|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,505.27 |
| Rate for Payer: Aetna Commercial |
$821.82
|
| Rate for Payer: Aetna Medicare |
$556.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| 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 |
$676.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$676.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$870.16
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.82
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$821.82
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.45
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health SBD |
$609.12
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,505.27
|
| Rate for Payer: UHC Core |
$715.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$715.47
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$301.06
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$663.58 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$589.28
|
| 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: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$662.94
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$626.11
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$464.06
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$545.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$545.08
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
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 FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$382.97 |
| Rate for Payer: Aetna Commercial |
$361.69
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$382.97
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$361.69
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$268.08
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$314.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$314.88
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
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 |
$55.59 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$441.77
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$518.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$518.91
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
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 |
$645.29
|
| Rate for Payer: Cofinity Commercial |
$792.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.29
|
| 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 |
$186.69 |
| Max. Negotiated Rate |
$980.43 |
| Rate for Payer: Aetna Commercial |
$783.57
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| 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 |
$645.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$829.66
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$783.57
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$580.77
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$682.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$682.17
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$2,168.96 |
| Rate for Payer: Aetna Commercial |
$1,264.93
|
| Rate for Payer: Aetna Medicare |
$801.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,041.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,339.34
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$1,264.93
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health SBD |
$937.53
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,168.96
|
| Rate for Payer: UHC Core |
$1,101.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,101.23
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$433.81
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$937.53 |
| Max. Negotiated Rate |
$1,339.34 |
| Rate for Payer: Aetna Commercial |
$1,264.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.30
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,041.70
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,041.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Healthscope Commercial |
$1,339.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: PHP Commercial |
$1,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: Priority Health SBD |
$937.53
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$289.17 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna Medicare |
$1,593.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.88
|
| Rate for Payer: BCBS Complete |
$1,275.00
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,231.25
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,231.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health SBD |
$2,008.12
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,008.12 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.88
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,231.25
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,231.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health SBD |
$2,008.12
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,565.52 |
| Max. Negotiated Rate |
$2,236.45 |
| Rate for Payer: Aetna Commercial |
$2,112.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.22
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$1,739.46
|
| Rate for Payer: Cofinity Commercial |
$2,137.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,739.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Healthscope Commercial |
$2,236.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: PHP Commercial |
$2,112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health SBD |
$1,565.52
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$2,236.45 |
| Rate for Payer: Aetna Commercial |
$2,112.21
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$2,137.06
|
| Rate for Payer: Cofinity Commercial |
$1,739.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,739.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$2,236.45
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$2,112.21
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$1,565.52
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$1,838.86
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,873.78 |
| Rate for Payer: Aetna Commercial |
$1,769.68
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,790.50
|
| Rate for Payer: Cofinity Commercial |
$1,457.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,457.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,873.78
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$1,769.68
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$1,311.65
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$1,540.67
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,311.65 |
| Max. Negotiated Rate |
$1,873.78 |
| Rate for Payer: Aetna Commercial |
$1,769.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.29
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,457.39
|
| Rate for Payer: Cofinity Commercial |
$1,790.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,457.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Healthscope Commercial |
$1,873.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: PHP Commercial |
$1,769.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health SBD |
$1,311.65
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$681.62
|
| Rate for Payer: Cofinity Commercial |
$554.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$713.32
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$673.69
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$499.33
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$586.51
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$499.33 |
| Max. Negotiated Rate |
$713.32 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.18
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$554.81
|
| Rate for Payer: Cofinity Commercial |
$681.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Healthscope Commercial |
$713.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: PHP Commercial |
$673.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health SBD |
$499.33
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,211.51
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$763.25 |
| Max. Negotiated Rate |
$1,090.36 |
| Rate for Payer: Aetna Commercial |
$1,029.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.48
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$1,041.90
|
| Rate for Payer: Cofinity Commercial |
$848.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$848.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Healthscope Commercial |
$1,090.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: PHP Commercial |
$1,029.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health SBD |
$763.25
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,211.51
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$1,090.36 |
| Rate for Payer: Aetna Commercial |
$1,029.78
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$848.06
|
| Rate for Payer: Cofinity Commercial |
$1,041.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$848.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$1,090.36
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$1,029.78
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$763.25
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$896.52
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$759.72
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$768.66
|
| Rate for Payer: Cofinity Commercial |
$625.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$804.41
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$759.72
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$563.09
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$661.40
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$563.09 |
| Max. Negotiated Rate |
$804.41 |
| Rate for Payer: Aetna Commercial |
$759.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.96
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$625.65
|
| Rate for Payer: Cofinity Commercial |
$768.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Healthscope Commercial |
$804.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: PHP Commercial |
$759.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health SBD |
$563.09
|
|
