Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING

Facility

$2,104.04

Service Code	CPT 36901
Hospital Charge Code	36100525
Hospital Revenue Code	361
Min. Negotiated Rate	$1,472.83
Max. Negotiated Rate	$2,104.04
Rate for Payer: Aetna Commercial	$1,893.64
Rate for Payer: ASR ASR	$2,040.92
Rate for Payer: BCBS Trust/PPO	$1,631.26
Rate for Payer: BCN Commercial	$1,631.26
Rate for Payer: Cash Price	$1,683.23
Rate for Payer: Cofinity Commercial	$1,977.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,683.23
Rate for Payer: Healthscope Commercial	$2,104.04
Rate for Payer: Healthscope Whirlpool	$2,040.92
Rate for Payer: Mclaren Commercial	$1,893.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,788.43
Rate for Payer: Priority Health Cigna Priority Health	$1,472.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,851.56

HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING

Facility

$18,171.61

Service Code	CPT 36903
Hospital Charge Code	36100527
Hospital Revenue Code	361
Min. Negotiated Rate	$5,348.94
Max. Negotiated Rate	$18,171.61
Rate for Payer: Aetna Commercial	$16,354.45
Rate for Payer: Aetna Medicare	$9,778.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,223.36
Rate for Payer: Amish Plain Church Group Commercial	$12,223.36
Rate for Payer: ASR ASR	$17,626.46
Rate for Payer: BCBS Complete	$5,616.88
Rate for Payer: BCBS MAPPO	$9,778.69
Rate for Payer: BCBS Trust/PPO	$14,088.45
Rate for Payer: BCN Commercial	$14,088.45
Rate for Payer: BCN Medicare Advantage	$9,778.69
Rate for Payer: Cash Price	$14,537.29
Rate for Payer: Cash Price	$14,537.29
Rate for Payer: Cofinity Commercial	$17,081.31
Rate for Payer: Encore Health Key Benefits Commercial	$14,537.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,778.69
Rate for Payer: Healthscope Commercial	$18,171.61
Rate for Payer: Healthscope Whirlpool	$17,626.46
Rate for Payer: Humana Choice PPO Medicare	$9,778.69
Rate for Payer: Mclaren Commercial	$16,354.45
Rate for Payer: Mclaren Medicaid	$5,348.94
Rate for Payer: Mclaren Medicare	$9,778.69
Rate for Payer: Meridian Medicaid	$5,616.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,267.62
Rate for Payer: MI Amish Medical Board Commercial	$11,245.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,445.87
Rate for Payer: PACE Medicare	$9,289.76
Rate for Payer: PACE SWMI	$9,778.69
Rate for Payer: PHP Commercial	$10,756.56
Rate for Payer: PHP Medicaid	$5,348.94
Rate for Payer: PHP Medicare Advantage	$9,778.69
Rate for Payer: Priority Health Choice Medicaid	$5,348.94
Rate for Payer: Priority Health Cigna Priority Health	$12,720.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,536.17
Rate for Payer: Priority Health Medicare	$9,778.69
Rate for Payer: Priority Health Narrow Network	$12,901.84
Rate for Payer: Railroad Medicare Medicare	$9,778.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15,991.02
Rate for Payer: UHC Medicare Advantage	$10,072.05
Rate for Payer: VA VA	$9,778.69

HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING

Facility

$18,171.61

Service Code	CPT 36903
Hospital Charge Code	36100527
Hospital Revenue Code	361
Min. Negotiated Rate	$12,720.13
Max. Negotiated Rate	$18,171.61
Rate for Payer: Aetna Commercial	$16,354.45
Rate for Payer: ASR ASR	$17,626.46
Rate for Payer: BCBS Trust/PPO	$14,088.45
Rate for Payer: BCN Commercial	$14,088.45
Rate for Payer: Cash Price	$14,537.29
Rate for Payer: Cofinity Commercial	$17,081.31
Rate for Payer: Encore Health Key Benefits Commercial	$14,537.29
Rate for Payer: Healthscope Commercial	$18,171.61
Rate for Payer: Healthscope Whirlpool	$17,626.46
Rate for Payer: Mclaren Commercial	$16,354.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,445.87
Rate for Payer: Priority Health Cigna Priority Health	$12,720.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15,991.02

HC DIALYSIS CATH LVL 10 LONG TERM

Facility

$1,026.90

Service Code	HCPCS C1750
Hospital Charge Code	27200268
Hospital Revenue Code	272
Min. Negotiated Rate	$718.83
Max. Negotiated Rate	$1,026.90
Rate for Payer: Aetna Commercial	$924.21
Rate for Payer: ASR ASR	$996.09
Rate for Payer: BCBS Trust/PPO	$796.16
Rate for Payer: BCN Commercial	$796.16
Rate for Payer: Cash Price	$821.52
Rate for Payer: Cofinity Commercial	$965.29
Rate for Payer: Encore Health Key Benefits Commercial	$821.52
Rate for Payer: Healthscope Commercial	$1,026.90
Rate for Payer: Healthscope Whirlpool	$996.09
Rate for Payer: Mclaren Commercial	$924.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$872.86
Rate for Payer: Priority Health Cigna Priority Health	$718.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$903.67

HC DIALYSIS CATH LVL 10 LONG TERM

Facility

$1,026.90

Service Code	HCPCS C1750
Hospital Charge Code	27200268
Hospital Revenue Code	272
Min. Negotiated Rate	$410.76
Max. Negotiated Rate	$1,026.90
Rate for Payer: Aetna Commercial	$924.21
Rate for Payer: ASR ASR	$996.09
Rate for Payer: BCBS Complete	$410.76
Rate for Payer: BCBS Trust/PPO	$796.16
Rate for Payer: BCN Commercial	$796.16
Rate for Payer: Cash Price	$821.52
Rate for Payer: Cofinity Commercial	$965.29
Rate for Payer: Encore Health Key Benefits Commercial	$821.52
Rate for Payer: Healthscope Commercial	$1,026.90
Rate for Payer: Healthscope Whirlpool	$996.09
Rate for Payer: Mclaren Commercial	$924.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$872.86
Rate for Payer: Priority Health Cigna Priority Health	$718.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$934.48
Rate for Payer: Priority Health Narrow Network	$729.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$903.67

HC DIALYSIS CATH LVL 11 LONG TERM

Facility

$1,148.99

Service Code	HCPCS C1750
Hospital Charge Code	27200269
Hospital Revenue Code	272
Min. Negotiated Rate	$804.29
Max. Negotiated Rate	$1,148.99
Rate for Payer: Aetna Commercial	$1,034.09
Rate for Payer: ASR ASR	$1,114.52
Rate for Payer: BCBS Trust/PPO	$890.81
Rate for Payer: BCN Commercial	$890.81
Rate for Payer: Cash Price	$919.19
Rate for Payer: Cofinity Commercial	$1,080.05
Rate for Payer: Encore Health Key Benefits Commercial	$919.19
Rate for Payer: Healthscope Commercial	$1,148.99
Rate for Payer: Healthscope Whirlpool	$1,114.52
Rate for Payer: Mclaren Commercial	$1,034.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$976.64
Rate for Payer: Priority Health Cigna Priority Health	$804.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,011.11

HC DIALYSIS CATH LVL 11 LONG TERM

Facility

$1,148.99

Service Code	HCPCS C1750
Hospital Charge Code	27200269
Hospital Revenue Code	272
Min. Negotiated Rate	$459.60
Max. Negotiated Rate	$1,148.99
Rate for Payer: Aetna Commercial	$1,034.09
Rate for Payer: ASR ASR	$1,114.52
Rate for Payer: BCBS Complete	$459.60
Rate for Payer: BCBS Trust/PPO	$890.81
Rate for Payer: BCN Commercial	$890.81
Rate for Payer: Cash Price	$919.19
Rate for Payer: Cofinity Commercial	$1,080.05
Rate for Payer: Encore Health Key Benefits Commercial	$919.19
Rate for Payer: Healthscope Commercial	$1,148.99
Rate for Payer: Healthscope Whirlpool	$1,114.52
Rate for Payer: Mclaren Commercial	$1,034.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$976.64
Rate for Payer: Priority Health Cigna Priority Health	$804.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,045.58
Rate for Payer: Priority Health Narrow Network	$815.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,011.11

HC DIALYSIS CATH LVL 13 LONG TERM

Facility

$1,353.00

Service Code	HCPCS C1750
Hospital Charge Code	27200266
Hospital Revenue Code	272
Min. Negotiated Rate	$947.10
Max. Negotiated Rate	$1,353.00
Rate for Payer: Aetna Commercial	$1,217.70
Rate for Payer: ASR ASR	$1,312.41
Rate for Payer: BCBS Trust/PPO	$1,048.98
Rate for Payer: BCN Commercial	$1,048.98
Rate for Payer: Cash Price	$1,082.40
Rate for Payer: Cofinity Commercial	$1,271.82
Rate for Payer: Encore Health Key Benefits Commercial	$1,082.40
Rate for Payer: Healthscope Commercial	$1,353.00
Rate for Payer: Healthscope Whirlpool	$1,312.41
Rate for Payer: Mclaren Commercial	$1,217.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,150.05
Rate for Payer: Priority Health Cigna Priority Health	$947.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,190.64

HC DIALYSIS CATH LVL 13 LONG TERM

Facility

$1,353.00

Service Code	HCPCS C1750
Hospital Charge Code	27200266
Hospital Revenue Code	272
Min. Negotiated Rate	$541.20
Max. Negotiated Rate	$1,353.00
Rate for Payer: Aetna Commercial	$1,217.70
Rate for Payer: ASR ASR	$1,312.41
Rate for Payer: BCBS Complete	$541.20
Rate for Payer: BCBS Trust/PPO	$1,048.98
Rate for Payer: BCN Commercial	$1,048.98
Rate for Payer: Cash Price	$1,082.40
Rate for Payer: Cofinity Commercial	$1,271.82
Rate for Payer: Encore Health Key Benefits Commercial	$1,082.40
Rate for Payer: Healthscope Commercial	$1,353.00
Rate for Payer: Healthscope Whirlpool	$1,312.41
Rate for Payer: Mclaren Commercial	$1,217.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,150.05
Rate for Payer: Priority Health Cigna Priority Health	$947.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,231.23
Rate for Payer: Priority Health Narrow Network	$960.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,190.64

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$203.99

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$142.79
Max. Negotiated Rate	$203.99
Rate for Payer: Aetna Commercial	$183.59
Rate for Payer: ASR ASR	$197.87
Rate for Payer: BCBS Trust/PPO	$158.15
Rate for Payer: BCN Commercial	$158.15
Rate for Payer: Cash Price	$163.19
Rate for Payer: Cofinity Commercial	$191.75
Rate for Payer: Encore Health Key Benefits Commercial	$163.19
Rate for Payer: Healthscope Commercial	$203.99
Rate for Payer: Healthscope Whirlpool	$197.87
Rate for Payer: Mclaren Commercial	$183.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.39
Rate for Payer: Priority Health Cigna Priority Health	$142.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.51

HC DIALYSIS CATH LVL 2 SHORT TERM

Facility

$203.99

Service Code	HCPCS C1752
Hospital Charge Code	27200002
Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$203.99
Rate for Payer: Aetna Commercial	$183.59
Rate for Payer: ASR ASR	$197.87
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: BCBS Trust/PPO	$158.15
Rate for Payer: BCN Commercial	$158.15
Rate for Payer: Cash Price	$163.19
Rate for Payer: Cofinity Commercial	$191.75
Rate for Payer: Encore Health Key Benefits Commercial	$163.19
Rate for Payer: Healthscope Commercial	$203.99
Rate for Payer: Healthscope Whirlpool	$197.87
Rate for Payer: Mclaren Commercial	$183.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.39
Rate for Payer: Priority Health Cigna Priority Health	$142.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$185.63
Rate for Payer: Priority Health Narrow Network	$144.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.51

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$308.99

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$216.29
Max. Negotiated Rate	$308.99
Rate for Payer: Aetna Commercial	$278.09
Rate for Payer: ASR ASR	$299.72
Rate for Payer: BCBS Trust/PPO	$239.56
Rate for Payer: BCN Commercial	$239.56
Rate for Payer: Cash Price	$247.19
Rate for Payer: Cofinity Commercial	$290.45
Rate for Payer: Encore Health Key Benefits Commercial	$247.19
Rate for Payer: Healthscope Commercial	$308.99
Rate for Payer: Healthscope Whirlpool	$299.72
Rate for Payer: Mclaren Commercial	$278.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$262.64
Rate for Payer: Priority Health Cigna Priority Health	$216.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$271.91

HC DIALYSIS CATH LVL 3 SHORT TERM

Facility

$308.99

Service Code	CPT C1752
Hospital Charge Code	27200317
Hospital Revenue Code	272
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$308.99
Rate for Payer: Aetna Commercial	$278.09
Rate for Payer: ASR ASR	$299.72
Rate for Payer: BCBS Complete	$123.60
Rate for Payer: BCBS Trust/PPO	$239.56
Rate for Payer: BCN Commercial	$239.56
Rate for Payer: Cash Price	$247.19
Rate for Payer: Cofinity Commercial	$290.45
Rate for Payer: Encore Health Key Benefits Commercial	$247.19
Rate for Payer: Healthscope Commercial	$308.99
Rate for Payer: Healthscope Whirlpool	$299.72
Rate for Payer: Mclaren Commercial	$278.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$262.64
Rate for Payer: Priority Health Cigna Priority Health	$216.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$281.18
Rate for Payer: Priority Health Narrow Network	$219.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$271.91

HC DIALYSIS CATH LVL 4 SHORT TERM

Facility

$413.99

Service Code	HCPCS C1752
Hospital Charge Code	27200085
Hospital Revenue Code	272
Min. Negotiated Rate	$289.79
Max. Negotiated Rate	$413.99
Rate for Payer: Aetna Commercial	$372.59
Rate for Payer: ASR ASR	$401.57
Rate for Payer: BCBS Trust/PPO	$320.97
Rate for Payer: BCN Commercial	$320.97
Rate for Payer: Cash Price	$331.19
Rate for Payer: Cofinity Commercial	$389.15
Rate for Payer: Encore Health Key Benefits Commercial	$331.19
Rate for Payer: Healthscope Commercial	$413.99
Rate for Payer: Healthscope Whirlpool	$401.57
Rate for Payer: Mclaren Commercial	$372.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$351.89
Rate for Payer: Priority Health Cigna Priority Health	$289.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$364.31

HC DIALYSIS CATH LVL 4 SHORT TERM

Facility

$413.99

Service Code	HCPCS C1752
Hospital Charge Code	27200085
Hospital Revenue Code	272
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$413.99
Rate for Payer: Aetna Commercial	$372.59
Rate for Payer: ASR ASR	$401.57
Rate for Payer: BCBS Complete	$165.60
Rate for Payer: BCBS Trust/PPO	$320.97
Rate for Payer: BCN Commercial	$320.97
Rate for Payer: Cash Price	$331.19
Rate for Payer: Cofinity Commercial	$389.15
Rate for Payer: Encore Health Key Benefits Commercial	$331.19
Rate for Payer: Healthscope Commercial	$413.99
Rate for Payer: Healthscope Whirlpool	$401.57
Rate for Payer: Mclaren Commercial	$372.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$351.89
Rate for Payer: Priority Health Cigna Priority Health	$289.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$376.73
Rate for Payer: Priority Health Narrow Network	$293.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$364.31

HC DIALYSIS CATH LVL 5 SHORT TERM

Facility

$518.99

Service Code	HCPCS C1752
Hospital Charge Code	27200318
Hospital Revenue Code	272
Min. Negotiated Rate	$363.29
Max. Negotiated Rate	$518.99
Rate for Payer: Aetna Commercial	$467.09
Rate for Payer: ASR ASR	$503.42
Rate for Payer: BCBS Trust/PPO	$402.37
Rate for Payer: BCN Commercial	$402.37
Rate for Payer: Cash Price	$415.19
Rate for Payer: Cofinity Commercial	$487.85
Rate for Payer: Encore Health Key Benefits Commercial	$415.19
Rate for Payer: Healthscope Commercial	$518.99
Rate for Payer: Healthscope Whirlpool	$503.42
Rate for Payer: Mclaren Commercial	$467.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$441.14
Rate for Payer: Priority Health Cigna Priority Health	$363.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$456.71

HC DIALYSIS CATH LVL 5 SHORT TERM

Facility

$518.99

Service Code	HCPCS C1752
Hospital Charge Code	27200318
Hospital Revenue Code	272
Min. Negotiated Rate	$207.60
Max. Negotiated Rate	$518.99
Rate for Payer: Aetna Commercial	$467.09
Rate for Payer: ASR ASR	$503.42
Rate for Payer: BCBS Complete	$207.60
Rate for Payer: BCBS Trust/PPO	$402.37
Rate for Payer: BCN Commercial	$402.37
Rate for Payer: Cash Price	$415.19
Rate for Payer: Cofinity Commercial	$487.85
Rate for Payer: Encore Health Key Benefits Commercial	$415.19
Rate for Payer: Healthscope Commercial	$518.99
Rate for Payer: Healthscope Whirlpool	$503.42
Rate for Payer: Mclaren Commercial	$467.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$441.14
Rate for Payer: Priority Health Cigna Priority Health	$363.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$472.28
Rate for Payer: Priority Health Narrow Network	$368.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$456.71

HC DIALYSIS CATH LVL 7 LONG TERM

Facility

$728.99

Service Code	CPT C1750
Hospital Charge Code	27200319
Hospital Revenue Code	272
Min. Negotiated Rate	$510.29
Max. Negotiated Rate	$728.99
Rate for Payer: Aetna Commercial	$656.09
Rate for Payer: ASR ASR	$707.12
Rate for Payer: BCBS Trust/PPO	$565.19
Rate for Payer: BCN Commercial	$565.19
Rate for Payer: Cash Price	$583.19
Rate for Payer: Cofinity Commercial	$685.25
Rate for Payer: Encore Health Key Benefits Commercial	$583.19
Rate for Payer: Healthscope Commercial	$728.99
Rate for Payer: Healthscope Whirlpool	$707.12
Rate for Payer: Mclaren Commercial	$656.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$619.64
Rate for Payer: Priority Health Cigna Priority Health	$510.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$641.51

HC DIALYSIS CATH LVL 7 LONG TERM

Facility

$728.99

Service Code	CPT C1750
Hospital Charge Code	27200319
Hospital Revenue Code	272
Min. Negotiated Rate	$291.60
Max. Negotiated Rate	$728.99
Rate for Payer: Aetna Commercial	$656.09
Rate for Payer: ASR ASR	$707.12
Rate for Payer: BCBS Complete	$291.60
Rate for Payer: BCBS Trust/PPO	$565.19
Rate for Payer: BCN Commercial	$565.19
Rate for Payer: Cash Price	$583.19
Rate for Payer: Cofinity Commercial	$685.25
Rate for Payer: Encore Health Key Benefits Commercial	$583.19
Rate for Payer: Healthscope Commercial	$728.99
Rate for Payer: Healthscope Whirlpool	$707.12
Rate for Payer: Mclaren Commercial	$656.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$619.64
Rate for Payer: Priority Health Cigna Priority Health	$510.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$663.38
Rate for Payer: Priority Health Narrow Network	$517.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$641.51

HC DIALYSIS CATH LVL 7 SHORT TERM

Facility

$777.75

Service Code	CPT C1752
Hospital Charge Code	27200347
Hospital Revenue Code	272
Min. Negotiated Rate	$311.10
Max. Negotiated Rate	$777.75
Rate for Payer: Aetna Commercial	$699.98
Rate for Payer: ASR ASR	$754.42
Rate for Payer: BCBS Complete	$311.10
Rate for Payer: BCBS Trust/PPO	$602.99
Rate for Payer: BCN Commercial	$602.99
Rate for Payer: Cash Price	$622.20
Rate for Payer: Cofinity Commercial	$731.08
Rate for Payer: Encore Health Key Benefits Commercial	$622.20
Rate for Payer: Healthscope Commercial	$777.75
Rate for Payer: Healthscope Whirlpool	$754.42
Rate for Payer: Mclaren Commercial	$699.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$661.09
Rate for Payer: Priority Health Cigna Priority Health	$544.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$707.75
Rate for Payer: Priority Health Narrow Network	$552.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$684.42

HC DIALYSIS CATH LVL 7 SHORT TERM

Facility

$777.75

Service Code	CPT C1752
Hospital Charge Code	27200347
Hospital Revenue Code	272
Min. Negotiated Rate	$544.42
Max. Negotiated Rate	$777.75
Rate for Payer: Aetna Commercial	$699.98
Rate for Payer: ASR ASR	$754.42
Rate for Payer: BCBS Trust/PPO	$602.99
Rate for Payer: BCN Commercial	$602.99
Rate for Payer: Cash Price	$622.20
Rate for Payer: Cofinity Commercial	$731.08
Rate for Payer: Encore Health Key Benefits Commercial	$622.20
Rate for Payer: Healthscope Commercial	$777.75
Rate for Payer: Healthscope Whirlpool	$754.42
Rate for Payer: Mclaren Commercial	$699.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$661.09
Rate for Payer: Priority Health Cigna Priority Health	$544.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$684.42

HC DIALYSIS CATH LVL 8 SHORT TERM

Facility

$833.99

Service Code	HCPCS C1752
Hospital Charge Code	27200175
Hospital Revenue Code	272
Min. Negotiated Rate	$583.79
Max. Negotiated Rate	$833.99
Rate for Payer: Aetna Commercial	$750.59
Rate for Payer: ASR ASR	$808.97
Rate for Payer: BCBS Trust/PPO	$646.59
Rate for Payer: BCN Commercial	$646.59
Rate for Payer: Cash Price	$667.19
Rate for Payer: Cofinity Commercial	$783.95
Rate for Payer: Encore Health Key Benefits Commercial	$667.19
Rate for Payer: Healthscope Commercial	$833.99
Rate for Payer: Healthscope Whirlpool	$808.97
Rate for Payer: Mclaren Commercial	$750.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$708.89
Rate for Payer: Priority Health Cigna Priority Health	$583.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$733.91

HC DIALYSIS CATH LVL 8 SHORT TERM

Facility

$833.99

Service Code	HCPCS C1752
Hospital Charge Code	27200175
Hospital Revenue Code	272
Min. Negotiated Rate	$333.60
Max. Negotiated Rate	$833.99
Rate for Payer: Aetna Commercial	$750.59
Rate for Payer: ASR ASR	$808.97
Rate for Payer: BCBS Complete	$333.60
Rate for Payer: BCBS Trust/PPO	$646.59
Rate for Payer: BCN Commercial	$646.59
Rate for Payer: Cash Price	$667.19
Rate for Payer: Cofinity Commercial	$783.95
Rate for Payer: Encore Health Key Benefits Commercial	$667.19
Rate for Payer: Healthscope Commercial	$833.99
Rate for Payer: Healthscope Whirlpool	$808.97
Rate for Payer: Mclaren Commercial	$750.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$708.89
Rate for Payer: Priority Health Cigna Priority Health	$583.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$758.93
Rate for Payer: Priority Health Narrow Network	$592.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$733.91

HC DIALYSIS CATH LVL 9 LONG TERM

Facility

$938.99

Service Code	HCPCS C1750
Hospital Charge Code	27200320
Hospital Revenue Code	272
Min. Negotiated Rate	$375.60
Max. Negotiated Rate	$938.99
Rate for Payer: Aetna Commercial	$845.09
Rate for Payer: ASR ASR	$910.82
Rate for Payer: BCBS Complete	$375.60
Rate for Payer: BCBS Trust/PPO	$728.00
Rate for Payer: BCN Commercial	$728.00
Rate for Payer: Cash Price	$751.19
Rate for Payer: Cofinity Commercial	$882.65
Rate for Payer: Encore Health Key Benefits Commercial	$751.19
Rate for Payer: Healthscope Commercial	$938.99
Rate for Payer: Healthscope Whirlpool	$910.82
Rate for Payer: Mclaren Commercial	$845.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$798.14
Rate for Payer: Priority Health Cigna Priority Health	$657.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$854.48
Rate for Payer: Priority Health Narrow Network	$666.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$826.31

HC DIALYSIS CATH LVL 9 LONG TERM

Facility

$938.99

Service Code	HCPCS C1750
Hospital Charge Code	27200320
Hospital Revenue Code	272
Min. Negotiated Rate	$657.29
Max. Negotiated Rate	$938.99
Rate for Payer: Aetna Commercial	$845.09
Rate for Payer: ASR ASR	$910.82
Rate for Payer: BCBS Trust/PPO	$728.00
Rate for Payer: BCN Commercial	$728.00
Rate for Payer: Cash Price	$751.19
Rate for Payer: Cofinity Commercial	$882.65
Rate for Payer: Encore Health Key Benefits Commercial	$751.19
Rate for Payer: Healthscope Commercial	$938.99
Rate for Payer: Healthscope Whirlpool	$910.82
Rate for Payer: Mclaren Commercial	$845.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$798.14
Rate for Payer: Priority Health Cigna Priority Health	$657.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$826.31

Know your out-of-pocket cost for care.

All Charges