Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC CANN RT ANG BALLOON 4-6MM

Facility

$297.00

Hospital Charge Code	27000446
Hospital Revenue Code	270
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$297.00
Rate for Payer: Aetna Commercial	$267.30
Rate for Payer: ASR ASR	$288.09
Rate for Payer: BCBS Complete	$118.80
Rate for Payer: BCBS Trust/PPO	$230.26
Rate for Payer: BCN Commercial	$230.26
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cofinity Commercial	$279.18
Rate for Payer: Encore Health Key Benefits Commercial	$237.60
Rate for Payer: Healthscope Commercial	$297.00
Rate for Payer: Healthscope Whirlpool	$288.09
Rate for Payer: Mclaren Commercial	$267.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$252.45
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$270.27
Rate for Payer: Priority Health Narrow Network	$210.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$261.36

HC CANN RT ANG BALLOON 4-6MM

Facility

$297.00

Hospital Charge Code	27000446
Hospital Revenue Code	270
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$297.00
Rate for Payer: Aetna Commercial	$267.30
Rate for Payer: ASR ASR	$288.09
Rate for Payer: BCBS Trust/PPO	$230.26
Rate for Payer: BCN Commercial	$230.26
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cofinity Commercial	$279.18
Rate for Payer: Encore Health Key Benefits Commercial	$237.60
Rate for Payer: Healthscope Commercial	$297.00
Rate for Payer: Healthscope Whirlpool	$288.09
Rate for Payer: Mclaren Commercial	$267.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$252.45
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$261.36

HC CANNULA ARTERIAL 21, 24 FR

Facility

$114.00

Hospital Charge Code	27000449
Hospital Revenue Code	270
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: ASR ASR	$110.58
Rate for Payer: BCBS Trust/PPO	$88.38
Rate for Payer: BCN Commercial	$88.38
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Encore Health Key Benefits Commercial	$91.20
Rate for Payer: Healthscope Commercial	$114.00
Rate for Payer: Healthscope Whirlpool	$110.58
Rate for Payer: Mclaren Commercial	$102.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.90
Rate for Payer: Priority Health Cigna Priority Health	$79.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$100.32

HC CANNULA ARTERIAL 21, 24 FR

Facility

$114.00

Hospital Charge Code	27000449
Hospital Revenue Code	270
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: ASR ASR	$110.58
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS Trust/PPO	$88.38
Rate for Payer: BCN Commercial	$88.38
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Encore Health Key Benefits Commercial	$91.20
Rate for Payer: Healthscope Commercial	$114.00
Rate for Payer: Healthscope Whirlpool	$110.58
Rate for Payer: Mclaren Commercial	$102.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.90
Rate for Payer: Priority Health Cigna Priority Health	$79.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.74
Rate for Payer: Priority Health Narrow Network	$80.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$100.32

HC CANNULA ARTERIOTOMY 2 MM

Facility

$24.00

Hospital Charge Code	27000675
Hospital Revenue Code	270
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: ASR ASR	$23.28
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: BCBS Trust/PPO	$18.61
Rate for Payer: BCN Commercial	$18.61
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$22.56
Rate for Payer: Encore Health Key Benefits Commercial	$19.20
Rate for Payer: Healthscope Commercial	$24.00
Rate for Payer: Healthscope Whirlpool	$23.28
Rate for Payer: Mclaren Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$16.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.84
Rate for Payer: Priority Health Narrow Network	$17.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.12

HC CANNULA ARTERIOTOMY 2 MM

Facility

$24.00

Hospital Charge Code	27000675
Hospital Revenue Code	270
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: ASR ASR	$23.28
Rate for Payer: BCBS Trust/PPO	$18.61
Rate for Payer: BCN Commercial	$18.61
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$22.56
Rate for Payer: Encore Health Key Benefits Commercial	$19.20
Rate for Payer: Healthscope Commercial	$24.00
Rate for Payer: Healthscope Whirlpool	$23.28
Rate for Payer: Mclaren Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$16.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.12

HC CANNULA BIOMEDICUS

Facility

$1,444.58

Hospital Charge Code	27006715
Hospital Revenue Code	270
Min. Negotiated Rate	$577.83
Max. Negotiated Rate	$1,444.58
Rate for Payer: Aetna Commercial	$1,300.12
Rate for Payer: ASR ASR	$1,401.24
Rate for Payer: BCBS Complete	$577.83
Rate for Payer: BCBS Trust/PPO	$1,119.98
Rate for Payer: BCN Commercial	$1,119.98
Rate for Payer: Cash Price	$1,155.66
Rate for Payer: Cofinity Commercial	$1,357.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,155.66
Rate for Payer: Healthscope Commercial	$1,444.58
Rate for Payer: Healthscope Whirlpool	$1,401.24
Rate for Payer: Mclaren Commercial	$1,300.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,227.89
Rate for Payer: Priority Health Cigna Priority Health	$1,011.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,314.57
Rate for Payer: Priority Health Narrow Network	$1,025.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,271.23

HC CANNULA BIOMEDICUS

Facility

$1,444.58

Hospital Charge Code	27006715
Hospital Revenue Code	270
Min. Negotiated Rate	$1,011.21
Max. Negotiated Rate	$1,444.58
Rate for Payer: Aetna Commercial	$1,300.12
Rate for Payer: ASR ASR	$1,401.24
Rate for Payer: BCBS Trust/PPO	$1,119.98
Rate for Payer: BCN Commercial	$1,119.98
Rate for Payer: Cash Price	$1,155.66
Rate for Payer: Cofinity Commercial	$1,357.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,155.66
Rate for Payer: Healthscope Commercial	$1,444.58
Rate for Payer: Healthscope Whirlpool	$1,401.24
Rate for Payer: Mclaren Commercial	$1,300.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,227.89
Rate for Payer: Priority Health Cigna Priority Health	$1,011.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,271.23

HC CANNULA CARDIOPLEGIA

Facility

$46.50

Hospital Charge Code	27000092
Hospital Revenue Code	270
Min. Negotiated Rate	$32.55
Max. Negotiated Rate	$46.50
Rate for Payer: Aetna Commercial	$41.85
Rate for Payer: ASR ASR	$45.10
Rate for Payer: BCBS Trust/PPO	$36.05
Rate for Payer: BCN Commercial	$36.05
Rate for Payer: Cash Price	$37.20
Rate for Payer: Cofinity Commercial	$43.71
Rate for Payer: Encore Health Key Benefits Commercial	$37.20
Rate for Payer: Healthscope Commercial	$46.50
Rate for Payer: Healthscope Whirlpool	$45.10
Rate for Payer: Mclaren Commercial	$41.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.52
Rate for Payer: Priority Health Cigna Priority Health	$32.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.92

HC CANNULA CARDIOPLEGIA

Facility

$46.50

Hospital Charge Code	27000092
Hospital Revenue Code	270
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$46.50
Rate for Payer: Aetna Commercial	$41.85
Rate for Payer: ASR ASR	$45.10
Rate for Payer: BCBS Complete	$18.60
Rate for Payer: BCBS Trust/PPO	$36.05
Rate for Payer: BCN Commercial	$36.05
Rate for Payer: Cash Price	$37.20
Rate for Payer: Cofinity Commercial	$43.71
Rate for Payer: Encore Health Key Benefits Commercial	$37.20
Rate for Payer: Healthscope Commercial	$46.50
Rate for Payer: Healthscope Whirlpool	$45.10
Rate for Payer: Mclaren Commercial	$41.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.52
Rate for Payer: Priority Health Cigna Priority Health	$32.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.32
Rate for Payer: Priority Health Narrow Network	$33.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.92

HC CANNULA COR ART 7MM ST

Facility

$316.73

Hospital Charge Code	27006707
Hospital Revenue Code	270
Min. Negotiated Rate	$126.69
Max. Negotiated Rate	$316.73
Rate for Payer: Aetna Commercial	$285.06
Rate for Payer: ASR ASR	$307.23
Rate for Payer: BCBS Complete	$126.69
Rate for Payer: BCBS Trust/PPO	$245.56
Rate for Payer: BCN Commercial	$245.56
Rate for Payer: Cash Price	$253.38
Rate for Payer: Cofinity Commercial	$297.73
Rate for Payer: Encore Health Key Benefits Commercial	$253.38
Rate for Payer: Healthscope Commercial	$316.73
Rate for Payer: Healthscope Whirlpool	$307.23
Rate for Payer: Mclaren Commercial	$285.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$269.22
Rate for Payer: Priority Health Cigna Priority Health	$221.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$288.22
Rate for Payer: Priority Health Narrow Network	$224.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$278.72

HC CANNULA COR ART 7MM ST

Facility

$316.73

Hospital Charge Code	27006707
Hospital Revenue Code	270
Min. Negotiated Rate	$221.71
Max. Negotiated Rate	$316.73
Rate for Payer: Aetna Commercial	$285.06
Rate for Payer: ASR ASR	$307.23
Rate for Payer: BCBS Trust/PPO	$245.56
Rate for Payer: BCN Commercial	$245.56
Rate for Payer: Cash Price	$253.38
Rate for Payer: Cofinity Commercial	$297.73
Rate for Payer: Encore Health Key Benefits Commercial	$253.38
Rate for Payer: Healthscope Commercial	$316.73
Rate for Payer: Healthscope Whirlpool	$307.23
Rate for Payer: Mclaren Commercial	$285.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$269.22
Rate for Payer: Priority Health Cigna Priority Health	$221.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$278.72

HC CANNULA COR ART 8 MM ST

Facility

$307.50

Hospital Charge Code	27006708
Hospital Revenue Code	270
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$276.75
Rate for Payer: ASR ASR	$298.28
Rate for Payer: BCBS Complete	$123.00
Rate for Payer: BCBS Trust/PPO	$238.40
Rate for Payer: BCN Commercial	$238.40
Rate for Payer: Cash Price	$246.00
Rate for Payer: Cofinity Commercial	$289.05
Rate for Payer: Encore Health Key Benefits Commercial	$246.00
Rate for Payer: Healthscope Commercial	$307.50
Rate for Payer: Healthscope Whirlpool	$298.28
Rate for Payer: Mclaren Commercial	$276.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.38
Rate for Payer: Priority Health Cigna Priority Health	$215.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$279.82
Rate for Payer: Priority Health Narrow Network	$218.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.60

HC CANNULA COR ART 8 MM ST

Facility

$307.50

Hospital Charge Code	27006708
Hospital Revenue Code	270
Min. Negotiated Rate	$215.25
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$276.75
Rate for Payer: ASR ASR	$298.28
Rate for Payer: BCBS Trust/PPO	$238.40
Rate for Payer: BCN Commercial	$238.40
Rate for Payer: Cash Price	$246.00
Rate for Payer: Cofinity Commercial	$289.05
Rate for Payer: Encore Health Key Benefits Commercial	$246.00
Rate for Payer: Healthscope Commercial	$307.50
Rate for Payer: Healthscope Whirlpool	$298.28
Rate for Payer: Mclaren Commercial	$276.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.38
Rate for Payer: Priority Health Cigna Priority Health	$215.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.60

HC CANNULA COR OSTIA CONCAVE

Facility

$75.00

Hospital Charge Code	27000265
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: ASR ASR	$72.75
Rate for Payer: BCBS Trust/PPO	$58.15
Rate for Payer: BCN Commercial	$58.15
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cofinity Commercial	$70.50
Rate for Payer: Encore Health Key Benefits Commercial	$60.00
Rate for Payer: Healthscope Commercial	$75.00
Rate for Payer: Healthscope Whirlpool	$72.75
Rate for Payer: Mclaren Commercial	$67.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.75
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$66.00

HC CANNULA COR OSTIA CONCAVE

Facility

$75.00

Hospital Charge Code	27000265
Hospital Revenue Code	270
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: ASR ASR	$72.75
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Trust/PPO	$58.15
Rate for Payer: BCN Commercial	$58.15
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cofinity Commercial	$70.50
Rate for Payer: Encore Health Key Benefits Commercial	$60.00
Rate for Payer: Healthscope Commercial	$75.00
Rate for Payer: Healthscope Whirlpool	$72.75
Rate for Payer: Mclaren Commercial	$67.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.75
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.25
Rate for Payer: Priority Health Narrow Network	$53.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$66.00

HC CANNULA COR OSTIA LPG 4MM

Facility

$334.50

Hospital Charge Code	27006704
Hospital Revenue Code	270
Min. Negotiated Rate	$234.15
Max. Negotiated Rate	$334.50
Rate for Payer: Aetna Commercial	$301.05
Rate for Payer: ASR ASR	$324.46
Rate for Payer: BCBS Trust/PPO	$259.34
Rate for Payer: BCN Commercial	$259.34
Rate for Payer: Cash Price	$267.60
Rate for Payer: Cofinity Commercial	$314.43
Rate for Payer: Encore Health Key Benefits Commercial	$267.60
Rate for Payer: Healthscope Commercial	$334.50
Rate for Payer: Healthscope Whirlpool	$324.46
Rate for Payer: Mclaren Commercial	$301.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$284.32
Rate for Payer: Priority Health Cigna Priority Health	$234.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$294.36

HC CANNULA COR OSTIA LPG 4MM

Facility

$334.50

Hospital Charge Code	27006704
Hospital Revenue Code	270
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$334.50
Rate for Payer: Aetna Commercial	$301.05
Rate for Payer: ASR ASR	$324.46
Rate for Payer: BCBS Complete	$133.80
Rate for Payer: BCBS Trust/PPO	$259.34
Rate for Payer: BCN Commercial	$259.34
Rate for Payer: Cash Price	$267.60
Rate for Payer: Cofinity Commercial	$314.43
Rate for Payer: Encore Health Key Benefits Commercial	$267.60
Rate for Payer: Healthscope Commercial	$334.50
Rate for Payer: Healthscope Whirlpool	$324.46
Rate for Payer: Mclaren Commercial	$301.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$284.32
Rate for Payer: Priority Health Cigna Priority Health	$234.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$304.40
Rate for Payer: Priority Health Narrow Network	$237.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$294.36

HC CANNULA COR OSTIA LPG 5MM

Facility

$334.50

Hospital Charge Code	27006705
Hospital Revenue Code	270
Min. Negotiated Rate	$234.15
Max. Negotiated Rate	$334.50
Rate for Payer: Aetna Commercial	$301.05
Rate for Payer: ASR ASR	$324.46
Rate for Payer: BCBS Trust/PPO	$259.34
Rate for Payer: BCN Commercial	$259.34
Rate for Payer: Cash Price	$267.60
Rate for Payer: Cofinity Commercial	$314.43
Rate for Payer: Encore Health Key Benefits Commercial	$267.60
Rate for Payer: Healthscope Commercial	$334.50
Rate for Payer: Healthscope Whirlpool	$324.46
Rate for Payer: Mclaren Commercial	$301.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$284.32
Rate for Payer: Priority Health Cigna Priority Health	$234.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$294.36

HC CANNULA COR OSTIA LPG 5MM

Facility

$334.50

Hospital Charge Code	27006705
Hospital Revenue Code	270
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$334.50
Rate for Payer: Aetna Commercial	$301.05
Rate for Payer: ASR ASR	$324.46
Rate for Payer: BCBS Complete	$133.80
Rate for Payer: BCBS Trust/PPO	$259.34
Rate for Payer: BCN Commercial	$259.34
Rate for Payer: Cash Price	$267.60
Rate for Payer: Cofinity Commercial	$314.43
Rate for Payer: Encore Health Key Benefits Commercial	$267.60
Rate for Payer: Healthscope Commercial	$334.50
Rate for Payer: Healthscope Whirlpool	$324.46
Rate for Payer: Mclaren Commercial	$301.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$284.32
Rate for Payer: Priority Health Cigna Priority Health	$234.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$304.40
Rate for Payer: Priority Health Narrow Network	$237.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$294.36

HC CANNULA COR OSTIA LPG 6MM

Facility

$307.50

Hospital Charge Code	27006706
Hospital Revenue Code	270
Min. Negotiated Rate	$215.25
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$276.75
Rate for Payer: ASR ASR	$298.28
Rate for Payer: BCBS Trust/PPO	$238.40
Rate for Payer: BCN Commercial	$238.40
Rate for Payer: Cash Price	$246.00
Rate for Payer: Cofinity Commercial	$289.05
Rate for Payer: Encore Health Key Benefits Commercial	$246.00
Rate for Payer: Healthscope Commercial	$307.50
Rate for Payer: Healthscope Whirlpool	$298.28
Rate for Payer: Mclaren Commercial	$276.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.38
Rate for Payer: Priority Health Cigna Priority Health	$215.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.60

HC CANNULA COR OSTIA LPG 6MM

Facility

$307.50

Hospital Charge Code	27006706
Hospital Revenue Code	270
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$276.75
Rate for Payer: ASR ASR	$298.28
Rate for Payer: BCBS Complete	$123.00
Rate for Payer: BCBS Trust/PPO	$238.40
Rate for Payer: BCN Commercial	$238.40
Rate for Payer: Cash Price	$246.00
Rate for Payer: Cofinity Commercial	$289.05
Rate for Payer: Encore Health Key Benefits Commercial	$246.00
Rate for Payer: Healthscope Commercial	$307.50
Rate for Payer: Healthscope Whirlpool	$298.28
Rate for Payer: Mclaren Commercial	$276.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.38
Rate for Payer: Priority Health Cigna Priority Health	$215.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$279.82
Rate for Payer: Priority Health Narrow Network	$218.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.60

HC CANNULA COR OSTIA RT ANG 4MM

Facility

$307.50

Hospital Charge Code	27006709
Hospital Revenue Code	270
Min. Negotiated Rate	$215.25
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$276.75
Rate for Payer: ASR ASR	$298.28
Rate for Payer: BCBS Trust/PPO	$238.40
Rate for Payer: BCN Commercial	$238.40
Rate for Payer: Cash Price	$246.00
Rate for Payer: Cofinity Commercial	$289.05
Rate for Payer: Encore Health Key Benefits Commercial	$246.00
Rate for Payer: Healthscope Commercial	$307.50
Rate for Payer: Healthscope Whirlpool	$298.28
Rate for Payer: Mclaren Commercial	$276.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.38
Rate for Payer: Priority Health Cigna Priority Health	$215.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.60

HC CANNULA COR OSTIA RT ANG 4MM

Facility

$307.50

Hospital Charge Code	27006709
Hospital Revenue Code	270
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$276.75
Rate for Payer: ASR ASR	$298.28
Rate for Payer: BCBS Complete	$123.00
Rate for Payer: BCBS Trust/PPO	$238.40
Rate for Payer: BCN Commercial	$238.40
Rate for Payer: Cash Price	$246.00
Rate for Payer: Cofinity Commercial	$289.05
Rate for Payer: Encore Health Key Benefits Commercial	$246.00
Rate for Payer: Healthscope Commercial	$307.50
Rate for Payer: Healthscope Whirlpool	$298.28
Rate for Payer: Mclaren Commercial	$276.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.38
Rate for Payer: Priority Health Cigna Priority Health	$215.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$279.82
Rate for Payer: Priority Health Narrow Network	$218.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.60

HC CANNULA COR OSTIA RT ANG 5MM

Facility

$334.50

Hospital Charge Code	27006710
Hospital Revenue Code	270
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$334.50
Rate for Payer: Aetna Commercial	$301.05
Rate for Payer: ASR ASR	$324.46
Rate for Payer: BCBS Complete	$133.80
Rate for Payer: BCBS Trust/PPO	$259.34
Rate for Payer: BCN Commercial	$259.34
Rate for Payer: Cash Price	$267.60
Rate for Payer: Cofinity Commercial	$314.43
Rate for Payer: Encore Health Key Benefits Commercial	$267.60
Rate for Payer: Healthscope Commercial	$334.50
Rate for Payer: Healthscope Whirlpool	$324.46
Rate for Payer: Mclaren Commercial	$301.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$284.32
Rate for Payer: Priority Health Cigna Priority Health	$234.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$304.40
Rate for Payer: Priority Health Narrow Network	$237.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$294.36

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