|
HC ELECTROPHYSIOLOGY CATH NO 3D OR VECTOR MAP OTHER THAN COOL TIP LVL 32
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,430.00 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Aetna American Axle |
$2,112.50
|
| Rate for Payer: Aetna Commercial |
$2,762.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,112.50
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cofinity Commercial |
$2,275.00
|
| Rate for Payer: Cofinity Commercial |
$2,795.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,275.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,600.00
|
| Rate for Payer: Healthscope Commercial |
$2,925.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,275.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,437.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,762.50
|
| Rate for Payer: PHP Commercial |
$2,762.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,112.50
|
| Rate for Payer: Priority Health SBD |
$2,047.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,437.50
|
|
|
HC ELECTROPHYSIOLOGY CATH NO 3D OR VECTOR MAP OTHER THAN COOL TIP LVL 32
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Aetna American Axle |
$2,112.50
|
| Rate for Payer: Aetna Commercial |
$2,762.50
|
| Rate for Payer: Aetna Medicare |
$1,625.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,112.50
|
| Rate for Payer: BCBS Complete |
$1,300.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cofinity Commercial |
$2,275.00
|
| Rate for Payer: Cofinity Commercial |
$2,795.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,275.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,600.00
|
| Rate for Payer: Healthscope Commercial |
$2,925.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,275.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,437.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,762.50
|
| Rate for Payer: PHP Commercial |
$2,762.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,112.50
|
| Rate for Payer: Priority Health SBD |
$2,047.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,202.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,437.50
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 14
|
Facility
|
OP
|
$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 American Axle |
$935.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,007.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,079.27
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$532.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,079.27
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 14
|
Facility
|
IP
|
$1,439.03
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.17 |
| Max. Negotiated Rate |
$1,295.13 |
| Rate for Payer: Aetna American Axle |
$935.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,007.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,079.27
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$633.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,079.27
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 37
|
Facility
|
OP
|
$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: 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: Kalamazoo County Sherrif's Dept Commercial |
$2,590.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,775.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,369.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,775.00
|
| Rate for Payer: Aetna American Axle |
$2,405.00
|
| 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
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 37
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,628.00 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna American Axle |
$2,405.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,590.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,775.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,628.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,775.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 40
|
Facility
|
OP
|
$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 American Axle |
$2,653.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,857.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,061.78
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,510.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,061.78
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 40
|
Facility
|
IP
|
$4,082.37
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,796.24 |
| Max. Negotiated Rate |
$3,674.13 |
| Rate for Payer: Aetna American Axle |
$2,653.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,857.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,061.78
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,796.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,061.78
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 41
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,804.00 |
| Max. Negotiated Rate |
$3,690.00 |
| Rate for Payer: Aetna American Axle |
$2,665.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,870.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,075.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,804.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,075.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 41
|
Facility
|
OP
|
$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 American Axle |
$2,665.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,870.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,075.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,517.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,075.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 45
|
Facility
|
OP
|
$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 American Axle |
$3,043.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,277.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,511.35
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,732.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,511.35
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 45
|
Facility
|
IP
|
$4,681.80
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,059.99 |
| Max. Negotiated Rate |
$4,213.62 |
| Rate for Payer: Aetna American Axle |
$3,043.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,277.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,511.35
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2,059.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,511.35
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 62
|
Facility
|
IP
|
$6,374.09
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,804.60 |
| Max. Negotiated Rate |
$5,736.68 |
| Rate for Payer: Aetna American Axle |
$4,143.16
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,461.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,780.57
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2,804.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,780.57
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 62
|
Facility
|
OP
|
$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 American Axle |
$4,143.16
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,461.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,780.57
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2,358.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,780.57
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 73
|
Facility
|
OP
|
$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 American Axle |
$4,745.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$5,110.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,475.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2,701.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,475.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS 3D OR VECTOR MAPPING LEVEL 73
|
Facility
|
IP
|
$7,300.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,212.00 |
| Max. Negotiated Rate |
$6,570.00 |
| Rate for Payer: Aetna American Axle |
$4,745.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$5,110.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,475.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$3,212.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,475.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 66
|
Facility
|
OP
|
$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 American Axle |
$4,349.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,683.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,018.40
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2,475.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,018.40
|
|
|
HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 66
|
Facility
|
IP
|
$6,691.20
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,944.13 |
| Max. Negotiated Rate |
$6,022.08 |
| Rate for Payer: Aetna American Axle |
$4,349.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$4,683.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,018.40
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2,944.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,018.40
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 12
|
Facility
|
OP
|
$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 American Axle |
$801.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$863.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$924.65
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$456.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$924.65
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 12
|
Facility
|
IP
|
$1,232.87
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
27200325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.46 |
| Max. Negotiated Rate |
$1,109.58 |
| Rate for Payer: Aetna American Axle |
$801.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$863.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$924.65
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$542.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$924.65
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 28
|
Facility
|
IP
|
$2,871.30
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.37 |
| Max. Negotiated Rate |
$2,584.17 |
| Rate for Payer: Aetna American Axle |
$1,866.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,009.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,153.48
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,263.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,153.48
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 28
|
Facility
|
OP
|
$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 American Axle |
$1,866.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,009.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,153.48
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,062.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,153.48
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 32
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,436.16 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Aetna American Axle |
$2,121.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,284.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,448.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,436.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,448.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 32
|
Facility
|
OP
|
$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 American Axle |
$2,121.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,284.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,448.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,207.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,448.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS NO 3D 19 OR < ELECTRODES LEVEL 6
|
Facility
|
IP
|
$688.50
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$302.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
