Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

HC INJECTION SI JOINT BIL ANESTHESIA/STEROID

Facility

$1,047.85

Service Code	CPT 27096
Hospital Charge Code	36100043
Hospital Revenue Code	361
Min. Negotiated Rate	$419.14
Max. Negotiated Rate	$943.07
Rate for Payer: Aetna Commercial	$890.67
Rate for Payer: Aetna Medicare	$523.92
Rate for Payer: Aetna New Business (MI Preferred)	$681.10
Rate for Payer: BCBS Complete	$419.14
Rate for Payer: Cash Price	$838.28
Rate for Payer: Cofinity Commercial	$733.50
Rate for Payer: Cofinity Commercial	$901.15
Rate for Payer: Cofinity Medicare Advantage	$733.50
Rate for Payer: Encore Health Key Benefits Commercial	$838.28
Rate for Payer: Healthscope Commercial	$943.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$890.67
Rate for Payer: PHP Commercial	$890.67
Rate for Payer: Priority Health Cigna Priority Health	$681.10
Rate for Payer: Priority Health SBD	$660.15

HC INJECTION SI JOINT BIL ANESTHESIA/STEROID

Facility

$1,047.85

Service Code	CPT 27096
Hospital Charge Code	36100043
Hospital Revenue Code	361
Min. Negotiated Rate	$660.15
Max. Negotiated Rate	$943.07
Rate for Payer: Aetna Commercial	$890.67
Rate for Payer: Aetna New Business (MI Preferred)	$681.10
Rate for Payer: Cash Price	$838.28
Rate for Payer: Cofinity Commercial	$733.50
Rate for Payer: Cofinity Commercial	$901.15
Rate for Payer: Cofinity Medicare Advantage	$733.50
Rate for Payer: Encore Health Key Benefits Commercial	$838.28
Rate for Payer: Healthscope Commercial	$943.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$890.67
Rate for Payer: PHP Commercial	$890.67
Rate for Payer: Priority Health Cigna Priority Health	$681.10
Rate for Payer: Priority Health SBD	$660.15

HC INJECTION SINGLE TENDON ORIGIN/INSERTION

Facility

$279.36

Service Code	CPT 20551
Hospital Charge Code	36100519
Hospital Revenue Code	761
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Commercial	$237.46
Rate for Payer: Aetna Medicare	$299.41
Rate for Payer: Aetna New Business (MI Preferred)	$181.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$359.86
Rate for Payer: Amish Plain Church Group Commercial	$359.86
Rate for Payer: BCBS Complete	$162.02
Rate for Payer: BCBS MAPPO	$287.89
Rate for Payer: BCN Medicare Advantage	$287.89
Rate for Payer: Cash Price	$223.49
Rate for Payer: Cash Price	$223.49
Rate for Payer: Cofinity Commercial	$240.25
Rate for Payer: Cofinity Commercial	$195.55
Rate for Payer: Cofinity Medicare Advantage	$195.55
Rate for Payer: Encore Health Key Benefits Commercial	$223.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$287.89
Rate for Payer: Healthscope Commercial	$251.42
Rate for Payer: Mclaren Medicaid	$154.31
Rate for Payer: Mclaren Medicare	$287.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$302.28
Rate for Payer: Meridian Medicaid	$162.02
Rate for Payer: MI Amish Medical Board Commercial	$331.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$237.46
Rate for Payer: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Commercial	$237.46
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Cigna Priority Health	$181.58
Rate for Payer: Priority Health Medicare	$287.89
Rate for Payer: Priority Health SBD	$176.00
Rate for Payer: Railroad Medicare Medicare	$287.89
Rate for Payer: UHC All Payor (Choice/PPO)	$810.38
Rate for Payer: UHC Dual Complete DSNP	$287.89
Rate for Payer: UHC Medicare Advantage	$287.89
Rate for Payer: UHCCP Medicaid	$162.08
Rate for Payer: VA VA	$287.89

HC INJECTION SINGLE TENDON ORIGIN/INSERTION

Facility

$279.36

Service Code	CPT 20551
Hospital Charge Code	36100519
Hospital Revenue Code	761
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$251.42
Rate for Payer: Aetna Commercial	$237.46
Rate for Payer: Aetna New Business (MI Preferred)	$181.58
Rate for Payer: Cash Price	$223.49
Rate for Payer: Cofinity Commercial	$195.55
Rate for Payer: Cofinity Commercial	$240.25
Rate for Payer: Cofinity Medicare Advantage	$195.55
Rate for Payer: Encore Health Key Benefits Commercial	$223.49
Rate for Payer: Healthscope Commercial	$251.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$237.46
Rate for Payer: PHP Commercial	$237.46
Rate for Payer: Priority Health Cigna Priority Health	$181.58
Rate for Payer: Priority Health SBD	$176.00

HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG

Facility

$437.63

Service Code	CPT 38200
Hospital Charge Code	36100183
Hospital Revenue Code	361
Min. Negotiated Rate	$275.71
Max. Negotiated Rate	$393.87
Rate for Payer: Aetna Commercial	$371.99
Rate for Payer: Aetna New Business (MI Preferred)	$284.46
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cofinity Commercial	$306.34
Rate for Payer: Cofinity Commercial	$376.36
Rate for Payer: Cofinity Medicare Advantage	$306.34
Rate for Payer: Encore Health Key Benefits Commercial	$350.10
Rate for Payer: Healthscope Commercial	$393.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.99
Rate for Payer: PHP Commercial	$371.99
Rate for Payer: Priority Health Cigna Priority Health	$284.46
Rate for Payer: Priority Health SBD	$275.71

HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG

Facility

$437.63

Service Code	CPT 38200
Hospital Charge Code	36100183
Hospital Revenue Code	361
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$393.87
Rate for Payer: Aetna Commercial	$371.99
Rate for Payer: Aetna Medicare	$218.81
Rate for Payer: Aetna New Business (MI Preferred)	$284.46
Rate for Payer: BCBS Complete	$175.05
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cofinity Commercial	$306.34
Rate for Payer: Cofinity Commercial	$376.36
Rate for Payer: Cofinity Medicare Advantage	$306.34
Rate for Payer: Encore Health Key Benefits Commercial	$350.10
Rate for Payer: Healthscope Commercial	$393.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.99
Rate for Payer: PHP Commercial	$371.99
Rate for Payer: Priority Health Cigna Priority Health	$284.46
Rate for Payer: Priority Health SBD	$275.71

HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK

Facility

$1,085.28

Service Code	CPT 36468
Hospital Charge Code	76100400
Hospital Revenue Code	761
Min. Negotiated Rate	$683.73
Max. Negotiated Rate	$976.75
Rate for Payer: Aetna Commercial	$922.49
Rate for Payer: Aetna New Business (MI Preferred)	$705.43
Rate for Payer: Cash Price	$868.22
Rate for Payer: Cofinity Commercial	$759.70
Rate for Payer: Cofinity Commercial	$933.34
Rate for Payer: Cofinity Medicare Advantage	$759.70
Rate for Payer: Encore Health Key Benefits Commercial	$868.22
Rate for Payer: Healthscope Commercial	$976.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$922.49
Rate for Payer: PHP Commercial	$922.49
Rate for Payer: Priority Health Cigna Priority Health	$705.43
Rate for Payer: Priority Health SBD	$683.73

HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK

Facility

$1,085.28

Service Code	CPT 36468
Hospital Charge Code	76100400
Hospital Revenue Code	761
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$922.49
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$705.43
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	$868.22
Rate for Payer: Cash Price	$868.22
Rate for Payer: Cofinity Commercial	$933.34
Rate for Payer: Cofinity Commercial	$759.70
Rate for Payer: Cofinity Medicare Advantage	$759.70
Rate for Payer: Encore Health Key Benefits Commercial	$868.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$976.75
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	$922.49
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$922.49
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	$705.43
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$683.73
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, TESTOSTERONE CYPIONATE, 1 MG

Facility

$0.16

Service Code	CPT J1071
Hospital Charge Code	63600109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna Commercial	$0.14
Rate for Payer: Aetna New Business (MI Preferred)	$0.10
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cofinity Commercial	$0.11
Rate for Payer: Cofinity Commercial	$0.14
Rate for Payer: Cofinity Medicare Advantage	$0.11
Rate for Payer: Encore Health Key Benefits Commercial	$0.13
Rate for Payer: Healthscope Commercial	$0.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.14
Rate for Payer: PHP Commercial	$0.14
Rate for Payer: Priority Health Cigna Priority Health	$0.10
Rate for Payer: Priority Health SBD	$0.10

HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG

Facility

$0.16

Service Code	CPT J1071
Hospital Charge Code	63600109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna Commercial	$0.14
Rate for Payer: Aetna Medicare	$0.08
Rate for Payer: Aetna New Business (MI Preferred)	$0.10
Rate for Payer: BCBS Complete	$0.06
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cofinity Commercial	$0.11
Rate for Payer: Cofinity Commercial	$0.14
Rate for Payer: Cofinity Medicare Advantage	$0.11
Rate for Payer: Encore Health Key Benefits Commercial	$0.13
Rate for Payer: Healthscope Commercial	$0.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.14
Rate for Payer: PHP Commercial	$0.14
Rate for Payer: Priority Health Cigna Priority Health	$0.10
Rate for Payer: Priority Health SBD	$0.10

HC INJECTION THERAPEUTIC SINUS TRACT

Facility

$923.66

Service Code	CPT 20500
Hospital Charge Code	36100020
Hospital Revenue Code	361
Min. Negotiated Rate	$581.91
Max. Negotiated Rate	$831.29
Rate for Payer: Aetna Commercial	$785.11
Rate for Payer: Aetna New Business (MI Preferred)	$600.38
Rate for Payer: Cash Price	$738.93
Rate for Payer: Cofinity Commercial	$646.56
Rate for Payer: Cofinity Commercial	$794.35
Rate for Payer: Cofinity Medicare Advantage	$646.56
Rate for Payer: Encore Health Key Benefits Commercial	$738.93
Rate for Payer: Healthscope Commercial	$831.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$785.11
Rate for Payer: PHP Commercial	$785.11
Rate for Payer: Priority Health Cigna Priority Health	$600.38
Rate for Payer: Priority Health SBD	$581.91

HC INJECTION THERAPEUTIC SINUS TRACT

Facility

$923.66

Service Code	CPT 20500
Hospital Charge Code	36100020
Hospital Revenue Code	361
Min. Negotiated Rate	$581.91
Max. Negotiated Rate	$4,066.57
Rate for Payer: Aetna Commercial	$785.11
Rate for Payer: Aetna Medicare	$1,502.45
Rate for Payer: Aetna New Business (MI Preferred)	$600.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,805.83
Rate for Payer: Amish Plain Church Group Commercial	$1,805.83
Rate for Payer: BCBS Complete	$813.05
Rate for Payer: BCBS MAPPO	$1,444.66
Rate for Payer: BCN Medicare Advantage	$1,444.66
Rate for Payer: Cash Price	$738.93
Rate for Payer: Cash Price	$738.93
Rate for Payer: Cofinity Commercial	$794.35
Rate for Payer: Cofinity Commercial	$646.56
Rate for Payer: Cofinity Medicare Advantage	$646.56
Rate for Payer: Encore Health Key Benefits Commercial	$738.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,444.66
Rate for Payer: Healthscope Commercial	$831.29
Rate for Payer: Mclaren Medicaid	$774.34
Rate for Payer: Mclaren Medicare	$1,444.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,516.89
Rate for Payer: Meridian Medicaid	$813.05
Rate for Payer: MI Amish Medical Board Commercial	$1,661.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$785.11
Rate for Payer: PACE Medicare	$1,372.43
Rate for Payer: PACE SWMI	$1,444.66
Rate for Payer: PHP Commercial	$785.11
Rate for Payer: PHP Medicare Advantage	$1,444.66
Rate for Payer: Priority Health Choice Medicaid	$774.34
Rate for Payer: Priority Health Cigna Priority Health	$600.38
Rate for Payer: Priority Health Medicare	$1,444.66
Rate for Payer: Priority Health SBD	$581.91
Rate for Payer: Railroad Medicare Medicare	$1,444.66
Rate for Payer: UHC All Payor (Choice/PPO)	$4,066.57
Rate for Payer: UHC Dual Complete DSNP	$1,444.66
Rate for Payer: UHC Medicare Advantage	$1,444.66
Rate for Payer: UHCCP Medicaid	$813.34
Rate for Payer: VA VA	$1,444.66

HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC

Facility

$1,724.42

Service Code	CPT 64479
Hospital Charge Code	36100286
Hospital Revenue Code	361
Min. Negotiated Rate	$1,086.38
Max. Negotiated Rate	$1,551.98
Rate for Payer: Aetna Commercial	$1,465.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,120.87
Rate for Payer: Cash Price	$1,379.54
Rate for Payer: Cofinity Commercial	$1,207.09
Rate for Payer: Cofinity Commercial	$1,483.00
Rate for Payer: Cofinity Medicare Advantage	$1,207.09
Rate for Payer: Encore Health Key Benefits Commercial	$1,379.54
Rate for Payer: Healthscope Commercial	$1,551.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,465.76
Rate for Payer: PHP Commercial	$1,465.76
Rate for Payer: Priority Health Cigna Priority Health	$1,120.87
Rate for Payer: Priority Health SBD	$1,086.38

HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC

Facility

$1,724.42

Service Code	CPT 64479
Hospital Charge Code	36100286
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$1,465.76
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$1,120.87
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	$1,379.54
Rate for Payer: Cash Price	$1,379.54
Rate for Payer: Cofinity Commercial	$1,483.00
Rate for Payer: Cofinity Commercial	$1,207.09
Rate for Payer: Cofinity Medicare Advantage	$1,207.09
Rate for Payer: Encore Health Key Benefits Commercial	$1,379.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$1,551.98
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	$1,465.76
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$1,465.76
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	$1,120.87
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$1,086.38
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 TRANSFORAMIN CERVICAL OR THORACIC BIL

Facility

$2,586.63

Service Code	CPT 64479
Hospital Charge Code	36100623
Hospital Revenue Code	361
Min. Negotiated Rate	$1,629.58
Max. Negotiated Rate	$2,327.97
Rate for Payer: Aetna Commercial	$2,198.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,681.31
Rate for Payer: Cash Price	$2,069.30
Rate for Payer: Cofinity Commercial	$1,810.64
Rate for Payer: Cofinity Commercial	$2,224.50
Rate for Payer: Cofinity Medicare Advantage	$1,810.64
Rate for Payer: Encore Health Key Benefits Commercial	$2,069.30
Rate for Payer: Healthscope Commercial	$2,327.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,198.64
Rate for Payer: PHP Commercial	$2,198.64
Rate for Payer: Priority Health Cigna Priority Health	$1,681.31
Rate for Payer: Priority Health SBD	$1,629.58

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL

Facility

$2,586.63

Service Code	CPT 64479
Hospital Charge Code	36100623
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Commercial	$2,198.64
Rate for Payer: Aetna Medicare	$903.01
Rate for Payer: Aetna New Business (MI Preferred)	$1,681.31
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	$2,069.30
Rate for Payer: Cash Price	$2,069.30
Rate for Payer: Cofinity Commercial	$2,224.50
Rate for Payer: Cofinity Commercial	$1,810.64
Rate for Payer: Cofinity Medicare Advantage	$1,810.64
Rate for Payer: Encore Health Key Benefits Commercial	$2,069.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$868.28
Rate for Payer: Healthscope Commercial	$2,327.97
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	$2,198.64
Rate for Payer: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Commercial	$2,198.64
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	$1,681.31
Rate for Payer: Priority Health Medicare	$868.28
Rate for Payer: Priority Health SBD	$1,629.58
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 TRANSFORAMIN CERVICAL OR THORACIC EA ADD

Facility

$911.49

Service Code	CPT 64480
Hospital Charge Code	36100287
Hospital Revenue Code	361
Min. Negotiated Rate	$364.60
Max. Negotiated Rate	$820.34
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna Medicare	$455.75
Rate for Payer: Aetna New Business (MI Preferred)	$592.47
Rate for Payer: BCBS Complete	$364.60
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cofinity Commercial	$638.04
Rate for Payer: Cofinity Commercial	$783.88
Rate for Payer: Cofinity Medicare Advantage	$638.04
Rate for Payer: Encore Health Key Benefits Commercial	$729.19
Rate for Payer: Healthscope Commercial	$820.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$774.77
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: Priority Health Cigna Priority Health	$592.47
Rate for Payer: Priority Health SBD	$574.24

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD

Facility

$911.49

Service Code	CPT 64480
Hospital Charge Code	36100287
Hospital Revenue Code	361
Min. Negotiated Rate	$574.24
Max. Negotiated Rate	$820.34
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna New Business (MI Preferred)	$592.47
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cofinity Commercial	$638.04
Rate for Payer: Cofinity Commercial	$783.88
Rate for Payer: Cofinity Medicare Advantage	$638.04
Rate for Payer: Encore Health Key Benefits Commercial	$729.19
Rate for Payer: Healthscope Commercial	$820.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$774.77
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: Priority Health Cigna Priority Health	$592.47
Rate for Payer: Priority Health SBD	$574.24

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL

Facility

$1,367.24

Service Code	CPT 64480
Hospital Charge Code	36100624
Hospital Revenue Code	361
Min. Negotiated Rate	$861.36
Max. Negotiated Rate	$1,230.52
Rate for Payer: Aetna Commercial	$1,162.15
Rate for Payer: Aetna New Business (MI Preferred)	$888.71
Rate for Payer: Cash Price	$1,093.79
Rate for Payer: Cofinity Commercial	$1,175.83
Rate for Payer: Cofinity Commercial	$957.07
Rate for Payer: Cofinity Medicare Advantage	$957.07
Rate for Payer: Encore Health Key Benefits Commercial	$1,093.79
Rate for Payer: Healthscope Commercial	$1,230.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,162.15
Rate for Payer: PHP Commercial	$1,162.15
Rate for Payer: Priority Health Cigna Priority Health	$888.71
Rate for Payer: Priority Health SBD	$861.36

HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL

Facility

$1,367.24

Service Code	CPT 64480
Hospital Charge Code	36100624
Hospital Revenue Code	361
Min. Negotiated Rate	$546.90
Max. Negotiated Rate	$1,230.52
Rate for Payer: Aetna Commercial	$1,162.15
Rate for Payer: Aetna Medicare	$683.62
Rate for Payer: Aetna New Business (MI Preferred)	$888.71
Rate for Payer: BCBS Complete	$546.90
Rate for Payer: Cash Price	$1,093.79
Rate for Payer: Cofinity Commercial	$1,175.83
Rate for Payer: Cofinity Commercial	$957.07
Rate for Payer: Cofinity Medicare Advantage	$957.07
Rate for Payer: Encore Health Key Benefits Commercial	$1,093.79
Rate for Payer: Healthscope Commercial	$1,230.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,162.15
Rate for Payer: PHP Commercial	$1,162.15
Rate for Payer: Priority Health Cigna Priority Health	$888.71
Rate for Payer: Priority Health SBD	$861.36

HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL

Facility

$972.13

Service Code	CPT 64484
Hospital Charge Code	36100289
Hospital Revenue Code	361
Min. Negotiated Rate	$388.85
Max. Negotiated Rate	$874.92
Rate for Payer: Aetna Commercial	$826.31
Rate for Payer: Aetna Medicare	$486.06
Rate for Payer: Aetna New Business (MI Preferred)	$631.88
Rate for Payer: BCBS Complete	$388.85
Rate for Payer: Cash Price	$777.70
Rate for Payer: Cofinity Commercial	$680.49
Rate for Payer: Cofinity Commercial	$836.03
Rate for Payer: Cofinity Medicare Advantage	$680.49
Rate for Payer: Encore Health Key Benefits Commercial	$777.70
Rate for Payer: Healthscope Commercial	$874.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$826.31
Rate for Payer: PHP Commercial	$826.31
Rate for Payer: Priority Health Cigna Priority Health	$631.88
Rate for Payer: Priority Health SBD	$612.44

HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL

Facility

$972.13

Service Code	CPT 64484
Hospital Charge Code	36100289
Hospital Revenue Code	361
Min. Negotiated Rate	$612.44
Max. Negotiated Rate	$874.92
Rate for Payer: Aetna Commercial	$826.31
Rate for Payer: Aetna New Business (MI Preferred)	$631.88
Rate for Payer: Cash Price	$777.70
Rate for Payer: Cofinity Commercial	$680.49
Rate for Payer: Cofinity Commercial	$836.03
Rate for Payer: Cofinity Medicare Advantage	$680.49
Rate for Payer: Encore Health Key Benefits Commercial	$777.70
Rate for Payer: Healthscope Commercial	$874.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$826.31
Rate for Payer: PHP Commercial	$826.31
Rate for Payer: Priority Health Cigna Priority Health	$631.88
Rate for Payer: Priority Health SBD	$612.44

HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL

Facility

$1,458.19

Service Code	CPT 64484
Hospital Charge Code	36100625
Hospital Revenue Code	361
Min. Negotiated Rate	$583.28
Max. Negotiated Rate	$1,312.37
Rate for Payer: Aetna Commercial	$1,239.46
Rate for Payer: Aetna Medicare	$729.10
Rate for Payer: Aetna New Business (MI Preferred)	$947.82
Rate for Payer: BCBS Complete	$583.28
Rate for Payer: Cash Price	$1,166.55
Rate for Payer: Cofinity Commercial	$1,020.73
Rate for Payer: Cofinity Commercial	$1,254.04
Rate for Payer: Cofinity Medicare Advantage	$1,020.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,166.55
Rate for Payer: Healthscope Commercial	$1,312.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,239.46
Rate for Payer: PHP Commercial	$1,239.46
Rate for Payer: Priority Health Cigna Priority Health	$947.82
Rate for Payer: Priority Health SBD	$918.66

HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL

Facility

$1,458.19

Service Code	CPT 64484
Hospital Charge Code	36100625
Hospital Revenue Code	361
Min. Negotiated Rate	$918.66
Max. Negotiated Rate	$1,312.37
Rate for Payer: Aetna Commercial	$1,239.46
Rate for Payer: Aetna New Business (MI Preferred)	$947.82
Rate for Payer: Cash Price	$1,166.55
Rate for Payer: Cofinity Commercial	$1,020.73
Rate for Payer: Cofinity Commercial	$1,254.04
Rate for Payer: Cofinity Medicare Advantage	$1,020.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,166.55
Rate for Payer: Healthscope Commercial	$1,312.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,239.46
Rate for Payer: PHP Commercial	$1,239.46
Rate for Payer: Priority Health Cigna Priority Health	$947.82
Rate for Payer: Priority Health SBD	$918.66

Know your out-of-pocket cost for care.

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