Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC CANNULA COR OSTIA RT ANG 5MM

Facility

$334.50

Hospital Charge Code	27006710
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 RT ANG 6MM

Facility

$334.50

Hospital Charge Code	27006711
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 RT ANG 6MM

Facility

$334.50

Hospital Charge Code	27006711
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 RT ANG 7MM

Facility

$307.50

Hospital Charge Code	27006712
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 7MM

Facility

$307.50

Hospital Charge Code	27006712
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 8MM

Facility

$307.50

Hospital Charge Code	27006713
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 8MM

Facility

$307.50

Hospital Charge Code	27006713
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 (DUCKBILL)

Facility

$17.25

Hospital Charge Code	27000059
Hospital Revenue Code	270
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$17.25
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: ASR ASR	$16.73
Rate for Payer: BCBS Trust/PPO	$13.37
Rate for Payer: BCN Commercial	$13.37
Rate for Payer: Cash Price	$13.80
Rate for Payer: Cofinity Commercial	$16.22
Rate for Payer: Encore Health Key Benefits Commercial	$13.80
Rate for Payer: Healthscope Commercial	$17.25
Rate for Payer: Healthscope Whirlpool	$16.73
Rate for Payer: Mclaren Commercial	$15.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.66
Rate for Payer: Priority Health Cigna Priority Health	$12.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.18

HC CANNULA (DUCKBILL)

Facility

$17.25

Hospital Charge Code	27000059
Hospital Revenue Code	270
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$17.25
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: ASR ASR	$16.73
Rate for Payer: BCBS Complete	$6.90
Rate for Payer: BCBS Trust/PPO	$13.37
Rate for Payer: BCN Commercial	$13.37
Rate for Payer: Cash Price	$13.80
Rate for Payer: Cofinity Commercial	$16.22
Rate for Payer: Encore Health Key Benefits Commercial	$13.80
Rate for Payer: Healthscope Commercial	$17.25
Rate for Payer: Healthscope Whirlpool	$16.73
Rate for Payer: Mclaren Commercial	$15.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.66
Rate for Payer: Priority Health Cigna Priority Health	$12.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.70
Rate for Payer: Priority Health Narrow Network	$12.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.18

HC CANNULA FEM ART

Facility

$727.28

Hospital Charge Code	27000392
Hospital Revenue Code	270
Min. Negotiated Rate	$509.10
Max. Negotiated Rate	$727.28
Rate for Payer: Aetna Commercial	$654.55
Rate for Payer: ASR ASR	$705.46
Rate for Payer: BCBS Trust/PPO	$563.86
Rate for Payer: BCN Commercial	$563.86
Rate for Payer: Cash Price	$581.82
Rate for Payer: Cofinity Commercial	$683.64
Rate for Payer: Encore Health Key Benefits Commercial	$581.82
Rate for Payer: Healthscope Commercial	$727.28
Rate for Payer: Healthscope Whirlpool	$705.46
Rate for Payer: Mclaren Commercial	$654.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$618.19
Rate for Payer: Priority Health Cigna Priority Health	$509.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$640.01

HC CANNULA FEM ART

Facility

$727.28

Hospital Charge Code	27000392
Hospital Revenue Code	270
Min. Negotiated Rate	$290.91
Max. Negotiated Rate	$727.28
Rate for Payer: Aetna Commercial	$654.55
Rate for Payer: ASR ASR	$705.46
Rate for Payer: BCBS Complete	$290.91
Rate for Payer: BCBS Trust/PPO	$563.86
Rate for Payer: BCN Commercial	$563.86
Rate for Payer: Cash Price	$581.82
Rate for Payer: Cofinity Commercial	$683.64
Rate for Payer: Encore Health Key Benefits Commercial	$581.82
Rate for Payer: Healthscope Commercial	$727.28
Rate for Payer: Healthscope Whirlpool	$705.46
Rate for Payer: Mclaren Commercial	$654.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$618.19
Rate for Payer: Priority Health Cigna Priority Health	$509.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$661.82
Rate for Payer: Priority Health Narrow Network	$516.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$640.01

HC CANNULA FEM VEN 19 FR

Facility

$1,312.50

Hospital Charge Code	27000671
Hospital Revenue Code	270
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$1,181.25
Rate for Payer: ASR ASR	$1,273.12
Rate for Payer: BCBS Trust/PPO	$1,017.58
Rate for Payer: BCN Commercial	$1,017.58
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cofinity Commercial	$1,233.75
Rate for Payer: Encore Health Key Benefits Commercial	$1,050.00
Rate for Payer: Healthscope Commercial	$1,312.50
Rate for Payer: Healthscope Whirlpool	$1,273.12
Rate for Payer: Mclaren Commercial	$1,181.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,115.62
Rate for Payer: Priority Health Cigna Priority Health	$918.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,155.00

HC CANNULA FEM VEN 19 FR

Facility

$1,312.50

Hospital Charge Code	27000671
Hospital Revenue Code	270
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$1,181.25
Rate for Payer: ASR ASR	$1,273.12
Rate for Payer: BCBS Complete	$525.00
Rate for Payer: BCBS Trust/PPO	$1,017.58
Rate for Payer: BCN Commercial	$1,017.58
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cofinity Commercial	$1,233.75
Rate for Payer: Encore Health Key Benefits Commercial	$1,050.00
Rate for Payer: Healthscope Commercial	$1,312.50
Rate for Payer: Healthscope Whirlpool	$1,273.12
Rate for Payer: Mclaren Commercial	$1,181.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,115.62
Rate for Payer: Priority Health Cigna Priority Health	$918.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,194.38
Rate for Payer: Priority Health Narrow Network	$931.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,155.00

HC CANNULA FEM VEN 21, 25 FR

Facility

$1,262.50

Hospital Charge Code	27000073
Hospital Revenue Code	270
Min. Negotiated Rate	$883.75
Max. Negotiated Rate	$1,262.50
Rate for Payer: Aetna Commercial	$1,136.25
Rate for Payer: ASR ASR	$1,224.62
Rate for Payer: BCBS Trust/PPO	$978.82
Rate for Payer: BCN Commercial	$978.82
Rate for Payer: Cash Price	$1,010.00
Rate for Payer: Cofinity Commercial	$1,186.75
Rate for Payer: Encore Health Key Benefits Commercial	$1,010.00
Rate for Payer: Healthscope Commercial	$1,262.50
Rate for Payer: Healthscope Whirlpool	$1,224.62
Rate for Payer: Mclaren Commercial	$1,136.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,073.12
Rate for Payer: Priority Health Cigna Priority Health	$883.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,111.00

HC CANNULA FEM VEN 21, 25 FR

Facility

$1,262.50

Hospital Charge Code	27000073
Hospital Revenue Code	270
Min. Negotiated Rate	$505.00
Max. Negotiated Rate	$1,262.50
Rate for Payer: Aetna Commercial	$1,136.25
Rate for Payer: ASR ASR	$1,224.62
Rate for Payer: BCBS Complete	$505.00
Rate for Payer: BCBS Trust/PPO	$978.82
Rate for Payer: BCN Commercial	$978.82
Rate for Payer: Cash Price	$1,010.00
Rate for Payer: Cofinity Commercial	$1,186.75
Rate for Payer: Encore Health Key Benefits Commercial	$1,010.00
Rate for Payer: Healthscope Commercial	$1,262.50
Rate for Payer: Healthscope Whirlpool	$1,224.62
Rate for Payer: Mclaren Commercial	$1,136.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,073.12
Rate for Payer: Priority Health Cigna Priority Health	$883.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,148.88
Rate for Payer: Priority Health Narrow Network	$896.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,111.00

HC CANNULA LV VENT

Facility

$69.00

Hospital Charge Code	27000104
Hospital Revenue Code	270
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: ASR ASR	$66.93
Rate for Payer: BCBS Trust/PPO	$53.50
Rate for Payer: BCN Commercial	$53.50
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$64.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.20
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Healthscope Whirlpool	$66.93
Rate for Payer: Mclaren Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.65
Rate for Payer: Priority Health Cigna Priority Health	$48.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.72

HC CANNULA LV VENT

Facility

$69.00

Hospital Charge Code	27000104
Hospital Revenue Code	270
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: ASR ASR	$66.93
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: BCBS Trust/PPO	$53.50
Rate for Payer: BCN Commercial	$53.50
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$64.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.20
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Healthscope Whirlpool	$66.93
Rate for Payer: Mclaren Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.65
Rate for Payer: Priority Health Cigna Priority Health	$48.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.79
Rate for Payer: Priority Health Narrow Network	$48.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.72

HC CANNULA OSTIA

Facility

$57.00

Hospital Charge Code	27000061
Hospital Revenue Code	270
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: ASR ASR	$55.29
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: BCBS Trust/PPO	$44.19
Rate for Payer: BCN Commercial	$44.19
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cofinity Commercial	$53.58
Rate for Payer: Encore Health Key Benefits Commercial	$45.60
Rate for Payer: Healthscope Commercial	$57.00
Rate for Payer: Healthscope Whirlpool	$55.29
Rate for Payer: Mclaren Commercial	$51.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.45
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$51.87
Rate for Payer: Priority Health Narrow Network	$40.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$50.16

HC CANNULA OSTIA

Facility

$57.00

Hospital Charge Code	27000061
Hospital Revenue Code	270
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: ASR ASR	$55.29
Rate for Payer: BCBS Trust/PPO	$44.19
Rate for Payer: BCN Commercial	$44.19
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cofinity Commercial	$53.58
Rate for Payer: Encore Health Key Benefits Commercial	$45.60
Rate for Payer: Healthscope Commercial	$57.00
Rate for Payer: Healthscope Whirlpool	$55.29
Rate for Payer: Mclaren Commercial	$51.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.45
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$50.16

HC CANNULA OSTIAL SPRIT FLEX ANGLE 6 MM

Facility

$297.00

Hospital Charge Code	27000664
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 OSTIAL SPRIT FLEX ANGLE 6 MM

Facility

$297.00

Hospital Charge Code	27000664
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 CANNULA RCSP PVC AUTO 15 FR

Facility

$255.00

Hospital Charge Code	27000683
Hospital Revenue Code	270
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: ASR ASR	$247.35
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: BCBS Trust/PPO	$197.70
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$239.70
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$255.00
Rate for Payer: Healthscope Whirlpool	$247.35
Rate for Payer: Mclaren Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$232.05
Rate for Payer: Priority Health Narrow Network	$181.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$224.40

HC CANNULA RCSP PVC AUTO 15 FR

Facility

$255.00

Hospital Charge Code	27000683
Hospital Revenue Code	270
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: ASR ASR	$247.35
Rate for Payer: BCBS Trust/PPO	$197.70
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$239.70
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$255.00
Rate for Payer: Healthscope Whirlpool	$247.35
Rate for Payer: Mclaren Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$224.40

HC CANNULA RETROGRADE

Facility

$204.00

Hospital Charge Code	27000142
Hospital Revenue Code	270
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: ASR ASR	$197.88
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: BCBS Trust/PPO	$158.16
Rate for Payer: BCN Commercial	$158.16
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$191.76
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$204.00
Rate for Payer: Healthscope Whirlpool	$197.88
Rate for Payer: Mclaren Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.40
Rate for Payer: Priority Health Cigna Priority Health	$142.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$185.64
Rate for Payer: Priority Health Narrow Network	$144.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.52

HC CANNULA RETROGRADE

Facility

$204.00

Hospital Charge Code	27000142
Hospital Revenue Code	270
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: ASR ASR	$197.88
Rate for Payer: BCBS Trust/PPO	$158.16
Rate for Payer: BCN Commercial	$158.16
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$191.76
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$204.00
Rate for Payer: Healthscope Whirlpool	$197.88
Rate for Payer: Mclaren Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.40
Rate for Payer: Priority Health Cigna Priority Health	$142.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.52

Know your out-of-pocket cost for care.

All Charges