Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC GUIDEWIRE GLIDEWIRE LVL 1

Facility

$79.56

Service Code	HCPCS C1769
Hospital Charge Code	27200273
Hospital Revenue Code	272
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna Medicare	$39.78
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: BCBS Complete	$31.82
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Cofinity Medicare Advantage	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health SBD	$50.12

HC GUIDEWIRE GLIDEWIRE LVL 1

Facility

$79.56

Service Code	HCPCS C1769
Hospital Charge Code	27200273
Hospital Revenue Code	272
Min. Negotiated Rate	$50.12
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Cofinity Medicare Advantage	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health SBD	$50.12

HC GUIDEWIRE GLIDEWIRE LVL 14

Facility

$1,475.00

Service Code	HCPCS C1769
Hospital Charge Code	27200391
Hospital Revenue Code	272
Min. Negotiated Rate	$929.25
Max. Negotiated Rate	$1,327.50
Rate for Payer: Aetna Commercial	$1,253.75
Rate for Payer: Aetna New Business (MI Preferred)	$958.75
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Cofinity Commercial	$1,032.50
Rate for Payer: Cofinity Commercial	$1,268.50
Rate for Payer: Cofinity Medicare Advantage	$1,032.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,180.00
Rate for Payer: Healthscope Commercial	$1,327.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,253.75
Rate for Payer: PHP Commercial	$1,253.75
Rate for Payer: Priority Health Cigna Priority Health	$958.75
Rate for Payer: Priority Health SBD	$929.25

HC GUIDEWIRE GLIDEWIRE LVL 14

Facility

$1,475.00

Service Code	HCPCS C1769
Hospital Charge Code	27200391
Hospital Revenue Code	272
Min. Negotiated Rate	$590.00
Max. Negotiated Rate	$1,327.50
Rate for Payer: Aetna Commercial	$1,253.75
Rate for Payer: Aetna Medicare	$737.50
Rate for Payer: Aetna New Business (MI Preferred)	$958.75
Rate for Payer: BCBS Complete	$590.00
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Cofinity Commercial	$1,032.50
Rate for Payer: Cofinity Commercial	$1,268.50
Rate for Payer: Cofinity Medicare Advantage	$1,032.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,180.00
Rate for Payer: Healthscope Commercial	$1,327.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,253.75
Rate for Payer: PHP Commercial	$1,253.75
Rate for Payer: Priority Health Cigna Priority Health	$958.75
Rate for Payer: Priority Health SBD	$929.25

HC GUIDEWIRE GLIDEWIRE LVL 2

Facility

$156.06

Service Code	HCPCS C1769
Hospital Charge Code	27200086
Hospital Revenue Code	272
Min. Negotiated Rate	$98.32
Max. Negotiated Rate	$140.45
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna New Business (MI Preferred)	$101.44
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$109.24
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Cofinity Medicare Advantage	$109.24
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: PHP Commercial	$132.65
Rate for Payer: Priority Health Cigna Priority Health	$101.44
Rate for Payer: Priority Health SBD	$98.32

HC GUIDEWIRE GLIDEWIRE LVL 2

Facility

$156.06

Service Code	HCPCS C1769
Hospital Charge Code	27200086
Hospital Revenue Code	272
Min. Negotiated Rate	$62.42
Max. Negotiated Rate	$140.45
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna Medicare	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$101.44
Rate for Payer: BCBS Complete	$62.42
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$109.24
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Cofinity Medicare Advantage	$109.24
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: PHP Commercial	$132.65
Rate for Payer: Priority Health Cigna Priority Health	$101.44
Rate for Payer: Priority Health SBD	$98.32

HC GUIDEWIRE GLIDEWIRE LVL 3

Facility

$324.51

Service Code	HCPCS C1769
Hospital Charge Code	27200274
Hospital Revenue Code	272
Min. Negotiated Rate	$204.44
Max. Negotiated Rate	$292.06
Rate for Payer: Aetna Commercial	$275.83
Rate for Payer: Aetna New Business (MI Preferred)	$210.93
Rate for Payer: Cash Price	$259.61
Rate for Payer: Cofinity Commercial	$227.16
Rate for Payer: Cofinity Commercial	$279.08
Rate for Payer: Cofinity Medicare Advantage	$227.16
Rate for Payer: Encore Health Key Benefits Commercial	$259.61
Rate for Payer: Healthscope Commercial	$292.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.83
Rate for Payer: PHP Commercial	$275.83
Rate for Payer: Priority Health Cigna Priority Health	$210.93
Rate for Payer: Priority Health SBD	$204.44

HC GUIDEWIRE GLIDEWIRE LVL 3

Facility

$324.51

Service Code	HCPCS C1769
Hospital Charge Code	27200274
Hospital Revenue Code	272
Min. Negotiated Rate	$129.80
Max. Negotiated Rate	$292.06
Rate for Payer: Aetna Commercial	$275.83
Rate for Payer: Aetna Medicare	$162.26
Rate for Payer: Aetna New Business (MI Preferred)	$210.93
Rate for Payer: BCBS Complete	$129.80
Rate for Payer: Cash Price	$259.61
Rate for Payer: Cofinity Commercial	$227.16
Rate for Payer: Cofinity Commercial	$279.08
Rate for Payer: Cofinity Medicare Advantage	$227.16
Rate for Payer: Encore Health Key Benefits Commercial	$259.61
Rate for Payer: Healthscope Commercial	$292.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.83
Rate for Payer: PHP Commercial	$275.83
Rate for Payer: Priority Health Cigna Priority Health	$210.93
Rate for Payer: Priority Health SBD	$204.44

HC GUIDEWIRE GLIDEWIRE LVL4

Facility

$462.06

Service Code	HCPCS C1769
Hospital Charge Code	27200080
Hospital Revenue Code	272
Min. Negotiated Rate	$291.10
Max. Negotiated Rate	$415.85
Rate for Payer: Aetna Commercial	$392.75
Rate for Payer: Aetna New Business (MI Preferred)	$300.34
Rate for Payer: Cash Price	$369.65
Rate for Payer: Cofinity Commercial	$323.44
Rate for Payer: Cofinity Commercial	$397.37
Rate for Payer: Cofinity Medicare Advantage	$323.44
Rate for Payer: Encore Health Key Benefits Commercial	$369.65
Rate for Payer: Healthscope Commercial	$415.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$392.75
Rate for Payer: PHP Commercial	$392.75
Rate for Payer: Priority Health Cigna Priority Health	$300.34
Rate for Payer: Priority Health SBD	$291.10

HC GUIDEWIRE GLIDEWIRE LVL4

Facility

$462.06

Service Code	HCPCS C1769
Hospital Charge Code	27200080
Hospital Revenue Code	272
Min. Negotiated Rate	$184.82
Max. Negotiated Rate	$415.85
Rate for Payer: Aetna Commercial	$392.75
Rate for Payer: Aetna Medicare	$231.03
Rate for Payer: Aetna New Business (MI Preferred)	$300.34
Rate for Payer: BCBS Complete	$184.82
Rate for Payer: Cash Price	$369.65
Rate for Payer: Cofinity Commercial	$323.44
Rate for Payer: Cofinity Commercial	$397.37
Rate for Payer: Cofinity Medicare Advantage	$323.44
Rate for Payer: Encore Health Key Benefits Commercial	$369.65
Rate for Payer: Healthscope Commercial	$415.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$392.75
Rate for Payer: PHP Commercial	$392.75
Rate for Payer: Priority Health Cigna Priority Health	$300.34
Rate for Payer: Priority Health SBD	$291.10

HC GUIDEWIRE GLIDWIRE LVL 5

Facility

$671.65

Service Code	HCPCS C1769
Hospital Charge Code	27200275
Hospital Revenue Code	272
Min. Negotiated Rate	$268.66
Max. Negotiated Rate	$604.48
Rate for Payer: Aetna Commercial	$570.90
Rate for Payer: Aetna Medicare	$335.82
Rate for Payer: Aetna New Business (MI Preferred)	$436.57
Rate for Payer: BCBS Complete	$268.66
Rate for Payer: Cash Price	$537.32
Rate for Payer: Cofinity Commercial	$470.16
Rate for Payer: Cofinity Commercial	$577.62
Rate for Payer: Cofinity Medicare Advantage	$470.16
Rate for Payer: Encore Health Key Benefits Commercial	$537.32
Rate for Payer: Healthscope Commercial	$604.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$570.90
Rate for Payer: PHP Commercial	$570.90
Rate for Payer: Priority Health Cigna Priority Health	$436.57
Rate for Payer: Priority Health SBD	$423.14

HC GUIDEWIRE GLIDWIRE LVL 5

Facility

$671.65

Service Code	HCPCS C1769
Hospital Charge Code	27200275
Hospital Revenue Code	272
Min. Negotiated Rate	$423.14
Max. Negotiated Rate	$604.48
Rate for Payer: Aetna Commercial	$570.90
Rate for Payer: Aetna New Business (MI Preferred)	$436.57
Rate for Payer: Cash Price	$537.32
Rate for Payer: Cofinity Commercial	$470.16
Rate for Payer: Cofinity Commercial	$577.62
Rate for Payer: Cofinity Medicare Advantage	$470.16
Rate for Payer: Encore Health Key Benefits Commercial	$537.32
Rate for Payer: Healthscope Commercial	$604.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$570.90
Rate for Payer: PHP Commercial	$570.90
Rate for Payer: Priority Health Cigna Priority Health	$436.57
Rate for Payer: Priority Health SBD	$423.14

HC GUIDING CATHETER LVL 1

Facility

$43.89

Service Code	HCPCS C1887
Hospital Charge Code	27200022
Hospital Revenue Code	272
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$37.31
Rate for Payer: Aetna New Business (MI Preferred)	$28.53
Rate for Payer: Cash Price	$35.11
Rate for Payer: Cofinity Commercial	$30.72
Rate for Payer: Cofinity Commercial	$37.75
Rate for Payer: Cofinity Medicare Advantage	$30.72
Rate for Payer: Encore Health Key Benefits Commercial	$35.11
Rate for Payer: Healthscope Commercial	$39.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.31
Rate for Payer: PHP Commercial	$37.31
Rate for Payer: Priority Health Cigna Priority Health	$28.53
Rate for Payer: Priority Health SBD	$27.65

HC GUIDING CATHETER LVL 1

Facility

$43.89

Service Code	HCPCS C1887
Hospital Charge Code	27200022
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$37.31
Rate for Payer: Aetna Medicare	$21.94
Rate for Payer: Aetna New Business (MI Preferred)	$28.53
Rate for Payer: BCBS Complete	$17.56
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$35.11
Rate for Payer: Cash Price	$35.11
Rate for Payer: Cofinity Commercial	$30.72
Rate for Payer: Cofinity Commercial	$37.75
Rate for Payer: Cofinity Medicare Advantage	$30.72
Rate for Payer: Encore Health Key Benefits Commercial	$35.11
Rate for Payer: Healthscope Commercial	$39.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.31
Rate for Payer: PHP Commercial	$37.31
Rate for Payer: Priority Health Cigna Priority Health	$28.53
Rate for Payer: Priority Health SBD	$27.65

HC GUIDING CATHETER LVL 17

Facility

$1,789.01

Service Code	HCPCS C1887
Hospital Charge Code	27800082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,127.08
Max. Negotiated Rate	$1,610.11
Rate for Payer: Aetna Commercial	$1,520.66
Rate for Payer: Aetna New Business (MI Preferred)	$1,162.86
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cofinity Commercial	$1,252.31
Rate for Payer: Cofinity Commercial	$1,538.55
Rate for Payer: Cofinity Medicare Advantage	$1,252.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,431.21
Rate for Payer: Healthscope Commercial	$1,610.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,520.66
Rate for Payer: PHP Commercial	$1,520.66
Rate for Payer: Priority Health Cigna Priority Health	$1,162.86
Rate for Payer: Priority Health SBD	$1,127.08

HC GUIDING CATHETER LVL 17

Facility

$1,789.01

Service Code	HCPCS C1887
Hospital Charge Code	27800082
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1,610.11
Rate for Payer: Aetna Commercial	$1,520.66
Rate for Payer: Aetna Medicare	$894.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,162.86
Rate for Payer: BCBS Complete	$715.60
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cofinity Commercial	$1,252.31
Rate for Payer: Cofinity Commercial	$1,538.55
Rate for Payer: Cofinity Medicare Advantage	$1,252.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,431.21
Rate for Payer: Healthscope Commercial	$1,610.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,520.66
Rate for Payer: PHP Commercial	$1,520.66
Rate for Payer: Priority Health Cigna Priority Health	$1,162.86
Rate for Payer: Priority Health SBD	$1,127.08

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1,780.53
Rate for Payer: Aetna Commercial	$1,681.61
Rate for Payer: Aetna Medicare	$989.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,285.94
Rate for Payer: BCBS Complete	$791.35
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,384.86
Rate for Payer: Cofinity Commercial	$1,701.40
Rate for Payer: Cofinity Medicare Advantage	$1,384.86
Rate for Payer: Encore Health Key Benefits Commercial	$1,582.70
Rate for Payer: Healthscope Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,681.61
Rate for Payer: PHP Commercial	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,285.94
Rate for Payer: Priority Health SBD	$1,246.37

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$1,246.37
Max. Negotiated Rate	$1,780.53
Rate for Payer: Aetna Commercial	$1,681.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,285.94
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,384.86
Rate for Payer: Cofinity Commercial	$1,701.40
Rate for Payer: Cofinity Medicare Advantage	$1,384.86
Rate for Payer: Encore Health Key Benefits Commercial	$1,582.70
Rate for Payer: Healthscope Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,681.61
Rate for Payer: PHP Commercial	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,285.94
Rate for Payer: Priority Health SBD	$1,246.37

HC GUIDING CATHETER LVL 2

Facility

$285.99

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$180.17
Max. Negotiated Rate	$257.39
Rate for Payer: Aetna Commercial	$243.09
Rate for Payer: Aetna New Business (MI Preferred)	$185.89
Rate for Payer: Cash Price	$228.79
Rate for Payer: Cofinity Commercial	$200.19
Rate for Payer: Cofinity Commercial	$245.95
Rate for Payer: Cofinity Medicare Advantage	$200.19
Rate for Payer: Encore Health Key Benefits Commercial	$228.79
Rate for Payer: Healthscope Commercial	$257.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.09
Rate for Payer: PHP Commercial	$243.09
Rate for Payer: Priority Health Cigna Priority Health	$185.89
Rate for Payer: Priority Health SBD	$180.17

HC GUIDING CATHETER LVL 2

Facility

$285.99

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$257.39
Rate for Payer: Aetna Commercial	$243.09
Rate for Payer: Aetna Medicare	$143.00
Rate for Payer: Aetna New Business (MI Preferred)	$185.89
Rate for Payer: BCBS Complete	$114.40
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$228.79
Rate for Payer: Cash Price	$228.79
Rate for Payer: Cofinity Commercial	$200.19
Rate for Payer: Cofinity Commercial	$245.95
Rate for Payer: Cofinity Medicare Advantage	$200.19
Rate for Payer: Encore Health Key Benefits Commercial	$228.79
Rate for Payer: Healthscope Commercial	$257.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.09
Rate for Payer: PHP Commercial	$243.09
Rate for Payer: Priority Health Cigna Priority Health	$185.89
Rate for Payer: Priority Health SBD	$180.17

HC GUIDING CATHETER LVL 24

Facility

$2,477.72

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$1,560.96
Max. Negotiated Rate	$2,229.95
Rate for Payer: Aetna Commercial	$2,106.06
Rate for Payer: Aetna New Business (MI Preferred)	$1,610.52
Rate for Payer: Cash Price	$1,982.18
Rate for Payer: Cofinity Commercial	$1,734.40
Rate for Payer: Cofinity Commercial	$2,130.84
Rate for Payer: Cofinity Medicare Advantage	$1,734.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,982.18
Rate for Payer: Healthscope Commercial	$2,229.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,106.06
Rate for Payer: PHP Commercial	$2,106.06
Rate for Payer: Priority Health Cigna Priority Health	$1,610.52
Rate for Payer: Priority Health SBD	$1,560.96

HC GUIDING CATHETER LVL 24

Facility

$2,477.72

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2,229.95
Rate for Payer: Aetna Commercial	$2,106.06
Rate for Payer: Aetna Medicare	$1,238.86
Rate for Payer: Aetna New Business (MI Preferred)	$1,610.52
Rate for Payer: BCBS Complete	$991.09
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,982.18
Rate for Payer: Cash Price	$1,982.18
Rate for Payer: Cofinity Commercial	$1,734.40
Rate for Payer: Cofinity Commercial	$2,130.84
Rate for Payer: Cofinity Medicare Advantage	$1,734.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,982.18
Rate for Payer: Healthscope Commercial	$2,229.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,106.06
Rate for Payer: PHP Commercial	$2,106.06
Rate for Payer: Priority Health Cigna Priority Health	$1,610.52
Rate for Payer: Priority Health SBD	$1,560.96

HC GUIDING CATHETER LVL 3

Facility

$337.50

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$212.62
Max. Negotiated Rate	$303.75
Rate for Payer: Aetna Commercial	$286.88
Rate for Payer: Aetna New Business (MI Preferred)	$219.38
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cofinity Commercial	$236.25
Rate for Payer: Cofinity Commercial	$290.25
Rate for Payer: Cofinity Medicare Advantage	$236.25
Rate for Payer: Encore Health Key Benefits Commercial	$270.00
Rate for Payer: Healthscope Commercial	$303.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.88
Rate for Payer: PHP Commercial	$286.88
Rate for Payer: Priority Health Cigna Priority Health	$219.38
Rate for Payer: Priority Health SBD	$212.62

HC GUIDING CATHETER LVL 3

Facility

$337.50

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$303.75
Rate for Payer: Aetna Commercial	$286.88
Rate for Payer: Aetna Medicare	$168.75
Rate for Payer: Aetna New Business (MI Preferred)	$219.38
Rate for Payer: BCBS Complete	$135.00
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cofinity Commercial	$236.25
Rate for Payer: Cofinity Commercial	$290.25
Rate for Payer: Cofinity Medicare Advantage	$236.25
Rate for Payer: Encore Health Key Benefits Commercial	$270.00
Rate for Payer: Healthscope Commercial	$303.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.88
Rate for Payer: PHP Commercial	$286.88
Rate for Payer: Priority Health Cigna Priority Health	$219.38
Rate for Payer: Priority Health SBD	$212.62

HC GUIDING CATHETER LVL 35

Facility

$3,592.55

Service Code	HCPCS C1887
Hospital Charge Code	27800061
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3,233.30
Rate for Payer: Aetna Commercial	$3,053.67
Rate for Payer: Aetna Medicare	$1,796.28
Rate for Payer: Aetna New Business (MI Preferred)	$2,335.16
Rate for Payer: BCBS Complete	$1,437.02
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$2,874.04
Rate for Payer: Cash Price	$2,874.04
Rate for Payer: Cofinity Commercial	$2,514.78
Rate for Payer: Cofinity Commercial	$3,089.59
Rate for Payer: Cofinity Medicare Advantage	$2,514.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,874.04
Rate for Payer: Healthscope Commercial	$3,233.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,053.67
Rate for Payer: PHP Commercial	$3,053.67
Rate for Payer: Priority Health Cigna Priority Health	$2,335.16
Rate for Payer: Priority Health SBD	$2,263.31

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