Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC DNA PROBES CMPT2

Facility

$76.34

Service Code	CPT 88275
Hospital Charge Code	31000043
Hospital Revenue Code	310
Min. Negotiated Rate	$53.44
Max. Negotiated Rate	$76.34
Rate for Payer: Aetna Commercial	$68.71
Rate for Payer: ASR ASR	$74.05
Rate for Payer: BCBS Trust/PPO	$59.19
Rate for Payer: BCN Commercial	$59.19
Rate for Payer: Cash Price	$61.07
Rate for Payer: Cofinity Commercial	$71.76
Rate for Payer: Encore Health Key Benefits Commercial	$61.07
Rate for Payer: Healthscope Commercial	$76.34
Rate for Payer: Healthscope Whirlpool	$74.05
Rate for Payer: Mclaren Commercial	$68.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.89
Rate for Payer: Priority Health Cigna Priority Health	$53.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.18

HC DNA PROBES CMPT2

Facility

$76.34

Service Code	CPT 88275
Hospital Charge Code	31000043
Hospital Revenue Code	310
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$76.34
Rate for Payer: Aetna Commercial	$68.71
Rate for Payer: Aetna Medicare	$51.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$63.99
Rate for Payer: Amish Plain Church Group Commercial	$63.99
Rate for Payer: ASR ASR	$74.05
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: BCBS MAPPO	$51.19
Rate for Payer: BCBS Trust/PPO	$59.19
Rate for Payer: BCN Commercial	$59.19
Rate for Payer: BCN Medicare Advantage	$51.19
Rate for Payer: Cash Price	$61.07
Rate for Payer: Cash Price	$61.07
Rate for Payer: Cofinity Commercial	$71.76
Rate for Payer: Encore Health Key Benefits Commercial	$61.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$51.19
Rate for Payer: Healthscope Commercial	$76.34
Rate for Payer: Healthscope Whirlpool	$74.05
Rate for Payer: Humana Choice PPO Medicare	$51.19
Rate for Payer: Mclaren Commercial	$68.71
Rate for Payer: Mclaren Medicaid	$28.00
Rate for Payer: Mclaren Medicare	$51.19
Rate for Payer: Meridian Medicaid	$29.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$53.75
Rate for Payer: MI Amish Medical Board Commercial	$58.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.89
Rate for Payer: PACE Medicare	$48.63
Rate for Payer: PACE SWMI	$51.19
Rate for Payer: PHP Commercial	$56.31
Rate for Payer: PHP Medicaid	$28.00
Rate for Payer: PHP Medicare Advantage	$51.19
Rate for Payer: Priority Health Choice Medicaid	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$53.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.47
Rate for Payer: Priority Health Medicare	$51.19
Rate for Payer: Priority Health Narrow Network	$54.20
Rate for Payer: Railroad Medicare Medicare	$51.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.18
Rate for Payer: UHC Medicare Advantage	$52.73
Rate for Payer: VA VA	$51.19

HC DOG IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200038
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$24.89
Rate for Payer: Aetna Commercial	$22.40
Rate for Payer: Aetna Medicare	$5.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: ASR ASR	$24.14
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$19.30
Rate for Payer: BCN Commercial	$19.30
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$23.40
Rate for Payer: Encore Health Key Benefits Commercial	$19.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$24.89
Rate for Payer: Healthscope Whirlpool	$24.14
Rate for Payer: Humana Choice PPO Medicare	$5.22
Rate for Payer: Mclaren Commercial	$22.40
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$5.74
Rate for Payer: PHP Medicaid	$2.86
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.65
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health Narrow Network	$17.67
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.90
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC DOG IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200038
Hospital Revenue Code	302
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$24.89
Rate for Payer: Aetna Commercial	$22.40
Rate for Payer: ASR ASR	$24.14
Rate for Payer: BCBS Trust/PPO	$19.30
Rate for Payer: BCN Commercial	$19.30
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$23.40
Rate for Payer: Encore Health Key Benefits Commercial	$19.91
Rate for Payer: Healthscope Commercial	$24.89
Rate for Payer: Healthscope Whirlpool	$24.14
Rate for Payer: Mclaren Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.90

HC DOPPLER COLOR FLOW

Facility

$431.96

Service Code	CPT 93325
Hospital Charge Code	48000007
Hospital Revenue Code	480
Min. Negotiated Rate	$302.37
Max. Negotiated Rate	$431.96
Rate for Payer: Aetna Commercial	$388.76
Rate for Payer: ASR ASR	$419.00
Rate for Payer: BCBS Trust/PPO	$334.90
Rate for Payer: BCN Commercial	$334.90
Rate for Payer: Cash Price	$345.57
Rate for Payer: Cofinity Commercial	$406.04
Rate for Payer: Encore Health Key Benefits Commercial	$345.57
Rate for Payer: Healthscope Commercial	$431.96
Rate for Payer: Healthscope Whirlpool	$419.00
Rate for Payer: Mclaren Commercial	$388.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$367.17
Rate for Payer: Priority Health Cigna Priority Health	$302.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$380.12

HC DOPPLER COLOR FLOW

Facility

$431.96

Service Code	CPT 93325
Hospital Charge Code	48000007
Hospital Revenue Code	480
Min. Negotiated Rate	$172.78
Max. Negotiated Rate	$431.96
Rate for Payer: Aetna Commercial	$388.76
Rate for Payer: ASR ASR	$419.00
Rate for Payer: BCBS Complete	$172.78
Rate for Payer: BCBS Trust/PPO	$334.90
Rate for Payer: BCN Commercial	$334.90
Rate for Payer: Cash Price	$345.57
Rate for Payer: Cash Price	$345.57
Rate for Payer: Cofinity Commercial	$406.04
Rate for Payer: Encore Health Key Benefits Commercial	$345.57
Rate for Payer: Healthscope Commercial	$431.96
Rate for Payer: Healthscope Whirlpool	$419.00
Rate for Payer: Mclaren Commercial	$388.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$367.17
Rate for Payer: Priority Health Cigna Priority Health	$302.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$364.81
Rate for Payer: Priority Health Narrow Network	$291.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$380.12

HC DOXYCYCLINE HYCLATE 100 MG

Facility

$221.29

Service Code	HCPCS J3490
Hospital Charge Code	63600189
Hospital Revenue Code	636
Min. Negotiated Rate	$88.52
Max. Negotiated Rate	$221.29
Rate for Payer: Aetna Commercial	$199.16
Rate for Payer: ASR ASR	$214.65
Rate for Payer: BCBS Complete	$88.52
Rate for Payer: BCBS Trust/PPO	$171.57
Rate for Payer: BCN Commercial	$171.57
Rate for Payer: Cash Price	$177.03
Rate for Payer: Cofinity Commercial	$208.01
Rate for Payer: Encore Health Key Benefits Commercial	$177.03
Rate for Payer: Healthscope Commercial	$221.29
Rate for Payer: Healthscope Whirlpool	$214.65
Rate for Payer: Mclaren Commercial	$199.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.10
Rate for Payer: Priority Health Cigna Priority Health	$154.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$201.37
Rate for Payer: Priority Health Narrow Network	$157.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$194.74

HC DOXYCYCLINE HYCLATE 100 MG

Facility

$221.29

Service Code	HCPCS J3490
Hospital Charge Code	63600189
Hospital Revenue Code	636
Min. Negotiated Rate	$154.90
Max. Negotiated Rate	$221.29
Rate for Payer: Aetna Commercial	$199.16
Rate for Payer: ASR ASR	$214.65
Rate for Payer: BCBS Trust/PPO	$171.57
Rate for Payer: BCN Commercial	$171.57
Rate for Payer: Cash Price	$177.03
Rate for Payer: Cofinity Commercial	$208.01
Rate for Payer: Encore Health Key Benefits Commercial	$177.03
Rate for Payer: Healthscope Commercial	$221.29
Rate for Payer: Healthscope Whirlpool	$214.65
Rate for Payer: Mclaren Commercial	$199.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.10
Rate for Payer: Priority Health Cigna Priority Health	$154.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$194.74

HC DPPX AB CBA, S

Facility

$250.00

Service Code	CPT 86255
Hospital Charge Code	30200462
Hospital Revenue Code	302
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: ASR ASR	$242.50
Rate for Payer: BCBS Trust/PPO	$193.82
Rate for Payer: BCN Commercial	$193.82
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$235.00
Rate for Payer: Encore Health Key Benefits Commercial	$200.00
Rate for Payer: Healthscope Commercial	$250.00
Rate for Payer: Healthscope Whirlpool	$242.50
Rate for Payer: Mclaren Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$220.00

HC DPPX AB CBA, S

Facility

$250.00

Service Code	CPT 86255
Hospital Charge Code	30200462
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare	$12.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.06
Rate for Payer: Amish Plain Church Group Commercial	$15.06
Rate for Payer: ASR ASR	$242.50
Rate for Payer: BCBS Complete	$6.92
Rate for Payer: BCBS MAPPO	$12.05
Rate for Payer: BCBS Trust/PPO	$193.82
Rate for Payer: BCN Commercial	$193.82
Rate for Payer: BCN Medicare Advantage	$12.05
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$235.00
Rate for Payer: Encore Health Key Benefits Commercial	$200.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.05
Rate for Payer: Healthscope Commercial	$250.00
Rate for Payer: Healthscope Whirlpool	$242.50
Rate for Payer: Humana Choice PPO Medicare	$12.05
Rate for Payer: Mclaren Commercial	$225.00
Rate for Payer: Mclaren Medicaid	$6.59
Rate for Payer: Mclaren Medicare	$12.05
Rate for Payer: Meridian Medicaid	$6.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.65
Rate for Payer: MI Amish Medical Board Commercial	$13.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PACE Medicare	$11.45
Rate for Payer: PACE SWMI	$12.05
Rate for Payer: PHP Commercial	$13.26
Rate for Payer: PHP Medicaid	$6.59
Rate for Payer: PHP Medicare Advantage	$12.05
Rate for Payer: Priority Health Choice Medicaid	$6.59
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.42
Rate for Payer: Priority Health Medicare	$12.05
Rate for Payer: Priority Health Narrow Network	$169.94
Rate for Payer: Railroad Medicare Medicare	$12.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$220.00
Rate for Payer: UHC Medicare Advantage	$12.41
Rate for Payer: VA VA	$12.05

HC DPPX AB IFA, S

Facility

$76.50

Service Code	CPT 86255
Hospital Charge Code	30200463
Hospital Revenue Code	302
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$68.85
Rate for Payer: ASR ASR	$74.20
Rate for Payer: BCBS Trust/PPO	$59.31
Rate for Payer: BCN Commercial	$59.31
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$71.91
Rate for Payer: Encore Health Key Benefits Commercial	$61.20
Rate for Payer: Healthscope Commercial	$76.50
Rate for Payer: Healthscope Whirlpool	$74.20
Rate for Payer: Mclaren Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.32

HC DPPX AB IFA, S

Facility

$76.50

Service Code	CPT 86255
Hospital Charge Code	30200463
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$212.42
Rate for Payer: Aetna Commercial	$68.85
Rate for Payer: Aetna Medicare	$12.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.06
Rate for Payer: Amish Plain Church Group Commercial	$15.06
Rate for Payer: ASR ASR	$74.20
Rate for Payer: BCBS Complete	$6.92
Rate for Payer: BCBS MAPPO	$12.05
Rate for Payer: BCBS Trust/PPO	$59.31
Rate for Payer: BCN Commercial	$59.31
Rate for Payer: BCN Medicare Advantage	$12.05
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$71.91
Rate for Payer: Encore Health Key Benefits Commercial	$61.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.05
Rate for Payer: Healthscope Commercial	$76.50
Rate for Payer: Healthscope Whirlpool	$74.20
Rate for Payer: Humana Choice PPO Medicare	$12.05
Rate for Payer: Mclaren Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$6.59
Rate for Payer: Mclaren Medicare	$12.05
Rate for Payer: Meridian Medicaid	$6.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.65
Rate for Payer: MI Amish Medical Board Commercial	$13.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$11.45
Rate for Payer: PACE SWMI	$12.05
Rate for Payer: PHP Commercial	$13.26
Rate for Payer: PHP Medicaid	$6.59
Rate for Payer: PHP Medicare Advantage	$12.05
Rate for Payer: Priority Health Choice Medicaid	$6.59
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.42
Rate for Payer: Priority Health Medicare	$12.05
Rate for Payer: Priority Health Narrow Network	$169.94
Rate for Payer: Railroad Medicare Medicare	$12.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.32
Rate for Payer: UHC Medicare Advantage	$12.41
Rate for Payer: VA VA	$12.05

HC DPPX AB IFA TITER, S

Facility

$76.50

Service Code	CPT 86255
Hospital Charge Code	30200461
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$212.42
Rate for Payer: Aetna Commercial	$68.85
Rate for Payer: Aetna Medicare	$12.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$15.06
Rate for Payer: Amish Plain Church Group Commercial	$15.06
Rate for Payer: ASR ASR	$74.20
Rate for Payer: BCBS Complete	$6.92
Rate for Payer: BCBS MAPPO	$12.05
Rate for Payer: BCBS Trust/PPO	$59.31
Rate for Payer: BCN Commercial	$59.31
Rate for Payer: BCN Medicare Advantage	$12.05
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$71.91
Rate for Payer: Encore Health Key Benefits Commercial	$61.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.05
Rate for Payer: Healthscope Commercial	$76.50
Rate for Payer: Healthscope Whirlpool	$74.20
Rate for Payer: Humana Choice PPO Medicare	$12.05
Rate for Payer: Mclaren Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$6.59
Rate for Payer: Mclaren Medicare	$12.05
Rate for Payer: Meridian Medicaid	$6.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12.65
Rate for Payer: MI Amish Medical Board Commercial	$13.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$11.45
Rate for Payer: PACE SWMI	$12.05
Rate for Payer: PHP Commercial	$13.26
Rate for Payer: PHP Medicaid	$6.59
Rate for Payer: PHP Medicare Advantage	$12.05
Rate for Payer: Priority Health Choice Medicaid	$6.59
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.42
Rate for Payer: Priority Health Medicare	$12.05
Rate for Payer: Priority Health Narrow Network	$169.94
Rate for Payer: Railroad Medicare Medicare	$12.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.32
Rate for Payer: UHC Medicare Advantage	$12.41
Rate for Payer: VA VA	$12.05

HC DPPX AB IFA TITER, S

Facility

$76.50

Service Code	CPT 86255
Hospital Charge Code	30200461
Hospital Revenue Code	302
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$68.85
Rate for Payer: ASR ASR	$74.20
Rate for Payer: BCBS Trust/PPO	$59.31
Rate for Payer: BCN Commercial	$59.31
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$71.91
Rate for Payer: Encore Health Key Benefits Commercial	$61.20
Rate for Payer: Healthscope Commercial	$76.50
Rate for Payer: Healthscope Whirlpool	$74.20
Rate for Payer: Mclaren Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.32

HC DRAINAGE CATHETER LVL 1

Facility

$21.00

Service Code	HCPCS C1729
Hospital Charge Code	27200354
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: ASR ASR	$20.37
Rate for Payer: BCBS Trust/PPO	$16.28
Rate for Payer: BCN Commercial	$16.28
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$19.74
Rate for Payer: Encore Health Key Benefits Commercial	$16.80
Rate for Payer: Healthscope Commercial	$21.00
Rate for Payer: Healthscope Whirlpool	$20.37
Rate for Payer: Mclaren Commercial	$18.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.85
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.48

HC DRAINAGE CATHETER LVL 1

Facility

$21.00

Service Code	HCPCS C1729
Hospital Charge Code	27200354
Hospital Revenue Code	272
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: ASR ASR	$20.37
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$16.28
Rate for Payer: BCN Commercial	$16.28
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$19.74
Rate for Payer: Encore Health Key Benefits Commercial	$16.80
Rate for Payer: Healthscope Commercial	$21.00
Rate for Payer: Healthscope Whirlpool	$20.37
Rate for Payer: Mclaren Commercial	$18.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.85
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.11
Rate for Payer: Priority Health Narrow Network	$14.91
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.48

HC DRAINAGE CATHETER LVL 15

Facility

$1,590.00

Service Code	HCPCS C1729
Hospital Charge Code	27200348
Hospital Revenue Code	272
Min. Negotiated Rate	$636.00
Max. Negotiated Rate	$1,590.00
Rate for Payer: Aetna Commercial	$1,431.00
Rate for Payer: ASR ASR	$1,542.30
Rate for Payer: BCBS Complete	$636.00
Rate for Payer: BCBS Trust/PPO	$1,232.73
Rate for Payer: BCN Commercial	$1,232.73
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Cofinity Commercial	$1,494.60
Rate for Payer: Encore Health Key Benefits Commercial	$1,272.00
Rate for Payer: Healthscope Commercial	$1,590.00
Rate for Payer: Healthscope Whirlpool	$1,542.30
Rate for Payer: Mclaren Commercial	$1,431.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,351.50
Rate for Payer: Priority Health Cigna Priority Health	$1,113.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,446.90
Rate for Payer: Priority Health Narrow Network	$1,128.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,399.20

HC DRAINAGE CATHETER LVL 15

Facility

$1,590.00

Service Code	HCPCS C1729
Hospital Charge Code	27200348
Hospital Revenue Code	272
Min. Negotiated Rate	$1,113.00
Max. Negotiated Rate	$1,590.00
Rate for Payer: Aetna Commercial	$1,431.00
Rate for Payer: ASR ASR	$1,542.30
Rate for Payer: BCBS Trust/PPO	$1,232.73
Rate for Payer: BCN Commercial	$1,232.73
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Cofinity Commercial	$1,494.60
Rate for Payer: Encore Health Key Benefits Commercial	$1,272.00
Rate for Payer: Healthscope Commercial	$1,590.00
Rate for Payer: Healthscope Whirlpool	$1,542.30
Rate for Payer: Mclaren Commercial	$1,431.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,351.50
Rate for Payer: Priority Health Cigna Priority Health	$1,113.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,399.20

HC DRAINAGE CATHETER LVL 2

Facility

$228.00

Service Code	HCPCS C1729
Hospital Charge Code	27200084
Hospital Revenue Code	272
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: ASR ASR	$221.16
Rate for Payer: BCBS Trust/PPO	$176.77
Rate for Payer: BCN Commercial	$176.77
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cofinity Commercial	$214.32
Rate for Payer: Encore Health Key Benefits Commercial	$182.40
Rate for Payer: Healthscope Commercial	$228.00
Rate for Payer: Healthscope Whirlpool	$221.16
Rate for Payer: Mclaren Commercial	$205.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.80
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$200.64

HC DRAINAGE CATHETER LVL 2

Facility

$228.00

Service Code	HCPCS C1729
Hospital Charge Code	27200084
Hospital Revenue Code	272
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: ASR ASR	$221.16
Rate for Payer: BCBS Complete	$91.20
Rate for Payer: BCBS Trust/PPO	$176.77
Rate for Payer: BCN Commercial	$176.77
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cofinity Commercial	$214.32
Rate for Payer: Encore Health Key Benefits Commercial	$182.40
Rate for Payer: Healthscope Commercial	$228.00
Rate for Payer: Healthscope Whirlpool	$221.16
Rate for Payer: Mclaren Commercial	$205.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.80
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$207.48
Rate for Payer: Priority Health Narrow Network	$161.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$200.64

HC DRAINAGE CATHETER LVL 3

Facility

$378.00

Service Code	HCPCS C1729
Hospital Charge Code	27200270
Hospital Revenue Code	272
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna Commercial	$340.20
Rate for Payer: ASR ASR	$366.66
Rate for Payer: BCBS Complete	$151.20
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: BCN Commercial	$293.06
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cofinity Commercial	$355.32
Rate for Payer: Encore Health Key Benefits Commercial	$302.40
Rate for Payer: Healthscope Commercial	$378.00
Rate for Payer: Healthscope Whirlpool	$366.66
Rate for Payer: Mclaren Commercial	$340.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$321.30
Rate for Payer: Priority Health Cigna Priority Health	$264.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.98
Rate for Payer: Priority Health Narrow Network	$268.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$332.64

HC DRAINAGE CATHETER LVL 3

Facility

$378.00

Service Code	HCPCS C1729
Hospital Charge Code	27200270
Hospital Revenue Code	272
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna Commercial	$340.20
Rate for Payer: ASR ASR	$366.66
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: BCN Commercial	$293.06
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cofinity Commercial	$355.32
Rate for Payer: Encore Health Key Benefits Commercial	$302.40
Rate for Payer: Healthscope Commercial	$378.00
Rate for Payer: Healthscope Whirlpool	$366.66
Rate for Payer: Mclaren Commercial	$340.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$321.30
Rate for Payer: Priority Health Cigna Priority Health	$264.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$332.64

HC DRAINAGE CATHETER LVL 4

Facility

$528.00

Service Code	HCPCS C1729
Hospital Charge Code	27200271
Hospital Revenue Code	272
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$528.00
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: ASR ASR	$512.16
Rate for Payer: BCBS Complete	$211.20
Rate for Payer: BCBS Trust/PPO	$409.36
Rate for Payer: BCN Commercial	$409.36
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cofinity Commercial	$496.32
Rate for Payer: Encore Health Key Benefits Commercial	$422.40
Rate for Payer: Healthscope Commercial	$528.00
Rate for Payer: Healthscope Whirlpool	$512.16
Rate for Payer: Mclaren Commercial	$475.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$448.80
Rate for Payer: Priority Health Cigna Priority Health	$369.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$480.48
Rate for Payer: Priority Health Narrow Network	$374.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$464.64

HC DRAINAGE CATHETER LVL 4

Facility

$528.00

Service Code	HCPCS C1729
Hospital Charge Code	27200271
Hospital Revenue Code	272
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$528.00
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: ASR ASR	$512.16
Rate for Payer: BCBS Trust/PPO	$409.36
Rate for Payer: BCN Commercial	$409.36
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cofinity Commercial	$496.32
Rate for Payer: Encore Health Key Benefits Commercial	$422.40
Rate for Payer: Healthscope Commercial	$528.00
Rate for Payer: Healthscope Whirlpool	$512.16
Rate for Payer: Mclaren Commercial	$475.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$448.80
Rate for Payer: Priority Health Cigna Priority Health	$369.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$464.64

HC DRAINAGE CATHETER LVL 9

Facility

$901.11

Service Code	HCPCS C1729
Hospital Charge Code	27200349
Hospital Revenue Code	272
Min. Negotiated Rate	$360.44
Max. Negotiated Rate	$901.11
Rate for Payer: Aetna Commercial	$811.00
Rate for Payer: ASR ASR	$874.08
Rate for Payer: BCBS Complete	$360.44
Rate for Payer: BCBS Trust/PPO	$698.63
Rate for Payer: BCN Commercial	$698.63
Rate for Payer: Cash Price	$720.89
Rate for Payer: Cofinity Commercial	$847.04
Rate for Payer: Encore Health Key Benefits Commercial	$720.89
Rate for Payer: Healthscope Commercial	$901.11
Rate for Payer: Healthscope Whirlpool	$874.08
Rate for Payer: Mclaren Commercial	$811.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$765.94
Rate for Payer: Priority Health Cigna Priority Health	$630.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$820.01
Rate for Payer: Priority Health Narrow Network	$639.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$792.98

Know your out-of-pocket cost for care.

All Charges