|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$266.93
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.50 |
| Max. Negotiated Rate |
$266.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: ASR ASR |
$258.92
|
| Rate for Payer: ASR Commercial |
$258.92
|
| Rate for Payer: BCBS Trust/PPO |
$217.52
|
| Rate for Payer: BCN Commercial |
$206.95
|
| Rate for Payer: Cash Price |
$213.54
|
| Rate for Payer: Cofinity Commercial |
$250.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.54
|
| Rate for Payer: Healthscope Commercial |
$266.93
|
| Rate for Payer: Healthscope Whirlpool |
$258.92
|
| Rate for Payer: Mclaren Commercial |
$240.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.89
|
| Rate for Payer: Nomi Health Commercial |
$218.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.90
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$27,014.28
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,966.68 |
| Max. Negotiated Rate |
$27,014.28 |
| Rate for Payer: Aetna Commercial |
$24,312.85
|
| Rate for Payer: Aetna Medicare |
$7,400.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,250.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,250.65
|
| Rate for Payer: ASR ASR |
$26,203.85
|
| Rate for Payer: ASR Commercial |
$26,203.85
|
| Rate for Payer: BCBS Complete |
$4,165.01
|
| Rate for Payer: BCBS MAPPO |
$7,400.52
|
| Rate for Payer: BCBS Trust/PPO |
$22,121.99
|
| Rate for Payer: BCN Commercial |
$20,944.17
|
| Rate for Payer: BCN Medicare Advantage |
$7,400.52
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cofinity Commercial |
$25,393.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,611.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,400.52
|
| Rate for Payer: Healthscope Commercial |
$27,014.28
|
| Rate for Payer: Healthscope Whirlpool |
$26,203.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,400.52
|
| Rate for Payer: Mclaren Commercial |
$24,312.85
|
| Rate for Payer: Mclaren Medicaid |
$3,966.68
|
| Rate for Payer: Mclaren Medicare |
$7,400.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,770.55
|
| Rate for Payer: Meridian Medicaid |
$4,165.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,510.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,962.14
|
| Rate for Payer: Nomi Health Commercial |
$22,151.71
|
| Rate for Payer: PACE Medicare |
$7,030.49
|
| Rate for Payer: PACE SWMI |
$7,400.52
|
| Rate for Payer: PHP Commercial |
$8,140.57
|
| Rate for Payer: PHP Medicaid |
$3,966.68
|
| Rate for Payer: PHP Medicare Advantage |
$7,400.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,966.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,559.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,669.91
|
| Rate for Payer: Priority Health Medicare |
$7,400.52
|
| Rate for Payer: Priority Health Narrow Network |
$18,937.01
|
| Rate for Payer: Railroad Medicare Medicare |
$7,400.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,772.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,400.52
|
| Rate for Payer: UHC Exchange |
$11,470.81
|
| Rate for Payer: UHC Medicare Advantage |
$7,400.52
|
| Rate for Payer: UHCCP DNSP |
$7,400.52
|
| Rate for Payer: UHCCP Medicaid |
$3,966.68
|
| Rate for Payer: VA VA |
$7,400.52
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$27,014.28
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,559.28 |
| Max. Negotiated Rate |
$27,014.28 |
| Rate for Payer: Aetna Commercial |
$24,312.85
|
| Rate for Payer: ASR ASR |
$26,203.85
|
| Rate for Payer: ASR Commercial |
$26,203.85
|
| Rate for Payer: BCBS Trust/PPO |
$22,013.94
|
| Rate for Payer: BCN Commercial |
$20,944.17
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cofinity Commercial |
$25,393.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,611.42
|
| Rate for Payer: Healthscope Commercial |
$27,014.28
|
| Rate for Payer: Healthscope Whirlpool |
$26,203.85
|
| Rate for Payer: Mclaren Commercial |
$24,312.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,962.14
|
| Rate for Payer: Nomi Health Commercial |
$22,151.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,559.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,772.57
|
|
|
HC ELM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
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 |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| 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 |
$23.87
|
| 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 |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren 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 |
$20.82
|
| 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 |
$2.80
|
| 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 |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
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 |
$379.96 |
| Max. Negotiated Rate |
$584.55 |
| Rate for Payer: Aetna Commercial |
$526.10
|
| Rate for Payer: ASR ASR |
$567.01
|
| Rate for Payer: ASR Commercial |
$567.01
|
| Rate for Payer: BCBS Trust/PPO |
$476.35
|
| Rate for Payer: BCN Commercial |
$453.20
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$549.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$584.55
|
| Rate for Payer: Healthscope Whirlpool |
$567.01
|
| Rate for Payer: Mclaren Commercial |
$526.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: Nomi Health Commercial |
$479.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.40
|
|
|
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 |
$584.55 |
| Rate for Payer: Aetna Commercial |
$526.10
|
| Rate for Payer: Aetna Medicare |
$292.27
|
| Rate for Payer: ASR ASR |
$567.01
|
| Rate for Payer: ASR Commercial |
$567.01
|
| Rate for Payer: BCBS Complete |
$233.82
|
| Rate for Payer: BCBS Trust/PPO |
$478.69
|
| Rate for Payer: BCN Commercial |
$453.20
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$549.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$584.55
|
| Rate for Payer: Healthscope Whirlpool |
$567.01
|
| Rate for Payer: Mclaren Commercial |
$526.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: Nomi Health Commercial |
$479.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.18
|
| Rate for Payer: Priority Health Narrow Network |
$409.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.40
|
|
|
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 |
$467.63 |
| Max. Negotiated Rate |
$1,169.07 |
| Rate for Payer: Aetna Commercial |
$1,052.16
|
| Rate for Payer: Aetna Medicare |
$584.53
|
| Rate for Payer: ASR ASR |
$1,134.00
|
| Rate for Payer: ASR Commercial |
$1,134.00
|
| Rate for Payer: BCBS Complete |
$467.63
|
| Rate for Payer: BCBS Trust/PPO |
$957.35
|
| Rate for Payer: BCN Commercial |
$906.38
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,098.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,169.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.00
|
| Rate for Payer: Mclaren Commercial |
$1,052.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: Nomi Health Commercial |
$958.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,024.34
|
| Rate for Payer: Priority Health Narrow Network |
$819.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.78
|
|
|
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 |
$759.90 |
| Max. Negotiated Rate |
$1,169.07 |
| Rate for Payer: Aetna Commercial |
$1,052.16
|
| Rate for Payer: ASR ASR |
$1,134.00
|
| Rate for Payer: ASR Commercial |
$1,134.00
|
| Rate for Payer: BCBS Trust/PPO |
$952.68
|
| Rate for Payer: BCN Commercial |
$906.38
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,098.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,169.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.00
|
| Rate for Payer: Mclaren Commercial |
$1,052.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: Nomi Health Commercial |
$958.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.78
|
|
|
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 |
$186.47 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Aetna Commercial |
$258.19
|
| Rate for Payer: ASR ASR |
$278.27
|
| Rate for Payer: ASR Commercial |
$278.27
|
| Rate for Payer: BCBS Trust/PPO |
$233.78
|
| Rate for Payer: BCN Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$269.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$286.88
|
| Rate for Payer: Healthscope Whirlpool |
$278.27
|
| Rate for Payer: Mclaren Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.45
|
|
|
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 |
$286.88 |
| Rate for Payer: Aetna Commercial |
$258.19
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: ASR ASR |
$278.27
|
| Rate for Payer: ASR Commercial |
$278.27
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$234.93
|
| Rate for Payer: BCN Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$269.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$286.88
|
| Rate for Payer: Healthscope Whirlpool |
$278.27
|
| Rate for Payer: Mclaren Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.36
|
| Rate for Payer: Priority Health Narrow Network |
$201.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.45
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$254.59 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: ASR ASR |
$246.95
|
| Rate for Payer: ASR Commercial |
$246.95
|
| Rate for Payer: BCBS Trust/PPO |
$207.47
|
| Rate for Payer: BCN Commercial |
$197.38
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$239.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$254.59
|
| Rate for Payer: Healthscope Whirlpool |
$246.95
|
| Rate for Payer: Mclaren Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.04
|
|
|
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 |
$254.59 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: ASR ASR |
$246.95
|
| Rate for Payer: ASR Commercial |
$246.95
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$208.48
|
| Rate for Payer: BCN Commercial |
$197.38
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$239.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$254.59
|
| Rate for Payer: Healthscope Whirlpool |
$246.95
|
| Rate for Payer: Mclaren Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.07
|
| Rate for Payer: Priority Health Narrow Network |
$178.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.04
|
|
|
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 |
$254.59 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: ASR ASR |
$246.95
|
| Rate for Payer: ASR Commercial |
$246.95
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$208.48
|
| Rate for Payer: BCN Commercial |
$197.38
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$239.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$254.59
|
| Rate for Payer: Healthscope Whirlpool |
$246.95
|
| Rate for Payer: Mclaren Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.07
|
| Rate for Payer: Priority Health Narrow Network |
$178.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.04
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$254.59 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: ASR ASR |
$246.95
|
| Rate for Payer: ASR Commercial |
$246.95
|
| Rate for Payer: BCBS Trust/PPO |
$207.47
|
| Rate for Payer: BCN Commercial |
$197.38
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$239.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$254.59
|
| Rate for Payer: Healthscope Whirlpool |
$246.95
|
| Rate for Payer: Mclaren Commercial |
$229.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.04
|
|
|
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 |
$186.47 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Aetna Commercial |
$258.19
|
| Rate for Payer: ASR ASR |
$278.27
|
| Rate for Payer: ASR Commercial |
$278.27
|
| Rate for Payer: BCBS Trust/PPO |
$233.78
|
| Rate for Payer: BCN Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$269.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$286.88
|
| Rate for Payer: Healthscope Whirlpool |
$278.27
|
| Rate for Payer: Mclaren Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.45
|
|
|
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 |
$286.88 |
| Rate for Payer: Aetna Commercial |
$258.19
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: ASR ASR |
$278.27
|
| Rate for Payer: ASR Commercial |
$278.27
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$234.93
|
| Rate for Payer: BCN Commercial |
$222.42
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$269.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$286.88
|
| Rate for Payer: Healthscope Whirlpool |
$278.27
|
| Rate for Payer: Mclaren Commercial |
$258.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.36
|
| Rate for Payer: Priority Health Narrow Network |
$201.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.45
|
|
|
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 |
$272.75 |
| Max. Negotiated Rate |
$419.62 |
| Rate for Payer: Aetna Commercial |
$377.66
|
| Rate for Payer: ASR ASR |
$407.03
|
| Rate for Payer: ASR Commercial |
$407.03
|
| Rate for Payer: BCBS Trust/PPO |
$341.95
|
| Rate for Payer: BCN Commercial |
$325.33
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$394.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$419.62
|
| Rate for Payer: Healthscope Whirlpool |
$407.03
|
| Rate for Payer: Mclaren Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: Nomi Health Commercial |
$344.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.27
|
|
|
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 |
$419.62 |
| Rate for Payer: Aetna Commercial |
$377.66
|
| Rate for Payer: Aetna Medicare |
$209.81
|
| Rate for Payer: ASR ASR |
$407.03
|
| Rate for Payer: ASR Commercial |
$407.03
|
| Rate for Payer: BCBS Complete |
$167.85
|
| Rate for Payer: BCBS Trust/PPO |
$343.63
|
| Rate for Payer: BCN Commercial |
$325.33
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$394.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$419.62
|
| Rate for Payer: Healthscope Whirlpool |
$407.03
|
| Rate for Payer: Mclaren Commercial |
$377.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: Nomi Health Commercial |
$344.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.67
|
| Rate for Payer: Priority Health Narrow Network |
$294.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.27
|
|
|
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 |
$538.93 |
| Rate for Payer: Aetna Commercial |
$485.04
|
| Rate for Payer: Aetna Medicare |
$269.46
|
| Rate for Payer: ASR ASR |
$522.76
|
| Rate for Payer: ASR Commercial |
$522.76
|
| Rate for Payer: BCBS Complete |
$215.57
|
| Rate for Payer: BCBS Trust/PPO |
$441.33
|
| Rate for Payer: BCN Commercial |
$417.83
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$506.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$538.93
|
| Rate for Payer: Healthscope Whirlpool |
$522.76
|
| Rate for Payer: Mclaren Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: Nomi Health Commercial |
$441.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.21
|
| Rate for Payer: Priority Health Narrow Network |
$377.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$474.26
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$350.30 |
| Max. Negotiated Rate |
$538.93 |
| Rate for Payer: Aetna Commercial |
$485.04
|
| Rate for Payer: ASR ASR |
$522.76
|
| Rate for Payer: ASR Commercial |
$522.76
|
| Rate for Payer: BCBS Trust/PPO |
$439.17
|
| Rate for Payer: BCN Commercial |
$417.83
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$506.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$538.93
|
| Rate for Payer: Healthscope Whirlpool |
$522.76
|
| Rate for Payer: Mclaren Commercial |
$485.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: Nomi Health Commercial |
$441.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$474.26
|
|
|
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 |
$69.28 |
| Rate for Payer: Aetna Commercial |
$62.35
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: ASR ASR |
$67.20
|
| Rate for Payer: ASR Commercial |
$67.20
|
| Rate for Payer: BCBS Complete |
$27.71
|
| Rate for Payer: BCBS Trust/PPO |
$56.73
|
| Rate for Payer: BCN Commercial |
$53.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$69.28
|
| Rate for Payer: Healthscope Whirlpool |
$67.20
|
| Rate for Payer: Mclaren Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.70
|
| Rate for Payer: Priority Health Narrow Network |
$48.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.97
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Aetna Commercial |
$62.35
|
| Rate for Payer: ASR ASR |
$67.20
|
| Rate for Payer: ASR Commercial |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.46
|
| Rate for Payer: BCN Commercial |
$53.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$69.28
|
| Rate for Payer: Healthscope Whirlpool |
$67.20
|
| Rate for Payer: Mclaren Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.97
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,743.00 |
| Max. Negotiated Rate |
$11,857.50 |
| Rate for Payer: Aetna Commercial |
$10,671.75
|
| Rate for Payer: Aetna Medicare |
$5,928.75
|
| Rate for Payer: ASR ASR |
$11,501.77
|
| Rate for Payer: ASR Commercial |
$11,501.77
|
| Rate for Payer: BCBS Complete |
$4,743.00
|
| Rate for Payer: BCBS Trust/PPO |
$9,710.11
|
| Rate for Payer: BCN Commercial |
$9,193.12
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$11,146.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$11,857.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,501.77
|
| Rate for Payer: Mclaren Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: Nomi Health Commercial |
$9,723.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,389.54
|
| Rate for Payer: Priority Health Narrow Network |
$8,312.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,434.60
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,707.38 |
| Max. Negotiated Rate |
$11,857.50 |
| Rate for Payer: Aetna Commercial |
$10,671.75
|
| Rate for Payer: ASR ASR |
$11,501.77
|
| Rate for Payer: ASR Commercial |
$11,501.77
|
| Rate for Payer: BCBS Trust/PPO |
$9,662.68
|
| Rate for Payer: BCN Commercial |
$9,193.12
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$11,146.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$11,857.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,501.77
|
| Rate for Payer: Mclaren Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: Nomi Health Commercial |
$9,723.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,434.60
|
|
