|
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 |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,674.43
|
| Rate for Payer: Aetna Medicare |
$688.38
|
| Rate for Payer: ASR ASR |
$1,804.67
|
| Rate for Payer: BCBS Complete |
$744.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,533.97
|
| Rate for Payer: BCN Commercial |
$1,533.97
|
| 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: MI Amish Medical Board Commercial |
$1,488.38
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,630.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,304.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,637.22
|
|
|
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 |
$14,718.75 |
| Max. Negotiated Rate |
$19,625.00 |
| Rate for Payer: Aetna Commercial |
$17,662.50
|
| Rate for Payer: ASR ASR |
$19,036.25
|
| Rate for Payer: BCBS Trust/PPO |
$16,116.05
|
| Rate for Payer: BCN Commercial |
$16,116.05
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$19,036.25
|
| Rate for Payer: Healthscope Whirlpool |
$19,625.00
|
| Rate for Payer: Mclaren Commercial |
$17,662.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,718.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,270.00
|
|
|
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 |
$19,625.00 |
| Rate for Payer: Aetna Commercial |
$17,662.50
|
| Rate for Payer: Aetna Medicare |
$7,261.25
|
| Rate for Payer: ASR ASR |
$19,036.25
|
| Rate for Payer: BCBS Complete |
$7,850.00
|
| Rate for Payer: BCBS Trust/PPO |
$16,180.81
|
| Rate for Payer: BCN Commercial |
$16,180.81
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$18,447.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$19,036.25
|
| Rate for Payer: Healthscope Whirlpool |
$19,625.00
|
| Rate for Payer: Mclaren Commercial |
$17,662.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,700.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,681.25
|
| Rate for Payer: Nomi Health Commercial |
$16,092.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,718.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,195.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,757.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,270.00
|
|
|
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 |
$1,538.68 |
| Max. Negotiated Rate |
$2,051.57 |
| Rate for Payer: Aetna Commercial |
$1,846.41
|
| Rate for Payer: ASR ASR |
$1,990.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.75
|
| Rate for Payer: BCN Commercial |
$1,684.75
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,928.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,990.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,051.57
|
| Rate for Payer: Mclaren Commercial |
$1,846.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.83
|
| Rate for Payer: Nomi Health Commercial |
$1,682.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,805.38
|
|
|
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 |
$2,051.57 |
| Rate for Payer: Aetna Commercial |
$1,846.41
|
| Rate for Payer: Aetna Medicare |
$759.08
|
| Rate for Payer: ASR ASR |
$1,990.02
|
| Rate for Payer: BCBS Complete |
$820.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.52
|
| Rate for Payer: BCN Commercial |
$1,691.52
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,928.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,990.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,051.57
|
| Rate for Payer: Mclaren Commercial |
$1,846.41
|
| 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: Nomi Health Commercial |
$1,682.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,538.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,797.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,438.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,805.38
|
|
|
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 |
$1,869.97 |
| Max. Negotiated Rate |
$2,493.29 |
| Rate for Payer: Aetna Commercial |
$2,243.96
|
| Rate for Payer: ASR ASR |
$2,418.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,047.49
|
| Rate for Payer: BCN Commercial |
$2,047.49
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Commercial |
$2,343.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,418.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,493.29
|
| Rate for Payer: Mclaren Commercial |
$2,243.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.30
|
| Rate for Payer: Nomi Health Commercial |
$2,044.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,194.10
|
|
|
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 |
$2,493.29 |
| Rate for Payer: Aetna Commercial |
$2,243.96
|
| Rate for Payer: Aetna Medicare |
$922.52
|
| Rate for Payer: ASR ASR |
$2,418.49
|
| Rate for Payer: BCBS Complete |
$997.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,055.72
|
| Rate for Payer: BCN Commercial |
$2,055.72
|
| Rate for Payer: Cash Price |
$1,994.63
|
| Rate for Payer: Cofinity Commercial |
$2,343.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.63
|
| Rate for Payer: Healthscope Commercial |
$2,418.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,493.29
|
| Rate for Payer: Mclaren Commercial |
$2,243.96
|
| 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: Nomi Health Commercial |
$2,044.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,184.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,747.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,194.10
|
|
|
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 |
$2,679.06 |
| Rate for Payer: Aetna Commercial |
$2,411.15
|
| Rate for Payer: Aetna Medicare |
$991.25
|
| Rate for Payer: ASR ASR |
$2,598.69
|
| Rate for Payer: BCBS Complete |
$1,071.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,208.88
|
| Rate for Payer: BCN Commercial |
$2,208.88
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Commercial |
$2,518.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,598.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,679.06
|
| Rate for Payer: Mclaren Commercial |
$2,411.15
|
| 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: Nomi Health Commercial |
$2,196.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,347.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,878.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,357.57
|
|
|
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 |
$2,009.30 |
| Max. Negotiated Rate |
$2,679.06 |
| Rate for Payer: Aetna Commercial |
$2,411.15
|
| Rate for Payer: ASR ASR |
$2,598.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,200.04
|
| Rate for Payer: BCN Commercial |
$2,200.04
|
| Rate for Payer: Cash Price |
$2,143.25
|
| Rate for Payer: Cofinity Commercial |
$2,518.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.25
|
| Rate for Payer: Healthscope Commercial |
$2,598.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,679.06
|
| Rate for Payer: Mclaren Commercial |
$2,411.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.20
|
| Rate for Payer: Nomi Health Commercial |
$2,196.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,357.57
|
|
|
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 |
$2,989.24 |
| Rate for Payer: Aetna Commercial |
$2,690.32
|
| Rate for Payer: Aetna Medicare |
$1,106.02
|
| Rate for Payer: ASR ASR |
$2,899.56
|
| Rate for Payer: BCBS Complete |
$1,195.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,464.63
|
| Rate for Payer: BCN Commercial |
$2,464.63
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,809.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,899.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,989.24
|
| Rate for Payer: Mclaren Commercial |
$2,690.32
|
| 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: Nomi Health Commercial |
$2,451.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,619.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,095.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.53
|
|
|
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 |
$2,241.93 |
| Max. Negotiated Rate |
$2,989.24 |
| Rate for Payer: Aetna Commercial |
$2,690.32
|
| Rate for Payer: ASR ASR |
$2,899.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,454.76
|
| Rate for Payer: BCN Commercial |
$2,454.76
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,809.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,899.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,989.24
|
| Rate for Payer: Mclaren Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.85
|
| Rate for Payer: Nomi Health Commercial |
$2,451.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.53
|
|
|
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 |
$2,660.18 |
| Max. Negotiated Rate |
$3,546.90 |
| Rate for Payer: Aetna Commercial |
$3,192.21
|
| Rate for Payer: ASR ASR |
$3,440.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,912.71
|
| Rate for Payer: BCN Commercial |
$2,912.71
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,334.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,440.49
|
| Rate for Payer: Healthscope Whirlpool |
$3,546.90
|
| Rate for Payer: Mclaren Commercial |
$3,192.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.86
|
| Rate for Payer: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,121.27
|
|
|
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 |
$3,546.90 |
| Rate for Payer: Aetna Commercial |
$3,192.21
|
| Rate for Payer: Aetna Medicare |
$1,312.35
|
| Rate for Payer: ASR ASR |
$3,440.49
|
| Rate for Payer: BCBS Complete |
$1,418.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,924.42
|
| Rate for Payer: BCN Commercial |
$2,924.42
|
| Rate for Payer: Cash Price |
$2,837.52
|
| Rate for Payer: Cofinity Commercial |
$3,334.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,837.52
|
| Rate for Payer: Healthscope Commercial |
$3,440.49
|
| Rate for Payer: Healthscope Whirlpool |
$3,546.90
|
| Rate for Payer: Mclaren Commercial |
$3,192.21
|
| 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: Nomi Health Commercial |
$2,908.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,107.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,486.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,121.27
|
|
|
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 |
$2,804.74 |
| Max. Negotiated Rate |
$3,739.66 |
| Rate for Payer: Aetna Commercial |
$3,365.69
|
| Rate for Payer: ASR ASR |
$3,627.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,071.01
|
| Rate for Payer: BCN Commercial |
$3,071.01
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,515.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,627.47
|
| Rate for Payer: Healthscope Whirlpool |
$3,739.66
|
| Rate for Payer: Mclaren Commercial |
$3,365.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,178.71
|
| Rate for Payer: Nomi Health Commercial |
$3,066.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,290.90
|
|
|
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 |
$3,739.66 |
| Rate for Payer: Aetna Commercial |
$3,365.69
|
| Rate for Payer: Aetna Medicare |
$1,383.67
|
| Rate for Payer: ASR ASR |
$3,627.47
|
| Rate for Payer: BCBS Complete |
$1,495.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,083.35
|
| Rate for Payer: BCN Commercial |
$3,083.35
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,515.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,627.47
|
| Rate for Payer: Healthscope Whirlpool |
$3,739.66
|
| Rate for Payer: Mclaren Commercial |
$3,365.69
|
| 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: Nomi Health Commercial |
$3,066.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,804.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,276.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,621.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,290.90
|
|
|
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 |
$3,338.25 |
| Max. Negotiated Rate |
$4,451.00 |
| Rate for Payer: Aetna Commercial |
$4,005.90
|
| Rate for Payer: ASR ASR |
$4,317.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,655.16
|
| Rate for Payer: BCN Commercial |
$3,655.16
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Commercial |
$4,183.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,317.47
|
| Rate for Payer: Healthscope Whirlpool |
$4,451.00
|
| Rate for Payer: Mclaren Commercial |
$4,005.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,783.35
|
| Rate for Payer: Nomi Health Commercial |
$3,649.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,916.88
|
|
|
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 |
$4,451.00 |
| Rate for Payer: Aetna Commercial |
$4,005.90
|
| Rate for Payer: Aetna Medicare |
$1,646.87
|
| Rate for Payer: ASR ASR |
$4,317.47
|
| Rate for Payer: BCBS Complete |
$1,780.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,669.85
|
| Rate for Payer: BCN Commercial |
$3,669.85
|
| Rate for Payer: Cash Price |
$3,560.80
|
| Rate for Payer: Cofinity Commercial |
$4,183.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,560.80
|
| Rate for Payer: Healthscope Commercial |
$4,317.47
|
| Rate for Payer: Healthscope Whirlpool |
$4,451.00
|
| Rate for Payer: Mclaren Commercial |
$4,005.90
|
| 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: Nomi Health Commercial |
$3,649.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,338.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,899.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,120.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,916.88
|
|
|
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 |
$3,721.50 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$4,465.80
|
| Rate for Payer: ASR ASR |
$4,813.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,074.79
|
| Rate for Payer: BCN Commercial |
$4,074.79
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,664.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,813.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,962.00
|
| Rate for Payer: Mclaren Commercial |
$4,465.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,217.70
|
| Rate for Payer: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,366.56
|
|
|
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 |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$4,465.80
|
| Rate for Payer: Aetna Medicare |
$1,835.94
|
| Rate for Payer: ASR ASR |
$4,813.14
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,091.17
|
| Rate for Payer: BCN Commercial |
$4,091.17
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$4,664.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,813.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,962.00
|
| Rate for Payer: Mclaren Commercial |
$4,465.80
|
| 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: Nomi Health Commercial |
$4,068.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,721.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,347.70
|
| Rate for Payer: Priority Health Narrow Network |
$3,478.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,366.56
|
|
|
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 |
$1,086.80 |
| Max. Negotiated Rate |
$1,449.06 |
| Rate for Payer: Aetna Commercial |
$1,304.15
|
| Rate for Payer: ASR ASR |
$1,405.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.97
|
| Rate for Payer: BCN Commercial |
$1,189.97
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,405.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,449.06
|
| Rate for Payer: Mclaren Commercial |
$1,304.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.70
|
| Rate for Payer: Nomi Health Commercial |
$1,188.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.17
|
|
|
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 |
$1,449.06 |
| Rate for Payer: Aetna Commercial |
$1,304.15
|
| Rate for Payer: Aetna Medicare |
$536.15
|
| Rate for Payer: ASR ASR |
$1,405.59
|
| Rate for Payer: BCBS Complete |
$579.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.75
|
| Rate for Payer: BCN Commercial |
$1,194.75
|
| Rate for Payer: Cash Price |
$1,159.25
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.25
|
| Rate for Payer: Healthscope Commercial |
$1,405.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,449.06
|
| Rate for Payer: Mclaren Commercial |
$1,304.15
|
| 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: Nomi Health Commercial |
$1,188.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,269.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.17
|
|
|
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 |
$5,488.15 |
| Rate for Payer: Aetna Commercial |
$4,939.34
|
| Rate for Payer: Aetna Medicare |
$2,030.62
|
| Rate for Payer: ASR ASR |
$5,323.51
|
| Rate for Payer: BCBS Complete |
$2,195.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,524.98
|
| Rate for Payer: BCN Commercial |
$4,524.98
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Commercial |
$5,158.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Healthscope Commercial |
$5,323.51
|
| Rate for Payer: Healthscope Whirlpool |
$5,488.15
|
| Rate for Payer: Mclaren Commercial |
$4,939.34
|
| 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: Nomi Health Commercial |
$4,500.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,808.72
|
| Rate for Payer: Priority Health Narrow Network |
$3,847.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,829.57
|
|
|
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 |
$4,116.11 |
| Max. Negotiated Rate |
$5,488.15 |
| Rate for Payer: Aetna Commercial |
$4,939.34
|
| Rate for Payer: ASR ASR |
$5,323.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,506.87
|
| Rate for Payer: BCN Commercial |
$4,506.87
|
| Rate for Payer: Cash Price |
$4,390.52
|
| Rate for Payer: Cofinity Commercial |
$5,158.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.52
|
| Rate for Payer: Healthscope Commercial |
$5,323.51
|
| Rate for Payer: Healthscope Whirlpool |
$5,488.15
|
| Rate for Payer: Mclaren Commercial |
$4,939.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,664.93
|
| Rate for Payer: Nomi Health Commercial |
$4,500.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,116.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,829.57
|
|
|
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 |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: Aetna Medicare |
$2,139.67
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,768.00
|
| Rate for Payer: BCN Commercial |
$4,768.00
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$5,435.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,609.41
|
| Rate for Payer: Healthscope Whirlpool |
$5,782.90
|
| Rate for Payer: Mclaren Commercial |
$5,204.61
|
| 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: Nomi Health Commercial |
$4,741.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,066.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,053.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
|
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 |
$4,337.18 |
| Max. Negotiated Rate |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,748.92
|
| Rate for Payer: BCN Commercial |
$4,748.92
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$5,435.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,609.41
|
| Rate for Payer: Healthscope Whirlpool |
$5,782.90
|
| Rate for Payer: Mclaren Commercial |
$5,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,915.47
|
| Rate for Payer: Nomi Health Commercial |
$4,741.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,337.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
