|
HC ELECTROPHYSIOLOGY CATHETET LEVEL 4
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,280.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,880.00
|
| Rate for Payer: ASR ASR |
$3,104.00
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,480.96
|
| Rate for Payer: BCN Commercial |
$2,480.96
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,008.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,104.00
|
| Rate for Payer: Mclaren Commercial |
$2,880.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,912.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,272.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,816.00
|
|
|
HC ELECTROPHYSIOLOGY CATHETET LEVEL 4
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,880.00
|
| Rate for Payer: ASR ASR |
$3,104.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,480.96
|
| Rate for Payer: BCN Commercial |
$2,480.96
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,008.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,104.00
|
| Rate for Payer: Mclaren Commercial |
$2,880.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,816.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 6
|
Facility
|
IP
|
$6,560.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,592.00 |
| Max. Negotiated Rate |
$6,560.00 |
| Rate for Payer: Aetna Commercial |
$5,904.00
|
| Rate for Payer: ASR ASR |
$6,363.20
|
| Rate for Payer: BCBS Trust/PPO |
$5,085.97
|
| Rate for Payer: BCN Commercial |
$5,085.97
|
| Rate for Payer: Cash Price |
$5,248.00
|
| Rate for Payer: Cofinity Commercial |
$6,166.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,248.00
|
| Rate for Payer: Healthscope Commercial |
$6,560.00
|
| Rate for Payer: Healthscope Whirlpool |
$6,363.20
|
| Rate for Payer: Mclaren Commercial |
$5,904.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,576.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,592.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,772.80
|
|
|
HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 6
|
Facility
|
OP
|
$6,560.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$6,560.00 |
| Rate for Payer: Aetna Commercial |
$5,904.00
|
| Rate for Payer: ASR ASR |
$6,363.20
|
| Rate for Payer: BCBS Complete |
$2,624.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,085.97
|
| Rate for Payer: BCN Commercial |
$5,085.97
|
| Rate for Payer: Cash Price |
$5,248.00
|
| Rate for Payer: Cofinity Commercial |
$6,166.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,248.00
|
| Rate for Payer: Healthscope Commercial |
$6,560.00
|
| Rate for Payer: Healthscope Whirlpool |
$6,363.20
|
| Rate for Payer: Mclaren Commercial |
$5,904.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,576.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,592.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,969.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,657.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,772.80
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 1
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: ASR ASR |
$654.75
|
| Rate for Payer: BCBS Trust/PPO |
$523.33
|
| Rate for Payer: BCN Commercial |
$523.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$634.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Healthscope Whirlpool |
$654.75
|
| Rate for Payer: Mclaren Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 1
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: ASR ASR |
$654.75
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS Trust/PPO |
$523.33
|
| Rate for Payer: BCN Commercial |
$523.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$634.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Healthscope Whirlpool |
$654.75
|
| Rate for Payer: Mclaren Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.25
|
| Rate for Payer: Priority Health Narrow Network |
$479.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 2
|
Facility
|
OP
|
$1,208.70
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
27200325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.48 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna Commercial |
$1,087.83
|
| Rate for Payer: ASR ASR |
$1,172.44
|
| Rate for Payer: BCBS Complete |
$483.48
|
| Rate for Payer: BCBS Trust/PPO |
$937.11
|
| Rate for Payer: BCN Commercial |
$937.11
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.44
|
| Rate for Payer: Mclaren Commercial |
$1,087.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.92
|
| Rate for Payer: Priority Health Narrow Network |
$858.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.66
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 2
|
Facility
|
IP
|
$1,208.70
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
27200325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.09 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna Commercial |
$1,087.83
|
| Rate for Payer: ASR ASR |
$1,172.44
|
| Rate for Payer: BCBS Trust/PPO |
$937.11
|
| Rate for Payer: BCN Commercial |
$937.11
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.44
|
| Rate for Payer: Mclaren Commercial |
$1,087.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.66
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 3
|
Facility
|
OP
|
$2,815.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,126.00 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Aetna Commercial |
$2,533.50
|
| Rate for Payer: ASR ASR |
$2,730.55
|
| Rate for Payer: BCBS Complete |
$1,126.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.47
|
| Rate for Payer: BCN Commercial |
$2,182.47
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Cofinity Commercial |
$2,646.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,252.00
|
| Rate for Payer: Healthscope Commercial |
$2,815.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,730.55
|
| Rate for Payer: Mclaren Commercial |
$2,533.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,392.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,561.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,998.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,477.20
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 3
|
Facility
|
IP
|
$2,815.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,970.50 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Aetna Commercial |
$2,533.50
|
| Rate for Payer: ASR ASR |
$2,730.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.47
|
| Rate for Payer: BCN Commercial |
$2,182.47
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Cofinity Commercial |
$2,646.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,252.00
|
| Rate for Payer: Healthscope Commercial |
$2,815.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,730.55
|
| Rate for Payer: Mclaren Commercial |
$2,533.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,392.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,477.20
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
OP
|
$261.70
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.68 |
| Max. Negotiated Rate |
$261.70 |
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: ASR ASR |
$253.85
|
| Rate for Payer: BCBS Complete |
$104.68
|
| Rate for Payer: BCBS Trust/PPO |
$202.90
|
| Rate for Payer: BCN Commercial |
$202.90
|
| Rate for Payer: Cash Price |
$209.36
|
| Rate for Payer: Cofinity Commercial |
$246.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$261.70
|
| Rate for Payer: Healthscope Whirlpool |
$253.85
|
| Rate for Payer: Mclaren Commercial |
$235.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.15
|
| Rate for Payer: Priority Health Narrow Network |
$185.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.30
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$261.70
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.19 |
| Max. Negotiated Rate |
$261.70 |
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: ASR ASR |
$253.85
|
| Rate for Payer: BCBS Trust/PPO |
$202.90
|
| Rate for Payer: BCN Commercial |
$202.90
|
| Rate for Payer: Cash Price |
$209.36
|
| Rate for Payer: Cofinity Commercial |
$246.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$261.70
|
| Rate for Payer: Healthscope Whirlpool |
$253.85
|
| Rate for Payer: Mclaren Commercial |
$235.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.30
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$26,484.59
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,631.15 |
| Max. Negotiated Rate |
$26,484.59 |
| Rate for Payer: Aetna Commercial |
$23,836.13
|
| Rate for Payer: Aetna Medicare |
$6,638.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,297.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,297.88
|
| Rate for Payer: ASR ASR |
$25,690.05
|
| Rate for Payer: BCBS Complete |
$3,813.04
|
| Rate for Payer: BCBS MAPPO |
$6,638.30
|
| Rate for Payer: BCBS Trust/PPO |
$20,533.50
|
| Rate for Payer: BCN Commercial |
$20,533.50
|
| Rate for Payer: BCN Medicare Advantage |
$6,638.30
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cofinity Commercial |
$24,895.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,187.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,638.30
|
| Rate for Payer: Healthscope Commercial |
$26,484.59
|
| Rate for Payer: Healthscope Whirlpool |
$25,690.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,638.30
|
| Rate for Payer: Mclaren Commercial |
$23,836.13
|
| Rate for Payer: Mclaren Medicaid |
$3,631.15
|
| Rate for Payer: Mclaren Medicare |
$6,638.30
|
| Rate for Payer: Meridian Medicaid |
$3,813.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,970.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,634.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,511.90
|
| Rate for Payer: PACE Medicare |
$6,306.38
|
| Rate for Payer: PACE SWMI |
$6,638.30
|
| Rate for Payer: PHP Commercial |
$7,302.13
|
| Rate for Payer: PHP Medicaid |
$3,631.15
|
| Rate for Payer: PHP Medicare Advantage |
$6,638.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,539.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,100.98
|
| Rate for Payer: Priority Health Medicare |
$6,638.30
|
| Rate for Payer: Priority Health Narrow Network |
$18,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6,638.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,306.44
|
| Rate for Payer: UHC Medicare Advantage |
$6,837.45
|
| Rate for Payer: VA VA |
$6,638.30
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$26,484.59
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,539.21 |
| Max. Negotiated Rate |
$26,484.59 |
| Rate for Payer: Aetna Commercial |
$23,836.13
|
| Rate for Payer: ASR ASR |
$25,690.05
|
| Rate for Payer: BCBS Trust/PPO |
$20,533.50
|
| Rate for Payer: BCN Commercial |
$20,533.50
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cofinity Commercial |
$24,895.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,187.67
|
| Rate for Payer: Healthscope Commercial |
$26,484.59
|
| Rate for Payer: Healthscope Whirlpool |
$25,690.05
|
| Rate for Payer: Mclaren Commercial |
$23,836.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,511.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,539.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,306.44
|
|
|
HC ELM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ELM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
OP
|
$573.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$229.24 |
| Max. Negotiated Rate |
$573.09 |
| Rate for Payer: Aetna Commercial |
$515.78
|
| Rate for Payer: ASR ASR |
$555.90
|
| Rate for Payer: BCBS Complete |
$229.24
|
| Rate for Payer: BCBS Trust/PPO |
$444.32
|
| Rate for Payer: BCN Commercial |
$444.32
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cofinity Commercial |
$538.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.47
|
| Rate for Payer: Healthscope Commercial |
$573.09
|
| Rate for Payer: Healthscope Whirlpool |
$555.90
|
| Rate for Payer: Mclaren Commercial |
$515.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.51
|
| Rate for Payer: Priority Health Narrow Network |
$406.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.32
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
IP
|
$573.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$401.16 |
| Max. Negotiated Rate |
$573.09 |
| Rate for Payer: Aetna Commercial |
$515.78
|
| Rate for Payer: ASR ASR |
$555.90
|
| Rate for Payer: BCBS Trust/PPO |
$444.32
|
| Rate for Payer: BCN Commercial |
$444.32
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cofinity Commercial |
$538.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.47
|
| Rate for Payer: Healthscope Commercial |
$573.09
|
| Rate for Payer: Healthscope Whirlpool |
$555.90
|
| Rate for Payer: Mclaren Commercial |
$515.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.32
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
IP
|
$1,146.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$802.30 |
| Max. Negotiated Rate |
$1,146.15 |
| Rate for Payer: Aetna Commercial |
$1,031.54
|
| Rate for Payer: ASR ASR |
$1,111.77
|
| Rate for Payer: BCBS Trust/PPO |
$888.61
|
| Rate for Payer: BCN Commercial |
$888.61
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cofinity Commercial |
$1,077.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.92
|
| Rate for Payer: Healthscope Commercial |
$1,146.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.77
|
| Rate for Payer: Mclaren Commercial |
$1,031.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$974.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,008.61
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
OP
|
$1,146.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$458.46 |
| Max. Negotiated Rate |
$1,146.15 |
| Rate for Payer: Aetna Commercial |
$1,031.54
|
| Rate for Payer: ASR ASR |
$1,111.77
|
| Rate for Payer: BCBS Complete |
$458.46
|
| Rate for Payer: BCBS Trust/PPO |
$888.61
|
| Rate for Payer: BCN Commercial |
$888.61
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cofinity Commercial |
$1,077.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.92
|
| Rate for Payer: Healthscope Commercial |
$1,146.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.77
|
| Rate for Payer: Mclaren Commercial |
$1,031.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$974.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,043.00
|
| Rate for Payer: Priority Health Narrow Network |
$813.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,008.61
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
IP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Aetna Commercial |
$253.12
|
| Rate for Payer: ASR ASR |
$272.81
|
| Rate for Payer: BCBS Trust/PPO |
$218.05
|
| Rate for Payer: BCN Commercial |
$218.05
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$264.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$281.25
|
| Rate for Payer: Healthscope Whirlpool |
$272.81
|
| Rate for Payer: Mclaren Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.50
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
OP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Aetna Commercial |
$253.12
|
| Rate for Payer: ASR ASR |
$272.81
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$218.05
|
| Rate for Payer: BCN Commercial |
$218.05
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$264.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$281.25
|
| Rate for Payer: Healthscope Whirlpool |
$272.81
|
| Rate for Payer: Mclaren Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.94
|
| Rate for Payer: Priority Health Narrow Network |
$199.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.50
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: ASR ASR |
$242.11
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS Trust/PPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$193.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$234.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$242.11
|
| Rate for Payer: Mclaren Commercial |
$224.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.14
|
| Rate for Payer: Priority Health Narrow Network |
$177.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.65
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: ASR ASR |
$242.11
|
| Rate for Payer: BCBS Trust/PPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$193.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$234.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$242.11
|
| Rate for Payer: Mclaren Commercial |
$224.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.65
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: ASR ASR |
$242.11
|
| Rate for Payer: BCBS Trust/PPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$193.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$234.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$242.11
|
| Rate for Payer: Mclaren Commercial |
$224.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.65
|
|
