27
Rate for Payer: Cofinity Commercial	$1,126.89
Rate for Payer: Cofinity Commercial	$917.24
Rate for Payer: Cofinity Medicare Advantage	$917.24
Rate for Payer: Encore Health Key Benefits Commercial	$1,048.27
Rate for Payer: Healthscope Commercial	$1,179.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,113.79
Rate for Payer: PHP Commercial	$1,113.79
Rate for Payer: Priority Health Cigna Priority Health	$851.72
Rate for Payer: Priority Health SBD	$825.51

HC INJECTION PROC CYSTOGRAPHY VOIDING

Facility

$1,310.34

Service Code	CPT 51600
Hospital Charge Code	36100251
Hospital Revenue Code	361
Min. Negotiated Rate	$524.14
Max. Negotiated Rate	$1,179.31
Rate for Payer: Aetna Commercial	$1,113.79
Rate for Payer: Aetna Medicare	$655.17
Rate for Payer: Aetna New Business (MI Preferred)	$851.72
Rate for Payer: BCBS Complete	$524.14
Rate for Payer: Cash Price	$1,048.27
Rate for Payer: Cofinity Commercial	$1,126.89
Rate for Payer: Cofinity Commercial	$917.24
Rate for Payer: Cofinity Medicare Advantage	$917.24
Rate for Payer: Encore Health Key Benefits Commercial	$1,048.27
Rate for Payer: Healthscope Commercial	$1,179.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,113.79
Rate for Payer: PHP Commercial	$1,113.79
Rate for Payer: Priority Health Cigna Priority Health	$851.72
Rate for Payer: Priority Health SBD	$825.51

HC INJECTION PROCEDURE

Facility

$603.48

Hospital Charge Code	36000085
Hospital Revenue Code	360
Min. Negotiated Rate	$241.39
Max. Negotiated Rate	$543.13
Rate for Payer: Aetna Commercial	$512.96
Rate for Payer: Aetna Medicare	$301.74
Rate for Payer: Aetna New Business (MI Preferred)	$392.26
Rate for Payer: BCBS Complete	$241.39
Rate for Payer: Cash Price	$482.78
Rate for Payer: Cofinity Commercial	$422.44
Rate for Payer: Cofinity Commercial	$518.99
Rate for Payer: Cofinity Medicare Advantage	$422.44
Rate for Payer: Encore Health Key Benefits Commercial	$482.78
Rate for Payer: Healthscope Commercial	$543.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$512.96
Rate for Payer: PHP Commercial	$512.96
Rate for Payer: Priority Health Cigna Priority Health	$392.26
Rate for Payer: Priority Health SBD	$380.19

HC INJECTION PROCEDURE

Facility

$603.48

Hospital Charge Code	36000085
Hospital Revenue Code	360
Min. Negotiated Rate	$380.19
Max. Negotiated Rate	$543.13
Rate for Payer: Aetna Commercial	$512.96
Rate for Payer: Aetna New Business (MI Preferred)	$392.26
Rate for Payer: Cash Price	$482.78
Rate for Payer: Cofinity Commercial	$422.44
Rate for Payer: Cofinity Commercial	$518.99
Rate for Payer: Cofinity Medicare Advantage	$422.44
Rate for Payer: Encore Health Key Benefits Commercial	$482.78
Rate for Payer: Healthscope Commercial	$543.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$512.96
Rate for Payer: PHP Commercial	$512.96
Rate for Payer: Priority Health Cigna Priority Health	$392.26
Rate for Payer: Priority Health SBD	$380.19

HC INJECTION PROCEDURE ILEAL CONDUIT

Facility

$643.53

Service Code	CPT 50690
Hospital Charge Code	36100249
Hospital Revenue Code	361
Min. Negotiated Rate	$405.42
Max. Negotiated Rate	$579.18
Rate for Payer: Aetna Commercial	$547.00
Rate for Payer: Aetna New Business (MI Preferred)	$418.29
Rate for Payer: Cash Price	$514.82
Rate for Payer: Cofinity Commercial	$450.47
Rate for Payer: Cofinity Commercial	$553.44
Rate for Payer: Cofinity Medicare Advantage	$450.47
Rate for Payer: Encore Health Key Benefits Commercial	$514.82
Rate for Payer: Healthscope Commercial	$579.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$547.00
Rate for Payer: PHP Commercial	$547.00
Rate for Payer: Priority Health Cigna Priority Health	$418.29
Rate for Payer: Priority Health SBD	$405.42

HC INJECTION PROCEDURE ILEAL CONDUIT

Facility

$643.53

Service Code	CPT 50690
Hospital Charge Code	36100249
Hospital Revenue Code	361
Min. Negotiated Rate	$257.41
Max. Negotiated Rate	$579.18
Rate for Payer: Aetna Commercial	$547.00
Rate for Payer: Aetna Medicare	$321.76
Rate for Payer: Aetna New Business (MI Preferred)	$418.29
Rate for Payer: BCBS Complete	$257.41
Rate for Payer: Cash Price	$514.82
Rate for Payer: Cofinity Commercial	$450.47
Rate for Payer: Cofinity Commercial	$553.44
Rate for Payer: Cofinity Medicare Advantage	$450.47
Rate for Payer: Encore Health Key Benefits Commercial	$514.82
Rate for Payer: Healthscope Commercial	$579.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$547.00
Rate for Payer: PHP Commercial	$547.00
Rate for Payer: Priority Health Cigna Priority Health	$418.29
Rate for Payer: Priority Health SBD	$405.42

HC INJECTION PROC RETROGRAD CYSTOGRAPHY

Facility

$832.48

Service Code	CPT 51610
Hospital Charge Code	36100252
Hospital Revenue Code	361
Min. Negotiated Rate	$524.46
Max. Negotiated Rate	$749.23
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna New Business (MI Preferred)	$541.11
Rate for Payer: Cash Price	$665.98
Rate for Payer: Cofinity Commercial	$582.74
Rate for Payer: Cofinity Commercial	$715.93
Rate for Payer: Cofinity Medicare Advantage	$582.74
Rate for Payer: Encore Health Key Benefits Commercial	$665.98
Rate for Payer: Healthscope Commercial	$749.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$707.61
Rate for Payer: PHP Commercial	$707.61
Rate for Payer: Priority Health Cigna Priority Health	$541.11
Rate for Payer: Priority Health SBD	$524.46

HC INJECTION PROC RETROGRAD CYSTOGRAPHY

Facility

$832.48

Service Code	CPT 51610
Hospital Charge Code	36100252
Hospital Revenue Code	361
Min. Negotiated Rate	$332.99
Max. Negotiated Rate	$749.23
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare	$416.24
Rate for Payer: Aetna New Business (MI Preferred)	$541.11
Rate for Payer: BCBS Complete	$332.99
Rate for Payer: Cash Price	$665.98
Rate for Payer: Cofinity Commercial	$582.74
Rate for Payer: Cofinity Commercial	$715.93
Rate for Payer: Cofinity Medicare Advantage	$582.74
Rate for Payer: Encore Health Key Benefits Commercial	$665.98
Rate for Payer: Healthscope Commercial	$749.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$707.61
Rate for Payer: PHP Commercial	$707.61
Rate for Payer: Priority Health Cigna Priority Health	$541.11
Rate for Payer: Priority Health SBD	$524.46

HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG

Facility

$15.61

Service Code	CPT J2550
Hospital Charge Code	63600100
Hospital Revenue Code	636
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$14.05
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare	$7.80
Rate for Payer: Aetna New Business (MI Preferred)	$10.15
Rate for Payer: BCBS Complete	$6.24
Rate for Payer: Cash Price	$12.49
Rate for Payer: Cofinity Commercial	$10.93
Rate for Payer: Cofinity Commercial	$13.42
Rate for Payer: Cofinity Medicare Advantage	$10.93
Rate for Payer: Encore Health Key Benefits Commercial	$12.49
Rate for Payer: Healthscope Commercial	$14.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.27
Rate for Payer: PHP Commercial	$13.27
Rate for Payer: Priority Health Cigna Priority Health	$10.15
Rate for Payer: Priority Health SBD	$9.83

HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG

Facility

$15.61

Service Code	CPT J2550
Hospital Charge Code	63600100
Hospital Revenue Code	636
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$14.05
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna New Business (MI Preferred)	$10.15
Rate for Payer: Cash Price	$12.49
Rate for Payer: Cofinity Commercial	$10.93
Rate for Payer: Cofinity Commercial	$13.42
Rate for Payer: Cofinity Medicare Advantage	$10.93
Rate for Payer: Encore Health Key Benefits Commercial	$12.49
Rate for Payer: Healthscope Commercial	$14.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.27
Rate for Payer: PHP Commercial	$13.27
Rate for Payer: Priority Health Cigna Priority Health	$10.15
Rate for Payer: Priority Health SBD	$9.83

HC INJECTION PUDENDAL NERVE

Facility

$1,193.61

Service Code	CPT 64430
Hospital Charge Code	36100570
Hospital Revenue Code	361
Min. Negotiated Rate	$751.97
Max. Negotiated Rate	$1,074.25
Rate for Payer: Aetna Commercial	$1,014.57
Rate for Payer: Aetna New Business (MI Preferred)	$775.85
Rate for Payer: Cash Price	$954.89
Rate for Payer: Cofinity Commercial	$1,026.50
Rate for Payer: Cofinity Commercial	$835.53
Rate for Payer: Cofinity Medicare Advantage	$835.53
Rate for Payer: Encore Health Key Benefits Commercial	$954.89
Rate for Payer: Healthscope Commercial	$1,074.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,014.57
Rate for Payer: PHP Commercial	$1,014.57
Rate for Payer: Priority Health Cigna Priority Health	$775.85
Rate for Payer: Priority Health SBD	$751.97

HC INJECTION PUDENDAL NERVE

Facility

$1,193.61

Service Code	CPT 64430
Hospital Charge Code	36100570
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$1,014.57
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$775.85
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	$954.89
Rate for Payer: Cash Price	$954.89
Rate for Payer: Cofinity Commercial	$835.53
Rate for Payer: Cofinity Commercial	$1,026.50
Rate for Payer: Cofinity Medicare Advantage	$835.53
Rate for Payer: Encore Health Key Benefits Commercial	$954.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$1,074.25
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	$1,014.57
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$1,014.57
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	$775.85
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$751.97
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 SCLEROSING SOL MULTIPLE

Facility

$329.29

Service Code	CPT 36471
Hospital Charge Code	36100117
Hospital Revenue Code	761
Min. Negotiated Rate	$207.45
Max. Negotiated Rate	$296.36
Rate for Payer: Aetna Commercial	$279.90
Rate for Payer: Aetna New Business (MI Preferred)	$214.04
Rate for Payer: Cash Price	$263.43
Rate for Payer: Cofinity Commercial	$230.50
Rate for Payer: Cofinity Commercial	$283.19
Rate for Payer: Cofinity Medicare Advantage	$230.50
Rate for Payer: Encore Health Key Benefits Commercial	$263.43
Rate for Payer: Healthscope Commercial	$296.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.90
Rate for Payer: PHP Commercial	$279.90
Rate for Payer: Priority Health Cigna Priority Health	$214.04
Rate for Payer: Priority Health SBD	$207.45

HC INJECTION SCLEROSING SOL MULTIPLE

Facility

$329.29

Service Code	CPT 36471
Hospital Charge Code	36100117
Hospital Revenue Code	761
Min. Negotiated Rate	$207.45
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$279.90
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$214.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$263.43
Rate for Payer: Cash Price	$263.43
Rate for Payer: Cofinity Commercial	$283.19
Rate for Payer: Cofinity Commercial	$230.50
Rate for Payer: Cofinity Medicare Advantage	$230.50
Rate for Payer: Encore Health Key Benefits Commercial	$263.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$296.36
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.90
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$279.90
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$214.04
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$207.45
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HC INJECTION SCLEROSING SOL SINGLE

Facility

$252.82

Service Code	CPT 36470
Hospital Charge Code	36100116
Hospital Revenue Code	761
Min. Negotiated Rate	$159.28
Max. Negotiated Rate	$227.54
Rate for Payer: Aetna Commercial	$214.90
Rate for Payer: Aetna New Business (MI Preferred)	$164.33
Rate for Payer: Cash Price	$202.26
Rate for Payer: Cofinity Commercial	$176.97
Rate for Payer: Cofinity Commercial	$217.43
Rate for Payer: Cofinity Medicare Advantage	$176.97
Rate for Payer: Encore Health Key Benefits Commercial	$202.26
Rate for Payer: Healthscope Commercial	$227.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.90
Rate for Payer: PHP Commercial	$214.90
Rate for Payer: Priority Health Cigna Priority Health	$164.33
Rate for Payer: Priority Health SBD	$159.28

HC INJECTION SCLEROSING SOL SINGLE

Facility

$252.82

Service Code	CPT 36470
Hospital Charge Code	36100116
Hospital Revenue Code	761
Min. Negotiated Rate	$159.28
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$214.90
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$164.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$202.26
Rate for Payer: Cash Price	$202.26
Rate for Payer: Cofinity Commercial	$217.43
Rate for Payer: Cofinity Commercial	$176.97
Rate for Payer: Cofinity Medicare Advantage	$176.97
Rate for Payer: Encore Health Key Benefits Commercial	$202.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$227.54
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.90
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$214.90
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$164.33
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$159.28
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HC INJECTION SHOULDER ARTHROGRAM

Facility

$863.45

Service Code	CPT 23350
Hospital Charge Code	36100037
Hospital Revenue Code	361
Min. Negotiated Rate	$345.38
Max. Negotiated Rate	$777.11
Rate for Payer: Aetna Commercial	$733.93
Rate for Payer: Aetna Medicare	$431.73
Rate for Payer: Aetna New Business (MI Preferred)	$561.24
Rate for Payer: BCBS Complete	$345.38
Rate for Payer: Cash Price	$690.76
Rate for Payer: Cofinity Commercial	$604.41
Rate for Payer: Cofinity Commercial	$742.57
Rate for Payer: Cofinity Medicare Advantage	$604.41
Rate for Payer: Encore Health Key Benefits Commercial	$690.76
Rate for Payer: Healthscope Commercial	$777.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$733.93
Rate for Payer: PHP Commercial	$733.93
Rate for Payer: Priority Health Cigna Priority Health	$561.24
Rate for Payer: Priority Health SBD	$543.97

HC INJECTION SHOULDER ARTHROGRAM

Facility

$863.45

Service Code	CPT 23350
Hospital Charge Code	36100037
Hospital Revenue Code	361
Min. Negotiated Rate	$543.97
Max. Negotiated Rate	$777.11
Rate for Payer: Aetna Commercial	$733.93
Rate for Payer: Aetna New Business (MI Preferred)	$561.24
Rate for Payer: Cash Price	$690.76
Rate for Payer: Cofinity Commercial	$604.41
Rate for Payer: Cofinity Commercial	$742.57
Rate for Payer: Cofinity Medicare Advantage	$604.41
Rate for Payer: Encore Health Key Benefits Commercial	$690.76
Rate for Payer: Healthscope Commercial	$777.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$733.93
Rate for Payer: PHP Commercial	$733.93
Rate for Payer: Priority Health Cigna Priority Health	$561.24
Rate for Payer: Priority Health SBD	$543.97

HC INJECTION SHUNTOGRAM

Facility

$388.71

Service Code	CPT 49427
Hospital Charge Code	36100224
Hospital Revenue Code	361
Min. Negotiated Rate	$244.89
Max. Negotiated Rate	$349.84
Rate for Payer: Aetna Commercial	$330.40
Rate for Payer: Aetna New Business (MI Preferred)	$252.66
Rate for Payer: Cash Price	$310.97
Rate for Payer: Cofinity Commercial	$272.10
Rate for Payer: Cofinity Commercial	$334.29
Rate for Payer: Cofinity Medicare Advantage	$272.10
Rate for Payer: Encore Health Key Benefits Commercial	$310.97
Rate for Payer: Healthscope Commercial	$349.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.40
Rate for Payer: PHP Commercial	$330.40
Rate for Payer: Priority Health Cigna Priority Health	$252.66
Rate for Payer: Priority Health SBD	$244.89

HC INJECTION SHUNTOGRAM

Facility

$388.71

Service Code	CPT 49427
Hospital Charge Code	36100224
Hospital Revenue Code	361
Min. Negotiated Rate	$155.48
Max. Negotiated Rate	$349.84
Rate for Payer: Aetna Commercial	$330.40
Rate for Payer: Aetna Medicare	$194.35
Rate for Payer: Aetna New Business (MI Preferred)	$252.66
Rate for Payer: BCBS Complete	$155.48
Rate for Payer: Cash Price	$310.97
Rate for Payer: Cofinity Commercial	$272.10
Rate for Payer: Cofinity Commercial	$334.29
Rate for Payer: Cofinity Medicare Advantage	$272.10
Rate for Payer: Encore Health Key Benefits Commercial	$310.97
Rate for Payer: Healthscope Commercial	$349.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.40
Rate for Payer: PHP Commercial	$330.40
Rate for Payer: Priority Health Cigna Priority Health	$252.66
Rate for Payer: Priority Health SBD	$244.89

HC INJECTION SIALOGRAM

Facility

$291.84

Service Code	CPT 42550
Hospital Charge Code	36100190
Hospital Revenue Code	361
Min. Negotiated Rate	$183.86
Max. Negotiated Rate	$262.66
Rate for Payer: Aetna Commercial	$248.06
Rate for Payer: Aetna New Business (MI Preferred)	$189.70
Rate for Payer: Cash Price	$233.47
Rate for Payer: Cofinity Commercial	$204.29
Rate for Payer: Cofinity Commercial	$250.98
Rate for Payer: Cofinity Medicare Advantage	$204.29
Rate for Payer: Encore Health Key Benefits Commercial	$233.47
Rate for Payer: Healthscope Commercial	$262.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$248.06
Rate for Payer: PHP Commercial	$248.06
Rate for Payer: Priority Health Cigna Priority Health	$189.70
Rate for Payer: Priority Health SBD	$183.86

HC INJECTION SIALOGRAM

Facility

$291.84

Service Code	CPT 42550
Hospital Charge Code	36100190
Hospital Revenue Code	361
Min. Negotiated Rate	$116.74
Max. Negotiated Rate	$262.66
Rate for Payer: Aetna Commercial	$248.06
Rate for Payer: Aetna Medicare	$145.92
Rate for Payer: Aetna New Business (MI Preferred)	$189.70
Rate for Payer: BCBS Complete	$116.74
Rate for Payer: Cash Price	$233.47
Rate for Payer: Cofinity Commercial	$204.29
Rate for Payer: Cofinity Commercial	$250.98
Rate for Payer: Cofinity Medicare Advantage	$204.29
Rate for Payer: Encore Health Key Benefits Commercial	$233.47
Rate for Payer: Healthscope Commercial	$262.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$248.06
Rate for Payer: PHP Commercial	$248.06
Rate for Payer: Priority Health Cigna Priority Health	$189.70
Rate for Payer: Priority Health SBD	$183.86

HC INJECTION SI JOINT ANESTHESIA/STEROID

Facility

$1,011.25

Service Code	CPT 27096
Hospital Charge Code	36100042
Hospital Revenue Code	361
Min. Negotiated Rate	$637.09
Max. Negotiated Rate	$910.12
Rate for Payer: Aetna Commercial	$859.56
Rate for Payer: Aetna New Business (MI Preferred)	$657.31
Rate for Payer: Cash Price	$809.00
Rate for Payer: Cofinity Commercial	$707.88
Rate for Payer: Cofinity Commercial	$869.67
Rate for Payer: Cofinity Medicare Advantage	$707.88
Rate for Payer: Encore Health Key Benefits Commercial	$809.00
Rate for Payer: Healthscope Commercial	$910.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$859.56
Rate for Payer: PHP Commercial	$859.56
Rate for Payer: Priority Health Cigna Priority Health	$657.31
Rate for Payer: Priority Health SBD	$637.09

Know your out-of-pocket cost for care.

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