|
HC DUST MITE DP IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
OP
|
$782.86
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$782.86 |
| Rate for Payer: Aetna Commercial |
$704.57
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$759.37
|
| Rate for Payer: ASR Commercial |
$759.37
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$641.08
|
| Rate for Payer: BCN Commercial |
$606.95
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$626.29
|
| Rate for Payer: Cash Price |
$626.29
|
| Rate for Payer: Cofinity Commercial |
$735.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$782.86
|
| Rate for Payer: Healthscope Whirlpool |
$759.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$704.57
|
| 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 |
$665.43
|
| Rate for Payer: Nomi Health Commercial |
$641.95
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| 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 |
$508.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.94
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$548.78
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$688.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
IP
|
$782.86
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$508.86 |
| Max. Negotiated Rate |
$782.86 |
| Rate for Payer: Aetna Commercial |
$704.57
|
| Rate for Payer: ASR ASR |
$759.37
|
| Rate for Payer: ASR Commercial |
$759.37
|
| Rate for Payer: BCBS Trust/PPO |
$637.95
|
| Rate for Payer: BCN Commercial |
$606.95
|
| Rate for Payer: Cash Price |
$626.29
|
| Rate for Payer: Cofinity Commercial |
$735.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.29
|
| Rate for Payer: Healthscope Commercial |
$782.86
|
| Rate for Payer: Healthscope Whirlpool |
$759.37
|
| Rate for Payer: Mclaren Commercial |
$704.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.43
|
| Rate for Payer: Nomi Health Commercial |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$688.92
|
|
|
HC E72 MOUSE URINE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC E72 MOUSE URINE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EAKIN SEAL 2"
|
Facility
|
IP
|
$12.54
|
|
| Hospital Charge Code |
27100013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Aetna Commercial |
$11.29
|
| Rate for Payer: ASR ASR |
$12.16
|
| Rate for Payer: ASR Commercial |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.22
|
| Rate for Payer: BCN Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cofinity Commercial |
$11.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.03
|
| Rate for Payer: Healthscope Commercial |
$12.54
|
| Rate for Payer: Healthscope Whirlpool |
$12.16
|
| Rate for Payer: Mclaren Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.66
|
| Rate for Payer: Nomi Health Commercial |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.04
|
|
|
HC EAKIN SEAL 2"
|
Facility
|
OP
|
$12.54
|
|
| Hospital Charge Code |
27100013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Aetna Commercial |
$11.29
|
| Rate for Payer: Aetna Medicare |
$6.27
|
| Rate for Payer: ASR ASR |
$12.16
|
| Rate for Payer: ASR Commercial |
$12.16
|
| Rate for Payer: BCBS Complete |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.27
|
| Rate for Payer: BCN Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cofinity Commercial |
$11.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.03
|
| Rate for Payer: Healthscope Commercial |
$12.54
|
| Rate for Payer: Healthscope Whirlpool |
$12.16
|
| Rate for Payer: Mclaren Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.66
|
| Rate for Payer: Nomi Health Commercial |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.99
|
| Rate for Payer: Priority Health Narrow Network |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.04
|
|
|
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 |
$120.77 |
| Rate for Payer: Aetna Commercial |
$26.71
|
| 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 |
$28.79
|
| Rate for Payer: ASR Commercial |
$28.79
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$24.30
|
| Rate for Payer: BCN Commercial |
$23.01
|
| 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 |
$27.90
|
| 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 |
$29.68
|
| Rate for Payer: Healthscope Whirlpool |
$28.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren 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 |
$24.34
|
| 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 |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.77
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$96.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Exchange |
$28.12
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
IP
|
$29.68
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$29.68 |
| Rate for Payer: Aetna Commercial |
$26.71
|
| Rate for Payer: ASR ASR |
$28.79
|
| Rate for Payer: ASR Commercial |
$28.79
|
| Rate for Payer: BCBS Trust/PPO |
$24.19
|
| Rate for Payer: BCN Commercial |
$23.01
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cofinity Commercial |
$27.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$29.68
|
| Rate for Payer: Healthscope Whirlpool |
$28.79
|
| Rate for Payer: Mclaren Commercial |
$26.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.23
|
| Rate for Payer: Nomi Health Commercial |
$24.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.12
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
IP
|
$37.02
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$37.02 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: ASR ASR |
$35.91
|
| Rate for Payer: ASR Commercial |
$35.91
|
| Rate for Payer: BCBS Trust/PPO |
$30.17
|
| Rate for Payer: BCN Commercial |
$28.70
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.62
|
| Rate for Payer: Healthscope Commercial |
$37.02
|
| Rate for Payer: Healthscope Whirlpool |
$35.91
|
| Rate for Payer: Mclaren Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.47
|
| Rate for Payer: Nomi Health Commercial |
$30.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.58
|
|
|
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 |
$37.33 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| 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 |
$35.91
|
| Rate for Payer: ASR Commercial |
$35.91
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.32
|
| Rate for Payer: BCN Commercial |
$28.70
|
| 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 |
$34.80
|
| 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 |
$37.02
|
| Rate for Payer: Healthscope Whirlpool |
$35.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.29
|
| Rate for Payer: Mclaren 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 |
$30.36
|
| 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 |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Exchange |
$23.70
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: UHCCP DNSP |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$15.29
|
|
|
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 |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| 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 |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$29.03
|
| 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 |
$35.20
|
| 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 |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren 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 |
$30.71
|
| 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 |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.81
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$26.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP DNSP |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: ASR Commercial |
$36.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$37.45
|
| Rate for Payer: Healthscope Whirlpool |
$36.33
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
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 |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
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 |
$31.20 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| 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 |
$48.90
|
| 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 |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren 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 |
$42.66
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| 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 |
$40.62
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
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 |
$1,305.45 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.63
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
|
|
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 |
$287.94 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.66
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| 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 |
$1,887.88
|
| 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 |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren 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 |
$1,646.87
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| 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 |
$1,496.59
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,197.27
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| 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 |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.66
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| 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 |
$1,887.88
|
| 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 |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren 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 |
$1,646.87
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| 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 |
$1,759.74
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,407.87
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| 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 |
$1,305.45 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.63
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,065.31 |
| Max. Negotiated Rate |
$1,638.94 |
| Rate for Payer: Aetna Commercial |
$1,475.05
|
| Rate for Payer: ASR ASR |
$1,589.77
|
| Rate for Payer: ASR Commercial |
$1,589.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.57
|
| Rate for Payer: BCN Commercial |
$1,270.67
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cofinity Commercial |
$1,540.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.15
|
| Rate for Payer: Healthscope Commercial |
$1,638.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,589.77
|
| Rate for Payer: Mclaren Commercial |
$1,475.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.10
|
| Rate for Payer: Nomi Health Commercial |
$1,343.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,442.27
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,638.94 |
| Rate for Payer: Aetna Commercial |
$1,475.05
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$1,589.77
|
| Rate for Payer: ASR Commercial |
$1,589.77
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.13
|
| Rate for Payer: BCN Commercial |
$1,270.67
|
| 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 |
$1,540.60
|
| 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 |
$1,638.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,589.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren 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 |
$1,343.93
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| 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 |
$1,436.04
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.90
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,442.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| 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 |
$744.03 |
| Max. Negotiated Rate |
$1,144.66 |
| Rate for Payer: Aetna Commercial |
$1,030.19
|
| Rate for Payer: ASR ASR |
$1,110.32
|
| Rate for Payer: ASR Commercial |
$1,110.32
|
| Rate for Payer: BCBS Trust/PPO |
$932.78
|
| Rate for Payer: BCN Commercial |
$887.45
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cofinity Commercial |
$1,075.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.73
|
| Rate for Payer: Healthscope Commercial |
$1,144.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.32
|
| Rate for Payer: Mclaren Commercial |
$1,030.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.96
|
| Rate for Payer: Nomi Health Commercial |
$938.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.30
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,144.66
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,144.66 |
| Rate for Payer: Aetna Commercial |
$1,030.19
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$1,110.32
|
| Rate for Payer: ASR Commercial |
$1,110.32
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$937.36
|
| Rate for Payer: BCN Commercial |
$887.45
|
| 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 |
$1,075.98
|
| 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 |
$1,144.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren 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 |
$938.62
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| 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 |
$1,002.95
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$802.41
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$966.85 |
| Rate for Payer: Aetna Commercial |
$870.16
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$937.84
|
| Rate for Payer: ASR Commercial |
$937.84
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$791.75
|
| Rate for Payer: BCN Commercial |
$749.60
|
| 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 |
$908.84
|
| 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 |
$966.85
|
| Rate for Payer: Healthscope Whirlpool |
$937.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren 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 |
$792.82
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| 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 |
$847.15
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$677.76
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$628.45 |
| Max. Negotiated Rate |
$966.85 |
| Rate for Payer: Aetna Commercial |
$870.16
|
| Rate for Payer: ASR ASR |
$937.84
|
| Rate for Payer: ASR Commercial |
$937.84
|
| Rate for Payer: BCBS Trust/PPO |
$787.89
|
| Rate for Payer: BCN Commercial |
$749.60
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cofinity Commercial |
$908.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.48
|
| Rate for Payer: Healthscope Commercial |
$966.85
|
| Rate for Payer: Healthscope Whirlpool |
$937.84
|
| Rate for Payer: Mclaren Commercial |
$870.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.82
|
| Rate for Payer: Nomi Health Commercial |
$792.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.83
|
|
