Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DHEA

Facility

$49.98

Service Code	CPT 82626
Hospital Charge Code	30100187
Hospital Revenue Code	301
Min. Negotiated Rate	$31.49
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Commercial	$42.48
Rate for Payer: Aetna New Business (MI Preferred)	$32.49
Rate for Payer: Cash Price	$39.98
Rate for Payer: Cofinity Commercial	$34.99
Rate for Payer: Cofinity Commercial	$42.98
Rate for Payer: Healthscope Commercial	$44.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.48
Rate for Payer: PHP Commercial	$42.48
Rate for Payer: Priority Health Cigna Priority Health	$34.99
Rate for Payer: Priority Health SBD	$31.49

HC DHEA-SULFATE

Facility

$55.08

Service Code	CPT 82627
Hospital Charge Code	30100188
Hospital Revenue Code	301
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$49.57
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna Medicare	$23.12
Rate for Payer: Aetna New Business (MI Preferred)	$35.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$27.79
Rate for Payer: Amish Plain Church Group Commercial	$27.79
Rate for Payer: BCBS Complete	$12.77
Rate for Payer: BCBS MAPPO	$22.23
Rate for Payer: BCBS Trust/PPO	$17.41
Rate for Payer: BCN Medicare Advantage	$22.23
Rate for Payer: Cash Price	$44.06
Rate for Payer: Cash Price	$44.06
Rate for Payer: Cofinity Commercial	$47.37
Rate for Payer: Cofinity Commercial	$38.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.23
Rate for Payer: Healthscope Commercial	$49.57
Rate for Payer: Mclaren Medicaid	$12.16
Rate for Payer: Mclaren Medicare	$22.23
Rate for Payer: Meridian Medicaid	$12.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23.34
Rate for Payer: MI Amish Medical Board Commercial	$25.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.82
Rate for Payer: PACE Medicare	$21.12
Rate for Payer: PACE SWMI	$22.23
Rate for Payer: PHP Commercial	$46.82
Rate for Payer: PHP Medicare Advantage	$22.23
Rate for Payer: Priority Health Choice Medicaid	$12.16
Rate for Payer: Priority Health Cigna Priority Health	$38.56
Rate for Payer: Priority Health Medicare	$22.23
Rate for Payer: Priority Health SBD	$34.70
Rate for Payer: Railroad Medicare Medicare	$22.23
Rate for Payer: UHC All Payor (Choice/PPO)	$26.68
Rate for Payer: UHC Core	$37.79
Rate for Payer: UHC Dual Complete DSNP	$22.23
Rate for Payer: UHC Exchange	$22.23
Rate for Payer: UHC Medicare Advantage	$22.90
Rate for Payer: VA VA	$22.23

HC DHEA-SULFATE

Facility

$55.08

Service Code	CPT 82627
Hospital Charge Code	30100188
Hospital Revenue Code	301
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$49.57
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna New Business (MI Preferred)	$35.80
Rate for Payer: Cash Price	$44.06
Rate for Payer: Cofinity Commercial	$38.56
Rate for Payer: Cofinity Commercial	$47.37
Rate for Payer: Healthscope Commercial	$49.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.82
Rate for Payer: PHP Commercial	$46.82
Rate for Payer: Priority Health Cigna Priority Health	$38.56
Rate for Payer: Priority Health SBD	$34.70

HC DIABETES GROUP SESSION PER 30"

Facility

$61.85

Service Code	HCPCS G0109
Hospital Charge Code	94200006
Hospital Revenue Code	942
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$55.66
Rate for Payer: Aetna Commercial	$52.57
Rate for Payer: Aetna New Business (MI Preferred)	$40.20
Rate for Payer: Cash Price	$49.48
Rate for Payer: Cofinity Commercial	$43.30
Rate for Payer: Cofinity Commercial	$53.19
Rate for Payer: Healthscope Commercial	$55.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.57
Rate for Payer: PHP Commercial	$52.57
Rate for Payer: Priority Health Cigna Priority Health	$43.30
Rate for Payer: Priority Health SBD	$38.97

HC DIABETES GROUP SESSION PER 30"

Facility

$61.85

Service Code	HCPCS G0109
Hospital Charge Code	94200006
Hospital Revenue Code	942
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$55.66
Rate for Payer: Aetna Commercial	$52.57
Rate for Payer: Aetna New Business (MI Preferred)	$40.20
Rate for Payer: BCBS Complete	$24.74
Rate for Payer: BCBS Trust/PPO	$30.71
Rate for Payer: Cash Price	$49.48
Rate for Payer: Cash Price	$49.48
Rate for Payer: Cofinity Commercial	$53.19
Rate for Payer: Cofinity Commercial	$43.30
Rate for Payer: Healthscope Commercial	$55.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.57
Rate for Payer: PHP Commercial	$52.57
Rate for Payer: Priority Health Cigna Priority Health	$43.30
Rate for Payer: Priority Health SBD	$38.97
Rate for Payer: UHC All Payor (Choice/PPO)	$16.93
Rate for Payer: UHC Exchange	$15.39

HC DIABETES MELLITUS TYPE 1 EVAL

Facility

$47.73

Service Code	CPT 86337
Hospital Charge Code	30200504
Hospital Revenue Code	302
Min. Negotiated Rate	$30.07
Max. Negotiated Rate	$42.96
Rate for Payer: Aetna Commercial	$40.57
Rate for Payer: Aetna New Business (MI Preferred)	$31.02
Rate for Payer: Cash Price	$38.18
Rate for Payer: Cofinity Commercial	$33.41
Rate for Payer: Cofinity Commercial	$41.05
Rate for Payer: Healthscope Commercial	$42.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.57
Rate for Payer: PHP Commercial	$40.57
Rate for Payer: Priority Health Cigna Priority Health	$33.41
Rate for Payer: Priority Health SBD	$30.07

HC DIABETES MELLITUS TYPE 1 EVAL

Facility

$47.73

Service Code	CPT 86337
Hospital Charge Code	30200504
Hospital Revenue Code	302
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$42.96
Rate for Payer: Aetna Commercial	$40.57
Rate for Payer: Aetna Medicare	$22.27
Rate for Payer: Aetna New Business (MI Preferred)	$31.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.76
Rate for Payer: Amish Plain Church Group Commercial	$26.76
Rate for Payer: BCBS Complete	$12.30
Rate for Payer: BCBS MAPPO	$21.41
Rate for Payer: BCBS Trust/PPO	$16.77
Rate for Payer: BCN Medicare Advantage	$21.41
Rate for Payer: Cash Price	$38.18
Rate for Payer: Cash Price	$38.18
Rate for Payer: Cofinity Commercial	$41.05
Rate for Payer: Cofinity Commercial	$33.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.41
Rate for Payer: Healthscope Commercial	$42.96
Rate for Payer: Mclaren Medicaid	$11.71
Rate for Payer: Mclaren Medicare	$21.41
Rate for Payer: Meridian Medicaid	$12.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.48
Rate for Payer: MI Amish Medical Board Commercial	$24.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.57
Rate for Payer: PACE Medicare	$20.34
Rate for Payer: PACE SWMI	$21.41
Rate for Payer: PHP Commercial	$40.57
Rate for Payer: PHP Medicare Advantage	$21.41
Rate for Payer: Priority Health Choice Medicaid	$11.71
Rate for Payer: Priority Health Cigna Priority Health	$33.41
Rate for Payer: Priority Health Medicare	$21.41
Rate for Payer: Priority Health SBD	$30.07
Rate for Payer: Railroad Medicare Medicare	$21.41
Rate for Payer: UHC All Payor (Choice/PPO)	$25.69
Rate for Payer: UHC Core	$36.40
Rate for Payer: UHC Dual Complete DSNP	$21.41
Rate for Payer: UHC Exchange	$21.41
Rate for Payer: UHC Medicare Advantage	$22.05
Rate for Payer: VA VA	$21.41

HC DIABETES TRAINING PER 30 MIN

Facility

$146.83

Service Code	HCPCS G0108
Hospital Charge Code	94200007
Hospital Revenue Code	942
Min. Negotiated Rate	$53.37
Max. Negotiated Rate	$132.15
Rate for Payer: Aetna Commercial	$124.81
Rate for Payer: Aetna New Business (MI Preferred)	$95.44
Rate for Payer: BCBS Complete	$58.73
Rate for Payer: BCBS Trust/PPO	$104.37
Rate for Payer: Cash Price	$117.46
Rate for Payer: Cash Price	$117.46
Rate for Payer: Cofinity Commercial	$126.27
Rate for Payer: Cofinity Commercial	$102.78
Rate for Payer: Healthscope Commercial	$132.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$124.81
Rate for Payer: PHP Commercial	$124.81
Rate for Payer: Priority Health Cigna Priority Health	$102.78
Rate for Payer: Priority Health SBD	$92.50
Rate for Payer: UHC All Payor (Choice/PPO)	$58.71
Rate for Payer: UHC Exchange	$53.37

HC DIABETES TRAINING PER 30 MIN

Facility

$146.83

Service Code	HCPCS G0108
Hospital Charge Code	94200007
Hospital Revenue Code	942
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$132.15
Rate for Payer: Aetna Commercial	$124.81
Rate for Payer: Aetna New Business (MI Preferred)	$95.44
Rate for Payer: Cash Price	$117.46
Rate for Payer: Cofinity Commercial	$102.78
Rate for Payer: Cofinity Commercial	$126.27
Rate for Payer: Healthscope Commercial	$132.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$124.81
Rate for Payer: PHP Commercial	$124.81
Rate for Payer: Priority Health Cigna Priority Health	$102.78
Rate for Payer: Priority Health SBD	$92.50

HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING

Facility

$10,793.44

Service Code	CPT 36902
Hospital Charge Code	36100526
Hospital Revenue Code	361
Min. Negotiated Rate	$6,799.87
Max. Negotiated Rate	$9,714.10
Rate for Payer: Aetna Commercial	$9,174.42
Rate for Payer: Aetna New Business (MI Preferred)	$7,015.74
Rate for Payer: Cash Price	$8,634.75
Rate for Payer: Cofinity Commercial	$7,555.41
Rate for Payer: Cofinity Commercial	$9,282.36
Rate for Payer: Healthscope Commercial	$9,714.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,174.42
Rate for Payer: PHP Commercial	$9,174.42
Rate for Payer: Priority Health Cigna Priority Health	$7,555.41
Rate for Payer: Priority Health SBD	$6,799.87

HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING

Facility

$10,793.44

Service Code	CPT 36902
Hospital Charge Code	36100526
Hospital Revenue Code	361
Min. Negotiated Rate	$228.88
Max. Negotiated Rate	$15,432.16
Rate for Payer: Aetna Commercial	$9,174.42
Rate for Payer: Aetna Medicare	$5,289.19
Rate for Payer: Aetna New Business (MI Preferred)	$7,015.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,357.20
Rate for Payer: Amish Plain Church Group Commercial	$6,357.20
Rate for Payer: BCBS Complete	$2,921.26
Rate for Payer: BCBS MAPPO	$5,085.76
Rate for Payer: BCBS Trust/PPO	$2,068.69
Rate for Payer: BCN Medicare Advantage	$5,085.76
Rate for Payer: Cash Price	$8,634.75
Rate for Payer: Cash Price	$8,634.75
Rate for Payer: Cofinity Commercial	$7,555.41
Rate for Payer: Cofinity Commercial	$9,282.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,085.76
Rate for Payer: Healthscope Commercial	$9,714.10
Rate for Payer: Mclaren Medicaid	$2,781.91
Rate for Payer: Mclaren Medicare	$5,085.76
Rate for Payer: Meridian Medicaid	$2,921.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,340.05
Rate for Payer: MI Amish Medical Board Commercial	$5,848.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,174.42
Rate for Payer: PACE Medicare	$4,831.47
Rate for Payer: PACE SWMI	$5,085.76
Rate for Payer: PHP Commercial	$9,174.42
Rate for Payer: PHP Medicare Advantage	$5,085.76
Rate for Payer: Priority Health Choice Medicaid	$2,781.91
Rate for Payer: Priority Health Cigna Priority Health	$7,555.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,432.16
Rate for Payer: Priority Health Medicare	$5,085.76
Rate for Payer: Priority Health Narrow Network	$12,345.73
Rate for Payer: Priority Health SBD	$6,799.87
Rate for Payer: Railroad Medicare Medicare	$5,085.76
Rate for Payer: UHC All Payor (Choice/PPO)	$251.77
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,085.76
Rate for Payer: UHC Exchange	$228.88
Rate for Payer: UHC Medicare Advantage	$5,238.33
Rate for Payer: VA VA	$5,085.76

HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING

Facility

$2,104.04

Service Code	CPT 36901
Hospital Charge Code	36100525
Hospital Revenue Code	361
Min. Negotiated Rate	$160.45
Max. Negotiated Rate	$4,378.42
Rate for Payer: Aetna Commercial	$1,788.43
Rate for Payer: Aetna Medicare	$1,482.04
Rate for Payer: Aetna New Business (MI Preferred)	$1,367.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,781.30
Rate for Payer: Amish Plain Church Group Commercial	$1,781.30
Rate for Payer: BCBS Complete	$818.54
Rate for Payer: BCBS MAPPO	$1,425.04
Rate for Payer: BCBS Trust/PPO	$930.06
Rate for Payer: BCN Medicare Advantage	$1,425.04
Rate for Payer: Cash Price	$1,683.23
Rate for Payer: Cash Price	$1,683.23
Rate for Payer: Cofinity Commercial	$1,472.83
Rate for Payer: Cofinity Commercial	$1,809.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,425.04
Rate for Payer: Healthscope Commercial	$1,893.64
Rate for Payer: Mclaren Medicaid	$779.50
Rate for Payer: Mclaren Medicare	$1,425.04
Rate for Payer: Meridian Medicaid	$818.54
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,496.29
Rate for Payer: MI Amish Medical Board Commercial	$1,638.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,788.43
Rate for Payer: PACE Medicare	$1,353.79
Rate for Payer: PACE SWMI	$1,425.04
Rate for Payer: PHP Commercial	$1,788.43
Rate for Payer: PHP Medicare Advantage	$1,425.04
Rate for Payer: Priority Health Choice Medicaid	$779.50
Rate for Payer: Priority Health Cigna Priority Health	$1,472.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,378.42
Rate for Payer: Priority Health Medicare	$1,425.04
Rate for Payer: Priority Health Narrow Network	$3,502.74
Rate for Payer: Priority Health SBD	$1,325.55
Rate for Payer: Railroad Medicare Medicare	$1,425.04
Rate for Payer: UHC All Payor (Choice/PPO)	$176.50
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,425.04
Rate for Payer: UHC Exchange	$160.45
Rate for Payer: UHC Medicare Advantage	$1,467.79
Rate for Payer: VA VA	$1,425.04

HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING

Facility

$2,104.04

Service Code	CPT 36901
Hospital Charge Code	36100525
Hospital Revenue Code	361
Min. Negotiated Rate	$1,325.55
Max. Negotiated Rate	$1,893.64
Rate for Payer: Aetna Commercial	$1,788.43
Rate for Payer: Aetna New Business (MI Preferred)	$1,367.63
Rate for Payer: Cash Price	$1,683.23
Rate for Payer: Cofinity Commercial	$1,472.83
Rate for Payer: Cofinity Commercial	$1,809.47
Rate for Payer: Healthscope Commercial	$1,893.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,788.43
Rate for Payer: PHP Commercial	$1,788.43
Rate for Payer: Priority Health Cigna Priority Health	$1,472.83
Rate for Payer: Priority Health SBD	$1,325.55

HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING

Facility

$18,171.61

Service Code	CPT 36903
Hospital Charge Code	36100527
Hospital Revenue Code	361
Min. Negotiated Rate	$300.92
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Commercial	$15,445.87
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Aetna New Business (MI Preferred)	$11,811.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$5,721.77
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Cash Price	$14,537.29
Rate for Payer: Cash Price	$14,537.29
Rate for Payer: Cofinity Commercial	$12,720.13
Rate for Payer: Cofinity Commercial	$15,627.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Healthscope Commercial	$16,354.45
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,445.87
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Commercial	$15,445.87
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health Cigna Priority Health	$12,720.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Priority Health SBD	$11,448.11
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$331.01
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$300.92
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING

Facility

$18,171.61

Service Code	CPT 36903
Hospital Charge Code	36100527
Hospital Revenue Code	361
Min. Negotiated Rate	$11,448.11
Max. Negotiated Rate	$16,354.45
Rate for Payer: Aetna Commercial	$15,445.87
Rate for Payer: Aetna New Business (MI Preferred)	$11,811.55
Rate for Payer: Cash Price	$14,537.29
Rate for Payer: Cofinity Commercial	$12,720.13
Rate for Payer: Cofinity Commercial	$15,627.58
Rate for Payer: Healthscope Commercial	$16,354.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,445.87
Rate for Payer: PHP Commercial	$15,445.87
Rate for Payer: Priority Health Cigna Priority Health	$12,720.13
Rate for Payer: Priority Health SBD	$11,448.11

HC DIALYSIS CATH LVL 10 LONG TERM

Facility

$1,026.90

Service Code	HCPCS C1750
Hospital Charge Code	27200268
Hospital Revenue Code	272
Min. Negotiated Rate	$410.76
Max. Negotiated Rate	$924.21
Rate for Payer: Aetna Commercial	$872.86
Rate for Payer: Aetna New Business (MI Preferred)	$667.48
Rate for Payer: BCBS Complete	$410.76
Rate for Payer: Cash Price	$821.52
Rate for Payer: Cofinity Commercial	$718.83
Rate for Payer: Cofinity Commercial	$883.13
Rate for Payer: Healthscope Commercial	$924.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$872.86
Rate for Payer: PHP Commercial	$872.86
Rate for Payer: Priority Health Cigna Priority Health	$718.83
Rate for Payer: Priority Health SBD	$646.95

HC DIALYSIS CATH LVL 10 LONG TERM

Facility

$1,026.90

Service Code	HCPCS C1750
Hospital Charge Code	27200268
Hospital Revenue Code	272
Min. Negotiated Rate	$646.95
Max. Negotiated Rate	$924.21
Rate for Payer: Aetna Commercial	$872.86
Rate for Payer: Aetna New Business (MI Preferred)	$667.48
Rate for Payer: Cash Price	$821.52
Rate for Payer: Cofinity Commercial	$718.83
Rate for Payer: Cofinity Commercial	$883.13
Rate for Payer: Healthscope Commercial	$924.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$872.86
Rate for Payer: PHP Commercial	$872.86
Rate for Payer: Priority Health Cigna Priority Health	$718.83
Rate for Payer: Priority Health SBD	$646.95

HC DIALYSIS CATH LVL 11 LONG TERM

Facility

$1,148.99

Service Code	HCPCS C1750
Hospital Charge Code	27200269
Hospital Revenue Code	272
Min. Negotiated Rate	$723.86
Max. Negotiated Rate	$1,034.09
Rate for Payer: Aetna Commercial	$976.64
Rate for Payer: Aetna New Business (MI Preferred)	$746.84
Rate for Payer: Cash Price	$919.19
Rate for Payer: Cofinity Commercial	$804.29
Rate for Payer: Cofinity Commercial	$988.13
Rate for Payer: Healthscope Commercial	$1,034.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$976.64
Rate for Payer: PHP Commercial	$976.64
Rate for Payer: Priority Health Cigna Priority Health	$804.29
Rate for Payer: Priority Health SBD	$723.86

HC DIALYSIS CATH LVL 11 LONG TERM

Facility

$1,148.99

Service Code	HCPCS C1750
Hospital Charge Code	27200269
Hospital Revenue Code	272
Min. Negotiated Rate	$459.60
Max. Negotiated Rate	$1,034.09
Rate for Payer: Aetna Commercial	$976.64
Rate for Payer: Aetna New Business (MI Preferred)	$746.84
Rate for Payer: BCBS Complete	$459.60
Rate for Payer: Cash Price	$919.19
Rate for Payer: Cofinity Commercial	$804.29
Rate for Payer: Cofinity Commercial	$988.13
Rate for Payer: Healthscope Commercial	$1,034.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$976.64
Rate for Payer: PHP Commercial	$976.64
Rate for Payer: Priority Health Cigna Priority Health	$804.29
Rate for Payer: Priority Health SBD	$723.86

HC DIALYSIS CATH LVL 13 LONG TERM

Facility

$1,353.00

Service Code	HCPCS C1750
Hospital Charge Code	27200266
Hospital Revenue Code	272
Min. Negotiated Rate	$852.39
Max. Negotiated Rate	$1,217.70
Rate for Payer: Aetna Commercial	$1,150.05
Rate for Payer: Aetna New Business (MI Preferred)	$879.45
Rate for Payer: Cash Price	$1,082.40
Rate for Payer: Cofinity Commercial	$1,163.58
Rate for Payer: Cofinity Commercial	$947.10
Rate for Payer: Healthscope Commercial	$1,217.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,150.05
Rate for Payer: PHP Commercial	$1,150.05
Rate for Payer: Priority Health Cigna Priority Health	$947.10
Rate for Payer: Priority Health SBD	$852.39

HC DIALYSIS CATH LVL 13 LONG TERM

Facility

$1,353.00

Service Code	HCPCS C1750
Hospital Charge Code	27200266
Hospital Revenue Code	272
Min. Negotiated Rate	$541.20
Max. Negotiated Rate	$1,217.70
Rate for Payer: Aetna Commercial	$1,150.05
Rate for Payer: Aetna New Business (MI Preferred)	$879.45
Rate for Payer: BCBS Complete	$541.20
Rate for Payer: Cash Price	$1,082.40
Rate for Payer: Cofinity Commercial	$1,163.58
Rate for Payer: Cofinity Commercial	$947.10
Rate for Payer: Healthscope Commercial	$1,217.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,150.05
Rate for Payer: PHP Commercial	$1,150.05
Rate for Payer: Priority Health Cigna Priority Health	$947.10
Rate for Payer: Priority Health SBD	$852.39

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$203.99

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$183.59
Rate for Payer: Aetna Commercial	$173.39
Rate for Payer: Aetna New Business (MI Preferred)	$132.59
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.19
Rate for Payer: Cofinity Commercial	$142.79
Rate for Payer: Cofinity Commercial	$175.43
Rate for Payer: Healthscope Commercial	$183.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.39
Rate for Payer: PHP Commercial	$173.39
Rate for Payer: Priority Health Cigna Priority Health	$142.79
Rate for Payer: Priority Health SBD	$128.51

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$203.99

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$128.51
Max. Negotiated Rate	$183.59
Rate for Payer: Aetna Commercial	$173.39
Rate for Payer: Aetna New Business (MI Preferred)	$132.59
Rate for Payer: Cash Price	$163.19
Rate for Payer: Cofinity Commercial	$142.79
Rate for Payer: Cofinity Commercial	$175.43
Rate for Payer: Healthscope Commercial	$183.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.39
Rate for Payer: PHP Commercial	$173.39
Rate for Payer: Priority Health Cigna Priority Health	$142.79
Rate for Payer: Priority Health SBD	$128.51

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$308.99

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$194.66
Max. Negotiated Rate	$278.09
Rate for Payer: Aetna Commercial	$262.64
Rate for Payer: Aetna New Business (MI Preferred)	$200.84
Rate for Payer: Cash Price	$247.19
Rate for Payer: Cofinity Commercial	$216.29
Rate for Payer: Cofinity Commercial	$265.73
Rate for Payer: Healthscope Commercial	$278.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$262.64
Rate for Payer: PHP Commercial	$262.64
Rate for Payer: Priority Health Cigna Priority Health	$216.29
Rate for Payer: Priority Health SBD	$194.66

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$308.99

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$278.09
Rate for Payer: Aetna Commercial	$262.64
Rate for Payer: Aetna New Business (MI Preferred)	$200.84
Rate for Payer: BCBS Complete	$123.60
Rate for Payer: Cash Price	$247.19
Rate for Payer: Cofinity Commercial	$216.29
Rate for Payer: Cofinity Commercial	$265.73
Rate for Payer: Healthscope Commercial	$278.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$262.64
Rate for Payer: PHP Commercial	$262.64
Rate for Payer: Priority Health Cigna Priority Health	$216.29
Rate for Payer: Priority Health SBD	$194.66

Know your out-of-pocket cost for care.

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