Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING

Facility

$2,146.12

Service Code	CPT 36901
Hospital Charge Code	36100525
Hospital Revenue Code	361
Min. Negotiated Rate	$812.06
Max. Negotiated Rate	$4,264.69
Rate for Payer: Aetna Commercial	$1,824.20
Rate for Payer: Aetna Medicare	$1,575.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,394.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,893.80
Rate for Payer: Amish Plain Church Group Commercial	$1,893.80
Rate for Payer: BCBS Complete	$852.66
Rate for Payer: BCBS MAPPO	$1,515.04
Rate for Payer: BCN Medicare Advantage	$1,515.04
Rate for Payer: Cash Price	$1,716.90
Rate for Payer: Cash Price	$1,716.90
Rate for Payer: Cofinity Commercial	$1,502.28
Rate for Payer: Cofinity Commercial	$1,845.66
Rate for Payer: Cofinity Medicare Advantage	$1,502.28
Rate for Payer: Encore Health Key Benefits Commercial	$1,716.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,515.04
Rate for Payer: Healthscope Commercial	$1,931.51
Rate for Payer: Mclaren Medicaid	$812.06
Rate for Payer: Mclaren Medicare	$1,515.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,590.79
Rate for Payer: Meridian Medicaid	$852.66
Rate for Payer: MI Amish Medical Board Commercial	$1,742.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,824.20
Rate for Payer: PACE Medicare	$1,439.29
Rate for Payer: PACE SWMI	$1,515.04
Rate for Payer: PHP Commercial	$1,824.20
Rate for Payer: PHP Medicare Advantage	$1,515.04
Rate for Payer: Priority Health Choice Medicaid	$812.06
Rate for Payer: Priority Health Cigna Priority Health	$1,394.98
Rate for Payer: Priority Health Medicare	$1,515.04
Rate for Payer: Priority Health SBD	$1,352.06
Rate for Payer: Railroad Medicare Medicare	$1,515.04
Rate for Payer: UHC All Payor (Choice/PPO)	$4,264.69
Rate for Payer: UHC Dual Complete DSNP	$1,515.04
Rate for Payer: UHC Medicare Advantage	$1,515.04
Rate for Payer: UHCCP Medicaid	$852.97
Rate for Payer: VA VA	$1,515.04

HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING

Facility

$18,535.04

Service Code	CPT 36903
Hospital Charge Code	36100527
Hospital Revenue Code	361
Min. Negotiated Rate	$11,677.08
Max. Negotiated Rate	$16,681.54
Rate for Payer: Aetna Commercial	$15,754.78
Rate for Payer: Aetna New Business (MI Preferred)	$12,047.78
Rate for Payer: Cash Price	$14,828.03
Rate for Payer: Cofinity Commercial	$12,974.53
Rate for Payer: Cofinity Commercial	$15,940.13
Rate for Payer: Cofinity Medicare Advantage	$12,974.53
Rate for Payer: Encore Health Key Benefits Commercial	$14,828.03
Rate for Payer: Healthscope Commercial	$16,681.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15,754.78
Rate for Payer: PHP Commercial	$15,754.78
Rate for Payer: Priority Health Cigna Priority Health	$12,047.78
Rate for Payer: Priority Health SBD	$11,677.08

HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING

Facility

$18,535.04

Service Code	CPT 36903
Hospital Charge Code	36100527
Hospital Revenue Code	361
Min. Negotiated Rate	$5,928.28
Max. Negotiated Rate	$31,133.44
Rate for Payer: Aetna Commercial	$15,754.78
Rate for Payer: Aetna Medicare	$11,502.64
Rate for Payer: Aetna New Business (MI Preferred)	$12,047.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,825.29
Rate for Payer: Amish Plain Church Group Commercial	$13,825.29
Rate for Payer: BCBS Complete	$6,224.70
Rate for Payer: BCBS MAPPO	$11,060.23
Rate for Payer: BCN Medicare Advantage	$11,060.23
Rate for Payer: Cash Price	$14,828.03
Rate for Payer: Cash Price	$14,828.03
Rate for Payer: Cofinity Commercial	$15,940.13
Rate for Payer: Cofinity Commercial	$12,974.53
Rate for Payer: Cofinity Medicare Advantage	$12,974.53
Rate for Payer: Encore Health Key Benefits Commercial	$14,828.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,060.23
Rate for Payer: Healthscope Commercial	$16,681.54
Rate for Payer: Mclaren Medicaid	$5,928.28
Rate for Payer: Mclaren Medicare	$11,060.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,613.24
Rate for Payer: Meridian Medicaid	$6,224.70
Rate for Payer: MI Amish Medical Board Commercial	$12,719.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15,754.78
Rate for Payer: PACE Medicare	$10,507.22
Rate for Payer: PACE SWMI	$11,060.23
Rate for Payer: PHP Commercial	$15,754.78
Rate for Payer: PHP Medicare Advantage	$11,060.23
Rate for Payer: Priority Health Choice Medicaid	$5,928.28
Rate for Payer: Priority Health Cigna Priority Health	$12,047.78
Rate for Payer: Priority Health Medicare	$11,060.23
Rate for Payer: Priority Health SBD	$11,677.08
Rate for Payer: Railroad Medicare Medicare	$11,060.23
Rate for Payer: UHC All Payor (Choice/PPO)	$31,133.44
Rate for Payer: UHC Dual Complete DSNP	$11,060.23
Rate for Payer: UHC Medicare Advantage	$11,060.23
Rate for Payer: UHCCP Medicaid	$6,226.91
Rate for Payer: VA VA	$11,060.23

HC DIALYSIS CATH LVL 10 LONG TERM

Facility

$1,047.44

Service Code	HCPCS C1750
Hospital Charge Code	27200268
Hospital Revenue Code	272
Min. Negotiated Rate	$418.98
Max. Negotiated Rate	$942.70
Rate for Payer: Aetna Commercial	$890.32
Rate for Payer: Aetna Medicare	$523.72
Rate for Payer: Aetna New Business (MI Preferred)	$680.84
Rate for Payer: BCBS Complete	$418.98
Rate for Payer: Cash Price	$837.95
Rate for Payer: Cofinity Commercial	$733.21
Rate for Payer: Cofinity Commercial	$900.80
Rate for Payer: Cofinity Medicare Advantage	$733.21
Rate for Payer: Encore Health Key Benefits Commercial	$837.95
Rate for Payer: Healthscope Commercial	$942.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$890.32
Rate for Payer: PHP Commercial	$890.32
Rate for Payer: Priority Health Cigna Priority Health	$680.84
Rate for Payer: Priority Health SBD	$659.89

HC DIALYSIS CATH LVL 10 LONG TERM

Facility

$1,047.44

Service Code	HCPCS C1750
Hospital Charge Code	27200268
Hospital Revenue Code	272
Min. Negotiated Rate	$659.89
Max. Negotiated Rate	$942.70
Rate for Payer: Aetna Commercial	$890.32
Rate for Payer: Aetna New Business (MI Preferred)	$680.84
Rate for Payer: Cash Price	$837.95
Rate for Payer: Cofinity Commercial	$733.21
Rate for Payer: Cofinity Commercial	$900.80
Rate for Payer: Cofinity Medicare Advantage	$733.21
Rate for Payer: Encore Health Key Benefits Commercial	$837.95
Rate for Payer: Healthscope Commercial	$942.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$890.32
Rate for Payer: PHP Commercial	$890.32
Rate for Payer: Priority Health Cigna Priority Health	$680.84
Rate for Payer: Priority Health SBD	$659.89

HC DIALYSIS CATH LVL 11 LONG TERM

Facility

$1,171.97

Service Code	HCPCS C1750
Hospital Charge Code	27200269
Hospital Revenue Code	272
Min. Negotiated Rate	$738.34
Max. Negotiated Rate	$1,054.77
Rate for Payer: Aetna Commercial	$996.17
Rate for Payer: Aetna New Business (MI Preferred)	$761.78
Rate for Payer: Cash Price	$937.58
Rate for Payer: Cofinity Commercial	$1,007.89
Rate for Payer: Cofinity Commercial	$820.38
Rate for Payer: Cofinity Medicare Advantage	$820.38
Rate for Payer: Encore Health Key Benefits Commercial	$937.58
Rate for Payer: Healthscope Commercial	$1,054.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$996.17
Rate for Payer: PHP Commercial	$996.17
Rate for Payer: Priority Health Cigna Priority Health	$761.78
Rate for Payer: Priority Health SBD	$738.34

HC DIALYSIS CATH LVL 11 LONG TERM

Facility

$1,171.97

Service Code	HCPCS C1750
Hospital Charge Code	27200269
Hospital Revenue Code	272
Min. Negotiated Rate	$468.79
Max. Negotiated Rate	$1,054.77
Rate for Payer: Aetna Commercial	$996.17
Rate for Payer: Aetna Medicare	$585.99
Rate for Payer: Aetna New Business (MI Preferred)	$761.78
Rate for Payer: BCBS Complete	$468.79
Rate for Payer: Cash Price	$937.58
Rate for Payer: Cofinity Commercial	$1,007.89
Rate for Payer: Cofinity Commercial	$820.38
Rate for Payer: Cofinity Medicare Advantage	$820.38
Rate for Payer: Encore Health Key Benefits Commercial	$937.58
Rate for Payer: Healthscope Commercial	$1,054.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$996.17
Rate for Payer: PHP Commercial	$996.17
Rate for Payer: Priority Health Cigna Priority Health	$761.78
Rate for Payer: Priority Health SBD	$738.34

HC DIALYSIS CATH LVL 13 LONG TERM

Facility

$1,380.06

Service Code	HCPCS C1750
Hospital Charge Code	27200266
Hospital Revenue Code	272
Min. Negotiated Rate	$552.02
Max. Negotiated Rate	$1,242.05
Rate for Payer: Aetna Commercial	$1,173.05
Rate for Payer: Aetna Medicare	$690.03
Rate for Payer: Aetna New Business (MI Preferred)	$897.04
Rate for Payer: BCBS Complete	$552.02
Rate for Payer: Cash Price	$1,104.05
Rate for Payer: Cofinity Commercial	$1,186.85
Rate for Payer: Cofinity Commercial	$966.04
Rate for Payer: Cofinity Medicare Advantage	$966.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.05
Rate for Payer: Healthscope Commercial	$1,242.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.05
Rate for Payer: PHP Commercial	$1,173.05
Rate for Payer: Priority Health Cigna Priority Health	$897.04
Rate for Payer: Priority Health SBD	$869.44

HC DIALYSIS CATH LVL 13 LONG TERM

Facility

$1,380.06

Service Code	HCPCS C1750
Hospital Charge Code	27200266
Hospital Revenue Code	272
Min. Negotiated Rate	$869.44
Max. Negotiated Rate	$1,242.05
Rate for Payer: Aetna Commercial	$1,173.05
Rate for Payer: Aetna New Business (MI Preferred)	$897.04
Rate for Payer: Cash Price	$1,104.05
Rate for Payer: Cofinity Commercial	$1,186.85
Rate for Payer: Cofinity Commercial	$966.04
Rate for Payer: Cofinity Medicare Advantage	$966.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.05
Rate for Payer: Healthscope Commercial	$1,242.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.05
Rate for Payer: PHP Commercial	$1,173.05
Rate for Payer: Priority Health Cigna Priority Health	$897.04
Rate for Payer: Priority Health SBD	$869.44

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$208.07

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$131.08
Max. Negotiated Rate	$187.26
Rate for Payer: Aetna Commercial	$176.86
Rate for Payer: Aetna New Business (MI Preferred)	$135.25
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$145.65
Rate for Payer: Cofinity Commercial	$178.94
Rate for Payer: Cofinity Medicare Advantage	$145.65
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$187.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.86
Rate for Payer: PHP Commercial	$176.86
Rate for Payer: Priority Health Cigna Priority Health	$135.25
Rate for Payer: Priority Health SBD	$131.08

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$208.07

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$83.23
Max. Negotiated Rate	$187.26
Rate for Payer: Aetna Commercial	$176.86
Rate for Payer: Aetna Medicare	$104.03
Rate for Payer: Aetna New Business (MI Preferred)	$135.25
Rate for Payer: BCBS Complete	$83.23
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$145.65
Rate for Payer: Cofinity Commercial	$178.94
Rate for Payer: Cofinity Medicare Advantage	$145.65
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$187.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.86
Rate for Payer: PHP Commercial	$176.86
Rate for Payer: Priority Health Cigna Priority Health	$135.25
Rate for Payer: Priority Health SBD	$131.08

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$315.17

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$126.07
Max. Negotiated Rate	$283.65
Rate for Payer: Aetna Commercial	$267.89
Rate for Payer: Aetna Medicare	$157.59
Rate for Payer: Aetna New Business (MI Preferred)	$204.86
Rate for Payer: BCBS Complete	$126.07
Rate for Payer: Cash Price	$252.14
Rate for Payer: Cofinity Commercial	$220.62
Rate for Payer: Cofinity Commercial	$271.05
Rate for Payer: Cofinity Medicare Advantage	$220.62
Rate for Payer: Encore Health Key Benefits Commercial	$252.14
Rate for Payer: Healthscope Commercial	$283.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$267.89
Rate for Payer: PHP Commercial	$267.89
Rate for Payer: Priority Health Cigna Priority Health	$204.86
Rate for Payer: Priority Health SBD	$198.56

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$315.17

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$198.56
Max. Negotiated Rate	$283.65
Rate for Payer: Aetna Commercial	$267.89
Rate for Payer: Aetna New Business (MI Preferred)	$204.86
Rate for Payer: Cash Price	$252.14
Rate for Payer: Cofinity Commercial	$220.62
Rate for Payer: Cofinity Commercial	$271.05
Rate for Payer: Cofinity Medicare Advantage	$220.62
Rate for Payer: Encore Health Key Benefits Commercial	$252.14
Rate for Payer: Healthscope Commercial	$283.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$267.89
Rate for Payer: PHP Commercial	$267.89
Rate for Payer: Priority Health Cigna Priority Health	$204.86
Rate for Payer: Priority Health SBD	$198.56

HC DIALYSIS CATH LVL 4 SHORT TERM

Facility

$422.27

Service Code	HCPCS C1752
Hospital Charge Code	27200085
Hospital Revenue Code	272
Min. Negotiated Rate	$168.91
Max. Negotiated Rate	$380.04
Rate for Payer: Aetna Commercial	$358.93
Rate for Payer: Aetna Medicare	$211.13
Rate for Payer: Aetna New Business (MI Preferred)	$274.48
Rate for Payer: BCBS Complete	$168.91
Rate for Payer: Cash Price	$337.82
Rate for Payer: Cofinity Commercial	$295.59
Rate for Payer: Cofinity Commercial	$363.15
Rate for Payer: Cofinity Medicare Advantage	$295.59
Rate for Payer: Encore Health Key Benefits Commercial	$337.82
Rate for Payer: Healthscope Commercial	$380.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.93
Rate for Payer: PHP Commercial	$358.93
Rate for Payer: Priority Health Cigna Priority Health	$274.48
Rate for Payer: Priority Health SBD	$266.03

HC DIALYSIS CATH LVL 4 SHORT TERM

Facility

$422.27

Service Code	HCPCS C1752
Hospital Charge Code	27200085
Hospital Revenue Code	272
Min. Negotiated Rate	$266.03
Max. Negotiated Rate	$380.04
Rate for Payer: Aetna Commercial	$358.93
Rate for Payer: Aetna New Business (MI Preferred)	$274.48
Rate for Payer: Cash Price	$337.82
Rate for Payer: Cofinity Commercial	$295.59
Rate for Payer: Cofinity Commercial	$363.15
Rate for Payer: Cofinity Medicare Advantage	$295.59
Rate for Payer: Encore Health Key Benefits Commercial	$337.82
Rate for Payer: Healthscope Commercial	$380.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.93
Rate for Payer: PHP Commercial	$358.93
Rate for Payer: Priority Health Cigna Priority Health	$274.48
Rate for Payer: Priority Health SBD	$266.03

HC DIALYSIS CATH LVL 5 SHORT TERM

Facility

$529.37

Service Code	HCPCS C1752
Hospital Charge Code	27200318
Hospital Revenue Code	272
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$476.43
Rate for Payer: Aetna Commercial	$449.96
Rate for Payer: Aetna Medicare	$264.69
Rate for Payer: Aetna New Business (MI Preferred)	$344.09
Rate for Payer: BCBS Complete	$211.75
Rate for Payer: Cash Price	$423.50
Rate for Payer: Cofinity Commercial	$370.56
Rate for Payer: Cofinity Commercial	$455.26
Rate for Payer: Cofinity Medicare Advantage	$370.56
Rate for Payer: Encore Health Key Benefits Commercial	$423.50
Rate for Payer: Healthscope Commercial	$476.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$449.96
Rate for Payer: PHP Commercial	$449.96
Rate for Payer: Priority Health Cigna Priority Health	$344.09
Rate for Payer: Priority Health SBD	$333.50

HC DIALYSIS CATH LVL 5 SHORT TERM

Facility

$529.37

Service Code	HCPCS C1752
Hospital Charge Code	27200318
Hospital Revenue Code	272
Min. Negotiated Rate	$333.50
Max. Negotiated Rate	$476.43
Rate for Payer: Aetna Commercial	$449.96
Rate for Payer: Aetna New Business (MI Preferred)	$344.09
Rate for Payer: Cash Price	$423.50
Rate for Payer: Cofinity Commercial	$370.56
Rate for Payer: Cofinity Commercial	$455.26
Rate for Payer: Cofinity Medicare Advantage	$370.56
Rate for Payer: Encore Health Key Benefits Commercial	$423.50
Rate for Payer: Healthscope Commercial	$476.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$449.96
Rate for Payer: PHP Commercial	$449.96
Rate for Payer: Priority Health Cigna Priority Health	$344.09
Rate for Payer: Priority Health SBD	$333.50

HC DIALYSIS CATH LVL 7 LONG TERM

Facility

$743.57

Service Code	CPT C1750
Hospital Charge Code	27200319
Hospital Revenue Code	272
Min. Negotiated Rate	$297.43
Max. Negotiated Rate	$669.21
Rate for Payer: Aetna Commercial	$632.03
Rate for Payer: Aetna Medicare	$371.79
Rate for Payer: Aetna New Business (MI Preferred)	$483.32
Rate for Payer: BCBS Complete	$297.43
Rate for Payer: Cash Price	$594.86
Rate for Payer: Cofinity Commercial	$520.50
Rate for Payer: Cofinity Commercial	$639.47
Rate for Payer: Cofinity Medicare Advantage	$520.50
Rate for Payer: Encore Health Key Benefits Commercial	$594.86
Rate for Payer: Healthscope Commercial	$669.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$632.03
Rate for Payer: PHP Commercial	$632.03
Rate for Payer: Priority Health Cigna Priority Health	$483.32
Rate for Payer: Priority Health SBD	$468.45

HC DIALYSIS CATH LVL 7 LONG TERM

Facility

$743.57

Service Code	CPT C1750
Hospital Charge Code	27200319
Hospital Revenue Code	272
Min. Negotiated Rate	$468.45
Max. Negotiated Rate	$669.21
Rate for Payer: Aetna Commercial	$632.03
Rate for Payer: Aetna New Business (MI Preferred)	$483.32
Rate for Payer: Cash Price	$594.86
Rate for Payer: Cofinity Commercial	$520.50
Rate for Payer: Cofinity Commercial	$639.47
Rate for Payer: Cofinity Medicare Advantage	$520.50
Rate for Payer: Encore Health Key Benefits Commercial	$594.86
Rate for Payer: Healthscope Commercial	$669.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$632.03
Rate for Payer: PHP Commercial	$632.03
Rate for Payer: Priority Health Cigna Priority Health	$483.32
Rate for Payer: Priority Health SBD	$468.45

HC DIALYSIS CATH LVL 7 SHORT TERM

Facility

$793.31

Service Code	CPT C1752
Hospital Charge Code	27200347
Hospital Revenue Code	272
Min. Negotiated Rate	$317.32
Max. Negotiated Rate	$713.98
Rate for Payer: Aetna Commercial	$674.31
Rate for Payer: Aetna Medicare	$396.65
Rate for Payer: Aetna New Business (MI Preferred)	$515.65
Rate for Payer: BCBS Complete	$317.32
Rate for Payer: Cash Price	$634.65
Rate for Payer: Cofinity Commercial	$555.32
Rate for Payer: Cofinity Commercial	$682.25
Rate for Payer: Cofinity Medicare Advantage	$555.32
Rate for Payer: Encore Health Key Benefits Commercial	$634.65
Rate for Payer: Healthscope Commercial	$713.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.31
Rate for Payer: PHP Commercial	$674.31
Rate for Payer: Priority Health Cigna Priority Health	$515.65
Rate for Payer: Priority Health SBD	$499.79

HC DIALYSIS CATH LVL 7 SHORT TERM

Facility

$793.31

Service Code	CPT C1752
Hospital Charge Code	27200347
Hospital Revenue Code	272
Min. Negotiated Rate	$499.79
Max. Negotiated Rate	$713.98
Rate for Payer: Aetna Commercial	$674.31
Rate for Payer: Aetna New Business (MI Preferred)	$515.65
Rate for Payer: Cash Price	$634.65
Rate for Payer: Cofinity Commercial	$555.32
Rate for Payer: Cofinity Commercial	$682.25
Rate for Payer: Cofinity Medicare Advantage	$555.32
Rate for Payer: Encore Health Key Benefits Commercial	$634.65
Rate for Payer: Healthscope Commercial	$713.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.31
Rate for Payer: PHP Commercial	$674.31
Rate for Payer: Priority Health Cigna Priority Health	$515.65
Rate for Payer: Priority Health SBD	$499.79

HC DIALYSIS CATH LVL 8 SHORT TERM

Facility

$850.67

Service Code	HCPCS C1752
Hospital Charge Code	27200175
Hospital Revenue Code	272
Min. Negotiated Rate	$340.27
Max. Negotiated Rate	$765.60
Rate for Payer: Aetna Commercial	$723.07
Rate for Payer: Aetna Medicare	$425.33
Rate for Payer: Aetna New Business (MI Preferred)	$552.94
Rate for Payer: BCBS Complete	$340.27
Rate for Payer: Cash Price	$680.54
Rate for Payer: Cofinity Commercial	$595.47
Rate for Payer: Cofinity Commercial	$731.58
Rate for Payer: Cofinity Medicare Advantage	$595.47
Rate for Payer: Encore Health Key Benefits Commercial	$680.54
Rate for Payer: Healthscope Commercial	$765.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$723.07
Rate for Payer: PHP Commercial	$723.07
Rate for Payer: Priority Health Cigna Priority Health	$552.94
Rate for Payer: Priority Health SBD	$535.92

HC DIALYSIS CATH LVL 8 SHORT TERM

Facility

$850.67

Service Code	HCPCS C1752
Hospital Charge Code	27200175
Hospital Revenue Code	272
Min. Negotiated Rate	$535.92
Max. Negotiated Rate	$765.60
Rate for Payer: Aetna Commercial	$723.07
Rate for Payer: Aetna New Business (MI Preferred)	$552.94
Rate for Payer: Cash Price	$680.54
Rate for Payer: Cofinity Commercial	$595.47
Rate for Payer: Cofinity Commercial	$731.58
Rate for Payer: Cofinity Medicare Advantage	$595.47
Rate for Payer: Encore Health Key Benefits Commercial	$680.54
Rate for Payer: Healthscope Commercial	$765.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$723.07
Rate for Payer: PHP Commercial	$723.07
Rate for Payer: Priority Health Cigna Priority Health	$552.94
Rate for Payer: Priority Health SBD	$535.92

HC DIALYSIS CATH LVL 9 LONG TERM

Facility

$957.77

Service Code	HCPCS C1750
Hospital Charge Code	27200320
Hospital Revenue Code	272
Min. Negotiated Rate	$603.40
Max. Negotiated Rate	$861.99
Rate for Payer: Aetna Commercial	$814.10
Rate for Payer: Aetna New Business (MI Preferred)	$622.55
Rate for Payer: Cash Price	$766.22
Rate for Payer: Cofinity Commercial	$670.44
Rate for Payer: Cofinity Commercial	$823.68
Rate for Payer: Cofinity Medicare Advantage	$670.44
Rate for Payer: Encore Health Key Benefits Commercial	$766.22
Rate for Payer: Healthscope Commercial	$861.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$814.10
Rate for Payer: PHP Commercial	$814.10
Rate for Payer: Priority Health Cigna Priority Health	$622.55
Rate for Payer: Priority Health SBD	$603.40

HC DIALYSIS CATH LVL 9 LONG TERM

Facility

$957.77

Service Code	HCPCS C1750
Hospital Charge Code	27200320
Hospital Revenue Code	272
Min. Negotiated Rate	$383.11
Max. Negotiated Rate	$861.99
Rate for Payer: Aetna Commercial	$814.10
Rate for Payer: Aetna Medicare	$478.88
Rate for Payer: Aetna New Business (MI Preferred)	$622.55
Rate for Payer: BCBS Complete	$383.11
Rate for Payer: Cash Price	$766.22
Rate for Payer: Cofinity Commercial	$670.44
Rate for Payer: Cofinity Commercial	$823.68
Rate for Payer: Cofinity Medicare Advantage	$670.44
Rate for Payer: Encore Health Key Benefits Commercial	$766.22
Rate for Payer: Healthscope Commercial	$861.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$814.10
Rate for Payer: PHP Commercial	$814.10
Rate for Payer: Priority Health Cigna Priority Health	$622.55
Rate for Payer: Priority Health SBD	$603.40

Know your out-of-pocket cost for care.

All Charges