|
HC ELECTROPHYSIOLOGY CATHS NO 3D 20 OR > ELECTRODES LEVEL 46
|
Facility
|
OP
|
$4,792.38
|
|
|
Service Code
|
HCPCS C1731
|
| Hospital Charge Code |
27200056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$4,313.14 |
| Rate for Payer: Aetna Commercial |
$4,073.52
|
| Rate for Payer: Aetna Medicare |
$2,396.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,115.05
|
| Rate for Payer: BCBS Complete |
$1,916.95
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$3,833.90
|
| 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
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
OP
|
$266.93
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna Commercial |
$226.89
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.50
|
| Rate for Payer: BCBS Complete |
$106.77
|
| Rate for Payer: Cash Price |
$213.54
|
| Rate for Payer: Cofinity Commercial |
$186.85
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.54
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.89
|
| Rate for Payer: PHP Commercial |
$226.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.50
|
| Rate for Payer: Priority Health SBD |
$168.17
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$266.93
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna Commercial |
$226.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.50
|
| Rate for Payer: Cash Price |
$213.54
|
| Rate for Payer: Cofinity Commercial |
$186.85
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.54
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.89
|
| Rate for Payer: PHP Commercial |
$226.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.50
|
| Rate for Payer: Priority Health SBD |
$168.17
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$27,014.28
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,984.98 |
| Max. Negotiated Rate |
$24,312.85 |
| Rate for Payer: Aetna Commercial |
$22,962.14
|
| Rate for Payer: Aetna Medicare |
$7,732.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,559.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,293.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,293.34
|
| Rate for Payer: BCBS Complete |
$4,184.23
|
| Rate for Payer: BCBS MAPPO |
$7,434.67
|
| Rate for Payer: BCBS Trust/PPO |
$19,728.06
|
| Rate for Payer: BCN Commercial |
$19,728.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,434.67
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cofinity Commercial |
$18,910.00
|
| Rate for Payer: Cofinity Commercial |
$23,232.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,611.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,434.67
|
| Rate for Payer: Healthscope Commercial |
$24,312.85
|
| Rate for Payer: Mclaren Medicaid |
$3,984.98
|
| Rate for Payer: Mclaren Medicare |
$7,434.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,806.40
|
| Rate for Payer: Meridian Medicaid |
$4,184.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,549.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,962.14
|
| Rate for Payer: Nomi Health Commercial |
$15,612.81
|
| Rate for Payer: PACE Medicare |
$7,062.94
|
| Rate for Payer: PACE SWMI |
$7,434.67
|
| Rate for Payer: PHP Commercial |
$22,962.14
|
| Rate for Payer: PHP Medicare Advantage |
$7,434.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,984.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,559.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,367.06
|
| Rate for Payer: Priority Health Medicare |
$7,434.67
|
| Rate for Payer: Priority Health Narrow Network |
$18,693.65
|
| Rate for Payer: Priority Health SBD |
$17,019.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,434.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,927.85
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,434.67
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,434.67
|
| Rate for Payer: UHCCP Medicaid |
$4,185.72
|
| Rate for Payer: VA VA |
$7,434.67
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$27,014.28
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,019.00 |
| Max. Negotiated Rate |
$24,312.85 |
| Rate for Payer: Aetna Commercial |
$22,962.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,559.28
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cofinity Commercial |
$18,910.00
|
| Rate for Payer: Cofinity Commercial |
$23,232.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,611.42
|
| Rate for Payer: Healthscope Commercial |
$24,312.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,962.14
|
| Rate for Payer: PHP Commercial |
$22,962.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,559.28
|
| Rate for Payer: Priority Health SBD |
$17,019.00
|
|
|
HC ELM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ELM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
IP
|
$584.55
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$368.27 |
| Max. Negotiated Rate |
$526.10 |
| Rate for Payer: Aetna Commercial |
$496.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.96
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$409.18
|
| Rate for Payer: Cofinity Commercial |
$502.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$526.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: PHP Commercial |
$496.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health SBD |
$368.27
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
OP
|
$584.55
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$233.82 |
| Max. Negotiated Rate |
$526.10 |
| Rate for Payer: Aetna Commercial |
$496.87
|
| Rate for Payer: Aetna Medicare |
$292.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.96
|
| Rate for Payer: BCBS Complete |
$233.82
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$409.18
|
| Rate for Payer: Cofinity Commercial |
$502.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$526.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: PHP Commercial |
$496.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health SBD |
$368.27
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
IP
|
$1,169.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$736.51 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna Commercial |
$993.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.90
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$818.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,052.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: PHP Commercial |
$993.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health SBD |
$736.51
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
OP
|
$1,169.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$364.08 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna Commercial |
$993.71
|
| Rate for Payer: Aetna Medicare |
$584.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.90
|
| Rate for Payer: BCBS Complete |
$467.63
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$818.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,052.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: PHP Commercial |
$993.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health SBD |
$736.51
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$364.08 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
OP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.84 |
| Max. Negotiated Rate |
$364.08 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
OP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.84 |
| Max. Negotiated Rate |
$364.08 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$364.08 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.36 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.75
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$293.73
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health SBD |
$264.36
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.85 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna Medicare |
$209.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.75
|
| Rate for Payer: BCBS Complete |
$167.85
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$293.73
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health SBD |
$264.36
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna Medicare |
$269.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.30
|
| Rate for Payer: BCBS Complete |
$215.57
|
| Rate for Payer: BCBS Trust/PPO |
$364.08
|
| Rate for Payer: BCN Commercial |
$364.08
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$377.25
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$377.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health SBD |
$339.53
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.30
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$377.25
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$377.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health SBD |
$339.53
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.03
|
| Rate for Payer: BCBS Complete |
$27.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health SBD |
$43.65
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.03
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health SBD |
$43.65
|
|
