|
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 |
$1,984.80 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$4,465.80
|
| Rate for Payer: Aetna Medicare |
$2,481.00
|
| Rate for Payer: ASR ASR |
$4,813.14
|
| Rate for Payer: ASR Commercial |
$4,813.14
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,063.38
|
| Rate for Payer: BCN Commercial |
$3,847.04
|
| 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 |
$4,962.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,813.14
|
| 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: Priority Health Cigna Priority Health |
$3,225.30
|
| Rate for Payer: 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 49
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,225.30 |
| 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: ASR Commercial |
$4,813.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,043.53
|
| Rate for Payer: BCN Commercial |
$3,847.04
|
| 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 |
$4,962.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,813.14
|
| 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: Priority Health Cigna Priority Health |
$3,225.30
|
| 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 |
$941.89 |
| 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: ASR Commercial |
$1,405.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.84
|
| Rate for Payer: BCN Commercial |
$1,123.46
|
| 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 |
$1,449.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,405.59
|
| 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: Priority Health Cigna Priority Health |
$941.89
|
| 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 |
$579.62 |
| Max. Negotiated Rate |
$1,449.06 |
| Rate for Payer: Aetna Commercial |
$1,304.15
|
| Rate for Payer: Aetna Medicare |
$724.53
|
| Rate for Payer: ASR ASR |
$1,405.59
|
| Rate for Payer: ASR Commercial |
$1,405.59
|
| Rate for Payer: BCBS Complete |
$579.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.64
|
| Rate for Payer: BCN Commercial |
$1,123.46
|
| 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 |
$1,449.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,405.59
|
| 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: Priority Health Cigna Priority Health |
$941.89
|
| Rate for Payer: 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
|
IP
|
$5,488.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,567.30 |
| 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: ASR Commercial |
$5,323.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,472.29
|
| Rate for Payer: BCN Commercial |
$4,254.96
|
| 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 |
$5,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,323.51
|
| 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: Priority Health Cigna Priority Health |
$3,567.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,829.57
|
|
|
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 |
$2,195.26 |
| Max. Negotiated Rate |
$5,488.15 |
| Rate for Payer: Aetna Commercial |
$4,939.34
|
| Rate for Payer: Aetna Medicare |
$2,744.07
|
| Rate for Payer: ASR ASR |
$5,323.51
|
| Rate for Payer: ASR Commercial |
$5,323.51
|
| Rate for Payer: BCBS Complete |
$2,195.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,494.25
|
| Rate for Payer: BCN Commercial |
$4,254.96
|
| 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 |
$5,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,323.51
|
| 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: Priority Health Cigna Priority Health |
$3,567.30
|
| Rate for Payer: 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 57
|
Facility
|
IP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.89 |
| 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: ASR Commercial |
$5,609.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,712.49
|
| Rate for Payer: BCN Commercial |
$4,483.48
|
| 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 |
$5,782.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,609.41
|
| 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: Priority Health Cigna Priority Health |
$3,758.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
|
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 |
$2,313.16 |
| Max. Negotiated Rate |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: Aetna Medicare |
$2,891.45
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: ASR Commercial |
$5,609.41
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,735.62
|
| Rate for Payer: BCN Commercial |
$4,483.48
|
| 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 |
$5,782.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,609.41
|
| 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: Priority Health Cigna Priority Health |
$3,758.89
|
| Rate for Payer: 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 59
|
Facility
|
IP
|
$5,979.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.64 |
| Max. Negotiated Rate |
$5,979.44 |
| Rate for Payer: Aetna Commercial |
$5,381.50
|
| Rate for Payer: ASR ASR |
$5,800.06
|
| Rate for Payer: ASR Commercial |
$5,800.06
|
| Rate for Payer: BCBS Trust/PPO |
$4,872.65
|
| Rate for Payer: BCN Commercial |
$4,635.86
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Commercial |
$5,620.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Healthscope Commercial |
$5,979.44
|
| Rate for Payer: Healthscope Whirlpool |
$5,800.06
|
| Rate for Payer: Mclaren Commercial |
$5,381.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,886.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,261.91
|
|
|
HC STENT NON COATED W SYS LVL 59
|
Facility
|
OP
|
$5,979.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,391.78 |
| Max. Negotiated Rate |
$5,979.44 |
| Rate for Payer: Aetna Commercial |
$5,381.50
|
| Rate for Payer: Aetna Medicare |
$2,989.72
|
| Rate for Payer: ASR ASR |
$5,800.06
|
| Rate for Payer: ASR Commercial |
$5,800.06
|
| Rate for Payer: BCBS Complete |
$2,391.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,896.56
|
| Rate for Payer: BCN Commercial |
$4,635.86
|
| Rate for Payer: Cash Price |
$4,783.55
|
| Rate for Payer: Cofinity Commercial |
$5,620.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,783.55
|
| Rate for Payer: Healthscope Commercial |
$5,979.44
|
| Rate for Payer: Healthscope Whirlpool |
$5,800.06
|
| Rate for Payer: Mclaren Commercial |
$5,381.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,082.52
|
| Rate for Payer: Nomi Health Commercial |
$4,903.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,886.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,239.19
|
| Rate for Payer: Priority Health Narrow Network |
$4,191.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,261.91
|
|
|
HC STENT NON COATED W SYS LVL 67
|
Facility
|
OP
|
$6,779.33
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.73 |
| Max. Negotiated Rate |
$6,779.33 |
| Rate for Payer: Aetna Commercial |
$6,101.40
|
| Rate for Payer: Aetna Medicare |
$3,389.66
|
| Rate for Payer: ASR ASR |
$6,575.95
|
| Rate for Payer: ASR Commercial |
$6,575.95
|
| Rate for Payer: BCBS Complete |
$2,711.73
|
| Rate for Payer: BCBS Trust/PPO |
$5,551.59
|
| Rate for Payer: BCN Commercial |
$5,256.01
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Commercial |
$6,372.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Healthscope Commercial |
$6,779.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,575.95
|
| Rate for Payer: Mclaren Commercial |
$6,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,406.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,940.05
|
| Rate for Payer: Priority Health Narrow Network |
$4,752.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,965.81
|
|
|
HC STENT NON COATED W SYS LVL 67
|
Facility
|
IP
|
$6,779.33
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,406.56 |
| Max. Negotiated Rate |
$6,779.33 |
| Rate for Payer: Aetna Commercial |
$6,101.40
|
| Rate for Payer: ASR ASR |
$6,575.95
|
| Rate for Payer: ASR Commercial |
$6,575.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,524.48
|
| Rate for Payer: BCN Commercial |
$5,256.01
|
| Rate for Payer: Cash Price |
$5,423.46
|
| Rate for Payer: Cofinity Commercial |
$6,372.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,423.46
|
| Rate for Payer: Healthscope Commercial |
$6,779.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,575.95
|
| Rate for Payer: Mclaren Commercial |
$6,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,762.43
|
| Rate for Payer: Nomi Health Commercial |
$5,559.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,406.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,965.81
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
IP
|
$244.19
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.72 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Aetna Commercial |
$219.77
|
| Rate for Payer: ASR ASR |
$236.86
|
| Rate for Payer: ASR Commercial |
$236.86
|
| Rate for Payer: BCBS Trust/PPO |
$198.99
|
| Rate for Payer: BCN Commercial |
$189.32
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$244.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.86
|
| Rate for Payer: Mclaren Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.89
|
|
|
HC STENT NON CORONARY LVL 2
|
Facility
|
OP
|
$244.19
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Aetna Commercial |
$219.77
|
| Rate for Payer: Aetna Medicare |
$122.09
|
| Rate for Payer: ASR ASR |
$236.86
|
| Rate for Payer: ASR Commercial |
$236.86
|
| Rate for Payer: BCBS Complete |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$199.97
|
| Rate for Payer: BCN Commercial |
$189.32
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$244.19
|
| Rate for Payer: Healthscope Whirlpool |
$236.86
|
| Rate for Payer: Mclaren Commercial |
$219.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.56
|
| Rate for Payer: Nomi Health Commercial |
$200.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.96
|
| Rate for Payer: Priority Health Narrow Network |
$171.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.89
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
IP
|
$501.23
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.80 |
| Max. Negotiated Rate |
$501.23 |
| Rate for Payer: Aetna Commercial |
$451.11
|
| Rate for Payer: ASR ASR |
$486.19
|
| Rate for Payer: ASR Commercial |
$486.19
|
| Rate for Payer: BCBS Trust/PPO |
$408.45
|
| Rate for Payer: BCN Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Commercial |
$471.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$501.23
|
| Rate for Payer: Healthscope Whirlpool |
$486.19
|
| Rate for Payer: Mclaren Commercial |
$451.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Nomi Health Commercial |
$411.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.08
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
OP
|
$501.23
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.49 |
| Max. Negotiated Rate |
$501.23 |
| Rate for Payer: Aetna Commercial |
$451.11
|
| Rate for Payer: Aetna Medicare |
$250.62
|
| Rate for Payer: ASR ASR |
$486.19
|
| Rate for Payer: ASR Commercial |
$486.19
|
| Rate for Payer: BCBS Complete |
$200.49
|
| Rate for Payer: BCBS Trust/PPO |
$410.46
|
| Rate for Payer: BCN Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Commercial |
$471.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$501.23
|
| Rate for Payer: Healthscope Whirlpool |
$486.19
|
| Rate for Payer: Mclaren Commercial |
$451.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: Nomi Health Commercial |
$411.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.18
|
| Rate for Payer: Priority Health Narrow Network |
$351.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.08
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
IP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.17 |
| Max. Negotiated Rate |
$838.73 |
| Rate for Payer: Aetna Commercial |
$754.86
|
| Rate for Payer: ASR ASR |
$813.57
|
| Rate for Payer: ASR Commercial |
$813.57
|
| Rate for Payer: BCBS Trust/PPO |
$683.48
|
| Rate for Payer: BCN Commercial |
$650.27
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Commercial |
$788.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Healthscope Commercial |
$838.73
|
| Rate for Payer: Healthscope Whirlpool |
$813.57
|
| Rate for Payer: Mclaren Commercial |
$754.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Nomi Health Commercial |
$687.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.08
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
OP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.49 |
| Max. Negotiated Rate |
$838.73 |
| Rate for Payer: Aetna Commercial |
$754.86
|
| Rate for Payer: Aetna Medicare |
$419.37
|
| Rate for Payer: ASR ASR |
$813.57
|
| Rate for Payer: ASR Commercial |
$813.57
|
| Rate for Payer: BCBS Complete |
$335.49
|
| Rate for Payer: BCBS Trust/PPO |
$686.84
|
| Rate for Payer: BCN Commercial |
$650.27
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Commercial |
$788.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Healthscope Commercial |
$838.73
|
| Rate for Payer: Healthscope Whirlpool |
$813.57
|
| Rate for Payer: Mclaren Commercial |
$754.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: Nomi Health Commercial |
$687.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.90
|
| Rate for Payer: Priority Health Narrow Network |
$587.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.08
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
OP
|
$10,616.58
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,246.63 |
| Max. Negotiated Rate |
$10,616.58 |
| Rate for Payer: Aetna Commercial |
$9,554.92
|
| Rate for Payer: Aetna Medicare |
$5,308.29
|
| Rate for Payer: ASR ASR |
$10,298.08
|
| Rate for Payer: ASR Commercial |
$10,298.08
|
| Rate for Payer: BCBS Complete |
$4,246.63
|
| Rate for Payer: BCBS Trust/PPO |
$8,693.92
|
| Rate for Payer: BCN Commercial |
$8,231.03
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,979.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$10,616.58
|
| Rate for Payer: Healthscope Whirlpool |
$10,298.08
|
| Rate for Payer: Mclaren Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,302.25
|
| Rate for Payer: Priority Health Narrow Network |
$7,442.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,342.59
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
IP
|
$10,616.58
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,900.78 |
| Max. Negotiated Rate |
$10,616.58 |
| Rate for Payer: Aetna Commercial |
$9,554.92
|
| Rate for Payer: ASR ASR |
$10,298.08
|
| Rate for Payer: ASR Commercial |
$10,298.08
|
| Rate for Payer: BCBS Trust/PPO |
$8,651.45
|
| Rate for Payer: BCN Commercial |
$8,231.03
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,979.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$10,616.58
|
| Rate for Payer: Healthscope Whirlpool |
$10,298.08
|
| Rate for Payer: Mclaren Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,342.59
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
IP
|
$16,403.51
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,662.28 |
| Max. Negotiated Rate |
$16,403.51 |
| Rate for Payer: Aetna Commercial |
$14,763.16
|
| Rate for Payer: ASR ASR |
$15,911.40
|
| Rate for Payer: ASR Commercial |
$15,911.40
|
| Rate for Payer: BCBS Trust/PPO |
$13,367.22
|
| Rate for Payer: BCN Commercial |
$12,717.64
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cofinity Commercial |
$15,419.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,122.81
|
| Rate for Payer: Healthscope Commercial |
$16,403.51
|
| Rate for Payer: Healthscope Whirlpool |
$15,911.40
|
| Rate for Payer: Mclaren Commercial |
$14,763.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,942.98
|
| Rate for Payer: Nomi Health Commercial |
$13,450.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,662.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,435.09
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
OP
|
$16,403.51
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$17,143.36 |
| Rate for Payer: Aetna Commercial |
$14,763.16
|
| Rate for Payer: Aetna Medicare |
$11,060.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: ASR ASR |
$15,911.40
|
| Rate for Payer: ASR Commercial |
$15,911.40
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCBS Trust/PPO |
$13,432.83
|
| Rate for Payer: BCN Commercial |
$12,717.64
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cofinity Commercial |
$15,419.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,122.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$16,403.51
|
| Rate for Payer: Healthscope Whirlpool |
$15,911.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,060.23
|
| Rate for Payer: Mclaren Commercial |
$14,763.16
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,942.98
|
| Rate for Payer: Nomi Health Commercial |
$13,450.88
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$12,166.25
|
| Rate for Payer: PHP Medicaid |
$5,928.28
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,662.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,372.76
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health Narrow Network |
$11,498.86
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,435.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$17,143.36
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP DNSP |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC STENT PLACE VENOUS
|
Facility
|
IP
|
$18,746.85
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,185.45 |
| Max. Negotiated Rate |
$18,746.85 |
| Rate for Payer: Aetna Commercial |
$16,872.17
|
| Rate for Payer: ASR ASR |
$18,184.44
|
| Rate for Payer: ASR Commercial |
$18,184.44
|
| Rate for Payer: BCBS Trust/PPO |
$15,276.81
|
| Rate for Payer: BCN Commercial |
$14,534.43
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cofinity Commercial |
$17,622.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,997.48
|
| Rate for Payer: Healthscope Commercial |
$18,746.85
|
| Rate for Payer: Healthscope Whirlpool |
$18,184.44
|
| Rate for Payer: Mclaren Commercial |
$16,872.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,934.82
|
| Rate for Payer: Nomi Health Commercial |
$15,372.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,185.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,497.23
|
|
|
HC STENT PLACE VENOUS
|
Facility
|
OP
|
$18,746.85
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$18,746.85 |
| Rate for Payer: Aetna Commercial |
$16,872.17
|
| Rate for Payer: Aetna Medicare |
$11,060.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: ASR ASR |
$18,184.44
|
| Rate for Payer: ASR Commercial |
$18,184.44
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCBS Trust/PPO |
$15,351.80
|
| Rate for Payer: BCN Commercial |
$14,534.43
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cofinity Commercial |
$17,622.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,997.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$18,746.85
|
| Rate for Payer: Healthscope Whirlpool |
$18,184.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,060.23
|
| Rate for Payer: Mclaren Commercial |
$16,872.17
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,934.82
|
| Rate for Payer: Nomi Health Commercial |
$15,372.42
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$12,166.25
|
| Rate for Payer: PHP Medicaid |
$5,928.28
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,185.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,425.99
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health Narrow Network |
$13,141.54
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,497.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$17,143.36
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP DNSP |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
OP
|
$10,616.58
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,246.63 |
| Max. Negotiated Rate |
$10,616.58 |
| Rate for Payer: Aetna Commercial |
$9,554.92
|
| Rate for Payer: Aetna Medicare |
$5,308.29
|
| Rate for Payer: ASR ASR |
$10,298.08
|
| Rate for Payer: ASR Commercial |
$10,298.08
|
| Rate for Payer: BCBS Complete |
$4,246.63
|
| Rate for Payer: BCBS Trust/PPO |
$8,693.92
|
| Rate for Payer: BCN Commercial |
$8,231.03
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$9,979.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$10,616.58
|
| Rate for Payer: Healthscope Whirlpool |
$10,298.08
|
| Rate for Payer: Mclaren Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: Nomi Health Commercial |
$8,705.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,302.25
|
| Rate for Payer: Priority Health Narrow Network |
$7,442.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,342.59
|
|
