Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 12

Facility

$1,232.87

Service Code	CPT C1730
Hospital Charge Code	27200325
Hospital Revenue Code	272
Min. Negotiated Rate	$776.71
Max. Negotiated Rate	$1,109.58
Rate for Payer: Aetna Commercial	$1,047.94
Rate for Payer: Aetna New Business (MI Preferred)	$801.37
Rate for Payer: Cash Price	$986.30
Rate for Payer: Cofinity Commercial	$1,060.27
Rate for Payer: Cofinity Commercial	$863.01
Rate for Payer: Cofinity Medicare Advantage	$863.01
Rate for Payer: Encore Health Key Benefits Commercial	$986.30
Rate for Payer: Healthscope Commercial	$1,109.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,047.94
Rate for Payer: PHP Commercial	$1,047.94
Rate for Payer: Priority Health Cigna Priority Health	$801.37
Rate for Payer: Priority Health SBD	$776.71

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 12

Facility

$1,232.87

Service Code	CPT C1730
Hospital Charge Code	27200325
Hospital Revenue Code	272
Min. Negotiated Rate	$493.15
Max. Negotiated Rate	$1,109.58
Rate for Payer: Aetna Commercial	$1,047.94
Rate for Payer: Aetna Medicare	$616.43
Rate for Payer: Aetna New Business (MI Preferred)	$801.37
Rate for Payer: BCBS Complete	$493.15
Rate for Payer: Cash Price	$986.30
Rate for Payer: Cofinity Commercial	$1,060.27
Rate for Payer: Cofinity Commercial	$863.01
Rate for Payer: Cofinity Medicare Advantage	$863.01
Rate for Payer: Encore Health Key Benefits Commercial	$986.30
Rate for Payer: Healthscope Commercial	$1,109.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,047.94
Rate for Payer: PHP Commercial	$1,047.94
Rate for Payer: Priority Health Cigna Priority Health	$801.37
Rate for Payer: Priority Health SBD	$776.71

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 28

Facility

$2,871.30

Service Code	HCPCS C1730
Hospital Charge Code	27200299
Hospital Revenue Code	272
Min. Negotiated Rate	$1,808.92
Max. Negotiated Rate	$2,584.17
Rate for Payer: Aetna Commercial	$2,440.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,866.35
Rate for Payer: Cash Price	$2,297.04
Rate for Payer: Cofinity Commercial	$2,009.91
Rate for Payer: Cofinity Commercial	$2,469.32
Rate for Payer: Cofinity Medicare Advantage	$2,009.91
Rate for Payer: Encore Health Key Benefits Commercial	$2,297.04
Rate for Payer: Healthscope Commercial	$2,584.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,440.61
Rate for Payer: PHP Commercial	$2,440.61
Rate for Payer: Priority Health Cigna Priority Health	$1,866.35
Rate for Payer: Priority Health SBD	$1,808.92

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 28

Facility

$2,871.30

Service Code	HCPCS C1730
Hospital Charge Code	27200299
Hospital Revenue Code	272
Min. Negotiated Rate	$1,148.52
Max. Negotiated Rate	$2,584.17
Rate for Payer: Aetna Commercial	$2,440.61
Rate for Payer: Aetna Medicare	$1,435.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,866.35
Rate for Payer: BCBS Complete	$1,148.52
Rate for Payer: Cash Price	$2,297.04
Rate for Payer: Cofinity Commercial	$2,009.91
Rate for Payer: Cofinity Commercial	$2,469.32
Rate for Payer: Cofinity Medicare Advantage	$2,009.91
Rate for Payer: Encore Health Key Benefits Commercial	$2,297.04
Rate for Payer: Healthscope Commercial	$2,584.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,440.61
Rate for Payer: PHP Commercial	$2,440.61
Rate for Payer: Priority Health Cigna Priority Health	$1,866.35
Rate for Payer: Priority Health SBD	$1,808.92

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 32

Facility

$3,264.00

Service Code	HCPCS C1730
Hospital Charge Code	27200304
Hospital Revenue Code	272
Min. Negotiated Rate	$2,056.32
Max. Negotiated Rate	$2,937.60
Rate for Payer: Aetna Commercial	$2,774.40
Rate for Payer: Aetna New Business (MI Preferred)	$2,121.60
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$2,284.80
Rate for Payer: Cofinity Commercial	$2,807.04
Rate for Payer: Cofinity Medicare Advantage	$2,284.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: PHP Commercial	$2,774.40
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health SBD	$2,056.32

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 32

Facility

$3,264.00

Service Code	HCPCS C1730
Hospital Charge Code	27200304
Hospital Revenue Code	272
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$2,937.60
Rate for Payer: Aetna Commercial	$2,774.40
Rate for Payer: Aetna Medicare	$1,632.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,121.60
Rate for Payer: BCBS Complete	$1,305.60
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$2,284.80
Rate for Payer: Cofinity Commercial	$2,807.04
Rate for Payer: Cofinity Medicare Advantage	$2,284.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: PHP Commercial	$2,774.40
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health SBD	$2,056.32

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 6

Facility

$688.50

Service Code	HCPCS C1730
Hospital Charge Code	27200298
Hospital Revenue Code	272
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$619.65
Rate for Payer: Aetna Commercial	$585.23
Rate for Payer: Aetna Medicare	$344.25
Rate for Payer: Aetna New Business (MI Preferred)	$447.52
Rate for Payer: BCBS Complete	$275.40
Rate for Payer: Cash Price	$550.80
Rate for Payer: Cofinity Commercial	$481.95
Rate for Payer: Cofinity Commercial	$592.11
Rate for Payer: Cofinity Medicare Advantage	$481.95
Rate for Payer: Encore Health Key Benefits Commercial	$550.80
Rate for Payer: Healthscope Commercial	$619.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.23
Rate for Payer: PHP Commercial	$585.23
Rate for Payer: Priority Health Cigna Priority Health	$447.52
Rate for Payer: Priority Health SBD	$433.75

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 6

Facility

$688.50

Service Code	HCPCS C1730
Hospital Charge Code	27200298
Hospital Revenue Code	272
Min. Negotiated Rate	$433.75
Max. Negotiated Rate	$619.65
Rate for Payer: Aetna Commercial	$585.23
Rate for Payer: Aetna New Business (MI Preferred)	$447.52
Rate for Payer: Cash Price	$550.80
Rate for Payer: Cofinity Commercial	$481.95
Rate for Payer: Cofinity Commercial	$592.11
Rate for Payer: Cofinity Medicare Advantage	$481.95
Rate for Payer: Encore Health Key Benefits Commercial	$550.80
Rate for Payer: Healthscope Commercial	$619.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.23
Rate for Payer: PHP Commercial	$585.23
Rate for Payer: Priority Health Cigna Priority Health	$447.52
Rate for Payer: Priority Health SBD	$433.75

HC ELECTROPHYSIOLOGY CATHS NO 3D 20 OR > ELECTRODES LEVEL 46

Facility

$4,792.38

Service Code	HCPCS C1731
Hospital Charge Code	27200056
Hospital Revenue Code	272
Min. Negotiated Rate	$1,916.95
Max. Negotiated Rate	$4,313.14
Rate for Payer: Aetna Commercial	$4,073.52
Rate for Payer: Aetna Medicare	$2,396.19
Rate for Payer: Aetna New Business (MI Preferred)	$3,115.05
Rate for Payer: BCBS Complete	$1,916.95
Rate for Payer: Cash Price	$3,833.90
Rate for Payer: Cofinity Commercial	$3,354.67
Rate for Payer: Cofinity Commercial	$4,121.45
Rate for Payer: Cofinity Medicare Advantage	$3,354.67
Rate for Payer: Encore Health Key Benefits Commercial	$3,833.90
Rate for Payer: Healthscope Commercial	$4,313.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,073.52
Rate for Payer: PHP Commercial	$4,073.52
Rate for Payer: Priority Health Cigna Priority Health	$3,115.05
Rate for Payer: Priority Health SBD	$3,019.20

HC ELECTROPHYSIOLOGY CATHS NO 3D 20 OR > ELECTRODES LEVEL 46

Facility

$4,792.38

Service Code	HCPCS C1731
Hospital Charge Code	27200056
Hospital Revenue Code	272
Min. Negotiated Rate	$3,019.20
Max. Negotiated Rate	$4,313.14
Rate for Payer: Aetna Commercial	$4,073.52
Rate for Payer: Aetna New Business (MI Preferred)	$3,115.05
Rate for Payer: Cash Price	$3,833.90
Rate for Payer: Cofinity Commercial	$3,354.67
Rate for Payer: Cofinity Commercial	$4,121.45
Rate for Payer: Cofinity Medicare Advantage	$3,354.67
Rate for Payer: Encore Health Key Benefits Commercial	$3,833.90
Rate for Payer: Healthscope Commercial	$4,313.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,073.52
Rate for Payer: PHP Commercial	$4,073.52
Rate for Payer: Priority Health Cigna Priority Health	$3,115.05
Rate for Payer: Priority Health SBD	$3,019.20

HC ELECTROPHYSIOLOGY PACK

Facility

$266.93

Hospital Charge Code	62200002
Hospital Revenue Code	270
Min. Negotiated Rate	$106.77
Max. Negotiated Rate	$240.24
Rate for Payer: Aetna Commercial	$226.89
Rate for Payer: Aetna Medicare	$133.47
Rate for Payer: Aetna New Business (MI Preferred)	$173.50
Rate for Payer: BCBS Complete	$106.77
Rate for Payer: Cash Price	$213.54
Rate for Payer: Cofinity Commercial	$186.85
Rate for Payer: Cofinity Commercial	$229.56
Rate for Payer: Cofinity Medicare Advantage	$186.85
Rate for Payer: Encore Health Key Benefits Commercial	$213.54
Rate for Payer: Healthscope Commercial	$240.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$226.89
Rate for Payer: PHP Commercial	$226.89
Rate for Payer: Priority Health Cigna Priority Health	$173.50
Rate for Payer: Priority Health SBD	$168.17

HC ELECTROPHYSIOLOGY PACK

Facility

$266.93

Hospital Charge Code	62200002
Hospital Revenue Code	270
Min. Negotiated Rate	$168.17
Max. Negotiated Rate	$240.24
Rate for Payer: Aetna Commercial	$226.89
Rate for Payer: Aetna New Business (MI Preferred)	$173.50
Rate for Payer: Cash Price	$213.54
Rate for Payer: Cofinity Commercial	$186.85
Rate for Payer: Cofinity Commercial	$229.56
Rate for Payer: Cofinity Medicare Advantage	$186.85
Rate for Payer: Encore Health Key Benefits Commercial	$213.54
Rate for Payer: Healthscope Commercial	$240.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$226.89
Rate for Payer: PHP Commercial	$226.89
Rate for Payer: Priority Health Cigna Priority Health	$173.50
Rate for Payer: Priority Health SBD	$168.17

HC ELECTROPHYSIOLOGY STUDY

Facility

$27,014.28

Service Code	CPT 93620
Hospital Charge Code	48100037
Hospital Revenue Code	481
Min. Negotiated Rate	$17,019.00
Max. Negotiated Rate	$24,312.85
Rate for Payer: Aetna Commercial	$22,962.14
Rate for Payer: Aetna New Business (MI Preferred)	$17,559.28
Rate for Payer: Cash Price	$21,611.42
Rate for Payer: Cofinity Commercial	$18,910.00
Rate for Payer: Cofinity Commercial	$23,232.28
Rate for Payer: Cofinity Medicare Advantage	$18,910.00
Rate for Payer: Encore Health Key Benefits Commercial	$21,611.42
Rate for Payer: Healthscope Commercial	$24,312.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22,962.14
Rate for Payer: PHP Commercial	$22,962.14
Rate for Payer: Priority Health Cigna Priority Health	$17,559.28
Rate for Payer: Priority Health SBD	$17,019.00

HC ELECTROPHYSIOLOGY STUDY

Facility

$27,014.28

Service Code	CPT 93620
Hospital Charge Code	48100037
Hospital Revenue Code	481
Min. Negotiated Rate	$3,966.68
Max. Negotiated Rate	$24,312.85
Rate for Payer: Aetna Commercial	$22,962.14
Rate for Payer: Aetna Medicare	$7,696.54
Rate for Payer: Aetna New Business (MI Preferred)	$17,559.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,250.65
Rate for Payer: Amish Plain Church Group Commercial	$9,250.65
Rate for Payer: BCBS Complete	$4,165.01
Rate for Payer: BCBS MAPPO	$7,400.52
Rate for Payer: BCN Medicare Advantage	$7,400.52
Rate for Payer: Cash Price	$21,611.42
Rate for Payer: Cash Price	$21,611.42
Rate for Payer: Cofinity Commercial	$23,232.28
Rate for Payer: Cofinity Commercial	$18,910.00
Rate for Payer: Cofinity Medicare Advantage	$18,910.00
Rate for Payer: Encore Health Key Benefits Commercial	$21,611.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,400.52
Rate for Payer: Healthscope Commercial	$24,312.85
Rate for Payer: Mclaren Medicaid	$3,966.68
Rate for Payer: Mclaren Medicare	$7,400.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,770.55
Rate for Payer: Meridian Medicaid	$4,165.01
Rate for Payer: MI Amish Medical Board Commercial	$8,510.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22,962.14
Rate for Payer: PACE Medicare	$7,030.49
Rate for Payer: PACE SWMI	$7,400.52
Rate for Payer: PHP Commercial	$22,962.14
Rate for Payer: PHP Medicare Advantage	$7,400.52
Rate for Payer: Priority Health Choice Medicaid	$3,966.68
Rate for Payer: Priority Health Cigna Priority Health	$17,559.28
Rate for Payer: Priority Health Medicare	$7,400.52
Rate for Payer: Priority Health SBD	$17,019.00
Rate for Payer: Railroad Medicare Medicare	$7,400.52
Rate for Payer: UHC All Payor (Choice/PPO)	$20,831.72
Rate for Payer: UHC Dual Complete DSNP	$7,400.52
Rate for Payer: UHC Medicare Advantage	$7,400.52
Rate for Payer: UHCCP Medicaid	$4,166.49
Rate for Payer: VA VA	$7,400.52

HC ELM IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200042
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 ELM IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200042
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 ELVAREX CHAP STYLE ONE LEG

Facility

$584.55

Service Code	HCPCS A6549
Hospital Charge Code	27000368
Hospital Revenue Code	270
Min. Negotiated Rate	$368.27
Max. Negotiated Rate	$526.10
Rate for Payer: Aetna Commercial	$496.87
Rate for Payer: Aetna New Business (MI Preferred)	$379.96
Rate for Payer: Cash Price	$467.64
Rate for Payer: Cofinity Commercial	$409.19
Rate for Payer: Cofinity Commercial	$502.71
Rate for Payer: Cofinity Medicare Advantage	$409.19
Rate for Payer: Encore Health Key Benefits Commercial	$467.64
Rate for Payer: Healthscope Commercial	$526.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$496.87
Rate for Payer: PHP Commercial	$496.87
Rate for Payer: Priority Health Cigna Priority Health	$379.96
Rate for Payer: Priority Health SBD	$368.27

HC ELVAREX CHAP STYLE ONE LEG

Facility

$584.55

Service Code	HCPCS A6549
Hospital Charge Code	27000368
Hospital Revenue Code	270
Min. Negotiated Rate	$233.82
Max. Negotiated Rate	$526.10
Rate for Payer: Aetna Commercial	$496.87
Rate for Payer: Aetna Medicare	$292.27
Rate for Payer: Aetna New Business (MI Preferred)	$379.96
Rate for Payer: BCBS Complete	$233.82
Rate for Payer: Cash Price	$467.64
Rate for Payer: Cofinity Commercial	$409.19
Rate for Payer: Cofinity Commercial	$502.71
Rate for Payer: Cofinity Medicare Advantage	$409.19
Rate for Payer: Encore Health Key Benefits Commercial	$467.64
Rate for Payer: Healthscope Commercial	$526.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$496.87
Rate for Payer: PHP Commercial	$496.87
Rate for Payer: Priority Health Cigna Priority Health	$379.96
Rate for Payer: Priority Health SBD	$368.27

HC ELVAREX CHAP STYLE TWO LEG

Facility

$1,169.07

Service Code	HCPCS A6549
Hospital Charge Code	27000369
Hospital Revenue Code	270
Min. Negotiated Rate	$736.51
Max. Negotiated Rate	$1,052.16
Rate for Payer: Aetna Commercial	$993.71
Rate for Payer: Aetna New Business (MI Preferred)	$759.90
Rate for Payer: Cash Price	$935.26
Rate for Payer: Cofinity Commercial	$1,005.40
Rate for Payer: Cofinity Commercial	$818.35
Rate for Payer: Cofinity Medicare Advantage	$818.35
Rate for Payer: Encore Health Key Benefits Commercial	$935.26
Rate for Payer: Healthscope Commercial	$1,052.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$993.71
Rate for Payer: PHP Commercial	$993.71
Rate for Payer: Priority Health Cigna Priority Health	$759.90
Rate for Payer: Priority Health SBD	$736.51

HC ELVAREX CHAP STYLE TWO LEG

Facility

$1,169.07

Service Code	HCPCS A6549
Hospital Charge Code	27000369
Hospital Revenue Code	270
Min. Negotiated Rate	$467.63
Max. Negotiated Rate	$1,052.16
Rate for Payer: Aetna Commercial	$993.71
Rate for Payer: Aetna Medicare	$584.53
Rate for Payer: Aetna New Business (MI Preferred)	$759.90
Rate for Payer: BCBS Complete	$467.63
Rate for Payer: Cash Price	$935.26
Rate for Payer: Cofinity Commercial	$1,005.40
Rate for Payer: Cofinity Commercial	$818.35
Rate for Payer: Cofinity Medicare Advantage	$818.35
Rate for Payer: Encore Health Key Benefits Commercial	$935.26
Rate for Payer: Healthscope Commercial	$1,052.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$993.71
Rate for Payer: PHP Commercial	$993.71
Rate for Payer: Priority Health Cigna Priority Health	$759.90
Rate for Payer: Priority Health SBD	$736.51

HC ELVAREX KNEE SLANT OPEN TOE

Facility

$286.88

Service Code	HCPCS A6549
Hospital Charge Code	27000366
Hospital Revenue Code	270
Min. Negotiated Rate	$180.73
Max. Negotiated Rate	$258.19
Rate for Payer: Aetna Commercial	$243.85
Rate for Payer: Aetna New Business (MI Preferred)	$186.47
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cofinity Commercial	$200.82
Rate for Payer: Cofinity Commercial	$246.72
Rate for Payer: Cofinity Medicare Advantage	$200.82
Rate for Payer: Encore Health Key Benefits Commercial	$229.50
Rate for Payer: Healthscope Commercial	$258.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.85
Rate for Payer: PHP Commercial	$243.85
Rate for Payer: Priority Health Cigna Priority Health	$186.47
Rate for Payer: Priority Health SBD	$180.73

HC ELVAREX KNEE SLANT OPEN TOE

Facility

$286.88

Service Code	HCPCS A6549
Hospital Charge Code	27000366
Hospital Revenue Code	270
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$258.19
Rate for Payer: Aetna Commercial	$243.85
Rate for Payer: Aetna Medicare	$143.44
Rate for Payer: Aetna New Business (MI Preferred)	$186.47
Rate for Payer: BCBS Complete	$114.75
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cofinity Commercial	$200.82
Rate for Payer: Cofinity Commercial	$246.72
Rate for Payer: Cofinity Medicare Advantage	$200.82
Rate for Payer: Encore Health Key Benefits Commercial	$229.50
Rate for Payer: Healthscope Commercial	$258.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.85
Rate for Payer: PHP Commercial	$243.85
Rate for Payer: Priority Health Cigna Priority Health	$186.47
Rate for Payer: Priority Health SBD	$180.73

HC ELVAREX SLEEVE

Facility

$254.59

Service Code	HCPCS A6549
Hospital Charge Code	27000365
Hospital Revenue Code	270
Min. Negotiated Rate	$160.39
Max. Negotiated Rate	$229.13
Rate for Payer: Aetna Commercial	$216.40
Rate for Payer: Aetna New Business (MI Preferred)	$165.48
Rate for Payer: Cash Price	$203.67
Rate for Payer: Cofinity Commercial	$178.21
Rate for Payer: Cofinity Commercial	$218.95
Rate for Payer: Cofinity Medicare Advantage	$178.21
Rate for Payer: Encore Health Key Benefits Commercial	$203.67
Rate for Payer: Healthscope Commercial	$229.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.40
Rate for Payer: PHP Commercial	$216.40
Rate for Payer: Priority Health Cigna Priority Health	$165.48
Rate for Payer: Priority Health SBD	$160.39

HC ELVAREX SLEEVE

Facility

$254.59

Service Code	HCPCS A6549
Hospital Charge Code	27000365
Hospital Revenue Code	270
Min. Negotiated Rate	$101.84
Max. Negotiated Rate	$229.13
Rate for Payer: Aetna Commercial	$216.40
Rate for Payer: Aetna Medicare	$127.30
Rate for Payer: Aetna New Business (MI Preferred)	$165.48
Rate for Payer: BCBS Complete	$101.84
Rate for Payer: Cash Price	$203.67
Rate for Payer: Cofinity Commercial	$178.21
Rate for Payer: Cofinity Commercial	$218.95
Rate for Payer: Cofinity Medicare Advantage	$178.21
Rate for Payer: Encore Health Key Benefits Commercial	$203.67
Rate for Payer: Healthscope Commercial	$229.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.40
Rate for Payer: PHP Commercial	$216.40
Rate for Payer: Priority Health Cigna Priority Health	$165.48
Rate for Payer: Priority Health SBD	$160.39

HC ELVAREX SOFT ARMSLEEVE

Facility

$254.59

Service Code	HCPCS A6549
Hospital Charge Code	27000372
Hospital Revenue Code	270
Min. Negotiated Rate	$160.39
Max. Negotiated Rate	$229.13
Rate for Payer: Aetna Commercial	$216.40
Rate for Payer: Aetna New Business (MI Preferred)	$165.48
Rate for Payer: Cash Price	$203.67
Rate for Payer: Cofinity Commercial	$178.21
Rate for Payer: Cofinity Commercial	$218.95
Rate for Payer: Cofinity Medicare Advantage	$178.21
Rate for Payer: Encore Health Key Benefits Commercial	$203.67
Rate for Payer: Healthscope Commercial	$229.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.40
Rate for Payer: PHP Commercial	$216.40
Rate for Payer: Priority Health Cigna Priority Health	$165.48
Rate for Payer: Priority Health SBD	$160.39

Know your out-of-pocket cost for care.

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