|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
OP
|
$29.68
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$27.21 |
| Rate for Payer: Aetna Commercial |
$25.23
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cofinity Commercial |
$25.52
|
| Rate for Payer: Cofinity Commercial |
$20.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$26.71
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.23
|
| Rate for Payer: Nomi Health Commercial |
$27.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.14
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: Priority Health SBD |
$18.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
IP
|
$37.02
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.06
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cofinity Commercial |
$25.91
|
| Rate for Payer: Cofinity Commercial |
$31.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.62
|
| Rate for Payer: Healthscope Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.47
|
| Rate for Payer: PHP Commercial |
$31.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.06
|
| Rate for Payer: Priority Health SBD |
$23.32
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
OP
|
$37.02
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cofinity Commercial |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$25.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$33.32
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.47
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$31.47
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.29
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.23
|
| Rate for Payer: Priority Health SBD |
$23.32
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.72
|
| Rate for Payer: BCN Commercial |
$5.72
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$9.70
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.65
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.32
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$182.90 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$26.59
|
| Rate for Payer: BCN Commercial |
$26.59
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$38.49
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$32.77
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,265.28 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$198.70 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$571.47
|
| Rate for Payer: BCN Commercial |
$571.47
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$1,486.20
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$900.43
|
| Rate for Payer: BCN Commercial |
$900.43
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,178.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,486.20
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,265.28 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$220.74 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$1,393.10
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$705.82
|
| Rate for Payer: BCN Commercial |
$705.82
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cofinity Commercial |
$1,409.49
|
| Rate for Payer: Cofinity Commercial |
$1,147.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,147.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$1,475.05
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.10
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$1,393.10
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$1,032.53
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$1,212.82
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,032.53 |
| Max. Negotiated Rate |
$1,475.05 |
| Rate for Payer: Aetna Commercial |
$1,393.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.31
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cofinity Commercial |
$1,147.26
|
| Rate for Payer: Cofinity Commercial |
$1,409.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,147.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.15
|
| Rate for Payer: Healthscope Commercial |
$1,475.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.10
|
| Rate for Payer: PHP Commercial |
$1,393.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.31
|
| Rate for Payer: Priority Health SBD |
$1,032.53
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,144.66
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$155.78 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$972.96
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$533.07
|
| Rate for Payer: BCN Commercial |
$533.07
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cofinity Commercial |
$984.41
|
| Rate for Payer: Cofinity Commercial |
$801.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$801.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$1,030.19
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.96
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$972.96
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$721.14
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$847.05
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,144.66
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$721.14 |
| Max. Negotiated Rate |
$1,030.19 |
| Rate for Payer: Aetna Commercial |
$972.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.03
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cofinity Commercial |
$801.26
|
| Rate for Payer: Cofinity Commercial |
$984.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$801.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.73
|
| Rate for Payer: Healthscope Commercial |
$1,030.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.96
|
| Rate for Payer: PHP Commercial |
$972.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.03
|
| Rate for Payer: Priority Health SBD |
$721.14
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$609.12 |
| Max. Negotiated Rate |
$870.16 |
| Rate for Payer: Aetna Commercial |
$821.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.45
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cofinity Commercial |
$676.80
|
| Rate for Payer: Cofinity Commercial |
$831.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$676.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.48
|
| Rate for Payer: Healthscope Commercial |
$870.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.82
|
| Rate for Payer: PHP Commercial |
$821.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.45
|
| Rate for Payer: Priority Health SBD |
$609.12
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.59 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$821.82
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$346.37
|
| Rate for Payer: BCN Commercial |
$346.37
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cofinity Commercial |
$831.49
|
| Rate for Payer: Cofinity Commercial |
$676.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$676.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$870.16
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.82
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$821.82
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$609.12
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$715.47
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$464.06 |
| Max. Negotiated Rate |
$662.94 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.79
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$515.62
|
| Rate for Payer: Cofinity Commercial |
$633.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Healthscope Commercial |
$662.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: PHP Commercial |
$626.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: Priority Health SBD |
$464.06
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$222.53
|
| Rate for Payer: BCN Commercial |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$633.48
|
| Rate for Payer: Cofinity Commercial |
$515.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$662.94
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$626.11
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$464.06
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$545.08
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$382.97 |
| Rate for Payer: Aetna Commercial |
$361.69
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$42.75
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$365.95
|
| Rate for Payer: Cofinity Commercial |
$297.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$382.97
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$361.69
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$268.08
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$314.88
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.08 |
| Max. Negotiated Rate |
$382.97 |
| Rate for Payer: Aetna Commercial |
$361.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.59
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$297.86
|
| Rate for Payer: Cofinity Commercial |
$365.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Healthscope Commercial |
$382.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: PHP Commercial |
$361.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: Priority Health SBD |
$268.08
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$80.46
|
| Rate for Payer: BCN Commercial |
$80.46
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Cofinity Commercial |
$490.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$441.77
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$518.91
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$701.23
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.77 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.80
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$490.86
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health SBD |
$441.77
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$580.77 |
| Max. Negotiated Rate |
$829.66 |
| Rate for Payer: Aetna Commercial |
$783.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.20
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$645.30
|
| Rate for Payer: Cofinity Commercial |
$792.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Healthscope Commercial |
$829.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: PHP Commercial |
$783.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health SBD |
$580.77
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna Commercial |
$783.57
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$432.49
|
| Rate for Payer: BCN Commercial |
$432.49
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$792.79
|
| Rate for Payer: Cofinity Commercial |
$645.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$829.66
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$783.57
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$580.77
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$682.17
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
