Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC POST-OP

Facility

$17.72

Hospital Charge Code	27000136
Hospital Revenue Code	270
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$15.95
Rate for Payer: Aetna Commercial	$15.06
Rate for Payer: Aetna New Business (MI Preferred)	$11.52
Rate for Payer: Cash Price	$14.18
Rate for Payer: Cofinity Commercial	$12.40
Rate for Payer: Cofinity Commercial	$15.24
Rate for Payer: Healthscope Commercial	$15.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.06
Rate for Payer: PHP Commercial	$15.06
Rate for Payer: Priority Health Cigna Priority Health	$12.40
Rate for Payer: Priority Health SBD	$11.16

HC POST-OP

Facility

$17.72

Hospital Charge Code	27000136
Hospital Revenue Code	270
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$15.95
Rate for Payer: Aetna Commercial	$15.06
Rate for Payer: Aetna New Business (MI Preferred)	$11.52
Rate for Payer: BCBS Complete	$7.09
Rate for Payer: Cash Price	$14.18
Rate for Payer: Cofinity Commercial	$12.40
Rate for Payer: Cofinity Commercial	$15.24
Rate for Payer: Healthscope Commercial	$15.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.06
Rate for Payer: PHP Commercial	$15.06
Rate for Payer: Priority Health Cigna Priority Health	$12.40
Rate for Payer: Priority Health SBD	$11.16

HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE

Facility

$378.64

Service Code	CPT 64566
Hospital Charge Code	76100208
Hospital Revenue Code	761
Min. Negotiated Rate	$238.54
Max. Negotiated Rate	$340.78
Rate for Payer: Aetna Commercial	$321.84
Rate for Payer: Aetna New Business (MI Preferred)	$246.12
Rate for Payer: Cash Price	$302.91
Rate for Payer: Cofinity Commercial	$265.05
Rate for Payer: Cofinity Commercial	$325.63
Rate for Payer: Healthscope Commercial	$340.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$321.84
Rate for Payer: PHP Commercial	$321.84
Rate for Payer: Priority Health Cigna Priority Health	$265.05
Rate for Payer: Priority Health SBD	$238.54

HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE

Facility

$378.64

Service Code	CPT 64566
Hospital Charge Code	76100208
Hospital Revenue Code	761
Min. Negotiated Rate	$29.47
Max. Negotiated Rate	$340.78
Rate for Payer: Aetna Commercial	$321.84
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$246.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.42
Rate for Payer: Amish Plain Church Group Commercial	$329.42
Rate for Payer: BCBS Complete	$151.38
Rate for Payer: BCBS MAPPO	$263.54
Rate for Payer: BCBS Trust/PPO	$82.38
Rate for Payer: BCN Medicare Advantage	$263.54
Rate for Payer: Cash Price	$302.91
Rate for Payer: Cash Price	$302.91
Rate for Payer: Cofinity Commercial	$265.05
Rate for Payer: Cofinity Commercial	$325.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$340.78
Rate for Payer: Mclaren Medicaid	$144.16
Rate for Payer: Mclaren Medicare	$263.54
Rate for Payer: Meridian Medicaid	$151.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.72
Rate for Payer: MI Amish Medical Board Commercial	$303.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$321.84
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$321.84
Rate for Payer: PHP Medicare Advantage	$263.54
Rate for Payer: Priority Health Choice Medicaid	$144.16
Rate for Payer: Priority Health Cigna Priority Health	$265.05
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health SBD	$238.54
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$32.42
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$29.47
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

HC POTASSIUM LEVEL

Facility

$20.40

Service Code	CPT 84132
Hospital Charge Code	30100396
Hospital Revenue Code	301
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$12.85

HC POTASSIUM LEVEL

Facility

$20.40

Service Code	CPT 84132
Hospital Charge Code	30100396
Hospital Revenue Code	301
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna Medicare	$4.95
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.95
Rate for Payer: Amish Plain Church Group Commercial	$5.95
Rate for Payer: BCBS Complete	$2.73
Rate for Payer: BCBS MAPPO	$4.76
Rate for Payer: BCN Medicare Advantage	$4.76
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.76
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Mclaren Medicaid	$2.60
Rate for Payer: Mclaren Medicare	$4.76
Rate for Payer: Meridian Medicaid	$2.73
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.00
Rate for Payer: MI Amish Medical Board Commercial	$5.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.34
Rate for Payer: PACE Medicare	$4.52
Rate for Payer: PACE SWMI	$4.76
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: PHP Medicare Advantage	$4.76
Rate for Payer: Priority Health Choice Medicaid	$2.60
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health Medicare	$4.76
Rate for Payer: Priority Health SBD	$12.85
Rate for Payer: Railroad Medicare Medicare	$4.76
Rate for Payer: UHC All Payor (Choice/PPO)	$5.71
Rate for Payer: UHC Core	$7.81
Rate for Payer: UHC Dual Complete DSNP	$4.76
Rate for Payer: UHC Exchange	$4.76
Rate for Payer: UHC Medicare Advantage	$4.90
Rate for Payer: VA VA	$4.76

HC POTASSIUM OTHER SOURCE

Facility

$20.80

Service Code	CPT 84999
Hospital Charge Code	30100556
Hospital Revenue Code	301
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$18.72
Rate for Payer: Aetna Commercial	$17.68
Rate for Payer: Aetna New Business (MI Preferred)	$13.52
Rate for Payer: Cash Price	$16.64
Rate for Payer: Cofinity Commercial	$14.56
Rate for Payer: Cofinity Commercial	$17.89
Rate for Payer: Healthscope Commercial	$18.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.68
Rate for Payer: PHP Commercial	$17.68
Rate for Payer: Priority Health Cigna Priority Health	$14.56
Rate for Payer: Priority Health SBD	$13.10

HC POTASSIUM OTHER SOURCE

Facility

$20.80

Service Code	CPT 84999
Hospital Charge Code	30100556
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$18.72
Rate for Payer: Aetna Commercial	$17.68
Rate for Payer: Aetna New Business (MI Preferred)	$13.52
Rate for Payer: BCBS Complete	$8.32
Rate for Payer: BCBS Trust/PPO	$10.41
Rate for Payer: Cash Price	$16.64
Rate for Payer: Cash Price	$16.64
Rate for Payer: Cofinity Commercial	$17.89
Rate for Payer: Cofinity Commercial	$14.56
Rate for Payer: Healthscope Commercial	$18.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.68
Rate for Payer: PHP Commercial	$17.68
Rate for Payer: Priority Health Cigna Priority Health	$14.56
Rate for Payer: Priority Health SBD	$13.10

HC POTASSIUM URINE

Facility

$36.20

Service Code	CPT 84133
Hospital Charge Code	30100397
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$32.58
Rate for Payer: Aetna Commercial	$30.77
Rate for Payer: Aetna Medicare	$4.92
Rate for Payer: Aetna New Business (MI Preferred)	$23.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.91
Rate for Payer: Amish Plain Church Group Commercial	$5.91
Rate for Payer: BCBS Complete	$2.72
Rate for Payer: BCBS MAPPO	$4.73
Rate for Payer: BCBS Trust/PPO	$3.71
Rate for Payer: BCN Medicare Advantage	$4.73
Rate for Payer: Cash Price	$28.96
Rate for Payer: Cash Price	$28.96
Rate for Payer: Cofinity Commercial	$31.13
Rate for Payer: Cofinity Commercial	$25.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.73
Rate for Payer: Healthscope Commercial	$32.58
Rate for Payer: Mclaren Medicaid	$2.59
Rate for Payer: Mclaren Medicare	$4.73
Rate for Payer: Meridian Medicaid	$2.72
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4.97
Rate for Payer: MI Amish Medical Board Commercial	$5.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$30.77
Rate for Payer: PACE Medicare	$4.49
Rate for Payer: PACE SWMI	$4.73
Rate for Payer: PHP Commercial	$30.77
Rate for Payer: PHP Medicare Advantage	$4.73
Rate for Payer: Priority Health Choice Medicaid	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$25.34
Rate for Payer: Priority Health Medicare	$4.73
Rate for Payer: Priority Health SBD	$22.81
Rate for Payer: Railroad Medicare Medicare	$4.73
Rate for Payer: UHC All Payor (Choice/PPO)	$5.68
Rate for Payer: UHC Core	$7.31
Rate for Payer: UHC Dual Complete DSNP	$4.73
Rate for Payer: UHC Exchange	$4.73
Rate for Payer: UHC Medicare Advantage	$4.87
Rate for Payer: VA VA	$4.73

HC POTASSIUM URINE

Facility

$36.20

Service Code	CPT 84133
Hospital Charge Code	30100397
Hospital Revenue Code	301
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$32.58
Rate for Payer: Aetna Commercial	$30.77
Rate for Payer: Aetna New Business (MI Preferred)	$23.53
Rate for Payer: Cash Price	$28.96
Rate for Payer: Cofinity Commercial	$25.34
Rate for Payer: Cofinity Commercial	$31.13
Rate for Payer: Healthscope Commercial	$32.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$30.77
Rate for Payer: PHP Commercial	$30.77
Rate for Payer: Priority Health Cigna Priority Health	$25.34
Rate for Payer: Priority Health SBD	$22.81

HC POUCH 1 PIECE OPEN END W/WAFER

Facility

$10.00

Hospital Charge Code	27000022
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna New Business (MI Preferred)	$6.50
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Cofinity Commercial	$8.60
Rate for Payer: Healthscope Commercial	$9.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.50
Rate for Payer: PHP Commercial	$8.50
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: Priority Health SBD	$6.30

HC POUCH 1 PIECE OPEN END W/WAFER

Facility

$10.00

Hospital Charge Code	27000022
Hospital Revenue Code	270
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna New Business (MI Preferred)	$6.50
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Cofinity Commercial	$8.60
Rate for Payer: Healthscope Commercial	$9.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.50
Rate for Payer: PHP Commercial	$8.50
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: Priority Health SBD	$6.30

HC POUCH 2-PIECE

Facility

$16.94

Hospital Charge Code	27000137
Hospital Revenue Code	270
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$15.25
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna New Business (MI Preferred)	$11.01
Rate for Payer: Cash Price	$13.55
Rate for Payer: Cofinity Commercial	$11.86
Rate for Payer: Cofinity Commercial	$14.57
Rate for Payer: Healthscope Commercial	$15.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.40
Rate for Payer: PHP Commercial	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$11.86
Rate for Payer: Priority Health SBD	$10.67

HC POUCH 2-PIECE

Facility

$16.94

Hospital Charge Code	27000137
Hospital Revenue Code	270
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$15.25
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna New Business (MI Preferred)	$11.01
Rate for Payer: BCBS Complete	$6.78
Rate for Payer: Cash Price	$13.55
Rate for Payer: Cofinity Commercial	$11.86
Rate for Payer: Cofinity Commercial	$14.57
Rate for Payer: Healthscope Commercial	$15.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.40
Rate for Payer: PHP Commercial	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$11.86
Rate for Payer: Priority Health SBD	$10.67

HC POUCH WOUND 11 X 5

Facility

$110.66

Service Code	HCPCS A6154
Hospital Charge Code	27000619
Hospital Revenue Code	270
Min. Negotiated Rate	$69.72
Max. Negotiated Rate	$99.59
Rate for Payer: Aetna Commercial	$94.06
Rate for Payer: Aetna New Business (MI Preferred)	$71.93
Rate for Payer: Cash Price	$88.53
Rate for Payer: Cofinity Commercial	$95.17
Rate for Payer: Cofinity Commercial	$77.46
Rate for Payer: Healthscope Commercial	$99.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.06
Rate for Payer: PHP Commercial	$94.06
Rate for Payer: Priority Health Cigna Priority Health	$77.46
Rate for Payer: Priority Health SBD	$69.72

HC POUCH WOUND 11 X 5

Facility

$110.66

Service Code	HCPCS A6154
Hospital Charge Code	27000619
Hospital Revenue Code	270
Min. Negotiated Rate	$19.62
Max. Negotiated Rate	$99.59
Rate for Payer: Aetna Commercial	$94.06
Rate for Payer: Aetna New Business (MI Preferred)	$71.93
Rate for Payer: BCBS Complete	$44.26
Rate for Payer: BCBS Trust/PPO	$55.56
Rate for Payer: Cash Price	$88.53
Rate for Payer: Cash Price	$88.53
Rate for Payer: Cofinity Commercial	$77.46
Rate for Payer: Cofinity Commercial	$95.17
Rate for Payer: Healthscope Commercial	$99.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.06
Rate for Payer: PHP Commercial	$94.06
Rate for Payer: Priority Health Cigna Priority Health	$77.46
Rate for Payer: Priority Health SBD	$69.72
Rate for Payer: UHC All Payor (Choice/PPO)	$23.54
Rate for Payer: UHC Exchange	$19.62

HC POUCH WOUND 1 X 1

Facility

$29.85

Service Code	HCPCS A6154
Hospital Charge Code	27000623
Hospital Revenue Code	270
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$26.86
Rate for Payer: Aetna Commercial	$25.37
Rate for Payer: Aetna New Business (MI Preferred)	$19.40
Rate for Payer: Cash Price	$23.88
Rate for Payer: Cofinity Commercial	$20.90
Rate for Payer: Cofinity Commercial	$25.67
Rate for Payer: Healthscope Commercial	$26.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.37
Rate for Payer: PHP Commercial	$25.37
Rate for Payer: Priority Health Cigna Priority Health	$20.90
Rate for Payer: Priority Health SBD	$18.81

HC POUCH WOUND 1 X 1

Facility

$29.85

Service Code	HCPCS A6154
Hospital Charge Code	27000623
Hospital Revenue Code	270
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$55.56
Rate for Payer: Aetna Commercial	$25.37
Rate for Payer: Aetna New Business (MI Preferred)	$19.40
Rate for Payer: BCBS Complete	$11.94
Rate for Payer: BCBS Trust/PPO	$55.56
Rate for Payer: Cash Price	$23.88
Rate for Payer: Cash Price	$23.88
Rate for Payer: Cofinity Commercial	$25.67
Rate for Payer: Cofinity Commercial	$20.90
Rate for Payer: Healthscope Commercial	$26.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.37
Rate for Payer: PHP Commercial	$25.37
Rate for Payer: Priority Health Cigna Priority Health	$20.90
Rate for Payer: Priority Health SBD	$18.81
Rate for Payer: UHC All Payor (Choice/PPO)	$23.54
Rate for Payer: UHC Exchange	$19.62

HC POUCH WOUND 2 X 3

Facility

$39.02

Service Code	HCPCS A6154
Hospital Charge Code	27000622
Hospital Revenue Code	270
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$35.12
Rate for Payer: Aetna Commercial	$33.17
Rate for Payer: Aetna New Business (MI Preferred)	$25.36
Rate for Payer: Cash Price	$31.22
Rate for Payer: Cofinity Commercial	$27.31
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Healthscope Commercial	$35.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.17
Rate for Payer: PHP Commercial	$33.17
Rate for Payer: Priority Health Cigna Priority Health	$27.31
Rate for Payer: Priority Health SBD	$24.58

HC POUCH WOUND 2 X 3

Facility

$39.02

Service Code	HCPCS A6154
Hospital Charge Code	27000622
Hospital Revenue Code	270
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$55.56
Rate for Payer: Aetna Commercial	$33.17
Rate for Payer: Aetna New Business (MI Preferred)	$25.36
Rate for Payer: BCBS Complete	$15.61
Rate for Payer: BCBS Trust/PPO	$55.56
Rate for Payer: Cash Price	$31.22
Rate for Payer: Cash Price	$31.22
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Cofinity Commercial	$27.31
Rate for Payer: Healthscope Commercial	$35.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.17
Rate for Payer: PHP Commercial	$33.17
Rate for Payer: Priority Health Cigna Priority Health	$27.31
Rate for Payer: Priority Health SBD	$24.58
Rate for Payer: UHC All Payor (Choice/PPO)	$23.54
Rate for Payer: UHC Exchange	$19.62

HC POUCH WOUND 6 X 4

Facility

$55.62

Service Code	HCPCS A6154
Hospital Charge Code	27000621
Hospital Revenue Code	270
Min. Negotiated Rate	$19.62
Max. Negotiated Rate	$55.56
Rate for Payer: Aetna Commercial	$47.28
Rate for Payer: Aetna New Business (MI Preferred)	$36.15
Rate for Payer: BCBS Complete	$22.25
Rate for Payer: BCBS Trust/PPO	$55.56
Rate for Payer: Cash Price	$44.50
Rate for Payer: Cash Price	$44.50
Rate for Payer: Cofinity Commercial	$47.83
Rate for Payer: Cofinity Commercial	$38.93
Rate for Payer: Healthscope Commercial	$50.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.28
Rate for Payer: PHP Commercial	$47.28
Rate for Payer: Priority Health Cigna Priority Health	$38.93
Rate for Payer: Priority Health SBD	$35.04
Rate for Payer: UHC All Payor (Choice/PPO)	$23.54
Rate for Payer: UHC Exchange	$19.62

HC POUCH WOUND 6 X 4

Facility

$55.62

Service Code	HCPCS A6154
Hospital Charge Code	27000621
Hospital Revenue Code	270
Min. Negotiated Rate	$35.04
Max. Negotiated Rate	$50.06
Rate for Payer: Aetna Commercial	$47.28
Rate for Payer: Aetna New Business (MI Preferred)	$36.15
Rate for Payer: Cash Price	$44.50
Rate for Payer: Cofinity Commercial	$38.93
Rate for Payer: Cofinity Commercial	$47.83
Rate for Payer: Healthscope Commercial	$50.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.28
Rate for Payer: PHP Commercial	$47.28
Rate for Payer: Priority Health Cigna Priority Health	$38.93
Rate for Payer: Priority Health SBD	$35.04

HC POUCH WOUND 9 X 6

Facility

$100.59

Service Code	HCPCS A6154
Hospital Charge Code	27000620
Hospital Revenue Code	270
Min. Negotiated Rate	$19.62
Max. Negotiated Rate	$90.53
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna New Business (MI Preferred)	$65.38
Rate for Payer: BCBS Complete	$40.24
Rate for Payer: BCBS Trust/PPO	$55.56
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cofinity Commercial	$70.41
Rate for Payer: Cofinity Commercial	$86.51
Rate for Payer: Healthscope Commercial	$90.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.50
Rate for Payer: PHP Commercial	$85.50
Rate for Payer: Priority Health Cigna Priority Health	$70.41
Rate for Payer: Priority Health SBD	$63.37
Rate for Payer: UHC All Payor (Choice/PPO)	$23.54
Rate for Payer: UHC Exchange	$19.62

HC POUCH WOUND 9 X 6

Facility

$100.59

Service Code	HCPCS A6154
Hospital Charge Code	27000620
Hospital Revenue Code	270
Min. Negotiated Rate	$63.37
Max. Negotiated Rate	$90.53
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna New Business (MI Preferred)	$65.38
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cofinity Commercial	$70.41
Rate for Payer: Cofinity Commercial	$86.51
Rate for Payer: Healthscope Commercial	$90.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.50
Rate for Payer: PHP Commercial	$85.50
Rate for Payer: Priority Health Cigna Priority Health	$70.41
Rate for Payer: Priority Health SBD	$63.37

HC POWDER MICANOZOLE

Facility

$19.60

Hospital Charge Code	27000625
Hospital Revenue Code	270
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$17.64
Rate for Payer: Aetna Commercial	$16.66
Rate for Payer: Aetna New Business (MI Preferred)	$12.74
Rate for Payer: Cash Price	$15.68
Rate for Payer: Cofinity Commercial	$13.72
Rate for Payer: Cofinity Commercial	$16.86
Rate for Payer: Healthscope Commercial	$17.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.66
Rate for Payer: PHP Commercial	$16.66
Rate for Payer: Priority Health Cigna Priority Health	$13.72
Rate for Payer: Priority Health SBD	$12.35

Know your out-of-pocket cost for care.

All Charges