|
HC STATLOCK
|
Facility
|
IP
|
$146.56
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$146.56 |
| Rate for Payer: Aetna Commercial |
$131.90
|
| Rate for Payer: ASR ASR |
$142.16
|
| Rate for Payer: BCBS Trust/PPO |
$120.36
|
| Rate for Payer: BCN Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cofinity Commercial |
$137.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.25
|
| Rate for Payer: Healthscope Commercial |
$142.16
|
| Rate for Payer: Healthscope Whirlpool |
$146.56
|
| Rate for Payer: Mclaren Commercial |
$131.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.58
|
| Rate for Payer: Nomi Health Commercial |
$120.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.97
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$146.56
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$146.56 |
| Rate for Payer: Aetna Commercial |
$131.90
|
| Rate for Payer: Aetna Medicare |
$54.23
|
| Rate for Payer: ASR ASR |
$142.16
|
| Rate for Payer: BCBS Complete |
$58.62
|
| Rate for Payer: BCBS Trust/PPO |
$120.84
|
| Rate for Payer: BCN Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cofinity Commercial |
$137.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.25
|
| Rate for Payer: Healthscope Commercial |
$142.16
|
| Rate for Payer: Healthscope Whirlpool |
$146.56
|
| Rate for Payer: Mclaren Commercial |
$131.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.58
|
| Rate for Payer: Nomi Health Commercial |
$120.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$128.42
|
| Rate for Payer: Priority Health Narrow Network |
$102.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.97
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$91.11 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$29.16
|
| Rate for Payer: BCN Commercial |
$29.16
|
| 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 Commercial |
$33.25
|
| 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 |
$34.31
|
| Rate for Payer: Healthscope Whirlpool |
$35.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| 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 |
$32.28
|
| 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 |
$29.00
|
| 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 |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| 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/Tiered Network |
$30.99
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$24.79
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$35.37 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$29.05
|
| Rate for Payer: BCN Commercial |
$29.05
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Healthscope Whirlpool |
$35.37
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,478.41
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,478.41 |
| Rate for Payer: Aetna Commercial |
$1,330.57
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,434.06
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.95
|
| Rate for Payer: BCN Commercial |
$1,218.95
|
| 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 Commercial |
$1,389.71
|
| 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 |
$1,434.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,478.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$1,330.57
|
| 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 |
$204.20
|
| 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 |
$1,212.30
|
| 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 |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| 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/Tiered Network |
$1,295.38
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.37
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,478.41
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,108.81 |
| Max. Negotiated Rate |
$1,478.41 |
| Rate for Payer: Aetna Commercial |
$1,330.57
|
| Rate for Payer: ASR ASR |
$1,434.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,214.07
|
| Rate for Payer: BCN Commercial |
$1,214.07
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cofinity Commercial |
$1,389.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.73
|
| Rate for Payer: Healthscope Commercial |
$1,434.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,478.41
|
| Rate for Payer: Mclaren Commercial |
$1,330.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.65
|
| Rate for Payer: Nomi Health Commercial |
$1,212.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.00
|
|
|
HC STENT
|
Facility
|
IP
|
$972.22
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.16 |
| Max. Negotiated Rate |
$972.22 |
| Rate for Payer: Aetna Commercial |
$875.00
|
| Rate for Payer: ASR ASR |
$943.05
|
| Rate for Payer: BCBS Trust/PPO |
$798.39
|
| Rate for Payer: BCN Commercial |
$798.39
|
| Rate for Payer: Cash Price |
$777.78
|
| Rate for Payer: Cofinity Commercial |
$913.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.78
|
| Rate for Payer: Healthscope Commercial |
$943.05
|
| Rate for Payer: Healthscope Whirlpool |
$972.22
|
| Rate for Payer: Mclaren Commercial |
$875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.39
|
| Rate for Payer: Nomi Health Commercial |
$797.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.55
|
|
|
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 |
$972.22 |
| Rate for Payer: Aetna Commercial |
$875.00
|
| Rate for Payer: Aetna Medicare |
$359.72
|
| Rate for Payer: ASR ASR |
$943.05
|
| Rate for Payer: BCBS Complete |
$388.89
|
| Rate for Payer: BCBS Trust/PPO |
$801.60
|
| Rate for Payer: BCN Commercial |
$801.60
|
| Rate for Payer: Cash Price |
$777.78
|
| Rate for Payer: Cofinity Commercial |
$913.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.78
|
| Rate for Payer: Healthscope Commercial |
$943.05
|
| Rate for Payer: Healthscope Whirlpool |
$972.22
|
| Rate for Payer: Mclaren Commercial |
$875.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$777.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.39
|
| Rate for Payer: Nomi Health Commercial |
$797.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$851.86
|
| Rate for Payer: Priority Health Narrow Network |
$681.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.55
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$17,350.78
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,419.79 |
| Max. Negotiated Rate |
$17,350.78 |
| Rate for Payer: Aetna Commercial |
$15,615.70
|
| Rate for Payer: Aetna Medicare |
$6,419.79
|
| Rate for Payer: ASR ASR |
$16,830.26
|
| Rate for Payer: BCBS Complete |
$6,940.31
|
| Rate for Payer: BCBS Trust/PPO |
$14,305.72
|
| Rate for Payer: BCN Commercial |
$14,305.72
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Commercial |
$16,309.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$16,830.26
|
| Rate for Payer: Healthscope Whirlpool |
$17,350.78
|
| Rate for Payer: Mclaren Commercial |
$15,615.70
|
| 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: Nomi Health Commercial |
$14,227.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,202.75
|
| Rate for Payer: Priority Health Narrow Network |
$12,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,268.69
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$17,350.78
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,013.08 |
| Max. Negotiated Rate |
$17,350.78 |
| Rate for Payer: Aetna Commercial |
$15,615.70
|
| Rate for Payer: ASR ASR |
$16,830.26
|
| Rate for Payer: BCBS Trust/PPO |
$14,248.46
|
| Rate for Payer: BCN Commercial |
$14,248.46
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Commercial |
$16,309.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$16,830.26
|
| Rate for Payer: Healthscope Whirlpool |
$17,350.78
|
| Rate for Payer: Mclaren Commercial |
$15,615.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Nomi Health Commercial |
$14,227.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,268.69
|
|
|
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 |
$12,112.82 |
| Rate for Payer: Aetna Commercial |
$10,901.54
|
| Rate for Payer: Aetna Medicare |
$4,481.74
|
| Rate for Payer: ASR ASR |
$11,749.44
|
| Rate for Payer: BCBS Complete |
$4,845.13
|
| Rate for Payer: BCBS Trust/PPO |
$9,987.02
|
| Rate for Payer: BCN Commercial |
$9,987.02
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Commercial |
$11,386.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Healthscope Commercial |
$11,749.44
|
| Rate for Payer: Healthscope Whirlpool |
$12,112.82
|
| Rate for Payer: Mclaren Commercial |
$10,901.54
|
| 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: Nomi Health Commercial |
$9,932.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,613.25
|
| Rate for Payer: Priority Health Narrow Network |
$8,491.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,659.28
|
|
|
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 |
$9,084.61 |
| Max. Negotiated Rate |
$12,112.82 |
| Rate for Payer: Aetna Commercial |
$10,901.54
|
| Rate for Payer: ASR ASR |
$11,749.44
|
| Rate for Payer: BCBS Trust/PPO |
$9,947.05
|
| Rate for Payer: BCN Commercial |
$9,947.05
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Commercial |
$11,386.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Healthscope Commercial |
$11,749.44
|
| Rate for Payer: Healthscope Whirlpool |
$12,112.82
|
| Rate for Payer: Mclaren Commercial |
$10,901.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,295.90
|
| Rate for Payer: Nomi Health Commercial |
$9,932.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,659.28
|
|
|
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 |
$5,572.41 |
| Rate for Payer: Aetna Commercial |
$5,015.17
|
| Rate for Payer: Aetna Medicare |
$2,061.79
|
| Rate for Payer: ASR ASR |
$5,405.24
|
| Rate for Payer: BCBS Complete |
$2,228.96
|
| Rate for Payer: BCBS Trust/PPO |
$4,594.45
|
| Rate for Payer: BCN Commercial |
$4,594.45
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$5,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,405.24
|
| Rate for Payer: Healthscope Whirlpool |
$5,572.41
|
| Rate for Payer: Mclaren Commercial |
$5,015.17
|
| 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: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,179.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,882.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,906.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,903.72
|
|
|
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 |
$4,179.31 |
| Max. Negotiated Rate |
$5,572.41 |
| Rate for Payer: Aetna Commercial |
$5,015.17
|
| Rate for Payer: ASR ASR |
$5,405.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,576.06
|
| Rate for Payer: BCN Commercial |
$4,576.06
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$5,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,405.24
|
| Rate for Payer: Healthscope Whirlpool |
$5,572.41
|
| Rate for Payer: Mclaren Commercial |
$5,015.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,179.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,903.72
|
|
|
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 |
$6,476.98 |
| Rate for Payer: Aetna Commercial |
$5,829.28
|
| Rate for Payer: Aetna Medicare |
$2,396.48
|
| Rate for Payer: ASR ASR |
$6,282.67
|
| Rate for Payer: BCBS Complete |
$2,590.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,340.27
|
| Rate for Payer: BCN Commercial |
$5,340.27
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$6,088.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$6,282.67
|
| Rate for Payer: Healthscope Whirlpool |
$6,476.98
|
| Rate for Payer: Mclaren Commercial |
$5,829.28
|
| 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: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,857.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,675.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,540.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,699.74
|
|
|
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 |
$4,857.73 |
| Max. Negotiated Rate |
$6,476.98 |
| Rate for Payer: Aetna Commercial |
$5,829.28
|
| Rate for Payer: ASR ASR |
$6,282.67
|
| Rate for Payer: BCBS Trust/PPO |
$5,318.90
|
| Rate for Payer: BCN Commercial |
$5,318.90
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$6,088.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$6,282.67
|
| Rate for Payer: Healthscope Whirlpool |
$6,476.98
|
| Rate for Payer: Mclaren Commercial |
$5,829.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,857.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,699.74
|
|
|
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 |
$6,581.13 |
| Max. Negotiated Rate |
$8,774.84 |
| Rate for Payer: Aetna Commercial |
$7,897.36
|
| Rate for Payer: ASR ASR |
$8,511.59
|
| Rate for Payer: BCBS Trust/PPO |
$7,205.90
|
| Rate for Payer: BCN Commercial |
$7,205.90
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$8,248.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$8,511.59
|
| Rate for Payer: Healthscope Whirlpool |
$8,774.84
|
| Rate for Payer: Mclaren Commercial |
$7,897.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,581.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,721.86
|
|
|
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 |
$8,774.84 |
| Rate for Payer: Aetna Commercial |
$7,897.36
|
| Rate for Payer: Aetna Medicare |
$3,246.69
|
| Rate for Payer: ASR ASR |
$8,511.59
|
| Rate for Payer: BCBS Complete |
$3,509.94
|
| Rate for Payer: BCBS Trust/PPO |
$7,234.86
|
| Rate for Payer: BCN Commercial |
$7,234.86
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$8,248.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$8,511.59
|
| Rate for Payer: Healthscope Whirlpool |
$8,774.84
|
| Rate for Payer: Mclaren Commercial |
$7,897.36
|
| 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: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,581.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,688.51
|
| Rate for Payer: Priority Health Narrow Network |
$6,151.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,721.86
|
|
|
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 |
$2,879.55 |
| Rate for Payer: Aetna Commercial |
$2,591.59
|
| Rate for Payer: Aetna Medicare |
$1,065.43
|
| Rate for Payer: ASR ASR |
$2,793.16
|
| Rate for Payer: BCBS Complete |
$1,151.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,374.19
|
| Rate for Payer: BCN Commercial |
$2,374.19
|
| Rate for Payer: Cash Price |
$2,303.64
|
| Rate for Payer: Cofinity Commercial |
$2,706.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.64
|
| Rate for Payer: Healthscope Commercial |
$2,793.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,879.55
|
| Rate for Payer: Mclaren Commercial |
$2,591.59
|
| 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: Nomi Health Commercial |
$2,361.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,159.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,523.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,018.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,534.00
|
|
|
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 |
$2,159.66 |
| Max. Negotiated Rate |
$2,879.55 |
| Rate for Payer: Aetna Commercial |
$2,591.59
|
| Rate for Payer: ASR ASR |
$2,793.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.69
|
| Rate for Payer: BCN Commercial |
$2,364.69
|
| Rate for Payer: Cash Price |
$2,303.64
|
| Rate for Payer: Cofinity Commercial |
$2,706.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.64
|
| Rate for Payer: Healthscope Commercial |
$2,793.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,879.55
|
| Rate for Payer: Mclaren Commercial |
$2,591.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,447.62
|
| Rate for Payer: Nomi Health Commercial |
$2,361.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,159.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,534.00
|
|
|
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 |
$8,434.12 |
| Max. Negotiated Rate |
$11,245.50 |
| Rate for Payer: Aetna Commercial |
$10,120.95
|
| Rate for Payer: ASR ASR |
$10,908.14
|
| Rate for Payer: BCBS Trust/PPO |
$9,234.80
|
| Rate for Payer: BCN Commercial |
$9,234.80
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$10,570.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,908.14
|
| Rate for Payer: Healthscope Whirlpool |
$11,245.50
|
| Rate for Payer: Mclaren Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,434.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,896.04
|
|
|
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 |
$11,245.50 |
| Rate for Payer: Aetna Commercial |
$10,120.95
|
| Rate for Payer: Aetna Medicare |
$4,160.84
|
| Rate for Payer: ASR ASR |
$10,908.14
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: BCBS Trust/PPO |
$9,271.91
|
| Rate for Payer: BCN Commercial |
$9,271.91
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$10,570.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,908.14
|
| Rate for Payer: Healthscope Whirlpool |
$11,245.50
|
| Rate for Payer: Mclaren Commercial |
$10,120.95
|
| 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: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,434.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,853.31
|
| Rate for Payer: Priority Health Narrow Network |
$7,883.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,896.04
|
|
|
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 |
$1,420.65 |
| Rate for Payer: Aetna Commercial |
$1,278.59
|
| Rate for Payer: Aetna Medicare |
$525.64
|
| Rate for Payer: ASR ASR |
$1,378.03
|
| Rate for Payer: BCBS Complete |
$568.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.33
|
| Rate for Payer: BCN Commercial |
$1,171.33
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,335.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,378.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,420.65
|
| Rate for Payer: Mclaren Commercial |
$1,278.59
|
| 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: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,244.77
|
| Rate for Payer: Priority Health Narrow Network |
$995.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,250.17
|
|
|
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 |
$1,065.49 |
| Max. Negotiated Rate |
$1,420.65 |
| Rate for Payer: Aetna Commercial |
$1,278.59
|
| Rate for Payer: ASR ASR |
$1,378.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.64
|
| Rate for Payer: BCN Commercial |
$1,166.64
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,335.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,378.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,420.65
|
| Rate for Payer: Mclaren Commercial |
$1,278.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.55
|
| Rate for Payer: Nomi Health Commercial |
$1,164.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,250.17
|
|
|
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 |
$1,395.36 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,674.43
|
| Rate for Payer: ASR ASR |
$1,804.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,527.83
|
| Rate for Payer: BCN Commercial |
$1,527.83
|
| Rate for Payer: Cash Price |
$1,488.38
|
| Rate for Payer: Cofinity Commercial |
$1,748.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.38
|
| Rate for Payer: Healthscope Commercial |
$1,804.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,860.48
|
| Rate for Payer: Mclaren Commercial |
$1,674.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.41
|
| Rate for Payer: Nomi Health Commercial |
$1,525.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,395.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,637.22
|
|
