|
HC STENT NONCOATED W SYS LVL 26
|
Facility
|
OP
|
$2,679.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.62 |
| Max. Negotiated Rate |
$2,679.06 |
| Rate for Payer: Aetna Commercial |
$2,411.15
|
| Rate for Payer: Aetna Medicare |
$1,339.53
|
| Rate for Payer: ASR ASR |
$2,598.69
|
| Rate for Payer: ASR Commercial |
$2,598.69
|
| Rate for Payer: BCBS Complete |
$1,071.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,193.88
|
| Rate for Payer: BCN Commercial |
$2,077.08
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Commercial |
$2,518.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,679.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,598.69
|
| Rate for Payer: Mclaren Commercial |
$2,411.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Nomi Health Commercial |
$2,196.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,347.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,878.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,357.57
|
|
|
HC STENT NONCOATED W SYS LVL 26
|
Facility
|
IP
|
$2,679.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,741.39 |
| Max. Negotiated Rate |
$2,679.06 |
| Rate for Payer: Aetna Commercial |
$2,411.15
|
| Rate for Payer: ASR ASR |
$2,598.69
|
| Rate for Payer: ASR Commercial |
$2,598.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,183.17
|
| Rate for Payer: BCN Commercial |
$2,077.08
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Commercial |
$2,518.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,679.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,598.69
|
| Rate for Payer: Mclaren Commercial |
$2,411.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Nomi Health Commercial |
$2,196.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,357.57
|
|
|
HC STENT NON COATED W SYS LVL 29
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,943.01 |
| Max. Negotiated Rate |
$2,989.24 |
| Rate for Payer: Aetna Commercial |
$2,690.32
|
| Rate for Payer: ASR ASR |
$2,899.56
|
| Rate for Payer: ASR Commercial |
$2,899.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.93
|
| Rate for Payer: BCN Commercial |
$2,317.56
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,809.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,989.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,899.56
|
| Rate for Payer: Mclaren Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Nomi Health Commercial |
$2,451.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,943.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.53
|
|
|
HC STENT NON COATED W SYS LVL 29
|
Facility
|
OP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.70 |
| Max. Negotiated Rate |
$2,989.24 |
| Rate for Payer: Aetna Commercial |
$2,690.32
|
| Rate for Payer: Aetna Medicare |
$1,494.62
|
| Rate for Payer: ASR ASR |
$2,899.56
|
| Rate for Payer: ASR Commercial |
$2,899.56
|
| Rate for Payer: BCBS Complete |
$1,195.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,447.89
|
| Rate for Payer: BCN Commercial |
$2,317.56
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,809.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,989.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,899.56
|
| Rate for Payer: Mclaren Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Nomi Health Commercial |
$2,451.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,943.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,619.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,095.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.53
|
|
|
HC STENT NON COATED W SYS LVL 35
|
Facility
|
IP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.48 |
| Max. Negotiated Rate |
$3,546.90 |
| Rate for Payer: Aetna Commercial |
$3,192.21
|
| Rate for Payer: ASR ASR |
$3,440.49
|
| Rate for Payer: ASR Commercial |
$3,440.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,890.37
|
| Rate for Payer: BCN Commercial |
$2,749.91
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,334.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,546.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,440.49
|
| Rate for Payer: Mclaren Commercial |
$3,192.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,121.27
|
|
|
HC STENT NON COATED W SYS LVL 35
|
Facility
|
OP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,418.76 |
| Max. Negotiated Rate |
$3,546.90 |
| Rate for Payer: Aetna Commercial |
$3,192.21
|
| Rate for Payer: Aetna Medicare |
$1,773.45
|
| Rate for Payer: ASR ASR |
$3,440.49
|
| Rate for Payer: ASR Commercial |
$3,440.49
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.56
|
| Rate for Payer: BCN Commercial |
$2,749.91
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,334.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,546.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,440.49
|
| Rate for Payer: Mclaren Commercial |
$3,192.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,107.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,486.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,121.27
|
|
|
HC STENT NONCOATED W SYS LVL 37
|
Facility
|
IP
|
$3,739.66
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.78 |
| Max. Negotiated Rate |
$3,739.66 |
| Rate for Payer: Aetna Commercial |
$3,365.69
|
| Rate for Payer: ASR ASR |
$3,627.47
|
| Rate for Payer: ASR Commercial |
$3,627.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,047.45
|
| Rate for Payer: BCN Commercial |
$2,899.36
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,515.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,739.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,627.47
|
| Rate for Payer: Mclaren Commercial |
$3,365.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Nomi Health Commercial |
$3,066.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,430.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,290.90
|
|
|
HC STENT NONCOATED W SYS LVL 37
|
Facility
|
OP
|
$3,739.66
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.86 |
| Max. Negotiated Rate |
$3,739.66 |
| Rate for Payer: Aetna Commercial |
$3,365.69
|
| Rate for Payer: Aetna Medicare |
$1,869.83
|
| Rate for Payer: ASR ASR |
$3,627.47
|
| Rate for Payer: ASR Commercial |
$3,627.47
|
| Rate for Payer: BCBS Complete |
$1,495.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,062.41
|
| Rate for Payer: BCN Commercial |
$2,899.36
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,515.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,739.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,627.47
|
| Rate for Payer: Mclaren Commercial |
$3,365.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Nomi Health Commercial |
$3,066.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,430.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,276.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,621.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,290.90
|
|
|
HC STENT NON COATED W SYS LVL 44
|
Facility
|
IP
|
$4,451.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.15 |
| Max. Negotiated Rate |
$4,451.00 |
| Rate for Payer: Aetna Commercial |
$4,005.90
|
| Rate for Payer: ASR ASR |
$4,317.47
|
| Rate for Payer: ASR Commercial |
$4,317.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,627.12
|
| Rate for Payer: BCN Commercial |
$3,450.86
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Commercial |
$4,183.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,451.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,317.47
|
| Rate for Payer: Mclaren Commercial |
$4,005.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Nomi Health Commercial |
$3,649.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,893.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,916.88
|
|
|
HC STENT NON COATED W SYS LVL 44
|
Facility
|
OP
|
$4,451.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.40 |
| Max. Negotiated Rate |
$4,451.00 |
| Rate for Payer: Aetna Commercial |
$4,005.90
|
| Rate for Payer: Aetna Medicare |
$2,225.50
|
| Rate for Payer: ASR ASR |
$4,317.47
|
| Rate for Payer: ASR Commercial |
$4,317.47
|
| Rate for Payer: BCBS Complete |
$1,780.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,644.92
|
| Rate for Payer: BCN Commercial |
$3,450.86
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Commercial |
$4,183.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,451.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,317.47
|
| Rate for Payer: Mclaren Commercial |
$4,005.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Nomi Health Commercial |
$3,649.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,893.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,899.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,120.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,916.88
|
|
|
HC STENT NON COATED W SYS LVL 49
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,225.30 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$4,465.80
|
| Rate for Payer: ASR ASR |
$4,813.14
|
| Rate for Payer: ASR Commercial |
$4,813.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,043.53
|
| Rate for Payer: BCN Commercial |
$3,847.04
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,664.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,962.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,813.14
|
| Rate for Payer: Mclaren Commercial |
$4,465.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,225.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,366.56
|
|
|
HC STENT NON COATED W SYS LVL 49
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.80 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$4,465.80
|
| Rate for Payer: Aetna Medicare |
$2,481.00
|
| Rate for Payer: ASR ASR |
$4,813.14
|
| Rate for Payer: ASR Commercial |
$4,813.14
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,063.38
|
| Rate for Payer: BCN Commercial |
$3,847.04
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,664.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,962.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,813.14
|
| Rate for Payer: Mclaren Commercial |
$4,465.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,225.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,347.70
|
| Rate for Payer: Priority Health Narrow Network |
$3,478.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,366.56
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
OP
|
$1,449.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.62 |
| Max. Negotiated Rate |
$1,449.06 |
| Rate for Payer: Aetna Commercial |
$1,304.15
|
| Rate for Payer: Aetna Medicare |
$724.53
|
| Rate for Payer: ASR ASR |
$1,405.59
|
| Rate for Payer: ASR Commercial |
$1,405.59
|
| Rate for Payer: BCBS Complete |
$579.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.64
|
| Rate for Payer: BCN Commercial |
$1,123.46
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,449.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,405.59
|
| Rate for Payer: Mclaren Commercial |
$1,304.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Nomi Health Commercial |
$1,188.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.17
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
IP
|
$1,449.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.89 |
| Max. Negotiated Rate |
$1,449.06 |
| Rate for Payer: Aetna Commercial |
$1,304.15
|
| Rate for Payer: ASR ASR |
$1,405.59
|
| Rate for Payer: ASR Commercial |
$1,405.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.84
|
| Rate for Payer: BCN Commercial |
$1,123.46
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,449.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,405.59
|
| Rate for Payer: Mclaren Commercial |
$1,304.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Nomi Health Commercial |
$1,188.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.17
|
|
|
HC STENT NON COATED W SYS LVL 53
|
Facility
|
IP
|
$5,488.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,567.30 |
| Max. Negotiated Rate |
$5,488.15 |
| Rate for Payer: Aetna Commercial |
$4,939.34
|
| Rate for Payer: ASR ASR |
$5,323.51
|
| Rate for Payer: ASR Commercial |
$5,323.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,472.29
|
| Rate for Payer: BCN Commercial |
$4,254.96
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Commercial |
$5,158.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Healthscope Commercial |
$5,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,323.51
|
| Rate for Payer: Mclaren Commercial |
$4,939.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Nomi Health Commercial |
$4,500.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,829.57
|
|
|
HC STENT NON COATED W SYS LVL 53
|
Facility
|
OP
|
$5,488.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,195.26 |
| Max. Negotiated Rate |
$5,488.15 |
| Rate for Payer: Aetna Commercial |
$4,939.34
|
| Rate for Payer: Aetna Medicare |
$2,744.08
|
| Rate for Payer: ASR ASR |
$5,323.51
|
| Rate for Payer: ASR Commercial |
$5,323.51
|
| Rate for Payer: BCBS Complete |
$2,195.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,494.25
|
| Rate for Payer: BCN Commercial |
$4,254.96
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Commercial |
$5,158.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Healthscope Commercial |
$5,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,323.51
|
| Rate for Payer: Mclaren Commercial |
$4,939.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Nomi Health Commercial |
$4,500.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,808.72
|
| Rate for Payer: Priority Health Narrow Network |
$3,847.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,829.57
|
|
|
HC STENT NON COATED W SYS LVL 57
|
Facility
|
OP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,313.16 |
| Max. Negotiated Rate |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: Aetna Medicare |
$2,891.45
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: ASR Commercial |
$5,609.41
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,735.62
|
| Rate for Payer: BCN Commercial |
$4,483.48
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$5,435.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,782.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,609.41
|
| Rate for Payer: Mclaren Commercial |
$5,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.46
|
| Rate for Payer: Nomi Health Commercial |
$4,741.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,066.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,053.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
|
HC STENT NON COATED W SYS LVL 57
|
Facility
|
IP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.88 |
| Max. Negotiated Rate |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: ASR Commercial |
$5,609.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,712.49
|
| Rate for Payer: BCN Commercial |
$4,483.48
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$5,435.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,782.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,609.41
|
| Rate for Payer: Mclaren Commercial |
$5,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.46
|
| Rate for Payer: Nomi Health Commercial |
$4,741.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
|
HC STENT NON COATED W SYS LVL 59
|
Facility
|
OP
|
$5,979.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,391.78 |
| Max. Negotiated Rate |
$5,979.44 |
| Rate for Payer: Aetna Commercial |
$5,381.50
|
| Rate for Payer: Aetna Medicare |
$2,989.72
|
| Rate for Payer: ASR ASR |
$5,800.06
|
| Rate for Payer: ASR Commercial |
$5,800.06
|
| Rate for Payer: BCBS Complete |
$2,391.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,896.56
|
| Rate for Payer: BCN Commercial |
$4,635.86
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Commercial |
$5,620.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Healthscope Commercial |
$5,979.44
|
| Rate for Payer: Healthscope Whirlpool |
$5,800.06
|
| Rate for Payer: Mclaren Commercial |
$5,381.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,886.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,239.19
|
| Rate for Payer: Priority Health Narrow Network |
$4,191.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,261.91
|
|
|
HC STENT NON COATED W SYS LVL 59
|
Facility
|
IP
|
$5,979.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.64 |
| Max. Negotiated Rate |
$5,979.44 |
| Rate for Payer: Aetna Commercial |
$5,381.50
|
| Rate for Payer: ASR ASR |
$5,800.06
|
| Rate for Payer: ASR Commercial |
$5,800.06
|
| Rate for Payer: BCBS Trust/PPO |
$4,872.65
|
| Rate for Payer: BCN Commercial |
$4,635.86
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Commercial |
$5,620.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Healthscope Commercial |
$5,979.44
|
| Rate for Payer: Healthscope Whirlpool |
$5,800.06
|
| Rate for Payer: Mclaren Commercial |
$5,381.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,886.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,261.91
|
|
|
HC STENT NON COATED W SYS LVL 67
|
Facility
|
OP
|
$6,779.33
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.73 |
| Max. Negotiated Rate |
$6,779.33 |
| Rate for Payer: Aetna Commercial |
$6,101.40
|
| Rate for Payer: Aetna Medicare |
$3,389.66
|
| Rate for Payer: ASR ASR |
$6,575.95
|
| Rate for Payer: ASR Commercial |
$6,575.95
|
| Rate for Payer: BCBS Complete |
$2,711.73
|
| Rate for Payer: BCBS Trust/PPO |
$5,551.59
|
| Rate for Payer: BCN Commercial |
$5,256.01
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Commercial |
$6,372.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Healthscope Commercial |
$6,779.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,575.95
|
| Rate for Payer: Mclaren Commercial |
$6,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,406.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,940.05
|
| Rate for Payer: Priority Health Narrow Network |
$4,752.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,965.81
|
|
|
HC STENT NON COATED W SYS LVL 67
|
Facility
|
IP
|
$6,779.33
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,406.56 |
| Max. Negotiated Rate |
$6,779.33 |
| Rate for Payer: Aetna Commercial |
$6,101.40
|
| Rate for Payer: ASR ASR |
$6,575.95
|
| Rate for Payer: ASR Commercial |
$6,575.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,524.48
|
| Rate for Payer: BCN Commercial |
$5,256.01
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Commercial |
$6,372.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Healthscope Commercial |
$6,779.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,575.95
|
| Rate for Payer: Mclaren Commercial |
$6,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,406.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,965.81
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
IP
|
$244.19
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.72 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Aetna Commercial |
$219.77
|
| Rate for Payer: ASR ASR |
$236.86
|
| Rate for Payer: ASR Commercial |
$236.86
|
| Rate for Payer: BCBS Trust/PPO |
$198.99
|
| Rate for Payer: BCN Commercial |
$189.32
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$244.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.86
|
| Rate for Payer: Mclaren Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.89
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
OP
|
$244.19
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Aetna Commercial |
$219.77
|
| Rate for Payer: Aetna Medicare |
$122.10
|
| Rate for Payer: ASR ASR |
$236.86
|
| Rate for Payer: ASR Commercial |
$236.86
|
| Rate for Payer: BCBS Complete |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$199.97
|
| Rate for Payer: BCN Commercial |
$189.32
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$244.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.86
|
| Rate for Payer: Mclaren Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.96
|
| Rate for Payer: Priority Health Narrow Network |
$171.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.89
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
OP
|
$501.23
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.49 |
| Max. Negotiated Rate |
$501.23 |
| Rate for Payer: Aetna Commercial |
$451.11
|
| Rate for Payer: Aetna Medicare |
$250.62
|
| Rate for Payer: ASR ASR |
$486.19
|
| Rate for Payer: ASR Commercial |
$486.19
|
| Rate for Payer: BCBS Complete |
$200.49
|
| Rate for Payer: BCBS Trust/PPO |
$410.46
|
| Rate for Payer: BCN Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Commercial |
$471.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$501.23
|
| Rate for Payer: Healthscope Whirlpool |
$486.19
|
| Rate for Payer: Mclaren Commercial |
$451.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Nomi Health Commercial |
$411.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.18
|
| Rate for Payer: Priority Health Narrow Network |
$351.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.08
|
|
