|
HC STENT
|
Facility
|
OP
|
$953.16
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.26 |
| Max. Negotiated Rate |
$953.16 |
| Rate for Payer: Aetna Commercial |
$857.84
|
| Rate for Payer: Aetna Medicare |
$476.58
|
| Rate for Payer: ASR ASR |
$924.57
|
| Rate for Payer: ASR Commercial |
$924.57
|
| Rate for Payer: BCBS Complete |
$381.26
|
| Rate for Payer: BCBS Trust/PPO |
$780.54
|
| Rate for Payer: BCN Commercial |
$738.98
|
| Rate for Payer: Cash Price |
$762.53
|
| Rate for Payer: Cofinity Commercial |
$895.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.53
|
| Rate for Payer: Healthscope Commercial |
$953.16
|
| Rate for Payer: Healthscope Whirlpool |
$924.57
|
| Rate for Payer: Mclaren Commercial |
$857.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.19
|
| Rate for Payer: Nomi Health Commercial |
$781.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.16
|
| Rate for Payer: Priority Health Narrow Network |
$668.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.78
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$17,010.57
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,596.67 |
| Max. Negotiated Rate |
$17,010.57 |
| Rate for Payer: Aetna Commercial |
$15,309.51
|
| Rate for Payer: Aetna Medicare |
$8,505.28
|
| Rate for Payer: ASR ASR |
$16,500.25
|
| Rate for Payer: ASR Commercial |
$16,500.25
|
| Rate for Payer: BCBS Complete |
$6,804.23
|
| Rate for Payer: BCBS Trust/PPO |
$13,929.96
|
| Rate for Payer: BCN Commercial |
$13,188.29
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$15,989.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$17,010.57
|
| Rate for Payer: Healthscope Whirlpool |
$16,500.25
|
| Rate for Payer: Mclaren Commercial |
$15,309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,995.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,969.30
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$17,010.57
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,056.87 |
| Max. Negotiated Rate |
$17,010.57 |
| Rate for Payer: Aetna Commercial |
$15,309.51
|
| Rate for Payer: ASR ASR |
$16,500.25
|
| Rate for Payer: ASR Commercial |
$16,500.25
|
| Rate for Payer: BCBS Trust/PPO |
$13,861.91
|
| Rate for Payer: BCN Commercial |
$13,188.29
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$15,989.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$17,010.57
|
| Rate for Payer: Healthscope Whirlpool |
$16,500.25
|
| Rate for Payer: Mclaren Commercial |
$15,309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,969.30
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$11,875.31
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,718.95 |
| Max. Negotiated Rate |
$11,875.31 |
| Rate for Payer: Aetna Commercial |
$10,687.78
|
| Rate for Payer: ASR ASR |
$11,519.05
|
| Rate for Payer: ASR Commercial |
$11,519.05
|
| Rate for Payer: BCBS Trust/PPO |
$9,677.19
|
| Rate for Payer: BCN Commercial |
$9,206.93
|
| Rate for Payer: Cash Price |
$9,500.25
|
| Rate for Payer: Cofinity Commercial |
$11,162.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,500.25
|
| Rate for Payer: Healthscope Commercial |
$11,875.31
|
| Rate for Payer: Healthscope Whirlpool |
$11,519.05
|
| Rate for Payer: Mclaren Commercial |
$10,687.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,094.01
|
| Rate for Payer: Nomi Health Commercial |
$9,737.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,718.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,450.27
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$11,875.31
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,750.12 |
| Max. Negotiated Rate |
$11,875.31 |
| Rate for Payer: Aetna Commercial |
$10,687.78
|
| Rate for Payer: Aetna Medicare |
$5,937.66
|
| Rate for Payer: ASR ASR |
$11,519.05
|
| Rate for Payer: ASR Commercial |
$11,519.05
|
| Rate for Payer: BCBS Complete |
$4,750.12
|
| Rate for Payer: BCBS Trust/PPO |
$9,724.69
|
| Rate for Payer: BCN Commercial |
$9,206.93
|
| Rate for Payer: Cash Price |
$9,500.25
|
| Rate for Payer: Cofinity Commercial |
$11,162.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,500.25
|
| Rate for Payer: Healthscope Commercial |
$11,875.31
|
| Rate for Payer: Healthscope Whirlpool |
$11,519.05
|
| Rate for Payer: Mclaren Commercial |
$10,687.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,094.01
|
| Rate for Payer: Nomi Health Commercial |
$9,737.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,718.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,405.15
|
| Rate for Payer: Priority Health Narrow Network |
$8,324.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,450.27
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.96 |
| Max. Negotiated Rate |
$5,572.41 |
| Rate for Payer: Aetna Commercial |
$5,015.17
|
| Rate for Payer: Aetna Medicare |
$2,786.20
|
| Rate for Payer: ASR ASR |
$5,405.24
|
| Rate for Payer: ASR Commercial |
$5,405.24
|
| Rate for Payer: BCBS Complete |
$2,228.96
|
| Rate for Payer: BCBS Trust/PPO |
$4,563.25
|
| Rate for Payer: BCN Commercial |
$4,320.29
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$5,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,572.41
|
| Rate for Payer: Healthscope Whirlpool |
$5,405.24
|
| Rate for Payer: Mclaren Commercial |
$5,015.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,622.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,882.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,906.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,903.72
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,622.07 |
| Max. Negotiated Rate |
$5,572.41 |
| Rate for Payer: Aetna Commercial |
$5,015.17
|
| Rate for Payer: ASR ASR |
$5,405.24
|
| Rate for Payer: ASR Commercial |
$5,405.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,540.96
|
| Rate for Payer: BCN Commercial |
$4,320.29
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$5,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,572.41
|
| Rate for Payer: Healthscope Whirlpool |
$5,405.24
|
| Rate for Payer: Mclaren Commercial |
$5,015.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,622.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,903.72
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.79 |
| Max. Negotiated Rate |
$6,476.98 |
| Rate for Payer: Aetna Commercial |
$5,829.28
|
| Rate for Payer: Aetna Medicare |
$3,238.49
|
| Rate for Payer: ASR ASR |
$6,282.67
|
| Rate for Payer: ASR Commercial |
$6,282.67
|
| Rate for Payer: BCBS Complete |
$2,590.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,304.00
|
| Rate for Payer: BCN Commercial |
$5,021.60
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$6,088.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$6,476.98
|
| Rate for Payer: Healthscope Whirlpool |
$6,282.67
|
| Rate for Payer: Mclaren Commercial |
$5,829.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,675.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,540.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,699.74
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,210.04 |
| Max. Negotiated Rate |
$6,476.98 |
| Rate for Payer: Aetna Commercial |
$5,829.28
|
| Rate for Payer: ASR ASR |
$6,282.67
|
| Rate for Payer: ASR Commercial |
$6,282.67
|
| Rate for Payer: BCBS Trust/PPO |
$5,278.09
|
| Rate for Payer: BCN Commercial |
$5,021.60
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$6,088.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$6,476.98
|
| Rate for Payer: Healthscope Whirlpool |
$6,282.67
|
| Rate for Payer: Mclaren Commercial |
$5,829.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,699.74
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
IP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,703.65 |
| Max. Negotiated Rate |
$8,774.84 |
| Rate for Payer: Aetna Commercial |
$7,897.36
|
| Rate for Payer: ASR ASR |
$8,511.59
|
| Rate for Payer: ASR Commercial |
$8,511.59
|
| Rate for Payer: BCBS Trust/PPO |
$7,150.62
|
| Rate for Payer: BCN Commercial |
$6,803.13
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$8,248.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$8,774.84
|
| Rate for Payer: Healthscope Whirlpool |
$8,511.59
|
| Rate for Payer: Mclaren Commercial |
$7,897.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,721.86
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,509.94 |
| Max. Negotiated Rate |
$8,774.84 |
| Rate for Payer: Aetna Commercial |
$7,897.36
|
| Rate for Payer: Aetna Medicare |
$4,387.42
|
| Rate for Payer: ASR ASR |
$8,511.59
|
| Rate for Payer: ASR Commercial |
$8,511.59
|
| Rate for Payer: BCBS Complete |
$3,509.94
|
| Rate for Payer: BCBS Trust/PPO |
$7,185.72
|
| Rate for Payer: BCN Commercial |
$6,803.13
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$8,248.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$8,774.84
|
| Rate for Payer: Healthscope Whirlpool |
$8,511.59
|
| Rate for Payer: Mclaren Commercial |
$7,897.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,688.51
|
| Rate for Payer: Priority Health Narrow Network |
$6,151.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,721.86
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.24 |
| Max. Negotiated Rate |
$2,823.09 |
| Rate for Payer: Aetna Commercial |
$2,540.78
|
| Rate for Payer: Aetna Medicare |
$1,411.54
|
| Rate for Payer: ASR ASR |
$2,738.40
|
| Rate for Payer: ASR Commercial |
$2,738.40
|
| Rate for Payer: BCBS Complete |
$1,129.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,311.83
|
| Rate for Payer: BCN Commercial |
$2,188.74
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$2,653.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Healthscope Commercial |
$2,823.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,738.40
|
| Rate for Payer: Mclaren Commercial |
$2,540.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: Nomi Health Commercial |
$2,314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,473.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,978.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,484.32
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.01 |
| Max. Negotiated Rate |
$2,823.09 |
| Rate for Payer: Aetna Commercial |
$2,540.78
|
| Rate for Payer: ASR ASR |
$2,738.40
|
| Rate for Payer: ASR Commercial |
$2,738.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.54
|
| Rate for Payer: BCN Commercial |
$2,188.74
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$2,653.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Healthscope Commercial |
$2,823.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,738.40
|
| Rate for Payer: Mclaren Commercial |
$2,540.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: Nomi Health Commercial |
$2,314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,484.32
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,498.20 |
| Max. Negotiated Rate |
$11,245.50 |
| Rate for Payer: Aetna Commercial |
$10,120.95
|
| Rate for Payer: Aetna Medicare |
$5,622.75
|
| Rate for Payer: ASR ASR |
$10,908.14
|
| Rate for Payer: ASR Commercial |
$10,908.14
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: BCBS Trust/PPO |
$9,208.94
|
| Rate for Payer: BCN Commercial |
$8,718.64
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$10,570.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$11,245.50
|
| Rate for Payer: Healthscope Whirlpool |
$10,908.14
|
| Rate for Payer: Mclaren Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.68
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,853.31
|
| Rate for Payer: Priority Health Narrow Network |
$7,883.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,896.04
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,309.58 |
| Max. Negotiated Rate |
$11,245.50 |
| Rate for Payer: Aetna Commercial |
$10,120.95
|
| Rate for Payer: ASR ASR |
$10,908.14
|
| Rate for Payer: ASR Commercial |
$10,908.14
|
| Rate for Payer: BCBS Trust/PPO |
$9,163.96
|
| Rate for Payer: BCN Commercial |
$8,718.64
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$10,570.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$11,245.50
|
| Rate for Payer: Healthscope Whirlpool |
$10,908.14
|
| Rate for Payer: Mclaren Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.68
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,896.04
|
|
|
HC STENT NON COATED W SYS LVL 14
|
Facility
|
IP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.42 |
| Max. Negotiated Rate |
$1,420.65 |
| Rate for Payer: Aetna Commercial |
$1,278.58
|
| Rate for Payer: ASR ASR |
$1,378.03
|
| Rate for Payer: ASR Commercial |
$1,378.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.69
|
| Rate for Payer: BCN Commercial |
$1,101.43
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,335.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,420.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,378.03
|
| Rate for Payer: Mclaren Commercial |
$1,278.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,250.17
|
|
|
HC STENT NON COATED W SYS LVL 14
|
Facility
|
OP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.26 |
| Max. Negotiated Rate |
$1,420.65 |
| Rate for Payer: Aetna Commercial |
$1,278.58
|
| Rate for Payer: Aetna Medicare |
$710.32
|
| Rate for Payer: ASR ASR |
$1,378.03
|
| Rate for Payer: ASR Commercial |
$1,378.03
|
| Rate for Payer: BCBS Complete |
$568.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.37
|
| Rate for Payer: BCN Commercial |
$1,101.43
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,335.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,420.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,378.03
|
| Rate for Payer: Mclaren Commercial |
$1,278.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,244.77
|
| Rate for Payer: Priority Health Narrow Network |
$995.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,250.17
|
|
|
HC STENT NON COATED W SYS LVL 18
|
Facility
|
OP
|
$1,860.48
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.19 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,674.43
|
| Rate for Payer: Aetna Medicare |
$930.24
|
| Rate for Payer: ASR ASR |
$1,804.67
|
| Rate for Payer: ASR Commercial |
$1,804.67
|
| Rate for Payer: BCBS Complete |
$744.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.55
|
| Rate for Payer: BCN Commercial |
$1,442.43
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Commercial |
$1,748.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.38
|
| Rate for Payer: Healthscope Commercial |
$1,860.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,804.67
|
| Rate for Payer: Mclaren Commercial |
$1,674.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Nomi Health Commercial |
$1,525.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,630.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,304.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,637.22
|
|
|
HC STENT NON COATED W SYS LVL 18
|
Facility
|
IP
|
$1,860.48
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,209.31 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,674.43
|
| Rate for Payer: ASR ASR |
$1,804.67
|
| Rate for Payer: ASR Commercial |
$1,804.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,516.11
|
| Rate for Payer: BCN Commercial |
$1,442.43
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Commercial |
$1,748.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.38
|
| Rate for Payer: Healthscope Commercial |
$1,860.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,804.67
|
| Rate for Payer: Mclaren Commercial |
$1,674.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Nomi Health Commercial |
$1,525.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,637.22
|
|
|
HC STENT NONCOATED W SYS LVL 196
|
Facility
|
IP
|
$19,625.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,756.25 |
| Max. Negotiated Rate |
$19,625.00 |
| Rate for Payer: Aetna Commercial |
$17,662.50
|
| Rate for Payer: ASR ASR |
$19,036.25
|
| Rate for Payer: ASR Commercial |
$19,036.25
|
| Rate for Payer: BCBS Trust/PPO |
$15,992.41
|
| Rate for Payer: BCN Commercial |
$15,215.26
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$19,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$19,036.25
|
| Rate for Payer: Mclaren Commercial |
$17,662.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,756.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,270.00
|
|
|
HC STENT NONCOATED W SYS LVL 196
|
Facility
|
OP
|
$19,625.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,850.00 |
| Max. Negotiated Rate |
$19,625.00 |
| Rate for Payer: Aetna Commercial |
$17,662.50
|
| Rate for Payer: Aetna Medicare |
$9,812.50
|
| Rate for Payer: ASR ASR |
$19,036.25
|
| Rate for Payer: ASR Commercial |
$19,036.25
|
| Rate for Payer: BCBS Complete |
$7,850.00
|
| Rate for Payer: BCBS Trust/PPO |
$16,070.91
|
| Rate for Payer: BCN Commercial |
$15,215.26
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$19,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$19,036.25
|
| Rate for Payer: Mclaren Commercial |
$17,662.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,756.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,195.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,757.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,270.00
|
|
|
HC STENT NON COATED W SYS LVL 20
|
Facility
|
IP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.52 |
| Max. Negotiated Rate |
$2,051.57 |
| Rate for Payer: Aetna Commercial |
$1,846.41
|
| Rate for Payer: ASR ASR |
$1,990.02
|
| Rate for Payer: ASR Commercial |
$1,990.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.82
|
| Rate for Payer: BCN Commercial |
$1,590.58
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,928.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$2,051.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,990.02
|
| Rate for Payer: Mclaren Commercial |
$1,846.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Nomi Health Commercial |
$1,682.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,805.38
|
|
|
HC STENT NON COATED W SYS LVL 20
|
Facility
|
OP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.63 |
| Max. Negotiated Rate |
$2,051.57 |
| Rate for Payer: Aetna Commercial |
$1,846.41
|
| Rate for Payer: Aetna Medicare |
$1,025.78
|
| Rate for Payer: ASR ASR |
$1,990.02
|
| Rate for Payer: ASR Commercial |
$1,990.02
|
| Rate for Payer: BCBS Complete |
$820.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.03
|
| Rate for Payer: BCN Commercial |
$1,590.58
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,928.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$2,051.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,990.02
|
| Rate for Payer: Mclaren Commercial |
$1,846.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Nomi Health Commercial |
$1,682.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,797.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,438.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,805.38
|
|
|
HC STENT NON COATED W SYS LVL 24
|
Facility
|
IP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.64 |
| Max. Negotiated Rate |
$2,493.29 |
| Rate for Payer: Aetna Commercial |
$2,243.96
|
| Rate for Payer: ASR ASR |
$2,418.49
|
| Rate for Payer: ASR Commercial |
$2,418.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.78
|
| Rate for Payer: BCN Commercial |
$1,933.05
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Commercial |
$2,343.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,493.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,418.49
|
| Rate for Payer: Mclaren Commercial |
$2,243.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Nomi Health Commercial |
$2,044.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,194.10
|
|
|
HC STENT NON COATED W SYS LVL 24
|
Facility
|
OP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.32 |
| Max. Negotiated Rate |
$2,493.29 |
| Rate for Payer: Aetna Commercial |
$2,243.96
|
| Rate for Payer: Aetna Medicare |
$1,246.64
|
| Rate for Payer: ASR ASR |
$2,418.49
|
| Rate for Payer: ASR Commercial |
$2,418.49
|
| Rate for Payer: BCBS Complete |
$997.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,041.76
|
| Rate for Payer: BCN Commercial |
$1,933.05
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Commercial |
$2,343.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,493.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,418.49
|
| Rate for Payer: Mclaren Commercial |
$2,243.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Nomi Health Commercial |
$2,044.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,184.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,747.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,194.10
|
|
