Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC GUIDEWIRE

Facility

$48.41

Service Code	HCPCS C1769
Hospital Charge Code	27200045
Hospital Revenue Code	272
Min. Negotiated Rate	$33.89
Max. Negotiated Rate	$48.41
Rate for Payer: Aetna Commercial	$43.57
Rate for Payer: ASR ASR	$46.96
Rate for Payer: BCBS Trust/PPO	$37.53
Rate for Payer: BCN Commercial	$37.53
Rate for Payer: Cash Price	$38.73
Rate for Payer: Cofinity Commercial	$45.51
Rate for Payer: Encore Health Key Benefits Commercial	$38.73
Rate for Payer: Healthscope Commercial	$48.41
Rate for Payer: Healthscope Whirlpool	$46.96
Rate for Payer: Mclaren Commercial	$43.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.15
Rate for Payer: Priority Health Cigna Priority Health	$33.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$42.60

HC GUIDEWIRE

Facility

$48.41

Service Code	HCPCS C1769
Hospital Charge Code	27200045
Hospital Revenue Code	272
Min. Negotiated Rate	$19.36
Max. Negotiated Rate	$48.41
Rate for Payer: Aetna Commercial	$43.57
Rate for Payer: ASR ASR	$46.96
Rate for Payer: BCBS Complete	$19.36
Rate for Payer: BCBS Trust/PPO	$37.53
Rate for Payer: BCN Commercial	$37.53
Rate for Payer: Cash Price	$38.73
Rate for Payer: Cofinity Commercial	$45.51
Rate for Payer: Encore Health Key Benefits Commercial	$38.73
Rate for Payer: Healthscope Commercial	$48.41
Rate for Payer: Healthscope Whirlpool	$46.96
Rate for Payer: Mclaren Commercial	$43.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.15
Rate for Payer: Priority Health Cigna Priority Health	$33.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.05
Rate for Payer: Priority Health Narrow Network	$34.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$42.60

HC GUIDE WIRE DILATATION

Facility

$1,319.07

Hospital Charge Code	36000050
Hospital Revenue Code	360
Min. Negotiated Rate	$923.35
Max. Negotiated Rate	$1,319.07
Rate for Payer: Aetna Commercial	$1,187.16
Rate for Payer: ASR ASR	$1,279.50
Rate for Payer: BCBS Trust/PPO	$1,022.67
Rate for Payer: BCN Commercial	$1,022.67
Rate for Payer: Cash Price	$1,055.26
Rate for Payer: Cofinity Commercial	$1,239.93
Rate for Payer: Encore Health Key Benefits Commercial	$1,055.26
Rate for Payer: Healthscope Commercial	$1,319.07
Rate for Payer: Healthscope Whirlpool	$1,279.50
Rate for Payer: Mclaren Commercial	$1,187.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,121.21
Rate for Payer: Priority Health Cigna Priority Health	$923.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,160.78

HC GUIDE WIRE DILATATION

Facility

$1,319.07

Hospital Charge Code	36000050
Hospital Revenue Code	360
Min. Negotiated Rate	$527.63
Max. Negotiated Rate	$1,319.07
Rate for Payer: Aetna Commercial	$1,187.16
Rate for Payer: ASR ASR	$1,279.50
Rate for Payer: BCBS Complete	$527.63
Rate for Payer: BCBS Trust/PPO	$1,022.67
Rate for Payer: BCN Commercial	$1,022.67
Rate for Payer: Cash Price	$1,055.26
Rate for Payer: Cofinity Commercial	$1,239.93
Rate for Payer: Encore Health Key Benefits Commercial	$1,055.26
Rate for Payer: Healthscope Commercial	$1,319.07
Rate for Payer: Healthscope Whirlpool	$1,279.50
Rate for Payer: Mclaren Commercial	$1,187.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,121.21
Rate for Payer: Priority Health Cigna Priority Health	$923.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,200.35
Rate for Payer: Priority Health Narrow Network	$936.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,160.78

HC GUIDEWIRE GLIDEWIRE LVL 1

Facility

$78.00

Service Code	HCPCS C1769
Hospital Charge Code	27200273
Hospital Revenue Code	272
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: ASR ASR	$75.66
Rate for Payer: BCBS Trust/PPO	$60.47
Rate for Payer: BCN Commercial	$60.47
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$73.32
Rate for Payer: Encore Health Key Benefits Commercial	$62.40
Rate for Payer: Healthscope Commercial	$78.00
Rate for Payer: Healthscope Whirlpool	$75.66
Rate for Payer: Mclaren Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$68.64

HC GUIDEWIRE GLIDEWIRE LVL 1

Facility

$78.00

Service Code	HCPCS C1769
Hospital Charge Code	27200273
Hospital Revenue Code	272
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: ASR ASR	$75.66
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$60.47
Rate for Payer: BCN Commercial	$60.47
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$73.32
Rate for Payer: Encore Health Key Benefits Commercial	$62.40
Rate for Payer: Healthscope Commercial	$78.00
Rate for Payer: Healthscope Whirlpool	$75.66
Rate for Payer: Mclaren Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.98
Rate for Payer: Priority Health Narrow Network	$55.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$68.64

HC GUIDEWIRE GLIDEWIRE LVL 2

Facility

$153.00

Service Code	HCPCS C1769
Hospital Charge Code	27200086
Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: ASR ASR	$148.41
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCBS Trust/PPO	$118.62
Rate for Payer: BCN Commercial	$118.62
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$143.82
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$153.00
Rate for Payer: Healthscope Whirlpool	$148.41
Rate for Payer: Mclaren Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$139.23
Rate for Payer: Priority Health Narrow Network	$108.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$134.64

HC GUIDEWIRE GLIDEWIRE LVL 2

Facility

$153.00

Service Code	HCPCS C1769
Hospital Charge Code	27200086
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: ASR ASR	$148.41
Rate for Payer: BCBS Trust/PPO	$118.62
Rate for Payer: BCN Commercial	$118.62
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$143.82
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$153.00
Rate for Payer: Healthscope Whirlpool	$148.41
Rate for Payer: Mclaren Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$134.64

HC GUIDEWIRE GLIDEWIRE LVL 3

Facility

$318.15

Service Code	HCPCS C1769
Hospital Charge Code	27200274
Hospital Revenue Code	272
Min. Negotiated Rate	$222.70
Max. Negotiated Rate	$318.15
Rate for Payer: Aetna Commercial	$286.34
Rate for Payer: ASR ASR	$308.61
Rate for Payer: BCBS Trust/PPO	$246.66
Rate for Payer: BCN Commercial	$246.66
Rate for Payer: Cash Price	$254.52
Rate for Payer: Cofinity Commercial	$299.06
Rate for Payer: Encore Health Key Benefits Commercial	$254.52
Rate for Payer: Healthscope Commercial	$318.15
Rate for Payer: Healthscope Whirlpool	$308.61
Rate for Payer: Mclaren Commercial	$286.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$270.43
Rate for Payer: Priority Health Cigna Priority Health	$222.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$279.97

HC GUIDEWIRE GLIDEWIRE LVL 3

Facility

$318.15

Service Code	HCPCS C1769
Hospital Charge Code	27200274
Hospital Revenue Code	272
Min. Negotiated Rate	$127.26
Max. Negotiated Rate	$318.15
Rate for Payer: Aetna Commercial	$286.34
Rate for Payer: ASR ASR	$308.61
Rate for Payer: BCBS Complete	$127.26
Rate for Payer: BCBS Trust/PPO	$246.66
Rate for Payer: BCN Commercial	$246.66
Rate for Payer: Cash Price	$254.52
Rate for Payer: Cofinity Commercial	$299.06
Rate for Payer: Encore Health Key Benefits Commercial	$254.52
Rate for Payer: Healthscope Commercial	$318.15
Rate for Payer: Healthscope Whirlpool	$308.61
Rate for Payer: Mclaren Commercial	$286.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$270.43
Rate for Payer: Priority Health Cigna Priority Health	$222.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$289.52
Rate for Payer: Priority Health Narrow Network	$225.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$279.97

HC GUIDEWIRE GLIDEWIRE LVL4

Facility

$453.00

Service Code	HCPCS C1769
Hospital Charge Code	27200080
Hospital Revenue Code	272
Min. Negotiated Rate	$317.10
Max. Negotiated Rate	$453.00
Rate for Payer: Aetna Commercial	$407.70
Rate for Payer: ASR ASR	$439.41
Rate for Payer: BCBS Trust/PPO	$351.21
Rate for Payer: BCN Commercial	$351.21
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cofinity Commercial	$425.82
Rate for Payer: Encore Health Key Benefits Commercial	$362.40
Rate for Payer: Healthscope Commercial	$453.00
Rate for Payer: Healthscope Whirlpool	$439.41
Rate for Payer: Mclaren Commercial	$407.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$385.05
Rate for Payer: Priority Health Cigna Priority Health	$317.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$398.64

HC GUIDEWIRE GLIDEWIRE LVL4

Facility

$453.00

Service Code	HCPCS C1769
Hospital Charge Code	27200080
Hospital Revenue Code	272
Min. Negotiated Rate	$181.20
Max. Negotiated Rate	$453.00
Rate for Payer: Aetna Commercial	$407.70
Rate for Payer: ASR ASR	$439.41
Rate for Payer: BCBS Complete	$181.20
Rate for Payer: BCBS Trust/PPO	$351.21
Rate for Payer: BCN Commercial	$351.21
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cofinity Commercial	$425.82
Rate for Payer: Encore Health Key Benefits Commercial	$362.40
Rate for Payer: Healthscope Commercial	$453.00
Rate for Payer: Healthscope Whirlpool	$439.41
Rate for Payer: Mclaren Commercial	$407.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$385.05
Rate for Payer: Priority Health Cigna Priority Health	$317.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$412.23
Rate for Payer: Priority Health Narrow Network	$321.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$398.64

HC GUIDEWIRE GLIDWIRE LVL 5

Facility

$658.48

Service Code	HCPCS C1769
Hospital Charge Code	27200275
Hospital Revenue Code	272
Min. Negotiated Rate	$263.39
Max. Negotiated Rate	$658.48
Rate for Payer: Aetna Commercial	$592.63
Rate for Payer: ASR ASR	$638.73
Rate for Payer: BCBS Complete	$263.39
Rate for Payer: BCBS Trust/PPO	$510.52
Rate for Payer: BCN Commercial	$510.52
Rate for Payer: Cash Price	$526.78
Rate for Payer: Cofinity Commercial	$618.97
Rate for Payer: Encore Health Key Benefits Commercial	$526.78
Rate for Payer: Healthscope Commercial	$658.48
Rate for Payer: Healthscope Whirlpool	$638.73
Rate for Payer: Mclaren Commercial	$592.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$559.71
Rate for Payer: Priority Health Cigna Priority Health	$460.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$599.22
Rate for Payer: Priority Health Narrow Network	$467.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$579.46

HC GUIDEWIRE GLIDWIRE LVL 5

Facility

$658.48

Service Code	HCPCS C1769
Hospital Charge Code	27200275
Hospital Revenue Code	272
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$658.48
Rate for Payer: Aetna Commercial	$592.63
Rate for Payer: ASR ASR	$638.73
Rate for Payer: BCBS Trust/PPO	$510.52
Rate for Payer: BCN Commercial	$510.52
Rate for Payer: Cash Price	$526.78
Rate for Payer: Cofinity Commercial	$618.97
Rate for Payer: Encore Health Key Benefits Commercial	$526.78
Rate for Payer: Healthscope Commercial	$658.48
Rate for Payer: Healthscope Whirlpool	$638.73
Rate for Payer: Mclaren Commercial	$592.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$559.71
Rate for Payer: Priority Health Cigna Priority Health	$460.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$579.46

HC GUIDING CATHETER LVL 1

Facility

$43.03

Service Code	HCPCS C1887
Hospital Charge Code	27200022
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$43.03
Rate for Payer: Aetna Commercial	$38.73
Rate for Payer: ASR ASR	$41.74
Rate for Payer: BCBS Trust/PPO	$33.36
Rate for Payer: BCN Commercial	$33.36
Rate for Payer: Cash Price	$34.42
Rate for Payer: Cofinity Commercial	$40.45
Rate for Payer: Encore Health Key Benefits Commercial	$34.42
Rate for Payer: Healthscope Commercial	$43.03
Rate for Payer: Healthscope Whirlpool	$41.74
Rate for Payer: Mclaren Commercial	$38.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.58
Rate for Payer: Priority Health Cigna Priority Health	$30.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.87

HC GUIDING CATHETER LVL 1

Facility

$43.03

Service Code	HCPCS C1887
Hospital Charge Code	27200022
Hospital Revenue Code	272
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$43.03
Rate for Payer: Aetna Commercial	$38.73
Rate for Payer: ASR ASR	$41.74
Rate for Payer: BCBS Complete	$17.21
Rate for Payer: BCBS Trust/PPO	$33.36
Rate for Payer: BCN Commercial	$33.36
Rate for Payer: Cash Price	$34.42
Rate for Payer: Cofinity Commercial	$40.45
Rate for Payer: Encore Health Key Benefits Commercial	$34.42
Rate for Payer: Healthscope Commercial	$43.03
Rate for Payer: Healthscope Whirlpool	$41.74
Rate for Payer: Mclaren Commercial	$38.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.58
Rate for Payer: Priority Health Cigna Priority Health	$30.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.16
Rate for Payer: Priority Health Narrow Network	$30.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.87

HC GUIDING CATHETER LVL 17

Facility

$1,789.01

Service Code	HCPCS C1887
Hospital Charge Code	27800082
Hospital Revenue Code	278
Min. Negotiated Rate	$715.60
Max. Negotiated Rate	$1,789.01
Rate for Payer: Aetna Commercial	$1,610.11
Rate for Payer: ASR ASR	$1,735.34
Rate for Payer: BCBS Complete	$715.60
Rate for Payer: BCBS Trust/PPO	$1,387.02
Rate for Payer: BCN Commercial	$1,387.02
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cofinity Commercial	$1,681.67
Rate for Payer: Encore Health Key Benefits Commercial	$1,431.21
Rate for Payer: Healthscope Commercial	$1,789.01
Rate for Payer: Healthscope Whirlpool	$1,735.34
Rate for Payer: Mclaren Commercial	$1,610.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,520.66
Rate for Payer: Priority Health Cigna Priority Health	$1,252.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,628.00
Rate for Payer: Priority Health Narrow Network	$1,270.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,574.33

HC GUIDING CATHETER LVL 17

Facility

$1,789.01

Service Code	HCPCS C1887
Hospital Charge Code	27800082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.31
Max. Negotiated Rate	$1,789.01
Rate for Payer: Aetna Commercial	$1,610.11
Rate for Payer: ASR ASR	$1,735.34
Rate for Payer: BCBS Trust/PPO	$1,387.02
Rate for Payer: BCN Commercial	$1,387.02
Rate for Payer: Cash Price	$1,431.21
Rate for Payer: Cofinity Commercial	$1,681.67
Rate for Payer: Encore Health Key Benefits Commercial	$1,431.21
Rate for Payer: Healthscope Commercial	$1,789.01
Rate for Payer: Healthscope Whirlpool	$1,735.34
Rate for Payer: Mclaren Commercial	$1,610.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,520.66
Rate for Payer: Priority Health Cigna Priority Health	$1,252.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,574.33

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$791.35
Max. Negotiated Rate	$1,978.37
Rate for Payer: Aetna Commercial	$1,780.53
Rate for Payer: ASR ASR	$1,919.02
Rate for Payer: BCBS Complete	$791.35
Rate for Payer: BCBS Trust/PPO	$1,533.83
Rate for Payer: BCN Commercial	$1,533.83
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,859.67
Rate for Payer: Encore Health Key Benefits Commercial	$1,582.70
Rate for Payer: Healthscope Commercial	$1,978.37
Rate for Payer: Healthscope Whirlpool	$1,919.02
Rate for Payer: Mclaren Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,384.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,800.32
Rate for Payer: Priority Health Narrow Network	$1,404.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,740.97

HC GUIDING CATHETER LVL19

Facility

$1,978.37

Service Code	HCPCS C1887
Hospital Charge Code	27200055
Hospital Revenue Code	272
Min. Negotiated Rate	$1,384.86
Max. Negotiated Rate	$1,978.37
Rate for Payer: Aetna Commercial	$1,780.53
Rate for Payer: ASR ASR	$1,919.02
Rate for Payer: BCBS Trust/PPO	$1,533.83
Rate for Payer: BCN Commercial	$1,533.83
Rate for Payer: Cash Price	$1,582.70
Rate for Payer: Cofinity Commercial	$1,859.67
Rate for Payer: Encore Health Key Benefits Commercial	$1,582.70
Rate for Payer: Healthscope Commercial	$1,978.37
Rate for Payer: Healthscope Whirlpool	$1,919.02
Rate for Payer: Mclaren Commercial	$1,780.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,681.61
Rate for Payer: Priority Health Cigna Priority Health	$1,384.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,740.97

HC GUIDING CATHETER LVL 2

Facility

$280.38

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$196.27
Max. Negotiated Rate	$280.38
Rate for Payer: Aetna Commercial	$252.34
Rate for Payer: ASR ASR	$271.97
Rate for Payer: BCBS Trust/PPO	$217.38
Rate for Payer: BCN Commercial	$217.38
Rate for Payer: Cash Price	$224.30
Rate for Payer: Cofinity Commercial	$263.56
Rate for Payer: Encore Health Key Benefits Commercial	$224.30
Rate for Payer: Healthscope Commercial	$280.38
Rate for Payer: Healthscope Whirlpool	$271.97
Rate for Payer: Mclaren Commercial	$252.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$238.32
Rate for Payer: Priority Health Cigna Priority Health	$196.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$246.73

HC GUIDING CATHETER LVL 2

Facility

$280.38

Service Code	HCPCS C1887
Hospital Charge Code	27200046
Hospital Revenue Code	272
Min. Negotiated Rate	$112.15
Max. Negotiated Rate	$280.38
Rate for Payer: Aetna Commercial	$252.34
Rate for Payer: ASR ASR	$271.97
Rate for Payer: BCBS Complete	$112.15
Rate for Payer: BCBS Trust/PPO	$217.38
Rate for Payer: BCN Commercial	$217.38
Rate for Payer: Cash Price	$224.30
Rate for Payer: Cofinity Commercial	$263.56
Rate for Payer: Encore Health Key Benefits Commercial	$224.30
Rate for Payer: Healthscope Commercial	$280.38
Rate for Payer: Healthscope Whirlpool	$271.97
Rate for Payer: Mclaren Commercial	$252.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$238.32
Rate for Payer: Priority Health Cigna Priority Health	$196.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$255.15
Rate for Payer: Priority Health Narrow Network	$199.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$246.73

HC GUIDING CATHETER LVL 24

Facility

$2,429.14

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$971.66
Max. Negotiated Rate	$2,429.14
Rate for Payer: Aetna Commercial	$2,186.23
Rate for Payer: ASR ASR	$2,356.27
Rate for Payer: BCBS Complete	$971.66
Rate for Payer: BCBS Trust/PPO	$1,883.31
Rate for Payer: BCN Commercial	$1,883.31
Rate for Payer: Cash Price	$1,943.31
Rate for Payer: Cofinity Commercial	$2,283.39
Rate for Payer: Encore Health Key Benefits Commercial	$1,943.31
Rate for Payer: Healthscope Commercial	$2,429.14
Rate for Payer: Healthscope Whirlpool	$2,356.27
Rate for Payer: Mclaren Commercial	$2,186.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,064.77
Rate for Payer: Priority Health Cigna Priority Health	$1,700.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,210.52
Rate for Payer: Priority Health Narrow Network	$1,724.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,137.64

HC GUIDING CATHETER LVL 24

Facility

$2,429.14

Service Code	HCPCS C1887
Hospital Charge Code	27200079
Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.40
Max. Negotiated Rate	$2,429.14
Rate for Payer: Aetna Commercial	$2,186.23
Rate for Payer: ASR ASR	$2,356.27
Rate for Payer: BCBS Trust/PPO	$1,883.31
Rate for Payer: BCN Commercial	$1,883.31
Rate for Payer: Cash Price	$1,943.31
Rate for Payer: Cofinity Commercial	$2,283.39
Rate for Payer: Encore Health Key Benefits Commercial	$1,943.31
Rate for Payer: Healthscope Commercial	$2,429.14
Rate for Payer: Healthscope Whirlpool	$2,356.27
Rate for Payer: Mclaren Commercial	$2,186.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,064.77
Rate for Payer: Priority Health Cigna Priority Health	$1,700.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,137.64

HC GUIDING CATHETER LVL 3

Facility

$330.88

Service Code	HCPCS C1887
Hospital Charge Code	27200061
Hospital Revenue Code	272
Min. Negotiated Rate	$132.35
Max. Negotiated Rate	$330.88
Rate for Payer: Aetna Commercial	$297.79
Rate for Payer: ASR ASR	$320.95
Rate for Payer: BCBS Complete	$132.35
Rate for Payer: BCBS Trust/PPO	$256.53
Rate for Payer: BCN Commercial	$256.53
Rate for Payer: Cash Price	$264.70
Rate for Payer: Cofinity Commercial	$311.03
Rate for Payer: Encore Health Key Benefits Commercial	$264.70
Rate for Payer: Healthscope Commercial	$330.88
Rate for Payer: Healthscope Whirlpool	$320.95
Rate for Payer: Mclaren Commercial	$297.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.25
Rate for Payer: Priority Health Cigna Priority Health	$231.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$301.10
Rate for Payer: Priority Health Narrow Network	$234.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$291.17

Know your out-of-pocket cost for care.

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