|
HC STENT NONCOATED W SYS LVL 6
|
Facility
|
OP
|
$2,011.34
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$1,810.21 |
| Rate for Payer: Aetna American Axle |
$1,307.37
|
| Rate for Payer: Aetna Commercial |
$1,709.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.37
|
| Rate for Payer: BCBS Complete |
$804.54
|
| Rate for Payer: Cash Price |
$1,609.07
|
| Rate for Payer: Cofinity Commercial |
$1,407.94
|
| Rate for Payer: Cofinity Commercial |
$1,729.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,609.07
|
| Rate for Payer: Healthscope Commercial |
$1,810.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,407.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,709.64
|
| Rate for Payer: PHP Commercial |
$1,709.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.94
|
| Rate for Payer: Priority Health SBD |
$1,267.14
|
| Rate for Payer: UMR Bronson Commercial |
$744.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,508.50
|
|
|
HC STENT NONCOATED W SYS LVL 6
|
Facility
|
IP
|
$2,011.34
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.99 |
| Max. Negotiated Rate |
$1,810.21 |
| Rate for Payer: Aetna American Axle |
$1,307.37
|
| Rate for Payer: Aetna Commercial |
$1,709.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.37
|
| Rate for Payer: Cash Price |
$1,609.07
|
| Rate for Payer: Cofinity Commercial |
$1,407.94
|
| Rate for Payer: Cofinity Commercial |
$1,729.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,609.07
|
| Rate for Payer: Healthscope Commercial |
$1,810.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,407.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,709.64
|
| Rate for Payer: PHP Commercial |
$1,709.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.94
|
| Rate for Payer: Priority Health SBD |
$1,267.14
|
| Rate for Payer: UMR Bronson Commercial |
$884.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,508.50
|
|
|
HC STENT NONCOATED W SYS LVL 7
|
Facility
|
OP
|
$2,444.40
|
|
|
Service Code
|
HCPCS c1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.43 |
| Max. Negotiated Rate |
$2,199.96 |
| Rate for Payer: Aetna American Axle |
$1,588.86
|
| Rate for Payer: Aetna Commercial |
$2,077.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,588.86
|
| Rate for Payer: BCBS Complete |
$977.76
|
| Rate for Payer: Cash Price |
$1,955.52
|
| Rate for Payer: Cofinity Commercial |
$1,711.08
|
| Rate for Payer: Cofinity Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.52
|
| Rate for Payer: Healthscope Commercial |
$2,199.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,711.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,833.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,077.74
|
| Rate for Payer: PHP Commercial |
$2,077.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.08
|
| Rate for Payer: Priority Health SBD |
$1,539.97
|
| Rate for Payer: UMR Bronson Commercial |
$904.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,833.30
|
|
|
HC STENT NONCOATED W SYS LVL 7
|
Facility
|
IP
|
$2,444.40
|
|
|
Service Code
|
HCPCS c1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.54 |
| Max. Negotiated Rate |
$2,199.96 |
| Rate for Payer: Aetna American Axle |
$1,588.86
|
| Rate for Payer: Aetna Commercial |
$2,077.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,588.86
|
| Rate for Payer: Cash Price |
$1,955.52
|
| Rate for Payer: Cofinity Commercial |
$1,711.08
|
| Rate for Payer: Cofinity Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.52
|
| Rate for Payer: Healthscope Commercial |
$2,199.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,711.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,833.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,077.74
|
| Rate for Payer: PHP Commercial |
$2,077.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.08
|
| Rate for Payer: Priority Health SBD |
$1,539.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,075.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,833.30
|
|
|
HC STENT NONCOATED W SYS LVL 8
|
Facility
|
OP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.35 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna American Axle |
$2,305.48
|
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,305.48
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$2,482.83
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,482.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,014.86
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,482.83
|
| Rate for Payer: Priority Health SBD |
$2,234.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,312.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
HC STENT NONCOATED W SYS LVL 8
|
Facility
|
IP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.64 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna American Axle |
$2,305.48
|
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,305.48
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$2,482.83
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,482.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,660.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,014.86
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,482.83
|
| Rate for Payer: Priority Health SBD |
$2,234.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,560.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
OP
|
$239.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.58 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: BCBS Complete |
$95.76
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.58
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UMR Bronson Commercial |
$88.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
IP
|
$239.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.58
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UMR Bronson Commercial |
$105.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
HCPCS c2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna American Axle |
$319.41
|
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: BCBS Complete |
$196.56
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.69
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.98
|
| Rate for Payer: Priority Health SBD |
$309.58
|
| Rate for Payer: UMR Bronson Commercial |
$181.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
HCPCS c2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna American Axle |
$319.41
|
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.69
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.98
|
| Rate for Payer: Priority Health SBD |
$309.58
|
| Rate for Payer: UMR Bronson Commercial |
$216.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
IP
|
$822.28
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Aetna American Axle |
$534.48
|
| Rate for Payer: Aetna Commercial |
$698.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.48
|
| Rate for Payer: Cash Price |
$657.82
|
| Rate for Payer: Cofinity Commercial |
$575.60
|
| Rate for Payer: Cofinity Commercial |
$707.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.82
|
| Rate for Payer: Healthscope Commercial |
$740.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.94
|
| Rate for Payer: PHP Commercial |
$698.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.60
|
| Rate for Payer: Priority Health SBD |
$518.04
|
| Rate for Payer: UMR Bronson Commercial |
$361.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.71
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
OP
|
$822.28
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.24 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Aetna American Axle |
$534.48
|
| Rate for Payer: Aetna Commercial |
$698.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.48
|
| Rate for Payer: BCBS Complete |
$328.91
|
| Rate for Payer: Cash Price |
$657.82
|
| Rate for Payer: Cofinity Commercial |
$575.60
|
| Rate for Payer: Cofinity Commercial |
$707.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.82
|
| Rate for Payer: Healthscope Commercial |
$740.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.94
|
| Rate for Payer: PHP Commercial |
$698.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.60
|
| Rate for Payer: Priority Health SBD |
$518.04
|
| Rate for Payer: UMR Bronson Commercial |
$304.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.71
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
IP
|
$10,408.41
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,579.70 |
| Max. Negotiated Rate |
$9,367.57 |
| Rate for Payer: Aetna American Axle |
$6,765.47
|
| Rate for Payer: Aetna Commercial |
$8,847.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,765.47
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cofinity Commercial |
$7,285.89
|
| Rate for Payer: Cofinity Commercial |
$8,951.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,326.73
|
| Rate for Payer: Healthscope Commercial |
$9,367.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,285.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,806.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,847.15
|
| Rate for Payer: PHP Commercial |
$8,847.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,285.89
|
| Rate for Payer: Priority Health SBD |
$6,557.30
|
| Rate for Payer: UMR Bronson Commercial |
$4,579.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,806.31
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
OP
|
$10,408.41
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.38 |
| Max. Negotiated Rate |
$9,367.57 |
| Rate for Payer: Aetna American Axle |
$6,765.47
|
| Rate for Payer: Aetna Commercial |
$8,847.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,765.47
|
| Rate for Payer: BCBS Complete |
$4,163.36
|
| Rate for Payer: BCBS Trust/PPO |
$8,238.74
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cofinity Commercial |
$8,951.23
|
| Rate for Payer: Cofinity Commercial |
$7,285.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,326.73
|
| Rate for Payer: Healthscope Commercial |
$9,367.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,285.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,806.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,847.15
|
| Rate for Payer: PHP Commercial |
$8,847.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,285.89
|
| Rate for Payer: Priority Health SBD |
$6,557.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.52
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$201.38
|
| Rate for Payer: UMR Bronson Commercial |
$3,851.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,806.31
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
IP
|
$16,081.87
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,076.02 |
| Max. Negotiated Rate |
$14,473.68 |
| Rate for Payer: Aetna American Axle |
$10,453.22
|
| Rate for Payer: Aetna Commercial |
$13,669.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,453.22
|
| Rate for Payer: Cash Price |
$12,865.50
|
| Rate for Payer: Cofinity Commercial |
$11,257.31
|
| Rate for Payer: Cofinity Commercial |
$13,830.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,865.50
|
| Rate for Payer: Healthscope Commercial |
$14,473.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,257.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,061.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,669.59
|
| Rate for Payer: PHP Commercial |
$13,669.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,257.31
|
| Rate for Payer: Priority Health SBD |
$10,131.58
|
| Rate for Payer: UMR Bronson Commercial |
$7,076.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,061.40
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
OP
|
$16,081.87
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.44 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna American Axle |
$10,453.22
|
| Rate for Payer: Aetna Commercial |
$13,669.59
|
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,453.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$11,194.58
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$12,865.50
|
| Rate for Payer: Cash Price |
$12,865.50
|
| Rate for Payer: Cofinity Commercial |
$13,830.41
|
| Rate for Payer: Cofinity Commercial |
$11,257.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,865.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$14,473.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,257.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,061.40
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,669.59
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$13,669.59
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,257.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Priority Health SBD |
$10,131.58
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.48
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$420.44
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: UMR Bronson Commercial |
$5,950.29
|
| Rate for Payer: VA VA |
$9,778.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,061.40
|
|
|
HC STENT PLACE VENOUS
|
Facility
|
IP
|
$18,379.26
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,086.87 |
| Max. Negotiated Rate |
$16,541.33 |
| Rate for Payer: Aetna American Axle |
$11,946.52
|
| Rate for Payer: Aetna Commercial |
$15,622.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,946.52
|
| Rate for Payer: Cash Price |
$14,703.41
|
| Rate for Payer: Cofinity Commercial |
$12,865.48
|
| Rate for Payer: Cofinity Commercial |
$15,806.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,703.41
|
| Rate for Payer: Healthscope Commercial |
$16,541.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,865.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,784.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,622.37
|
| Rate for Payer: PHP Commercial |
$15,622.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,865.48
|
| Rate for Payer: Priority Health SBD |
$11,578.93
|
| Rate for Payer: UMR Bronson Commercial |
$8,086.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,784.44
|
|
|
HC STENT PLACE VENOUS
|
Facility
|
OP
|
$18,379.26
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.73 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna American Axle |
$11,946.52
|
| Rate for Payer: Aetna Commercial |
$15,622.37
|
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,946.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$14,547.79
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$14,703.41
|
| Rate for Payer: Cash Price |
$14,703.41
|
| Rate for Payer: Cofinity Commercial |
$12,865.48
|
| Rate for Payer: Cofinity Commercial |
$15,806.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,703.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$16,541.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,865.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,784.44
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,622.37
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$15,622.37
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,865.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Priority Health SBD |
$11,578.93
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.00
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$292.73
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: UMR Bronson Commercial |
$6,800.33
|
| Rate for Payer: VA VA |
$9,778.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,784.44
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
OP
|
$10,408.41
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$9,367.57 |
| Rate for Payer: Aetna American Axle |
$6,765.47
|
| Rate for Payer: Aetna Commercial |
$8,847.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,765.47
|
| Rate for Payer: BCBS Complete |
$4,163.36
|
| Rate for Payer: BCBS Trust/PPO |
$6,831.68
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cofinity Commercial |
$7,285.89
|
| Rate for Payer: Cofinity Commercial |
$8,951.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,326.73
|
| Rate for Payer: Healthscope Commercial |
$9,367.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,285.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,806.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,847.15
|
| Rate for Payer: PHP Commercial |
$8,847.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,285.89
|
| Rate for Payer: Priority Health SBD |
$6,557.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.76
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$143.42
|
| Rate for Payer: UMR Bronson Commercial |
$3,851.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,806.31
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
IP
|
$10,408.41
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,579.70 |
| Max. Negotiated Rate |
$9,367.57 |
| Rate for Payer: Aetna American Axle |
$6,765.47
|
| Rate for Payer: Aetna Commercial |
$8,847.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,765.47
|
| Rate for Payer: Cash Price |
$8,326.73
|
| Rate for Payer: Cofinity Commercial |
$7,285.89
|
| Rate for Payer: Cofinity Commercial |
$8,951.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,326.73
|
| Rate for Payer: Healthscope Commercial |
$9,367.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,285.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,806.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,847.15
|
| Rate for Payer: PHP Commercial |
$8,847.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,285.89
|
| Rate for Payer: Priority Health SBD |
$6,557.30
|
| Rate for Payer: UMR Bronson Commercial |
$4,579.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,806.31
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
IP
|
$6,720.90
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,957.20 |
| Max. Negotiated Rate |
$6,048.81 |
| Rate for Payer: Aetna American Axle |
$4,368.58
|
| Rate for Payer: Aetna Commercial |
$5,712.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,368.58
|
| Rate for Payer: Cash Price |
$5,376.72
|
| Rate for Payer: Cofinity Commercial |
$4,704.63
|
| Rate for Payer: Cofinity Commercial |
$5,779.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,376.72
|
| Rate for Payer: Healthscope Commercial |
$6,048.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,704.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,040.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,712.76
|
| Rate for Payer: PHP Commercial |
$5,712.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,704.63
|
| Rate for Payer: Priority Health SBD |
$4,234.17
|
| Rate for Payer: UMR Bronson Commercial |
$2,957.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,040.68
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
OP
|
$6,720.90
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$8,596.00 |
| Rate for Payer: Aetna American Axle |
$4,368.58
|
| Rate for Payer: Aetna Commercial |
$5,712.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,368.58
|
| Rate for Payer: BCBS Complete |
$2,688.36
|
| Rate for Payer: BCBS Trust/PPO |
$6,831.68
|
| Rate for Payer: Cash Price |
$5,376.72
|
| Rate for Payer: Cash Price |
$5,376.72
|
| Rate for Payer: Cofinity Commercial |
$5,779.97
|
| Rate for Payer: Cofinity Commercial |
$4,704.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,376.72
|
| Rate for Payer: Healthscope Commercial |
$6,048.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,704.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,040.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,712.76
|
| Rate for Payer: PHP Commercial |
$5,712.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,704.63
|
| Rate for Payer: Priority Health SBD |
$4,234.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.76
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$143.42
|
| Rate for Payer: UMR Bronson Commercial |
$2,486.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,040.68
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
OP
|
$24,183.90
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$562.87 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna American Axle |
$15,719.54
|
| Rate for Payer: Aetna Commercial |
$20,556.32
|
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,719.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$10,776.43
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cofinity Commercial |
$20,798.15
|
| Rate for Payer: Cofinity Commercial |
$16,928.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,347.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$21,765.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,928.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,137.92
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,556.32
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$20,556.32
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,928.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Priority Health SBD |
$15,235.86
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.16
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$562.87
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: UMR Bronson Commercial |
$8,948.04
|
| Rate for Payer: VA VA |
$9,778.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,137.92
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
IP
|
$24,183.90
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,640.92 |
| Max. Negotiated Rate |
$21,765.51 |
| Rate for Payer: Aetna American Axle |
$15,719.54
|
| Rate for Payer: Aetna Commercial |
$20,556.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,719.54
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cofinity Commercial |
$16,928.73
|
| Rate for Payer: Cofinity Commercial |
$20,798.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,347.12
|
| Rate for Payer: Healthscope Commercial |
$21,765.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,928.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,137.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,556.32
|
| Rate for Payer: PHP Commercial |
$20,556.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,928.73
|
| Rate for Payer: Priority Health SBD |
$15,235.86
|
| Rate for Payer: UMR Bronson Commercial |
$10,640.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,137.92
|
|
|
HC STIZ MARKER
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna American Axle |
$54.60
|
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.60
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health SBD |
$52.92
|
| Rate for Payer: UMR Bronson Commercial |
$31.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
