|
HC STENT NON COATED W SYS LVL 29
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,080.51 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,468.81
|
| Rate for Payer: BCN Commercial |
$2,468.81
|
| 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: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,241.93
|
| 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: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,600.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,080.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,630.53
|
| Rate for Payer: UHC Core |
$2,496.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
|
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 |
$625.32 |
| 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 |
$656.53
|
| Rate for Payer: BCBS MAPPO |
$886.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.91
|
| Rate for Payer: BCN Commercial |
$2,915.91
|
| Rate for Payer: BCN Medicare Advantage |
$886.73
|
| 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 |
$886.73
|
| Rate for Payer: Healthscope Commercial |
$3,192.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Mclaren Medicaid |
$625.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$931.06
|
| Rate for Payer: Meridian Medicaid |
$656.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,019.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$975.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: PACE Senior Care Partners |
$842.39
|
| Rate for Payer: PACE SWMI |
$886.73
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: PHP Medicare Advantage |
$886.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,085.80
|
| Rate for Payer: Priority Health Medicare |
$895.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,468.64
|
| Rate for Payer: Railroad Medicare Medicare |
$886.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,121.27
|
| Rate for Payer: UHC Core |
$2,961.66
|
| Rate for Payer: UHC Exchange |
$886.73
|
| Rate for Payer: UHC Medicaid |
$625.32
|
| Rate for Payer: UHC Medicare Advantage |
$886.73
|
| Rate for Payer: UHCCP Medicaid |
$625.32
|
| Rate for Payer: VA VA |
$886.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
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 |
$2,468.64 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,929.38
|
| Rate for Payer: BCN Commercial |
$2,929.38
|
| 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 Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,085.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,468.64
|
| 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 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 |
$2,602.80 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,088.59
|
| Rate for Payer: BCN Commercial |
$3,088.59
|
| Rate for Payer: Cash Price |
$2,991.73
|
| 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: Lakeland Regional Health Systems Commercial |
$2,804.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Nomi Health Commercial |
$3,066.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,253.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,602.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,290.90
|
| Rate for Payer: UHC Core |
$3,122.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,804.74
|
|
|
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 |
$659.30 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: Aetna Medicare |
$972.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,168.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,168.64
|
| Rate for Payer: BCBS Complete |
$692.21
|
| Rate for Payer: BCBS MAPPO |
$934.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,074.37
|
| Rate for Payer: BCN Commercial |
$3,074.37
|
| Rate for Payer: BCN Medicare Advantage |
$934.91
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.91
|
| Rate for Payer: Healthscope Commercial |
$3,365.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,804.74
|
| Rate for Payer: Mclaren Medicaid |
$659.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$981.66
|
| Rate for Payer: Meridian Medicaid |
$692.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,075.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,028.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Nomi Health Commercial |
$3,066.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: PACE Senior Care Partners |
$888.17
|
| Rate for Payer: PACE SWMI |
$934.91
|
| Rate for Payer: PHP Commercial |
$3,178.71
|
| Rate for Payer: PHP Medicare Advantage |
$934.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,253.50
|
| Rate for Payer: Priority Health Medicare |
$944.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,602.80
|
| Rate for Payer: Railroad Medicare Medicare |
$934.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,290.90
|
| Rate for Payer: UHC Core |
$3,122.62
|
| Rate for Payer: UHC Exchange |
$934.91
|
| Rate for Payer: UHC Medicaid |
$659.30
|
| Rate for Payer: UHC Medicare Advantage |
$934.91
|
| Rate for Payer: UHCCP Medicaid |
$659.30
|
| Rate for Payer: VA VA |
$934.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,804.74
|
|
|
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 |
$3,097.90 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,676.08
|
| Rate for Payer: BCN Commercial |
$3,676.08
|
| Rate for Payer: Cash Price |
$3,560.80
|
| 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: Lakeland Regional Health Systems Commercial |
$3,338.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Nomi Health Commercial |
$3,649.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,872.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,097.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,916.88
|
| Rate for Payer: UHC Core |
$3,716.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,338.25
|
|
|
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 |
$784.71 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: Aetna Medicare |
$1,157.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,390.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,390.94
|
| Rate for Payer: BCBS Complete |
$823.88
|
| Rate for Payer: BCBS MAPPO |
$1,112.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,659.17
|
| Rate for Payer: BCN Commercial |
$3,659.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.75
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.75
|
| Rate for Payer: Healthscope Commercial |
$4,005.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,338.25
|
| Rate for Payer: Mclaren Medicaid |
$784.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.39
|
| Rate for Payer: Meridian Medicaid |
$823.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,279.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,224.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Nomi Health Commercial |
$3,649.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: PACE Senior Care Partners |
$1,057.11
|
| Rate for Payer: PACE SWMI |
$1,112.75
|
| Rate for Payer: PHP Commercial |
$3,783.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,872.37
|
| Rate for Payer: Priority Health Medicare |
$1,123.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,097.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,112.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,916.88
|
| Rate for Payer: UHC Core |
$3,716.59
|
| Rate for Payer: UHC Exchange |
$1,112.75
|
| Rate for Payer: UHC Medicaid |
$784.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.75
|
| Rate for Payer: UHCCP Medicaid |
$784.71
|
| Rate for Payer: VA VA |
$1,112.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,338.25
|
|
|
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 |
$874.80 |
| 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 |
$918.47
|
| Rate for Payer: BCBS MAPPO |
$1,240.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,079.26
|
| Rate for Payer: BCN Commercial |
$4,079.26
|
| 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: Mclaren Medicaid |
$874.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,302.53
|
| Rate for Payer: Meridian Medicaid |
$918.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,426.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,364.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,178.47
|
| 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 Choice Medicaid |
$874.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,316.94
|
| Rate for Payer: Priority Health Medicare |
$1,252.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,453.55
|
| 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 Exchange |
$1,240.50
|
| Rate for Payer: UHC Medicaid |
$874.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,240.50
|
| Rate for Payer: UHCCP Medicaid |
$874.80
|
| 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 SYS LVL 49
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,453.55 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,098.12
|
| Rate for Payer: BCN Commercial |
$4,098.12
|
| 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 Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,316.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,453.55
|
| 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 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 |
$255.47 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Aetna Medicare |
$376.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.83
|
| Rate for Payer: BCBS Complete |
$268.22
|
| Rate for Payer: BCBS MAPPO |
$362.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.27
|
| Rate for Payer: BCN Commercial |
$1,191.27
|
| Rate for Payer: BCN Medicare Advantage |
$362.26
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Commercial |
$1,246.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.26
|
| Rate for Payer: Healthscope Commercial |
$1,304.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.80
|
| Rate for Payer: Mclaren Medicaid |
$255.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.38
|
| Rate for Payer: Meridian Medicaid |
$268.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$398.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Nomi Health Commercial |
$1,188.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: PACE Senior Care Partners |
$344.15
|
| Rate for Payer: PACE SWMI |
$362.26
|
| Rate for Payer: PHP Commercial |
$1,231.70
|
| Rate for Payer: PHP Medicare Advantage |
$362.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,260.68
|
| Rate for Payer: Priority Health Medicare |
$365.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.55
|
| Rate for Payer: Railroad Medicare Medicare |
$362.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.17
|
| Rate for Payer: UHC Core |
$1,209.97
|
| Rate for Payer: UHC Exchange |
$362.26
|
| Rate for Payer: UHC Medicaid |
$255.47
|
| Rate for Payer: UHC Medicare Advantage |
$362.26
|
| Rate for Payer: UHCCP Medicaid |
$255.47
|
| Rate for Payer: VA VA |
$362.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.80
|
|
|
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 |
$1,008.55 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.78
|
| Rate for Payer: BCN Commercial |
$1,196.78
|
| Rate for Payer: Cash Price |
$1,159.25
|
| 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: Lakeland Regional Health Systems Commercial |
$1,086.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Nomi Health Commercial |
$1,188.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: PHP Commercial |
$1,231.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,260.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.17
|
| Rate for Payer: UHC Core |
$1,209.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.80
|
|
|
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 |
$3,819.75 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,532.66
|
| Rate for Payer: BCN Commercial |
$4,532.66
|
| Rate for Payer: Cash Price |
$4,390.52
|
| 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: Lakeland Regional Health Systems Commercial |
$4,116.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Nomi Health Commercial |
$4,500.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: PHP Commercial |
$4,664.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,774.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,819.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,829.57
|
| Rate for Payer: UHC Core |
$4,582.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,116.11
|
|
|
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 |
$967.56 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: Aetna Medicare |
$1,426.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,715.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,715.05
|
| Rate for Payer: BCBS Complete |
$1,015.86
|
| Rate for Payer: BCBS MAPPO |
$1,372.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,511.81
|
| Rate for Payer: BCN Commercial |
$4,511.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.04
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Commercial |
$4,719.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.04
|
| Rate for Payer: Healthscope Commercial |
$4,939.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,116.11
|
| Rate for Payer: Mclaren Medicaid |
$967.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,440.64
|
| Rate for Payer: Meridian Medicaid |
$1,015.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,577.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,509.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Nomi Health Commercial |
$4,500.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: PACE Senior Care Partners |
$1,303.44
|
| Rate for Payer: PACE SWMI |
$1,372.04
|
| Rate for Payer: PHP Commercial |
$4,664.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$967.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,774.69
|
| Rate for Payer: Priority Health Medicare |
$1,385.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,819.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,372.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,829.57
|
| Rate for Payer: UHC Core |
$4,582.61
|
| Rate for Payer: UHC Exchange |
$1,372.04
|
| Rate for Payer: UHC Medicaid |
$967.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.04
|
| Rate for Payer: UHCCP Medicaid |
$967.56
|
| Rate for Payer: VA VA |
$1,372.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,116.11
|
|
|
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 |
$1,019.53 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: Aetna Medicare |
$1,503.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,807.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,807.16
|
| Rate for Payer: BCBS Complete |
$1,070.41
|
| Rate for Payer: BCBS MAPPO |
$1,445.72
|
| Rate for Payer: BCBS Trust/PPO |
$4,754.12
|
| Rate for Payer: BCN Commercial |
$4,754.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,445.72
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$4,973.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,445.72
|
| Rate for Payer: Healthscope Commercial |
$5,204.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,337.18
|
| Rate for Payer: Mclaren Medicaid |
$1,019.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,518.01
|
| Rate for Payer: Meridian Medicaid |
$1,070.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,662.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,590.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Nomi Health Commercial |
$4,741.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: PACE Senior Care Partners |
$1,373.44
|
| Rate for Payer: PACE SWMI |
$1,445.72
|
| Rate for Payer: PHP Commercial |
$4,915.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,445.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,019.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,031.12
|
| Rate for Payer: Priority Health Medicare |
$1,460.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,024.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,445.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,088.95
|
| Rate for Payer: UHC Core |
$4,828.72
|
| Rate for Payer: UHC Exchange |
$1,445.72
|
| Rate for Payer: UHC Medicaid |
$1,019.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,445.72
|
| Rate for Payer: UHCCP Medicaid |
$1,019.53
|
| Rate for Payer: VA VA |
$1,445.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.18
|
|
|
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 |
$4,024.90 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,776.10
|
| Rate for Payer: BCN Commercial |
$4,776.10
|
| Rate for Payer: Cash Price |
$4,626.32
|
| 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: Lakeland Regional Health Systems Commercial |
$4,337.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Nomi Health Commercial |
$4,741.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: PHP Commercial |
$4,915.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,031.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,024.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,088.95
|
| Rate for Payer: UHC Core |
$4,828.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.18
|
|
|
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 |
$1,054.18 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: Aetna Medicare |
$1,554.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,868.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,868.58
|
| Rate for Payer: BCBS Complete |
$1,106.79
|
| Rate for Payer: BCBS MAPPO |
$1,494.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,915.70
|
| Rate for Payer: BCN Commercial |
$4,915.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,494.86
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Commercial |
$5,142.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,494.86
|
| Rate for Payer: Healthscope Commercial |
$5,381.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,484.58
|
| Rate for Payer: Mclaren Medicaid |
$1,054.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,569.60
|
| Rate for Payer: Meridian Medicaid |
$1,106.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,719.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,644.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,484.58
|
| Rate for Payer: PACE Senior Care Partners |
$1,420.12
|
| Rate for Payer: PACE SWMI |
$1,494.86
|
| Rate for Payer: PHP Commercial |
$5,082.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,494.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,202.11
|
| Rate for Payer: Priority Health Medicare |
$1,509.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,161.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,494.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,261.91
|
| Rate for Payer: UHC Core |
$4,992.83
|
| Rate for Payer: UHC Exchange |
$1,494.86
|
| Rate for Payer: UHC Medicaid |
$1,054.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,494.86
|
| Rate for Payer: UHCCP Medicaid |
$1,054.18
|
| Rate for Payer: VA VA |
$1,494.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,484.58
|
|
|
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 |
$4,161.69 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,938.42
|
| Rate for Payer: BCN Commercial |
$4,938.42
|
| Rate for Payer: Cash Price |
$4,783.55
|
| 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: Lakeland Regional Health Systems Commercial |
$4,484.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,484.58
|
| Rate for Payer: PHP Commercial |
$5,082.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,202.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,161.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,261.91
|
| Rate for Payer: UHC Core |
$4,992.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,484.58
|
|
|
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 |
$1,195.20 |
| Max. Negotiated Rate |
$6,101.40 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: Aetna Medicare |
$1,762.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,118.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,118.54
|
| Rate for Payer: BCBS Complete |
$1,254.85
|
| Rate for Payer: BCBS MAPPO |
$1,694.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,573.29
|
| Rate for Payer: BCN Commercial |
$5,573.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,694.83
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Commercial |
$5,830.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,694.83
|
| Rate for Payer: Healthscope Commercial |
$6,101.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,084.50
|
| Rate for Payer: Mclaren Medicaid |
$1,195.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.57
|
| Rate for Payer: Meridian Medicaid |
$1,254.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,949.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,864.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,084.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,610.09
|
| Rate for Payer: PACE SWMI |
$1,694.83
|
| Rate for Payer: PHP Commercial |
$5,762.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,694.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,195.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,898.02
|
| Rate for Payer: Priority Health Medicare |
$1,711.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,718.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,694.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,965.81
|
| Rate for Payer: UHC Core |
$5,660.74
|
| Rate for Payer: UHC Exchange |
$1,694.83
|
| Rate for Payer: UHC Medicaid |
$1,195.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,694.83
|
| Rate for Payer: UHCCP Medicaid |
$1,195.20
|
| Rate for Payer: VA VA |
$1,694.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,084.50
|
|
|
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 |
$4,718.41 |
| Max. Negotiated Rate |
$6,101.40 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: BCBS Trust/PPO |
$5,599.05
|
| Rate for Payer: BCN Commercial |
$5,599.05
|
| Rate for Payer: Cash Price |
$5,423.46
|
| 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: Lakeland Regional Health Systems Commercial |
$5,084.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,084.50
|
| Rate for Payer: PHP Commercial |
$5,762.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,898.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,718.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,965.81
|
| Rate for Payer: UHC Core |
$5,660.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,084.50
|
|
|
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 |
$43.05 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: Aetna Medicare |
$63.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.31
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$61.05
|
| Rate for Payer: BCBS Trust/PPO |
$200.75
|
| Rate for Payer: BCN Commercial |
$200.75
|
| Rate for Payer: BCN Medicare Advantage |
$61.05
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.14
|
| Rate for Payer: Mclaren Medicaid |
$43.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.10
|
| Rate for Payer: Meridian Medicaid |
$45.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.14
|
| Rate for Payer: PACE Senior Care Partners |
$58.00
|
| Rate for Payer: PACE SWMI |
$61.05
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: PHP Medicare Advantage |
$61.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.45
|
| Rate for Payer: Priority Health Medicare |
$61.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.96
|
| Rate for Payer: Railroad Medicare Medicare |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.89
|
| Rate for Payer: UHC Core |
$203.90
|
| Rate for Payer: UHC Exchange |
$61.05
|
| Rate for Payer: UHC Medicaid |
$43.05
|
| Rate for Payer: UHC Medicare Advantage |
$61.05
|
| Rate for Payer: UHCCP Medicaid |
$43.05
|
| Rate for Payer: VA VA |
$61.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.14
|
|
|
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 |
$169.96 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: BCBS Trust/PPO |
$201.68
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: Cash Price |
$195.35
|
| 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: Lakeland Regional Health Systems Commercial |
$183.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.14
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.89
|
| Rate for Payer: UHC Core |
$203.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.14
|
|
|
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 |
$348.86 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: BCBS Trust/PPO |
$413.97
|
| Rate for Payer: BCN Commercial |
$413.97
|
| Rate for Payer: Cash Price |
$400.98
|
| 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: Lakeland Regional Health Systems Commercial |
$375.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Nomi Health Commercial |
$411.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.92
|
| Rate for Payer: PHP Commercial |
$426.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$436.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.08
|
| Rate for Payer: UHC Core |
$418.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.92
|
|
|
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 |
$88.37 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: Aetna Medicare |
$130.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.63
|
| Rate for Payer: BCBS Complete |
$92.78
|
| Rate for Payer: BCBS MAPPO |
$125.31
|
| Rate for Payer: BCBS Trust/PPO |
$412.06
|
| Rate for Payer: BCN Commercial |
$412.06
|
| Rate for Payer: BCN Medicare Advantage |
$125.31
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Commercial |
$431.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.31
|
| Rate for Payer: Healthscope Commercial |
$451.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.92
|
| Rate for Payer: Mclaren Medicaid |
$88.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.57
|
| Rate for Payer: Meridian Medicaid |
$92.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$137.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Nomi Health Commercial |
$411.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.92
|
| Rate for Payer: PACE Senior Care Partners |
$119.04
|
| Rate for Payer: PACE SWMI |
$125.31
|
| Rate for Payer: PHP Commercial |
$426.05
|
| Rate for Payer: PHP Medicare Advantage |
$125.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$126.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.86
|
| Rate for Payer: Railroad Medicare Medicare |
$125.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.08
|
| Rate for Payer: UHC Core |
$418.53
|
| Rate for Payer: UHC Exchange |
$125.31
|
| Rate for Payer: UHC Medicaid |
$88.37
|
| Rate for Payer: UHC Medicare Advantage |
$125.31
|
| Rate for Payer: UHCCP Medicaid |
$88.37
|
| Rate for Payer: VA VA |
$125.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.92
|
|
|
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 |
$147.87 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: Aetna Medicare |
$218.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.10
|
| Rate for Payer: BCBS Complete |
$155.25
|
| Rate for Payer: BCBS MAPPO |
$209.68
|
| Rate for Payer: BCBS Trust/PPO |
$689.52
|
| Rate for Payer: BCN Commercial |
$689.52
|
| Rate for Payer: BCN Medicare Advantage |
$209.68
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Commercial |
$721.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.68
|
| Rate for Payer: Healthscope Commercial |
$754.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.05
|
| Rate for Payer: Mclaren Medicaid |
$147.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.17
|
| Rate for Payer: Meridian Medicaid |
$155.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Nomi Health Commercial |
$687.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.05
|
| Rate for Payer: PACE Senior Care Partners |
$199.20
|
| Rate for Payer: PACE SWMI |
$209.68
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: PHP Medicare Advantage |
$209.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$729.70
|
| Rate for Payer: Priority Health Medicare |
$211.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$583.76
|
| Rate for Payer: Railroad Medicare Medicare |
$209.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.08
|
| Rate for Payer: UHC Core |
$700.34
|
| Rate for Payer: UHC Exchange |
$209.68
|
| Rate for Payer: UHC Medicaid |
$147.87
|
| Rate for Payer: UHC Medicare Advantage |
$209.68
|
| Rate for Payer: UHCCP Medicaid |
$147.87
|
| Rate for Payer: VA VA |
$209.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.05
|
|
|
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 |
$583.76 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: BCBS Trust/PPO |
$692.71
|
| Rate for Payer: BCN Commercial |
$692.71
|
| Rate for Payer: Cash Price |
$670.98
|
| 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: Lakeland Regional Health Systems Commercial |
$629.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Nomi Health Commercial |
$687.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.05
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$729.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$583.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.08
|
| Rate for Payer: UHC Core |
$700.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.05
|
|
