Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC BACK SCREEN, VBISD

Facility

$69.71

Hospital Charge Code	43000014
Hospital Revenue Code	430
Min. Negotiated Rate	$52.28
Max. Negotiated Rate	$69.71
Rate for Payer: Aetna Commercial	$62.74
Rate for Payer: ASR ASR	$67.62
Rate for Payer: BCBS Trust/PPO	$57.25
Rate for Payer: BCN Commercial	$57.25
Rate for Payer: Cash Price	$55.77
Rate for Payer: Cofinity Commercial	$65.53
Rate for Payer: Encore Health Key Benefits Commercial	$55.77
Rate for Payer: Healthscope Commercial	$67.62
Rate for Payer: Healthscope Whirlpool	$69.71
Rate for Payer: Mclaren Commercial	$62.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.25
Rate for Payer: Nomi Health Commercial	$57.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.34

HC BACTERIAL VAGINOSIS PANEL

Facility

$156.06

Service Code	CPT 0352U
Hospital Charge Code	30600337
Hospital Revenue Code	306
Min. Negotiated Rate	$117.05
Max. Negotiated Rate	$156.06
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: ASR ASR	$151.38
Rate for Payer: BCBS Trust/PPO	$128.16
Rate for Payer: BCN Commercial	$128.16
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$146.70
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Whirlpool	$156.06
Rate for Payer: Mclaren Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Nomi Health Commercial	$127.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.33

HC BACTERIAL VAGINOSIS PANEL

Facility

$156.06

Service Code	CPT 0352U
Hospital Charge Code	30600337
Hospital Revenue Code	306
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$156.06
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: Aetna Medicare	$57.74
Rate for Payer: ASR ASR	$151.38
Rate for Payer: BCBS Complete	$62.42
Rate for Payer: BCBS Trust/PPO	$128.67
Rate for Payer: BCN Commercial	$128.67
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$146.70
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Whirlpool	$156.06
Rate for Payer: Mclaren Commercial	$140.45
Rate for Payer: MI Amish Medical Board Commercial	$124.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Nomi Health Commercial	$127.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$136.74
Rate for Payer: Priority Health Narrow Network	$109.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.33

HC BAG BLOOD TRANSFER

Facility

$9.05

Hospital Charge Code	27000161
Hospital Revenue Code	270
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$9.05
Rate for Payer: Aetna Commercial	$8.14
Rate for Payer: ASR ASR	$8.78
Rate for Payer: BCBS Trust/PPO	$7.43
Rate for Payer: BCN Commercial	$7.43
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cofinity Commercial	$8.51
Rate for Payer: Encore Health Key Benefits Commercial	$7.24
Rate for Payer: Healthscope Commercial	$8.78
Rate for Payer: Healthscope Whirlpool	$9.05
Rate for Payer: Mclaren Commercial	$8.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.69
Rate for Payer: Nomi Health Commercial	$7.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.96

HC BAG BLOOD TRANSFER

Facility

$9.05

Hospital Charge Code	27000161
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$9.05
Rate for Payer: Aetna Commercial	$8.14
Rate for Payer: Aetna Medicare	$3.35
Rate for Payer: ASR ASR	$8.78
Rate for Payer: BCBS Complete	$3.62
Rate for Payer: BCBS Trust/PPO	$7.46
Rate for Payer: BCN Commercial	$7.46
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cofinity Commercial	$8.51
Rate for Payer: Encore Health Key Benefits Commercial	$7.24
Rate for Payer: Healthscope Commercial	$8.78
Rate for Payer: Healthscope Whirlpool	$9.05
Rate for Payer: Mclaren Commercial	$8.14
Rate for Payer: MI Amish Medical Board Commercial	$7.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.69
Rate for Payer: Nomi Health Commercial	$7.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7.93
Rate for Payer: Priority Health Narrow Network	$6.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.96

HC BAG WASTE

Facility

$65.55

Hospital Charge Code	27000670
Hospital Revenue Code	270
Min. Negotiated Rate	$49.16
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$58.99
Rate for Payer: ASR ASR	$63.58
Rate for Payer: BCBS Trust/PPO	$53.83
Rate for Payer: BCN Commercial	$53.83
Rate for Payer: Cash Price	$52.44
Rate for Payer: Cofinity Commercial	$61.62
Rate for Payer: Encore Health Key Benefits Commercial	$52.44
Rate for Payer: Healthscope Commercial	$63.58
Rate for Payer: Healthscope Whirlpool	$65.55
Rate for Payer: Mclaren Commercial	$58.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.72
Rate for Payer: Nomi Health Commercial	$53.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$57.68

HC BAG WASTE

Facility

$65.55

Hospital Charge Code	27000670
Hospital Revenue Code	270
Min. Negotiated Rate	$24.25
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$58.99
Rate for Payer: Aetna Medicare	$24.25
Rate for Payer: ASR ASR	$63.58
Rate for Payer: BCBS Complete	$26.22
Rate for Payer: BCBS Trust/PPO	$54.05
Rate for Payer: BCN Commercial	$54.05
Rate for Payer: Cash Price	$52.44
Rate for Payer: Cofinity Commercial	$61.62
Rate for Payer: Encore Health Key Benefits Commercial	$52.44
Rate for Payer: Healthscope Commercial	$63.58
Rate for Payer: Healthscope Whirlpool	$65.55
Rate for Payer: Mclaren Commercial	$58.99
Rate for Payer: MI Amish Medical Board Commercial	$52.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.72
Rate for Payer: Nomi Health Commercial	$53.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$57.43
Rate for Payer: Priority Health Narrow Network	$45.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$57.68

HC BAKRI BALLOON CATHETER

Facility

$1,209.83

Hospital Charge Code	27200112
Hospital Revenue Code	272
Min. Negotiated Rate	$447.64
Max. Negotiated Rate	$1,209.83
Rate for Payer: Aetna Commercial	$1,088.85
Rate for Payer: Aetna Medicare	$447.64
Rate for Payer: ASR ASR	$1,173.54
Rate for Payer: BCBS Complete	$483.93
Rate for Payer: BCBS Trust/PPO	$997.50
Rate for Payer: BCN Commercial	$997.50
Rate for Payer: Cash Price	$967.86
Rate for Payer: Cofinity Commercial	$1,137.24
Rate for Payer: Encore Health Key Benefits Commercial	$967.86
Rate for Payer: Healthscope Commercial	$1,173.54
Rate for Payer: Healthscope Whirlpool	$1,209.83
Rate for Payer: Mclaren Commercial	$1,088.85
Rate for Payer: MI Amish Medical Board Commercial	$967.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,028.36
Rate for Payer: Nomi Health Commercial	$992.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,060.05
Rate for Payer: Priority Health Narrow Network	$848.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,064.65

HC BAKRI BALLOON CATHETER

Facility

$1,209.83

Hospital Charge Code	27200112
Hospital Revenue Code	272
Min. Negotiated Rate	$907.37
Max. Negotiated Rate	$1,209.83
Rate for Payer: Aetna Commercial	$1,088.85
Rate for Payer: ASR ASR	$1,173.54
Rate for Payer: BCBS Trust/PPO	$993.51
Rate for Payer: BCN Commercial	$993.51
Rate for Payer: Cash Price	$967.86
Rate for Payer: Cofinity Commercial	$1,137.24
Rate for Payer: Encore Health Key Benefits Commercial	$967.86
Rate for Payer: Healthscope Commercial	$1,173.54
Rate for Payer: Healthscope Whirlpool	$1,209.83
Rate for Payer: Mclaren Commercial	$1,088.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,028.36
Rate for Payer: Nomi Health Commercial	$992.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,064.65

HC BALLOON CATH TRANSLUMINAL LVL 10

Facility

$1,041.42

Service Code	HCPCS C1725
Hospital Charge Code	27200066
Hospital Revenue Code	272
Min. Negotiated Rate	$781.07
Max. Negotiated Rate	$1,041.42
Rate for Payer: Aetna Commercial	$937.28
Rate for Payer: ASR ASR	$1,010.18
Rate for Payer: BCBS Trust/PPO	$855.21
Rate for Payer: BCN Commercial	$855.21
Rate for Payer: Cash Price	$833.14
Rate for Payer: Cofinity Commercial	$978.93
Rate for Payer: Encore Health Key Benefits Commercial	$833.14
Rate for Payer: Healthscope Commercial	$1,010.18
Rate for Payer: Healthscope Whirlpool	$1,041.42
Rate for Payer: Mclaren Commercial	$937.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$885.21
Rate for Payer: Nomi Health Commercial	$853.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$781.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$916.45

HC BALLOON CATH TRANSLUMINAL LVL 10

Facility

$1,041.42

Service Code	HCPCS C1725
Hospital Charge Code	27200066
Hospital Revenue Code	272
Min. Negotiated Rate	$385.33
Max. Negotiated Rate	$1,041.42
Rate for Payer: Aetna Commercial	$937.28
Rate for Payer: Aetna Medicare	$385.33
Rate for Payer: ASR ASR	$1,010.18
Rate for Payer: BCBS Complete	$416.57
Rate for Payer: BCBS Trust/PPO	$858.65
Rate for Payer: BCN Commercial	$858.65
Rate for Payer: Cash Price	$833.14
Rate for Payer: Cofinity Commercial	$978.93
Rate for Payer: Encore Health Key Benefits Commercial	$833.14
Rate for Payer: Healthscope Commercial	$1,010.18
Rate for Payer: Healthscope Whirlpool	$1,041.42
Rate for Payer: Mclaren Commercial	$937.28
Rate for Payer: MI Amish Medical Board Commercial	$833.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$885.21
Rate for Payer: Nomi Health Commercial	$853.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$781.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$912.49
Rate for Payer: Priority Health Narrow Network	$730.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$916.45

HC BALLOON CATH TRANSLUMINAL LVL 12

Facility

$1,289.14

Service Code	HCPCS C1725
Hospital Charge Code	27200001
Hospital Revenue Code	272
Min. Negotiated Rate	$966.86
Max. Negotiated Rate	$1,289.14
Rate for Payer: Aetna Commercial	$1,160.23
Rate for Payer: ASR ASR	$1,250.47
Rate for Payer: BCBS Trust/PPO	$1,058.64
Rate for Payer: BCN Commercial	$1,058.64
Rate for Payer: Cash Price	$1,031.31
Rate for Payer: Cofinity Commercial	$1,211.79
Rate for Payer: Encore Health Key Benefits Commercial	$1,031.31
Rate for Payer: Healthscope Commercial	$1,250.47
Rate for Payer: Healthscope Whirlpool	$1,289.14
Rate for Payer: Mclaren Commercial	$1,160.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,095.77
Rate for Payer: Nomi Health Commercial	$1,057.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$966.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,134.44

HC BALLOON CATH TRANSLUMINAL LVL 12

Facility

$1,289.14

Service Code	HCPCS C1725
Hospital Charge Code	27200001
Hospital Revenue Code	272
Min. Negotiated Rate	$476.98
Max. Negotiated Rate	$1,289.14
Rate for Payer: Aetna Commercial	$1,160.23
Rate for Payer: Aetna Medicare	$476.98
Rate for Payer: ASR ASR	$1,250.47
Rate for Payer: BCBS Complete	$515.66
Rate for Payer: BCBS Trust/PPO	$1,062.90
Rate for Payer: BCN Commercial	$1,062.90
Rate for Payer: Cash Price	$1,031.31
Rate for Payer: Cofinity Commercial	$1,211.79
Rate for Payer: Encore Health Key Benefits Commercial	$1,031.31
Rate for Payer: Healthscope Commercial	$1,250.47
Rate for Payer: Healthscope Whirlpool	$1,289.14
Rate for Payer: Mclaren Commercial	$1,160.23
Rate for Payer: MI Amish Medical Board Commercial	$1,031.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,095.77
Rate for Payer: Nomi Health Commercial	$1,057.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$966.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,129.54
Rate for Payer: Priority Health Narrow Network	$903.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,134.44

HC BALLOON CATH TRANSLUMINAL LVL 15

Facility

$1,553.34

Service Code	HCPCS C1725
Hospital Charge Code	27200083
Hospital Revenue Code	272
Min. Negotiated Rate	$1,165.01
Max. Negotiated Rate	$1,553.34
Rate for Payer: Aetna Commercial	$1,398.01
Rate for Payer: ASR ASR	$1,506.74
Rate for Payer: BCBS Trust/PPO	$1,275.60
Rate for Payer: BCN Commercial	$1,275.60
Rate for Payer: Cash Price	$1,242.67
Rate for Payer: Cofinity Commercial	$1,460.14
Rate for Payer: Encore Health Key Benefits Commercial	$1,242.67
Rate for Payer: Healthscope Commercial	$1,506.74
Rate for Payer: Healthscope Whirlpool	$1,553.34
Rate for Payer: Mclaren Commercial	$1,398.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,320.34
Rate for Payer: Nomi Health Commercial	$1,273.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,165.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,366.94

HC BALLOON CATH TRANSLUMINAL LVL 15

Facility

$1,553.34

Service Code	HCPCS C1725
Hospital Charge Code	27200083
Hospital Revenue Code	272
Min. Negotiated Rate	$574.74
Max. Negotiated Rate	$1,553.34
Rate for Payer: Aetna Commercial	$1,398.01
Rate for Payer: Aetna Medicare	$574.74
Rate for Payer: ASR ASR	$1,506.74
Rate for Payer: BCBS Complete	$621.34
Rate for Payer: BCBS Trust/PPO	$1,280.73
Rate for Payer: BCN Commercial	$1,280.73
Rate for Payer: Cash Price	$1,242.67
Rate for Payer: Cofinity Commercial	$1,460.14
Rate for Payer: Encore Health Key Benefits Commercial	$1,242.67
Rate for Payer: Healthscope Commercial	$1,506.74
Rate for Payer: Healthscope Whirlpool	$1,553.34
Rate for Payer: Mclaren Commercial	$1,398.01
Rate for Payer: MI Amish Medical Board Commercial	$1,242.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,320.34
Rate for Payer: Nomi Health Commercial	$1,273.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,165.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,361.04
Rate for Payer: Priority Health Narrow Network	$1,088.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,366.94

HC BALLOON CATH TRANSLUMINAL LVL 16

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	27200407
Hospital Revenue Code	272
Min. Negotiated Rate	$601.25
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare	$601.25
Rate for Payer: ASR ASR	$1,576.25
Rate for Payer: BCBS Complete	$650.00
Rate for Payer: BCBS Trust/PPO	$1,339.81
Rate for Payer: BCN Commercial	$1,339.81
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cofinity Commercial	$1,527.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,300.00
Rate for Payer: Healthscope Commercial	$1,576.25
Rate for Payer: Healthscope Whirlpool	$1,625.00
Rate for Payer: Mclaren Commercial	$1,462.50
Rate for Payer: MI Amish Medical Board Commercial	$1,300.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,381.25
Rate for Payer: Nomi Health Commercial	$1,332.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,218.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,423.83
Rate for Payer: Priority Health Narrow Network	$1,139.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,430.00

HC BALLOON CATH TRANSLUMINAL LVL 16

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	27200407
Hospital Revenue Code	272
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: ASR ASR	$1,576.25
Rate for Payer: BCBS Trust/PPO	$1,334.45
Rate for Payer: BCN Commercial	$1,334.45
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cofinity Commercial	$1,527.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,300.00
Rate for Payer: Healthscope Commercial	$1,576.25
Rate for Payer: Healthscope Whirlpool	$1,625.00
Rate for Payer: Mclaren Commercial	$1,462.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,381.25
Rate for Payer: Nomi Health Commercial	$1,332.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,218.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,430.00

HC BALLOON CATH TRANSLUMINAL LVL 24

Facility

$2,448.00

Service Code	HCPCS C1725
Hospital Charge Code	27200024
Hospital Revenue Code	272
Min. Negotiated Rate	$905.76
Max. Negotiated Rate	$2,448.00
Rate for Payer: Aetna Commercial	$2,203.20
Rate for Payer: Aetna Medicare	$905.76
Rate for Payer: ASR ASR	$2,374.56
Rate for Payer: BCBS Complete	$979.20
Rate for Payer: BCBS Trust/PPO	$2,018.38
Rate for Payer: BCN Commercial	$2,018.38
Rate for Payer: Cash Price	$1,958.40
Rate for Payer: Cofinity Commercial	$2,301.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,958.40
Rate for Payer: Healthscope Commercial	$2,374.56
Rate for Payer: Healthscope Whirlpool	$2,448.00
Rate for Payer: Mclaren Commercial	$2,203.20
Rate for Payer: MI Amish Medical Board Commercial	$1,958.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,080.80
Rate for Payer: Nomi Health Commercial	$2,007.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2,144.94
Rate for Payer: Priority Health Narrow Network	$1,716.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,154.24

HC BALLOON CATH TRANSLUMINAL LVL 24

Facility

$2,448.00

Service Code	HCPCS C1725
Hospital Charge Code	27200024
Hospital Revenue Code	272
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,448.00
Rate for Payer: Aetna Commercial	$2,203.20
Rate for Payer: ASR ASR	$2,374.56
Rate for Payer: BCBS Trust/PPO	$2,010.30
Rate for Payer: BCN Commercial	$2,010.30
Rate for Payer: Cash Price	$1,958.40
Rate for Payer: Cofinity Commercial	$2,301.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,958.40
Rate for Payer: Healthscope Commercial	$2,374.56
Rate for Payer: Healthscope Whirlpool	$2,448.00
Rate for Payer: Mclaren Commercial	$2,203.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,080.80
Rate for Payer: Nomi Health Commercial	$2,007.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,154.24

HC BALLOON CATH TRANSLUMINAL LVL 4

Facility

$421.04

Service Code	HCPCS C1725
Hospital Charge Code	27200053
Hospital Revenue Code	272
Min. Negotiated Rate	$155.78
Max. Negotiated Rate	$421.04
Rate for Payer: Aetna Commercial	$378.94
Rate for Payer: Aetna Medicare	$155.78
Rate for Payer: ASR ASR	$408.41
Rate for Payer: BCBS Complete	$168.42
Rate for Payer: BCBS Trust/PPO	$347.15
Rate for Payer: BCN Commercial	$347.15
Rate for Payer: Cash Price	$336.83
Rate for Payer: Cofinity Commercial	$395.78
Rate for Payer: Encore Health Key Benefits Commercial	$336.83
Rate for Payer: Healthscope Commercial	$408.41
Rate for Payer: Healthscope Whirlpool	$421.04
Rate for Payer: Mclaren Commercial	$378.94
Rate for Payer: MI Amish Medical Board Commercial	$336.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.88
Rate for Payer: Nomi Health Commercial	$345.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$368.92
Rate for Payer: Priority Health Narrow Network	$295.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.52

HC BALLOON CATH TRANSLUMINAL LVL 4

Facility

$421.04

Service Code	HCPCS C1725
Hospital Charge Code	27200053
Hospital Revenue Code	272
Min. Negotiated Rate	$315.78
Max. Negotiated Rate	$421.04
Rate for Payer: Aetna Commercial	$378.94
Rate for Payer: ASR ASR	$408.41
Rate for Payer: BCBS Trust/PPO	$345.76
Rate for Payer: BCN Commercial	$345.76
Rate for Payer: Cash Price	$336.83
Rate for Payer: Cofinity Commercial	$395.78
Rate for Payer: Encore Health Key Benefits Commercial	$336.83
Rate for Payer: Healthscope Commercial	$408.41
Rate for Payer: Healthscope Whirlpool	$421.04
Rate for Payer: Mclaren Commercial	$378.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.88
Rate for Payer: Nomi Health Commercial	$345.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.52

HC BALLOON CATH TRANSLUMINAL LVL 5

Facility

$588.11

Service Code	HCPCS C1725
Hospital Charge Code	27200078
Hospital Revenue Code	272
Min. Negotiated Rate	$441.08
Max. Negotiated Rate	$588.11
Rate for Payer: Aetna Commercial	$529.30
Rate for Payer: ASR ASR	$570.47
Rate for Payer: BCBS Trust/PPO	$482.96
Rate for Payer: BCN Commercial	$482.96
Rate for Payer: Cash Price	$470.49
Rate for Payer: Cofinity Commercial	$552.82
Rate for Payer: Encore Health Key Benefits Commercial	$470.49
Rate for Payer: Healthscope Commercial	$570.47
Rate for Payer: Healthscope Whirlpool	$588.11
Rate for Payer: Mclaren Commercial	$529.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.89
Rate for Payer: Nomi Health Commercial	$482.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$441.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$517.54

HC BALLOON CATH TRANSLUMINAL LVL 5

Facility

$588.11

Service Code	HCPCS C1725
Hospital Charge Code	27200078
Hospital Revenue Code	272
Min. Negotiated Rate	$217.60
Max. Negotiated Rate	$588.11
Rate for Payer: Aetna Commercial	$529.30
Rate for Payer: Aetna Medicare	$217.60
Rate for Payer: ASR ASR	$570.47
Rate for Payer: BCBS Complete	$235.24
Rate for Payer: BCBS Trust/PPO	$484.90
Rate for Payer: BCN Commercial	$484.90
Rate for Payer: Cash Price	$470.49
Rate for Payer: Cofinity Commercial	$552.82
Rate for Payer: Encore Health Key Benefits Commercial	$470.49
Rate for Payer: Healthscope Commercial	$570.47
Rate for Payer: Healthscope Whirlpool	$588.11
Rate for Payer: Mclaren Commercial	$529.30
Rate for Payer: MI Amish Medical Board Commercial	$470.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.89
Rate for Payer: Nomi Health Commercial	$482.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$441.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$515.30
Rate for Payer: Priority Health Narrow Network	$412.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$517.54

HC BALLOON CATH TRANSLUMINAL LVL 6

Facility

$691.56

Service Code	HCPCS C1725
Hospital Charge Code	27200016
Hospital Revenue Code	272
Min. Negotiated Rate	$518.67
Max. Negotiated Rate	$691.56
Rate for Payer: Aetna Commercial	$622.40
Rate for Payer: ASR ASR	$670.81
Rate for Payer: BCBS Trust/PPO	$567.91
Rate for Payer: BCN Commercial	$567.91
Rate for Payer: Cash Price	$553.25
Rate for Payer: Cofinity Commercial	$650.07
Rate for Payer: Encore Health Key Benefits Commercial	$553.25
Rate for Payer: Healthscope Commercial	$670.81
Rate for Payer: Healthscope Whirlpool	$691.56
Rate for Payer: Mclaren Commercial	$622.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$587.83
Rate for Payer: Nomi Health Commercial	$567.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$518.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$608.57

HC BALLOON CATH TRANSLUMINAL LVL 6

Facility

$691.56

Service Code	HCPCS C1725
Hospital Charge Code	27200016
Hospital Revenue Code	272
Min. Negotiated Rate	$255.88
Max. Negotiated Rate	$691.56
Rate for Payer: Aetna Commercial	$622.40
Rate for Payer: Aetna Medicare	$255.88
Rate for Payer: ASR ASR	$670.81
Rate for Payer: BCBS Complete	$276.62
Rate for Payer: BCBS Trust/PPO	$570.19
Rate for Payer: BCN Commercial	$570.19
Rate for Payer: Cash Price	$553.25
Rate for Payer: Cofinity Commercial	$650.07
Rate for Payer: Encore Health Key Benefits Commercial	$553.25
Rate for Payer: Healthscope Commercial	$670.81
Rate for Payer: Healthscope Whirlpool	$691.56
Rate for Payer: Mclaren Commercial	$622.40
Rate for Payer: MI Amish Medical Board Commercial	$553.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$587.83
Rate for Payer: Nomi Health Commercial	$567.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$518.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$605.94
Rate for Payer: Priority Health Narrow Network	$484.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$608.57

Know your out-of-pocket cost for care.

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