|
HC GUIDEWIRE GLIDEWIRE LVL 14
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$1,327.50
|
| Rate for Payer: Aetna Medicare |
$737.50
|
| Rate for Payer: ASR ASR |
$1,430.75
|
| Rate for Payer: ASR Commercial |
$1,430.75
|
| Rate for Payer: BCBS Complete |
$590.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.88
|
| Rate for Payer: BCN Commercial |
$1,143.57
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,386.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.00
|
| Rate for Payer: Healthscope Commercial |
$1,475.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,430.75
|
| Rate for Payer: Mclaren Commercial |
$1,327.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.75
|
| Rate for Payer: Nomi Health Commercial |
$1,209.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,033.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.00
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 14
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$958.75 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$1,327.50
|
| Rate for Payer: ASR ASR |
$1,430.75
|
| Rate for Payer: ASR Commercial |
$1,430.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.98
|
| Rate for Payer: BCN Commercial |
$1,143.57
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,386.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.00
|
| Rate for Payer: Healthscope Commercial |
$1,475.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,430.75
|
| Rate for Payer: Mclaren Commercial |
$1,327.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.75
|
| Rate for Payer: Nomi Health Commercial |
$1,209.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.00
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$127.80
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$127.17
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
OP
|
$324.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.80 |
| Max. Negotiated Rate |
$324.51 |
| Rate for Payer: Aetna Commercial |
$292.06
|
| Rate for Payer: Aetna Medicare |
$162.25
|
| Rate for Payer: ASR ASR |
$314.77
|
| Rate for Payer: ASR Commercial |
$314.77
|
| Rate for Payer: BCBS Complete |
$129.80
|
| Rate for Payer: BCBS Trust/PPO |
$265.74
|
| Rate for Payer: BCN Commercial |
$251.59
|
| Rate for Payer: Cash Price |
$259.61
|
| Rate for Payer: Cofinity Commercial |
$305.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.61
|
| Rate for Payer: Healthscope Commercial |
$324.51
|
| Rate for Payer: Healthscope Whirlpool |
$314.77
|
| Rate for Payer: Mclaren Commercial |
$292.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.83
|
| Rate for Payer: Nomi Health Commercial |
$266.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.34
|
| Rate for Payer: Priority Health Narrow Network |
$227.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.57
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
IP
|
$324.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.93 |
| Max. Negotiated Rate |
$324.51 |
| Rate for Payer: Aetna Commercial |
$292.06
|
| Rate for Payer: ASR ASR |
$314.77
|
| Rate for Payer: ASR Commercial |
$314.77
|
| Rate for Payer: BCBS Trust/PPO |
$264.44
|
| Rate for Payer: BCN Commercial |
$251.59
|
| Rate for Payer: Cash Price |
$259.61
|
| Rate for Payer: Cofinity Commercial |
$305.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.61
|
| Rate for Payer: Healthscope Commercial |
$324.51
|
| Rate for Payer: Healthscope Whirlpool |
$314.77
|
| Rate for Payer: Mclaren Commercial |
$292.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.83
|
| Rate for Payer: Nomi Health Commercial |
$266.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.57
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
OP
|
$462.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$462.06 |
| Rate for Payer: Aetna Commercial |
$415.85
|
| Rate for Payer: Aetna Medicare |
$231.03
|
| Rate for Payer: ASR ASR |
$448.20
|
| Rate for Payer: ASR Commercial |
$448.20
|
| Rate for Payer: BCBS Complete |
$184.82
|
| Rate for Payer: BCBS Trust/PPO |
$378.38
|
| Rate for Payer: BCN Commercial |
$358.24
|
| Rate for Payer: Cash Price |
$369.65
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.65
|
| Rate for Payer: Healthscope Commercial |
$462.06
|
| Rate for Payer: Healthscope Whirlpool |
$448.20
|
| Rate for Payer: Mclaren Commercial |
$415.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.75
|
| Rate for Payer: Nomi Health Commercial |
$378.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.86
|
| Rate for Payer: Priority Health Narrow Network |
$323.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$406.61
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
IP
|
$462.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.34 |
| Max. Negotiated Rate |
$462.06 |
| Rate for Payer: Aetna Commercial |
$415.85
|
| Rate for Payer: ASR ASR |
$448.20
|
| Rate for Payer: ASR Commercial |
$448.20
|
| Rate for Payer: BCBS Trust/PPO |
$376.53
|
| Rate for Payer: BCN Commercial |
$358.24
|
| Rate for Payer: Cash Price |
$369.65
|
| Rate for Payer: Cofinity Commercial |
$434.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.65
|
| Rate for Payer: Healthscope Commercial |
$462.06
|
| Rate for Payer: Healthscope Whirlpool |
$448.20
|
| Rate for Payer: Mclaren Commercial |
$415.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.75
|
| Rate for Payer: Nomi Health Commercial |
$378.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$406.61
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
OP
|
$671.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.66 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Aetna Commercial |
$604.49
|
| Rate for Payer: Aetna Medicare |
$335.82
|
| Rate for Payer: ASR ASR |
$651.50
|
| Rate for Payer: ASR Commercial |
$651.50
|
| Rate for Payer: BCBS Complete |
$268.66
|
| Rate for Payer: BCBS Trust/PPO |
$550.01
|
| Rate for Payer: BCN Commercial |
$520.73
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Cofinity Commercial |
$631.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.32
|
| Rate for Payer: Healthscope Commercial |
$671.65
|
| Rate for Payer: Healthscope Whirlpool |
$651.50
|
| Rate for Payer: Mclaren Commercial |
$604.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.90
|
| Rate for Payer: Nomi Health Commercial |
$550.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$588.50
|
| Rate for Payer: Priority Health Narrow Network |
$470.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.05
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
IP
|
$671.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.57 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Aetna Commercial |
$604.49
|
| Rate for Payer: ASR ASR |
$651.50
|
| Rate for Payer: ASR Commercial |
$651.50
|
| Rate for Payer: BCBS Trust/PPO |
$547.33
|
| Rate for Payer: BCN Commercial |
$520.73
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Cofinity Commercial |
$631.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.32
|
| Rate for Payer: Healthscope Commercial |
$671.65
|
| Rate for Payer: Healthscope Whirlpool |
$651.50
|
| Rate for Payer: Mclaren Commercial |
$604.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.90
|
| Rate for Payer: Nomi Health Commercial |
$550.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.05
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
OP
|
$43.89
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$43.89 |
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: Aetna Medicare |
$21.95
|
| Rate for Payer: ASR ASR |
$42.57
|
| Rate for Payer: ASR Commercial |
$42.57
|
| Rate for Payer: BCBS Complete |
$17.56
|
| Rate for Payer: BCBS Trust/PPO |
$35.94
|
| Rate for Payer: BCN Commercial |
$34.03
|
| Rate for Payer: Cash Price |
$35.11
|
| Rate for Payer: Cofinity Commercial |
$41.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.11
|
| Rate for Payer: Healthscope Commercial |
$43.89
|
| Rate for Payer: Healthscope Whirlpool |
$42.57
|
| Rate for Payer: Mclaren Commercial |
$39.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.31
|
| Rate for Payer: Nomi Health Commercial |
$35.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$30.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.62
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
IP
|
$43.89
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$43.89 |
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: ASR ASR |
$42.57
|
| Rate for Payer: ASR Commercial |
$42.57
|
| Rate for Payer: BCBS Trust/PPO |
$35.77
|
| Rate for Payer: BCN Commercial |
$34.03
|
| Rate for Payer: Cash Price |
$35.11
|
| Rate for Payer: Cofinity Commercial |
$41.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.11
|
| Rate for Payer: Healthscope Commercial |
$43.89
|
| Rate for Payer: Healthscope Whirlpool |
$42.57
|
| Rate for Payer: Mclaren Commercial |
$39.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.31
|
| Rate for Payer: Nomi Health Commercial |
$35.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.62
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
IP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.86 |
| 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: ASR Commercial |
$1,735.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.86
|
| 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 Commercial |
$1,520.66
|
| Rate for Payer: Nomi Health Commercial |
$1,466.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,574.33
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
OP
|
$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: Aetna Medicare |
$894.50
|
| Rate for Payer: ASR ASR |
$1,735.34
|
| Rate for Payer: ASR Commercial |
$1,735.34
|
| Rate for Payer: BCBS Complete |
$715.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,465.02
|
| 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 Commercial |
$1,520.66
|
| Rate for Payer: Nomi Health Commercial |
$1,466.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,567.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,574.33
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
IP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,285.94 |
| 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: ASR Commercial |
$1,919.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.17
|
| 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 Commercial |
$1,681.61
|
| Rate for Payer: Nomi Health Commercial |
$1,622.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.97
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
OP
|
$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: Aetna Medicare |
$989.18
|
| Rate for Payer: ASR ASR |
$1,919.02
|
| Rate for Payer: ASR Commercial |
$1,919.02
|
| Rate for Payer: BCBS Complete |
$791.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.09
|
| 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 Commercial |
$1,681.61
|
| Rate for Payer: Nomi Health Commercial |
$1,622.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,386.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.97
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
OP
|
$285.99
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$285.99 |
| Rate for Payer: Aetna Commercial |
$257.39
|
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: ASR ASR |
$277.41
|
| Rate for Payer: ASR Commercial |
$277.41
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: BCBS Trust/PPO |
$234.20
|
| Rate for Payer: BCN Commercial |
$221.73
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$268.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.79
|
| Rate for Payer: Healthscope Commercial |
$285.99
|
| Rate for Payer: Healthscope Whirlpool |
$277.41
|
| Rate for Payer: Mclaren Commercial |
$257.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.09
|
| Rate for Payer: Nomi Health Commercial |
$234.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.67
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
IP
|
$285.99
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.89 |
| Max. Negotiated Rate |
$285.99 |
| Rate for Payer: Aetna Commercial |
$257.39
|
| Rate for Payer: ASR ASR |
$277.41
|
| Rate for Payer: ASR Commercial |
$277.41
|
| Rate for Payer: BCBS Trust/PPO |
$233.05
|
| Rate for Payer: BCN Commercial |
$221.73
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$268.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.79
|
| Rate for Payer: Healthscope Commercial |
$285.99
|
| Rate for Payer: Healthscope Whirlpool |
$277.41
|
| Rate for Payer: Mclaren Commercial |
$257.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.09
|
| Rate for Payer: Nomi Health Commercial |
$234.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.67
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
IP
|
$2,477.72
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,610.52 |
| Max. Negotiated Rate |
$2,477.72 |
| Rate for Payer: Aetna Commercial |
$2,229.95
|
| Rate for Payer: ASR ASR |
$2,403.39
|
| Rate for Payer: ASR Commercial |
$2,403.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,019.09
|
| Rate for Payer: BCN Commercial |
$1,920.98
|
| Rate for Payer: Cash Price |
$1,982.18
|
| Rate for Payer: Cofinity Commercial |
$2,329.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.18
|
| Rate for Payer: Healthscope Commercial |
$2,477.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,403.39
|
| Rate for Payer: Mclaren Commercial |
$2,229.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.06
|
| Rate for Payer: Nomi Health Commercial |
$2,031.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,180.39
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
OP
|
$2,477.72
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.09 |
| Max. Negotiated Rate |
$2,477.72 |
| Rate for Payer: Aetna Commercial |
$2,229.95
|
| Rate for Payer: Aetna Medicare |
$1,238.86
|
| Rate for Payer: ASR ASR |
$2,403.39
|
| Rate for Payer: ASR Commercial |
$2,403.39
|
| Rate for Payer: BCBS Complete |
$991.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,029.00
|
| Rate for Payer: BCN Commercial |
$1,920.98
|
| Rate for Payer: Cash Price |
$1,982.18
|
| Rate for Payer: Cofinity Commercial |
$2,329.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.18
|
| Rate for Payer: Healthscope Commercial |
$2,477.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,403.39
|
| Rate for Payer: Mclaren Commercial |
$2,229.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.06
|
| Rate for Payer: Nomi Health Commercial |
$2,031.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,170.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,736.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,180.39
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.38 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$303.75
|
| Rate for Payer: ASR ASR |
$327.38
|
| Rate for Payer: ASR Commercial |
$327.38
|
| Rate for Payer: BCBS Trust/PPO |
$275.03
|
| Rate for Payer: BCN Commercial |
$261.66
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$317.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Whirlpool |
$327.38
|
| Rate for Payer: Mclaren Commercial |
$303.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.00
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$303.75
|
| Rate for Payer: Aetna Medicare |
$168.75
|
| Rate for Payer: ASR ASR |
$327.38
|
| Rate for Payer: ASR Commercial |
$327.38
|
| Rate for Payer: BCBS Complete |
$135.00
|
| Rate for Payer: BCBS Trust/PPO |
$276.38
|
| Rate for Payer: BCN Commercial |
$261.66
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$317.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Whirlpool |
$327.38
|
| Rate for Payer: Mclaren Commercial |
$303.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$236.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.00
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,335.16 |
| Max. Negotiated Rate |
$3,592.55 |
| Rate for Payer: Aetna Commercial |
$3,233.30
|
| Rate for Payer: ASR ASR |
$3,484.77
|
| Rate for Payer: ASR Commercial |
$3,484.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,927.57
|
| Rate for Payer: BCN Commercial |
$2,785.30
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$3,377.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,592.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,484.77
|
| Rate for Payer: Mclaren Commercial |
$3,233.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,945.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,161.44
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
OP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,437.02 |
| Max. Negotiated Rate |
$3,592.55 |
| Rate for Payer: Aetna Commercial |
$3,233.30
|
| Rate for Payer: Aetna Medicare |
$1,796.28
|
| Rate for Payer: ASR ASR |
$3,484.77
|
| Rate for Payer: ASR Commercial |
$3,484.77
|
| Rate for Payer: BCBS Complete |
$1,437.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,941.94
|
| Rate for Payer: BCN Commercial |
$2,785.30
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$3,377.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,592.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,484.77
|
| Rate for Payer: Mclaren Commercial |
$3,233.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,945.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,147.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,518.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,161.44
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.84 |
| Max. Negotiated Rate |
$490.52 |
| Rate for Payer: Aetna Commercial |
$441.47
|
| Rate for Payer: ASR ASR |
$475.80
|
| Rate for Payer: ASR Commercial |
$475.80
|
| Rate for Payer: BCBS Trust/PPO |
$399.72
|
| Rate for Payer: BCN Commercial |
$380.30
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$490.52
|
| Rate for Payer: Healthscope Whirlpool |
$475.80
|
| Rate for Payer: Mclaren Commercial |
$441.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.66
|
|
