|
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 |
$1,278.59 |
| 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 |
$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 |
$1,278.59
|
| 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 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 |
$1,278.59 |
| 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 |
$1,278.59
|
| 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: 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 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
|
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 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 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
|
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 |
$886.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.91
|
| Rate for Payer: BCN Commercial |
$2,757.71
|
| 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: 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 |
$886.73
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: PHP Medicare Advantage |
$886.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.49
|
| 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 |
$886.73
|
| 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 |
$886.73
|
| Rate for Payer: UHC Exchange |
$886.73
|
| Rate for Payer: UHC Medicare Advantage |
$886.73
|
| 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 |
$2,305.49 |
| 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 |
$2,305.49
|
| 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 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 |
$888.17 |
| 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 |
$1,495.86
|
| Rate for Payer: BCBS MAPPO |
$934.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,074.37
|
| Rate for Payer: BCN Commercial |
$2,907.59
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$981.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,075.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Nomi Health Commercial |
$3,066.52
|
| 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 Cigna Priority Health |
$2,430.78
|
| Rate for Payer: Priority Health HMO/PPO |
$3,253.50
|
| Rate for Payer: Priority Health Medicare |
$944.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,505.57
|
| 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 Dual Complete DSNP |
$934.91
|
| Rate for Payer: UHC Exchange |
$934.91
|
| Rate for Payer: UHC Medicare Advantage |
$934.91
|
| Rate for Payer: VA VA |
$934.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,804.74
|
|
|
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 |
$2,430.78 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,052.68
|
| Rate for Payer: BCN Commercial |
$2,890.01
|
| 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: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,430.78
|
| Rate for Payer: Priority Health HMO/PPO |
$3,253.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,505.57
|
| 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 NON COATED W SYS LVL 44
|
Facility
|
OP
|
$4,451.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.11 |
| 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 |
$1,780.40
|
| Rate for Payer: BCBS MAPPO |
$1,112.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,659.17
|
| Rate for Payer: BCN Commercial |
$3,460.65
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,279.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Nomi Health Commercial |
$3,649.82
|
| 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 Cigna Priority Health |
$2,893.15
|
| Rate for Payer: Priority Health HMO/PPO |
$3,872.37
|
| Rate for Payer: Priority Health Medicare |
$1,123.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,982.17
|
| 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 Dual Complete DSNP |
$1,112.75
|
| Rate for Payer: UHC Exchange |
$1,112.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.75
|
| 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 44
|
Facility
|
IP
|
$4,451.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.15 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,633.35
|
| Rate for Payer: BCN Commercial |
$3,439.73
|
| 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: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,893.15
|
| Rate for Payer: Priority Health HMO/PPO |
$3,872.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,982.17
|
| 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 49
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,225.30 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,050.48
|
| Rate for Payer: BCN Commercial |
$3,834.63
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,225.30
|
| Rate for Payer: Priority Health HMO/PPO |
$4,316.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,324.54
|
| 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 49
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,178.47 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna Medicare |
$1,290.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,550.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,550.62
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: BCBS MAPPO |
$1,240.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,079.26
|
| Rate for Payer: BCN Commercial |
$3,857.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,240.50
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,240.50
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,302.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,426.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| 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 Cigna Priority Health |
$3,225.30
|
| Rate for Payer: Priority Health HMO/PPO |
$4,316.94
|
| Rate for Payer: Priority Health Medicare |
$1,252.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,324.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,240.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,366.56
|
| Rate for Payer: UHC Core |
$4,143.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,240.50
|
| Rate for Payer: UHC Exchange |
$1,240.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,240.50
|
| 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 5
|
Facility
|
OP
|
$1,449.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.15 |
| 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 |
$579.62
|
| Rate for Payer: BCBS MAPPO |
$362.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.27
|
| Rate for Payer: BCN Commercial |
$1,126.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Nomi Health Commercial |
$1,188.23
|
| 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 Cigna Priority Health |
$941.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,260.68
|
| Rate for Payer: Priority Health Medicare |
$365.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.87
|
| 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 Dual Complete DSNP |
$362.26
|
| Rate for Payer: UHC Exchange |
$362.26
|
| Rate for Payer: UHC Medicare Advantage |
$362.26
|
| 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 |
$941.89 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.87
|
| Rate for Payer: BCN Commercial |
$1,119.83
|
| 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: PHP Commercial |
$1,231.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,260.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.87
|
| 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 |
$3,567.30 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,479.98
|
| Rate for Payer: BCN Commercial |
$4,241.24
|
| 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: PHP Commercial |
$4,664.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.30
|
| Rate for Payer: Priority Health HMO/PPO |
$4,774.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,677.06
|
| 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
|
|
