|
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
|
|
|
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 |
$1,373.44 |
| 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 |
$2,313.16
|
| Rate for Payer: BCBS MAPPO |
$1,445.72
|
| Rate for Payer: BCBS Trust/PPO |
$4,754.12
|
| Rate for Payer: BCN Commercial |
$4,496.20
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,518.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,662.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Nomi Health Commercial |
$4,741.98
|
| 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 Cigna Priority Health |
$3,758.89
|
| Rate for Payer: Priority Health HMO/PPO |
$5,031.12
|
| Rate for Payer: Priority Health Medicare |
$1,460.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,874.54
|
| 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 Dual Complete DSNP |
$1,445.72
|
| Rate for Payer: UHC Exchange |
$1,445.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,445.72
|
| 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 |
$3,758.89 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,720.58
|
| Rate for Payer: BCN Commercial |
$4,469.03
|
| 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: PHP Commercial |
$4,915.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.89
|
| Rate for Payer: Priority Health HMO/PPO |
$5,031.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,874.54
|
| 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
|
IP
|
$5,979.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.64 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,881.02
|
| Rate for Payer: BCN Commercial |
$4,620.91
|
| 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: PHP Commercial |
$5,082.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,886.64
|
| Rate for Payer: Priority Health HMO/PPO |
$5,202.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,006.22
|
| 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 59
|
Facility
|
OP
|
$5,979.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.12 |
| 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 |
$2,391.78
|
| Rate for Payer: BCBS MAPPO |
$1,494.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,915.70
|
| Rate for Payer: BCN Commercial |
$4,649.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,569.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,719.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| 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 Cigna Priority Health |
$3,886.64
|
| Rate for Payer: Priority Health HMO/PPO |
$5,202.11
|
| Rate for Payer: Priority Health Medicare |
$1,509.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,006.22
|
| 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 Dual Complete DSNP |
$1,494.86
|
| Rate for Payer: UHC Exchange |
$1,494.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,494.86
|
| 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 67
|
Facility
|
OP
|
$6,779.33
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.09 |
| 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 |
$2,711.73
|
| Rate for Payer: BCBS MAPPO |
$1,694.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,573.29
|
| Rate for Payer: BCN Commercial |
$5,270.93
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,949.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| 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 Cigna Priority Health |
$4,406.56
|
| Rate for Payer: Priority Health HMO/PPO |
$5,898.02
|
| Rate for Payer: Priority Health Medicare |
$1,711.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,542.15
|
| 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 Dual Complete DSNP |
$1,694.83
|
| Rate for Payer: UHC Exchange |
$1,694.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,694.83
|
| 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 |
$4,406.56 |
| Max. Negotiated Rate |
$6,101.40 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: BCBS Trust/PPO |
$5,533.97
|
| Rate for Payer: BCN Commercial |
$5,239.07
|
| 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: PHP Commercial |
$5,762.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,406.56
|
| Rate for Payer: Priority Health HMO/PPO |
$5,898.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,542.15
|
| 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 |
$58.00 |
| 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 |
$97.68
|
| Rate for Payer: BCBS MAPPO |
$61.05
|
| Rate for Payer: BCBS Trust/PPO |
$200.75
|
| Rate for Payer: BCN Commercial |
$189.86
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| 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 Cigna Priority Health |
$158.72
|
| Rate for Payer: Priority Health HMO/PPO |
$212.45
|
| Rate for Payer: Priority Health Medicare |
$61.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.61
|
| 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 Dual Complete DSNP |
$61.05
|
| Rate for Payer: UHC Exchange |
$61.05
|
| Rate for Payer: UHC Medicare Advantage |
$61.05
|
| 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 |
$158.72 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: BCBS Trust/PPO |
$199.33
|
| Rate for Payer: BCN Commercial |
$188.71
|
| 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: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.72
|
| Rate for Payer: Priority Health HMO/PPO |
$212.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.61
|
| 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 |
$325.80 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: BCBS Trust/PPO |
$409.15
|
| Rate for Payer: BCN Commercial |
$387.35
|
| 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: PHP Commercial |
$426.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.80
|
| Rate for Payer: Priority Health HMO/PPO |
$436.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.82
|
| 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 |
$119.04 |
| 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 |
$200.49
|
| Rate for Payer: BCBS MAPPO |
$125.31
|
| Rate for Payer: BCBS Trust/PPO |
$412.06
|
| Rate for Payer: BCN Commercial |
$389.71
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Nomi Health Commercial |
$411.01
|
| 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 Cigna Priority Health |
$325.80
|
| Rate for Payer: Priority Health HMO/PPO |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$126.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.82
|
| 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 Dual Complete DSNP |
$125.31
|
| Rate for Payer: UHC Exchange |
$125.31
|
| Rate for Payer: UHC Medicare Advantage |
$125.31
|
| 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
|
IP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.17 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: BCBS Trust/PPO |
$684.66
|
| Rate for Payer: BCN Commercial |
$648.17
|
| 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: PHP Commercial |
$712.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.17
|
| Rate for Payer: Priority Health HMO/PPO |
$729.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.95
|
| 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
|
|
|
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 |
$199.20 |
| 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 |
$335.49
|
| Rate for Payer: BCBS MAPPO |
$209.68
|
| Rate for Payer: BCBS Trust/PPO |
$689.52
|
| Rate for Payer: BCN Commercial |
$652.11
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Nomi Health Commercial |
$687.76
|
| 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 Cigna Priority Health |
$545.17
|
| Rate for Payer: Priority Health HMO/PPO |
$729.70
|
| Rate for Payer: Priority Health Medicare |
$211.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.95
|
| 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 Dual Complete DSNP |
$209.68
|
| Rate for Payer: UHC Exchange |
$209.68
|
| Rate for Payer: UHC Medicare Advantage |
$209.68
|
| Rate for Payer: VA VA |
$209.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.05
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
IP
|
$10,616.58
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,900.78 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,666.31
|
| Rate for Payer: BCN Commercial |
$8,204.49
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,962.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health HMO/PPO |
$9,236.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,113.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,342.59
|
| Rate for Payer: UHC Core |
$8,864.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,962.44
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
OP
|
$10,616.58
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,521.44 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: Aetna Medicare |
$2,760.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,317.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,317.68
|
| Rate for Payer: BCBS Complete |
$4,246.63
|
| Rate for Payer: BCBS MAPPO |
$2,654.14
|
| Rate for Payer: BCBS Trust/PPO |
$8,727.89
|
| Rate for Payer: BCN Commercial |
$8,254.39
|
| Rate for Payer: BCN Medicare Advantage |
$2,654.14
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,654.14
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,962.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,786.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,052.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: PACE Senior Care Partners |
$2,521.44
|
| Rate for Payer: PACE SWMI |
$2,654.14
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,654.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health HMO/PPO |
$9,236.42
|
| Rate for Payer: Priority Health Medicare |
$2,680.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,113.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,654.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,342.59
|
| Rate for Payer: UHC Core |
$8,864.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,654.14
|
| Rate for Payer: UHC Exchange |
$2,654.14
|
| Rate for Payer: UHC Medicare Advantage |
$2,654.14
|
| Rate for Payer: VA VA |
$2,654.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,962.44
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
IP
|
$16,403.51
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,662.28 |
| Max. Negotiated Rate |
$14,763.16 |
| Rate for Payer: Aetna Commercial |
$13,942.98
|
| Rate for Payer: BCBS Trust/PPO |
$13,390.19
|
| Rate for Payer: BCN Commercial |
$12,676.63
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cofinity Commercial |
$14,107.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,122.81
|
| Rate for Payer: Healthscope Commercial |
$14,763.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,302.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,942.98
|
| Rate for Payer: Nomi Health Commercial |
$13,450.88
|
| Rate for Payer: PHP Commercial |
$13,942.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,662.28
|
| Rate for Payer: Priority Health HMO/PPO |
$14,271.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,990.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,435.09
|
| Rate for Payer: UHC Core |
$13,696.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,302.63
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
OP
|
$16,403.51
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,895.83 |
| Max. Negotiated Rate |
$14,763.16 |
| Rate for Payer: Aetna Commercial |
$13,942.98
|
| Rate for Payer: Aetna Medicare |
$4,264.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,126.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,126.10
|
| Rate for Payer: BCBS Complete |
$8,609.76
|
| Rate for Payer: BCBS MAPPO |
$4,100.88
|
| Rate for Payer: BCBS Trust/PPO |
$13,485.33
|
| Rate for Payer: BCN Commercial |
$12,753.73
|
| Rate for Payer: BCN Medicare Advantage |
$4,100.88
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cofinity Commercial |
$14,107.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,122.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,100.88
|
| Rate for Payer: Healthscope Commercial |
$14,763.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,302.63
|
| Rate for Payer: Mclaren Medicaid |
$8,199.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,305.92
|
| Rate for Payer: Meridian Medicaid |
$8,609.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,716.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,942.98
|
| Rate for Payer: Nomi Health Commercial |
$13,450.88
|
| Rate for Payer: PACE Senior Care Partners |
$3,895.83
|
| Rate for Payer: PACE SWMI |
$4,100.88
|
| Rate for Payer: PHP Commercial |
$13,942.98
|
| Rate for Payer: PHP Medicare Advantage |
$4,100.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,199.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,662.28
|
| Rate for Payer: Priority Health HMO/PPO |
$14,271.05
|
| Rate for Payer: Priority Health Medicare |
$4,141.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,990.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4,100.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,435.09
|
| Rate for Payer: UHC Core |
$13,696.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,100.88
|
| Rate for Payer: UHC Exchange |
$4,100.88
|
| Rate for Payer: UHC Medicare Advantage |
$4,100.88
|
| Rate for Payer: UHCCP Medicaid |
$8,199.23
|
| Rate for Payer: VA VA |
$4,100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,302.63
|
|
|
HC STENT PLACE VENOUS
|
Facility
|
IP
|
$18,746.85
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,185.45 |
| Max. Negotiated Rate |
$16,872.17 |
| Rate for Payer: Aetna Commercial |
$15,934.82
|
| Rate for Payer: BCBS Trust/PPO |
$15,303.05
|
| Rate for Payer: BCN Commercial |
$14,487.57
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cofinity Commercial |
$16,122.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,997.48
|
| Rate for Payer: Healthscope Commercial |
$16,872.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,060.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,934.82
|
| Rate for Payer: Nomi Health Commercial |
$15,372.42
|
| Rate for Payer: PHP Commercial |
$15,934.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,185.45
|
| Rate for Payer: Priority Health HMO/PPO |
$16,309.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,560.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,497.23
|
| Rate for Payer: UHC Core |
$15,653.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,060.14
|
|
|
HC STENT PLACE VENOUS
|
Facility
|
OP
|
$18,746.85
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,452.38 |
| Max. Negotiated Rate |
$16,872.17 |
| Rate for Payer: Aetna Commercial |
$15,934.82
|
| Rate for Payer: Aetna Medicare |
$4,874.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,858.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,858.39
|
| Rate for Payer: BCBS Complete |
$8,609.76
|
| Rate for Payer: BCBS MAPPO |
$4,686.71
|
| Rate for Payer: BCBS Trust/PPO |
$15,411.79
|
| Rate for Payer: BCN Commercial |
$14,575.68
|
| Rate for Payer: BCN Medicare Advantage |
$4,686.71
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cofinity Commercial |
$16,122.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,997.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,686.71
|
| Rate for Payer: Healthscope Commercial |
$16,872.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,060.14
|
| Rate for Payer: Mclaren Medicaid |
$8,199.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,921.05
|
| Rate for Payer: Meridian Medicaid |
$8,609.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,389.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,934.82
|
| Rate for Payer: Nomi Health Commercial |
$15,372.42
|
| Rate for Payer: PACE Senior Care Partners |
$4,452.38
|
| Rate for Payer: PACE SWMI |
$4,686.71
|
| Rate for Payer: PHP Commercial |
$15,934.82
|
| Rate for Payer: PHP Medicare Advantage |
$4,686.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,199.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,185.45
|
| Rate for Payer: Priority Health HMO/PPO |
$16,309.76
|
| Rate for Payer: Priority Health Medicare |
$4,733.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,560.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4,686.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,497.23
|
| Rate for Payer: UHC Core |
$15,653.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,686.71
|
| Rate for Payer: UHC Exchange |
$4,686.71
|
| Rate for Payer: UHC Medicare Advantage |
$4,686.71
|
| Rate for Payer: UHCCP Medicaid |
$8,199.23
|
| Rate for Payer: VA VA |
$4,686.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,060.14
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
IP
|
$10,616.58
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,900.78 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,666.31
|
| Rate for Payer: BCN Commercial |
$8,204.49
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,962.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health HMO/PPO |
$9,236.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,113.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,342.59
|
| Rate for Payer: UHC Core |
$8,864.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,962.44
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
OP
|
$10,616.58
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,521.44 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: Aetna Medicare |
$2,760.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,317.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,317.68
|
| Rate for Payer: BCBS Complete |
$4,246.63
|
| Rate for Payer: BCBS MAPPO |
$2,654.14
|
| Rate for Payer: BCBS Trust/PPO |
$8,727.89
|
| Rate for Payer: BCN Commercial |
$8,254.39
|
| Rate for Payer: BCN Medicare Advantage |
$2,654.14
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,654.14
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,962.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,786.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,052.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: PACE Senior Care Partners |
$2,521.44
|
| Rate for Payer: PACE SWMI |
$2,654.14
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,654.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health HMO/PPO |
$9,236.42
|
| Rate for Payer: Priority Health Medicare |
$2,680.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,113.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,654.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,342.59
|
| Rate for Payer: UHC Core |
$8,864.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,654.14
|
| Rate for Payer: UHC Exchange |
$2,654.14
|
| Rate for Payer: UHC Medicare Advantage |
$2,654.14
|
| Rate for Payer: VA VA |
$2,654.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,962.44
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
OP
|
$6,855.32
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,628.14 |
| Max. Negotiated Rate |
$6,169.79 |
| Rate for Payer: Aetna Commercial |
$5,827.02
|
| Rate for Payer: Aetna Medicare |
$1,782.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,142.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,142.29
|
| Rate for Payer: BCBS Complete |
$2,742.13
|
| Rate for Payer: BCBS MAPPO |
$1,713.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,635.76
|
| Rate for Payer: BCN Commercial |
$5,330.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,713.83
|
| Rate for Payer: Cash Price |
$5,484.26
|
| Rate for Payer: Cofinity Commercial |
$5,895.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,484.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,713.83
|
| Rate for Payer: Healthscope Commercial |
$6,169.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,141.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,799.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,970.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,827.02
|
| Rate for Payer: Nomi Health Commercial |
$5,621.36
|
| Rate for Payer: PACE Senior Care Partners |
$1,628.14
|
| Rate for Payer: PACE SWMI |
$1,713.83
|
| Rate for Payer: PHP Commercial |
$5,827.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,713.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,455.96
|
| Rate for Payer: Priority Health HMO/PPO |
$5,964.13
|
| Rate for Payer: Priority Health Medicare |
$1,730.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,593.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,713.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,032.68
|
| Rate for Payer: UHC Core |
$5,724.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,713.83
|
| Rate for Payer: UHC Exchange |
$1,713.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,713.83
|
| Rate for Payer: VA VA |
$1,713.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,141.49
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
IP
|
$6,855.32
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,455.96 |
| Max. Negotiated Rate |
$6,169.79 |
| Rate for Payer: Aetna Commercial |
$5,827.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,596.00
|
| Rate for Payer: BCN Commercial |
$5,297.79
|
| Rate for Payer: Cash Price |
$5,484.26
|
| Rate for Payer: Cofinity Commercial |
$5,895.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,484.26
|
| Rate for Payer: Healthscope Commercial |
$6,169.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,141.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,827.02
|
| Rate for Payer: Nomi Health Commercial |
$5,621.36
|
| Rate for Payer: PHP Commercial |
$5,827.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,455.96
|
| Rate for Payer: Priority Health HMO/PPO |
$5,964.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,593.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,032.68
|
| Rate for Payer: UHC Core |
$5,724.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,141.49
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
OP
|
$24,667.58
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,858.55 |
| Max. Negotiated Rate |
$22,200.82 |
| Rate for Payer: Aetna Commercial |
$20,967.44
|
| Rate for Payer: Aetna Medicare |
$6,413.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,708.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,708.62
|
| Rate for Payer: BCBS Complete |
$8,609.76
|
| Rate for Payer: BCBS MAPPO |
$6,166.90
|
| Rate for Payer: BCBS Trust/PPO |
$20,279.22
|
| Rate for Payer: BCN Commercial |
$19,179.04
|
| Rate for Payer: BCN Medicare Advantage |
$6,166.90
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$21,214.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,166.90
|
| Rate for Payer: Healthscope Commercial |
$22,200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,500.69
|
| Rate for Payer: Mclaren Medicaid |
$8,199.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,475.24
|
| Rate for Payer: Meridian Medicaid |
$8,609.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,091.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: PACE Senior Care Partners |
$5,858.55
|
| Rate for Payer: PACE SWMI |
$6,166.90
|
| Rate for Payer: PHP Commercial |
$20,967.44
|
| Rate for Payer: PHP Medicare Advantage |
$6,166.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,199.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21,460.79
|
| Rate for Payer: Priority Health Medicare |
$6,228.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16,527.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6,166.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,707.47
|
| Rate for Payer: UHC Core |
$20,597.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,166.90
|
| Rate for Payer: UHC Exchange |
$6,166.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,166.90
|
| Rate for Payer: UHCCP Medicaid |
$8,199.23
|
| Rate for Payer: VA VA |
$6,166.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,500.69
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
IP
|
$24,667.58
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,033.93 |
| Max. Negotiated Rate |
$22,200.82 |
| Rate for Payer: Aetna Commercial |
$20,967.44
|
| Rate for Payer: BCBS Trust/PPO |
$20,136.15
|
| Rate for Payer: BCN Commercial |
$19,063.11
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$21,214.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Healthscope Commercial |
$22,200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,500.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: PHP Commercial |
$20,967.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21,460.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16,527.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,707.47
|
| Rate for Payer: UHC Core |
$20,597.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,500.69
|
|
