Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NEEDLE LOC WIRE

Facility

$53.06

Service Code	HCPCS C1819
Hospital Charge Code	27200323
Hospital Revenue Code	272
Min. Negotiated Rate	$33.43
Max. Negotiated Rate	$47.75
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna New Business (MI Preferred)	$34.49
Rate for Payer: Cash Price	$42.45
Rate for Payer: Cofinity Commercial	$37.14
Rate for Payer: Cofinity Commercial	$45.63
Rate for Payer: Cofinity Medicare Advantage	$37.14
Rate for Payer: Encore Health Key Benefits Commercial	$42.45
Rate for Payer: Healthscope Commercial	$47.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.10
Rate for Payer: PHP Commercial	$45.10
Rate for Payer: Priority Health Cigna Priority Health	$34.49
Rate for Payer: Priority Health SBD	$33.43

HC NEG PRES CANIST 1000CC

Facility

$233.19

Hospital Charge Code	27200232
Hospital Revenue Code	272
Min. Negotiated Rate	$93.28
Max. Negotiated Rate	$209.87
Rate for Payer: Aetna Commercial	$198.21
Rate for Payer: Aetna Medicare	$116.59
Rate for Payer: Aetna New Business (MI Preferred)	$151.57
Rate for Payer: BCBS Complete	$93.28
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cofinity Commercial	$163.23
Rate for Payer: Cofinity Commercial	$200.54
Rate for Payer: Cofinity Medicare Advantage	$163.23
Rate for Payer: Encore Health Key Benefits Commercial	$186.55
Rate for Payer: Healthscope Commercial	$209.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$198.21
Rate for Payer: PHP Commercial	$198.21
Rate for Payer: Priority Health Cigna Priority Health	$151.57
Rate for Payer: Priority Health SBD	$146.91

HC NEG PRES CANIST 1000CC

Facility

$233.19

Hospital Charge Code	27200232
Hospital Revenue Code	272
Min. Negotiated Rate	$146.91
Max. Negotiated Rate	$209.87
Rate for Payer: Aetna Commercial	$198.21
Rate for Payer: Aetna New Business (MI Preferred)	$151.57
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cofinity Commercial	$163.23
Rate for Payer: Cofinity Commercial	$200.54
Rate for Payer: Cofinity Medicare Advantage	$163.23
Rate for Payer: Encore Health Key Benefits Commercial	$186.55
Rate for Payer: Healthscope Commercial	$209.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$198.21
Rate for Payer: PHP Commercial	$198.21
Rate for Payer: Priority Health Cigna Priority Health	$151.57
Rate for Payer: Priority Health SBD	$146.91

HC NEG PRES CANIST 500CC

Facility

$151.46

Hospital Charge Code	27200136
Hospital Revenue Code	272
Min. Negotiated Rate	$60.58
Max. Negotiated Rate	$136.31
Rate for Payer: Aetna Commercial	$128.74
Rate for Payer: Aetna Medicare	$75.73
Rate for Payer: Aetna New Business (MI Preferred)	$98.45
Rate for Payer: BCBS Complete	$60.58
Rate for Payer: Cash Price	$121.17
Rate for Payer: Cofinity Commercial	$106.02
Rate for Payer: Cofinity Commercial	$130.26
Rate for Payer: Cofinity Medicare Advantage	$106.02
Rate for Payer: Encore Health Key Benefits Commercial	$121.17
Rate for Payer: Healthscope Commercial	$136.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.74
Rate for Payer: PHP Commercial	$128.74
Rate for Payer: Priority Health Cigna Priority Health	$98.45
Rate for Payer: Priority Health SBD	$95.42

HC NEG PRES CANIST 500CC

Facility

$151.46

Hospital Charge Code	27200136
Hospital Revenue Code	272
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$136.31
Rate for Payer: Aetna Commercial	$128.74
Rate for Payer: Aetna New Business (MI Preferred)	$98.45
Rate for Payer: Cash Price	$121.17
Rate for Payer: Cofinity Commercial	$106.02
Rate for Payer: Cofinity Commercial	$130.26
Rate for Payer: Cofinity Medicare Advantage	$106.02
Rate for Payer: Encore Health Key Benefits Commercial	$121.17
Rate for Payer: Healthscope Commercial	$136.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.74
Rate for Payer: PHP Commercial	$128.74
Rate for Payer: Priority Health Cigna Priority Health	$98.45
Rate for Payer: Priority Health SBD	$95.42

HC NEG PRES CLEANSE DRSG MED

Facility

$510.90

Hospital Charge Code	27200229
Hospital Revenue Code	272
Min. Negotiated Rate	$321.87
Max. Negotiated Rate	$459.81
Rate for Payer: Aetna Commercial	$434.26
Rate for Payer: Aetna New Business (MI Preferred)	$332.08
Rate for Payer: Cash Price	$408.72
Rate for Payer: Cofinity Commercial	$357.63
Rate for Payer: Cofinity Commercial	$439.37
Rate for Payer: Cofinity Medicare Advantage	$357.63
Rate for Payer: Encore Health Key Benefits Commercial	$408.72
Rate for Payer: Healthscope Commercial	$459.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$434.26
Rate for Payer: PHP Commercial	$434.26
Rate for Payer: Priority Health Cigna Priority Health	$332.08
Rate for Payer: Priority Health SBD	$321.87

HC NEG PRES CLEANSE DRSG MED

Facility

$510.90

Hospital Charge Code	27200229
Hospital Revenue Code	272
Min. Negotiated Rate	$204.36
Max. Negotiated Rate	$459.81
Rate for Payer: Aetna Commercial	$434.26
Rate for Payer: Aetna Medicare	$255.45
Rate for Payer: Aetna New Business (MI Preferred)	$332.08
Rate for Payer: BCBS Complete	$204.36
Rate for Payer: Cash Price	$408.72
Rate for Payer: Cofinity Commercial	$357.63
Rate for Payer: Cofinity Commercial	$439.37
Rate for Payer: Cofinity Medicare Advantage	$357.63
Rate for Payer: Encore Health Key Benefits Commercial	$408.72
Rate for Payer: Healthscope Commercial	$459.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$434.26
Rate for Payer: PHP Commercial	$434.26
Rate for Payer: Priority Health Cigna Priority Health	$332.08
Rate for Payer: Priority Health SBD	$321.87

HC NEG PRESSURE DERMATAC DRAPE

Facility

$64.50

Hospital Charge Code	27200374
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$58.05
Rate for Payer: Aetna Commercial	$54.83
Rate for Payer: Aetna Medicare	$32.25
Rate for Payer: Aetna New Business (MI Preferred)	$41.92
Rate for Payer: BCBS Complete	$25.80
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cofinity Commercial	$45.15
Rate for Payer: Cofinity Commercial	$55.47
Rate for Payer: Cofinity Medicare Advantage	$45.15
Rate for Payer: Encore Health Key Benefits Commercial	$51.60
Rate for Payer: Healthscope Commercial	$58.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.83
Rate for Payer: PHP Commercial	$54.83
Rate for Payer: Priority Health Cigna Priority Health	$41.92
Rate for Payer: Priority Health SBD	$40.63

HC NEG PRESSURE DERMATAC DRAPE

Facility

$64.50

Hospital Charge Code	27200374
Hospital Revenue Code	272
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$58.05
Rate for Payer: Aetna Commercial	$54.83
Rate for Payer: Aetna New Business (MI Preferred)	$41.92
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cofinity Commercial	$45.15
Rate for Payer: Cofinity Commercial	$55.47
Rate for Payer: Cofinity Medicare Advantage	$45.15
Rate for Payer: Encore Health Key Benefits Commercial	$51.60
Rate for Payer: Healthscope Commercial	$58.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.83
Rate for Payer: PHP Commercial	$54.83
Rate for Payer: Priority Health Cigna Priority Health	$41.92
Rate for Payer: Priority Health SBD	$40.63

HC NEG PRESSURE WND TX DME GT 50 SQ CM

Facility

$540.83

Service Code	CPT 97606
Hospital Charge Code	76100009
Hospital Revenue Code	761
Min. Negotiated Rate	$340.72
Max. Negotiated Rate	$486.75
Rate for Payer: Aetna Commercial	$459.71
Rate for Payer: Aetna New Business (MI Preferred)	$351.54
Rate for Payer: Cash Price	$432.66
Rate for Payer: Cofinity Commercial	$378.58
Rate for Payer: Cofinity Commercial	$465.11
Rate for Payer: Cofinity Medicare Advantage	$378.58
Rate for Payer: Encore Health Key Benefits Commercial	$432.66
Rate for Payer: Healthscope Commercial	$486.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$459.71
Rate for Payer: PHP Commercial	$459.71
Rate for Payer: Priority Health Cigna Priority Health	$351.54
Rate for Payer: Priority Health SBD	$340.72

HC NEG PRESSURE WND TX DME GT 50 SQ CM

Facility

$540.83

Service Code	CPT 97606
Hospital Charge Code	76100009
Hospital Revenue Code	761
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$459.71
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Aetna New Business (MI Preferred)	$351.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Cash Price	$432.66
Rate for Payer: Cash Price	$432.66
Rate for Payer: Cofinity Commercial	$465.11
Rate for Payer: Cofinity Commercial	$378.58
Rate for Payer: Cofinity Medicare Advantage	$378.58
Rate for Payer: Encore Health Key Benefits Commercial	$432.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Healthscope Commercial	$486.75
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$459.71
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Commercial	$459.71
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Cigna Priority Health	$351.54
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Priority Health SBD	$340.72
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

HC NEG PRESSURE WND TX DME UP TO 50 SQ CM

Facility

$428.32

Service Code	CPT 97605
Hospital Charge Code	76100008
Hospital Revenue Code	761
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Commercial	$364.07
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Aetna New Business (MI Preferred)	$278.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Cash Price	$342.66
Rate for Payer: Cash Price	$342.66
Rate for Payer: Cofinity Commercial	$368.36
Rate for Payer: Cofinity Commercial	$299.82
Rate for Payer: Cofinity Medicare Advantage	$299.82
Rate for Payer: Encore Health Key Benefits Commercial	$342.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Healthscope Commercial	$385.49
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.07
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Commercial	$364.07
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$278.41
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Priority Health SBD	$269.84
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

HC NEG PRESSURE WND TX DME UP TO 50 SQ CM

Facility

$428.32

Service Code	CPT 97605
Hospital Charge Code	76100008
Hospital Revenue Code	761
Min. Negotiated Rate	$269.84
Max. Negotiated Rate	$385.49
Rate for Payer: Aetna Commercial	$364.07
Rate for Payer: Aetna New Business (MI Preferred)	$278.41
Rate for Payer: Cash Price	$342.66
Rate for Payer: Cofinity Commercial	$299.82
Rate for Payer: Cofinity Commercial	$368.36
Rate for Payer: Cofinity Medicare Advantage	$299.82
Rate for Payer: Encore Health Key Benefits Commercial	$342.66
Rate for Payer: Healthscope Commercial	$385.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.07
Rate for Payer: PHP Commercial	$364.07
Rate for Payer: Priority Health Cigna Priority Health	$278.41
Rate for Payer: Priority Health SBD	$269.84

HC NEG PRES TRAC PAD

Facility

$73.81

Hospital Charge Code	27000158
Hospital Revenue Code	270
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$66.43
Rate for Payer: Aetna Commercial	$62.74
Rate for Payer: Aetna Medicare	$36.91
Rate for Payer: Aetna New Business (MI Preferred)	$47.98
Rate for Payer: BCBS Complete	$29.52
Rate for Payer: Cash Price	$59.05
Rate for Payer: Cofinity Commercial	$51.67
Rate for Payer: Cofinity Commercial	$63.48
Rate for Payer: Cofinity Medicare Advantage	$51.67
Rate for Payer: Encore Health Key Benefits Commercial	$59.05
Rate for Payer: Healthscope Commercial	$66.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.74
Rate for Payer: PHP Commercial	$62.74
Rate for Payer: Priority Health Cigna Priority Health	$47.98
Rate for Payer: Priority Health SBD	$46.50

HC NEG PRES TRAC PAD

Facility

$73.81

Hospital Charge Code	27000158
Hospital Revenue Code	270
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$66.43
Rate for Payer: Aetna Commercial	$62.74
Rate for Payer: Aetna New Business (MI Preferred)	$47.98
Rate for Payer: Cash Price	$59.05
Rate for Payer: Cofinity Commercial	$51.67
Rate for Payer: Cofinity Commercial	$63.48
Rate for Payer: Cofinity Medicare Advantage	$51.67
Rate for Payer: Encore Health Key Benefits Commercial	$59.05
Rate for Payer: Healthscope Commercial	$66.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.74
Rate for Payer: PHP Commercial	$62.74
Rate for Payer: Priority Health Cigna Priority Health	$47.98
Rate for Payer: Priority Health SBD	$46.50

HC NEG PRES VF CASSETTE

Facility

$212.87

Hospital Charge Code	27200230
Hospital Revenue Code	272
Min. Negotiated Rate	$85.15
Max. Negotiated Rate	$191.58
Rate for Payer: Aetna Commercial	$180.94
Rate for Payer: Aetna Medicare	$106.44
Rate for Payer: Aetna New Business (MI Preferred)	$138.37
Rate for Payer: BCBS Complete	$85.15
Rate for Payer: Cash Price	$170.30
Rate for Payer: Cofinity Commercial	$149.01
Rate for Payer: Cofinity Commercial	$183.07
Rate for Payer: Cofinity Medicare Advantage	$149.01
Rate for Payer: Encore Health Key Benefits Commercial	$170.30
Rate for Payer: Healthscope Commercial	$191.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.94
Rate for Payer: PHP Commercial	$180.94
Rate for Payer: Priority Health Cigna Priority Health	$138.37
Rate for Payer: Priority Health SBD	$134.11

HC NEG PRES VF CASSETTE

Facility

$212.87

Hospital Charge Code	27200230
Hospital Revenue Code	272
Min. Negotiated Rate	$134.11
Max. Negotiated Rate	$191.58
Rate for Payer: Aetna Commercial	$180.94
Rate for Payer: Aetna New Business (MI Preferred)	$138.37
Rate for Payer: Cash Price	$170.30
Rate for Payer: Cofinity Commercial	$149.01
Rate for Payer: Cofinity Commercial	$183.07
Rate for Payer: Cofinity Medicare Advantage	$149.01
Rate for Payer: Encore Health Key Benefits Commercial	$170.30
Rate for Payer: Healthscope Commercial	$191.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.94
Rate for Payer: PHP Commercial	$180.94
Rate for Payer: Priority Health Cigna Priority Health	$138.37
Rate for Payer: Priority Health SBD	$134.11

HC NEG PRES VF DRSG MED

Facility

$445.10

Hospital Charge Code	27200228
Hospital Revenue Code	272
Min. Negotiated Rate	$178.04
Max. Negotiated Rate	$400.59
Rate for Payer: Aetna Commercial	$378.33
Rate for Payer: Aetna Medicare	$222.55
Rate for Payer: Aetna New Business (MI Preferred)	$289.31
Rate for Payer: BCBS Complete	$178.04
Rate for Payer: Cash Price	$356.08
Rate for Payer: Cofinity Commercial	$311.57
Rate for Payer: Cofinity Commercial	$382.79
Rate for Payer: Cofinity Medicare Advantage	$311.57
Rate for Payer: Encore Health Key Benefits Commercial	$356.08
Rate for Payer: Healthscope Commercial	$400.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.33
Rate for Payer: PHP Commercial	$378.33
Rate for Payer: Priority Health Cigna Priority Health	$289.31
Rate for Payer: Priority Health SBD	$280.41

HC NEG PRES VF DRSG MED

Facility

$445.10

Hospital Charge Code	27200228
Hospital Revenue Code	272
Min. Negotiated Rate	$280.41
Max. Negotiated Rate	$400.59
Rate for Payer: Aetna Commercial	$378.33
Rate for Payer: Aetna New Business (MI Preferred)	$289.31
Rate for Payer: Cash Price	$356.08
Rate for Payer: Cofinity Commercial	$311.57
Rate for Payer: Cofinity Commercial	$382.79
Rate for Payer: Cofinity Medicare Advantage	$311.57
Rate for Payer: Encore Health Key Benefits Commercial	$356.08
Rate for Payer: Healthscope Commercial	$400.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.33
Rate for Payer: PHP Commercial	$378.33
Rate for Payer: Priority Health Cigna Priority Health	$289.31
Rate for Payer: Priority Health SBD	$280.41

HC NEG PRES VF DRSG SMA

Facility

$379.30

Hospital Charge Code	27200227
Hospital Revenue Code	272
Min. Negotiated Rate	$151.72
Max. Negotiated Rate	$341.37
Rate for Payer: Aetna Commercial	$322.40
Rate for Payer: Aetna Medicare	$189.65
Rate for Payer: Aetna New Business (MI Preferred)	$246.54
Rate for Payer: BCBS Complete	$151.72
Rate for Payer: Cash Price	$303.44
Rate for Payer: Cofinity Commercial	$265.51
Rate for Payer: Cofinity Commercial	$326.20
Rate for Payer: Cofinity Medicare Advantage	$265.51
Rate for Payer: Encore Health Key Benefits Commercial	$303.44
Rate for Payer: Healthscope Commercial	$341.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.40
Rate for Payer: PHP Commercial	$322.40
Rate for Payer: Priority Health Cigna Priority Health	$246.54
Rate for Payer: Priority Health SBD	$238.96

HC NEG PRES VF DRSG SMA

Facility

$379.30

Hospital Charge Code	27200227
Hospital Revenue Code	272
Min. Negotiated Rate	$238.96
Max. Negotiated Rate	$341.37
Rate for Payer: Aetna Commercial	$322.40
Rate for Payer: Aetna New Business (MI Preferred)	$246.54
Rate for Payer: Cash Price	$303.44
Rate for Payer: Cofinity Commercial	$265.51
Rate for Payer: Cofinity Commercial	$326.20
Rate for Payer: Cofinity Medicare Advantage	$265.51
Rate for Payer: Encore Health Key Benefits Commercial	$303.44
Rate for Payer: Healthscope Commercial	$341.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.40
Rate for Payer: PHP Commercial	$322.40
Rate for Payer: Priority Health Cigna Priority Health	$246.54
Rate for Payer: Priority Health SBD	$238.96

HC NEG PRES VF DUO TRAC PAD

Facility

$290.28

Hospital Charge Code	27200231
Hospital Revenue Code	272
Min. Negotiated Rate	$182.88
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$246.74
Rate for Payer: Aetna New Business (MI Preferred)	$188.68
Rate for Payer: Cash Price	$232.22
Rate for Payer: Cofinity Commercial	$203.20
Rate for Payer: Cofinity Commercial	$249.64
Rate for Payer: Cofinity Medicare Advantage	$203.20
Rate for Payer: Encore Health Key Benefits Commercial	$232.22
Rate for Payer: Healthscope Commercial	$261.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.74
Rate for Payer: PHP Commercial	$246.74
Rate for Payer: Priority Health Cigna Priority Health	$188.68
Rate for Payer: Priority Health SBD	$182.88

HC NEG PRES VF DUO TRAC PAD

Facility

$290.28

Hospital Charge Code	27200231
Hospital Revenue Code	272
Min. Negotiated Rate	$116.11
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$246.74
Rate for Payer: Aetna Medicare	$145.14
Rate for Payer: Aetna New Business (MI Preferred)	$188.68
Rate for Payer: BCBS Complete	$116.11
Rate for Payer: Cash Price	$232.22
Rate for Payer: Cofinity Commercial	$203.20
Rate for Payer: Cofinity Commercial	$249.64
Rate for Payer: Cofinity Medicare Advantage	$203.20
Rate for Payer: Encore Health Key Benefits Commercial	$232.22
Rate for Payer: Healthscope Commercial	$261.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.74
Rate for Payer: PHP Commercial	$246.74
Rate for Payer: Priority Health Cigna Priority Health	$188.68
Rate for Payer: Priority Health SBD	$182.88

HC NEG PRES WHT FOAM DRSG

Facility

$180.10

Hospital Charge Code	27200158
Hospital Revenue Code	272
Min. Negotiated Rate	$72.04
Max. Negotiated Rate	$162.09
Rate for Payer: Aetna Commercial	$153.09
Rate for Payer: Aetna Medicare	$90.05
Rate for Payer: Aetna New Business (MI Preferred)	$117.06
Rate for Payer: BCBS Complete	$72.04
Rate for Payer: Cash Price	$144.08
Rate for Payer: Cofinity Commercial	$126.07
Rate for Payer: Cofinity Commercial	$154.89
Rate for Payer: Cofinity Medicare Advantage	$126.07
Rate for Payer: Encore Health Key Benefits Commercial	$144.08
Rate for Payer: Healthscope Commercial	$162.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.09
Rate for Payer: PHP Commercial	$153.09
Rate for Payer: Priority Health Cigna Priority Health	$117.06
Rate for Payer: Priority Health SBD	$113.46

HC NEG PRES WHT FOAM DRSG

Facility

$180.10

Hospital Charge Code	27200158
Hospital Revenue Code	272
Min. Negotiated Rate	$113.46
Max. Negotiated Rate	$162.09
Rate for Payer: Aetna Commercial	$153.09
Rate for Payer: Aetna New Business (MI Preferred)	$117.06
Rate for Payer: Cash Price	$144.08
Rate for Payer: Cofinity Commercial	$126.07
Rate for Payer: Cofinity Commercial	$154.89
Rate for Payer: Cofinity Medicare Advantage	$126.07
Rate for Payer: Encore Health Key Benefits Commercial	$144.08
Rate for Payer: Healthscope Commercial	$162.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.09
Rate for Payer: PHP Commercial	$153.09
Rate for Payer: Priority Health Cigna Priority Health	$117.06
Rate for Payer: Priority Health SBD	$113.46

Know your out-of-pocket cost for care.

All Charges