|
HC EAKIN SEAL 2"
|
Facility
|
IP
|
$12.79
|
|
| Hospital Charge Code |
27100013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna Commercial |
$11.51
|
| Rate for Payer: ASR ASR |
$12.41
|
| Rate for Payer: BCBS Trust/PPO |
$10.50
|
| Rate for Payer: BCN Commercial |
$10.50
|
| Rate for Payer: Cash Price |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.23
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.79
|
| Rate for Payer: Mclaren Commercial |
$11.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.87
|
| Rate for Payer: Nomi Health Commercial |
$10.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.26
|
|
|
HC EAKIN SEAL 2"
|
Facility
|
OP
|
$12.79
|
|
| Hospital Charge Code |
27100013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna Commercial |
$11.51
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: ASR ASR |
$12.41
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$10.55
|
| Rate for Payer: Cash Price |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.23
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.79
|
| Rate for Payer: Mclaren Commercial |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.87
|
| Rate for Payer: Nomi Health Commercial |
$10.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.21
|
| Rate for Payer: Priority Health Narrow Network |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.26
|
|
|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
IP
|
$32.48
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: ASR ASR |
$31.51
|
| Rate for Payer: BCBS Trust/PPO |
$26.67
|
| Rate for Payer: BCN Commercial |
$26.67
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$31.51
|
| Rate for Payer: Healthscope Whirlpool |
$32.48
|
| Rate for Payer: Mclaren Commercial |
$29.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Nomi Health Commercial |
$26.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.58
|
|
|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
OP
|
$32.48
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$31.51
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$26.78
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$31.51
|
| Rate for Payer: Healthscope Whirlpool |
$32.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$29.23
|
| Rate for Payer: Mclaren Medicaid |
$18.14
|
| 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 |
$9.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Nomi Health Commercial |
$26.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.36
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.15
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$106.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.14
|
| Rate for Payer: UHC Exchange |
$28.12
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$37.76 |
| Rate for Payer: Aetna Commercial |
$33.98
|
| Rate for Payer: ASR ASR |
$36.63
|
| Rate for Payer: BCBS Trust/PPO |
$31.01
|
| Rate for Payer: BCN Commercial |
$31.01
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$35.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Healthscope Whirlpool |
$37.76
|
| Rate for Payer: Mclaren Commercial |
$33.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Nomi Health Commercial |
$30.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.23
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
OP
|
$37.76
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$41.16 |
| Rate for Payer: Aetna Commercial |
$33.98
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$36.63
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$31.13
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$35.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Healthscope Whirlpool |
$37.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.29
|
| Rate for Payer: Mclaren Commercial |
$33.98
|
| Rate for Payer: Mclaren Medicaid |
$15.29
|
| 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 |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Nomi Health Commercial |
$30.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$16.82
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.29
|
| Rate for Payer: UHC Exchange |
$23.70
|
| Rate for Payer: UHC Medicaid |
$8.00
|
| Rate for Payer: UHCCP DNSP |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.00
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$31.50
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| 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 |
$3.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.12
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$26.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UHC Medicaid |
$3.38
|
| Rate for Payer: UHCCP DNSP |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$91.11 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,536.41 |
| Max. Negotiated Rate |
$2,048.55 |
| Rate for Payer: Aetna Commercial |
$1,843.69
|
| Rate for Payer: ASR ASR |
$1,987.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,682.27
|
| Rate for Payer: BCN Commercial |
$1,682.27
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,925.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,987.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.55
|
| Rate for Payer: Mclaren Commercial |
$1,843.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.72
|
|
|
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 |
$2,048.55 |
| Rate for Payer: Aetna Commercial |
$1,843.69
|
| Rate for Payer: Aetna Medicare |
$544.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: ASR ASR |
$1,987.09
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,689.03
|
| Rate for Payer: BCN Commercial |
$1,689.03
|
| 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 Commercial |
$1,925.64
|
| 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 |
$1,987.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$544.45
|
| Rate for Payer: Mclaren Commercial |
$1,843.69
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| 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 |
$299.01
|
| 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 |
$1,679.81
|
| 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 |
$598.89
|
| Rate for Payer: PHP Medicaid |
$291.83
|
| 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/Tiered Network |
$1,649.99
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,319.99
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$843.90
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP DNSP |
$544.45
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
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 |
$1,536.41 |
| Max. Negotiated Rate |
$2,048.55 |
| Rate for Payer: Aetna Commercial |
$1,843.69
|
| Rate for Payer: ASR ASR |
$1,987.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,682.27
|
| Rate for Payer: BCN Commercial |
$1,682.27
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,925.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,987.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.55
|
| Rate for Payer: Mclaren Commercial |
$1,843.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.72
|
|
|
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 |
$2,048.55 |
| Rate for Payer: Aetna Commercial |
$1,843.69
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$1,987.09
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,689.03
|
| Rate for Payer: BCN Commercial |
$1,689.03
|
| 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 Commercial |
$1,925.64
|
| 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 |
$1,987.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$1,843.69
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| 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 |
$428.98
|
| 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 |
$1,679.81
|
| 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 |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| 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/Tiered Network |
$1,794.94
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.03
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,253.79 |
| Max. Negotiated Rate |
$1,671.72 |
| Rate for Payer: Aetna Commercial |
$1,504.55
|
| Rate for Payer: ASR ASR |
$1,621.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.82
|
| Rate for Payer: BCN Commercial |
$1,372.82
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Commercial |
$1,571.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Healthscope Commercial |
$1,621.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,671.72
|
| Rate for Payer: Mclaren Commercial |
$1,504.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Nomi Health Commercial |
$1,370.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,471.11
|
|
|
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 |
$1,671.72 |
| Rate for Payer: Aetna Commercial |
$1,504.55
|
| Rate for Payer: Aetna Medicare |
$544.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: ASR ASR |
$1,621.57
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,378.33
|
| Rate for Payer: BCN Commercial |
$1,378.33
|
| 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 Commercial |
$1,571.42
|
| 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 |
$1,621.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,671.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$544.45
|
| Rate for Payer: Mclaren Commercial |
$1,504.55
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| 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 |
$299.01
|
| 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 |
$1,370.81
|
| 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 |
$598.89
|
| Rate for Payer: PHP Medicaid |
$291.83
|
| 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/Tiered Network |
$1,464.76
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,171.88
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,471.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$843.90
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP DNSP |
$544.45
|
| 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 |
$1,167.55 |
| Rate for Payer: Aetna Commercial |
$1,050.80
|
| Rate for Payer: Aetna Medicare |
$544.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: ASR ASR |
$1,132.52
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$962.64
|
| Rate for Payer: BCN Commercial |
$962.64
|
| 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 Commercial |
$1,097.50
|
| 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 |
$1,132.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,167.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$544.45
|
| Rate for Payer: Mclaren Commercial |
$1,050.80
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| 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 |
$299.01
|
| 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 |
$957.39
|
| 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 |
$598.89
|
| Rate for Payer: PHP Medicaid |
$291.83
|
| 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/Tiered Network |
$1,023.01
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health Narrow Network |
$818.45
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,027.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$843.90
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP DNSP |
$544.45
|
| 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 |
$875.66 |
| Max. Negotiated Rate |
$1,167.55 |
| Rate for Payer: Aetna Commercial |
$1,050.80
|
| Rate for Payer: ASR ASR |
$1,132.52
|
| Rate for Payer: BCBS Trust/PPO |
$958.79
|
| Rate for Payer: BCN Commercial |
$958.79
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Commercial |
$1,097.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Healthscope Commercial |
$1,132.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,167.55
|
| Rate for Payer: Mclaren Commercial |
$1,050.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Nomi Health Commercial |
$957.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,027.44
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$739.64 |
| Max. Negotiated Rate |
$986.19 |
| Rate for Payer: Aetna Commercial |
$887.57
|
| Rate for Payer: ASR ASR |
$956.60
|
| Rate for Payer: BCBS Trust/PPO |
$809.86
|
| Rate for Payer: BCN Commercial |
$809.86
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Commercial |
$927.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Healthscope Commercial |
$956.60
|
| Rate for Payer: Healthscope Whirlpool |
$986.19
|
| Rate for Payer: Mclaren Commercial |
$887.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Nomi Health Commercial |
$808.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$867.85
|
|
|
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 |
$986.19 |
| Rate for Payer: Aetna Commercial |
$887.57
|
| Rate for Payer: Aetna Medicare |
$544.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: ASR ASR |
$956.60
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$813.11
|
| Rate for Payer: BCN Commercial |
$813.11
|
| 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 Commercial |
$927.02
|
| 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 |
$956.60
|
| Rate for Payer: Healthscope Whirlpool |
$986.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$544.45
|
| Rate for Payer: Mclaren Commercial |
$887.57
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| 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 |
$299.01
|
| 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 |
$808.68
|
| 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 |
$598.89
|
| Rate for Payer: PHP Medicaid |
$291.83
|
| 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/Tiered Network |
$864.10
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health Narrow Network |
$691.32
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$867.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$843.90
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP DNSP |
$544.45
|
| 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 |
$751.33 |
| Rate for Payer: Aetna Commercial |
$676.20
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$728.79
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$619.47
|
| Rate for Payer: BCN Commercial |
$619.47
|
| 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 Commercial |
$706.25
|
| 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 |
$728.79
|
| Rate for Payer: Healthscope Whirlpool |
$751.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$676.20
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| 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 |
$130.57
|
| 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 |
$616.09
|
| 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 |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| 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/Tiered Network |
$658.32
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$526.68
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$661.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| 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 |
$563.50 |
| Max. Negotiated Rate |
$751.33 |
| Rate for Payer: Aetna Commercial |
$676.20
|
| Rate for Payer: ASR ASR |
$728.79
|
| Rate for Payer: BCBS Trust/PPO |
$616.99
|
| Rate for Payer: BCN Commercial |
$616.99
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Commercial |
$706.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Healthscope Commercial |
$728.79
|
| Rate for Payer: Healthscope Whirlpool |
$751.33
|
| Rate for Payer: Mclaren Commercial |
$676.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Nomi Health Commercial |
$616.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$661.17
|
|
|
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 |
$325.52 |
| Max. Negotiated Rate |
$434.03 |
| Rate for Payer: Aetna Commercial |
$390.63
|
| Rate for Payer: ASR ASR |
$421.01
|
| Rate for Payer: BCBS Trust/PPO |
$356.43
|
| Rate for Payer: BCN Commercial |
$356.43
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Commercial |
$407.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Healthscope Commercial |
$421.01
|
| Rate for Payer: Healthscope Whirlpool |
$434.03
|
| Rate for Payer: Mclaren Commercial |
$390.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Nomi Health Commercial |
$355.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.95
|
|
|
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 |
$54.48 |
| Max. Negotiated Rate |
$434.03 |
| Rate for Payer: Aetna Commercial |
$390.63
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$421.01
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$357.86
|
| Rate for Payer: BCN Commercial |
$357.86
|
| 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 Commercial |
$407.99
|
| 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 |
$421.01
|
| Rate for Payer: Healthscope Whirlpool |
$434.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$390.63
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| 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 |
$57.21
|
| 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 |
$355.90
|
| 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 |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| 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/Tiered Network |
$380.30
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$304.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
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 |
$715.25 |
| Rate for Payer: Aetna Commercial |
$643.73
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$693.79
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$589.72
|
| Rate for Payer: BCN Commercial |
$589.72
|
| 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 Commercial |
$672.34
|
| 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 |
$693.79
|
| Rate for Payer: Healthscope Whirlpool |
$715.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$643.73
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| 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 |
$57.21
|
| 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 |
$586.50
|
| 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 |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| 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/Tiered Network |
$626.70
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$501.39
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$629.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
