|
HC STENT NON COATED W SYS LVL 20
|
Facility
|
OP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$759.08 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna American Axle |
$1,333.52
|
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: Aetna Medicare |
$1,025.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.52
|
| Rate for Payer: BCBS Complete |
$820.63
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Advantage |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,436.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,641.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health SBD |
$1,292.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,333.52
|
| Rate for Payer: UHC Core |
$1,068.87
|
| Rate for Payer: UHC Exchange |
$806.27
|
| Rate for Payer: UMR Bronson Commercial |
$759.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
HC STENT NON COATED W SYS LVL 20
|
Facility
|
IP
|
$2,051.57
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.69 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna American Axle |
$1,333.52
|
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.52
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Advantage |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,436.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health SBD |
$1,292.49
|
| Rate for Payer: UMR Bronson Commercial |
$902.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
HC STENT NON COATED W SYS LVL 24
|
Facility
|
IP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.05 |
| Max. Negotiated Rate |
$2,243.96 |
| Rate for Payer: Aetna American Axle |
$1,620.64
|
| Rate for Payer: Aetna Commercial |
$2,119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.64
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Advantage |
$1,745.30
|
| Rate for Payer: Cofinity Commercial |
$2,144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,243.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,745.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,869.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.97
|
| Rate for Payer: PHP Commercial |
$2,119.30
|
| Rate for Payer: Priority Health SBD |
$1,570.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,097.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.97
|
|
|
HC STENT NON COATED W SYS LVL 24
|
Facility
|
OP
|
$2,493.29
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.52 |
| Max. Negotiated Rate |
$2,243.96 |
| Rate for Payer: Aetna American Axle |
$1,620.64
|
| Rate for Payer: Aetna Commercial |
$2,119.30
|
| Rate for Payer: Aetna Medicare |
$1,246.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.64
|
| Rate for Payer: BCBS Complete |
$997.32
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Advantage |
$1,745.30
|
| Rate for Payer: Cofinity Commercial |
$2,144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,243.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,745.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,869.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,994.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.97
|
| Rate for Payer: PHP Commercial |
$2,119.30
|
| Rate for Payer: Priority Health SBD |
$1,570.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,620.64
|
| Rate for Payer: UHC Core |
$1,299.00
|
| Rate for Payer: UHC Exchange |
$979.86
|
| Rate for Payer: UMR Bronson Commercial |
$922.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.97
|
|
|
HC STENT NONCOATED W SYS LVL 26
|
Facility
|
IP
|
$2,679.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,178.79 |
| Max. Negotiated Rate |
$2,411.15 |
| Rate for Payer: Aetna American Axle |
$1,741.39
|
| Rate for Payer: Aetna Commercial |
$2,277.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.39
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Advantage |
$1,875.34
|
| Rate for Payer: Cofinity Commercial |
$2,303.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,411.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,875.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.30
|
| Rate for Payer: PHP Commercial |
$2,277.20
|
| Rate for Payer: Priority Health SBD |
$1,687.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.30
|
|
|
HC STENT NONCOATED W SYS LVL 26
|
Facility
|
OP
|
$2,679.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.25 |
| Max. Negotiated Rate |
$2,411.15 |
| Rate for Payer: Aetna American Axle |
$1,741.39
|
| Rate for Payer: Aetna Commercial |
$2,277.20
|
| Rate for Payer: Aetna Medicare |
$1,339.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.39
|
| Rate for Payer: BCBS Complete |
$1,071.62
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Advantage |
$1,875.34
|
| Rate for Payer: Cofinity Commercial |
$2,303.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,411.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,875.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,143.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.30
|
| Rate for Payer: PHP Commercial |
$2,277.20
|
| Rate for Payer: Priority Health SBD |
$1,687.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,741.39
|
| Rate for Payer: UHC Core |
$1,395.79
|
| Rate for Payer: UHC Exchange |
$1,052.87
|
| Rate for Payer: UMR Bronson Commercial |
$991.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.30
|
|
|
HC STENT NON COATED W SYS LVL 29
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.27 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna American Axle |
$1,943.01
|
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.01
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Advantage |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,092.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,241.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.93
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
|
HC STENT NON COATED W SYS LVL 29
|
Facility
|
OP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.02 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna American Axle |
$1,943.01
|
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna Medicare |
$1,494.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.01
|
| Rate for Payer: BCBS Complete |
$1,195.70
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Advantage |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,092.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,241.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,391.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.93
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,943.01
|
| Rate for Payer: UHC Core |
$1,557.39
|
| Rate for Payer: UHC Exchange |
$1,174.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,106.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
|
HC STENT NON COATED W SYS LVL 35
|
Facility
|
OP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.35 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna American Axle |
$2,305.49
|
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna Medicare |
$1,773.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,305.49
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2,837.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health SBD |
$2,234.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.49
|
| Rate for Payer: UHC Core |
$1,847.93
|
| Rate for Payer: UHC Exchange |
$1,393.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,312.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,660.18
|
|
|
HC STENT NON COATED W SYS LVL 35
|
Facility
|
IP
|
$3,546.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.64 |
| Max. Negotiated Rate |
$3,192.21 |
| Rate for Payer: Aetna American Axle |
$2,305.49
|
| Rate for Payer: Aetna Commercial |
$3,014.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,305.49
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$3,014.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: PHP Commercial |
$3,014.86
|
| 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 NONCOATED W SYS LVL 37
|
Facility
|
IP
|
$3,739.66
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,645.45 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna American Axle |
$2,430.78
|
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,430.78
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Advantage |
$2,617.76
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,365.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,617.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,804.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health SBD |
$2,355.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,645.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,804.74
|
|
|
HC STENT NONCOATED W SYS LVL 37
|
Facility
|
OP
|
$3,739.66
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.67 |
| Max. Negotiated Rate |
$3,365.69 |
| Rate for Payer: Aetna American Axle |
$2,430.78
|
| Rate for Payer: Aetna Commercial |
$3,178.71
|
| Rate for Payer: Aetna Medicare |
$1,869.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,430.78
|
| Rate for Payer: BCBS Complete |
$1,495.86
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Advantage |
$2,617.76
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,365.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,617.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,804.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,991.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health SBD |
$2,355.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,430.78
|
| Rate for Payer: UHC Core |
$1,948.36
|
| Rate for Payer: UHC Exchange |
$1,469.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,383.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,804.74
|
|
|
HC STENT NON COATED W SYS LVL 44
|
Facility
|
OP
|
$4,451.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.87 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna American Axle |
$2,893.15
|
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: Aetna Medicare |
$2,225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,893.15
|
| Rate for Payer: BCBS Complete |
$1,780.40
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Advantage |
$3,115.70
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,005.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,115.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,338.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,560.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health SBD |
$2,804.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,893.15
|
| Rate for Payer: UHC Core |
$2,318.97
|
| Rate for Payer: UHC Exchange |
$1,749.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,646.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,338.25
|
|
|
HC STENT NON COATED W SYS LVL 44
|
Facility
|
IP
|
$4,451.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,958.44 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Aetna American Axle |
$2,893.15
|
| Rate for Payer: Aetna Commercial |
$3,783.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,893.15
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Advantage |
$3,115.70
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,005.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,115.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,338.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health SBD |
$2,804.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,958.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,338.25
|
|
|
HC STENT NON COATED W SYS LVL 49
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,183.28 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna American Axle |
$3,225.30
|
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,225.30
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Advantage |
$3,473.40
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,473.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health SBD |
$3,126.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,183.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,721.50
|
|
|
HC STENT NON COATED W SYS LVL 49
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.94 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna American Axle |
$3,225.30
|
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna Medicare |
$2,481.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,225.30
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Advantage |
$3,473.40
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,473.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,969.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health SBD |
$3,126.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,225.30
|
| Rate for Payer: UHC Core |
$2,585.20
|
| Rate for Payer: UHC Exchange |
$1,950.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,835.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,721.50
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
IP
|
$1,449.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.59 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna American Axle |
$941.89
|
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.89
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Advantage |
$1,014.34
|
| Rate for Payer: Cofinity Commercial |
$1,246.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,304.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: PHP Commercial |
$1,231.70
|
| Rate for Payer: Priority Health SBD |
$912.91
|
| Rate for Payer: UMR Bronson Commercial |
$637.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.80
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
OP
|
$1,449.06
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.15 |
| Max. Negotiated Rate |
$1,304.15 |
| Rate for Payer: Aetna American Axle |
$941.89
|
| Rate for Payer: Aetna Commercial |
$1,231.70
|
| Rate for Payer: Aetna Medicare |
$724.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.89
|
| Rate for Payer: BCBS Complete |
$579.62
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Advantage |
$1,014.34
|
| Rate for Payer: Cofinity Commercial |
$1,246.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,304.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,159.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: PHP Commercial |
$1,231.70
|
| Rate for Payer: Priority Health SBD |
$912.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.89
|
| Rate for Payer: UHC Core |
$754.96
|
| Rate for Payer: UHC Exchange |
$569.48
|
| Rate for Payer: UMR Bronson Commercial |
$536.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.80
|
|
|
HC STENT NON COATED W SYS LVL 53
|
Facility
|
OP
|
$5,488.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,030.62 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna American Axle |
$3,567.30
|
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: Aetna Medicare |
$2,744.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,567.30
|
| Rate for Payer: BCBS Complete |
$2,195.26
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Advantage |
$3,841.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,841.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,116.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,390.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: PHP Commercial |
$4,664.93
|
| Rate for Payer: Priority Health SBD |
$3,457.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,567.30
|
| Rate for Payer: UHC Core |
$2,859.33
|
| Rate for Payer: UHC Exchange |
$2,156.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,030.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,116.11
|
|
|
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 |
$2,414.79 |
| Max. Negotiated Rate |
$4,939.34 |
| Rate for Payer: Aetna American Axle |
$3,567.30
|
| Rate for Payer: Aetna Commercial |
$4,664.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,567.30
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Advantage |
$3,841.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,841.70
|
| 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: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: PHP Commercial |
$4,664.93
|
| Rate for Payer: Priority Health SBD |
$3,457.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,414.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,116.11
|
|
|
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 |
$2,544.48 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna American Axle |
$3,758.89
|
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,758.89
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Advantage |
$4,048.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,048.03
|
| 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: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: PHP Commercial |
$4,915.47
|
| Rate for Payer: Priority Health SBD |
$3,643.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,544.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.18
|
|
|
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 |
$2,139.67 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna American Axle |
$3,758.89
|
| Rate for Payer: Aetna Commercial |
$4,915.47
|
| Rate for Payer: Aetna Medicare |
$2,891.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,758.89
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Advantage |
$4,048.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,048.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,337.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,626.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: PHP Commercial |
$4,915.47
|
| Rate for Payer: Priority Health SBD |
$3,643.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,758.89
|
| Rate for Payer: UHC Core |
$3,012.89
|
| Rate for Payer: UHC Exchange |
$2,272.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,139.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.18
|
|
|
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 |
$2,212.39 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna American Axle |
$3,886.64
|
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: Aetna Medicare |
$2,989.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,886.64
|
| Rate for Payer: BCBS Complete |
$2,391.78
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Advantage |
$4,185.61
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,185.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,484.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,783.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,484.58
|
| Rate for Payer: PHP Commercial |
$5,082.52
|
| Rate for Payer: Priority Health SBD |
$3,767.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,886.64
|
| Rate for Payer: UHC Core |
$3,115.29
|
| Rate for Payer: UHC Exchange |
$2,349.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,212.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,484.58
|
|
|
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 |
$2,630.95 |
| Max. Negotiated Rate |
$5,381.50 |
| Rate for Payer: Aetna American Axle |
$3,886.64
|
| Rate for Payer: Aetna Commercial |
$5,082.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,886.64
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Advantage |
$4,185.61
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,185.61
|
| 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: Opus (Opus Packaging Group) HMA |
$4,484.58
|
| Rate for Payer: PHP Commercial |
$5,082.52
|
| Rate for Payer: Priority Health SBD |
$3,767.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,630.95
|
| 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 |
$2,508.35 |
| Max. Negotiated Rate |
$6,101.40 |
| Rate for Payer: Aetna American Axle |
$4,406.56
|
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: Aetna Medicare |
$3,389.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,406.56
|
| Rate for Payer: BCBS Complete |
$2,711.73
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Advantage |
$4,745.53
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,745.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,084.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,423.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,084.50
|
| Rate for Payer: PHP Commercial |
$5,762.43
|
| Rate for Payer: Priority Health SBD |
$4,270.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,406.56
|
| Rate for Payer: UHC Core |
$3,532.03
|
| Rate for Payer: UHC Exchange |
$2,664.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,508.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,084.50
|
|
