Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC MASTECTOMY SLEEVE EA $350

Facility

$350.00

Service Code	HCPCS L8010
Hospital Charge Code	96000014
Hospital Revenue Code	270
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: ASR ASR	$339.50
Rate for Payer: BCBS Complete	$140.00
Rate for Payer: BCBS Trust/PPO	$271.36
Rate for Payer: BCN Commercial	$271.36
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cofinity Commercial	$329.00
Rate for Payer: Encore Health Key Benefits Commercial	$280.00
Rate for Payer: Healthscope Commercial	$350.00
Rate for Payer: Healthscope Whirlpool	$339.50
Rate for Payer: Mclaren Commercial	$315.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$297.50
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$318.50
Rate for Payer: Priority Health Narrow Network	$248.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$308.00

HC MASTECTOMY SLEEVE EA $350

Facility

$350.00

Service Code	HCPCS L8010
Hospital Charge Code	96000014
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: ASR ASR	$339.50
Rate for Payer: BCBS Trust/PPO	$271.36
Rate for Payer: BCN Commercial	$271.36
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cofinity Commercial	$329.00
Rate for Payer: Encore Health Key Benefits Commercial	$280.00
Rate for Payer: Healthscope Commercial	$350.00
Rate for Payer: Healthscope Whirlpool	$339.50
Rate for Payer: Mclaren Commercial	$315.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$297.50
Rate for Payer: Priority Health Cigna Priority Health	$245.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$308.00

HC MASTECTOMY SLEEVE EA $375

Facility

$375.00

Service Code	HCPCS L8010
Hospital Charge Code	96000015
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: ASR ASR	$363.75
Rate for Payer: BCBS Trust/PPO	$290.74
Rate for Payer: BCN Commercial	$290.74
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cofinity Commercial	$352.50
Rate for Payer: Encore Health Key Benefits Commercial	$300.00
Rate for Payer: Healthscope Commercial	$375.00
Rate for Payer: Healthscope Whirlpool	$363.75
Rate for Payer: Mclaren Commercial	$337.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.75
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.00

HC MASTECTOMY SLEEVE EA $375

Facility

$375.00

Service Code	HCPCS L8010
Hospital Charge Code	96000015
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: ASR ASR	$363.75
Rate for Payer: BCBS Complete	$150.00
Rate for Payer: BCBS Trust/PPO	$290.74
Rate for Payer: BCN Commercial	$290.74
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cofinity Commercial	$352.50
Rate for Payer: Encore Health Key Benefits Commercial	$300.00
Rate for Payer: Healthscope Commercial	$375.00
Rate for Payer: Healthscope Whirlpool	$363.75
Rate for Payer: Mclaren Commercial	$337.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.75
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$341.25
Rate for Payer: Priority Health Narrow Network	$266.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.00

HC MASTECTOMY SLEEVE EA $40

Facility

$40.00

Service Code	HCPCS L8010
Hospital Charge Code	96000016
Hospital Revenue Code	270
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: ASR ASR	$38.80
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$31.01
Rate for Payer: BCN Commercial	$31.01
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$37.60
Rate for Payer: Encore Health Key Benefits Commercial	$32.00
Rate for Payer: Healthscope Commercial	$40.00
Rate for Payer: Healthscope Whirlpool	$38.80
Rate for Payer: Mclaren Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.40
Rate for Payer: Priority Health Narrow Network	$28.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.20

HC MASTECTOMY SLEEVE EA $40

Facility

$40.00

Service Code	HCPCS L8010
Hospital Charge Code	96000016
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: ASR ASR	$38.80
Rate for Payer: BCBS Trust/PPO	$31.01
Rate for Payer: BCN Commercial	$31.01
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$37.60
Rate for Payer: Encore Health Key Benefits Commercial	$32.00
Rate for Payer: Healthscope Commercial	$40.00
Rate for Payer: Healthscope Whirlpool	$38.80
Rate for Payer: Mclaren Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.20

HC MASTECTOMY SLEEVE EA $400

Facility

$400.00

Service Code	HCPCS L8010
Hospital Charge Code	96000017
Hospital Revenue Code	270
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: ASR ASR	$388.00
Rate for Payer: BCBS Trust/PPO	$310.12
Rate for Payer: BCN Commercial	$310.12
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cofinity Commercial	$376.00
Rate for Payer: Encore Health Key Benefits Commercial	$320.00
Rate for Payer: Healthscope Commercial	$400.00
Rate for Payer: Healthscope Whirlpool	$388.00
Rate for Payer: Mclaren Commercial	$360.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$352.00

HC MASTECTOMY SLEEVE EA $400

Facility

$400.00

Service Code	HCPCS L8010
Hospital Charge Code	96000017
Hospital Revenue Code	270
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: ASR ASR	$388.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: BCBS Trust/PPO	$310.12
Rate for Payer: BCN Commercial	$310.12
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cofinity Commercial	$376.00
Rate for Payer: Encore Health Key Benefits Commercial	$320.00
Rate for Payer: Healthscope Commercial	$400.00
Rate for Payer: Healthscope Whirlpool	$388.00
Rate for Payer: Mclaren Commercial	$360.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$364.00
Rate for Payer: Priority Health Narrow Network	$284.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$352.00

HC MASTECTOMY SLEEVE EA $425

Facility

$425.00

Service Code	HCPCS L8010
Hospital Charge Code	96000018
Hospital Revenue Code	270
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: ASR ASR	$412.25
Rate for Payer: BCBS Complete	$170.00
Rate for Payer: BCBS Trust/PPO	$329.50
Rate for Payer: BCN Commercial	$329.50
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cofinity Commercial	$399.50
Rate for Payer: Encore Health Key Benefits Commercial	$340.00
Rate for Payer: Healthscope Commercial	$425.00
Rate for Payer: Healthscope Whirlpool	$412.25
Rate for Payer: Mclaren Commercial	$382.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$361.25
Rate for Payer: Priority Health Cigna Priority Health	$297.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$386.75
Rate for Payer: Priority Health Narrow Network	$301.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$374.00

HC MASTECTOMY SLEEVE EA $425

Facility

$425.00

Service Code	HCPCS L8010
Hospital Charge Code	96000018
Hospital Revenue Code	270
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: ASR ASR	$412.25
Rate for Payer: BCBS Trust/PPO	$329.50
Rate for Payer: BCN Commercial	$329.50
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cofinity Commercial	$399.50
Rate for Payer: Encore Health Key Benefits Commercial	$340.00
Rate for Payer: Healthscope Commercial	$425.00
Rate for Payer: Healthscope Whirlpool	$412.25
Rate for Payer: Mclaren Commercial	$382.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$361.25
Rate for Payer: Priority Health Cigna Priority Health	$297.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$374.00

HC MASTECTOMY SLEEVE EA $450

Facility

$450.00

Service Code	HCPCS L8010
Hospital Charge Code	96000019
Hospital Revenue Code	270
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: ASR ASR	$436.50
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: BCBS Trust/PPO	$348.88
Rate for Payer: BCN Commercial	$348.88
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cofinity Commercial	$423.00
Rate for Payer: Encore Health Key Benefits Commercial	$360.00
Rate for Payer: Healthscope Commercial	$450.00
Rate for Payer: Healthscope Whirlpool	$436.50
Rate for Payer: Mclaren Commercial	$405.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$382.50
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$409.50
Rate for Payer: Priority Health Narrow Network	$319.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$396.00

HC MASTECTOMY SLEEVE EA $450

Facility

$450.00

Service Code	HCPCS L8010
Hospital Charge Code	96000019
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: ASR ASR	$436.50
Rate for Payer: BCBS Trust/PPO	$348.88
Rate for Payer: BCN Commercial	$348.88
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cofinity Commercial	$423.00
Rate for Payer: Encore Health Key Benefits Commercial	$360.00
Rate for Payer: Healthscope Commercial	$450.00
Rate for Payer: Healthscope Whirlpool	$436.50
Rate for Payer: Mclaren Commercial	$405.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$382.50
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$396.00

HC MASTECTOMY SLEEVE EA $50

Facility

$50.00

Service Code	HCPCS L8010
Hospital Charge Code	96000020
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: ASR ASR	$48.50
Rate for Payer: BCBS Trust/PPO	$38.76
Rate for Payer: BCN Commercial	$38.76
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$47.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$50.00
Rate for Payer: Healthscope Whirlpool	$48.50
Rate for Payer: Mclaren Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.00

HC MASTECTOMY SLEEVE EA $50

Facility

$50.00

Service Code	HCPCS L8010
Hospital Charge Code	96000020
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: ASR ASR	$48.50
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$38.76
Rate for Payer: BCN Commercial	$38.76
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$47.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$50.00
Rate for Payer: Healthscope Whirlpool	$48.50
Rate for Payer: Mclaren Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.50
Rate for Payer: Priority Health Narrow Network	$35.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.00

HC MASTECTOMY SLEEVE EA $60

Facility

$60.00

Service Code	HCPCS L8010
Hospital Charge Code	96000021
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: ASR ASR	$58.20
Rate for Payer: BCBS Trust/PPO	$46.52
Rate for Payer: BCN Commercial	$46.52
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$56.40
Rate for Payer: Encore Health Key Benefits Commercial	$48.00
Rate for Payer: Healthscope Commercial	$60.00
Rate for Payer: Healthscope Whirlpool	$58.20
Rate for Payer: Mclaren Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.80

HC MASTECTOMY SLEEVE EA $60

Facility

$60.00

Service Code	HCPCS L8010
Hospital Charge Code	96000021
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: ASR ASR	$58.20
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$46.52
Rate for Payer: BCN Commercial	$46.52
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$56.40
Rate for Payer: Encore Health Key Benefits Commercial	$48.00
Rate for Payer: Healthscope Commercial	$60.00
Rate for Payer: Healthscope Whirlpool	$58.20
Rate for Payer: Mclaren Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$54.60
Rate for Payer: Priority Health Narrow Network	$42.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.80

HC MASTECTOMY SLEEVE EA $70

Facility

$70.00

Service Code	HCPCS L8010
Hospital Charge Code	96000022
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: ASR ASR	$67.90
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: BCBS Trust/PPO	$54.27
Rate for Payer: BCN Commercial	$54.27
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$56.00
Rate for Payer: Healthscope Commercial	$70.00
Rate for Payer: Healthscope Whirlpool	$67.90
Rate for Payer: Mclaren Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.70
Rate for Payer: Priority Health Narrow Network	$49.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.60

HC MASTECTOMY SLEEVE EA $70

Facility

$70.00

Service Code	HCPCS L8010
Hospital Charge Code	96000022
Hospital Revenue Code	270
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: ASR ASR	$67.90
Rate for Payer: BCBS Trust/PPO	$54.27
Rate for Payer: BCN Commercial	$54.27
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$56.00
Rate for Payer: Healthscope Commercial	$70.00
Rate for Payer: Healthscope Whirlpool	$67.90
Rate for Payer: Mclaren Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.60

HC MASTECTOMY SLEEVE EA $80

Facility

$80.00

Service Code	HCPCS L8010
Hospital Charge Code	96000023
Hospital Revenue Code	270
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: ASR ASR	$77.60
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$62.02
Rate for Payer: BCN Commercial	$62.02
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$75.20
Rate for Payer: Encore Health Key Benefits Commercial	$64.00
Rate for Payer: Healthscope Commercial	$80.00
Rate for Payer: Healthscope Whirlpool	$77.60
Rate for Payer: Mclaren Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.80
Rate for Payer: Priority Health Narrow Network	$56.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.40

HC MASTECTOMY SLEEVE EA $80

Facility

$80.00

Service Code	HCPCS L8010
Hospital Charge Code	96000023
Hospital Revenue Code	270
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: ASR ASR	$77.60
Rate for Payer: BCBS Trust/PPO	$62.02
Rate for Payer: BCN Commercial	$62.02
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$75.20
Rate for Payer: Encore Health Key Benefits Commercial	$64.00
Rate for Payer: Healthscope Commercial	$80.00
Rate for Payer: Healthscope Whirlpool	$77.60
Rate for Payer: Mclaren Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.40

HC MASTECTOMY SLEEVE EA $90

Facility

$90.00

Service Code	HCPCS L8010
Hospital Charge Code	96000024
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: ASR ASR	$87.30
Rate for Payer: BCBS Trust/PPO	$69.78
Rate for Payer: BCN Commercial	$69.78
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$84.60
Rate for Payer: Encore Health Key Benefits Commercial	$72.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Healthscope Whirlpool	$87.30
Rate for Payer: Mclaren Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.20

HC MASTECTOMY SLEEVE EA $90

Facility

$90.00

Service Code	HCPCS L8010
Hospital Charge Code	96000024
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: ASR ASR	$87.30
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$69.78
Rate for Payer: BCN Commercial	$69.78
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$84.60
Rate for Payer: Encore Health Key Benefits Commercial	$72.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Healthscope Whirlpool	$87.30
Rate for Payer: Mclaren Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$81.90
Rate for Payer: Priority Health Narrow Network	$63.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.20

HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$2,100.08

Service Code	CPT 19020
Hospital Charge Code	76100281
Hospital Revenue Code	761
Min. Negotiated Rate	$788.30
Max. Negotiated Rate	$2,100.08
Rate for Payer: Aetna Commercial	$1,890.07
Rate for Payer: Aetna Medicare	$1,441.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,801.41
Rate for Payer: Amish Plain Church Group Commercial	$1,801.41
Rate for Payer: ASR ASR	$2,037.08
Rate for Payer: BCBS Complete	$827.79
Rate for Payer: BCBS MAPPO	$1,441.13
Rate for Payer: BCBS Trust/PPO	$1,628.19
Rate for Payer: BCN Commercial	$1,628.19
Rate for Payer: BCN Medicare Advantage	$1,441.13
Rate for Payer: Cash Price	$1,680.06
Rate for Payer: Cash Price	$1,680.06
Rate for Payer: Cofinity Commercial	$1,974.08
Rate for Payer: Encore Health Key Benefits Commercial	$1,680.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,441.13
Rate for Payer: Healthscope Commercial	$2,100.08
Rate for Payer: Healthscope Whirlpool	$2,037.08
Rate for Payer: Humana Choice PPO Medicare	$1,441.13
Rate for Payer: Mclaren Commercial	$1,890.07
Rate for Payer: Mclaren Medicaid	$788.30
Rate for Payer: Mclaren Medicare	$1,441.13
Rate for Payer: Meridian Medicaid	$827.79
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,513.19
Rate for Payer: MI Amish Medical Board Commercial	$1,657.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,785.07
Rate for Payer: PACE Medicare	$1,369.07
Rate for Payer: PACE SWMI	$1,441.13
Rate for Payer: PHP Commercial	$1,585.24
Rate for Payer: PHP Medicaid	$788.30
Rate for Payer: PHP Medicare Advantage	$1,441.13
Rate for Payer: Priority Health Choice Medicaid	$788.30
Rate for Payer: Priority Health Cigna Priority Health	$1,470.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,911.07
Rate for Payer: Priority Health Medicare	$1,441.13
Rate for Payer: Priority Health Narrow Network	$1,491.06
Rate for Payer: Railroad Medicare Medicare	$1,441.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,848.07
Rate for Payer: UHC Medicare Advantage	$1,484.36
Rate for Payer: VA VA	$1,441.13

HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$2,100.08

Service Code	CPT 19020
Hospital Charge Code	76100281
Hospital Revenue Code	761
Min. Negotiated Rate	$1,470.06
Max. Negotiated Rate	$2,100.08
Rate for Payer: Aetna Commercial	$1,890.07
Rate for Payer: ASR ASR	$2,037.08
Rate for Payer: BCBS Trust/PPO	$1,628.19
Rate for Payer: BCN Commercial	$1,628.19
Rate for Payer: Cash Price	$1,680.06
Rate for Payer: Cofinity Commercial	$1,974.08
Rate for Payer: Encore Health Key Benefits Commercial	$1,680.06
Rate for Payer: Healthscope Commercial	$2,100.08
Rate for Payer: Healthscope Whirlpool	$2,037.08
Rate for Payer: Mclaren Commercial	$1,890.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,785.07
Rate for Payer: Priority Health Cigna Priority Health	$1,470.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,848.07

HC MATERNAL SCRN INTEGRATED SERUM 1

Facility

$110.00

Service Code	CPT 84163
Hospital Charge Code	30100641
Hospital Revenue Code	301
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Aetna Medicare	$15.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.81
Rate for Payer: Amish Plain Church Group Commercial	$18.81
Rate for Payer: ASR ASR	$106.70
Rate for Payer: BCBS Complete	$8.64
Rate for Payer: BCBS MAPPO	$15.05
Rate for Payer: BCBS Trust/PPO	$85.28
Rate for Payer: BCN Commercial	$85.28
Rate for Payer: BCN Medicare Advantage	$15.05
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$103.40
Rate for Payer: Encore Health Key Benefits Commercial	$88.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.05
Rate for Payer: Healthscope Commercial	$110.00
Rate for Payer: Healthscope Whirlpool	$106.70
Rate for Payer: Humana Choice PPO Medicare	$15.05
Rate for Payer: Mclaren Commercial	$99.00
Rate for Payer: Mclaren Medicaid	$8.23
Rate for Payer: Mclaren Medicare	$15.05
Rate for Payer: Meridian Medicaid	$8.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15.80
Rate for Payer: MI Amish Medical Board Commercial	$17.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PACE Medicare	$14.30
Rate for Payer: PACE SWMI	$15.05
Rate for Payer: PHP Commercial	$16.56
Rate for Payer: PHP Medicaid	$8.23
Rate for Payer: PHP Medicare Advantage	$15.05
Rate for Payer: Priority Health Choice Medicaid	$8.23
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.10
Rate for Payer: Priority Health Medicare	$15.05
Rate for Payer: Priority Health Narrow Network	$78.10
Rate for Payer: Railroad Medicare Medicare	$15.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$96.80
Rate for Payer: UHC Medicare Advantage	$15.50
Rate for Payer: VA VA	$15.05

Know your out-of-pocket cost for care.

All Charges