Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 14

Facility

$1,439.03

Service Code	HCPCS C1732
Hospital Charge Code	27200028
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1,295.13
Rate for Payer: Aetna Commercial	$1,223.18
Rate for Payer: Aetna Medicare	$719.52
Rate for Payer: Aetna New Business (MI Preferred)	$935.37
Rate for Payer: BCBS Complete	$575.61
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$1,151.22
Rate for Payer: Cash Price	$1,151.22
Rate for Payer: Cofinity Commercial	$1,007.32
Rate for Payer: Cofinity Commercial	$1,237.57
Rate for Payer: Cofinity Medicare Advantage	$1,007.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,151.22
Rate for Payer: Healthscope Commercial	$1,295.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,223.18
Rate for Payer: PHP Commercial	$1,223.18
Rate for Payer: Priority Health Cigna Priority Health	$935.37
Rate for Payer: Priority Health SBD	$906.59

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 14

Facility

$1,439.03

Service Code	HCPCS C1732
Hospital Charge Code	27200028
Hospital Revenue Code	272
Min. Negotiated Rate	$906.59
Max. Negotiated Rate	$1,295.13
Rate for Payer: Aetna Commercial	$1,223.18
Rate for Payer: Aetna New Business (MI Preferred)	$935.37
Rate for Payer: Cash Price	$1,151.22
Rate for Payer: Cofinity Commercial	$1,007.32
Rate for Payer: Cofinity Commercial	$1,237.57
Rate for Payer: Cofinity Medicare Advantage	$1,007.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,151.22
Rate for Payer: Healthscope Commercial	$1,295.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,223.18
Rate for Payer: PHP Commercial	$1,223.18
Rate for Payer: Priority Health Cigna Priority Health	$935.37
Rate for Payer: Priority Health SBD	$906.59

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 37

Facility

$3,700.00

Service Code	HCPCS C1732
Hospital Charge Code	27200377
Hospital Revenue Code	272
Min. Negotiated Rate	$2,331.00
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$3,145.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,405.00
Rate for Payer: Cash Price	$2,960.00
Rate for Payer: Cofinity Commercial	$2,590.00
Rate for Payer: Cofinity Commercial	$3,182.00
Rate for Payer: Cofinity Medicare Advantage	$2,590.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,960.00
Rate for Payer: Healthscope Commercial	$3,330.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,145.00
Rate for Payer: PHP Commercial	$3,145.00
Rate for Payer: Priority Health Cigna Priority Health	$2,405.00
Rate for Payer: Priority Health SBD	$2,331.00

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 37

Facility

$3,700.00

Service Code	HCPCS C1732
Hospital Charge Code	27200377
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$3,145.00
Rate for Payer: Aetna Medicare	$1,850.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,405.00
Rate for Payer: BCBS Complete	$1,480.00
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$2,960.00
Rate for Payer: Cash Price	$2,960.00
Rate for Payer: Cofinity Commercial	$2,590.00
Rate for Payer: Cofinity Commercial	$3,182.00
Rate for Payer: Cofinity Medicare Advantage	$2,590.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,960.00
Rate for Payer: Healthscope Commercial	$3,330.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,145.00
Rate for Payer: PHP Commercial	$3,145.00
Rate for Payer: Priority Health Cigna Priority Health	$2,405.00
Rate for Payer: Priority Health SBD	$2,331.00

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 40

Facility

$4,082.37

Service Code	HCPCS C1732
Hospital Charge Code	27200014
Hospital Revenue Code	272
Min. Negotiated Rate	$2,571.89
Max. Negotiated Rate	$3,674.13
Rate for Payer: Aetna Commercial	$3,470.01
Rate for Payer: Aetna New Business (MI Preferred)	$2,653.54
Rate for Payer: Cash Price	$3,265.90
Rate for Payer: Cofinity Commercial	$2,857.66
Rate for Payer: Cofinity Commercial	$3,510.84
Rate for Payer: Cofinity Medicare Advantage	$2,857.66
Rate for Payer: Encore Health Key Benefits Commercial	$3,265.90
Rate for Payer: Healthscope Commercial	$3,674.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,470.01
Rate for Payer: PHP Commercial	$3,470.01
Rate for Payer: Priority Health Cigna Priority Health	$2,653.54
Rate for Payer: Priority Health SBD	$2,571.89

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 40

Facility

$4,082.37

Service Code	HCPCS C1732
Hospital Charge Code	27200014
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3,674.13
Rate for Payer: Aetna Commercial	$3,470.01
Rate for Payer: Aetna Medicare	$2,041.18
Rate for Payer: Aetna New Business (MI Preferred)	$2,653.54
Rate for Payer: BCBS Complete	$1,632.95
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$3,265.90
Rate for Payer: Cash Price	$3,265.90
Rate for Payer: Cofinity Commercial	$2,857.66
Rate for Payer: Cofinity Commercial	$3,510.84
Rate for Payer: Cofinity Medicare Advantage	$2,857.66
Rate for Payer: Encore Health Key Benefits Commercial	$3,265.90
Rate for Payer: Healthscope Commercial	$3,674.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,470.01
Rate for Payer: PHP Commercial	$3,470.01
Rate for Payer: Priority Health Cigna Priority Health	$2,653.54
Rate for Payer: Priority Health SBD	$2,571.89

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 41

Facility

$4,100.00

Service Code	HCPCS C1732
Hospital Charge Code	27200380
Hospital Revenue Code	272
Min. Negotiated Rate	$2,583.00
Max. Negotiated Rate	$3,690.00
Rate for Payer: Aetna Commercial	$3,485.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,665.00
Rate for Payer: Cash Price	$3,280.00
Rate for Payer: Cofinity Commercial	$2,870.00
Rate for Payer: Cofinity Commercial	$3,526.00
Rate for Payer: Cofinity Medicare Advantage	$2,870.00
Rate for Payer: Encore Health Key Benefits Commercial	$3,280.00
Rate for Payer: Healthscope Commercial	$3,690.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,485.00
Rate for Payer: PHP Commercial	$3,485.00
Rate for Payer: Priority Health Cigna Priority Health	$2,665.00
Rate for Payer: Priority Health SBD	$2,583.00

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 41

Facility

$4,100.00

Service Code	HCPCS C1732
Hospital Charge Code	27200380
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3,690.00
Rate for Payer: Aetna Commercial	$3,485.00
Rate for Payer: Aetna Medicare	$2,050.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,665.00
Rate for Payer: BCBS Complete	$1,640.00
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$3,280.00
Rate for Payer: Cash Price	$3,280.00
Rate for Payer: Cofinity Commercial	$2,870.00
Rate for Payer: Cofinity Commercial	$3,526.00
Rate for Payer: Cofinity Medicare Advantage	$2,870.00
Rate for Payer: Encore Health Key Benefits Commercial	$3,280.00
Rate for Payer: Healthscope Commercial	$3,690.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,485.00
Rate for Payer: PHP Commercial	$3,485.00
Rate for Payer: Priority Health Cigna Priority Health	$2,665.00
Rate for Payer: Priority Health SBD	$2,583.00

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 45

Facility

$4,681.80

Service Code	HCPCS C1732
Hospital Charge Code	27200013
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$4,213.62
Rate for Payer: Aetna Commercial	$3,979.53
Rate for Payer: Aetna Medicare	$2,340.90
Rate for Payer: Aetna New Business (MI Preferred)	$3,043.17
Rate for Payer: BCBS Complete	$1,872.72
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cofinity Commercial	$3,277.26
Rate for Payer: Cofinity Commercial	$4,026.35
Rate for Payer: Cofinity Medicare Advantage	$3,277.26
Rate for Payer: Encore Health Key Benefits Commercial	$3,745.44
Rate for Payer: Healthscope Commercial	$4,213.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,979.53
Rate for Payer: PHP Commercial	$3,979.53
Rate for Payer: Priority Health Cigna Priority Health	$3,043.17
Rate for Payer: Priority Health SBD	$2,949.53

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 45

Facility

$4,681.80

Service Code	HCPCS C1732
Hospital Charge Code	27200013
Hospital Revenue Code	272
Min. Negotiated Rate	$2,949.53
Max. Negotiated Rate	$4,213.62
Rate for Payer: Aetna Commercial	$3,979.53
Rate for Payer: Aetna New Business (MI Preferred)	$3,043.17
Rate for Payer: Cash Price	$3,745.44
Rate for Payer: Cofinity Commercial	$3,277.26
Rate for Payer: Cofinity Commercial	$4,026.35
Rate for Payer: Cofinity Medicare Advantage	$3,277.26
Rate for Payer: Encore Health Key Benefits Commercial	$3,745.44
Rate for Payer: Healthscope Commercial	$4,213.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,979.53
Rate for Payer: PHP Commercial	$3,979.53
Rate for Payer: Priority Health Cigna Priority Health	$3,043.17
Rate for Payer: Priority Health SBD	$2,949.53

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 62

Facility

$6,374.09

Service Code	HCPCS C1732
Hospital Charge Code	27200015
Hospital Revenue Code	272
Min. Negotiated Rate	$4,015.68
Max. Negotiated Rate	$5,736.68
Rate for Payer: Aetna Commercial	$5,417.98
Rate for Payer: Aetna New Business (MI Preferred)	$4,143.16
Rate for Payer: Cash Price	$5,099.27
Rate for Payer: Cofinity Commercial	$4,461.86
Rate for Payer: Cofinity Commercial	$5,481.72
Rate for Payer: Cofinity Medicare Advantage	$4,461.86
Rate for Payer: Encore Health Key Benefits Commercial	$5,099.27
Rate for Payer: Healthscope Commercial	$5,736.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,417.98
Rate for Payer: PHP Commercial	$5,417.98
Rate for Payer: Priority Health Cigna Priority Health	$4,143.16
Rate for Payer: Priority Health SBD	$4,015.68

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 62

Facility

$6,374.09

Service Code	HCPCS C1732
Hospital Charge Code	27200015
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5,736.68
Rate for Payer: Aetna Commercial	$5,417.98
Rate for Payer: Aetna Medicare	$3,187.04
Rate for Payer: Aetna New Business (MI Preferred)	$4,143.16
Rate for Payer: BCBS Complete	$2,549.64
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$5,099.27
Rate for Payer: Cash Price	$5,099.27
Rate for Payer: Cofinity Commercial	$4,461.86
Rate for Payer: Cofinity Commercial	$5,481.72
Rate for Payer: Cofinity Medicare Advantage	$4,461.86
Rate for Payer: Encore Health Key Benefits Commercial	$5,099.27
Rate for Payer: Healthscope Commercial	$5,736.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,417.98
Rate for Payer: PHP Commercial	$5,417.98
Rate for Payer: Priority Health Cigna Priority Health	$4,143.16
Rate for Payer: Priority Health SBD	$4,015.68

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 73

Facility

$7,300.00

Service Code	HCPCS C1732
Hospital Charge Code	27200378
Hospital Revenue Code	272
Min. Negotiated Rate	$4,599.00
Max. Negotiated Rate	$6,570.00
Rate for Payer: Aetna Commercial	$6,205.00
Rate for Payer: Aetna New Business (MI Preferred)	$4,745.00
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Cofinity Commercial	$5,110.00
Rate for Payer: Cofinity Commercial	$6,278.00
Rate for Payer: Cofinity Medicare Advantage	$5,110.00
Rate for Payer: Encore Health Key Benefits Commercial	$5,840.00
Rate for Payer: Healthscope Commercial	$6,570.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,205.00
Rate for Payer: PHP Commercial	$6,205.00
Rate for Payer: Priority Health Cigna Priority Health	$4,745.00
Rate for Payer: Priority Health SBD	$4,599.00

HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 73

Facility

$7,300.00

Service Code	HCPCS C1732
Hospital Charge Code	27200378
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$6,570.00
Rate for Payer: Aetna Commercial	$6,205.00
Rate for Payer: Aetna Medicare	$3,650.00
Rate for Payer: Aetna New Business (MI Preferred)	$4,745.00
Rate for Payer: BCBS Complete	$2,920.00
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Cash Price	$5,840.00
Rate for Payer: Cofinity Commercial	$5,110.00
Rate for Payer: Cofinity Commercial	$6,278.00
Rate for Payer: Cofinity Medicare Advantage	$5,110.00
Rate for Payer: Encore Health Key Benefits Commercial	$5,840.00
Rate for Payer: Healthscope Commercial	$6,570.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,205.00
Rate for Payer: PHP Commercial	$6,205.00
Rate for Payer: Priority Health Cigna Priority Health	$4,745.00
Rate for Payer: Priority Health SBD	$4,599.00

HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 66

Facility

$6,691.20

Service Code	HCPCS C1733
Hospital Charge Code	27200300
Hospital Revenue Code	272
Min. Negotiated Rate	$4,215.46
Max. Negotiated Rate	$6,022.08
Rate for Payer: Aetna Commercial	$5,687.52
Rate for Payer: Aetna New Business (MI Preferred)	$4,349.28
Rate for Payer: Cash Price	$5,352.96
Rate for Payer: Cofinity Commercial	$4,683.84
Rate for Payer: Cofinity Commercial	$5,754.43
Rate for Payer: Cofinity Medicare Advantage	$4,683.84
Rate for Payer: Encore Health Key Benefits Commercial	$5,352.96
Rate for Payer: Healthscope Commercial	$6,022.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,687.52
Rate for Payer: PHP Commercial	$5,687.52
Rate for Payer: Priority Health Cigna Priority Health	$4,349.28
Rate for Payer: Priority Health SBD	$4,215.46

HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 66

Facility

$6,691.20

Service Code	HCPCS C1733
Hospital Charge Code	27200300
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$6,022.08
Rate for Payer: Aetna Commercial	$5,687.52
Rate for Payer: Aetna Medicare	$3,345.60
Rate for Payer: Aetna New Business (MI Preferred)	$4,349.28
Rate for Payer: BCBS Complete	$2,676.48
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$5,352.96
Rate for Payer: Cash Price	$5,352.96
Rate for Payer: Cofinity Commercial	$4,683.84
Rate for Payer: Cofinity Commercial	$5,754.43
Rate for Payer: Cofinity Medicare Advantage	$4,683.84
Rate for Payer: Encore Health Key Benefits Commercial	$5,352.96
Rate for Payer: Healthscope Commercial	$6,022.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,687.52
Rate for Payer: PHP Commercial	$5,687.52
Rate for Payer: Priority Health Cigna Priority Health	$4,349.28
Rate for Payer: Priority Health SBD	$4,215.46

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 12

Facility

$1,232.87

Service Code	CPT C1730
Hospital Charge Code	27200325
Hospital Revenue Code	272
Min. Negotiated Rate	$776.71
Max. Negotiated Rate	$1,109.58
Rate for Payer: Aetna Commercial	$1,047.94
Rate for Payer: Aetna New Business (MI Preferred)	$801.37
Rate for Payer: Cash Price	$986.30
Rate for Payer: Cofinity Commercial	$1,060.27
Rate for Payer: Cofinity Commercial	$863.01
Rate for Payer: Cofinity Medicare Advantage	$863.01
Rate for Payer: Encore Health Key Benefits Commercial	$986.30
Rate for Payer: Healthscope Commercial	$1,109.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,047.94
Rate for Payer: PHP Commercial	$1,047.94
Rate for Payer: Priority Health Cigna Priority Health	$801.37
Rate for Payer: Priority Health SBD	$776.71

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 12

Facility

$1,232.87

Service Code	CPT C1730
Hospital Charge Code	27200325
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1,109.58
Rate for Payer: Aetna Commercial	$1,047.94
Rate for Payer: Aetna Medicare	$616.44
Rate for Payer: Aetna New Business (MI Preferred)	$801.37
Rate for Payer: BCBS Complete	$493.15
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$986.30
Rate for Payer: Cash Price	$986.30
Rate for Payer: Cofinity Commercial	$1,060.27
Rate for Payer: Cofinity Commercial	$863.01
Rate for Payer: Cofinity Medicare Advantage	$863.01
Rate for Payer: Encore Health Key Benefits Commercial	$986.30
Rate for Payer: Healthscope Commercial	$1,109.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,047.94
Rate for Payer: PHP Commercial	$1,047.94
Rate for Payer: Priority Health Cigna Priority Health	$801.37
Rate for Payer: Priority Health SBD	$776.71

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 28

Facility

$2,871.30

Service Code	HCPCS C1730
Hospital Charge Code	27200299
Hospital Revenue Code	272
Min. Negotiated Rate	$1,808.92
Max. Negotiated Rate	$2,584.17
Rate for Payer: Aetna Commercial	$2,440.60
Rate for Payer: Aetna New Business (MI Preferred)	$1,866.34
Rate for Payer: Cash Price	$2,297.04
Rate for Payer: Cofinity Commercial	$2,009.91
Rate for Payer: Cofinity Commercial	$2,469.32
Rate for Payer: Cofinity Medicare Advantage	$2,009.91
Rate for Payer: Encore Health Key Benefits Commercial	$2,297.04
Rate for Payer: Healthscope Commercial	$2,584.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,440.60
Rate for Payer: PHP Commercial	$2,440.60
Rate for Payer: Priority Health Cigna Priority Health	$1,866.34
Rate for Payer: Priority Health SBD	$1,808.92

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 28

Facility

$2,871.30

Service Code	HCPCS C1730
Hospital Charge Code	27200299
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2,584.17
Rate for Payer: Aetna Commercial	$2,440.60
Rate for Payer: Aetna Medicare	$1,435.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,866.34
Rate for Payer: BCBS Complete	$1,148.52
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$2,297.04
Rate for Payer: Cash Price	$2,297.04
Rate for Payer: Cofinity Commercial	$2,009.91
Rate for Payer: Cofinity Commercial	$2,469.32
Rate for Payer: Cofinity Medicare Advantage	$2,009.91
Rate for Payer: Encore Health Key Benefits Commercial	$2,297.04
Rate for Payer: Healthscope Commercial	$2,584.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,440.60
Rate for Payer: PHP Commercial	$2,440.60
Rate for Payer: Priority Health Cigna Priority Health	$1,866.34
Rate for Payer: Priority Health SBD	$1,808.92

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 32

Facility

$3,264.00

Service Code	HCPCS C1730
Hospital Charge Code	27200304
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2,937.60
Rate for Payer: Aetna Commercial	$2,774.40
Rate for Payer: Aetna Medicare	$1,632.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,121.60
Rate for Payer: BCBS Complete	$1,305.60
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$2,284.80
Rate for Payer: Cofinity Commercial	$2,807.04
Rate for Payer: Cofinity Medicare Advantage	$2,284.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: PHP Commercial	$2,774.40
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health SBD	$2,056.32

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 32

Facility

$3,264.00

Service Code	HCPCS C1730
Hospital Charge Code	27200304
Hospital Revenue Code	272
Min. Negotiated Rate	$2,056.32
Max. Negotiated Rate	$2,937.60
Rate for Payer: Aetna Commercial	$2,774.40
Rate for Payer: Aetna New Business (MI Preferred)	$2,121.60
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$2,284.80
Rate for Payer: Cofinity Commercial	$2,807.04
Rate for Payer: Cofinity Medicare Advantage	$2,284.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: PHP Commercial	$2,774.40
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health SBD	$2,056.32

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 6

Facility

$688.50

Service Code	HCPCS C1730
Hospital Charge Code	27200298
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$619.65
Rate for Payer: Aetna Commercial	$585.22
Rate for Payer: Aetna Medicare	$344.25
Rate for Payer: Aetna New Business (MI Preferred)	$447.52
Rate for Payer: BCBS Complete	$275.40
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$550.80
Rate for Payer: Cash Price	$550.80
Rate for Payer: Cofinity Commercial	$481.95
Rate for Payer: Cofinity Commercial	$592.11
Rate for Payer: Cofinity Medicare Advantage	$481.95
Rate for Payer: Encore Health Key Benefits Commercial	$550.80
Rate for Payer: Healthscope Commercial	$619.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.22
Rate for Payer: PHP Commercial	$585.22
Rate for Payer: Priority Health Cigna Priority Health	$447.52
Rate for Payer: Priority Health SBD	$433.76

HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 6

Facility

$688.50

Service Code	HCPCS C1730
Hospital Charge Code	27200298
Hospital Revenue Code	272
Min. Negotiated Rate	$433.76
Max. Negotiated Rate	$619.65
Rate for Payer: Aetna Commercial	$585.22
Rate for Payer: Aetna New Business (MI Preferred)	$447.52
Rate for Payer: Cash Price	$550.80
Rate for Payer: Cofinity Commercial	$481.95
Rate for Payer: Cofinity Commercial	$592.11
Rate for Payer: Cofinity Medicare Advantage	$481.95
Rate for Payer: Encore Health Key Benefits Commercial	$550.80
Rate for Payer: Healthscope Commercial	$619.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.22
Rate for Payer: PHP Commercial	$585.22
Rate for Payer: Priority Health Cigna Priority Health	$447.52
Rate for Payer: Priority Health SBD	$433.76

HC ELECTROPHYSIOLOGY CATHS NO 3D 20 OR > ELECTRODES LEVEL 46

Facility

$4,792.38

Service Code	HCPCS C1731
Hospital Charge Code	27200056
Hospital Revenue Code	272
Min. Negotiated Rate	$3,019.20
Max. Negotiated Rate	$4,313.14
Rate for Payer: Aetna Commercial	$4,073.52
Rate for Payer: Aetna New Business (MI Preferred)	$3,115.05
Rate for Payer: Cash Price	$3,833.90
Rate for Payer: Cofinity Commercial	$3,354.67
Rate for Payer: Cofinity Commercial	$4,121.45
Rate for Payer: Cofinity Medicare Advantage	$3,354.67
Rate for Payer: Encore Health Key Benefits Commercial	$3,833.90
Rate for Payer: Healthscope Commercial	$4,313.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,073.52
Rate for Payer: PHP Commercial	$4,073.52
Rate for Payer: Priority Health Cigna Priority Health	$3,115.05
Rate for Payer: Priority Health SBD	$3,019.20

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