|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.70 |
| Max. Negotiated Rate |
$1,997.47 |
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$773.42
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,997.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$1,361.54
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,606.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,012.28 |
| Max. Negotiated Rate |
$1,446.12 |
| Rate for Payer: Aetna Commercial |
$1,365.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.42
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cofinity Commercial |
$1,124.76
|
| Rate for Payer: Cofinity Commercial |
$1,381.85
|
| Rate for Payer: Healthscope Commercial |
$1,446.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.78
|
| Rate for Payer: PHP Commercial |
$1,365.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.76
|
| Rate for Payer: Priority Health SBD |
$1,012.28
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,606.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,504.47 |
| Rate for Payer: Aetna Commercial |
$1,365.78
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$735.32
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cofinity Commercial |
$1,124.76
|
| Rate for Payer: Cofinity Commercial |
$1,381.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$1,446.12
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.78
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$1,365.78
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$1,012.28
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$215.46
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,122.22
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$1,504.47 |
| Rate for Payer: Aetna Commercial |
$953.89
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$551.10
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cofinity Commercial |
$965.11
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$1,010.00
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.89
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$953.89
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$707.00
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,122.22
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$707.00 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna Commercial |
$953.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.44
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Commercial |
$965.11
|
| Rate for Payer: Healthscope Commercial |
$1,010.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.89
|
| Rate for Payer: PHP Commercial |
$953.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.55
|
| Rate for Payer: Priority Health SBD |
$707.00
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$947.89
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$1,504.47 |
| Rate for Payer: Aetna Commercial |
$805.71
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$305.03
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$758.31
|
| Rate for Payer: Cash Price |
$758.31
|
| Rate for Payer: Cofinity Commercial |
$663.52
|
| Rate for Payer: Cofinity Commercial |
$815.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$853.10
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.71
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$805.71
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$597.17
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$947.89
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$597.17 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$805.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.13
|
| Rate for Payer: Cash Price |
$758.31
|
| Rate for Payer: Cofinity Commercial |
$663.52
|
| Rate for Payer: Cofinity Commercial |
$815.19
|
| Rate for Payer: Healthscope Commercial |
$853.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.71
|
| Rate for Payer: PHP Commercial |
$805.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.52
|
| Rate for Payer: Priority Health SBD |
$597.17
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$722.16
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$716.43 |
| Rate for Payer: Aetna Commercial |
$613.84
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$195.82
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$577.73
|
| Rate for Payer: Cash Price |
$577.73
|
| Rate for Payer: Cofinity Commercial |
$505.51
|
| Rate for Payer: Cofinity Commercial |
$621.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$649.94
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$613.84
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$613.84
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$454.96
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$153.90
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$722.16
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$454.96 |
| Max. Negotiated Rate |
$649.94 |
| Rate for Payer: Aetna Commercial |
$613.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.40
|
| Rate for Payer: Cash Price |
$577.73
|
| Rate for Payer: Cofinity Commercial |
$505.51
|
| Rate for Payer: Cofinity Commercial |
$621.06
|
| Rate for Payer: Healthscope Commercial |
$649.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$613.84
|
| Rate for Payer: PHP Commercial |
$613.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$454.96
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$417.18
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$262.82 |
| Max. Negotiated Rate |
$375.46 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.17
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cofinity Commercial |
$292.03
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Healthscope Commercial |
$375.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.60
|
| Rate for Payer: PHP Commercial |
$354.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.03
|
| Rate for Payer: Priority Health SBD |
$262.82
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$417.18
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$375.46 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.06
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Cofinity Commercial |
$292.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$375.46
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.60
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$354.60
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$262.82
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$47.81
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$433.11 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$481.24
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health SBD |
$433.11
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$70.05
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Cofinity Commercial |
$481.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$433.11
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$68.76
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$569.38 |
| Max. Negotiated Rate |
$813.39 |
| Rate for Payer: Aetna Commercial |
$768.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.45
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$632.64
|
| Rate for Payer: Cofinity Commercial |
$777.24
|
| Rate for Payer: Healthscope Commercial |
$813.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PHP Commercial |
$768.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health SBD |
$569.38
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$768.20
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$384.68
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$632.64
|
| Rate for Payer: Cofinity Commercial |
$777.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$813.39
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$768.20
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$569.38
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$919.15 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health SBD |
$919.15
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.70 |
| Max. Negotiated Rate |
$1,997.47 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$773.42
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health SBD |
$919.15
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,997.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$1,361.54
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna Commercial |
$2,656.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.25
|
| Rate for Payer: BCBS Complete |
$1,250.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,187.50
|
| Rate for Payer: Cofinity Commercial |
$2,687.50
|
| Rate for Payer: Healthscope Commercial |
$2,812.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: PHP Commercial |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health SBD |
$1,968.75
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,968.75 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna Commercial |
$2,656.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.25
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,187.50
|
| Rate for Payer: Cofinity Commercial |
$2,687.50
|
| Rate for Payer: Healthscope Commercial |
$2,812.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: PHP Commercial |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health SBD |
$1,968.75
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,534.82 |
| Max. Negotiated Rate |
$2,192.61 |
| Rate for Payer: Aetna Commercial |
$2,070.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,583.55
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$1,705.36
|
| Rate for Payer: Cofinity Commercial |
$2,095.16
|
| Rate for Payer: Healthscope Commercial |
$2,192.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: PHP Commercial |
$2,070.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: Priority Health SBD |
$1,534.82
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$2,192.61 |
| Rate for Payer: Aetna Commercial |
$2,070.80
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,583.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,783.75
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$2,095.16
|
| Rate for Payer: Cofinity Commercial |
$1,705.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$2,192.61
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$2,070.80
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$1,534.82
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$446.96
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,041.16
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$1,837.04 |
| Rate for Payer: Aetna Commercial |
$1,734.99
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.86
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cofinity Commercial |
$1,755.40
|
| Rate for Payer: Cofinity Commercial |
$1,428.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$1,837.04
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.99
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$1,734.99
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.81
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$1,285.93
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$388.02
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,041.16
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,285.93 |
| Max. Negotiated Rate |
$1,837.04 |
| Rate for Payer: Aetna Commercial |
$1,734.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.75
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cofinity Commercial |
$1,428.81
|
| Rate for Payer: Cofinity Commercial |
$1,755.40
|
| Rate for Payer: Healthscope Commercial |
$1,837.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.99
|
| Rate for Payer: PHP Commercial |
$1,734.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.81
|
| Rate for Payer: Priority Health SBD |
$1,285.93
|
|
