|
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 |
$3,622.07 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: BCBS Trust/PPO |
$4,548.76
|
| Rate for Payer: BCN Commercial |
$4,306.36
|
| 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: PHP Commercial |
$4,736.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,622.07
|
| Rate for Payer: Priority Health HMO/PPO |
$4,848.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,733.51
|
| 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 13
|
Facility
|
IP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,210.04 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: BCBS Trust/PPO |
$5,287.16
|
| Rate for Payer: BCN Commercial |
$5,005.41
|
| 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 |
$4,857.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: Priority Health HMO/PPO |
$5,634.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,339.58
|
| 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 |
$4,857.74
|
|
|
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 |
$1,538.28 |
| 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 |
$2,590.79
|
| Rate for Payer: BCBS MAPPO |
$1,619.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,324.73
|
| Rate for Payer: BCN Commercial |
$5,035.85
|
| 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 |
$4,857.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,700.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,862.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| 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 Cigna Priority Health |
$4,210.04
|
| Rate for Payer: Priority Health HMO/PPO |
$5,634.97
|
| Rate for Payer: Priority Health Medicare |
$1,635.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,339.58
|
| 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 Dual Complete DSNP |
$1,619.24
|
| Rate for Payer: UHC Exchange |
$1,619.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,619.24
|
| Rate for Payer: VA VA |
$1,619.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.74
|
|
|
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 |
$2,084.02 |
| 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 |
$3,509.94
|
| Rate for Payer: BCBS MAPPO |
$2,193.71
|
| Rate for Payer: BCBS Trust/PPO |
$7,213.80
|
| Rate for Payer: BCN Commercial |
$6,822.44
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,303.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,522.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| 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 Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health HMO/PPO |
$7,634.11
|
| Rate for Payer: Priority Health Medicare |
$2,215.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,879.14
|
| 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 Dual Complete DSNP |
$2,193.71
|
| Rate for Payer: UHC Exchange |
$2,193.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,193.71
|
| Rate for Payer: VA VA |
$2,193.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
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 |
$5,703.65 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: BCBS Trust/PPO |
$7,162.90
|
| Rate for Payer: BCN Commercial |
$6,781.20
|
| 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: PHP Commercial |
$7,458.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health HMO/PPO |
$7,634.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,879.14
|
| 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 NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.01 |
| Max. Negotiated Rate |
$2,540.78 |
| Rate for Payer: Aetna Commercial |
$2,399.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,304.49
|
| Rate for Payer: BCN Commercial |
$2,181.68
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$2,427.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Healthscope Commercial |
$2,540.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: Nomi Health Commercial |
$2,314.93
|
| Rate for Payer: PHP Commercial |
$2,399.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,456.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,891.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,484.32
|
| Rate for Payer: UHC Core |
$2,357.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.32
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$2,540.78 |
| Rate for Payer: Aetna Commercial |
$2,399.63
|
| Rate for Payer: Aetna Medicare |
$734.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$882.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$882.22
|
| Rate for Payer: BCBS Complete |
$1,129.24
|
| Rate for Payer: BCBS MAPPO |
$705.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.86
|
| Rate for Payer: BCN Commercial |
$2,194.95
|
| Rate for Payer: BCN Medicare Advantage |
$705.77
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$2,427.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.77
|
| Rate for Payer: Healthscope Commercial |
$2,540.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: Nomi Health Commercial |
$2,314.93
|
| Rate for Payer: PACE Senior Care Partners |
$670.48
|
| Rate for Payer: PACE SWMI |
$705.77
|
| Rate for Payer: PHP Commercial |
$2,399.63
|
| Rate for Payer: PHP Medicare Advantage |
$705.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,456.09
|
| Rate for Payer: Priority Health Medicare |
$712.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,891.47
|
| Rate for Payer: Railroad Medicare Medicare |
$705.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,484.32
|
| Rate for Payer: UHC Core |
$2,357.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$705.77
|
| Rate for Payer: UHC Exchange |
$705.77
|
| Rate for Payer: UHC Medicare Advantage |
$705.77
|
| Rate for Payer: VA VA |
$705.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.32
|
|
|
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 |
$2,670.81 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| 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 |
$4,498.20
|
| Rate for Payer: BCBS MAPPO |
$2,811.38
|
| Rate for Payer: BCBS Trust/PPO |
$9,244.93
|
| Rate for Payer: BCN Commercial |
$8,743.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,951.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,233.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.68
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: PACE Senior Care Partners |
$2,670.81
|
| Rate for Payer: PACE SWMI |
$2,811.38
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,811.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.58
|
| Rate for Payer: Priority Health HMO/PPO |
$9,783.58
|
| Rate for Payer: Priority Health Medicare |
$2,839.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,534.48
|
| 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 Dual Complete DSNP |
$2,811.38
|
| Rate for Payer: UHC Exchange |
$2,811.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,811.38
|
| Rate for Payer: VA VA |
$2,811.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
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 |
$7,309.58 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: BCBS Trust/PPO |
$9,179.70
|
| Rate for Payer: BCN Commercial |
$8,690.52
|
| 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 |
$9,558.68
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.58
|
| Rate for Payer: Priority Health HMO/PPO |
$9,783.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,534.48
|
| 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 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 |
$923.42 |
| Max. Negotiated Rate |
$1,278.58 |
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.68
|
| Rate for Payer: BCN Commercial |
$1,097.88
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,221.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,278.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,235.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$951.84
|
| 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 14
|
Facility
|
OP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$1,278.58 |
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: Aetna Medicare |
$369.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.95
|
| Rate for Payer: BCBS Complete |
$568.26
|
| Rate for Payer: BCBS MAPPO |
$355.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.92
|
| Rate for Payer: BCN Commercial |
$1,104.56
|
| Rate for Payer: BCN Medicare Advantage |
$355.16
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,221.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.16
|
| Rate for Payer: Healthscope Commercial |
$1,278.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$372.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: PACE Senior Care Partners |
$337.40
|
| Rate for Payer: PACE SWMI |
$355.16
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: PHP Medicare Advantage |
$355.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,235.97
|
| Rate for Payer: Priority Health Medicare |
$358.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$951.84
|
| Rate for Payer: Railroad Medicare Medicare |
$355.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,250.17
|
| Rate for Payer: UHC Core |
$1,186.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.16
|
| Rate for Payer: UHC Exchange |
$355.16
|
| Rate for Payer: UHC Medicare Advantage |
$355.16
|
| 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 18
|
Facility
|
IP
|
$1,860.48
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,209.31 |
| Max. Negotiated Rate |
$1,674.43 |
| Rate for Payer: Aetna Commercial |
$1,581.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.71
|
| Rate for Payer: BCN Commercial |
$1,437.78
|
| 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: PHP Commercial |
$1,581.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,618.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,246.52
|
| 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 |
$441.86 |
| 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 |
$744.19
|
| Rate for Payer: BCBS MAPPO |
$465.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,529.50
|
| Rate for Payer: BCN Commercial |
$1,446.52
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$534.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Nomi Health Commercial |
$1,525.59
|
| 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 Cigna Priority Health |
$1,209.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,618.62
|
| Rate for Payer: Priority Health Medicare |
$469.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,246.52
|
| 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 Dual Complete DSNP |
$465.12
|
| Rate for Payer: UHC Exchange |
$465.12
|
| Rate for Payer: UHC Medicare Advantage |
$465.12
|
| 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 |
$12,756.25 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: BCBS Trust/PPO |
$16,019.89
|
| Rate for Payer: BCN Commercial |
$15,166.20
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$17,662.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,756.25
|
| Rate for Payer: Priority Health HMO/PPO |
$17,073.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,148.75
|
| 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 |
$4,660.94 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: Aetna Medicare |
$5,102.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,132.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,132.81
|
| Rate for Payer: BCBS Complete |
$7,850.00
|
| Rate for Payer: BCBS MAPPO |
$4,906.25
|
| Rate for Payer: BCBS Trust/PPO |
$16,133.71
|
| Rate for Payer: BCN Commercial |
$15,258.44
|
| Rate for Payer: BCN Medicare Advantage |
$4,906.25
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,906.25
|
| Rate for Payer: Healthscope Commercial |
$17,662.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,151.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,642.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: PACE Senior Care Partners |
$4,660.94
|
| Rate for Payer: PACE SWMI |
$4,906.25
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: PHP Medicare Advantage |
$4,906.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,756.25
|
| Rate for Payer: Priority Health HMO/PPO |
$17,073.75
|
| Rate for Payer: Priority Health Medicare |
$4,955.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,148.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,906.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,270.00
|
| Rate for Payer: UHC Core |
$16,386.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,906.25
|
| Rate for Payer: UHC Exchange |
$4,906.25
|
| Rate for Payer: UHC Medicare Advantage |
$4,906.25
|
| 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
|
IP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.52 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.70
|
| Rate for Payer: BCN Commercial |
$1,585.45
|
| 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: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.52
|
| Rate for Payer: Priority Health HMO/PPO |
$1,784.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,374.55
|
| 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 20
|
Facility
|
OP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.25 |
| 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 |
$820.63
|
| Rate for Payer: BCBS MAPPO |
$512.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,686.60
|
| Rate for Payer: BCN Commercial |
$1,595.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$538.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$589.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Nomi Health Commercial |
$1,682.29
|
| 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 Cigna Priority Health |
$1,333.52
|
| Rate for Payer: Priority Health HMO/PPO |
$1,784.87
|
| Rate for Payer: Priority Health Medicare |
$518.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,374.55
|
| 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 Dual Complete DSNP |
$512.89
|
| Rate for Payer: UHC Exchange |
$512.89
|
| Rate for Payer: UHC Medicare Advantage |
$512.89
|
| 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 24
|
Facility
|
OP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.16 |
| 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 |
$997.32
|
| Rate for Payer: BCBS MAPPO |
$623.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.73
|
| Rate for Payer: BCN Commercial |
$1,938.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$716.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Nomi Health Commercial |
$2,044.50
|
| 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 Cigna Priority Health |
$1,620.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2,169.16
|
| Rate for Payer: Priority Health Medicare |
$629.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,670.50
|
| 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 Dual Complete DSNP |
$623.32
|
| Rate for Payer: UHC Exchange |
$623.32
|
| Rate for Payer: UHC Medicare Advantage |
$623.32
|
| 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 |
$1,620.64 |
| Max. Negotiated Rate |
$2,243.96 |
| Rate for Payer: Aetna Commercial |
$2,119.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,035.27
|
| Rate for Payer: BCN Commercial |
$1,926.81
|
| 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: PHP Commercial |
$2,119.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2,169.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,670.50
|
| 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
|
OP
|
$2,679.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.28 |
| 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 |
$1,071.62
|
| Rate for Payer: BCBS MAPPO |
$669.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,202.46
|
| Rate for Payer: BCN Commercial |
$2,082.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$703.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$770.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Nomi Health Commercial |
$2,196.83
|
| 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 Cigna Priority Health |
$1,741.39
|
| Rate for Payer: Priority Health HMO/PPO |
$2,330.78
|
| Rate for Payer: Priority Health Medicare |
$676.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,794.97
|
| 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 Dual Complete DSNP |
$669.76
|
| Rate for Payer: UHC Exchange |
$669.76
|
| Rate for Payer: UHC Medicare Advantage |
$669.76
|
| Rate for Payer: VA VA |
$669.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.30
|
|
|
HC STENT NONCOATED W SYS LVL 26
|
Facility
|
IP
|
$2,679.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,741.39 |
| Max. Negotiated Rate |
$2,411.15 |
| Rate for Payer: Aetna Commercial |
$2,277.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,186.92
|
| Rate for Payer: BCN Commercial |
$2,070.38
|
| 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: PHP Commercial |
$2,277.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.39
|
| Rate for Payer: Priority Health HMO/PPO |
$2,330.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,794.97
|
| 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 NON COATED W SYS LVL 29
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,943.01 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,440.12
|
| Rate for Payer: BCN Commercial |
$2,310.08
|
| 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: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,943.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,600.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,002.79
|
| 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 29
|
Facility
|
OP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.94 |
| 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 |
$1,195.70
|
| Rate for Payer: BCBS MAPPO |
$747.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,457.45
|
| Rate for Payer: BCN Commercial |
$2,324.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$859.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Nomi Health Commercial |
$2,451.18
|
| 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 Cigna Priority Health |
$1,943.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,600.64
|
| Rate for Payer: Priority Health Medicare |
$754.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,002.79
|
| 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 Dual Complete DSNP |
$747.31
|
| Rate for Payer: UHC Exchange |
$747.31
|
| Rate for Payer: UHC Medicare Advantage |
$747.31
|
| Rate for Payer: VA VA |
$747.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
|
HC STENT NON COATED W SYS LVL 35
|
Facility
|
IP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.48 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,895.33
|
| Rate for Payer: BCN Commercial |
$2,741.04
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,192.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.48
|
| Rate for Payer: Priority Health HMO/PPO |
$3,085.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,376.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,121.27
|
| Rate for Payer: UHC Core |
$2,961.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
HC STENT NON 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 |
$842.39 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna Medicare |
$922.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,108.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,108.41
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: BCBS MAPPO |
$886.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.91
|
| Rate for Payer: BCN Commercial |
$2,757.71
|
| Rate for Payer: BCN Medicare Advantage |
$886.72
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.72
|
| Rate for Payer: Healthscope Commercial |
$3,192.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$931.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,019.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: PACE Senior Care Partners |
$842.39
|
| Rate for Payer: PACE SWMI |
$886.72
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: PHP Medicare Advantage |
$886.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.48
|
| Rate for Payer: Priority Health HMO/PPO |
$3,085.80
|
| Rate for Payer: Priority Health Medicare |
$895.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,376.42
|
| Rate for Payer: Railroad Medicare Medicare |
$886.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,121.27
|
| Rate for Payer: UHC Core |
$2,961.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.72
|
| Rate for Payer: UHC Exchange |
$886.72
|
| Rate for Payer: UHC Medicare Advantage |
$886.72
|
| Rate for Payer: VA VA |
$886.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
