|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna American Axle |
$22.99
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$91.58
|
| Rate for Payer: BCN Commercial |
$91.58
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.53
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.99
|
| Rate for Payer: UHC Core |
$18.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$13.90
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.53
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,478.41
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$1,330.57 |
| Rate for Payer: Aetna American Axle |
$960.97
|
| Rate for Payer: Aetna Commercial |
$1,256.65
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$95.81
|
| Rate for Payer: BCN Commercial |
$95.81
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cofinity Advantage |
$1,034.89
|
| Rate for Payer: Cofinity Commercial |
$1,271.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,330.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.81
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.65
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.81
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,256.65
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$931.40
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.97
|
| Rate for Payer: UHC Core |
$770.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$581.02
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$547.01
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.81
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,478.41
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.50 |
| Max. Negotiated Rate |
$1,330.57 |
| Rate for Payer: Aetna American Axle |
$960.97
|
| Rate for Payer: Aetna Commercial |
$1,256.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.97
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cofinity Advantage |
$1,034.89
|
| Rate for Payer: Cofinity Commercial |
$1,271.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.73
|
| Rate for Payer: Healthscope Commercial |
$1,330.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.81
|
| Rate for Payer: PHP Commercial |
$1,256.65
|
| Rate for Payer: Priority Health SBD |
$931.40
|
| Rate for Payer: UMR Bronson Commercial |
$650.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.81
|
|
|
HC STENT
|
Facility
|
OP
|
$972.22
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna American Axle |
$631.94
|
| Rate for Payer: Aetna Commercial |
$826.39
|
| Rate for Payer: Aetna Medicare |
$486.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.94
|
| Rate for Payer: BCBS Complete |
$388.89
|
| Rate for Payer: Cash Price |
$777.78
|
| Rate for Payer: Cofinity Advantage |
$680.55
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.78
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$680.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$777.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.16
|
| Rate for Payer: PHP Commercial |
$826.39
|
| Rate for Payer: Priority Health SBD |
$612.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.94
|
| Rate for Payer: UHC Core |
$506.53
|
| Rate for Payer: UHC Exchange |
$382.08
|
| Rate for Payer: UMR Bronson Commercial |
$359.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.16
|
|
|
HC STENT
|
Facility
|
IP
|
$972.22
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.78 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna American Axle |
$631.94
|
| Rate for Payer: Aetna Commercial |
$826.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.94
|
| Rate for Payer: Cash Price |
$777.78
|
| Rate for Payer: Cofinity Advantage |
$680.55
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.78
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$680.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.16
|
| Rate for Payer: PHP Commercial |
$826.39
|
| Rate for Payer: Priority Health SBD |
$612.50
|
| Rate for Payer: UMR Bronson Commercial |
$427.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.16
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$17,350.78
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna American Axle |
$11,278.01
|
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna Medicare |
$8,675.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,278.01
|
| Rate for Payer: BCBS Complete |
$6,940.31
|
| Rate for Payer: BCBS Trust/PPO |
$640.64
|
| Rate for Payer: BCN Commercial |
$640.64
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Advantage |
$12,145.55
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,145.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,013.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,880.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health SBD |
$10,930.99
|
| Rate for Payer: UMR Bronson Commercial |
$6,419.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,013.08
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$17,350.78
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,634.34 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna American Axle |
$11,278.01
|
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,278.01
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Advantage |
$12,145.55
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,145.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,013.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health SBD |
$10,930.99
|
| Rate for Payer: UMR Bronson Commercial |
$7,634.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,013.08
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$12,112.82
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,329.64 |
| Max. Negotiated Rate |
$10,901.54 |
| Rate for Payer: Aetna American Axle |
$7,873.33
|
| Rate for Payer: Aetna Commercial |
$10,295.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,873.33
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Advantage |
$8,478.97
|
| Rate for Payer: Cofinity Commercial |
$10,417.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Healthscope Commercial |
$10,901.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,478.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,084.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,295.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: PHP Commercial |
$10,295.90
|
| Rate for Payer: Priority Health SBD |
$7,631.08
|
| Rate for Payer: UMR Bronson Commercial |
$5,329.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,084.61
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$12,112.82
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,481.74 |
| Max. Negotiated Rate |
$10,901.54 |
| Rate for Payer: Aetna American Axle |
$7,873.33
|
| Rate for Payer: Aetna Commercial |
$10,295.90
|
| Rate for Payer: Aetna Medicare |
$6,056.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,873.33
|
| Rate for Payer: BCBS Complete |
$4,845.13
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Advantage |
$8,478.97
|
| Rate for Payer: Cofinity Commercial |
$10,417.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Healthscope Commercial |
$10,901.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,478.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,084.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,690.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,295.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: PHP Commercial |
$10,295.90
|
| Rate for Payer: Priority Health SBD |
$7,631.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,873.33
|
| Rate for Payer: UHC Core |
$6,310.78
|
| Rate for Payer: UHC Exchange |
$4,760.34
|
| Rate for Payer: UMR Bronson Commercial |
$4,481.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,084.61
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,061.79 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna American Axle |
$3,622.07
|
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: Aetna Medicare |
$2,786.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,622.07
|
| Rate for Payer: BCBS Complete |
$2,228.96
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Advantage |
$3,900.69
|
| Rate for Payer: Cofinity Commercial |
$4,792.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,015.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,900.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,179.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,457.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,179.31
|
| Rate for Payer: PHP Commercial |
$4,736.55
|
| Rate for Payer: Priority Health SBD |
$3,510.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,622.07
|
| Rate for Payer: UHC Core |
$2,903.23
|
| Rate for Payer: UHC Exchange |
$2,189.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,061.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,179.31
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.86 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna American Axle |
$3,622.07
|
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,622.07
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Advantage |
$3,900.69
|
| Rate for Payer: Cofinity Commercial |
$4,792.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,015.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,900.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,179.31
|
| Rate for Payer: PHP Commercial |
$4,736.55
|
| Rate for Payer: Priority Health SBD |
$3,510.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,451.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,179.31
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.87 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna American Axle |
$4,210.04
|
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,210.04
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Advantage |
$4,533.89
|
| Rate for Payer: Cofinity Commercial |
$5,570.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$5,829.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,533.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,857.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,857.73
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: Priority Health SBD |
$4,080.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,849.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.73
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.48 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna American Axle |
$4,210.04
|
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: Aetna Medicare |
$3,238.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,210.04
|
| Rate for Payer: BCBS Complete |
$2,590.79
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Advantage |
$4,533.89
|
| Rate for Payer: Cofinity Commercial |
$5,570.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$5,829.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,533.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,857.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,181.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,857.73
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: Priority Health SBD |
$4,080.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,210.04
|
| Rate for Payer: UHC Core |
$3,374.51
|
| Rate for Payer: UHC Exchange |
$2,545.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,396.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.73
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
IP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.93 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna American Axle |
$5,703.65
|
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,703.65
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Advantage |
$6,142.39
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$7,897.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,142.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,581.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,581.13
|
| Rate for Payer: PHP Commercial |
$7,458.61
|
| Rate for Payer: Priority Health SBD |
$5,528.15
|
| Rate for Payer: UMR Bronson Commercial |
$3,860.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,246.69 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna American Axle |
$5,703.65
|
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: Aetna Medicare |
$4,387.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,703.65
|
| Rate for Payer: BCBS Complete |
$3,509.94
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Advantage |
$6,142.39
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$7,897.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,142.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,581.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,019.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,581.13
|
| Rate for Payer: PHP Commercial |
$7,458.61
|
| Rate for Payer: Priority Health SBD |
$5,528.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,703.65
|
| Rate for Payer: UHC Core |
$4,571.69
|
| Rate for Payer: UHC Exchange |
$3,448.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,246.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,879.55
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.00 |
| Max. Negotiated Rate |
$2,591.59 |
| Rate for Payer: Aetna American Axle |
$1,871.71
|
| Rate for Payer: Aetna Commercial |
$2,447.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,871.71
|
| Rate for Payer: Cash Price |
$2,303.64
|
| Rate for Payer: Cofinity Advantage |
$2,015.68
|
| Rate for Payer: Cofinity Commercial |
$2,476.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.64
|
| Rate for Payer: Healthscope Commercial |
$2,591.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,015.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,159.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,447.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,159.66
|
| Rate for Payer: PHP Commercial |
$2,447.62
|
| Rate for Payer: Priority Health SBD |
$1,814.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,267.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,159.66
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,879.55
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.43 |
| Max. Negotiated Rate |
$2,591.59 |
| Rate for Payer: Aetna American Axle |
$1,871.71
|
| Rate for Payer: Aetna Commercial |
$2,447.62
|
| Rate for Payer: Aetna Medicare |
$1,439.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,871.71
|
| Rate for Payer: BCBS Complete |
$1,151.82
|
| Rate for Payer: Cash Price |
$2,303.64
|
| Rate for Payer: Cofinity Advantage |
$2,015.68
|
| Rate for Payer: Cofinity Commercial |
$2,476.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.64
|
| Rate for Payer: Healthscope Commercial |
$2,591.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,015.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,159.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,303.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,447.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,159.66
|
| Rate for Payer: PHP Commercial |
$2,447.62
|
| Rate for Payer: Priority Health SBD |
$1,814.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,871.71
|
| Rate for Payer: UHC Core |
$1,500.25
|
| Rate for Payer: UHC Exchange |
$1,131.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,065.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,159.66
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,948.02 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna American Axle |
$7,309.57
|
| Rate for Payer: Aetna Commercial |
$9,558.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,309.57
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Advantage |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,871.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,434.12
|
| Rate for Payer: PHP Commercial |
$9,558.67
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
| Rate for Payer: UMR Bronson Commercial |
$4,948.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,160.84 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna American Axle |
$7,309.57
|
| Rate for Payer: Aetna Commercial |
$9,558.67
|
| Rate for Payer: Aetna Medicare |
$5,622.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,309.57
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Advantage |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,871.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,996.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,434.12
|
| Rate for Payer: PHP Commercial |
$9,558.67
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,309.57
|
| Rate for Payer: UHC Core |
$5,858.91
|
| Rate for Payer: UHC Exchange |
$4,419.48
|
| Rate for Payer: UMR Bronson Commercial |
$4,160.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC STENT NON COATED W SYS LVL 14
|
Facility
|
IP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.09 |
| Max. Negotiated Rate |
$1,278.59 |
| Rate for Payer: Aetna American Axle |
$923.42
|
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.42
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Advantage |
$994.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$994.46
|
| 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: Opus (Opus Packaging Group) HMA |
$1,065.49
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health SBD |
$895.01
|
| Rate for Payer: UMR Bronson Commercial |
$625.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.49
|
|
|
HC STENT NON COATED W SYS LVL 14
|
Facility
|
OP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.64 |
| Max. Negotiated Rate |
$1,278.59 |
| Rate for Payer: Aetna American Axle |
$923.42
|
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: Aetna Medicare |
$710.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.42
|
| Rate for Payer: BCBS Complete |
$568.26
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Advantage |
$994.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$994.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,136.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.49
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health SBD |
$895.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$923.42
|
| Rate for Payer: UHC Core |
$740.16
|
| Rate for Payer: UHC Exchange |
$558.32
|
| Rate for Payer: UMR Bronson Commercial |
$525.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.49
|
|
|
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 |
$688.38 |
| Max. Negotiated Rate |
$1,674.43 |
| Rate for Payer: Aetna American Axle |
$1,209.31
|
| Rate for Payer: Aetna Commercial |
$1,581.41
|
| Rate for Payer: Aetna Medicare |
$930.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.31
|
| Rate for Payer: BCBS Complete |
$744.19
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Advantage |
$1,302.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,302.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,488.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,395.36
|
| Rate for Payer: PHP Commercial |
$1,581.41
|
| Rate for Payer: Priority Health SBD |
$1,172.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,209.31
|
| Rate for Payer: UHC Core |
$969.31
|
| Rate for Payer: UHC Exchange |
$731.17
|
| Rate for Payer: UMR Bronson Commercial |
$688.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.36
|
|
|
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 |
$818.61 |
| Max. Negotiated Rate |
$1,674.43 |
| Rate for Payer: Aetna American Axle |
$1,209.31
|
| Rate for Payer: Aetna Commercial |
$1,581.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.31
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Advantage |
$1,302.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,302.34
|
| 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: Opus (Opus Packaging Group) HMA |
$1,395.36
|
| Rate for Payer: PHP Commercial |
$1,581.41
|
| Rate for Payer: Priority Health SBD |
$1,172.10
|
| Rate for Payer: UMR Bronson Commercial |
$818.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.36
|
|
|
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 |
$7,261.25 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna American Axle |
$12,756.25
|
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: Aetna Medicare |
$9,812.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,756.25
|
| Rate for Payer: BCBS Complete |
$7,850.00
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Advantage |
$13,737.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13,737.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,700.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,718.75
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health SBD |
$12,363.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,756.25
|
| Rate for Payer: UHC Core |
$10,224.62
|
| Rate for Payer: UHC Exchange |
$7,712.62
|
| Rate for Payer: UMR Bronson Commercial |
$7,261.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,718.75
|
|
|
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 |
$8,635.00 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna American Axle |
$12,756.25
|
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,756.25
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Advantage |
$13,737.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13,737.50
|
| 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: Opus (Opus Packaging Group) HMA |
$14,718.75
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health SBD |
$12,363.75
|
| Rate for Payer: UMR Bronson Commercial |
$8,635.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,718.75
|
|
