Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE TLSO PREFAB

Facility

$3,016.68

Service Code	HCPCS L0464
Hospital Charge Code	27400037
Hospital Revenue Code	274
Min. Negotiated Rate	$1,900.51
Max. Negotiated Rate	$2,715.01
Rate for Payer: Aetna Commercial	$2,564.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,960.84
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cofinity Commercial	$2,111.68
Rate for Payer: Cofinity Commercial	$2,594.34
Rate for Payer: Cofinity Medicare Advantage	$2,111.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,413.34
Rate for Payer: Healthscope Commercial	$2,715.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,564.18
Rate for Payer: PHP Commercial	$2,564.18
Rate for Payer: Priority Health Cigna Priority Health	$1,960.84
Rate for Payer: Priority Health SBD	$1,900.51

HC BRACE TLSO PREFAB

Facility

$3,016.68

Service Code	HCPCS L0464
Hospital Charge Code	27400037
Hospital Revenue Code	274
Min. Negotiated Rate	$1,206.67
Max. Negotiated Rate	$2,715.01
Rate for Payer: Aetna Commercial	$2,564.18
Rate for Payer: Aetna Medicare	$1,508.34
Rate for Payer: Aetna New Business (MI Preferred)	$1,960.84
Rate for Payer: BCBS Complete	$1,206.67
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cofinity Commercial	$2,111.68
Rate for Payer: Cofinity Commercial	$2,594.34
Rate for Payer: Cofinity Medicare Advantage	$2,111.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,413.34
Rate for Payer: Healthscope Commercial	$2,715.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,564.18
Rate for Payer: PHP Commercial	$2,564.18
Rate for Payer: Priority Health Cigna Priority Health	$1,960.84
Rate for Payer: Priority Health SBD	$1,900.51

HC BRACE TLSO PREFAB CUSTOM FIT

Facility

$2,003.54

Service Code	HCPCS L0460
Hospital Charge Code	27400023
Hospital Revenue Code	274
Min. Negotiated Rate	$801.42
Max. Negotiated Rate	$1,803.19
Rate for Payer: Aetna Commercial	$1,703.01
Rate for Payer: Aetna Medicare	$1,001.77
Rate for Payer: Aetna New Business (MI Preferred)	$1,302.30
Rate for Payer: BCBS Complete	$801.42
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cofinity Commercial	$1,402.48
Rate for Payer: Cofinity Commercial	$1,723.04
Rate for Payer: Cofinity Medicare Advantage	$1,402.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,602.83
Rate for Payer: Healthscope Commercial	$1,803.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.01
Rate for Payer: PHP Commercial	$1,703.01
Rate for Payer: Priority Health Cigna Priority Health	$1,302.30
Rate for Payer: Priority Health SBD	$1,262.23

HC BRACE TLSO PREFAB CUSTOM FIT

Facility

$2,003.54

Service Code	HCPCS L0460
Hospital Charge Code	27400023
Hospital Revenue Code	274
Min. Negotiated Rate	$1,262.23
Max. Negotiated Rate	$1,803.19
Rate for Payer: Aetna Commercial	$1,703.01
Rate for Payer: Aetna New Business (MI Preferred)	$1,302.30
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cofinity Commercial	$1,402.48
Rate for Payer: Cofinity Commercial	$1,723.04
Rate for Payer: Cofinity Medicare Advantage	$1,402.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,602.83
Rate for Payer: Healthscope Commercial	$1,803.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.01
Rate for Payer: PHP Commercial	$1,703.01
Rate for Payer: Priority Health Cigna Priority Health	$1,302.30
Rate for Payer: Priority Health SBD	$1,262.23

HC BRACE UE FX RAD/ULNAR ORTHOSIS

Facility

$47.94

Service Code	HCPCS L3982
Hospital Charge Code	27400026
Hospital Revenue Code	274
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$43.15
Rate for Payer: Aetna Commercial	$40.75
Rate for Payer: Aetna Medicare	$23.97
Rate for Payer: Aetna New Business (MI Preferred)	$31.16
Rate for Payer: BCBS Complete	$19.18
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Cofinity Commercial	$41.23
Rate for Payer: Cofinity Medicare Advantage	$33.56
Rate for Payer: Encore Health Key Benefits Commercial	$38.35
Rate for Payer: Healthscope Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.75
Rate for Payer: PHP Commercial	$40.75
Rate for Payer: Priority Health Cigna Priority Health	$31.16
Rate for Payer: Priority Health SBD	$30.20

HC BRACE UE FX RAD/ULNAR ORTHOSIS

Facility

$47.94

Service Code	HCPCS L3982
Hospital Charge Code	27400026
Hospital Revenue Code	274
Min. Negotiated Rate	$30.20
Max. Negotiated Rate	$43.15
Rate for Payer: Aetna Commercial	$40.75
Rate for Payer: Aetna New Business (MI Preferred)	$31.16
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Cofinity Commercial	$41.23
Rate for Payer: Cofinity Medicare Advantage	$33.56
Rate for Payer: Encore Health Key Benefits Commercial	$38.35
Rate for Payer: Healthscope Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.75
Rate for Payer: PHP Commercial	$40.75
Rate for Payer: Priority Health Cigna Priority Health	$31.16
Rate for Payer: Priority Health SBD	$30.20

HC BRACE UNIVERSAL COCKUP SPLINT

Facility

$36.15

Service Code	HCPCS L3908
Hospital Charge Code	27400012
Hospital Revenue Code	274
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$32.53
Rate for Payer: Aetna Commercial	$30.73
Rate for Payer: Aetna Medicare	$18.07
Rate for Payer: Aetna New Business (MI Preferred)	$23.50
Rate for Payer: BCBS Complete	$14.46
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cofinity Commercial	$25.30
Rate for Payer: Cofinity Commercial	$31.09
Rate for Payer: Cofinity Medicare Advantage	$25.30
Rate for Payer: Encore Health Key Benefits Commercial	$28.92
Rate for Payer: Healthscope Commercial	$32.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.73
Rate for Payer: PHP Commercial	$30.73
Rate for Payer: Priority Health Cigna Priority Health	$23.50
Rate for Payer: Priority Health SBD	$22.77

HC BRACE UNIVERSAL COCKUP SPLINT

Facility

$36.15

Service Code	HCPCS L3908
Hospital Charge Code	27400012
Hospital Revenue Code	274
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$32.53
Rate for Payer: Aetna Commercial	$30.73
Rate for Payer: Aetna New Business (MI Preferred)	$23.50
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cofinity Commercial	$25.30
Rate for Payer: Cofinity Commercial	$31.09
Rate for Payer: Cofinity Medicare Advantage	$25.30
Rate for Payer: Encore Health Key Benefits Commercial	$28.92
Rate for Payer: Healthscope Commercial	$32.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.73
Rate for Payer: PHP Commercial	$30.73
Rate for Payer: Priority Health Cigna Priority Health	$23.50
Rate for Payer: Priority Health SBD	$22.77

HC BRACE WAIST BELT

Facility

$147.52

Service Code	HCPCS L5688
Hospital Charge Code	27400031
Hospital Revenue Code	274
Min. Negotiated Rate	$59.01
Max. Negotiated Rate	$132.77
Rate for Payer: Aetna Commercial	$125.39
Rate for Payer: Aetna Medicare	$73.76
Rate for Payer: Aetna New Business (MI Preferred)	$95.89
Rate for Payer: BCBS Complete	$59.01
Rate for Payer: Cash Price	$118.02
Rate for Payer: Cofinity Commercial	$103.26
Rate for Payer: Cofinity Commercial	$126.87
Rate for Payer: Cofinity Medicare Advantage	$103.26
Rate for Payer: Encore Health Key Benefits Commercial	$118.02
Rate for Payer: Healthscope Commercial	$132.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.39
Rate for Payer: PHP Commercial	$125.39
Rate for Payer: Priority Health Cigna Priority Health	$95.89
Rate for Payer: Priority Health SBD	$92.94

HC BRACE WAIST BELT

Facility

$147.52

Service Code	HCPCS L5688
Hospital Charge Code	27400031
Hospital Revenue Code	274
Min. Negotiated Rate	$92.94
Max. Negotiated Rate	$132.77
Rate for Payer: Aetna Commercial	$125.39
Rate for Payer: Aetna New Business (MI Preferred)	$95.89
Rate for Payer: Cash Price	$118.02
Rate for Payer: Cofinity Commercial	$103.26
Rate for Payer: Cofinity Commercial	$126.87
Rate for Payer: Cofinity Medicare Advantage	$103.26
Rate for Payer: Encore Health Key Benefits Commercial	$118.02
Rate for Payer: Healthscope Commercial	$132.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.39
Rate for Payer: PHP Commercial	$125.39
Rate for Payer: Priority Health Cigna Priority Health	$95.89
Rate for Payer: Priority Health SBD	$92.94

HC BRACE WHFO RIGID W/O JOINTS

Facility

$339.17

Service Code	HCPCS L3808
Hospital Charge Code	27400040
Hospital Revenue Code	274
Min. Negotiated Rate	$213.68
Max. Negotiated Rate	$305.25
Rate for Payer: Aetna Commercial	$288.29
Rate for Payer: Aetna New Business (MI Preferred)	$220.46
Rate for Payer: Cash Price	$271.34
Rate for Payer: Cofinity Commercial	$237.42
Rate for Payer: Cofinity Commercial	$291.69
Rate for Payer: Cofinity Medicare Advantage	$237.42
Rate for Payer: Encore Health Key Benefits Commercial	$271.34
Rate for Payer: Healthscope Commercial	$305.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.29
Rate for Payer: PHP Commercial	$288.29
Rate for Payer: Priority Health Cigna Priority Health	$220.46
Rate for Payer: Priority Health SBD	$213.68

HC BRACE WHFO RIGID W/O JOINTS

Facility

$339.17

Service Code	HCPCS L3808
Hospital Charge Code	27400040
Hospital Revenue Code	274
Min. Negotiated Rate	$135.67
Max. Negotiated Rate	$305.25
Rate for Payer: Aetna Commercial	$288.29
Rate for Payer: Aetna Medicare	$169.59
Rate for Payer: Aetna New Business (MI Preferred)	$220.46
Rate for Payer: BCBS Complete	$135.67
Rate for Payer: Cash Price	$271.34
Rate for Payer: Cofinity Commercial	$237.42
Rate for Payer: Cofinity Commercial	$291.69
Rate for Payer: Cofinity Medicare Advantage	$237.42
Rate for Payer: Encore Health Key Benefits Commercial	$271.34
Rate for Payer: Healthscope Commercial	$305.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.29
Rate for Payer: PHP Commercial	$288.29
Rate for Payer: Priority Health Cigna Priority Health	$220.46
Rate for Payer: Priority Health SBD	$213.68

HC BRACE WHO W/O JOINTS CF

Facility

$482.75

Service Code	HCPCS L3906
Hospital Charge Code	27400041
Hospital Revenue Code	274
Min. Negotiated Rate	$304.13
Max. Negotiated Rate	$434.48
Rate for Payer: Aetna Commercial	$410.34
Rate for Payer: Aetna New Business (MI Preferred)	$313.79
Rate for Payer: Cash Price	$386.20
Rate for Payer: Cofinity Commercial	$337.93
Rate for Payer: Cofinity Commercial	$415.17
Rate for Payer: Cofinity Medicare Advantage	$337.93
Rate for Payer: Encore Health Key Benefits Commercial	$386.20
Rate for Payer: Healthscope Commercial	$434.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$410.34
Rate for Payer: PHP Commercial	$410.34
Rate for Payer: Priority Health Cigna Priority Health	$313.79
Rate for Payer: Priority Health SBD	$304.13

HC BRACE WHO W/O JOINTS CF

Facility

$482.75

Service Code	HCPCS L3906
Hospital Charge Code	27400041
Hospital Revenue Code	274
Min. Negotiated Rate	$193.10
Max. Negotiated Rate	$434.48
Rate for Payer: Aetna Commercial	$410.34
Rate for Payer: Aetna Medicare	$241.38
Rate for Payer: Aetna New Business (MI Preferred)	$313.79
Rate for Payer: BCBS Complete	$193.10
Rate for Payer: Cash Price	$386.20
Rate for Payer: Cofinity Commercial	$337.93
Rate for Payer: Cofinity Commercial	$415.17
Rate for Payer: Cofinity Medicare Advantage	$337.93
Rate for Payer: Encore Health Key Benefits Commercial	$386.20
Rate for Payer: Healthscope Commercial	$434.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$410.34
Rate for Payer: PHP Commercial	$410.34
Rate for Payer: Priority Health Cigna Priority Health	$313.79
Rate for Payer: Priority Health SBD	$304.13

HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF

Facility

$2,315.40

Service Code	HCPCS L3905
Hospital Charge Code	27400053
Hospital Revenue Code	274
Min. Negotiated Rate	$1,458.70
Max. Negotiated Rate	$2,083.86
Rate for Payer: Aetna Commercial	$1,968.09
Rate for Payer: Aetna New Business (MI Preferred)	$1,505.01
Rate for Payer: Cash Price	$1,852.32
Rate for Payer: Cofinity Commercial	$1,620.78
Rate for Payer: Cofinity Commercial	$1,991.24
Rate for Payer: Cofinity Medicare Advantage	$1,620.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,852.32
Rate for Payer: Healthscope Commercial	$2,083.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,968.09
Rate for Payer: PHP Commercial	$1,968.09
Rate for Payer: Priority Health Cigna Priority Health	$1,505.01
Rate for Payer: Priority Health SBD	$1,458.70

HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF

Facility

$2,315.40

Service Code	HCPCS L3905
Hospital Charge Code	27400053
Hospital Revenue Code	274
Min. Negotiated Rate	$926.16
Max. Negotiated Rate	$2,083.86
Rate for Payer: Aetna Commercial	$1,968.09
Rate for Payer: Aetna Medicare	$1,157.70
Rate for Payer: Aetna New Business (MI Preferred)	$1,505.01
Rate for Payer: BCBS Complete	$926.16
Rate for Payer: Cash Price	$1,852.32
Rate for Payer: Cofinity Commercial	$1,620.78
Rate for Payer: Cofinity Commercial	$1,991.24
Rate for Payer: Cofinity Medicare Advantage	$1,620.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,852.32
Rate for Payer: Healthscope Commercial	$2,083.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,968.09
Rate for Payer: PHP Commercial	$1,968.09
Rate for Payer: Priority Health Cigna Priority Health	$1,505.01
Rate for Payer: Priority Health SBD	$1,458.70

HC BRACE WRIST/THUMB SPLINT

Facility

$153.04

Service Code	HCPCS L3908
Hospital Charge Code	27400014
Hospital Revenue Code	274
Min. Negotiated Rate	$61.22
Max. Negotiated Rate	$137.74
Rate for Payer: Aetna Commercial	$130.08
Rate for Payer: Aetna Medicare	$76.52
Rate for Payer: Aetna New Business (MI Preferred)	$99.48
Rate for Payer: BCBS Complete	$61.22
Rate for Payer: Cash Price	$122.43
Rate for Payer: Cofinity Commercial	$107.13
Rate for Payer: Cofinity Commercial	$131.61
Rate for Payer: Cofinity Medicare Advantage	$107.13
Rate for Payer: Encore Health Key Benefits Commercial	$122.43
Rate for Payer: Healthscope Commercial	$137.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.08
Rate for Payer: PHP Commercial	$130.08
Rate for Payer: Priority Health Cigna Priority Health	$99.48
Rate for Payer: Priority Health SBD	$96.42

HC BRACE WRIST/THUMB SPLINT

Facility

$153.04

Service Code	HCPCS L3908
Hospital Charge Code	27400014
Hospital Revenue Code	274
Min. Negotiated Rate	$96.42
Max. Negotiated Rate	$137.74
Rate for Payer: Aetna Commercial	$130.08
Rate for Payer: Aetna New Business (MI Preferred)	$99.48
Rate for Payer: Cash Price	$122.43
Rate for Payer: Cofinity Commercial	$107.13
Rate for Payer: Cofinity Commercial	$131.61
Rate for Payer: Cofinity Medicare Advantage	$107.13
Rate for Payer: Encore Health Key Benefits Commercial	$122.43
Rate for Payer: Healthscope Commercial	$137.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.08
Rate for Payer: PHP Commercial	$130.08
Rate for Payer: Priority Health Cigna Priority Health	$99.48
Rate for Payer: Priority Health SBD	$96.42

HC BRACHY SOURCE I-125 NSTRD

Facility

$224.21

Service Code	HCPCS C2639
Hospital Charge Code	27800089
Hospital Revenue Code	278
Min. Negotiated Rate	$18.35
Max. Negotiated Rate	$201.79
Rate for Payer: Aetna Commercial	$190.58
Rate for Payer: Aetna Medicare	$35.61
Rate for Payer: Aetna New Business (MI Preferred)	$145.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$42.80
Rate for Payer: Amish Plain Church Group Commercial	$42.80
Rate for Payer: BCBS Complete	$19.27
Rate for Payer: BCBS MAPPO	$34.24
Rate for Payer: BCN Medicare Advantage	$34.24
Rate for Payer: Cash Price	$179.37
Rate for Payer: Cash Price	$179.37
Rate for Payer: Cofinity Commercial	$192.82
Rate for Payer: Cofinity Commercial	$156.95
Rate for Payer: Cofinity Medicare Advantage	$156.95
Rate for Payer: Encore Health Key Benefits Commercial	$179.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$34.24
Rate for Payer: Healthscope Commercial	$201.79
Rate for Payer: Mclaren Medicaid	$18.35
Rate for Payer: Mclaren Medicare	$34.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.95
Rate for Payer: Meridian Medicaid	$19.27
Rate for Payer: MI Amish Medical Board Commercial	$39.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.58
Rate for Payer: PACE Medicare	$32.53
Rate for Payer: PACE SWMI	$34.24
Rate for Payer: PHP Commercial	$190.58
Rate for Payer: PHP Medicare Advantage	$34.24
Rate for Payer: Priority Health Choice Medicaid	$18.35
Rate for Payer: Priority Health Cigna Priority Health	$145.74
Rate for Payer: Priority Health Medicare	$34.24
Rate for Payer: Priority Health SBD	$141.25
Rate for Payer: Railroad Medicare Medicare	$34.24
Rate for Payer: UHC All Payor (Choice/PPO)	$96.38
Rate for Payer: UHC Dual Complete DSNP	$34.24
Rate for Payer: UHC Medicare Advantage	$34.24
Rate for Payer: UHCCP Medicaid	$19.28
Rate for Payer: VA VA	$34.24

HC BRACHY SOURCE I-125 NSTRD

Facility

$224.21

Service Code	HCPCS C2639
Hospital Charge Code	27800089
Hospital Revenue Code	278
Min. Negotiated Rate	$141.25
Max. Negotiated Rate	$201.79
Rate for Payer: Aetna Commercial	$190.58
Rate for Payer: Aetna New Business (MI Preferred)	$145.74
Rate for Payer: Cash Price	$179.37
Rate for Payer: Cofinity Commercial	$156.95
Rate for Payer: Cofinity Commercial	$192.82
Rate for Payer: Cofinity Medicare Advantage	$156.95
Rate for Payer: Encore Health Key Benefits Commercial	$179.37
Rate for Payer: Healthscope Commercial	$201.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.58
Rate for Payer: PHP Commercial	$190.58
Rate for Payer: Priority Health Cigna Priority Health	$145.74
Rate for Payer: Priority Health SBD	$141.25

HC BRAVO PROCEDURE

Facility

$1,786.85

Hospital Charge Code	36000091
Hospital Revenue Code	360
Min. Negotiated Rate	$1,125.72
Max. Negotiated Rate	$1,608.16
Rate for Payer: Aetna Commercial	$1,518.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,161.45
Rate for Payer: Cash Price	$1,429.48
Rate for Payer: Cofinity Commercial	$1,250.80
Rate for Payer: Cofinity Commercial	$1,536.69
Rate for Payer: Cofinity Medicare Advantage	$1,250.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,429.48
Rate for Payer: Healthscope Commercial	$1,608.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,518.82
Rate for Payer: PHP Commercial	$1,518.82
Rate for Payer: Priority Health Cigna Priority Health	$1,161.45
Rate for Payer: Priority Health SBD	$1,125.72

HC BRAVO PROCEDURE

Facility

$1,786.85

Hospital Charge Code	36000091
Hospital Revenue Code	360
Min. Negotiated Rate	$714.74
Max. Negotiated Rate	$1,608.16
Rate for Payer: Aetna Commercial	$1,518.82
Rate for Payer: Aetna Medicare	$893.42
Rate for Payer: Aetna New Business (MI Preferred)	$1,161.45
Rate for Payer: BCBS Complete	$714.74
Rate for Payer: Cash Price	$1,429.48
Rate for Payer: Cofinity Commercial	$1,250.80
Rate for Payer: Cofinity Commercial	$1,536.69
Rate for Payer: Cofinity Medicare Advantage	$1,250.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,429.48
Rate for Payer: Healthscope Commercial	$1,608.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,518.82
Rate for Payer: PHP Commercial	$1,518.82
Rate for Payer: Priority Health Cigna Priority Health	$1,161.45
Rate for Payer: Priority Health SBD	$1,125.72

HC BRAZIL NUT IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200076
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.53
Rate for Payer: Amish Plain Church Group Commercial	$6.53
Rate for Payer: BCBS Complete	$2.94
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Mclaren Medicaid	$2.80
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.48
Rate for Payer: Meridian Medicaid	$2.94
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$16.00
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$14.69
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Medicare Advantage	$5.22
Rate for Payer: UHCCP Medicaid	$2.94
Rate for Payer: VA VA	$5.22

HC BRAZIL NUT IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200076
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health SBD	$16.00

HC BREAST BX W CLIP EACH ADDL LESION MR

Facility

$5,179.22

Service Code	CPT 19086
Hospital Charge Code	36100413
Hospital Revenue Code	361
Min. Negotiated Rate	$2,071.69
Max. Negotiated Rate	$4,661.30
Rate for Payer: Aetna Commercial	$4,402.34
Rate for Payer: Aetna Medicare	$2,589.61
Rate for Payer: Aetna New Business (MI Preferred)	$3,366.49
Rate for Payer: BCBS Complete	$2,071.69
Rate for Payer: Cash Price	$4,143.38
Rate for Payer: Cofinity Commercial	$3,625.45
Rate for Payer: Cofinity Commercial	$4,454.13
Rate for Payer: Cofinity Medicare Advantage	$3,625.45
Rate for Payer: Encore Health Key Benefits Commercial	$4,143.38
Rate for Payer: Healthscope Commercial	$4,661.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,402.34
Rate for Payer: PHP Commercial	$4,402.34
Rate for Payer: Priority Health Cigna Priority Health	$3,366.49
Rate for Payer: Priority Health SBD	$3,262.91

Know your out-of-pocket cost for care.

All Charges