|
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 Commercial |
$6,142.39
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,142.39
|
| 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: PHP Commercial |
$7,458.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health SBD |
$5,528.15
|
| 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
|
OP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.54 |
| Max. Negotiated Rate |
$2,540.78 |
| Rate for Payer: Aetna American Axle |
$1,835.01
|
| Rate for Payer: Aetna Commercial |
$2,399.63
|
| Rate for Payer: Aetna Medicare |
$1,411.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,835.01
|
| Rate for Payer: BCBS Complete |
$1,129.24
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$1,976.16
|
| Rate for Payer: Cofinity Commercial |
$2,427.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,976.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Healthscope Commercial |
$2,540.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,976.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: PHP Commercial |
$2,399.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health SBD |
$1,778.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,044.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.32
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.16 |
| Max. Negotiated Rate |
$2,540.78 |
| Rate for Payer: Aetna American Axle |
$1,835.01
|
| Rate for Payer: Aetna Commercial |
$2,399.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,835.01
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$1,976.16
|
| Rate for Payer: Cofinity Commercial |
$2,427.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,976.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Healthscope Commercial |
$2,540.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,976.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: PHP Commercial |
$2,399.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health SBD |
$1,778.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,242.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.32
|
|
|
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 Commercial |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,871.85
|
| 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: PHP Commercial |
$9,558.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.57
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
| Rate for Payer: UMR Bronson Commercial |
$4,160.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
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 Commercial |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,871.85
|
| 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: PHP Commercial |
$9,558.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.57
|
| 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 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 Commercial |
$1,221.76
|
| Rate for Payer: Cofinity Commercial |
$994.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.46
|
| 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: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.42
|
| Rate for Payer: Priority Health SBD |
$895.01
|
| 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 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 Commercial |
$1,221.76
|
| Rate for Payer: Cofinity Commercial |
$994.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.46
|
| 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: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.42
|
| 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 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 Commercial |
$1,302.34
|
| Rate for Payer: Cofinity Commercial |
$1,600.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,302.34
|
| 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: PHP Commercial |
$1,581.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.31
|
| 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 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 Commercial |
$1,302.34
|
| Rate for Payer: Cofinity Commercial |
$1,600.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,302.34
|
| 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: PHP Commercial |
$1,581.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.31
|
| Rate for Payer: Priority Health SBD |
$1,172.10
|
| Rate for Payer: UMR Bronson Commercial |
$688.38
|
| 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 Commercial |
$13,737.50
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,737.50
|
| 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: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,756.25
|
| Rate for Payer: Priority Health SBD |
$12,363.75
|
| 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 Commercial |
$13,737.50
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,737.50
|
| 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: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,756.25
|
| 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
|
|
|
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 Commercial |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,436.10
|
| 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: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.52
|
| Rate for Payer: Priority Health SBD |
$1,292.49
|
| 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 Commercial |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,436.10
|
| 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: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.52
|
| 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
|
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 Commercial |
$1,745.30
|
| Rate for Payer: Cofinity Commercial |
$2,144.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,745.30
|
| 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: PHP Commercial |
$2,119.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.64
|
| Rate for Payer: Priority Health SBD |
$1,570.77
|
| Rate for Payer: UMR Bronson Commercial |
$922.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.97
|
|
|
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 Commercial |
$1,745.30
|
| Rate for Payer: Cofinity Commercial |
$2,144.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,745.30
|
| 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: PHP Commercial |
$2,119.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.64
|
| 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 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 Commercial |
$1,875.34
|
| Rate for Payer: Cofinity Commercial |
$2,303.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,875.34
|
| 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: PHP Commercial |
$2,277.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.39
|
| 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 Commercial |
$1,875.34
|
| Rate for Payer: Cofinity Commercial |
$2,303.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,875.34
|
| 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: PHP Commercial |
$2,277.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,741.39
|
| Rate for Payer: Priority Health SBD |
$1,687.81
|
| 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
|
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 Commercial |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,092.47
|
| 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: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,943.01
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
| 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 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 Commercial |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,092.47
|
| 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: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,943.01
|
| 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 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 Commercial |
$2,482.83
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,482.83
|
| 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: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.49
|
| 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 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 Commercial |
$2,482.83
|
| Rate for Payer: Cofinity Commercial |
$3,050.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,482.83
|
| 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: PHP Commercial |
$3,014.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,305.49
|
| 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 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 Commercial |
$2,617.76
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,617.76
|
| 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: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,430.78
|
| 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 Commercial |
$2,617.76
|
| Rate for Payer: Cofinity Commercial |
$3,216.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,617.76
|
| 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: PHP Commercial |
$3,178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,430.78
|
| Rate for Payer: Priority Health SBD |
$2,355.99
|
| 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 Commercial |
$3,115.70
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,115.70
|
| 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: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,893.15
|
| Rate for Payer: Priority Health SBD |
$2,804.13
|
| 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 Commercial |
$3,115.70
|
| Rate for Payer: Cofinity Commercial |
$3,827.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,115.70
|
| 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: PHP Commercial |
$3,783.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,893.15
|
| 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
|
|
