|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$505.39 |
| Max. Negotiated Rate |
$721.99 |
| Rate for Payer: Aetna Commercial |
$681.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.44
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$561.55
|
| Rate for Payer: Cofinity Commercial |
$689.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Healthscope Commercial |
$721.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: PHP Commercial |
$681.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health SBD |
$505.39
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$721.99 |
| Rate for Payer: Aetna Commercial |
$681.88
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$689.90
|
| Rate for Payer: Cofinity Commercial |
$561.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$721.99
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$681.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$505.39
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Core |
$593.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$593.64
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
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 OYSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,074.79 |
| Max. Negotiated Rate |
$77,249.70 |
| Rate for Payer: Aetna Commercial |
$72,958.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55,791.45
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$60,083.10
|
| Rate for Payer: Cofinity Commercial |
$73,816.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$60,083.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$77,249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: PHP Commercial |
$72,958.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health SBD |
$54,074.79
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$34,333.20 |
| Max. Negotiated Rate |
$77,249.70 |
| Rate for Payer: Aetna Commercial |
$72,958.05
|
| Rate for Payer: Aetna Medicare |
$42,916.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55,791.45
|
| Rate for Payer: BCBS Complete |
$34,333.20
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$60,083.10
|
| Rate for Payer: Cofinity Commercial |
$73,816.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$60,083.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$77,249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: PHP Commercial |
$72,958.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health SBD |
$54,074.79
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,180.80 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna Medicare |
$3,976.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,168.80
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$5,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,566.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health SBD |
$5,009.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,009.76 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,168.80
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$5,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,566.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health SBD |
$5,009.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,693.22 |
| Max. Negotiated Rate |
$8,309.74 |
| Rate for Payer: Aetna Commercial |
$7,848.08
|
| Rate for Payer: Aetna Medicare |
$4,616.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,001.48
|
| Rate for Payer: BCBS Complete |
$3,693.22
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$6,463.13
|
| Rate for Payer: Cofinity Commercial |
$7,940.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,463.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: PHP Commercial |
$7,848.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: Priority Health SBD |
$5,816.82
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,816.82 |
| Max. Negotiated Rate |
$8,309.74 |
| Rate for Payer: Aetna Commercial |
$7,848.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,001.48
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$6,463.13
|
| Rate for Payer: Cofinity Commercial |
$7,940.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,463.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: PHP Commercial |
$7,848.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: Priority Health SBD |
$5,816.82
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$19,347.05
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,188.64 |
| Max. Negotiated Rate |
$17,412.35 |
| Rate for Payer: Aetna Commercial |
$16,444.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,575.58
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cofinity Commercial |
$13,542.93
|
| Rate for Payer: Cofinity Commercial |
$16,638.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,477.64
|
| Rate for Payer: Healthscope Commercial |
$17,412.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,444.99
|
| Rate for Payer: PHP Commercial |
$16,444.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,575.58
|
| Rate for Payer: Priority Health SBD |
$12,188.64
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
OP
|
$19,347.05
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,470.75 |
| Max. Negotiated Rate |
$28,730.64 |
| Rate for Payer: Aetna Commercial |
$16,444.99
|
| Rate for Payer: Aetna Medicare |
$10,614.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,575.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,758.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,758.29
|
| Rate for Payer: BCBS Complete |
$5,744.29
|
| Rate for Payer: BCBS MAPPO |
$10,206.63
|
| Rate for Payer: BCN Medicare Advantage |
$10,206.63
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cofinity Commercial |
$16,638.46
|
| Rate for Payer: Cofinity Commercial |
$13,542.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,477.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,206.63
|
| Rate for Payer: Healthscope Commercial |
$17,412.35
|
| Rate for Payer: Mclaren Medicaid |
$5,470.75
|
| Rate for Payer: Mclaren Medicare |
$10,206.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,716.96
|
| Rate for Payer: Meridian Medicaid |
$5,744.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,737.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,444.99
|
| Rate for Payer: PACE Medicare |
$9,696.30
|
| Rate for Payer: PACE SWMI |
$10,206.63
|
| Rate for Payer: PHP Commercial |
$16,444.99
|
| Rate for Payer: PHP Medicare Advantage |
$10,206.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,470.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,575.58
|
| Rate for Payer: Priority Health Medicare |
$10,206.63
|
| Rate for Payer: Priority Health SBD |
$12,188.64
|
| Rate for Payer: Railroad Medicare Medicare |
$10,206.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,730.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,206.63
|
| Rate for Payer: UHC Medicare Advantage |
$10,206.63
|
| Rate for Payer: UHCCP Medicaid |
$5,746.33
|
| Rate for Payer: VA VA |
$10,206.63
|
|
|
HC PACEMAKER LEAD
|
Facility
|
OP
|
$1,949.22
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.69 |
| Max. Negotiated Rate |
$1,754.30 |
| Rate for Payer: Aetna Commercial |
$1,656.84
|
| Rate for Payer: Aetna Medicare |
$974.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.99
|
| Rate for Payer: BCBS Complete |
$779.69
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,364.45
|
| Rate for Payer: Cofinity Commercial |
$1,676.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,364.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: PHP Commercial |
$1,656.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: Priority Health SBD |
$1,228.01
|
|
|
HC PACEMAKER LEAD
|
Facility
|
IP
|
$1,949.22
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.01 |
| Max. Negotiated Rate |
$1,754.30 |
| Rate for Payer: Aetna Commercial |
$1,656.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.99
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,364.45
|
| Rate for Payer: Cofinity Commercial |
$1,676.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,364.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: PHP Commercial |
$1,656.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: Priority Health SBD |
$1,228.01
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
IP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,490.07 |
| Max. Negotiated Rate |
$10,700.10 |
| Rate for Payer: Aetna Commercial |
$10,105.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,727.85
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$10,224.54
|
| Rate for Payer: Cofinity Commercial |
$8,322.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,322.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,105.65
|
| Rate for Payer: PHP Commercial |
$10,105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,727.85
|
| Rate for Payer: Priority Health SBD |
$7,490.07
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
OP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,755.60 |
| Max. Negotiated Rate |
$10,700.10 |
| Rate for Payer: Aetna Commercial |
$10,105.65
|
| Rate for Payer: Aetna Medicare |
$5,944.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,727.85
|
| Rate for Payer: BCBS Complete |
$4,755.60
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$10,224.54
|
| Rate for Payer: Cofinity Commercial |
$8,322.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,322.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,105.65
|
| Rate for Payer: PHP Commercial |
$10,105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,727.85
|
| Rate for Payer: Priority Health SBD |
$7,490.07
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
IP
|
$13,770.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,675.10 |
| Max. Negotiated Rate |
$12,393.00 |
| Rate for Payer: Aetna Commercial |
$11,704.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,950.50
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cofinity Commercial |
$11,842.20
|
| Rate for Payer: Cofinity Commercial |
$9,639.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,639.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,016.00
|
| Rate for Payer: Healthscope Commercial |
$12,393.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,704.50
|
| Rate for Payer: PHP Commercial |
$11,704.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,950.50
|
| Rate for Payer: Priority Health SBD |
$8,675.10
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
OP
|
$13,770.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,508.00 |
| Max. Negotiated Rate |
$12,393.00 |
| Rate for Payer: Aetna Commercial |
$11,704.50
|
| Rate for Payer: Aetna Medicare |
$6,885.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,950.50
|
| Rate for Payer: BCBS Complete |
$5,508.00
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cofinity Commercial |
$11,842.20
|
| Rate for Payer: Cofinity Commercial |
$9,639.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,639.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,016.00
|
| Rate for Payer: Healthscope Commercial |
$12,393.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,704.50
|
| Rate for Payer: PHP Commercial |
$11,704.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,950.50
|
| Rate for Payer: Priority Health SBD |
$8,675.10
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
IP
|
$16,863.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,623.78 |
| Max. Negotiated Rate |
$15,176.83 |
| Rate for Payer: Aetna Commercial |
$14,333.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,961.05
|
| Rate for Payer: Cash Price |
$13,490.52
|
| Rate for Payer: Cofinity Commercial |
$11,804.20
|
| Rate for Payer: Cofinity Commercial |
$14,502.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,804.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,490.52
|
| Rate for Payer: Healthscope Commercial |
$15,176.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,333.68
|
| Rate for Payer: PHP Commercial |
$14,333.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,961.05
|
| Rate for Payer: Priority Health SBD |
$10,623.78
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
OP
|
$16,863.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,745.26 |
| Max. Negotiated Rate |
$15,176.83 |
| Rate for Payer: Aetna Commercial |
$14,333.68
|
| Rate for Payer: Aetna Medicare |
$8,431.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,961.05
|
| Rate for Payer: BCBS Complete |
$6,745.26
|
| Rate for Payer: Cash Price |
$13,490.52
|
| Rate for Payer: Cofinity Commercial |
$11,804.20
|
| Rate for Payer: Cofinity Commercial |
$14,502.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,804.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,490.52
|
| Rate for Payer: Healthscope Commercial |
$15,176.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,333.68
|
| Rate for Payer: PHP Commercial |
$14,333.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,961.05
|
| Rate for Payer: Priority Health SBD |
$10,623.78
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
IP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,981.55 |
| Max. Negotiated Rate |
$5,687.93 |
| Rate for Payer: Aetna Commercial |
$5,371.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,107.95
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Commercial |
$4,423.94
|
| Rate for Payer: Cofinity Commercial |
$5,435.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,423.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$5,687.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: PHP Commercial |
$5,371.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,107.95
|
| Rate for Payer: Priority Health SBD |
$3,981.55
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
OP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,527.97 |
| Max. Negotiated Rate |
$5,687.93 |
| Rate for Payer: Aetna Commercial |
$5,371.93
|
| Rate for Payer: Aetna Medicare |
$3,159.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,107.95
|
| Rate for Payer: BCBS Complete |
$2,527.97
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Commercial |
$4,423.94
|
| Rate for Payer: Cofinity Commercial |
$5,435.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,423.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$5,687.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: PHP Commercial |
$5,371.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,107.95
|
| Rate for Payer: Priority Health SBD |
$3,981.55
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
OP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,326.02 |
| Max. Negotiated Rate |
$7,483.54 |
| Rate for Payer: Aetna Commercial |
$7,067.78
|
| Rate for Payer: Aetna Medicare |
$4,157.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,404.78
|
| Rate for Payer: BCBS Complete |
$3,326.02
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Commercial |
$5,820.53
|
| Rate for Payer: Cofinity Commercial |
$7,150.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,820.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$7,483.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: PHP Commercial |
$7,067.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,404.78
|
| Rate for Payer: Priority Health SBD |
$5,238.48
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
IP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,238.48 |
| Max. Negotiated Rate |
$7,483.54 |
| Rate for Payer: Aetna Commercial |
$7,067.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,404.78
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Commercial |
$5,820.53
|
| Rate for Payer: Cofinity Commercial |
$7,150.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,820.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$7,483.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: PHP Commercial |
$7,067.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,404.78
|
| Rate for Payer: Priority Health SBD |
$5,238.48
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
IP
|
$114.69
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$103.22 |
| Rate for Payer: Aetna Commercial |
$97.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.55
|
| Rate for Payer: Cash Price |
$91.75
|
| Rate for Payer: Cofinity Commercial |
$80.28
|
| Rate for Payer: Cofinity Commercial |
$98.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.75
|
| Rate for Payer: Healthscope Commercial |
$103.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.49
|
| Rate for Payer: PHP Commercial |
$97.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.55
|
| Rate for Payer: Priority Health SBD |
$72.25
|
|
