|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$561.11
|
| Rate for Payer: BCN Commercial |
$561.11
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,331.56
|
| Rate for Payer: UHC Core |
$1,067.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$805.08
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.15
|
| Rate for Payer: BCN Commercial |
$1,123.15
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,331.56
|
| Rate for Payer: UHC Core |
$1,067.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$805.08
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,290.59 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,053.18 |
| Max. Negotiated Rate |
$1,504.55 |
| Rate for Payer: Aetna Commercial |
$1,420.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.62
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Advantage |
$1,170.20
|
| Rate for Payer: Cofinity Commercial |
$1,437.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Healthscope Commercial |
$1,504.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: PHP Commercial |
$1,420.96
|
| Rate for Payer: Priority Health SBD |
$1,053.18
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$1,420.96
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$688.42
|
| Rate for Payer: BCN Commercial |
$688.42
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Advantage |
$1,170.20
|
| Rate for Payer: Cofinity Commercial |
$1,437.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,504.55
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$1,420.96
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$1,053.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.62
|
| Rate for Payer: UHC Core |
$870.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$656.99
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,167.55
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$992.42
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$518.16
|
| Rate for Payer: BCN Commercial |
$518.16
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Advantage |
$817.28
|
| Rate for Payer: Cofinity Commercial |
$1,004.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,050.80
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$992.42
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$735.56
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.91
|
| Rate for Payer: UHC Core |
$608.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$458.85
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,167.55
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$735.56 |
| Max. Negotiated Rate |
$1,050.80 |
| Rate for Payer: Aetna Commercial |
$992.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.91
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Advantage |
$817.28
|
| Rate for Payer: Cofinity Commercial |
$1,004.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Healthscope Commercial |
$1,050.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: PHP Commercial |
$992.42
|
| Rate for Payer: Priority Health SBD |
$735.56
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$621.30 |
| Max. Negotiated Rate |
$887.57 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.02
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Advantage |
$690.33
|
| Rate for Payer: Cofinity Commercial |
$848.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Healthscope Commercial |
$887.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: PHP Commercial |
$838.26
|
| Rate for Payer: Priority Health SBD |
$621.30
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$404.32
|
| Rate for Payer: BCN Commercial |
$404.32
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Advantage |
$690.33
|
| Rate for Payer: Cofinity Commercial |
$848.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$887.57
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$838.26
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$621.30
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.02
|
| Rate for Payer: UHC Core |
$513.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$387.57
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$751.33
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$638.63
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$261.22
|
| Rate for Payer: BCN Commercial |
$261.22
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Advantage |
$525.93
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$676.20
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$638.63
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$473.34
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.36
|
| Rate for Payer: UHC Core |
$391.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$295.27
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$751.33
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$473.34 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna Commercial |
$638.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.36
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Advantage |
$525.93
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Healthscope Commercial |
$676.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: PHP Commercial |
$638.63
|
| Rate for Payer: Priority Health SBD |
$473.34
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$434.03
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.44 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna Commercial |
$368.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.12
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Advantage |
$303.82
|
| Rate for Payer: Cofinity Commercial |
$373.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: PHP Commercial |
$368.93
|
| Rate for Payer: Priority Health SBD |
$273.44
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$434.03
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.97 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna Commercial |
$368.93
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$49.97
|
| Rate for Payer: BCN Commercial |
$49.97
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Advantage |
$303.82
|
| Rate for Payer: Cofinity Commercial |
$373.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$368.93
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$273.44
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.12
|
| Rate for Payer: UHC Core |
$226.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$170.57
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$450.61 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: Priority Health SBD |
$450.61
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$93.88
|
| Rate for Payer: BCN Commercial |
$93.88
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.91
|
| Rate for Payer: UHC Core |
$372.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$281.09
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,124.16 |
| Rate for Payer: Aetna Commercial |
$799.25
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$507.70
|
| Rate for Payer: BCN Commercial |
$507.70
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Advantage |
$658.20
|
| Rate for Payer: Cofinity Commercial |
$808.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$846.26
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$799.25
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$592.38
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.19
|
| Rate for Payer: UHC Core |
$489.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$369.53
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$592.38 |
| Max. Negotiated Rate |
$846.26 |
| Rate for Payer: Aetna Commercial |
$799.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.19
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Advantage |
$658.20
|
| Rate for Payer: Cofinity Commercial |
$808.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Healthscope Commercial |
$846.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PHP Commercial |
$799.25
|
| Rate for Payer: Priority Health SBD |
$592.38
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.15
|
| Rate for Payer: BCN Commercial |
$1,123.15
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Advantage |
$1,062.54
|
| Rate for Payer: Cofinity Commercial |
$1,305.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,366.12
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$956.28
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.64
|
| Rate for Payer: UHC Core |
$790.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$596.54
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$956.28 |
| Max. Negotiated Rate |
$1,366.12 |
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.64
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Advantage |
$1,062.54
|
| Rate for Payer: Cofinity Commercial |
$1,305.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Healthscope Commercial |
$1,366.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: Priority Health SBD |
$956.28
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$294.95 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.99 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$234.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: BCBS Complete |
$187.27
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.32
|
| Rate for Payer: UHC Core |
$243.92
|
| Rate for Payer: UHC Exchange |
$183.99
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,048.29 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.31
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Advantage |
$2,275.88
|
| Rate for Payer: Cofinity Commercial |
$2,796.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: Priority Health SBD |
$2,048.29
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,277.74 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna Medicare |
$1,625.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.31
|
| Rate for Payer: BCBS Complete |
$1,300.50
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Advantage |
$2,275.88
|
| Rate for Payer: Cofinity Commercial |
$2,796.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,601.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: Priority Health SBD |
$2,048.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,113.31
|
| Rate for Payer: UHC Core |
$1,693.90
|
| Rate for Payer: UHC Exchange |
$1,277.74
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,596.83 |
| Max. Negotiated Rate |
$2,281.18 |
| Rate for Payer: Aetna Commercial |
$2,154.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.52
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Advantage |
$1,774.26
|
| Rate for Payer: Cofinity Commercial |
$2,179.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Healthscope Commercial |
$2,281.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: PHP Commercial |
$2,154.45
|
| Rate for Payer: Priority Health SBD |
$1,596.83
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$2,281.18 |
| Rate for Payer: Aetna Commercial |
$2,154.45
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.33
|
| Rate for Payer: BCN Commercial |
$1,757.33
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Advantage |
$1,774.26
|
| Rate for Payer: Cofinity Commercial |
$2,179.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$2,281.18
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.45
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$2,154.45
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,596.83
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,647.52
|
| Rate for Payer: UHC Core |
$1,320.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$996.12
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
