|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$521.44 |
| Max. Negotiated Rate |
$802.21 |
| Rate for Payer: Aetna Commercial |
$721.99
|
| Rate for Payer: ASR ASR |
$778.14
|
| Rate for Payer: ASR Commercial |
$778.14
|
| Rate for Payer: BCBS Trust/PPO |
$653.72
|
| Rate for Payer: BCN Commercial |
$621.95
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$754.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Healthscope Commercial |
$802.21
|
| Rate for Payer: Healthscope Whirlpool |
$778.14
|
| Rate for Payer: Mclaren Commercial |
$721.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: Nomi Health Commercial |
$657.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.94
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
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 OYSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| 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 PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$34,333.20 |
| Max. Negotiated Rate |
$85,833.00 |
| Rate for Payer: Aetna Commercial |
$77,249.70
|
| Rate for Payer: Aetna Medicare |
$42,916.50
|
| Rate for Payer: ASR ASR |
$83,258.01
|
| Rate for Payer: ASR Commercial |
$83,258.01
|
| Rate for Payer: BCBS Complete |
$34,333.20
|
| Rate for Payer: BCBS Trust/PPO |
$70,288.64
|
| Rate for Payer: BCN Commercial |
$66,546.32
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$80,683.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$85,833.00
|
| Rate for Payer: Healthscope Whirlpool |
$83,258.01
|
| Rate for Payer: Mclaren Commercial |
$77,249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: Nomi Health Commercial |
$70,383.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,206.87
|
| Rate for Payer: Priority Health Narrow Network |
$60,168.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75,533.04
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$55,791.45 |
| Max. Negotiated Rate |
$85,833.00 |
| Rate for Payer: Aetna Commercial |
$77,249.70
|
| Rate for Payer: ASR ASR |
$83,258.01
|
| Rate for Payer: ASR Commercial |
$83,258.01
|
| Rate for Payer: BCBS Trust/PPO |
$69,945.31
|
| Rate for Payer: BCN Commercial |
$66,546.32
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$80,683.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$85,833.00
|
| Rate for Payer: Healthscope Whirlpool |
$83,258.01
|
| Rate for Payer: Mclaren Commercial |
$77,249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: Nomi Health Commercial |
$70,383.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75,533.04
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,180.80 |
| Max. Negotiated Rate |
$7,952.00 |
| Rate for Payer: Aetna Commercial |
$7,156.80
|
| Rate for Payer: Aetna Medicare |
$3,976.00
|
| Rate for Payer: ASR ASR |
$7,713.44
|
| Rate for Payer: ASR Commercial |
$7,713.44
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: BCBS Trust/PPO |
$6,511.89
|
| Rate for Payer: BCN Commercial |
$6,165.19
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$7,474.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,952.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,713.44
|
| Rate for Payer: Mclaren Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Nomi Health Commercial |
$6,520.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,967.54
|
| Rate for Payer: Priority Health Narrow Network |
$5,574.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,997.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,168.80 |
| Max. Negotiated Rate |
$7,952.00 |
| Rate for Payer: Aetna Commercial |
$7,156.80
|
| Rate for Payer: ASR ASR |
$7,713.44
|
| Rate for Payer: ASR Commercial |
$7,713.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,480.08
|
| Rate for Payer: BCN Commercial |
$6,165.19
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$7,474.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,952.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,713.44
|
| Rate for Payer: Mclaren Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Nomi Health Commercial |
$6,520.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,997.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,693.22 |
| Max. Negotiated Rate |
$9,233.04 |
| Rate for Payer: Aetna Commercial |
$8,309.74
|
| Rate for Payer: Aetna Medicare |
$4,616.52
|
| Rate for Payer: ASR ASR |
$8,956.05
|
| Rate for Payer: ASR Commercial |
$8,956.05
|
| Rate for Payer: BCBS Complete |
$3,693.22
|
| Rate for Payer: BCBS Trust/PPO |
$7,560.94
|
| Rate for Payer: BCN Commercial |
$7,158.38
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$8,679.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$9,233.04
|
| Rate for Payer: Healthscope Whirlpool |
$8,956.05
|
| Rate for Payer: Mclaren Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: Nomi Health Commercial |
$7,571.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,089.99
|
| Rate for Payer: Priority Health Narrow Network |
$6,472.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,125.08
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,001.48 |
| Max. Negotiated Rate |
$9,233.04 |
| Rate for Payer: Aetna Commercial |
$8,309.74
|
| Rate for Payer: ASR ASR |
$8,956.05
|
| Rate for Payer: ASR Commercial |
$8,956.05
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.00
|
| Rate for Payer: BCN Commercial |
$7,158.38
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$8,679.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$9,233.04
|
| Rate for Payer: Healthscope Whirlpool |
$8,956.05
|
| Rate for Payer: Mclaren Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: Nomi Health Commercial |
$7,571.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,125.08
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
OP
|
$19,347.05
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,495.99 |
| Max. Negotiated Rate |
$19,347.05 |
| Rate for Payer: Aetna Commercial |
$17,412.34
|
| Rate for Payer: Aetna Medicare |
$10,253.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,817.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,817.15
|
| Rate for Payer: ASR ASR |
$18,766.64
|
| Rate for Payer: ASR Commercial |
$18,766.64
|
| Rate for Payer: BCBS Complete |
$5,770.79
|
| Rate for Payer: BCBS MAPPO |
$10,253.72
|
| Rate for Payer: BCBS Trust/PPO |
$15,843.30
|
| Rate for Payer: BCN Commercial |
$14,999.77
|
| Rate for Payer: BCN Medicare Advantage |
$10,253.72
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cofinity Commercial |
$18,186.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,477.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,253.72
|
| Rate for Payer: Healthscope Commercial |
$19,347.05
|
| Rate for Payer: Healthscope Whirlpool |
$18,766.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,253.72
|
| Rate for Payer: Mclaren Commercial |
$17,412.34
|
| Rate for Payer: Mclaren Medicaid |
$5,495.99
|
| Rate for Payer: Mclaren Medicare |
$10,253.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,766.41
|
| Rate for Payer: Meridian Medicaid |
$5,770.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,791.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,444.99
|
| Rate for Payer: Nomi Health Commercial |
$15,864.58
|
| Rate for Payer: PACE Medicare |
$9,741.03
|
| Rate for Payer: PACE SWMI |
$10,253.72
|
| Rate for Payer: PHP Commercial |
$11,279.09
|
| Rate for Payer: PHP Medicaid |
$5,495.99
|
| Rate for Payer: PHP Medicare Advantage |
$10,253.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,495.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,575.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,951.89
|
| Rate for Payer: Priority Health Medicare |
$10,253.72
|
| Rate for Payer: Priority Health Narrow Network |
$13,562.28
|
| Rate for Payer: Railroad Medicare Medicare |
$10,253.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,025.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,253.72
|
| Rate for Payer: UHC Exchange |
$15,893.27
|
| Rate for Payer: UHC Medicare Advantage |
$10,253.72
|
| Rate for Payer: UHCCP DNSP |
$10,253.72
|
| Rate for Payer: UHCCP Medicaid |
$5,495.99
|
| Rate for Payer: VA VA |
$10,253.72
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$19,347.05
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,575.58 |
| Max. Negotiated Rate |
$19,347.05 |
| Rate for Payer: Aetna Commercial |
$17,412.34
|
| Rate for Payer: ASR ASR |
$18,766.64
|
| Rate for Payer: ASR Commercial |
$18,766.64
|
| Rate for Payer: BCBS Trust/PPO |
$15,765.91
|
| Rate for Payer: BCN Commercial |
$14,999.77
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cofinity Commercial |
$18,186.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,477.64
|
| Rate for Payer: Healthscope Commercial |
$19,347.05
|
| Rate for Payer: Healthscope Whirlpool |
$18,766.64
|
| Rate for Payer: Mclaren Commercial |
$17,412.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,444.99
|
| Rate for Payer: Nomi Health Commercial |
$15,864.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,575.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,025.40
|
|
|
HC PACEMAKER LEAD
|
Facility
|
IP
|
$1,949.22
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.99 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,754.30
|
| Rate for Payer: ASR ASR |
$1,890.74
|
| Rate for Payer: ASR Commercial |
$1,890.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.42
|
| Rate for Payer: BCN Commercial |
$1,511.23
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,832.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Healthscope Commercial |
$1,949.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,890.74
|
| Rate for Payer: Mclaren Commercial |
$1,754.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: Nomi Health Commercial |
$1,598.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,715.31
|
|
|
HC PACEMAKER LEAD
|
Facility
|
OP
|
$1,949.22
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.69 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,754.30
|
| Rate for Payer: Aetna Medicare |
$974.61
|
| Rate for Payer: ASR ASR |
$1,890.74
|
| Rate for Payer: ASR Commercial |
$1,890.74
|
| Rate for Payer: BCBS Complete |
$779.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.22
|
| Rate for Payer: BCN Commercial |
$1,511.23
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,832.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Healthscope Commercial |
$1,949.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,890.74
|
| Rate for Payer: Mclaren Commercial |
$1,754.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: Nomi Health Commercial |
$1,598.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,707.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,366.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,715.31
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
IP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,727.85 |
| Max. Negotiated Rate |
$11,889.00 |
| Rate for Payer: Aetna Commercial |
$10,700.10
|
| Rate for Payer: ASR ASR |
$11,532.33
|
| Rate for Payer: ASR Commercial |
$11,532.33
|
| Rate for Payer: BCBS Trust/PPO |
$9,688.35
|
| Rate for Payer: BCN Commercial |
$9,217.54
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$11,175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$11,889.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,532.33
|
| Rate for Payer: Mclaren Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,105.65
|
| Rate for Payer: Nomi Health Commercial |
$9,748.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,727.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,462.32
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
OP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,755.60 |
| Max. Negotiated Rate |
$11,889.00 |
| Rate for Payer: Aetna Commercial |
$10,700.10
|
| Rate for Payer: Aetna Medicare |
$5,944.50
|
| Rate for Payer: ASR ASR |
$11,532.33
|
| Rate for Payer: ASR Commercial |
$11,532.33
|
| Rate for Payer: BCBS Complete |
$4,755.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,735.90
|
| Rate for Payer: BCN Commercial |
$9,217.54
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$11,175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$11,889.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,532.33
|
| Rate for Payer: Mclaren Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,105.65
|
| Rate for Payer: Nomi Health Commercial |
$9,748.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,727.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,417.14
|
| Rate for Payer: Priority Health Narrow Network |
$8,334.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,462.32
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
IP
|
$13,770.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,950.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Aetna Commercial |
$12,393.00
|
| Rate for Payer: ASR ASR |
$13,356.90
|
| Rate for Payer: ASR Commercial |
$13,356.90
|
| Rate for Payer: BCBS Trust/PPO |
$11,221.17
|
| Rate for Payer: BCN Commercial |
$10,675.88
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cofinity Commercial |
$12,943.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,016.00
|
| Rate for Payer: Healthscope Commercial |
$13,770.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,356.90
|
| Rate for Payer: Mclaren Commercial |
$12,393.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,704.50
|
| Rate for Payer: Nomi Health Commercial |
$11,291.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,950.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,117.60
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
OP
|
$13,770.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,508.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Aetna Commercial |
$12,393.00
|
| Rate for Payer: Aetna Medicare |
$6,885.00
|
| Rate for Payer: ASR ASR |
$13,356.90
|
| Rate for Payer: ASR Commercial |
$13,356.90
|
| Rate for Payer: BCBS Complete |
$5,508.00
|
| Rate for Payer: BCBS Trust/PPO |
$11,276.25
|
| Rate for Payer: BCN Commercial |
$10,675.88
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cofinity Commercial |
$12,943.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,016.00
|
| Rate for Payer: Healthscope Commercial |
$13,770.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,356.90
|
| Rate for Payer: Mclaren Commercial |
$12,393.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,704.50
|
| Rate for Payer: Nomi Health Commercial |
$11,291.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,950.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,065.27
|
| Rate for Payer: Priority Health Narrow Network |
$9,652.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,117.60
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
IP
|
$16,863.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,961.05 |
| Max. Negotiated Rate |
$16,863.15 |
| Rate for Payer: Aetna Commercial |
$15,176.84
|
| Rate for Payer: ASR ASR |
$16,357.26
|
| Rate for Payer: ASR Commercial |
$16,357.26
|
| Rate for Payer: BCBS Trust/PPO |
$13,741.78
|
| Rate for Payer: BCN Commercial |
$13,074.00
|
| Rate for Payer: Cash Price |
$13,490.52
|
| Rate for Payer: Cofinity Commercial |
$15,851.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,490.52
|
| Rate for Payer: Healthscope Commercial |
$16,863.15
|
| Rate for Payer: Healthscope Whirlpool |
$16,357.26
|
| Rate for Payer: Mclaren Commercial |
$15,176.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,333.68
|
| Rate for Payer: Nomi Health Commercial |
$13,827.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,961.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,839.57
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
OP
|
$16,863.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,745.26 |
| Max. Negotiated Rate |
$16,863.15 |
| Rate for Payer: Aetna Commercial |
$15,176.84
|
| Rate for Payer: Aetna Medicare |
$8,431.58
|
| Rate for Payer: ASR ASR |
$16,357.26
|
| Rate for Payer: ASR Commercial |
$16,357.26
|
| Rate for Payer: BCBS Complete |
$6,745.26
|
| Rate for Payer: BCBS Trust/PPO |
$13,809.23
|
| Rate for Payer: BCN Commercial |
$13,074.00
|
| Rate for Payer: Cash Price |
$13,490.52
|
| Rate for Payer: Cofinity Commercial |
$15,851.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,490.52
|
| Rate for Payer: Healthscope Commercial |
$16,863.15
|
| Rate for Payer: Healthscope Whirlpool |
$16,357.26
|
| Rate for Payer: Mclaren Commercial |
$15,176.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,333.68
|
| Rate for Payer: Nomi Health Commercial |
$13,827.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,961.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,775.49
|
| Rate for Payer: Priority Health Narrow Network |
$11,821.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,839.57
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
OP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,527.97 |
| Max. Negotiated Rate |
$6,319.92 |
| Rate for Payer: Aetna Commercial |
$5,687.93
|
| Rate for Payer: Aetna Medicare |
$3,159.96
|
| Rate for Payer: ASR ASR |
$6,130.32
|
| Rate for Payer: ASR Commercial |
$6,130.32
|
| Rate for Payer: BCBS Complete |
$2,527.97
|
| Rate for Payer: BCBS Trust/PPO |
$5,175.38
|
| Rate for Payer: BCN Commercial |
$4,899.83
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Commercial |
$5,940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$6,319.92
|
| Rate for Payer: Healthscope Whirlpool |
$6,130.32
|
| Rate for Payer: Mclaren Commercial |
$5,687.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: Nomi Health Commercial |
$5,182.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,107.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,537.51
|
| Rate for Payer: Priority Health Narrow Network |
$4,430.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,561.53
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
IP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,107.95 |
| Max. Negotiated Rate |
$6,319.92 |
| Rate for Payer: Aetna Commercial |
$5,687.93
|
| Rate for Payer: ASR ASR |
$6,130.32
|
| Rate for Payer: ASR Commercial |
$6,130.32
|
| Rate for Payer: BCBS Trust/PPO |
$5,150.10
|
| Rate for Payer: BCN Commercial |
$4,899.83
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Commercial |
$5,940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$6,319.92
|
| Rate for Payer: Healthscope Whirlpool |
$6,130.32
|
| Rate for Payer: Mclaren Commercial |
$5,687.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: Nomi Health Commercial |
$5,182.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,107.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,561.53
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
OP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,326.02 |
| Max. Negotiated Rate |
$8,315.04 |
| Rate for Payer: Aetna Commercial |
$7,483.54
|
| Rate for Payer: Aetna Medicare |
$4,157.52
|
| Rate for Payer: ASR ASR |
$8,065.59
|
| Rate for Payer: ASR Commercial |
$8,065.59
|
| Rate for Payer: BCBS Complete |
$3,326.02
|
| Rate for Payer: BCBS Trust/PPO |
$6,809.19
|
| Rate for Payer: BCN Commercial |
$6,446.65
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Commercial |
$7,816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$8,315.04
|
| Rate for Payer: Healthscope Whirlpool |
$8,065.59
|
| Rate for Payer: Mclaren Commercial |
$7,483.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: Nomi Health Commercial |
$6,818.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,404.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,285.64
|
| Rate for Payer: Priority Health Narrow Network |
$5,828.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,317.24
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
IP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,404.78 |
| Max. Negotiated Rate |
$8,315.04 |
| Rate for Payer: Aetna Commercial |
$7,483.54
|
| Rate for Payer: ASR ASR |
$8,065.59
|
| Rate for Payer: ASR Commercial |
$8,065.59
|
| Rate for Payer: BCBS Trust/PPO |
$6,775.93
|
| Rate for Payer: BCN Commercial |
$6,446.65
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Commercial |
$7,816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$8,315.04
|
| Rate for Payer: Healthscope Whirlpool |
$8,065.59
|
| Rate for Payer: Mclaren Commercial |
$7,483.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: Nomi Health Commercial |
$6,818.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,404.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,317.24
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
OP
|
$114.69
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$114.69 |
| Rate for Payer: Aetna Commercial |
$103.22
|
| Rate for Payer: Aetna Medicare |
$57.34
|
| Rate for Payer: ASR ASR |
$111.25
|
| Rate for Payer: ASR Commercial |
$111.25
|
| Rate for Payer: BCBS Complete |
$45.88
|
| Rate for Payer: BCBS Trust/PPO |
$93.92
|
| Rate for Payer: BCN Commercial |
$88.92
|
| Rate for Payer: Cash Price |
$91.75
|
| Rate for Payer: Cofinity Commercial |
$107.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.75
|
| Rate for Payer: Healthscope Commercial |
$114.69
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$103.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.49
|
| Rate for Payer: Nomi Health Commercial |
$94.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.49
|
| Rate for Payer: Priority Health Narrow Network |
$80.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.93
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
IP
|
$114.69
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$114.69 |
| Rate for Payer: Aetna Commercial |
$103.22
|
| Rate for Payer: ASR ASR |
$111.25
|
| Rate for Payer: ASR Commercial |
$111.25
|
| Rate for Payer: BCBS Trust/PPO |
$93.46
|
| Rate for Payer: BCN Commercial |
$88.92
|
| Rate for Payer: Cash Price |
$91.75
|
| Rate for Payer: Cofinity Commercial |
$107.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.75
|
| Rate for Payer: Healthscope Commercial |
$114.69
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$103.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.49
|
| Rate for Payer: Nomi Health Commercial |
$94.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.93
|
|
