|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,349.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,508.12 |
| Max. Negotiated Rate |
$5,714.98 |
| Rate for Payer: Aetna Commercial |
$5,397.48
|
| Rate for Payer: Aetna Medicare |
$1,650.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.37
|
| Rate for Payer: BCBS Complete |
$2,539.99
|
| Rate for Payer: BCBS MAPPO |
$1,587.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,937.11
|
| Rate for Payer: BCN Commercial |
$4,937.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.50
|
| Rate for Payer: Cash Price |
$5,079.98
|
| Rate for Payer: Cofinity Commercial |
$5,460.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,079.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.50
|
| Rate for Payer: Healthscope Commercial |
$5,714.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,762.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,666.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,397.48
|
| Rate for Payer: PACE Senior Care Partners |
$1,508.12
|
| Rate for Payer: PACE SWMI |
$1,587.50
|
| Rate for Payer: PHP Commercial |
$5,397.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,444.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,524.48
|
| Rate for Payer: Priority Health Medicare |
$1,587.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,872.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,587.98
|
| Rate for Payer: UHC Core |
$5,302.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.12
|
| Rate for Payer: VA VA |
$1,587.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,762.48
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,602.78
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.16 |
| Max. Negotiated Rate |
$7,742.50 |
| Rate for Payer: Aetna Commercial |
$7,312.36
|
| Rate for Payer: Aetna Medicare |
$2,236.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,688.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,688.37
|
| Rate for Payer: BCBS Complete |
$3,441.11
|
| Rate for Payer: BCBS MAPPO |
$2,150.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,688.66
|
| Rate for Payer: BCN Commercial |
$6,688.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,150.70
|
| Rate for Payer: Cash Price |
$6,882.22
|
| Rate for Payer: Cofinity Commercial |
$7,398.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,882.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,150.70
|
| Rate for Payer: Healthscope Commercial |
$7,742.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,452.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,258.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,473.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,312.36
|
| Rate for Payer: PACE Senior Care Partners |
$2,043.16
|
| Rate for Payer: PACE SWMI |
$2,150.70
|
| Rate for Payer: PHP Commercial |
$7,312.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,150.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,021.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,484.42
|
| Rate for Payer: Priority Health Medicare |
$2,150.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,246.84
|
| Rate for Payer: Railroad Medicare Medicare |
$2,150.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,570.45
|
| Rate for Payer: UHC Core |
$7,183.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,150.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,215.22
|
| Rate for Payer: VA VA |
$2,150.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,452.08
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
IP
|
$8,602.78
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,246.84 |
| Max. Negotiated Rate |
$7,742.50 |
| Rate for Payer: Aetna Commercial |
$7,312.36
|
| Rate for Payer: BCBS Trust/PPO |
$6,648.23
|
| Rate for Payer: BCN Commercial |
$6,648.23
|
| Rate for Payer: Cash Price |
$6,882.22
|
| Rate for Payer: Cofinity Commercial |
$7,398.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,882.22
|
| Rate for Payer: Healthscope Commercial |
$7,742.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,452.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,312.36
|
| Rate for Payer: PHP Commercial |
$7,312.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,021.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,484.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,246.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,570.45
|
| Rate for Payer: UHC Core |
$7,183.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,452.08
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,767.74
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,688.04 |
| Max. Negotiated Rate |
$2,490.97 |
| Rate for Payer: Aetna Commercial |
$2,352.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,138.91
|
| Rate for Payer: BCN Commercial |
$2,138.91
|
| Rate for Payer: Cash Price |
$2,214.19
|
| Rate for Payer: Cofinity Commercial |
$2,380.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,214.19
|
| Rate for Payer: Healthscope Commercial |
$2,490.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,075.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,352.58
|
| Rate for Payer: PHP Commercial |
$2,352.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,937.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,407.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,688.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,435.61
|
| Rate for Payer: UHC Core |
$2,311.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,075.80
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,767.74
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.34 |
| Max. Negotiated Rate |
$2,490.97 |
| Rate for Payer: Aetna Commercial |
$2,352.58
|
| Rate for Payer: Aetna Medicare |
$719.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$864.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$864.92
|
| Rate for Payer: BCBS Complete |
$1,107.10
|
| Rate for Payer: BCBS MAPPO |
$691.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,151.92
|
| Rate for Payer: BCN Commercial |
$2,151.92
|
| Rate for Payer: BCN Medicare Advantage |
$691.94
|
| Rate for Payer: Cash Price |
$2,214.19
|
| Rate for Payer: Cofinity Commercial |
$2,380.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,214.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$691.94
|
| Rate for Payer: Healthscope Commercial |
$2,490.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,075.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$726.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$795.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,352.58
|
| Rate for Payer: PACE Senior Care Partners |
$657.34
|
| Rate for Payer: PACE SWMI |
$691.94
|
| Rate for Payer: PHP Commercial |
$2,352.58
|
| Rate for Payer: PHP Medicare Advantage |
$691.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,937.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,407.93
|
| Rate for Payer: Priority Health Medicare |
$691.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,688.04
|
| Rate for Payer: Railroad Medicare Medicare |
$691.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,435.61
|
| Rate for Payer: UHC Core |
$2,311.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$691.94
|
| Rate for Payer: UHC Medicare Advantage |
$712.69
|
| Rate for Payer: VA VA |
$691.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,075.80
|
|
|
HC STENT NON-COATED W/DELIVERY SYS
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,178.48 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna Medicare |
$1,290.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,550.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,550.62
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: BCBS MAPPO |
$1,240.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,857.96
|
| Rate for Payer: BCN Commercial |
$3,857.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,240.50
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,240.50
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,302.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,426.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,217.70
|
| Rate for Payer: PACE Senior Care Partners |
$1,178.48
|
| Rate for Payer: PACE SWMI |
$1,240.50
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,240.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,473.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,316.94
|
| Rate for Payer: Priority Health Medicare |
$1,240.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,026.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,240.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,366.56
|
| Rate for Payer: UHC Core |
$4,143.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,240.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,277.72
|
| Rate for Payer: VA VA |
$1,240.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,721.50
|
|
|
HC STENT NON-COATED W/DELIVERY SYS
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,026.32 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,834.63
|
| Rate for Payer: BCN Commercial |
$3,834.63
|
| Rate for Payer: Cash Price |
$3,969.60
|
| 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: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,217.70
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,473.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,316.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,026.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,366.56
|
| Rate for Payer: UHC Core |
$4,143.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,721.50
|
|
|
HC STENT NONCOATED W SYS LVL 19
|
Facility
|
IP
|
$19,625.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.29 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: BCBS Trust/PPO |
$15,166.20
|
| Rate for Payer: BCN Commercial |
$15,166.20
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$17,662.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,681.25
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,737.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,073.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,969.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,270.00
|
| Rate for Payer: UHC Core |
$16,386.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,718.75
|
|
|
HC STENT NONCOATED W SYS LVL 19
|
Facility
|
OP
|
$19,625.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,660.94 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: Aetna Medicare |
$5,102.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,132.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,132.81
|
| Rate for Payer: BCBS Complete |
$7,850.00
|
| Rate for Payer: BCBS MAPPO |
$4,906.25
|
| Rate for Payer: BCBS Trust/PPO |
$15,258.44
|
| Rate for Payer: BCN Commercial |
$15,258.44
|
| Rate for Payer: BCN Medicare Advantage |
$4,906.25
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,906.25
|
| Rate for Payer: Healthscope Commercial |
$17,662.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,151.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,642.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,681.25
|
| Rate for Payer: PACE Senior Care Partners |
$4,660.94
|
| Rate for Payer: PACE SWMI |
$4,906.25
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: PHP Medicare Advantage |
$4,906.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,737.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,073.75
|
| Rate for Payer: Priority Health Medicare |
$4,906.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,969.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4,906.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,270.00
|
| Rate for Payer: UHC Core |
$16,386.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,906.25
|
| Rate for Payer: UHC Medicare Advantage |
$5,053.44
|
| Rate for Payer: VA VA |
$4,906.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,718.75
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
OP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$1,278.58 |
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: Aetna Medicare |
$369.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.95
|
| Rate for Payer: BCBS Complete |
$568.26
|
| Rate for Payer: BCBS MAPPO |
$355.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.56
|
| Rate for Payer: BCN Commercial |
$1,104.56
|
| Rate for Payer: BCN Medicare Advantage |
$355.16
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,221.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.16
|
| Rate for Payer: Healthscope Commercial |
$1,278.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.55
|
| Rate for Payer: PACE Senior Care Partners |
$337.40
|
| Rate for Payer: PACE SWMI |
$355.16
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: PHP Medicare Advantage |
$355.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.97
|
| Rate for Payer: Priority Health Medicare |
$355.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$866.45
|
| Rate for Payer: Railroad Medicare Medicare |
$355.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,250.17
|
| Rate for Payer: UHC Core |
$1,186.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.16
|
| Rate for Payer: UHC Medicare Advantage |
$365.82
|
| Rate for Payer: VA VA |
$355.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.49
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
IP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.45 |
| Max. Negotiated Rate |
$1,278.58 |
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.88
|
| Rate for Payer: BCN Commercial |
$1,097.88
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,221.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,278.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.55
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$866.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,250.17
|
| Rate for Payer: UHC Core |
$1,186.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.49
|
|
|
HC STENT NONCOATED W SYS LVL 6
|
Facility
|
OP
|
$2,011.34
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.69 |
| Max. Negotiated Rate |
$1,810.21 |
| Rate for Payer: Aetna Commercial |
$1,709.64
|
| Rate for Payer: Aetna Medicare |
$522.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$628.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$628.54
|
| Rate for Payer: BCBS Complete |
$804.54
|
| Rate for Payer: BCBS MAPPO |
$502.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,563.82
|
| Rate for Payer: BCN Commercial |
$1,563.82
|
| Rate for Payer: BCN Medicare Advantage |
$502.84
|
| Rate for Payer: Cash Price |
$1,609.07
|
| Rate for Payer: Cofinity Commercial |
$1,729.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,609.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.84
|
| Rate for Payer: Healthscope Commercial |
$1,810.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,508.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$527.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$578.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,709.64
|
| Rate for Payer: PACE Senior Care Partners |
$477.69
|
| Rate for Payer: PACE SWMI |
$502.84
|
| Rate for Payer: PHP Commercial |
$1,709.64
|
| Rate for Payer: PHP Medicare Advantage |
$502.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,749.87
|
| Rate for Payer: Priority Health Medicare |
$502.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,226.72
|
| Rate for Payer: Railroad Medicare Medicare |
$502.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,769.98
|
| Rate for Payer: UHC Core |
$1,679.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.84
|
| Rate for Payer: UHC Medicare Advantage |
$517.92
|
| Rate for Payer: VA VA |
$502.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,508.50
|
|
|
HC STENT NONCOATED W SYS LVL 6
|
Facility
|
IP
|
$2,011.34
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.72 |
| Max. Negotiated Rate |
$1,810.21 |
| Rate for Payer: Aetna Commercial |
$1,709.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.36
|
| Rate for Payer: BCN Commercial |
$1,554.36
|
| Rate for Payer: Cash Price |
$1,609.07
|
| Rate for Payer: Cofinity Commercial |
$1,729.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,609.07
|
| Rate for Payer: Healthscope Commercial |
$1,810.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,709.64
|
| Rate for Payer: PHP Commercial |
$1,709.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,749.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,226.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,769.98
|
| Rate for Payer: UHC Core |
$1,679.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,508.50
|
|
|
HC STENT NONCOATED W SYS LVL 7
|
Facility
|
IP
|
$2,444.40
|
|
|
Service Code
|
HCPCS c1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.84 |
| Max. Negotiated Rate |
$2,199.96 |
| Rate for Payer: Aetna Commercial |
$2,077.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.03
|
| Rate for Payer: BCN Commercial |
$1,889.03
|
| Rate for Payer: Cash Price |
$1,955.52
|
| Rate for Payer: Cofinity Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.52
|
| Rate for Payer: Healthscope Commercial |
$2,199.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,833.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,077.74
|
| Rate for Payer: PHP Commercial |
$2,077.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,126.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,490.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,151.07
|
| Rate for Payer: UHC Core |
$2,041.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,833.30
|
|
|
HC STENT NONCOATED W SYS LVL 7
|
Facility
|
OP
|
$2,444.40
|
|
|
Service Code
|
HCPCS c1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.54 |
| Max. Negotiated Rate |
$2,199.96 |
| Rate for Payer: Aetna Commercial |
$2,077.74
|
| Rate for Payer: Aetna Medicare |
$635.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$763.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$763.88
|
| Rate for Payer: BCBS Complete |
$977.76
|
| Rate for Payer: BCBS MAPPO |
$611.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,900.52
|
| Rate for Payer: BCN Commercial |
$1,900.52
|
| Rate for Payer: BCN Medicare Advantage |
$611.10
|
| Rate for Payer: Cash Price |
$1,955.52
|
| Rate for Payer: Cofinity Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.10
|
| Rate for Payer: Healthscope Commercial |
$2,199.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,833.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$641.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$702.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,077.74
|
| Rate for Payer: PACE Senior Care Partners |
$580.54
|
| Rate for Payer: PACE SWMI |
$611.10
|
| Rate for Payer: PHP Commercial |
$2,077.74
|
| Rate for Payer: PHP Medicare Advantage |
$611.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,126.63
|
| Rate for Payer: Priority Health Medicare |
$611.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,490.84
|
| Rate for Payer: Railroad Medicare Medicare |
$611.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,151.07
|
| Rate for Payer: UHC Core |
$2,041.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$611.10
|
| Rate for Payer: UHC Medicare Advantage |
$629.43
|
| Rate for Payer: VA VA |
$611.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,833.30
|
|
|
HC STENT NONCOATED W SYS LVL 8
|
Facility
|
OP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.39 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna Medicare |
$922.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,108.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,108.41
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: BCBS MAPPO |
$886.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,757.71
|
| Rate for Payer: BCN Commercial |
$2,757.71
|
| Rate for Payer: BCN Medicare Advantage |
$886.72
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.72
|
| Rate for Payer: Healthscope Commercial |
$3,192.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$931.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,019.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,014.86
|
| Rate for Payer: PACE Senior Care Partners |
$842.39
|
| Rate for Payer: PACE SWMI |
$886.72
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: PHP Medicare Advantage |
$886.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,482.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,085.80
|
| Rate for Payer: Priority Health Medicare |
$886.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,163.25
|
| Rate for Payer: Railroad Medicare Medicare |
$886.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,121.27
|
| Rate for Payer: UHC Core |
$2,961.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.72
|
| Rate for Payer: UHC Medicare Advantage |
$913.33
|
| Rate for Payer: VA VA |
$886.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
HC STENT NONCOATED W SYS LVL 8
|
Facility
|
IP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,163.25 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,741.04
|
| Rate for Payer: BCN Commercial |
$2,741.04
|
| Rate for Payer: Cash Price |
$2,837.52
|
| 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: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,014.86
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,482.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,085.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,163.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,121.27
|
| Rate for Payer: UHC Core |
$2,961.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
IP
|
$239.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.01 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: BCBS Trust/PPO |
$185.01
|
| Rate for Payer: BCN Commercial |
$185.01
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.67
|
| Rate for Payer: UHC Core |
$199.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
OP
|
$239.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna Medicare |
$62.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.81
|
| Rate for Payer: BCBS Complete |
$95.76
|
| Rate for Payer: BCBS MAPPO |
$59.85
|
| Rate for Payer: BCBS Trust/PPO |
$186.13
|
| Rate for Payer: BCN Commercial |
$186.13
|
| Rate for Payer: BCN Medicare Advantage |
$59.85
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.85
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.49
|
| Rate for Payer: PACE Senior Care Partners |
$56.86
|
| Rate for Payer: PACE SWMI |
$59.85
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: PHP Medicare Advantage |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.28
|
| Rate for Payer: Priority Health Medicare |
$59.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.01
|
| Rate for Payer: Railroad Medicare Medicare |
$59.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.67
|
| Rate for Payer: UHC Core |
$199.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.85
|
| Rate for Payer: UHC Medicare Advantage |
$61.65
|
| Rate for Payer: VA VA |
$59.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
HCPCS c2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.71 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$127.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.56
|
| Rate for Payer: BCBS Complete |
$196.56
|
| Rate for Payer: BCBS MAPPO |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$382.06
|
| Rate for Payer: BCN Commercial |
$382.06
|
| Rate for Payer: BCN Medicare Advantage |
$122.85
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.85
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.69
|
| Rate for Payer: PACE Senior Care Partners |
$116.71
|
| Rate for Payer: PACE SWMI |
$122.85
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: PHP Medicare Advantage |
$122.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$427.52
|
| Rate for Payer: Priority Health Medicare |
$122.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.70
|
| Rate for Payer: Railroad Medicare Medicare |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.43
|
| Rate for Payer: UHC Core |
$410.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.85
|
| Rate for Payer: UHC Medicare Advantage |
$126.54
|
| Rate for Payer: VA VA |
$122.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
HCPCS c2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.70 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$379.75
|
| Rate for Payer: BCN Commercial |
$379.75
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.69
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$427.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.43
|
| Rate for Payer: UHC Core |
$410.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
IP
|
$822.28
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.51 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Aetna Commercial |
$698.94
|
| Rate for Payer: BCBS Trust/PPO |
$635.46
|
| Rate for Payer: BCN Commercial |
$635.46
|
| Rate for Payer: Cash Price |
$657.82
|
| Rate for Payer: Cofinity Commercial |
$707.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.82
|
| Rate for Payer: Healthscope Commercial |
$740.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.94
|
| Rate for Payer: PHP Commercial |
$698.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.61
|
| Rate for Payer: UHC Core |
$686.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.71
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
OP
|
$822.28
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.29 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Aetna Commercial |
$698.94
|
| Rate for Payer: Aetna Medicare |
$213.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.96
|
| Rate for Payer: BCBS Complete |
$328.91
|
| Rate for Payer: BCBS MAPPO |
$205.57
|
| Rate for Payer: BCBS Trust/PPO |
$639.32
|
| Rate for Payer: BCN Commercial |
$639.32
|
| Rate for Payer: BCN Medicare Advantage |
$205.57
|
| Rate for Payer: Cash Price |
$657.82
|
| Rate for Payer: Cofinity Commercial |
$707.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.57
|
| Rate for Payer: Healthscope Commercial |
$740.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$215.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.94
|
| Rate for Payer: PACE Senior Care Partners |
$195.29
|
| Rate for Payer: PACE SWMI |
$205.57
|
| Rate for Payer: PHP Commercial |
$698.94
|
| Rate for Payer: PHP Medicare Advantage |
$205.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.38
|
| Rate for Payer: Priority Health Medicare |
$205.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.51
|
| Rate for Payer: Railroad Medicare Medicare |
$205.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.61
|
| Rate for Payer: UHC Core |
$686.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.57
|
| Rate for Payer: UHC Medicare Advantage |
$211.74
|
| Rate for Payer: VA VA |
$205.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.71
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
IP
|
$10,408.41
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,348.09 |
| Max. Negotiated Rate |
$9,367.57 |
| Rate for Payer: Aetna Commercial |
$8,847.15
|
| Rate for Payer: BCBS Trust/PPO |
$8,043.62
|
| Rate for Payer: BCN Commercial |
$8,043.62
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cofinity Commercial |
$8,951.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,326.73
|
| Rate for Payer: Healthscope Commercial |
$9,367.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,806.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,847.15
|
| Rate for Payer: PHP Commercial |
$8,847.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,285.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,055.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,348.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,159.40
|
| Rate for Payer: UHC Core |
$8,691.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,806.31
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
OP
|
$10,408.41
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,472.00 |
| Max. Negotiated Rate |
$9,367.57 |
| Rate for Payer: Aetna Commercial |
$8,847.15
|
| Rate for Payer: Aetna Medicare |
$2,706.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,252.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,252.63
|
| Rate for Payer: BCBS Complete |
$4,163.36
|
| Rate for Payer: BCBS MAPPO |
$2,602.10
|
| Rate for Payer: BCBS Trust/PPO |
$8,092.54
|
| Rate for Payer: BCN Commercial |
$8,092.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,602.10
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cofinity Commercial |
$8,951.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,326.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,602.10
|
| Rate for Payer: Healthscope Commercial |
$9,367.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,806.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,732.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,992.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,847.15
|
| Rate for Payer: PACE Senior Care Partners |
$2,472.00
|
| Rate for Payer: PACE SWMI |
$2,602.10
|
| Rate for Payer: PHP Commercial |
$8,847.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,602.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,285.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,055.32
|
| Rate for Payer: Priority Health Medicare |
$2,602.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,602.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,159.40
|
| Rate for Payer: UHC Core |
$8,691.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,602.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,680.17
|
| Rate for Payer: VA VA |
$2,602.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,806.31
|
|
