Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM

Facility

$42.00

Service Code	CPT 90656
Hospital Charge Code	63600072
Hospital Revenue Code	636
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health SBD	$26.46

HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL

Facility

$68.00

Service Code	CPT 90660
Hospital Charge Code	63600252
Hospital Revenue Code	636
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Medicare Advantage	$47.60
Rate for Payer: Encore Health Key Benefits Commercial	$54.40
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$44.20
Rate for Payer: Priority Health SBD	$42.84

HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL

Facility

$68.00

Service Code	CPT 90660
Hospital Charge Code	63600252
Hospital Revenue Code	636
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna Medicare	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Medicare Advantage	$47.60
Rate for Payer: Encore Health Key Benefits Commercial	$54.40
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$44.20
Rate for Payer: Priority Health SBD	$42.84

HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM

Facility

$109.00

Service Code	CPT 90673
Hospital Charge Code	63600249
Hospital Revenue Code	636
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna Commercial	$92.65
Rate for Payer: Aetna Medicare	$54.50
Rate for Payer: Aetna New Business (MI Preferred)	$70.85
Rate for Payer: BCBS Complete	$43.60
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cofinity Commercial	$76.30
Rate for Payer: Cofinity Commercial	$93.74
Rate for Payer: Cofinity Medicare Advantage	$76.30
Rate for Payer: Encore Health Key Benefits Commercial	$87.20
Rate for Payer: Healthscope Commercial	$98.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.65
Rate for Payer: PHP Commercial	$92.65
Rate for Payer: Priority Health Cigna Priority Health	$70.85
Rate for Payer: Priority Health SBD	$68.67

HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM

Facility

$109.00

Service Code	CPT 90673
Hospital Charge Code	63600249
Hospital Revenue Code	636
Min. Negotiated Rate	$68.67
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna Commercial	$92.65
Rate for Payer: Aetna New Business (MI Preferred)	$70.85
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cofinity Commercial	$76.30
Rate for Payer: Cofinity Commercial	$93.74
Rate for Payer: Cofinity Medicare Advantage	$76.30
Rate for Payer: Encore Health Key Benefits Commercial	$87.20
Rate for Payer: Healthscope Commercial	$98.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.65
Rate for Payer: PHP Commercial	$92.65
Rate for Payer: Priority Health Cigna Priority Health	$70.85
Rate for Payer: Priority Health SBD	$68.67

HC INF PUMP PROGRAMMABLE LVL 6

Facility

$690.00

Service Code	HCPCS C1772
Hospital Charge Code	27800141
Hospital Revenue Code	278
Min. Negotiated Rate	$276.00
Max. Negotiated Rate	$621.00
Rate for Payer: Aetna Commercial	$586.50
Rate for Payer: Aetna Medicare	$345.00
Rate for Payer: Aetna New Business (MI Preferred)	$448.50
Rate for Payer: BCBS Complete	$276.00
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cofinity Commercial	$483.00
Rate for Payer: Cofinity Commercial	$593.40
Rate for Payer: Cofinity Medicare Advantage	$483.00
Rate for Payer: Encore Health Key Benefits Commercial	$552.00
Rate for Payer: Healthscope Commercial	$621.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$586.50
Rate for Payer: PHP Commercial	$586.50
Rate for Payer: Priority Health Cigna Priority Health	$448.50
Rate for Payer: Priority Health SBD	$434.70

HC INF PUMP PROGRAMMABLE LVL 6

Facility

$690.00

Service Code	HCPCS C1772
Hospital Charge Code	27800141
Hospital Revenue Code	278
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$621.00
Rate for Payer: Aetna Commercial	$586.50
Rate for Payer: Aetna New Business (MI Preferred)	$448.50
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cofinity Commercial	$483.00
Rate for Payer: Cofinity Commercial	$593.40
Rate for Payer: Cofinity Medicare Advantage	$483.00
Rate for Payer: Encore Health Key Benefits Commercial	$552.00
Rate for Payer: Healthscope Commercial	$621.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$586.50
Rate for Payer: PHP Commercial	$586.50
Rate for Payer: Priority Health Cigna Priority Health	$448.50
Rate for Payer: Priority Health SBD	$434.70

HC INFRARED THERAPY

Facility

$58.63

Service Code	CPT 97026
Hospital Charge Code	42000013
Hospital Revenue Code	420
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$49.84
Rate for Payer: Aetna Medicare	$29.32
Rate for Payer: Aetna New Business (MI Preferred)	$38.11
Rate for Payer: BCBS Complete	$23.45
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cofinity Commercial	$50.42
Rate for Payer: Cofinity Commercial	$41.04
Rate for Payer: Cofinity Medicare Advantage	$41.04
Rate for Payer: Encore Health Key Benefits Commercial	$46.90
Rate for Payer: Healthscope Commercial	$52.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.84
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$49.84
Rate for Payer: Priority Health Cigna Priority Health	$38.11
Rate for Payer: Priority Health SBD	$36.94
Rate for Payer: UHC Core	$43.39
Rate for Payer: UHC Exchange	$43.39

HC INFRARED THERAPY

Facility

$58.63

Service Code	CPT 97026
Hospital Charge Code	42000013
Hospital Revenue Code	420
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$52.77
Rate for Payer: Aetna Commercial	$49.84
Rate for Payer: Aetna New Business (MI Preferred)	$38.11
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cofinity Commercial	$41.04
Rate for Payer: Cofinity Commercial	$50.42
Rate for Payer: Cofinity Medicare Advantage	$41.04
Rate for Payer: Encore Health Key Benefits Commercial	$46.90
Rate for Payer: Healthscope Commercial	$52.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.84
Rate for Payer: PHP Commercial	$49.84
Rate for Payer: Priority Health Cigna Priority Health	$38.11
Rate for Payer: Priority Health SBD	$36.94

HC INFUSION CATHETER LVL 1

Facility

$160.65

Service Code	HCPCS C1751
Hospital Charge Code	27200278
Hospital Revenue Code	272
Min. Negotiated Rate	$101.21
Max. Negotiated Rate	$144.59
Rate for Payer: Aetna Commercial	$136.55
Rate for Payer: Aetna New Business (MI Preferred)	$104.42
Rate for Payer: Cash Price	$128.52
Rate for Payer: Cofinity Commercial	$112.45
Rate for Payer: Cofinity Commercial	$138.16
Rate for Payer: Cofinity Medicare Advantage	$112.45
Rate for Payer: Encore Health Key Benefits Commercial	$128.52
Rate for Payer: Healthscope Commercial	$144.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.55
Rate for Payer: PHP Commercial	$136.55
Rate for Payer: Priority Health Cigna Priority Health	$104.42
Rate for Payer: Priority Health SBD	$101.21

HC INFUSION CATHETER LVL 1

Facility

$160.65

Service Code	HCPCS C1751
Hospital Charge Code	27200278
Hospital Revenue Code	272
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$144.59
Rate for Payer: Aetna Commercial	$136.55
Rate for Payer: Aetna Medicare	$80.33
Rate for Payer: Aetna New Business (MI Preferred)	$104.42
Rate for Payer: BCBS Complete	$64.26
Rate for Payer: Cash Price	$128.52
Rate for Payer: Cofinity Commercial	$112.45
Rate for Payer: Cofinity Commercial	$138.16
Rate for Payer: Cofinity Medicare Advantage	$112.45
Rate for Payer: Encore Health Key Benefits Commercial	$128.52
Rate for Payer: Healthscope Commercial	$144.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.55
Rate for Payer: PHP Commercial	$136.55
Rate for Payer: Priority Health Cigna Priority Health	$104.42
Rate for Payer: Priority Health SBD	$101.21

HC INFUSION CATHETER LVL 2

Facility

$241.86

Service Code	HCPCS C1751
Hospital Charge Code	27200005
Hospital Revenue Code	272
Min. Negotiated Rate	$96.74
Max. Negotiated Rate	$217.67
Rate for Payer: Aetna Commercial	$205.58
Rate for Payer: Aetna Medicare	$120.93
Rate for Payer: Aetna New Business (MI Preferred)	$157.21
Rate for Payer: BCBS Complete	$96.74
Rate for Payer: Cash Price	$193.49
Rate for Payer: Cofinity Commercial	$169.30
Rate for Payer: Cofinity Commercial	$208.00
Rate for Payer: Cofinity Medicare Advantage	$169.30
Rate for Payer: Encore Health Key Benefits Commercial	$193.49
Rate for Payer: Healthscope Commercial	$217.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.58
Rate for Payer: PHP Commercial	$205.58
Rate for Payer: Priority Health Cigna Priority Health	$157.21
Rate for Payer: Priority Health SBD	$152.37

HC INFUSION CATHETER LVL 2

Facility

$241.86

Service Code	HCPCS C1751
Hospital Charge Code	27200005
Hospital Revenue Code	272
Min. Negotiated Rate	$152.37
Max. Negotiated Rate	$217.67
Rate for Payer: Aetna Commercial	$205.58
Rate for Payer: Aetna New Business (MI Preferred)	$157.21
Rate for Payer: Cash Price	$193.49
Rate for Payer: Cofinity Commercial	$169.30
Rate for Payer: Cofinity Commercial	$208.00
Rate for Payer: Cofinity Medicare Advantage	$169.30
Rate for Payer: Encore Health Key Benefits Commercial	$193.49
Rate for Payer: Healthscope Commercial	$217.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.58
Rate for Payer: PHP Commercial	$205.58
Rate for Payer: Priority Health Cigna Priority Health	$157.21
Rate for Payer: Priority Health SBD	$152.37

HC INFUSION CATHETER LVL 3

Facility

$396.90

Service Code	HCPCS C1751
Hospital Charge Code	27200265
Hospital Revenue Code	272
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$357.21
Rate for Payer: Aetna Commercial	$337.37
Rate for Payer: Aetna Medicare	$198.45
Rate for Payer: Aetna New Business (MI Preferred)	$257.99
Rate for Payer: BCBS Complete	$158.76
Rate for Payer: Cash Price	$317.52
Rate for Payer: Cofinity Commercial	$277.83
Rate for Payer: Cofinity Commercial	$341.33
Rate for Payer: Cofinity Medicare Advantage	$277.83
Rate for Payer: Encore Health Key Benefits Commercial	$317.52
Rate for Payer: Healthscope Commercial	$357.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.37
Rate for Payer: PHP Commercial	$337.37
Rate for Payer: Priority Health Cigna Priority Health	$257.99
Rate for Payer: Priority Health SBD	$250.05

HC INFUSION CATHETER LVL 3

Facility

$396.90

Service Code	HCPCS C1751
Hospital Charge Code	27200265
Hospital Revenue Code	272
Min. Negotiated Rate	$250.05
Max. Negotiated Rate	$357.21
Rate for Payer: Aetna Commercial	$337.37
Rate for Payer: Aetna New Business (MI Preferred)	$257.99
Rate for Payer: Cash Price	$317.52
Rate for Payer: Cofinity Commercial	$277.83
Rate for Payer: Cofinity Commercial	$341.33
Rate for Payer: Cofinity Medicare Advantage	$277.83
Rate for Payer: Encore Health Key Benefits Commercial	$317.52
Rate for Payer: Healthscope Commercial	$357.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.37
Rate for Payer: PHP Commercial	$337.37
Rate for Payer: Priority Health Cigna Priority Health	$257.99
Rate for Payer: Priority Health SBD	$250.05

HC INFUSION CATHETER LVL 6

Facility

$676.12

Service Code	HCPCS C1751
Hospital Charge Code	27200280
Hospital Revenue Code	272
Min. Negotiated Rate	$425.96
Max. Negotiated Rate	$608.51
Rate for Payer: Aetna Commercial	$574.70
Rate for Payer: Aetna New Business (MI Preferred)	$439.48
Rate for Payer: Cash Price	$540.90
Rate for Payer: Cofinity Commercial	$473.28
Rate for Payer: Cofinity Commercial	$581.46
Rate for Payer: Cofinity Medicare Advantage	$473.28
Rate for Payer: Encore Health Key Benefits Commercial	$540.90
Rate for Payer: Healthscope Commercial	$608.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$574.70
Rate for Payer: PHP Commercial	$574.70
Rate for Payer: Priority Health Cigna Priority Health	$439.48
Rate for Payer: Priority Health SBD	$425.96

HC INFUSION CATHETER LVL 6

Facility

$676.12

Service Code	HCPCS C1751
Hospital Charge Code	27200280
Hospital Revenue Code	272
Min. Negotiated Rate	$270.45
Max. Negotiated Rate	$608.51
Rate for Payer: Aetna Commercial	$574.70
Rate for Payer: Aetna Medicare	$338.06
Rate for Payer: Aetna New Business (MI Preferred)	$439.48
Rate for Payer: BCBS Complete	$270.45
Rate for Payer: Cash Price	$540.90
Rate for Payer: Cofinity Commercial	$473.28
Rate for Payer: Cofinity Commercial	$581.46
Rate for Payer: Cofinity Medicare Advantage	$473.28
Rate for Payer: Encore Health Key Benefits Commercial	$540.90
Rate for Payer: Healthscope Commercial	$608.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$574.70
Rate for Payer: PHP Commercial	$574.70
Rate for Payer: Priority Health Cigna Priority Health	$439.48
Rate for Payer: Priority Health SBD	$425.96

HC INFUSION CATHETER LVL 7

Facility

$755.19

Service Code	HCPCS C1751
Hospital Charge Code	27200003
Hospital Revenue Code	272
Min. Negotiated Rate	$475.77
Max. Negotiated Rate	$679.67
Rate for Payer: Aetna Commercial	$641.91
Rate for Payer: Aetna New Business (MI Preferred)	$490.87
Rate for Payer: Cash Price	$604.15
Rate for Payer: Cofinity Commercial	$528.63
Rate for Payer: Cofinity Commercial	$649.46
Rate for Payer: Cofinity Medicare Advantage	$528.63
Rate for Payer: Encore Health Key Benefits Commercial	$604.15
Rate for Payer: Healthscope Commercial	$679.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$641.91
Rate for Payer: PHP Commercial	$641.91
Rate for Payer: Priority Health Cigna Priority Health	$490.87
Rate for Payer: Priority Health SBD	$475.77

HC INFUSION CATHETER LVL 7

Facility

$755.19

Service Code	HCPCS C1751
Hospital Charge Code	27200003
Hospital Revenue Code	272
Min. Negotiated Rate	$302.08
Max. Negotiated Rate	$679.67
Rate for Payer: Aetna Commercial	$641.91
Rate for Payer: Aetna Medicare	$377.60
Rate for Payer: Aetna New Business (MI Preferred)	$490.87
Rate for Payer: BCBS Complete	$302.08
Rate for Payer: Cash Price	$604.15
Rate for Payer: Cofinity Commercial	$528.63
Rate for Payer: Cofinity Commercial	$649.46
Rate for Payer: Cofinity Medicare Advantage	$528.63
Rate for Payer: Encore Health Key Benefits Commercial	$604.15
Rate for Payer: Healthscope Commercial	$679.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$641.91
Rate for Payer: PHP Commercial	$641.91
Rate for Payer: Priority Health Cigna Priority Health	$490.87
Rate for Payer: Priority Health SBD	$475.77

HC INFUSION CATHETER LVL 9

Facility

$922.26

Service Code	HCPCS C1751
Hospital Charge Code	27200170
Hospital Revenue Code	272
Min. Negotiated Rate	$581.02
Max. Negotiated Rate	$830.03
Rate for Payer: Aetna Commercial	$783.92
Rate for Payer: Aetna New Business (MI Preferred)	$599.47
Rate for Payer: Cash Price	$737.81
Rate for Payer: Cofinity Commercial	$645.58
Rate for Payer: Cofinity Commercial	$793.14
Rate for Payer: Cofinity Medicare Advantage	$645.58
Rate for Payer: Encore Health Key Benefits Commercial	$737.81
Rate for Payer: Healthscope Commercial	$830.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$783.92
Rate for Payer: PHP Commercial	$783.92
Rate for Payer: Priority Health Cigna Priority Health	$599.47
Rate for Payer: Priority Health SBD	$581.02

HC INFUSION CATHETER LVL 9

Facility

$922.26

Service Code	HCPCS C1751
Hospital Charge Code	27200170
Hospital Revenue Code	272
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$830.03
Rate for Payer: Aetna Commercial	$783.92
Rate for Payer: Aetna Medicare	$461.13
Rate for Payer: Aetna New Business (MI Preferred)	$599.47
Rate for Payer: BCBS Complete	$368.90
Rate for Payer: Cash Price	$737.81
Rate for Payer: Cofinity Commercial	$645.58
Rate for Payer: Cofinity Commercial	$793.14
Rate for Payer: Cofinity Medicare Advantage	$645.58
Rate for Payer: Encore Health Key Benefits Commercial	$737.81
Rate for Payer: Healthscope Commercial	$830.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$783.92
Rate for Payer: PHP Commercial	$783.92
Rate for Payer: Priority Health Cigna Priority Health	$599.47
Rate for Payer: Priority Health SBD	$581.02

HC INFUSION CATH LVL 10

Facility

$1,026.84

Service Code	HCPCS C1751
Hospital Charge Code	27200310
Hospital Revenue Code	272
Min. Negotiated Rate	$410.74
Max. Negotiated Rate	$924.16
Rate for Payer: Aetna Commercial	$872.81
Rate for Payer: Aetna Medicare	$513.42
Rate for Payer: Aetna New Business (MI Preferred)	$667.45
Rate for Payer: BCBS Complete	$410.74
Rate for Payer: Cash Price	$821.47
Rate for Payer: Cofinity Commercial	$718.79
Rate for Payer: Cofinity Commercial	$883.08
Rate for Payer: Cofinity Medicare Advantage	$718.79
Rate for Payer: Encore Health Key Benefits Commercial	$821.47
Rate for Payer: Healthscope Commercial	$924.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$872.81
Rate for Payer: PHP Commercial	$872.81
Rate for Payer: Priority Health Cigna Priority Health	$667.45
Rate for Payer: Priority Health SBD	$646.91

HC INFUSION CATH LVL 10

Facility

$1,026.84

Service Code	HCPCS C1751
Hospital Charge Code	27200310
Hospital Revenue Code	272
Min. Negotiated Rate	$646.91
Max. Negotiated Rate	$924.16
Rate for Payer: Aetna Commercial	$872.81
Rate for Payer: Aetna New Business (MI Preferred)	$667.45
Rate for Payer: Cash Price	$821.47
Rate for Payer: Cofinity Commercial	$718.79
Rate for Payer: Cofinity Commercial	$883.08
Rate for Payer: Cofinity Medicare Advantage	$718.79
Rate for Payer: Encore Health Key Benefits Commercial	$821.47
Rate for Payer: Healthscope Commercial	$924.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$872.81
Rate for Payer: PHP Commercial	$872.81
Rate for Payer: Priority Health Cigna Priority Health	$667.45
Rate for Payer: Priority Health SBD	$646.91

HC INFUSION CATH LVL 11

Facility

$1,143.29

Service Code	HCPCS C1751
Hospital Charge Code	27200311
Hospital Revenue Code	272
Min. Negotiated Rate	$720.27
Max. Negotiated Rate	$1,028.96
Rate for Payer: Aetna Commercial	$971.80
Rate for Payer: Aetna New Business (MI Preferred)	$743.14
Rate for Payer: Cash Price	$914.63
Rate for Payer: Cofinity Commercial	$800.30
Rate for Payer: Cofinity Commercial	$983.23
Rate for Payer: Cofinity Medicare Advantage	$800.30
Rate for Payer: Encore Health Key Benefits Commercial	$914.63
Rate for Payer: Healthscope Commercial	$1,028.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$971.80
Rate for Payer: PHP Commercial	$971.80
Rate for Payer: Priority Health Cigna Priority Health	$743.14
Rate for Payer: Priority Health SBD	$720.27

HC INFUSION CATH LVL 11

Facility

$1,143.29

Service Code	HCPCS C1751
Hospital Charge Code	27200311
Hospital Revenue Code	272
Min. Negotiated Rate	$457.32
Max. Negotiated Rate	$1,028.96
Rate for Payer: Aetna Commercial	$971.80
Rate for Payer: Aetna Medicare	$571.64
Rate for Payer: Aetna New Business (MI Preferred)	$743.14
Rate for Payer: BCBS Complete	$457.32
Rate for Payer: Cash Price	$914.63
Rate for Payer: Cofinity Commercial	$800.30
Rate for Payer: Cofinity Commercial	$983.23
Rate for Payer: Cofinity Medicare Advantage	$800.30
Rate for Payer: Encore Health Key Benefits Commercial	$914.63
Rate for Payer: Healthscope Commercial	$1,028.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$971.80
Rate for Payer: PHP Commercial	$971.80
Rate for Payer: Priority Health Cigna Priority Health	$743.14
Rate for Payer: Priority Health SBD	$720.27

Know your out-of-pocket cost for care.

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