Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM STRETCH INSERT

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Cofinity Commercial	$8.74
Rate for Payer: Cofinity Medicare Advantage	$8.74
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna Medicare	$22.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: BCBS Complete	$18.36
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$387.60

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$244.19
Max. Negotiated Rate	$348.84
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna New Business (MI Preferred)	$251.94
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$271.32
Rate for Payer: Cofinity Commercial	$333.34
Rate for Payer: Cofinity Medicare Advantage	$271.32
Rate for Payer: Encore Health Key Benefits Commercial	$310.08
Rate for Payer: Healthscope Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.46
Rate for Payer: PHP Commercial	$329.46
Rate for Payer: Priority Health Cigna Priority Health	$251.94
Rate for Payer: Priority Health SBD	$244.19

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$387.60

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$155.04
Max. Negotiated Rate	$348.84
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare	$193.80
Rate for Payer: Aetna New Business (MI Preferred)	$251.94
Rate for Payer: BCBS Complete	$155.04
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$271.32
Rate for Payer: Cofinity Commercial	$333.34
Rate for Payer: Cofinity Medicare Advantage	$271.32
Rate for Payer: Encore Health Key Benefits Commercial	$310.08
Rate for Payer: Healthscope Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.46
Rate for Payer: PHP Commercial	$329.46
Rate for Payer: Priority Health Cigna Priority Health	$251.94
Rate for Payer: Priority Health SBD	$244.19

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$491.64

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$309.73
Max. Negotiated Rate	$442.48
Rate for Payer: Aetna Commercial	$417.89
Rate for Payer: Aetna New Business (MI Preferred)	$319.57
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cofinity Commercial	$344.15
Rate for Payer: Cofinity Commercial	$422.81
Rate for Payer: Cofinity Medicare Advantage	$344.15
Rate for Payer: Encore Health Key Benefits Commercial	$393.31
Rate for Payer: Healthscope Commercial	$442.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$417.89
Rate for Payer: PHP Commercial	$417.89
Rate for Payer: Priority Health Cigna Priority Health	$319.57
Rate for Payer: Priority Health SBD	$309.73

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$491.64

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$196.66
Max. Negotiated Rate	$442.48
Rate for Payer: Aetna Commercial	$417.89
Rate for Payer: Aetna Medicare	$245.82
Rate for Payer: Aetna New Business (MI Preferred)	$319.57
Rate for Payer: BCBS Complete	$196.66
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cofinity Commercial	$344.15
Rate for Payer: Cofinity Commercial	$422.81
Rate for Payer: Cofinity Medicare Advantage	$344.15
Rate for Payer: Encore Health Key Benefits Commercial	$393.31
Rate for Payer: Healthscope Commercial	$442.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$417.89
Rate for Payer: PHP Commercial	$417.89
Rate for Payer: Priority Health Cigna Priority Health	$319.57
Rate for Payer: Priority Health SBD	$309.73

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$320.28

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$201.78
Max. Negotiated Rate	$288.25
Rate for Payer: Aetna Commercial	$272.24
Rate for Payer: Aetna New Business (MI Preferred)	$208.18
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cofinity Commercial	$224.20
Rate for Payer: Cofinity Commercial	$275.44
Rate for Payer: Cofinity Medicare Advantage	$224.20
Rate for Payer: Encore Health Key Benefits Commercial	$256.22
Rate for Payer: Healthscope Commercial	$288.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.24
Rate for Payer: PHP Commercial	$272.24
Rate for Payer: Priority Health Cigna Priority Health	$208.18
Rate for Payer: Priority Health SBD	$201.78

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$320.28

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$128.11
Max. Negotiated Rate	$288.25
Rate for Payer: Aetna Commercial	$272.24
Rate for Payer: Aetna Medicare	$160.14
Rate for Payer: Aetna New Business (MI Preferred)	$208.18
Rate for Payer: BCBS Complete	$128.11
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cofinity Commercial	$224.20
Rate for Payer: Cofinity Commercial	$275.44
Rate for Payer: Cofinity Medicare Advantage	$224.20
Rate for Payer: Encore Health Key Benefits Commercial	$256.22
Rate for Payer: Healthscope Commercial	$288.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.24
Rate for Payer: PHP Commercial	$272.24
Rate for Payer: Priority Health Cigna Priority Health	$208.18
Rate for Payer: Priority Health SBD	$201.78

HC COMP BURN GARM SUIT SLVLS-TWO LEGS

Facility

$375.36

Service Code	HCPCS A6512
Hospital Charge Code	98300062
Hospital Revenue Code	270
Min. Negotiated Rate	$236.48
Max. Negotiated Rate	$337.82
Rate for Payer: Aetna Commercial	$319.06
Rate for Payer: Aetna New Business (MI Preferred)	$243.98
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$262.75
Rate for Payer: Cofinity Commercial	$322.81
Rate for Payer: Cofinity Medicare Advantage	$262.75
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: PHP Commercial	$319.06
Rate for Payer: Priority Health Cigna Priority Health	$243.98
Rate for Payer: Priority Health SBD	$236.48

HC COMP BURN GARM SUIT SLVLS-TWO LEGS

Facility

$375.36

Service Code	HCPCS A6512
Hospital Charge Code	98300062
Hospital Revenue Code	270
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$337.82
Rate for Payer: Aetna Commercial	$319.06
Rate for Payer: Aetna Medicare	$187.68
Rate for Payer: Aetna New Business (MI Preferred)	$243.98
Rate for Payer: BCBS Complete	$150.14
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$262.75
Rate for Payer: Cofinity Commercial	$322.81
Rate for Payer: Cofinity Medicare Advantage	$262.75
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: PHP Commercial	$319.06
Rate for Payer: Priority Health Cigna Priority Health	$243.98
Rate for Payer: Priority Health SBD	$236.48

HC COMP BURN GARM SUSPENDERS ATTA

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300063
Hospital Revenue Code	270
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM SUSPENDERS ATTA

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300063
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna Medicare	$22.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: BCBS Complete	$18.36
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM SUSPENDERS REMO

Facility

$12.24

Service Code	HCPCS A9900
Hospital Charge Code	98300064
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM SUSPENDERS REMO

Facility

$12.24

Service Code	HCPCS A9900
Hospital Charge Code	98300064
Hospital Revenue Code	270
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM TWO LEGS PREGNA

Facility

$255.00

Service Code	HCPCS A6512
Hospital Charge Code	98300065
Hospital Revenue Code	270
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Medicare Advantage	$178.50
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health SBD	$160.65

HC COMP BURN GARM TWO LEGS PREGNA

Facility

$255.00

Service Code	HCPCS A6512
Hospital Charge Code	98300065
Hospital Revenue Code	270
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Medicare Advantage	$178.50
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health SBD	$160.65

HC COMP BURN GARM VEST SLEEVED

Facility

$255.00

Service Code	HCPCS A6509
Hospital Charge Code	98300066
Hospital Revenue Code	270
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Medicare Advantage	$178.50
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health SBD	$160.65

HC COMP BURN GARM VEST SLEEVED

Facility

$255.00

Service Code	HCPCS A6509
Hospital Charge Code	98300066
Hospital Revenue Code	270
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Medicare Advantage	$178.50
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health SBD	$160.65

HC COMP BURN GARM VEST SLEEVELESS

Facility

$134.64

Service Code	HCPCS A6509
Hospital Charge Code	98300067
Hospital Revenue Code	270
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

HC COMP BURN GARM VEST SLEEVELESS

Facility

$134.64

Service Code	HCPCS A6509
Hospital Charge Code	98300067
Hospital Revenue Code	270
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna Medicare	$67.32
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: BCBS Complete	$53.86
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

HC COMP BURN GARM ZIPPER

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300068
Hospital Revenue Code	270
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM ZIPPER

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300068
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna Medicare	$22.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: BCBS Complete	$18.36
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMPLEMENT C 3

Facility

$115.26

Service Code	CPT 86160
Hospital Charge Code	30200150
Hospital Revenue Code	302
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$103.73
Rate for Payer: Aetna Commercial	$97.97
Rate for Payer: Aetna Medicare	$12.48
Rate for Payer: Aetna New Business (MI Preferred)	$74.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.00
Rate for Payer: Amish Plain Church Group Commercial	$15.00
Rate for Payer: BCBS Complete	$6.75
Rate for Payer: BCBS MAPPO	$12.00
Rate for Payer: BCN Medicare Advantage	$12.00
Rate for Payer: Cash Price	$92.21
Rate for Payer: Cash Price	$92.21
Rate for Payer: Cofinity Commercial	$99.12
Rate for Payer: Cofinity Commercial	$80.68
Rate for Payer: Cofinity Medicare Advantage	$80.68
Rate for Payer: Encore Health Key Benefits Commercial	$92.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.00
Rate for Payer: Healthscope Commercial	$103.73
Rate for Payer: Mclaren Medicaid	$6.43
Rate for Payer: Mclaren Medicare	$12.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12.60
Rate for Payer: Meridian Medicaid	$6.75
Rate for Payer: MI Amish Medical Board Commercial	$13.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.97
Rate for Payer: PACE Medicare	$11.40
Rate for Payer: PACE SWMI	$12.00
Rate for Payer: PHP Commercial	$97.97
Rate for Payer: PHP Medicare Advantage	$12.00
Rate for Payer: Priority Health Choice Medicaid	$6.43
Rate for Payer: Priority Health Cigna Priority Health	$74.92
Rate for Payer: Priority Health Medicare	$12.00
Rate for Payer: Priority Health SBD	$72.61
Rate for Payer: Railroad Medicare Medicare	$12.00
Rate for Payer: UHC All Payor (Choice/PPO)	$33.78
Rate for Payer: UHC Dual Complete DSNP	$12.00
Rate for Payer: UHC Medicare Advantage	$12.00
Rate for Payer: UHCCP Medicaid	$6.76
Rate for Payer: VA VA	$12.00

HC COMPLEMENT C 3

Facility

$115.26

Service Code	CPT 86160
Hospital Charge Code	30200150
Hospital Revenue Code	302
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$103.73
Rate for Payer: Aetna Commercial	$97.97
Rate for Payer: Aetna New Business (MI Preferred)	$74.92
Rate for Payer: Cash Price	$92.21
Rate for Payer: Cofinity Commercial	$80.68
Rate for Payer: Cofinity Commercial	$99.12
Rate for Payer: Cofinity Medicare Advantage	$80.68
Rate for Payer: Encore Health Key Benefits Commercial	$92.21
Rate for Payer: Healthscope Commercial	$103.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.97
Rate for Payer: PHP Commercial	$97.97
Rate for Payer: Priority Health Cigna Priority Health	$74.92
Rate for Payer: Priority Health SBD	$72.61

Know your out-of-pocket cost for care.

All Charges