Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC INFUSION CATHETER LVL 2

Facility

$241.86

Service Code	HCPCS C1751
Hospital Charge Code	27200005
Hospital Revenue Code	272
Min. Negotiated Rate	$157.21
Max. Negotiated Rate	$241.86
Rate for Payer: Aetna Commercial	$217.67
Rate for Payer: ASR ASR	$234.60
Rate for Payer: ASR Commercial	$234.60
Rate for Payer: BCBS Trust/PPO	$197.09
Rate for Payer: BCN Commercial	$187.51
Rate for Payer: Cash Price	$193.49
Rate for Payer: Cofinity Commercial	$227.35
Rate for Payer: Encore Health Key Benefits Commercial	$193.49
Rate for Payer: Healthscope Commercial	$241.86
Rate for Payer: Healthscope Whirlpool	$234.60
Rate for Payer: Mclaren Commercial	$217.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.58
Rate for Payer: Nomi Health Commercial	$198.33
Rate for Payer: Priority Health Cigna Priority Health	$157.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$212.84

HC INFUSION CATHETER LVL 2

Facility

$241.86

Service Code	HCPCS C1751
Hospital Charge Code	27200005
Hospital Revenue Code	272
Min. Negotiated Rate	$96.74
Max. Negotiated Rate	$241.86
Rate for Payer: Aetna Commercial	$217.67
Rate for Payer: Aetna Medicare	$120.93
Rate for Payer: ASR ASR	$234.60
Rate for Payer: ASR Commercial	$234.60
Rate for Payer: BCBS Complete	$96.74
Rate for Payer: BCBS Trust/PPO	$198.06
Rate for Payer: BCN Commercial	$187.51
Rate for Payer: Cash Price	$193.49
Rate for Payer: Cofinity Commercial	$227.35
Rate for Payer: Encore Health Key Benefits Commercial	$193.49
Rate for Payer: Healthscope Commercial	$241.86
Rate for Payer: Healthscope Whirlpool	$234.60
Rate for Payer: Mclaren Commercial	$217.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.58
Rate for Payer: Nomi Health Commercial	$198.33
Rate for Payer: Priority Health Cigna Priority Health	$157.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$211.92
Rate for Payer: Priority Health Narrow Network	$169.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$212.84

HC INFUSION CATHETER LVL 3

Facility

$396.90

Service Code	HCPCS C1751
Hospital Charge Code	27200265
Hospital Revenue Code	272
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna Commercial	$357.21
Rate for Payer: Aetna Medicare	$198.45
Rate for Payer: ASR ASR	$384.99
Rate for Payer: ASR Commercial	$384.99
Rate for Payer: BCBS Complete	$158.76
Rate for Payer: BCBS Trust/PPO	$325.02
Rate for Payer: BCN Commercial	$307.72
Rate for Payer: Cash Price	$317.52
Rate for Payer: Cofinity Commercial	$373.09
Rate for Payer: Encore Health Key Benefits Commercial	$317.52
Rate for Payer: Healthscope Commercial	$396.90
Rate for Payer: Healthscope Whirlpool	$384.99
Rate for Payer: Mclaren Commercial	$357.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.37
Rate for Payer: Nomi Health Commercial	$325.46
Rate for Payer: Priority Health Cigna Priority Health	$257.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$347.76
Rate for Payer: Priority Health Narrow Network	$278.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$349.27

HC INFUSION CATHETER LVL 3

Facility

$396.90

Service Code	HCPCS C1751
Hospital Charge Code	27200265
Hospital Revenue Code	272
Min. Negotiated Rate	$257.99
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna Commercial	$357.21
Rate for Payer: ASR ASR	$384.99
Rate for Payer: ASR Commercial	$384.99
Rate for Payer: BCBS Trust/PPO	$323.43
Rate for Payer: BCN Commercial	$307.72
Rate for Payer: Cash Price	$317.52
Rate for Payer: Cofinity Commercial	$373.09
Rate for Payer: Encore Health Key Benefits Commercial	$317.52
Rate for Payer: Healthscope Commercial	$396.90
Rate for Payer: Healthscope Whirlpool	$384.99
Rate for Payer: Mclaren Commercial	$357.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.37
Rate for Payer: Nomi Health Commercial	$325.46
Rate for Payer: Priority Health Cigna Priority Health	$257.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$349.27

HC INFUSION CATHETER LVL 6

Facility

$676.12

Service Code	HCPCS C1751
Hospital Charge Code	27200280
Hospital Revenue Code	272
Min. Negotiated Rate	$270.45
Max. Negotiated Rate	$676.12
Rate for Payer: Aetna Commercial	$608.51
Rate for Payer: Aetna Medicare	$338.06
Rate for Payer: ASR ASR	$655.84
Rate for Payer: ASR Commercial	$655.84
Rate for Payer: BCBS Complete	$270.45
Rate for Payer: BCBS Trust/PPO	$553.67
Rate for Payer: BCN Commercial	$524.20
Rate for Payer: Cash Price	$540.90
Rate for Payer: Cofinity Commercial	$635.55
Rate for Payer: Encore Health Key Benefits Commercial	$540.90
Rate for Payer: Healthscope Commercial	$676.12
Rate for Payer: Healthscope Whirlpool	$655.84
Rate for Payer: Mclaren Commercial	$608.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$574.70
Rate for Payer: Nomi Health Commercial	$554.42
Rate for Payer: Priority Health Cigna Priority Health	$439.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$592.42
Rate for Payer: Priority Health Narrow Network	$473.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$594.99

HC INFUSION CATHETER LVL 6

Facility

$676.12

Service Code	HCPCS C1751
Hospital Charge Code	27200280
Hospital Revenue Code	272
Min. Negotiated Rate	$439.48
Max. Negotiated Rate	$676.12
Rate for Payer: Aetna Commercial	$608.51
Rate for Payer: ASR ASR	$655.84
Rate for Payer: ASR Commercial	$655.84
Rate for Payer: BCBS Trust/PPO	$550.97
Rate for Payer: BCN Commercial	$524.20
Rate for Payer: Cash Price	$540.90
Rate for Payer: Cofinity Commercial	$635.55
Rate for Payer: Encore Health Key Benefits Commercial	$540.90
Rate for Payer: Healthscope Commercial	$676.12
Rate for Payer: Healthscope Whirlpool	$655.84
Rate for Payer: Mclaren Commercial	$608.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$574.70
Rate for Payer: Nomi Health Commercial	$554.42
Rate for Payer: Priority Health Cigna Priority Health	$439.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$594.99

HC INFUSION CATHETER LVL 7

Facility

$755.19

Service Code	HCPCS C1751
Hospital Charge Code	27200003
Hospital Revenue Code	272
Min. Negotiated Rate	$490.87
Max. Negotiated Rate	$755.19
Rate for Payer: Aetna Commercial	$679.67
Rate for Payer: ASR ASR	$732.53
Rate for Payer: ASR Commercial	$732.53
Rate for Payer: BCBS Trust/PPO	$615.40
Rate for Payer: BCN Commercial	$585.50
Rate for Payer: Cash Price	$604.15
Rate for Payer: Cofinity Commercial	$709.88
Rate for Payer: Encore Health Key Benefits Commercial	$604.15
Rate for Payer: Healthscope Commercial	$755.19
Rate for Payer: Healthscope Whirlpool	$732.53
Rate for Payer: Mclaren Commercial	$679.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$641.91
Rate for Payer: Nomi Health Commercial	$619.26
Rate for Payer: Priority Health Cigna Priority Health	$490.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$664.57

HC INFUSION CATHETER LVL 7

Facility

$755.19

Service Code	HCPCS C1751
Hospital Charge Code	27200003
Hospital Revenue Code	272
Min. Negotiated Rate	$302.08
Max. Negotiated Rate	$755.19
Rate for Payer: Aetna Commercial	$679.67
Rate for Payer: Aetna Medicare	$377.60
Rate for Payer: ASR ASR	$732.53
Rate for Payer: ASR Commercial	$732.53
Rate for Payer: BCBS Complete	$302.08
Rate for Payer: BCBS Trust/PPO	$618.43
Rate for Payer: BCN Commercial	$585.50
Rate for Payer: Cash Price	$604.15
Rate for Payer: Cofinity Commercial	$709.88
Rate for Payer: Encore Health Key Benefits Commercial	$604.15
Rate for Payer: Healthscope Commercial	$755.19
Rate for Payer: Healthscope Whirlpool	$732.53
Rate for Payer: Mclaren Commercial	$679.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$641.91
Rate for Payer: Nomi Health Commercial	$619.26
Rate for Payer: Priority Health Cigna Priority Health	$490.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$661.70
Rate for Payer: Priority Health Narrow Network	$529.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$664.57

HC INFUSION CATHETER LVL 9

Facility

$922.26

Service Code	HCPCS C1751
Hospital Charge Code	27200170
Hospital Revenue Code	272
Min. Negotiated Rate	$599.47
Max. Negotiated Rate	$922.26
Rate for Payer: Aetna Commercial	$830.03
Rate for Payer: ASR ASR	$894.59
Rate for Payer: ASR Commercial	$894.59
Rate for Payer: BCBS Trust/PPO	$751.55
Rate for Payer: BCN Commercial	$715.03
Rate for Payer: Cash Price	$737.81
Rate for Payer: Cofinity Commercial	$866.92
Rate for Payer: Encore Health Key Benefits Commercial	$737.81
Rate for Payer: Healthscope Commercial	$922.26
Rate for Payer: Healthscope Whirlpool	$894.59
Rate for Payer: Mclaren Commercial	$830.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$783.92
Rate for Payer: Nomi Health Commercial	$756.25
Rate for Payer: Priority Health Cigna Priority Health	$599.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$811.59

HC INFUSION CATHETER LVL 9

Facility

$922.26

Service Code	HCPCS C1751
Hospital Charge Code	27200170
Hospital Revenue Code	272
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$922.26
Rate for Payer: Aetna Commercial	$830.03
Rate for Payer: Aetna Medicare	$461.13
Rate for Payer: ASR ASR	$894.59
Rate for Payer: ASR Commercial	$894.59
Rate for Payer: BCBS Complete	$368.90
Rate for Payer: BCBS Trust/PPO	$755.24
Rate for Payer: BCN Commercial	$715.03
Rate for Payer: Cash Price	$737.81
Rate for Payer: Cofinity Commercial	$866.92
Rate for Payer: Encore Health Key Benefits Commercial	$737.81
Rate for Payer: Healthscope Commercial	$922.26
Rate for Payer: Healthscope Whirlpool	$894.59
Rate for Payer: Mclaren Commercial	$830.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$783.92
Rate for Payer: Nomi Health Commercial	$756.25
Rate for Payer: Priority Health Cigna Priority Health	$599.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$808.08
Rate for Payer: Priority Health Narrow Network	$646.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$811.59

HC INFUSION CATH LVL 10

Facility

$1,026.84

Service Code	HCPCS C1751
Hospital Charge Code	27200310
Hospital Revenue Code	272
Min. Negotiated Rate	$667.45
Max. Negotiated Rate	$1,026.84
Rate for Payer: Aetna Commercial	$924.16
Rate for Payer: ASR ASR	$996.03
Rate for Payer: ASR Commercial	$996.03
Rate for Payer: BCBS Trust/PPO	$836.77
Rate for Payer: BCN Commercial	$796.11
Rate for Payer: Cash Price	$821.47
Rate for Payer: Cofinity Commercial	$965.23
Rate for Payer: Encore Health Key Benefits Commercial	$821.47
Rate for Payer: Healthscope Commercial	$1,026.84
Rate for Payer: Healthscope Whirlpool	$996.03
Rate for Payer: Mclaren Commercial	$924.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$872.81
Rate for Payer: Nomi Health Commercial	$842.01
Rate for Payer: Priority Health Cigna Priority Health	$667.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$903.62

HC INFUSION CATH LVL 10

Facility

$1,026.84

Service Code	HCPCS C1751
Hospital Charge Code	27200310
Hospital Revenue Code	272
Min. Negotiated Rate	$410.74
Max. Negotiated Rate	$1,026.84
Rate for Payer: Aetna Commercial	$924.16
Rate for Payer: Aetna Medicare	$513.42
Rate for Payer: ASR ASR	$996.03
Rate for Payer: ASR Commercial	$996.03
Rate for Payer: BCBS Complete	$410.74
Rate for Payer: BCBS Trust/PPO	$840.88
Rate for Payer: BCN Commercial	$796.11
Rate for Payer: Cash Price	$821.47
Rate for Payer: Cofinity Commercial	$965.23
Rate for Payer: Encore Health Key Benefits Commercial	$821.47
Rate for Payer: Healthscope Commercial	$1,026.84
Rate for Payer: Healthscope Whirlpool	$996.03
Rate for Payer: Mclaren Commercial	$924.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$872.81
Rate for Payer: Nomi Health Commercial	$842.01
Rate for Payer: Priority Health Cigna Priority Health	$667.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$899.72
Rate for Payer: Priority Health Narrow Network	$719.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$903.62

HC INFUSION CATH LVL 11

Facility

$1,143.29

Service Code	HCPCS C1751
Hospital Charge Code	27200311
Hospital Revenue Code	272
Min. Negotiated Rate	$743.14
Max. Negotiated Rate	$1,143.29
Rate for Payer: Aetna Commercial	$1,028.96
Rate for Payer: ASR ASR	$1,108.99
Rate for Payer: ASR Commercial	$1,108.99
Rate for Payer: BCBS Trust/PPO	$931.67
Rate for Payer: BCN Commercial	$886.39
Rate for Payer: Cash Price	$914.63
Rate for Payer: Cofinity Commercial	$1,074.69
Rate for Payer: Encore Health Key Benefits Commercial	$914.63
Rate for Payer: Healthscope Commercial	$1,143.29
Rate for Payer: Healthscope Whirlpool	$1,108.99
Rate for Payer: Mclaren Commercial	$1,028.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$971.80
Rate for Payer: Nomi Health Commercial	$937.50
Rate for Payer: Priority Health Cigna Priority Health	$743.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,006.10

HC INFUSION CATH LVL 11

Facility

$1,143.29

Service Code	HCPCS C1751
Hospital Charge Code	27200311
Hospital Revenue Code	272
Min. Negotiated Rate	$457.32
Max. Negotiated Rate	$1,143.29
Rate for Payer: Aetna Commercial	$1,028.96
Rate for Payer: Aetna Medicare	$571.64
Rate for Payer: ASR ASR	$1,108.99
Rate for Payer: ASR Commercial	$1,108.99
Rate for Payer: BCBS Complete	$457.32
Rate for Payer: BCBS Trust/PPO	$936.24
Rate for Payer: BCN Commercial	$886.39
Rate for Payer: Cash Price	$914.63
Rate for Payer: Cofinity Commercial	$1,074.69
Rate for Payer: Encore Health Key Benefits Commercial	$914.63
Rate for Payer: Healthscope Commercial	$1,143.29
Rate for Payer: Healthscope Whirlpool	$1,108.99
Rate for Payer: Mclaren Commercial	$1,028.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$971.80
Rate for Payer: Nomi Health Commercial	$937.50
Rate for Payer: Priority Health Cigna Priority Health	$743.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,001.75
Rate for Payer: Priority Health Narrow Network	$801.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,006.10

HC INFUSION CATH LVL 12

Facility

$1,272.93

Service Code	HCPCS C1751
Hospital Charge Code	27200312
Hospital Revenue Code	272
Min. Negotiated Rate	$509.17
Max. Negotiated Rate	$1,272.93
Rate for Payer: Aetna Commercial	$1,145.64
Rate for Payer: Aetna Medicare	$636.47
Rate for Payer: ASR ASR	$1,234.74
Rate for Payer: ASR Commercial	$1,234.74
Rate for Payer: BCBS Complete	$509.17
Rate for Payer: BCBS Trust/PPO	$1,042.40
Rate for Payer: BCN Commercial	$986.90
Rate for Payer: Cash Price	$1,018.34
Rate for Payer: Cofinity Commercial	$1,196.55
Rate for Payer: Encore Health Key Benefits Commercial	$1,018.34
Rate for Payer: Healthscope Commercial	$1,272.93
Rate for Payer: Healthscope Whirlpool	$1,234.74
Rate for Payer: Mclaren Commercial	$1,145.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,081.99
Rate for Payer: Nomi Health Commercial	$1,043.80
Rate for Payer: Priority Health Cigna Priority Health	$827.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,115.34
Rate for Payer: Priority Health Narrow Network	$892.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,120.18

HC INFUSION CATH LVL 12

Facility

$1,272.93

Service Code	HCPCS C1751
Hospital Charge Code	27200312
Hospital Revenue Code	272
Min. Negotiated Rate	$827.40
Max. Negotiated Rate	$1,272.93
Rate for Payer: Aetna Commercial	$1,145.64
Rate for Payer: ASR ASR	$1,234.74
Rate for Payer: ASR Commercial	$1,234.74
Rate for Payer: BCBS Trust/PPO	$1,037.31
Rate for Payer: BCN Commercial	$986.90
Rate for Payer: Cash Price	$1,018.34
Rate for Payer: Cofinity Commercial	$1,196.55
Rate for Payer: Encore Health Key Benefits Commercial	$1,018.34
Rate for Payer: Healthscope Commercial	$1,272.93
Rate for Payer: Healthscope Whirlpool	$1,234.74
Rate for Payer: Mclaren Commercial	$1,145.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,081.99
Rate for Payer: Nomi Health Commercial	$1,043.80
Rate for Payer: Priority Health Cigna Priority Health	$827.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,120.18

HC INFUSION CATH LVL 13

Facility

$1,380.06

Service Code	HCPCS C1751
Hospital Charge Code	27200313
Hospital Revenue Code	272
Min. Negotiated Rate	$552.02
Max. Negotiated Rate	$1,380.06
Rate for Payer: Aetna Commercial	$1,242.05
Rate for Payer: Aetna Medicare	$690.03
Rate for Payer: ASR ASR	$1,338.66
Rate for Payer: ASR Commercial	$1,338.66
Rate for Payer: BCBS Complete	$552.02
Rate for Payer: BCBS Trust/PPO	$1,130.13
Rate for Payer: BCN Commercial	$1,069.96
Rate for Payer: Cash Price	$1,104.05
Rate for Payer: Cofinity Commercial	$1,297.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.05
Rate for Payer: Healthscope Commercial	$1,380.06
Rate for Payer: Healthscope Whirlpool	$1,338.66
Rate for Payer: Mclaren Commercial	$1,242.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.05
Rate for Payer: Nomi Health Commercial	$1,131.65
Rate for Payer: Priority Health Cigna Priority Health	$897.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,209.21
Rate for Payer: Priority Health Narrow Network	$967.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,214.45

HC INFUSION CATH LVL 13

Facility

$1,380.06

Service Code	HCPCS C1751
Hospital Charge Code	27200313
Hospital Revenue Code	272
Min. Negotiated Rate	$897.04
Max. Negotiated Rate	$1,380.06
Rate for Payer: Aetna Commercial	$1,242.05
Rate for Payer: ASR ASR	$1,338.66
Rate for Payer: ASR Commercial	$1,338.66
Rate for Payer: BCBS Trust/PPO	$1,124.61
Rate for Payer: BCN Commercial	$1,069.96
Rate for Payer: Cash Price	$1,104.05
Rate for Payer: Cofinity Commercial	$1,297.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.05
Rate for Payer: Healthscope Commercial	$1,380.06
Rate for Payer: Healthscope Whirlpool	$1,338.66
Rate for Payer: Mclaren Commercial	$1,242.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.05
Rate for Payer: Nomi Health Commercial	$1,131.65
Rate for Payer: Priority Health Cigna Priority Health	$897.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,214.45

HC INFUSION CATH LVL 14

Facility

$1,475.84

Service Code	HCPCS C1751
Hospital Charge Code	27200267
Hospital Revenue Code	272
Min. Negotiated Rate	$959.30
Max. Negotiated Rate	$1,475.84
Rate for Payer: Aetna Commercial	$1,328.26
Rate for Payer: ASR ASR	$1,431.56
Rate for Payer: ASR Commercial	$1,431.56
Rate for Payer: BCBS Trust/PPO	$1,202.66
Rate for Payer: BCN Commercial	$1,144.22
Rate for Payer: Cash Price	$1,180.67
Rate for Payer: Cofinity Commercial	$1,387.29
Rate for Payer: Encore Health Key Benefits Commercial	$1,180.67
Rate for Payer: Healthscope Commercial	$1,475.84
Rate for Payer: Healthscope Whirlpool	$1,431.56
Rate for Payer: Mclaren Commercial	$1,328.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,254.46
Rate for Payer: Nomi Health Commercial	$1,210.19
Rate for Payer: Priority Health Cigna Priority Health	$959.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,298.74

HC INFUSION CATH LVL 14

Facility

$1,475.84

Service Code	HCPCS C1751
Hospital Charge Code	27200267
Hospital Revenue Code	272
Min. Negotiated Rate	$590.34
Max. Negotiated Rate	$1,475.84
Rate for Payer: Aetna Commercial	$1,328.26
Rate for Payer: Aetna Medicare	$737.92
Rate for Payer: ASR ASR	$1,431.56
Rate for Payer: ASR Commercial	$1,431.56
Rate for Payer: BCBS Complete	$590.34
Rate for Payer: BCBS Trust/PPO	$1,208.57
Rate for Payer: BCN Commercial	$1,144.22
Rate for Payer: Cash Price	$1,180.67
Rate for Payer: Cofinity Commercial	$1,387.29
Rate for Payer: Encore Health Key Benefits Commercial	$1,180.67
Rate for Payer: Healthscope Commercial	$1,475.84
Rate for Payer: Healthscope Whirlpool	$1,431.56
Rate for Payer: Mclaren Commercial	$1,328.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,254.46
Rate for Payer: Nomi Health Commercial	$1,210.19
Rate for Payer: Priority Health Cigna Priority Health	$959.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,293.13
Rate for Payer: Priority Health Narrow Network	$1,034.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,298.74

HC INFUSION CATH LVL 4

Facility

$459.00

Service Code	HCPCS C1751
Hospital Charge Code	27200093
Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: ASR ASR	$445.23
Rate for Payer: ASR Commercial	$445.23
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: BCBS Trust/PPO	$375.88
Rate for Payer: BCN Commercial	$355.86
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$431.46
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$459.00
Rate for Payer: Healthscope Whirlpool	$445.23
Rate for Payer: Mclaren Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: Nomi Health Commercial	$376.38
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$402.18
Rate for Payer: Priority Health Narrow Network	$321.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.92

HC INFUSION CATH LVL 4

Facility

$459.00

Service Code	HCPCS C1751
Hospital Charge Code	27200093
Hospital Revenue Code	272
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: ASR ASR	$445.23
Rate for Payer: ASR Commercial	$445.23
Rate for Payer: BCBS Trust/PPO	$374.04
Rate for Payer: BCN Commercial	$355.86
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$431.46
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$459.00
Rate for Payer: Healthscope Whirlpool	$445.23
Rate for Payer: Mclaren Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: Nomi Health Commercial	$376.38
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.92

HC INFUSION CATH LVL 5

Facility

$595.35

Service Code	CPT C1751
Hospital Charge Code	27200296
Hospital Revenue Code	272
Min. Negotiated Rate	$238.14
Max. Negotiated Rate	$595.35
Rate for Payer: Aetna Commercial	$535.82
Rate for Payer: Aetna Medicare	$297.68
Rate for Payer: ASR ASR	$577.49
Rate for Payer: ASR Commercial	$577.49
Rate for Payer: BCBS Complete	$238.14
Rate for Payer: BCBS Trust/PPO	$487.53
Rate for Payer: BCN Commercial	$461.57
Rate for Payer: Cash Price	$476.28
Rate for Payer: Cofinity Commercial	$559.63
Rate for Payer: Encore Health Key Benefits Commercial	$476.28
Rate for Payer: Healthscope Commercial	$595.35
Rate for Payer: Healthscope Whirlpool	$577.49
Rate for Payer: Mclaren Commercial	$535.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$506.05
Rate for Payer: Nomi Health Commercial	$488.19
Rate for Payer: Priority Health Cigna Priority Health	$386.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$521.65
Rate for Payer: Priority Health Narrow Network	$417.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$523.91

HC INFUSION CATH LVL 5

Facility

$595.35

Service Code	CPT C1751
Hospital Charge Code	27200296
Hospital Revenue Code	272
Min. Negotiated Rate	$386.98
Max. Negotiated Rate	$595.35
Rate for Payer: Aetna Commercial	$535.82
Rate for Payer: ASR ASR	$577.49
Rate for Payer: ASR Commercial	$577.49
Rate for Payer: BCBS Trust/PPO	$485.15
Rate for Payer: BCN Commercial	$461.57
Rate for Payer: Cash Price	$476.28
Rate for Payer: Cofinity Commercial	$559.63
Rate for Payer: Encore Health Key Benefits Commercial	$476.28
Rate for Payer: Healthscope Commercial	$595.35
Rate for Payer: Healthscope Whirlpool	$577.49
Rate for Payer: Mclaren Commercial	$535.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$506.05
Rate for Payer: Nomi Health Commercial	$488.19
Rate for Payer: Priority Health Cigna Priority Health	$386.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$523.91

HC INFUSION CATH LVL 8

Facility

$843.51

Service Code	CPT C1751
Hospital Charge Code	27200309
Hospital Revenue Code	272
Min. Negotiated Rate	$548.28
Max. Negotiated Rate	$843.51
Rate for Payer: Aetna Commercial	$759.16
Rate for Payer: ASR ASR	$818.20
Rate for Payer: ASR Commercial	$818.20
Rate for Payer: BCBS Trust/PPO	$687.38
Rate for Payer: BCN Commercial	$653.97
Rate for Payer: Cash Price	$674.81
Rate for Payer: Cofinity Commercial	$792.90
Rate for Payer: Encore Health Key Benefits Commercial	$674.81
Rate for Payer: Healthscope Commercial	$843.51
Rate for Payer: Healthscope Whirlpool	$818.20
Rate for Payer: Mclaren Commercial	$759.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.98
Rate for Payer: Nomi Health Commercial	$691.68
Rate for Payer: Priority Health Cigna Priority Health	$548.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$742.29

Know your out-of-pocket cost for care.

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