Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION

Facility

$325.64

Service Code	NDC 17478070125
Hospital Charge Code	10266
Hospital Revenue Code	250
Min. Negotiated Rate	$130.26
Max. Negotiated Rate	$293.08
Rate for Payer: Aetna Commercial	$276.79
Rate for Payer: Aetna Medicare	$162.82
Rate for Payer: Aetna New Business (MI Preferred)	$211.67
Rate for Payer: BCBS Complete	$130.26
Rate for Payer: Cash Price	$260.51
Rate for Payer: Cofinity Commercial	$227.95
Rate for Payer: Cofinity Commercial	$280.05
Rate for Payer: Cofinity Medicare Advantage	$227.95
Rate for Payer: Encore Health Key Benefits Commercial	$260.51
Rate for Payer: Healthscope Commercial	$293.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$276.79
Rate for Payer: PHP Commercial	$276.79
Rate for Payer: Priority Health Cigna Priority Health	$211.67
Rate for Payer: Priority Health SBD	$205.15

INDOMETHACIN 25 MG CAPSULE

Facility

$120.18

Service Code	NDC 50268043015
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$75.71
Max. Negotiated Rate	$108.16
Rate for Payer: Aetna Commercial	$102.15
Rate for Payer: Aetna New Business (MI Preferred)	$78.12
Rate for Payer: Cash Price	$96.14
Rate for Payer: Cofinity Commercial	$103.35
Rate for Payer: Cofinity Commercial	$84.13
Rate for Payer: Cofinity Medicare Advantage	$84.13
Rate for Payer: Encore Health Key Benefits Commercial	$96.14
Rate for Payer: Healthscope Commercial	$108.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.15
Rate for Payer: PHP Commercial	$102.15
Rate for Payer: Priority Health Cigna Priority Health	$78.12
Rate for Payer: Priority Health SBD	$75.71

INDOMETHACIN 25 MG CAPSULE

Facility

$420.65

Service Code	NDC 23155001001
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$265.01
Max. Negotiated Rate	$378.58
Rate for Payer: Aetna Commercial	$357.55
Rate for Payer: Aetna New Business (MI Preferred)	$273.42
Rate for Payer: Cash Price	$336.52
Rate for Payer: Cofinity Commercial	$294.45
Rate for Payer: Cofinity Commercial	$361.76
Rate for Payer: Cofinity Medicare Advantage	$294.45
Rate for Payer: Encore Health Key Benefits Commercial	$336.52
Rate for Payer: Healthscope Commercial	$378.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.55
Rate for Payer: PHP Commercial	$357.55
Rate for Payer: Priority Health Cigna Priority Health	$273.42
Rate for Payer: Priority Health SBD	$265.01

INDOMETHACIN 25 MG CAPSULE

Facility

$2.41

Service Code	NDC 50268043011
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.17
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna Medicare	$1.21
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: BCBS Complete	$0.96
Rate for Payer: Cash Price	$1.93
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.07
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.93
Rate for Payer: Healthscope Commercial	$2.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.05
Rate for Payer: PHP Commercial	$2.05
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

INDOMETHACIN 25 MG CAPSULE

Facility

$2.41

Service Code	NDC 50268043011
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.17
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: Cash Price	$1.93
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.07
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.93
Rate for Payer: Healthscope Commercial	$2.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.05
Rate for Payer: PHP Commercial	$2.05
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

INDOMETHACIN 25 MG CAPSULE

Facility

$420.65

Service Code	NDC 23155001001
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$168.26
Max. Negotiated Rate	$378.58
Rate for Payer: Aetna Commercial	$357.55
Rate for Payer: Aetna Medicare	$210.32
Rate for Payer: Aetna New Business (MI Preferred)	$273.42
Rate for Payer: BCBS Complete	$168.26
Rate for Payer: Cash Price	$336.52
Rate for Payer: Cofinity Commercial	$294.45
Rate for Payer: Cofinity Commercial	$361.76
Rate for Payer: Cofinity Medicare Advantage	$294.45
Rate for Payer: Encore Health Key Benefits Commercial	$336.52
Rate for Payer: Healthscope Commercial	$378.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.55
Rate for Payer: PHP Commercial	$357.55
Rate for Payer: Priority Health Cigna Priority Health	$273.42
Rate for Payer: Priority Health SBD	$265.01

INDOMETHACIN 25 MG CAPSULE

Facility

$120.18

Service Code	NDC 50268043015
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$48.07
Max. Negotiated Rate	$108.16
Rate for Payer: Aetna Commercial	$102.15
Rate for Payer: Aetna Medicare	$60.09
Rate for Payer: Aetna New Business (MI Preferred)	$78.12
Rate for Payer: BCBS Complete	$48.07
Rate for Payer: Cash Price	$96.14
Rate for Payer: Cofinity Commercial	$103.35
Rate for Payer: Cofinity Commercial	$84.13
Rate for Payer: Cofinity Medicare Advantage	$84.13
Rate for Payer: Encore Health Key Benefits Commercial	$96.14
Rate for Payer: Healthscope Commercial	$108.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.15
Rate for Payer: PHP Commercial	$102.15
Rate for Payer: Priority Health Cigna Priority Health	$78.12
Rate for Payer: Priority Health SBD	$75.71

INFLIXIMAB 100 MG INTRAVENOUS SOLUTION

Facility

$1,481.25

Service Code	HCPCS J1745
Hospital Charge Code	23796
Hospital Revenue Code	636
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$1,333.12
Rate for Payer: Aetna Commercial	$1,259.06
Rate for Payer: Aetna Commercial	$3,095.53
Rate for Payer: Aetna Medicare	$32.33
Rate for Payer: Aetna Medicare	$32.33
Rate for Payer: Aetna New Business (MI Preferred)	$962.81
Rate for Payer: Aetna New Business (MI Preferred)	$2,367.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$38.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$38.86
Rate for Payer: Amish Plain Church Group Commercial	$38.86
Rate for Payer: Amish Plain Church Group Commercial	$38.86
Rate for Payer: BCBS Complete	$17.50
Rate for Payer: BCBS Complete	$17.50
Rate for Payer: BCBS MAPPO	$31.09
Rate for Payer: BCBS MAPPO	$31.09
Rate for Payer: BCN Medicare Advantage	$31.09
Rate for Payer: BCN Medicare Advantage	$31.09
Rate for Payer: Cash Price	$2,913.44
Rate for Payer: Cash Price	$2,913.44
Rate for Payer: Cash Price	$1,185.00
Rate for Payer: Cash Price	$1,185.00
Rate for Payer: Cofinity Commercial	$2,549.26
Rate for Payer: Cofinity Commercial	$3,131.95
Rate for Payer: Cofinity Commercial	$1,273.88
Rate for Payer: Cofinity Commercial	$1,036.88
Rate for Payer: Cofinity Medicare Advantage	$1,036.88
Rate for Payer: Cofinity Medicare Advantage	$2,549.26
Rate for Payer: Encore Health Key Benefits Commercial	$2,913.44
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.09
Rate for Payer: Healthscope Commercial	$1,333.12
Rate for Payer: Healthscope Commercial	$3,277.62
Rate for Payer: Mclaren Medicaid	$16.66
Rate for Payer: Mclaren Medicaid	$16.66
Rate for Payer: Mclaren Medicare	$31.09
Rate for Payer: Mclaren Medicare	$31.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$32.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$32.64
Rate for Payer: Meridian Medicaid	$17.50
Rate for Payer: Meridian Medicaid	$17.50
Rate for Payer: MI Amish Medical Board Commercial	$35.75
Rate for Payer: MI Amish Medical Board Commercial	$35.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,095.53
Rate for Payer: PACE Medicare	$29.54
Rate for Payer: PACE Medicare	$29.54
Rate for Payer: PACE SWMI	$31.09
Rate for Payer: PACE SWMI	$31.09
Rate for Payer: PHP Commercial	$3,095.53
Rate for Payer: PHP Commercial	$1,259.06
Rate for Payer: PHP Medicare Advantage	$31.09
Rate for Payer: PHP Medicare Advantage	$31.09
Rate for Payer: Priority Health Choice Medicaid	$16.66
Rate for Payer: Priority Health Choice Medicaid	$16.66
Rate for Payer: Priority Health Cigna Priority Health	$2,367.17
Rate for Payer: Priority Health Cigna Priority Health	$962.81
Rate for Payer: Priority Health Medicare	$31.09
Rate for Payer: Priority Health Medicare	$31.09
Rate for Payer: Priority Health SBD	$2,294.33
Rate for Payer: Priority Health SBD	$933.19
Rate for Payer: Railroad Medicare Medicare	$31.09
Rate for Payer: Railroad Medicare Medicare	$31.09
Rate for Payer: UHC All Payor (Choice/PPO)	$87.52
Rate for Payer: UHC All Payor (Choice/PPO)	$87.52
Rate for Payer: UHC Dual Complete DSNP	$31.09
Rate for Payer: UHC Dual Complete DSNP	$31.09
Rate for Payer: UHC Medicare Advantage	$31.09
Rate for Payer: UHC Medicare Advantage	$31.09
Rate for Payer: UHCCP Medicaid	$17.50
Rate for Payer: UHCCP Medicaid	$17.50
Rate for Payer: VA VA	$31.09
Rate for Payer: VA VA	$31.09

INFLIXIMAB 100 MG INTRAVENOUS SOLUTION

Facility

$1,481.25

Service Code	HCPCS J1745
Hospital Charge Code	23796
Hospital Revenue Code	636
Min. Negotiated Rate	$933.19
Max. Negotiated Rate	$1,333.12
Rate for Payer: Aetna Commercial	$1,259.06
Rate for Payer: Aetna Commercial	$3,095.53
Rate for Payer: Aetna New Business (MI Preferred)	$962.81
Rate for Payer: Aetna New Business (MI Preferred)	$2,367.17
Rate for Payer: Cash Price	$1,185.00
Rate for Payer: Cash Price	$2,913.44
Rate for Payer: Cofinity Commercial	$1,036.88
Rate for Payer: Cofinity Commercial	$2,549.26
Rate for Payer: Cofinity Commercial	$3,131.95
Rate for Payer: Cofinity Commercial	$1,273.88
Rate for Payer: Cofinity Medicare Advantage	$2,549.26
Rate for Payer: Cofinity Medicare Advantage	$1,036.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,913.44
Rate for Payer: Healthscope Commercial	$1,333.12
Rate for Payer: Healthscope Commercial	$3,277.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,095.53
Rate for Payer: PHP Commercial	$1,259.06
Rate for Payer: PHP Commercial	$3,095.53
Rate for Payer: Priority Health Cigna Priority Health	$2,367.17
Rate for Payer: Priority Health Cigna Priority Health	$962.81
Rate for Payer: Priority Health SBD	$2,294.33
Rate for Payer: Priority Health SBD	$933.19

INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION

Facility

$1,482.02

Service Code	HCPCS Q5104
Hospital Charge Code	184064
Hospital Revenue Code	636
Min. Negotiated Rate	$933.67
Max. Negotiated Rate	$1,333.82
Rate for Payer: Aetna Commercial	$1,259.72
Rate for Payer: Aetna New Business (MI Preferred)	$963.31
Rate for Payer: Cash Price	$1,185.62
Rate for Payer: Cofinity Commercial	$1,037.41
Rate for Payer: Cofinity Commercial	$1,274.54
Rate for Payer: Cofinity Medicare Advantage	$1,037.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.62
Rate for Payer: Healthscope Commercial	$1,333.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.72
Rate for Payer: PHP Commercial	$1,259.72
Rate for Payer: Priority Health Cigna Priority Health	$963.31
Rate for Payer: Priority Health SBD	$933.67

INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION

Facility

$1,482.02

Service Code	HCPCS Q5104
Hospital Charge Code	184064
Hospital Revenue Code	636
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$1,333.82
Rate for Payer: Aetna Commercial	$1,259.72
Rate for Payer: Aetna Medicare	$28.08
Rate for Payer: Aetna New Business (MI Preferred)	$963.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$33.75
Rate for Payer: Amish Plain Church Group Commercial	$33.75
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS MAPPO	$27.00
Rate for Payer: BCN Medicare Advantage	$27.00
Rate for Payer: Cash Price	$1,185.62
Rate for Payer: Cash Price	$1,185.62
Rate for Payer: Cofinity Commercial	$1,274.54
Rate for Payer: Cofinity Commercial	$1,037.41
Rate for Payer: Cofinity Medicare Advantage	$1,037.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.00
Rate for Payer: Healthscope Commercial	$1,333.82
Rate for Payer: Mclaren Medicaid	$14.47
Rate for Payer: Mclaren Medicare	$27.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28.35
Rate for Payer: Meridian Medicaid	$15.20
Rate for Payer: MI Amish Medical Board Commercial	$31.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.72
Rate for Payer: PACE Medicare	$25.65
Rate for Payer: PACE SWMI	$27.00
Rate for Payer: PHP Commercial	$1,259.72
Rate for Payer: PHP Medicare Advantage	$27.00
Rate for Payer: Priority Health Choice Medicaid	$14.47
Rate for Payer: Priority Health Cigna Priority Health	$963.31
Rate for Payer: Priority Health Medicare	$27.00
Rate for Payer: Priority Health SBD	$933.67
Rate for Payer: Railroad Medicare Medicare	$27.00
Rate for Payer: UHC All Payor (Choice/PPO)	$76.00
Rate for Payer: UHC Dual Complete DSNP	$27.00
Rate for Payer: UHC Medicare Advantage	$27.00
Rate for Payer: UHCCP Medicaid	$15.20
Rate for Payer: VA VA	$27.00

INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION

Facility

$1,818.98

Service Code	HCPCS Q5103
Hospital Charge Code	181037
Hospital Revenue Code	636
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$1,637.08
Rate for Payer: Aetna Commercial	$1,546.13
Rate for Payer: Aetna Medicare	$20.79
Rate for Payer: Aetna New Business (MI Preferred)	$1,182.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$24.99
Rate for Payer: Amish Plain Church Group Commercial	$24.99
Rate for Payer: BCBS Complete	$11.25
Rate for Payer: BCBS MAPPO	$19.99
Rate for Payer: BCN Medicare Advantage	$19.99
Rate for Payer: Cash Price	$1,455.18
Rate for Payer: Cash Price	$1,455.18
Rate for Payer: Cofinity Commercial	$1,273.29
Rate for Payer: Cofinity Commercial	$1,564.32
Rate for Payer: Cofinity Medicare Advantage	$1,273.29
Rate for Payer: Encore Health Key Benefits Commercial	$1,455.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$19.99
Rate for Payer: Healthscope Commercial	$1,637.08
Rate for Payer: Mclaren Medicaid	$10.71
Rate for Payer: Mclaren Medicare	$19.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$20.99
Rate for Payer: Meridian Medicaid	$11.25
Rate for Payer: MI Amish Medical Board Commercial	$22.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,546.13
Rate for Payer: PACE Medicare	$18.99
Rate for Payer: PACE SWMI	$19.99
Rate for Payer: PHP Commercial	$1,546.13
Rate for Payer: PHP Medicare Advantage	$19.99
Rate for Payer: Priority Health Choice Medicaid	$10.71
Rate for Payer: Priority Health Cigna Priority Health	$1,182.34
Rate for Payer: Priority Health Medicare	$19.99
Rate for Payer: Priority Health SBD	$1,145.96
Rate for Payer: Railroad Medicare Medicare	$19.99
Rate for Payer: UHC All Payor (Choice/PPO)	$56.27
Rate for Payer: UHC Dual Complete DSNP	$19.99
Rate for Payer: UHC Medicare Advantage	$19.99
Rate for Payer: UHCCP Medicaid	$11.25
Rate for Payer: VA VA	$19.99

INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION

Facility

$1,818.98

Service Code	HCPCS Q5103
Hospital Charge Code	181037
Hospital Revenue Code	636
Min. Negotiated Rate	$1,145.96
Max. Negotiated Rate	$1,637.08
Rate for Payer: Aetna Commercial	$1,546.13
Rate for Payer: Aetna New Business (MI Preferred)	$1,182.34
Rate for Payer: Cash Price	$1,455.18
Rate for Payer: Cofinity Commercial	$1,273.29
Rate for Payer: Cofinity Commercial	$1,564.32
Rate for Payer: Cofinity Medicare Advantage	$1,273.29
Rate for Payer: Encore Health Key Benefits Commercial	$1,455.18
Rate for Payer: Healthscope Commercial	$1,637.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,546.13
Rate for Payer: PHP Commercial	$1,546.13
Rate for Payer: Priority Health Cigna Priority Health	$1,182.34
Rate for Payer: Priority Health SBD	$1,145.96

INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)

Facility

$2,444.12

Service Code	CPT 64510
Hospital Revenue Code	361
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Medicare	$903.01
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: Health Alliance Plan Medicare Advantage	$868.28
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: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Medicare	$868.28
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

INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY

Facility

$1,901.18

Service Code	CPT G0260
Hospital Revenue Code	361
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Medicare	$702.42
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: Health Alliance Plan Medicare Advantage	$675.40
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: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Medicare	$675.40
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

INJECTION PROCEDURE; RADIOACTIVE TRACER FOR IDENTIFICATION OF SENTINEL NODE

Facility

$1,103.16

Service Code	CPT 38792
Hospital Revenue Code	360
Min. Negotiated Rate	$210.06
Max. Negotiated Rate	$1,103.16
Rate for Payer: Aetna Medicare	$407.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$489.88
Rate for Payer: Amish Plain Church Group Commercial	$489.88
Rate for Payer: BCBS Complete	$220.56
Rate for Payer: BCBS MAPPO	$391.90
Rate for Payer: BCN Medicare Advantage	$391.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$391.90
Rate for Payer: Mclaren Medicaid	$210.06
Rate for Payer: Mclaren Medicare	$391.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$411.50
Rate for Payer: Meridian Medicaid	$220.56
Rate for Payer: MI Amish Medical Board Commercial	$450.69
Rate for Payer: PACE Medicare	$372.31
Rate for Payer: PACE SWMI	$391.90
Rate for Payer: PHP Medicare Advantage	$391.90
Rate for Payer: Priority Health Choice Medicaid	$210.06
Rate for Payer: Priority Health Medicare	$391.90
Rate for Payer: Railroad Medicare Medicare	$391.90
Rate for Payer: UHC All Payor (Choice/PPO)	$1,103.16
Rate for Payer: UHC Dual Complete DSNP	$391.90
Rate for Payer: UHC Medicare Advantage	$391.90
Rate for Payer: UHCCP Medicaid	$220.64
Rate for Payer: VA VA	$391.90

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT), INCLUDING IMAGING GUIDANCE, WHEN PERFORMED

Facility

$2,444.12

Service Code	CPT 64448
Hospital Revenue Code	360
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$2,444.12
Rate for Payer: Aetna Medicare	$903.01
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: Health Alliance Plan Medicare Advantage	$868.28
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: PACE Medicare	$824.87
Rate for Payer: PACE SWMI	$868.28
Rate for Payer: PHP Medicare Advantage	$868.28
Rate for Payer: Priority Health Choice Medicaid	$465.40
Rate for Payer: Priority Health Medicare	$868.28
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

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED

Facility

$1,901.18

Service Code	CPT 64454
Hospital Revenue Code	361
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Medicare	$702.42
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: Health Alliance Plan Medicare Advantage	$675.40
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: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Medicare	$675.40
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

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH

Facility

$1,901.18

Service Code	CPT 64450
Hospital Revenue Code	360
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Medicare	$702.42
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: Health Alliance Plan Medicare Advantage	$675.40
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: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Medicare	$675.40
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

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH

Facility

$1,901.18

Service Code	CPT 64450
Hospital Revenue Code	361
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Medicare	$702.42
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: Health Alliance Plan Medicare Advantage	$675.40
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: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Medicare	$675.40
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

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRIGEMINAL NERVE, EACH BRANCH (IE, OPHTHALMIC, MAXILLARY, MANDIBULAR)

Facility

$810.38

Service Code	CPT 64400
Hospital Revenue Code	361
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
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: Health Alliance Plan Medicare Advantage	$287.89
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: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
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

INJECTION(S); SINGLE TENDON ORIGIN/INSERTION

Facility

$810.38

Service Code	CPT 20551
Hospital Revenue Code	360
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
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: Health Alliance Plan Medicare Advantage	$287.89
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: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
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

INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")

Facility

$810.38

Service Code	CPT 20550
Hospital Revenue Code	360
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
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: Health Alliance Plan Medicare Advantage	$287.89
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: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
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

INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL

Facility

$810.38

Service Code	CPT 20526
Hospital Revenue Code	360
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
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: Health Alliance Plan Medicare Advantage	$287.89
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: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
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

INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)

Facility

$353.86

Service Code	CPT 11981
Hospital Revenue Code	360
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$353.86
Rate for Payer: Aetna Medicare	$130.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$157.14
Rate for Payer: Amish Plain Church Group Commercial	$157.14
Rate for Payer: BCBS Complete	$70.75
Rate for Payer: BCBS MAPPO	$125.71
Rate for Payer: BCN Medicare Advantage	$125.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$125.71
Rate for Payer: Mclaren Medicaid	$67.38
Rate for Payer: Mclaren Medicare	$125.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$132.00
Rate for Payer: Meridian Medicaid	$70.75
Rate for Payer: MI Amish Medical Board Commercial	$144.57
Rate for Payer: PACE Medicare	$119.42
Rate for Payer: PACE SWMI	$125.71
Rate for Payer: PHP Medicare Advantage	$125.71
Rate for Payer: Priority Health Choice Medicaid	$67.38
Rate for Payer: Priority Health Medicare	$125.71
Rate for Payer: Railroad Medicare Medicare	$125.71
Rate for Payer: UHC All Payor (Choice/PPO)	$353.86
Rate for Payer: UHC Dual Complete DSNP	$125.71
Rate for Payer: UHC Medicare Advantage	$125.71
Rate for Payer: UHCCP Medicaid	$70.77
Rate for Payer: VA VA	$125.71

Know your out-of-pocket cost for care.

All Charges