|
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 |
$2,234.55 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,305.49
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Advantage |
$2,482.83
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,192.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health SBD |
$2,234.55
|
|
|
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 |
$1,393.93 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna Medicare |
$1,773.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,305.49
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Advantage |
$2,482.83
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,192.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,837.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health SBD |
$2,234.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.49
|
| Rate for Payer: UHC Core |
$1,847.93
|
| Rate for Payer: UHC Exchange |
$1,393.93
|
|
|
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 |
$2,355.99 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,430.78
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Advantage |
$2,617.76
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,365.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health SBD |
$2,355.99
|
|
|
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 |
$1,469.69 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: Aetna Medicare |
$1,869.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,430.78
|
| Rate for Payer: BCBS Complete |
$1,495.86
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Advantage |
$2,617.76
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,365.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,991.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health SBD |
$2,355.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,430.78
|
| Rate for Payer: UHC Core |
$1,948.36
|
| Rate for Payer: UHC Exchange |
$1,469.69
|
|
|
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 |
$1,749.24 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: Aetna Medicare |
$2,225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,893.15
|
| Rate for Payer: BCBS Complete |
$1,780.40
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Advantage |
$3,115.70
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,005.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,560.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health SBD |
$2,804.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,893.15
|
| Rate for Payer: UHC Core |
$2,318.97
|
| Rate for Payer: UHC Exchange |
$1,749.24
|
|
|
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 |
$2,804.13 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,893.15
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Advantage |
$3,115.70
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,005.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health SBD |
$2,804.13
|
|
|
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 |
$3,126.06 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,225.30
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Advantage |
$3,473.40
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health SBD |
$3,126.06
|
|
|
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 |
$1,950.07 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna Medicare |
$2,481.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,225.30
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Advantage |
$3,473.40
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,969.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health SBD |
$3,126.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,225.30
|
| Rate for Payer: UHC Core |
$2,585.20
|
| Rate for Payer: UHC Exchange |
$1,950.07
|
|
|
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 |
$912.91 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.89
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Advantage |
$1,014.34
|
| Rate for Payer: Cofinity Commercial |
$1,246.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,304.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: PHP Commercial |
$1,231.70
|
| Rate for Payer: Priority Health SBD |
$912.91
|
|
|
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 |
$569.48 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Aetna Medicare |
$724.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.89
|
| Rate for Payer: BCBS Complete |
$579.62
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Advantage |
$1,014.34
|
| Rate for Payer: Cofinity Commercial |
$1,246.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,304.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,159.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: PHP Commercial |
$1,231.70
|
| Rate for Payer: Priority Health SBD |
$912.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.89
|
| Rate for Payer: UHC Core |
$754.96
|
| Rate for Payer: UHC Exchange |
$569.48
|
|
|
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 |
$3,457.53 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,567.30
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Advantage |
$3,841.70
|
| Rate for Payer: Cofinity Commercial |
$4,719.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Healthscope Commercial |
$4,939.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: PHP Commercial |
$4,664.93
|
| Rate for Payer: Priority Health SBD |
$3,457.53
|
|
|
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 |
$2,156.84 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: Aetna Medicare |
$2,744.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,567.30
|
| Rate for Payer: BCBS Complete |
$2,195.26
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Advantage |
$3,841.70
|
| Rate for Payer: Cofinity Commercial |
$4,719.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Healthscope Commercial |
$4,939.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,390.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: PHP Commercial |
$4,664.93
|
| Rate for Payer: Priority Health SBD |
$3,457.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,567.30
|
| Rate for Payer: UHC Core |
$2,859.33
|
| Rate for Payer: UHC Exchange |
$2,156.84
|
|
|
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 |
$3,643.23 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,758.89
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Advantage |
$4,048.03
|
| Rate for Payer: Cofinity Commercial |
$4,973.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: PHP Commercial |
$4,915.47
|
| Rate for Payer: Priority Health SBD |
$3,643.23
|
|
|
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 |
$2,272.68 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: Aetna Medicare |
$2,891.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,758.89
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Advantage |
$4,048.03
|
| Rate for Payer: Cofinity Commercial |
$4,973.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,204.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,626.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: PHP Commercial |
$4,915.47
|
| Rate for Payer: Priority Health SBD |
$3,643.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,758.89
|
| Rate for Payer: UHC Core |
$3,012.89
|
| Rate for Payer: UHC Exchange |
$2,272.68
|
|
|
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 |
$2,349.92 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: Aetna Medicare |
$2,989.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,886.64
|
| Rate for Payer: BCBS Complete |
$2,391.78
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Advantage |
$4,185.61
|
| Rate for Payer: Cofinity Commercial |
$5,142.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Healthscope Commercial |
$5,381.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,783.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,484.58
|
| Rate for Payer: PHP Commercial |
$5,082.52
|
| Rate for Payer: Priority Health SBD |
$3,767.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,886.64
|
| Rate for Payer: UHC Core |
$3,115.29
|
| Rate for Payer: UHC Exchange |
$2,349.92
|
|
|
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 |
$3,767.05 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,886.64
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Advantage |
$4,185.61
|
| Rate for Payer: Cofinity Commercial |
$5,142.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Healthscope Commercial |
$5,381.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,484.58
|
| Rate for Payer: PHP Commercial |
$5,082.52
|
| Rate for Payer: Priority Health SBD |
$3,767.05
|
|
|
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 |
$4,270.98 |
| Max. Negotiated Rate |
$6,101.40 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,406.56
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Advantage |
$4,745.53
|
| Rate for Payer: Cofinity Commercial |
$5,830.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Healthscope Commercial |
$6,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,084.50
|
| Rate for Payer: PHP Commercial |
$5,762.43
|
| Rate for Payer: Priority Health SBD |
$4,270.98
|
|
|
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 |
$2,664.28 |
| Max. Negotiated Rate |
$6,101.40 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: Aetna Medicare |
$3,389.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,406.56
|
| Rate for Payer: BCBS Complete |
$2,711.73
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Advantage |
$4,745.53
|
| Rate for Payer: Cofinity Commercial |
$5,830.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Healthscope Commercial |
$6,101.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,423.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,084.50
|
| Rate for Payer: PHP Commercial |
$5,762.43
|
| Rate for Payer: Priority Health SBD |
$4,270.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,406.56
|
| Rate for Payer: UHC Core |
$3,532.03
|
| Rate for Payer: UHC Exchange |
$2,664.28
|
|
|
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 |
$95.97 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: Aetna Medicare |
$122.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.72
|
| Rate for Payer: BCBS Complete |
$97.68
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Advantage |
$170.93
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.14
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health SBD |
$153.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.72
|
| Rate for Payer: UHC Core |
$127.22
|
| Rate for Payer: UHC Exchange |
$95.97
|
|
|
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 |
$153.84 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.72
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Advantage |
$170.93
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.14
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health SBD |
$153.84
|
|
|
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 |
$196.98 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: Aetna Medicare |
$250.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.80
|
| Rate for Payer: BCBS Complete |
$200.49
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Advantage |
$350.86
|
| Rate for Payer: Cofinity Commercial |
$431.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$451.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.92
|
| Rate for Payer: PHP Commercial |
$426.05
|
| Rate for Payer: Priority Health SBD |
$315.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.80
|
| Rate for Payer: UHC Core |
$261.14
|
| Rate for Payer: UHC Exchange |
$196.98
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
IP
|
$501.23
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.80
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Advantage |
$350.86
|
| Rate for Payer: Cofinity Commercial |
$431.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$451.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.92
|
| Rate for Payer: PHP Commercial |
$426.05
|
| Rate for Payer: Priority Health SBD |
$315.77
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
IP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.40 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.17
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Advantage |
$587.11
|
| Rate for Payer: Cofinity Commercial |
$721.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Healthscope Commercial |
$754.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.05
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: Priority Health SBD |
$528.40
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
OP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.62 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: Aetna Medicare |
$419.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.17
|
| Rate for Payer: BCBS Complete |
$335.49
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Advantage |
$587.11
|
| Rate for Payer: Cofinity Commercial |
$721.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Healthscope Commercial |
$754.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$670.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.05
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: Priority Health SBD |
$528.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.17
|
| Rate for Payer: UHC Core |
$436.98
|
| Rate for Payer: UHC Exchange |
$329.62
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
OP
|
$10,828.91
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,331.56 |
| Max. Negotiated Rate |
$9,746.02 |
| Rate for Payer: Aetna Commercial |
$9,204.57
|
| Rate for Payer: Aetna Medicare |
$5,414.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,038.79
|
| Rate for Payer: BCBS Complete |
$4,331.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,352.01
|
| Rate for Payer: BCN Commercial |
$6,352.01
|
| Rate for Payer: Cash Price |
$8,663.13
|
| Rate for Payer: Cash Price |
$8,663.13
|
| Rate for Payer: Cofinity Advantage |
$7,580.24
|
| Rate for Payer: Cofinity Commercial |
$9,312.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,663.13
|
| Rate for Payer: Healthscope Commercial |
$9,746.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,663.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,204.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,121.68
|
| Rate for Payer: PHP Commercial |
$9,204.57
|
| Rate for Payer: Priority Health SBD |
$6,822.21
|
|
