Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE CTO REPLACEMENT PADS

Facility

$275.40

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$173.50
Max. Negotiated Rate	$247.86
Rate for Payer: Aetna Commercial	$234.09
Rate for Payer: Aetna New Business (MI Preferred)	$179.01
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$192.78
Rate for Payer: Cofinity Commercial	$236.84
Rate for Payer: Cofinity Medicare Advantage	$192.78
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: PHP Commercial	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: Priority Health SBD	$173.50

HC BRACE D RING SPLINT

Facility

$70.38

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$63.34
Rate for Payer: Aetna Commercial	$59.82
Rate for Payer: Aetna New Business (MI Preferred)	$45.75
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cofinity Commercial	$49.27
Rate for Payer: Cofinity Commercial	$60.53
Rate for Payer: Cofinity Medicare Advantage	$49.27
Rate for Payer: Encore Health Key Benefits Commercial	$56.30
Rate for Payer: Healthscope Commercial	$63.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.82
Rate for Payer: PHP Commercial	$59.82
Rate for Payer: Priority Health Cigna Priority Health	$45.75
Rate for Payer: Priority Health SBD	$44.34

HC BRACE D RING SPLINT

Facility

$70.38

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$63.34
Rate for Payer: Aetna Commercial	$59.82
Rate for Payer: Aetna Medicare	$35.19
Rate for Payer: Aetna New Business (MI Preferred)	$45.75
Rate for Payer: BCBS Complete	$28.15
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cofinity Commercial	$49.27
Rate for Payer: Cofinity Commercial	$60.53
Rate for Payer: Cofinity Medicare Advantage	$49.27
Rate for Payer: Encore Health Key Benefits Commercial	$56.30
Rate for Payer: Healthscope Commercial	$63.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.82
Rate for Payer: PHP Commercial	$59.82
Rate for Payer: Priority Health Cigna Priority Health	$45.75
Rate for Payer: Priority Health SBD	$44.34

HC BRACE ELBOW ORTHOSIS

Facility

$1,076.95

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$430.78
Max. Negotiated Rate	$969.25
Rate for Payer: Aetna Commercial	$915.41
Rate for Payer: Aetna Medicare	$538.48
Rate for Payer: Aetna New Business (MI Preferred)	$700.02
Rate for Payer: BCBS Complete	$430.78
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cofinity Commercial	$753.87
Rate for Payer: Cofinity Commercial	$926.18
Rate for Payer: Cofinity Medicare Advantage	$753.87
Rate for Payer: Encore Health Key Benefits Commercial	$861.56
Rate for Payer: Healthscope Commercial	$969.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$915.41
Rate for Payer: PHP Commercial	$915.41
Rate for Payer: Priority Health Cigna Priority Health	$700.02
Rate for Payer: Priority Health SBD	$678.48

HC BRACE ELBOW ORTHOSIS

Facility

$1,076.95

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$678.48
Max. Negotiated Rate	$969.25
Rate for Payer: Aetna Commercial	$915.41
Rate for Payer: Aetna New Business (MI Preferred)	$700.02
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cofinity Commercial	$753.87
Rate for Payer: Cofinity Commercial	$926.18
Rate for Payer: Cofinity Medicare Advantage	$753.87
Rate for Payer: Encore Health Key Benefits Commercial	$861.56
Rate for Payer: Healthscope Commercial	$969.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$915.41
Rate for Payer: PHP Commercial	$915.41
Rate for Payer: Priority Health Cigna Priority Health	$700.02
Rate for Payer: Priority Health SBD	$678.48

HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF

Facility

$698.70

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$440.18
Max. Negotiated Rate	$628.83
Rate for Payer: Aetna Commercial	$593.89
Rate for Payer: Aetna New Business (MI Preferred)	$454.15
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cofinity Commercial	$489.09
Rate for Payer: Cofinity Commercial	$600.88
Rate for Payer: Cofinity Medicare Advantage	$489.09
Rate for Payer: Encore Health Key Benefits Commercial	$558.96
Rate for Payer: Healthscope Commercial	$628.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$593.89
Rate for Payer: PHP Commercial	$593.89
Rate for Payer: Priority Health Cigna Priority Health	$454.15
Rate for Payer: Priority Health SBD	$440.18

HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF

Facility

$698.70

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$279.48
Max. Negotiated Rate	$628.83
Rate for Payer: Aetna Commercial	$593.89
Rate for Payer: Aetna Medicare	$349.35
Rate for Payer: Aetna New Business (MI Preferred)	$454.15
Rate for Payer: BCBS Complete	$279.48
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cofinity Commercial	$489.09
Rate for Payer: Cofinity Commercial	$600.88
Rate for Payer: Cofinity Medicare Advantage	$489.09
Rate for Payer: Encore Health Key Benefits Commercial	$558.96
Rate for Payer: Healthscope Commercial	$628.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$593.89
Rate for Payer: PHP Commercial	$593.89
Rate for Payer: Priority Health Cigna Priority Health	$454.15
Rate for Payer: Priority Health SBD	$440.18

HC BRACE FOREFOOT RELIEF SHOE

Facility

$40.80

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC BRACE FOREFOOT RELIEF SHOE

Facility

$40.80

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC BRACE FO W/O JOINTS CF

Facility

$199.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$79.97
Max. Negotiated Rate	$179.93
Rate for Payer: Aetna Commercial	$169.93
Rate for Payer: Aetna Medicare	$99.96
Rate for Payer: Aetna New Business (MI Preferred)	$129.95
Rate for Payer: BCBS Complete	$79.97
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cofinity Commercial	$139.94
Rate for Payer: Cofinity Commercial	$171.93
Rate for Payer: Cofinity Medicare Advantage	$139.94
Rate for Payer: Encore Health Key Benefits Commercial	$159.94
Rate for Payer: Healthscope Commercial	$179.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.93
Rate for Payer: PHP Commercial	$169.93
Rate for Payer: Priority Health Cigna Priority Health	$129.95
Rate for Payer: Priority Health SBD	$125.95

HC BRACE FO W/O JOINTS CF

Facility

$199.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$179.93
Rate for Payer: Aetna Commercial	$169.93
Rate for Payer: Aetna New Business (MI Preferred)	$129.95
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cofinity Commercial	$139.94
Rate for Payer: Cofinity Commercial	$171.93
Rate for Payer: Cofinity Medicare Advantage	$139.94
Rate for Payer: Encore Health Key Benefits Commercial	$159.94
Rate for Payer: Healthscope Commercial	$179.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.93
Rate for Payer: PHP Commercial	$169.93
Rate for Payer: Priority Health Cigna Priority Health	$129.95
Rate for Payer: Priority Health SBD	$125.95

HC BRACE FRACTURE BOOT CUSTOM

Facility

$422.66

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$266.28
Max. Negotiated Rate	$380.39
Rate for Payer: Aetna Commercial	$359.26
Rate for Payer: Aetna New Business (MI Preferred)	$274.73
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cofinity Commercial	$295.86
Rate for Payer: Cofinity Commercial	$363.49
Rate for Payer: Cofinity Medicare Advantage	$295.86
Rate for Payer: Encore Health Key Benefits Commercial	$338.13
Rate for Payer: Healthscope Commercial	$380.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.26
Rate for Payer: PHP Commercial	$359.26
Rate for Payer: Priority Health Cigna Priority Health	$274.73
Rate for Payer: Priority Health SBD	$266.28

HC BRACE FRACTURE BOOT CUSTOM

Facility

$422.66

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$169.06
Max. Negotiated Rate	$380.39
Rate for Payer: Aetna Commercial	$359.26
Rate for Payer: Aetna Medicare	$211.33
Rate for Payer: Aetna New Business (MI Preferred)	$274.73
Rate for Payer: BCBS Complete	$169.06
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cofinity Commercial	$295.86
Rate for Payer: Cofinity Commercial	$363.49
Rate for Payer: Cofinity Medicare Advantage	$295.86
Rate for Payer: Encore Health Key Benefits Commercial	$338.13
Rate for Payer: Healthscope Commercial	$380.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.26
Rate for Payer: PHP Commercial	$359.26
Rate for Payer: Priority Health Cigna Priority Health	$274.73
Rate for Payer: Priority Health SBD	$266.28

HC BRACE FRACTURE BOOT OTS

Facility

$507.18

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$202.87
Max. Negotiated Rate	$456.46
Rate for Payer: Aetna Commercial	$431.10
Rate for Payer: Aetna Medicare	$253.59
Rate for Payer: Aetna New Business (MI Preferred)	$329.67
Rate for Payer: BCBS Complete	$202.87
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cofinity Commercial	$355.03
Rate for Payer: Cofinity Commercial	$436.17
Rate for Payer: Cofinity Medicare Advantage	$355.03
Rate for Payer: Encore Health Key Benefits Commercial	$405.74
Rate for Payer: Healthscope Commercial	$456.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.10
Rate for Payer: PHP Commercial	$431.10
Rate for Payer: Priority Health Cigna Priority Health	$329.67
Rate for Payer: Priority Health SBD	$319.52

HC BRACE FRACTURE BOOT OTS

Facility

$507.18

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$319.52
Max. Negotiated Rate	$456.46
Rate for Payer: Aetna Commercial	$431.10
Rate for Payer: Aetna New Business (MI Preferred)	$329.67
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cofinity Commercial	$355.03
Rate for Payer: Cofinity Commercial	$436.17
Rate for Payer: Cofinity Medicare Advantage	$355.03
Rate for Payer: Encore Health Key Benefits Commercial	$405.74
Rate for Payer: Healthscope Commercial	$456.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.10
Rate for Payer: PHP Commercial	$431.10
Rate for Payer: Priority Health Cigna Priority Health	$329.67
Rate for Payer: Priority Health SBD	$319.52

HC BRACE HAND/FINGER ORTHOSIS

Facility

$299.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$119.95
Max. Negotiated Rate	$269.89
Rate for Payer: Aetna Commercial	$254.90
Rate for Payer: Aetna Medicare	$149.94
Rate for Payer: Aetna New Business (MI Preferred)	$194.92
Rate for Payer: BCBS Complete	$119.95
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cofinity Commercial	$209.92
Rate for Payer: Cofinity Commercial	$257.90
Rate for Payer: Cofinity Medicare Advantage	$209.92
Rate for Payer: Encore Health Key Benefits Commercial	$239.90
Rate for Payer: Healthscope Commercial	$269.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.90
Rate for Payer: PHP Commercial	$254.90
Rate for Payer: Priority Health Cigna Priority Health	$194.92
Rate for Payer: Priority Health SBD	$188.92

HC BRACE HAND/FINGER ORTHOSIS

Facility

$299.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$188.92
Max. Negotiated Rate	$269.89
Rate for Payer: Aetna Commercial	$254.90
Rate for Payer: Aetna New Business (MI Preferred)	$194.92
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cofinity Commercial	$209.92
Rate for Payer: Cofinity Commercial	$257.90
Rate for Payer: Cofinity Medicare Advantage	$209.92
Rate for Payer: Encore Health Key Benefits Commercial	$239.90
Rate for Payer: Healthscope Commercial	$269.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.90
Rate for Payer: PHP Commercial	$254.90
Rate for Payer: Priority Health Cigna Priority Health	$194.92
Rate for Payer: Priority Health SBD	$188.92

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$513.96

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$205.58
Max. Negotiated Rate	$462.56
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare	$256.98
Rate for Payer: Aetna New Business (MI Preferred)	$334.07
Rate for Payer: BCBS Complete	$205.58
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cofinity Commercial	$359.77
Rate for Payer: Cofinity Commercial	$442.01
Rate for Payer: Cofinity Medicare Advantage	$359.77
Rate for Payer: Encore Health Key Benefits Commercial	$411.17
Rate for Payer: Healthscope Commercial	$462.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.87
Rate for Payer: PHP Commercial	$436.87
Rate for Payer: Priority Health Cigna Priority Health	$334.07
Rate for Payer: Priority Health SBD	$323.79

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$513.96

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$323.79
Max. Negotiated Rate	$462.56
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna New Business (MI Preferred)	$334.07
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cofinity Commercial	$359.77
Rate for Payer: Cofinity Commercial	$442.01
Rate for Payer: Cofinity Medicare Advantage	$359.77
Rate for Payer: Encore Health Key Benefits Commercial	$411.17
Rate for Payer: Healthscope Commercial	$462.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.87
Rate for Payer: PHP Commercial	$436.87
Rate for Payer: Priority Health Cigna Priority Health	$334.07
Rate for Payer: Priority Health SBD	$323.79

HC BRACE HARD HELMET

Facility

$420.79

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$168.32
Max. Negotiated Rate	$378.71
Rate for Payer: Aetna Commercial	$357.67
Rate for Payer: Aetna Medicare	$210.40
Rate for Payer: Aetna New Business (MI Preferred)	$273.51
Rate for Payer: BCBS Complete	$168.32
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cofinity Commercial	$294.55
Rate for Payer: Cofinity Commercial	$361.88
Rate for Payer: Cofinity Medicare Advantage	$294.55
Rate for Payer: Encore Health Key Benefits Commercial	$336.63
Rate for Payer: Healthscope Commercial	$378.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.67
Rate for Payer: PHP Commercial	$357.67
Rate for Payer: Priority Health Cigna Priority Health	$273.51
Rate for Payer: Priority Health SBD	$265.10

HC BRACE HARD HELMET

Facility

$420.79

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$265.10
Max. Negotiated Rate	$378.71
Rate for Payer: Aetna Commercial	$357.67
Rate for Payer: Aetna New Business (MI Preferred)	$273.51
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cofinity Commercial	$294.55
Rate for Payer: Cofinity Commercial	$361.88
Rate for Payer: Cofinity Medicare Advantage	$294.55
Rate for Payer: Encore Health Key Benefits Commercial	$336.63
Rate for Payer: Healthscope Commercial	$378.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.67
Rate for Payer: PHP Commercial	$357.67
Rate for Payer: Priority Health Cigna Priority Health	$273.51
Rate for Payer: Priority Health SBD	$265.10

HC BRACE HEEL RELIEF SHOE

Facility

$183.60

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$165.24
Rate for Payer: Aetna Commercial	$156.06
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: Aetna New Business (MI Preferred)	$119.34
Rate for Payer: BCBS Complete	$73.44
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cofinity Commercial	$128.52
Rate for Payer: Cofinity Commercial	$157.90
Rate for Payer: Cofinity Medicare Advantage	$128.52
Rate for Payer: Encore Health Key Benefits Commercial	$146.88
Rate for Payer: Healthscope Commercial	$165.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.06
Rate for Payer: PHP Commercial	$156.06
Rate for Payer: Priority Health Cigna Priority Health	$119.34
Rate for Payer: Priority Health SBD	$115.67

HC BRACE HEEL RELIEF SHOE

Facility

$183.60

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$115.67
Max. Negotiated Rate	$165.24
Rate for Payer: Aetna Commercial	$156.06
Rate for Payer: Aetna New Business (MI Preferred)	$119.34
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cofinity Commercial	$128.52
Rate for Payer: Cofinity Commercial	$157.90
Rate for Payer: Cofinity Medicare Advantage	$128.52
Rate for Payer: Encore Health Key Benefits Commercial	$146.88
Rate for Payer: Healthscope Commercial	$165.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.06
Rate for Payer: PHP Commercial	$156.06
Rate for Payer: Priority Health Cigna Priority Health	$119.34
Rate for Payer: Priority Health SBD	$115.67

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$127.50

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$80.33
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna New Business (MI Preferred)	$82.88
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$109.65
Rate for Payer: Cofinity Commercial	$89.25
Rate for Payer: Cofinity Medicare Advantage	$89.25
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: PHP Commercial	$108.38
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health SBD	$80.33

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$127.50

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna Medicare	$63.75
Rate for Payer: Aetna New Business (MI Preferred)	$82.88
Rate for Payer: BCBS Complete	$51.00
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$109.65
Rate for Payer: Cofinity Commercial	$89.25
Rate for Payer: Cofinity Medicare Advantage	$89.25
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: PHP Commercial	$108.38
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health SBD	$80.33

Know your out-of-pocket cost for care.

All Charges