Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC MAPPING W/INTRACARDIAC 3D

Facility

$6,169.57

Service Code	CPT 93613
Hospital Charge Code	48100035
Hospital Revenue Code	481
Min. Negotiated Rate	$2,467.83
Max. Negotiated Rate	$5,552.61
Rate for Payer: Aetna Commercial	$5,244.13
Rate for Payer: Aetna Medicare	$3,084.78
Rate for Payer: Aetna New Business (MI Preferred)	$4,010.22
Rate for Payer: BCBS Complete	$2,467.83
Rate for Payer: Cash Price	$4,935.66
Rate for Payer: Cofinity Commercial	$4,318.70
Rate for Payer: Cofinity Commercial	$5,305.83
Rate for Payer: Cofinity Medicare Advantage	$4,318.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,935.66
Rate for Payer: Healthscope Commercial	$5,552.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,244.13
Rate for Payer: PHP Commercial	$5,244.13
Rate for Payer: Priority Health Cigna Priority Health	$4,010.22
Rate for Payer: Priority Health SBD	$3,886.83

HC MAPPING W/INTRACARDIAC 3D

Facility

$6,169.57

Service Code	CPT 93613
Hospital Charge Code	48100035
Hospital Revenue Code	481
Min. Negotiated Rate	$3,886.83
Max. Negotiated Rate	$5,552.61
Rate for Payer: Aetna Commercial	$5,244.13
Rate for Payer: Aetna New Business (MI Preferred)	$4,010.22
Rate for Payer: Cash Price	$4,935.66
Rate for Payer: Cofinity Commercial	$4,318.70
Rate for Payer: Cofinity Commercial	$5,305.83
Rate for Payer: Cofinity Medicare Advantage	$4,318.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,935.66
Rate for Payer: Healthscope Commercial	$5,552.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,244.13
Rate for Payer: PHP Commercial	$5,244.13
Rate for Payer: Priority Health Cigna Priority Health	$4,010.22
Rate for Payer: Priority Health SBD	$3,886.83

HC MAPPING W/OUT INTRACARDIAC 3D

Facility

$4,398.08

Service Code	CPT 93609
Hospital Charge Code	48100032
Hospital Revenue Code	481
Min. Negotiated Rate	$1,759.23
Max. Negotiated Rate	$3,958.27
Rate for Payer: Aetna Commercial	$3,738.37
Rate for Payer: Aetna Medicare	$2,199.04
Rate for Payer: Aetna New Business (MI Preferred)	$2,858.75
Rate for Payer: BCBS Complete	$1,759.23
Rate for Payer: Cash Price	$3,518.46
Rate for Payer: Cofinity Commercial	$3,078.66
Rate for Payer: Cofinity Commercial	$3,782.35
Rate for Payer: Cofinity Medicare Advantage	$3,078.66
Rate for Payer: Encore Health Key Benefits Commercial	$3,518.46
Rate for Payer: Healthscope Commercial	$3,958.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,738.37
Rate for Payer: PHP Commercial	$3,738.37
Rate for Payer: Priority Health Cigna Priority Health	$2,858.75
Rate for Payer: Priority Health SBD	$2,770.79

HC MAPPING W/OUT INTRACARDIAC 3D

Facility

$4,398.08

Service Code	CPT 93609
Hospital Charge Code	48100032
Hospital Revenue Code	481
Min. Negotiated Rate	$2,770.79
Max. Negotiated Rate	$3,958.27
Rate for Payer: Aetna Commercial	$3,738.37
Rate for Payer: Aetna New Business (MI Preferred)	$2,858.75
Rate for Payer: Cash Price	$3,518.46
Rate for Payer: Cofinity Commercial	$3,078.66
Rate for Payer: Cofinity Commercial	$3,782.35
Rate for Payer: Cofinity Medicare Advantage	$3,078.66
Rate for Payer: Encore Health Key Benefits Commercial	$3,518.46
Rate for Payer: Healthscope Commercial	$3,958.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,738.37
Rate for Payer: PHP Commercial	$3,738.37
Rate for Payer: Priority Health Cigna Priority Health	$2,858.75
Rate for Payer: Priority Health SBD	$2,770.79

HC MARS BARTHOLINS GLAND CYST

Facility

$7,945.53

Service Code	CPT 56440
Hospital Charge Code	76100331
Hospital Revenue Code	761
Min. Negotiated Rate	$5,005.68
Max. Negotiated Rate	$7,150.98
Rate for Payer: Aetna Commercial	$6,753.70
Rate for Payer: Aetna New Business (MI Preferred)	$5,164.59
Rate for Payer: Cash Price	$6,356.42
Rate for Payer: Cofinity Commercial	$5,561.87
Rate for Payer: Cofinity Commercial	$6,833.16
Rate for Payer: Cofinity Medicare Advantage	$5,561.87
Rate for Payer: Encore Health Key Benefits Commercial	$6,356.42
Rate for Payer: Healthscope Commercial	$7,150.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,753.70
Rate for Payer: PHP Commercial	$6,753.70
Rate for Payer: Priority Health Cigna Priority Health	$5,164.59
Rate for Payer: Priority Health SBD	$5,005.68

HC MARS BARTHOLINS GLAND CYST

Facility

$7,945.53

Service Code	CPT 56440
Hospital Charge Code	76100331
Hospital Revenue Code	761
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Commercial	$6,753.70
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Aetna New Business (MI Preferred)	$5,164.59
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Cash Price	$6,356.42
Rate for Payer: Cash Price	$6,356.42
Rate for Payer: Cofinity Commercial	$6,833.16
Rate for Payer: Cofinity Commercial	$5,561.87
Rate for Payer: Cofinity Medicare Advantage	$5,561.87
Rate for Payer: Encore Health Key Benefits Commercial	$6,356.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Healthscope Commercial	$7,150.98
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,753.70
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Commercial	$6,753.70
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Cigna Priority Health	$5,164.59
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Priority Health SBD	$5,005.68
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,745.82
Rate for Payer: VA VA	$3,100.93

HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA

Facility

$8,058.00

Service Code	CPT 42409
Hospital Charge Code	76100472
Hospital Revenue Code	761
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Commercial	$6,849.30
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Aetna New Business (MI Preferred)	$5,237.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Cash Price	$6,446.40
Rate for Payer: Cash Price	$6,446.40
Rate for Payer: Cofinity Commercial	$6,929.88
Rate for Payer: Cofinity Commercial	$5,640.60
Rate for Payer: Cofinity Medicare Advantage	$5,640.60
Rate for Payer: Encore Health Key Benefits Commercial	$6,446.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Healthscope Commercial	$7,252.20
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,849.30
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Commercial	$6,849.30
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Cigna Priority Health	$5,237.70
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Priority Health SBD	$5,076.54
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,780.71
Rate for Payer: VA VA	$3,162.90

HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA

Facility

$8,058.00

Service Code	CPT 42409
Hospital Charge Code	76100472
Hospital Revenue Code	761
Min. Negotiated Rate	$5,076.54
Max. Negotiated Rate	$7,252.20
Rate for Payer: Aetna Commercial	$6,849.30
Rate for Payer: Aetna New Business (MI Preferred)	$5,237.70
Rate for Payer: Cash Price	$6,446.40
Rate for Payer: Cofinity Commercial	$5,640.60
Rate for Payer: Cofinity Commercial	$6,929.88
Rate for Payer: Cofinity Medicare Advantage	$5,640.60
Rate for Payer: Encore Health Key Benefits Commercial	$6,446.40
Rate for Payer: Healthscope Commercial	$7,252.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,849.30
Rate for Payer: PHP Commercial	$6,849.30
Rate for Payer: Priority Health Cigna Priority Health	$5,237.70
Rate for Payer: Priority Health SBD	$5,076.54

HC MASSAGE THERAPY

Facility

$30.60

Service Code	CPT 97124
Hospital Charge Code	42000024
Hospital Revenue Code	420
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$26.01
Rate for Payer: Aetna Medicare	$15.30
Rate for Payer: Aetna New Business (MI Preferred)	$19.89
Rate for Payer: BCBS Complete	$12.24
Rate for Payer: Cash Price	$24.48
Rate for Payer: Cash Price	$24.48
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$21.42
Rate for Payer: Cofinity Medicare Advantage	$21.42
Rate for Payer: Encore Health Key Benefits Commercial	$24.48
Rate for Payer: Healthscope Commercial	$27.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.01
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$26.01
Rate for Payer: Priority Health Cigna Priority Health	$19.89
Rate for Payer: Priority Health SBD	$19.28
Rate for Payer: UHC Core	$22.64
Rate for Payer: UHC Exchange	$22.64

HC MASSAGE THERAPY

Facility

$30.60

Service Code	CPT 97124
Hospital Charge Code	42000024
Hospital Revenue Code	420
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$27.54
Rate for Payer: Aetna Commercial	$26.01
Rate for Payer: Aetna New Business (MI Preferred)	$19.89
Rate for Payer: Cash Price	$24.48
Rate for Payer: Cofinity Commercial	$21.42
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Medicare Advantage	$21.42
Rate for Payer: Encore Health Key Benefits Commercial	$24.48
Rate for Payer: Healthscope Commercial	$27.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.01
Rate for Payer: PHP Commercial	$26.01
Rate for Payer: Priority Health Cigna Priority Health	$19.89
Rate for Payer: Priority Health SBD	$19.28

HC MASTECTOMY SLEEVE EA $100

Facility

$102.00

Service Code	HCPCS L8010
Hospital Charge Code	96000004
Hospital Revenue Code	270
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$66.30
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$71.40
Rate for Payer: Cofinity Commercial	$87.72
Rate for Payer: Cofinity Medicare Advantage	$71.40
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: PHP Commercial	$86.70
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health SBD	$64.26

HC MASTECTOMY SLEEVE EA $100

Facility

$102.00

Service Code	HCPCS L8010
Hospital Charge Code	96000004
Hospital Revenue Code	270
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna New Business (MI Preferred)	$66.30
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$71.40
Rate for Payer: Cofinity Commercial	$87.72
Rate for Payer: Cofinity Medicare Advantage	$71.40
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: PHP Commercial	$86.70
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health SBD	$64.26

HC MASTECTOMY SLEEVE EA $125

Facility

$127.50

Service Code	HCPCS L8010
Hospital Charge Code	96000005
Hospital Revenue Code	270
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

HC MASTECTOMY SLEEVE EA $125

Facility

$127.50

Service Code	HCPCS L8010
Hospital Charge Code	96000005
Hospital Revenue Code	270
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 MASTECTOMY SLEEVE EA $150

Facility

$153.00

Service Code	HCPCS L8010
Hospital Charge Code	96000006
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC MASTECTOMY SLEEVE EA $150

Facility

$153.00

Service Code	HCPCS L8010
Hospital Charge Code	96000006
Hospital Revenue Code	270
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC MASTECTOMY SLEEVE EA $175

Facility

$178.50

Service Code	HCPCS L8010
Hospital Charge Code	96000007
Hospital Revenue Code	270
Min. Negotiated Rate	$112.45
Max. Negotiated Rate	$160.65
Rate for Payer: Aetna Commercial	$151.72
Rate for Payer: Aetna New Business (MI Preferred)	$116.03
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Commercial	$124.95
Rate for Payer: Cofinity Commercial	$153.51
Rate for Payer: Cofinity Medicare Advantage	$124.95
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$160.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: PHP Commercial	$151.72
Rate for Payer: Priority Health Cigna Priority Health	$116.03
Rate for Payer: Priority Health SBD	$112.45

HC MASTECTOMY SLEEVE EA $175

Facility

$178.50

Service Code	HCPCS L8010
Hospital Charge Code	96000007
Hospital Revenue Code	270
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$160.65
Rate for Payer: Aetna Commercial	$151.72
Rate for Payer: Aetna Medicare	$89.25
Rate for Payer: Aetna New Business (MI Preferred)	$116.03
Rate for Payer: BCBS Complete	$71.40
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Commercial	$124.95
Rate for Payer: Cofinity Commercial	$153.51
Rate for Payer: Cofinity Medicare Advantage	$124.95
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$160.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: PHP Commercial	$151.72
Rate for Payer: Priority Health Cigna Priority Health	$116.03
Rate for Payer: Priority Health SBD	$112.45

HC MASTECTOMY SLEEVE EA $200

Facility

$204.00

Service Code	HCPCS L8010
Hospital Charge Code	96000008
Hospital Revenue Code	270
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna Commercial	$173.40
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: Aetna New Business (MI Preferred)	$132.60
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$142.80
Rate for Payer: Cofinity Commercial	$175.44
Rate for Payer: Cofinity Medicare Advantage	$142.80
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: PHP Commercial	$173.40
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: Priority Health SBD	$128.52

HC MASTECTOMY SLEEVE EA $200

Facility

$204.00

Service Code	HCPCS L8010
Hospital Charge Code	96000008
Hospital Revenue Code	270
Min. Negotiated Rate	$128.52
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna Commercial	$173.40
Rate for Payer: Aetna New Business (MI Preferred)	$132.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$142.80
Rate for Payer: Cofinity Commercial	$175.44
Rate for Payer: Cofinity Medicare Advantage	$142.80
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: PHP Commercial	$173.40
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: Priority Health SBD	$128.52

HC MASTECTOMY SLEEVE EA $225

Facility

$229.50

Service Code	HCPCS L8010
Hospital Charge Code	96000009
Hospital Revenue Code	270
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$206.55
Rate for Payer: Aetna Commercial	$195.07
Rate for Payer: Aetna Medicare	$114.75
Rate for Payer: Aetna New Business (MI Preferred)	$149.18
Rate for Payer: BCBS Complete	$91.80
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$160.65
Rate for Payer: Cofinity Commercial	$197.37
Rate for Payer: Cofinity Medicare Advantage	$160.65
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.07
Rate for Payer: PHP Commercial	$195.07
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: Priority Health SBD	$144.59

HC MASTECTOMY SLEEVE EA $225

Facility

$229.50

Service Code	HCPCS L8010
Hospital Charge Code	96000009
Hospital Revenue Code	270
Min. Negotiated Rate	$144.59
Max. Negotiated Rate	$206.55
Rate for Payer: Aetna Commercial	$195.07
Rate for Payer: Aetna New Business (MI Preferred)	$149.18
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$160.65
Rate for Payer: Cofinity Commercial	$197.37
Rate for Payer: Cofinity Medicare Advantage	$160.65
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.07
Rate for Payer: PHP Commercial	$195.07
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: Priority Health SBD	$144.59

HC MASTECTOMY SLEEVE EA $250

Facility

$255.00

Service Code	HCPCS L8010
Hospital Charge Code	96000010
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 MASTECTOMY SLEEVE EA $250

Facility

$255.00

Service Code	HCPCS L8010
Hospital Charge Code	96000010
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 MASTECTOMY SLEEVE EA $275

Facility

$280.50

Service Code	HCPCS L8010
Hospital Charge Code	96000011
Hospital Revenue Code	270
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna Medicare	$140.25
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: BCBS Complete	$112.20
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72

Know your out-of-pocket cost for care.

All Charges