|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$12,112.82
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,430.52 |
| Max. Negotiated Rate |
$10,901.54 |
| Rate for Payer: Aetna Commercial |
$10,295.90
|
| Rate for Payer: BCBS Trust/PPO |
$10,003.98
|
| Rate for Payer: BCN Commercial |
$10,003.98
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Commercial |
$10,417.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Healthscope Commercial |
$10,901.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,084.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,295.90
|
| Rate for Payer: Nomi Health Commercial |
$9,932.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: PHP Commercial |
$10,295.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,538.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,430.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,659.28
|
| Rate for Payer: UHC Core |
$10,114.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,084.61
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$12,112.82
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.49 |
| Max. Negotiated Rate |
$10,901.54 |
| Rate for Payer: Aetna Commercial |
$10,295.90
|
| Rate for Payer: Aetna Medicare |
$3,149.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,785.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,785.26
|
| Rate for Payer: BCBS Complete |
$2,242.08
|
| Rate for Payer: BCBS MAPPO |
$3,028.20
|
| Rate for Payer: BCBS Trust/PPO |
$9,957.95
|
| Rate for Payer: BCN Commercial |
$9,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,028.20
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Commercial |
$10,417.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,028.20
|
| Rate for Payer: Healthscope Commercial |
$10,901.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,084.61
|
| Rate for Payer: Mclaren Medicaid |
$2,135.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,179.62
|
| Rate for Payer: Meridian Medicaid |
$2,242.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,482.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,331.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,295.90
|
| Rate for Payer: Nomi Health Commercial |
$9,932.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: PACE Senior Care Partners |
$2,876.79
|
| Rate for Payer: PACE SWMI |
$3,028.20
|
| Rate for Payer: PHP Commercial |
$10,295.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,028.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,135.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,538.15
|
| Rate for Payer: Priority Health Medicare |
$3,058.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,430.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3,028.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,659.28
|
| Rate for Payer: UHC Core |
$10,114.20
|
| Rate for Payer: UHC Exchange |
$3,028.20
|
| Rate for Payer: UHC Medicaid |
$2,135.49
|
| Rate for Payer: UHC Medicare Advantage |
$3,028.20
|
| Rate for Payer: UHCCP Medicaid |
$2,135.49
|
| Rate for Payer: VA VA |
$3,028.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,084.61
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,878.40 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: BCBS Trust/PPO |
$4,602.25
|
| Rate for Payer: BCN Commercial |
$4,602.25
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$4,792.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,015.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,179.31
|
| Rate for Payer: PHP Commercial |
$4,736.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,848.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,878.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,903.72
|
| Rate for Payer: UHC Core |
$4,652.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,179.31
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.42 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: Aetna Medicare |
$1,448.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,741.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,741.38
|
| Rate for Payer: BCBS Complete |
$1,031.45
|
| Rate for Payer: BCBS MAPPO |
$1,393.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,581.08
|
| Rate for Payer: BCN Commercial |
$4,581.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,393.10
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$4,792.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,393.10
|
| Rate for Payer: Healthscope Commercial |
$5,015.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,179.31
|
| Rate for Payer: Mclaren Medicaid |
$982.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,462.76
|
| Rate for Payer: Meridian Medicaid |
$1,031.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,602.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,532.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,179.31
|
| Rate for Payer: PACE Senior Care Partners |
$1,323.45
|
| Rate for Payer: PACE SWMI |
$1,393.10
|
| Rate for Payer: PHP Commercial |
$4,736.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,393.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$982.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,848.00
|
| Rate for Payer: Priority Health Medicare |
$1,407.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,878.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,393.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,903.72
|
| Rate for Payer: UHC Core |
$4,652.96
|
| Rate for Payer: UHC Exchange |
$1,393.10
|
| Rate for Payer: UHC Medicaid |
$982.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,393.10
|
| Rate for Payer: UHCCP Medicaid |
$982.42
|
| Rate for Payer: VA VA |
$1,393.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,179.31
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.89 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: Aetna Medicare |
$1,684.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,024.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,024.06
|
| Rate for Payer: BCBS Complete |
$1,198.89
|
| Rate for Payer: BCBS MAPPO |
$1,619.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,324.73
|
| Rate for Payer: BCN Commercial |
$5,324.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,619.24
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$5,570.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,619.24
|
| Rate for Payer: Healthscope Commercial |
$5,829.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,857.73
|
| Rate for Payer: Mclaren Medicaid |
$1,141.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,700.21
|
| Rate for Payer: Meridian Medicaid |
$1,198.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,862.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,781.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,857.73
|
| Rate for Payer: PACE Senior Care Partners |
$1,538.28
|
| Rate for Payer: PACE SWMI |
$1,619.24
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,619.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,141.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,634.97
|
| Rate for Payer: Priority Health Medicare |
$1,635.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,507.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,619.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,699.74
|
| Rate for Payer: UHC Core |
$5,408.28
|
| Rate for Payer: UHC Exchange |
$1,619.24
|
| Rate for Payer: UHC Medicaid |
$1,141.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,619.24
|
| Rate for Payer: UHCCP Medicaid |
$1,141.89
|
| Rate for Payer: VA VA |
$1,619.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.73
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,507.98 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: BCBS Trust/PPO |
$5,349.34
|
| Rate for Payer: BCN Commercial |
$5,349.34
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$5,570.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$5,829.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,857.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,857.73
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,634.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,507.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,699.74
|
| Rate for Payer: UHC Core |
$5,408.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.73
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
IP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,107.29 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: BCBS Trust/PPO |
$7,247.14
|
| Rate for Payer: BCN Commercial |
$7,247.14
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$7,897.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,581.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,581.13
|
| Rate for Payer: PHP Commercial |
$7,458.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,634.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,107.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,721.86
|
| Rate for Payer: UHC Core |
$7,326.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.00 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: Aetna Medicare |
$2,281.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,742.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,742.14
|
| Rate for Payer: BCBS Complete |
$1,624.22
|
| Rate for Payer: BCBS MAPPO |
$2,193.71
|
| Rate for Payer: BCBS Trust/PPO |
$7,213.80
|
| Rate for Payer: BCN Commercial |
$7,213.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,193.71
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,193.71
|
| Rate for Payer: Healthscope Commercial |
$7,897.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,581.13
|
| Rate for Payer: Mclaren Medicaid |
$1,547.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,303.40
|
| Rate for Payer: Meridian Medicaid |
$1,624.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,522.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,413.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,581.13
|
| Rate for Payer: PACE Senior Care Partners |
$2,084.02
|
| Rate for Payer: PACE SWMI |
$2,193.71
|
| Rate for Payer: PHP Commercial |
$7,458.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,193.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,547.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,634.11
|
| Rate for Payer: Priority Health Medicare |
$2,215.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,107.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,193.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,721.86
|
| Rate for Payer: UHC Core |
$7,326.99
|
| Rate for Payer: UHC Exchange |
$2,193.71
|
| Rate for Payer: UHC Medicaid |
$1,547.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,193.71
|
| Rate for Payer: UHCCP Medicaid |
$1,547.00
|
| Rate for Payer: VA VA |
$2,193.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,879.55
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.17 |
| Max. Negotiated Rate |
$2,591.59 |
| Rate for Payer: Aetna Commercial |
$2,447.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.22
|
| Rate for Payer: BCN Commercial |
$2,378.22
|
| Rate for Payer: Cash Price |
$2,303.64
|
| Rate for Payer: Cofinity Commercial |
$2,476.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.64
|
| Rate for Payer: Healthscope Commercial |
$2,591.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,159.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,447.62
|
| Rate for Payer: Nomi Health Commercial |
$2,361.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,159.66
|
| Rate for Payer: PHP Commercial |
$2,447.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,505.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,004.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,534.00
|
| Rate for Payer: UHC Core |
$2,404.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,159.66
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,879.55
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.66 |
| Max. Negotiated Rate |
$2,591.59 |
| Rate for Payer: Aetna Commercial |
$2,447.62
|
| Rate for Payer: Aetna Medicare |
$748.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$899.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$899.86
|
| Rate for Payer: BCBS Complete |
$533.00
|
| Rate for Payer: BCBS MAPPO |
$719.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,367.28
|
| Rate for Payer: BCN Commercial |
$2,367.28
|
| Rate for Payer: BCN Medicare Advantage |
$719.89
|
| Rate for Payer: Cash Price |
$2,303.64
|
| Rate for Payer: Cofinity Commercial |
$2,476.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.89
|
| Rate for Payer: Healthscope Commercial |
$2,591.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,159.66
|
| Rate for Payer: Mclaren Medicaid |
$507.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.88
|
| Rate for Payer: Meridian Medicaid |
$533.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$827.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$791.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,447.62
|
| Rate for Payer: Nomi Health Commercial |
$2,361.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,159.66
|
| Rate for Payer: PACE Senior Care Partners |
$683.89
|
| Rate for Payer: PACE SWMI |
$719.89
|
| Rate for Payer: PHP Commercial |
$2,447.62
|
| Rate for Payer: PHP Medicare Advantage |
$719.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$507.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,505.21
|
| Rate for Payer: Priority Health Medicare |
$727.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,004.17
|
| Rate for Payer: Railroad Medicare Medicare |
$719.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,534.00
|
| Rate for Payer: UHC Core |
$2,404.42
|
| Rate for Payer: UHC Exchange |
$719.89
|
| Rate for Payer: UHC Medicaid |
$507.66
|
| Rate for Payer: UHC Medicare Advantage |
$719.89
|
| Rate for Payer: UHCCP Medicaid |
$507.66
|
| Rate for Payer: VA VA |
$719.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,159.66
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,826.87 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.67
|
| Rate for Payer: BCBS Trust/PPO |
$9,287.66
|
| Rate for Payer: BCN Commercial |
$9,287.66
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,434.12
|
| Rate for Payer: PHP Commercial |
$9,558.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,783.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,826.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,896.04
|
| Rate for Payer: UHC Core |
$9,389.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,982.58 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.67
|
| Rate for Payer: Aetna Medicare |
$2,923.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,514.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,514.22
|
| Rate for Payer: BCBS Complete |
$2,081.54
|
| Rate for Payer: BCBS MAPPO |
$2,811.38
|
| Rate for Payer: BCBS Trust/PPO |
$9,244.93
|
| Rate for Payer: BCN Commercial |
$9,244.93
|
| Rate for Payer: BCN Medicare Advantage |
$2,811.38
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,811.38
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Mclaren Medicaid |
$1,982.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,951.94
|
| Rate for Payer: Meridian Medicaid |
$2,081.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,233.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,092.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,434.12
|
| Rate for Payer: PACE Senior Care Partners |
$2,670.81
|
| Rate for Payer: PACE SWMI |
$2,811.38
|
| Rate for Payer: PHP Commercial |
$9,558.67
|
| Rate for Payer: PHP Medicare Advantage |
$2,811.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,982.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,783.58
|
| Rate for Payer: Priority Health Medicare |
$2,839.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,826.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2,811.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,896.04
|
| Rate for Payer: UHC Core |
$9,389.99
|
| Rate for Payer: UHC Exchange |
$2,811.38
|
| Rate for Payer: UHC Medicaid |
$1,982.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,811.38
|
| Rate for Payer: UHCCP Medicaid |
$1,982.58
|
| Rate for Payer: VA VA |
$2,811.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC STENT NON COATED W SYS LVL 14
|
Facility
|
OP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.46 |
| Max. Negotiated Rate |
$1,278.59 |
| 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 |
$262.96
|
| Rate for Payer: BCBS MAPPO |
$355.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.92
|
| Rate for Payer: BCN Commercial |
$1,167.92
|
| 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 |
$1,278.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Mclaren Medicaid |
$250.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$372.92
|
| Rate for Payer: Meridian Medicaid |
$262.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$390.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.49
|
| 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 Choice Medicaid |
$250.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,235.97
|
| Rate for Payer: Priority Health Medicare |
$358.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.77
|
| 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 Exchange |
$355.16
|
| Rate for Payer: UHC Medicaid |
$250.46
|
| Rate for Payer: UHC Medicare Advantage |
$355.16
|
| Rate for Payer: UHCCP Medicaid |
$250.46
|
| 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 14
|
Facility
|
IP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.77 |
| Max. Negotiated Rate |
$1,278.59 |
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.31
|
| Rate for Payer: BCN Commercial |
$1,173.31
|
| 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 |
$1,278.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.49
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,235.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.77
|
| 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 NON COATED W SYS LVL 18
|
Facility
|
IP
|
$1,860.48
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.89 |
| Max. Negotiated Rate |
$1,674.43 |
| Rate for Payer: Aetna Commercial |
$1,581.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,536.57
|
| Rate for Payer: BCN Commercial |
$1,536.57
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Commercial |
$1,600.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.38
|
| Rate for Payer: Healthscope Commercial |
$1,674.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Nomi Health Commercial |
$1,525.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,395.36
|
| Rate for Payer: PHP Commercial |
$1,581.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,618.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,294.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,637.22
|
| Rate for Payer: UHC Core |
$1,553.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.36
|
|
|
HC STENT NON COATED W SYS LVL 18
|
Facility
|
OP
|
$1,860.48
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,674.43 |
| Rate for Payer: Aetna Commercial |
$1,581.41
|
| Rate for Payer: Aetna Medicare |
$483.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$581.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$581.40
|
| Rate for Payer: BCBS Complete |
$344.37
|
| Rate for Payer: BCBS MAPPO |
$465.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,529.50
|
| Rate for Payer: BCN Commercial |
$1,529.50
|
| Rate for Payer: BCN Medicare Advantage |
$465.12
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Commercial |
$1,600.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.12
|
| Rate for Payer: Healthscope Commercial |
$1,674.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.36
|
| Rate for Payer: Mclaren Medicaid |
$328.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.38
|
| Rate for Payer: Meridian Medicaid |
$344.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$534.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$511.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Nomi Health Commercial |
$1,525.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,395.36
|
| Rate for Payer: PACE Senior Care Partners |
$441.86
|
| Rate for Payer: PACE SWMI |
$465.12
|
| Rate for Payer: PHP Commercial |
$1,581.41
|
| Rate for Payer: PHP Medicare Advantage |
$465.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,618.62
|
| Rate for Payer: Priority Health Medicare |
$469.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,294.89
|
| Rate for Payer: Railroad Medicare Medicare |
$465.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,637.22
|
| Rate for Payer: UHC Core |
$1,553.50
|
| Rate for Payer: UHC Exchange |
$465.12
|
| Rate for Payer: UHC Medicaid |
$328.00
|
| Rate for Payer: UHC Medicare Advantage |
$465.12
|
| Rate for Payer: UHCCP Medicaid |
$328.00
|
| Rate for Payer: VA VA |
$465.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.36
|
|
|
HC STENT NONCOATED W SYS LVL 196
|
Facility
|
IP
|
$19,625.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,659.00 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: BCBS Trust/PPO |
$16,208.29
|
| Rate for Payer: BCN Commercial |
$16,208.29
|
| 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 Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,718.75
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17,073.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,659.00
|
| 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 196
|
Facility
|
OP
|
$19,625.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.89 |
| 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 |
$3,632.59
|
| Rate for Payer: BCBS MAPPO |
$4,906.25
|
| Rate for Payer: BCBS Trust/PPO |
$16,133.71
|
| Rate for Payer: BCN Commercial |
$16,133.71
|
| 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: Mclaren Medicaid |
$3,459.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,151.56
|
| Rate for Payer: Meridian Medicaid |
$3,632.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,642.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,396.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,718.75
|
| 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 Choice Medicaid |
$3,459.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17,073.75
|
| Rate for Payer: Priority Health Medicare |
$4,955.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,659.00
|
| 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 Exchange |
$4,906.25
|
| Rate for Payer: UHC Medicaid |
$3,459.89
|
| Rate for Payer: UHC Medicare Advantage |
$4,906.25
|
| Rate for Payer: UHCCP Medicaid |
$3,459.89
|
| 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 20
|
Facility
|
OP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.69 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: Aetna Medicare |
$533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$641.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$641.12
|
| Rate for Payer: BCBS Complete |
$379.75
|
| Rate for Payer: BCBS MAPPO |
$512.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,686.60
|
| Rate for Payer: BCN Commercial |
$1,686.60
|
| Rate for Payer: BCN Medicare Advantage |
$512.89
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.89
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: Mclaren Medicaid |
$361.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$538.54
|
| Rate for Payer: Meridian Medicaid |
$379.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$589.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$564.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Nomi Health Commercial |
$1,682.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: PACE Senior Care Partners |
$487.25
|
| Rate for Payer: PACE SWMI |
$512.89
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: PHP Medicare Advantage |
$512.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,784.87
|
| Rate for Payer: Priority Health Medicare |
$518.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,427.89
|
| Rate for Payer: Railroad Medicare Medicare |
$512.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,805.38
|
| Rate for Payer: UHC Core |
$1,713.06
|
| Rate for Payer: UHC Exchange |
$512.89
|
| Rate for Payer: UHC Medicaid |
$361.69
|
| Rate for Payer: UHC Medicare Advantage |
$512.89
|
| Rate for Payer: UHCCP Medicaid |
$361.69
|
| Rate for Payer: VA VA |
$512.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
HC STENT NON COATED W SYS LVL 20
|
Facility
|
IP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,427.89 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,694.39
|
| Rate for Payer: BCN Commercial |
$1,694.39
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Nomi Health Commercial |
$1,682.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,784.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,427.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,805.38
|
| Rate for Payer: UHC Core |
$1,713.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
HC STENT NON COATED W SYS LVL 24
|
Facility
|
OP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.57 |
| Max. Negotiated Rate |
$2,243.96 |
| Rate for Payer: Aetna Commercial |
$2,119.30
|
| Rate for Payer: Aetna Medicare |
$648.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$779.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$779.15
|
| Rate for Payer: BCBS Complete |
$461.51
|
| Rate for Payer: BCBS MAPPO |
$623.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.73
|
| Rate for Payer: BCN Commercial |
$2,049.73
|
| Rate for Payer: BCN Medicare Advantage |
$623.32
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Commercial |
$2,144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.32
|
| Rate for Payer: Healthscope Commercial |
$2,243.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,869.97
|
| Rate for Payer: Mclaren Medicaid |
$439.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.49
|
| Rate for Payer: Meridian Medicaid |
$461.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$716.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$685.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Nomi Health Commercial |
$2,044.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.97
|
| Rate for Payer: PACE Senior Care Partners |
$592.16
|
| Rate for Payer: PACE SWMI |
$623.32
|
| Rate for Payer: PHP Commercial |
$2,119.30
|
| Rate for Payer: PHP Medicare Advantage |
$623.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$439.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,169.16
|
| Rate for Payer: Priority Health Medicare |
$629.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,735.33
|
| Rate for Payer: Railroad Medicare Medicare |
$623.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,194.10
|
| Rate for Payer: UHC Core |
$2,081.90
|
| Rate for Payer: UHC Exchange |
$623.32
|
| Rate for Payer: UHC Medicaid |
$439.57
|
| Rate for Payer: UHC Medicare Advantage |
$623.32
|
| Rate for Payer: UHCCP Medicaid |
$439.57
|
| Rate for Payer: VA VA |
$623.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.97
|
|
|
HC STENT NON COATED W SYS LVL 24
|
Facility
|
IP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,735.33 |
| Max. Negotiated Rate |
$2,243.96 |
| Rate for Payer: Aetna Commercial |
$2,119.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.21
|
| Rate for Payer: BCN Commercial |
$2,059.21
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Commercial |
$2,144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,243.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,869.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Nomi Health Commercial |
$2,044.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.97
|
| Rate for Payer: PHP Commercial |
$2,119.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,169.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,735.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,194.10
|
| Rate for Payer: UHC Core |
$2,081.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.97
|
|
|
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 |
$1,864.63 |
| Max. Negotiated Rate |
$2,411.15 |
| Rate for Payer: Aetna Commercial |
$2,277.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,212.64
|
| Rate for Payer: BCN Commercial |
$2,212.64
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Commercial |
$2,303.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,411.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Nomi Health Commercial |
$2,196.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.30
|
| Rate for Payer: PHP Commercial |
$2,277.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,330.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,864.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,357.57
|
| Rate for Payer: UHC Core |
$2,237.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.30
|
|
|
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 |
$472.32 |
| Max. Negotiated Rate |
$2,411.15 |
| Rate for Payer: Aetna Commercial |
$2,277.20
|
| Rate for Payer: Aetna Medicare |
$696.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$837.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$837.21
|
| Rate for Payer: BCBS Complete |
$495.89
|
| Rate for Payer: BCBS MAPPO |
$669.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,202.46
|
| Rate for Payer: BCN Commercial |
$2,202.46
|
| Rate for Payer: BCN Medicare Advantage |
$669.76
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Commercial |
$2,303.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.76
|
| Rate for Payer: Healthscope Commercial |
$2,411.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.30
|
| Rate for Payer: Mclaren Medicaid |
$472.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$703.25
|
| Rate for Payer: Meridian Medicaid |
$495.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$770.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$736.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Nomi Health Commercial |
$2,196.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.30
|
| Rate for Payer: PACE Senior Care Partners |
$636.28
|
| Rate for Payer: PACE SWMI |
$669.76
|
| Rate for Payer: PHP Commercial |
$2,277.20
|
| Rate for Payer: PHP Medicare Advantage |
$669.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,330.78
|
| Rate for Payer: Priority Health Medicare |
$676.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,864.63
|
| Rate for Payer: Railroad Medicare Medicare |
$669.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,357.57
|
| Rate for Payer: UHC Core |
$2,237.02
|
| Rate for Payer: UHC Exchange |
$669.76
|
| Rate for Payer: UHC Medicaid |
$472.32
|
| Rate for Payer: UHC Medicare Advantage |
$669.76
|
| Rate for Payer: UHCCP Medicaid |
$472.32
|
| Rate for Payer: VA VA |
$669.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.30
|
|
|
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 |
$527.00 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna Medicare |
$777.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$934.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$934.14
|
| Rate for Payer: BCBS Complete |
$553.31
|
| Rate for Payer: BCBS MAPPO |
$747.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,457.45
|
| Rate for Payer: BCN Commercial |
$2,457.45
|
| Rate for Payer: BCN Medicare Advantage |
$747.31
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.31
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,241.93
|
| Rate for Payer: Mclaren Medicaid |
$527.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.68
|
| Rate for Payer: Meridian Medicaid |
$553.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$859.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$822.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Nomi Health Commercial |
$2,451.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.93
|
| Rate for Payer: PACE Senior Care Partners |
$709.94
|
| Rate for Payer: PACE SWMI |
$747.31
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: PHP Medicare Advantage |
$747.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,600.64
|
| Rate for Payer: Priority Health Medicare |
$754.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,080.51
|
| Rate for Payer: Railroad Medicare Medicare |
$747.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,630.53
|
| Rate for Payer: UHC Core |
$2,496.02
|
| Rate for Payer: UHC Exchange |
$747.31
|
| Rate for Payer: UHC Medicaid |
$527.00
|
| Rate for Payer: UHC Medicare Advantage |
$747.31
|
| Rate for Payer: UHCCP Medicaid |
$527.00
|
| Rate for Payer: VA VA |
$747.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
