|
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 |
$37.02 |
| 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 |
$32.44
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$25.95
|
| 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
|
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 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 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 |
$31.05 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| 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 |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
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 |
$286.63 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.66
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| 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 |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| 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 |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| 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 |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.74
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,407.87
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
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 COMPLETE W/DEFINITY
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$2,008.38 |
| Rate for Payer: Aetna Commercial |
$1,807.54
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$1,948.13
|
| Rate for Payer: ASR Commercial |
$1,948.13
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.66
|
| Rate for Payer: BCN Commercial |
$1,557.10
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| 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 |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$2,008.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,948.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$1,807.54
|
| 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 |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| 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 |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.74
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,407.87
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,638.94 |
| Rate for Payer: Aetna Commercial |
$1,475.05
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$1,589.77
|
| Rate for Payer: ASR Commercial |
$1,589.77
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.13
|
| Rate for Payer: BCN Commercial |
$1,270.67
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| 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 |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$1,638.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,589.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$1,475.05
|
| 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 |
$1,393.10
|
| Rate for Payer: Nomi Health Commercial |
$1,343.93
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| 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 |
$1,065.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.04
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.90
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,442.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
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 LMTD
|
Facility
|
OP
|
$1,144.66
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,144.66 |
| Rate for Payer: Aetna Commercial |
$1,030.19
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$1,110.32
|
| Rate for Payer: ASR Commercial |
$1,110.32
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$937.36
|
| Rate for Payer: BCN Commercial |
$887.45
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| 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 |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$1,144.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$1,030.19
|
| 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 |
$972.96
|
| Rate for Payer: Nomi Health Commercial |
$938.62
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| 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 |
$744.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,002.95
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$802.41
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
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 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 |
$966.85 |
| Rate for Payer: Aetna Commercial |
$870.16
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$937.84
|
| Rate for Payer: ASR Commercial |
$937.84
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$791.75
|
| Rate for Payer: BCN Commercial |
$749.60
|
| 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 |
$908.84
|
| 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 |
$966.85
|
| Rate for Payer: Healthscope Whirlpool |
$937.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$792.82
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| 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 HMO/PPO/Tiered Network |
$847.15
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$677.76
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
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
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$478.79 |
| Max. Negotiated Rate |
$736.60 |
| Rate for Payer: Aetna Commercial |
$662.94
|
| Rate for Payer: ASR ASR |
$714.50
|
| Rate for Payer: ASR Commercial |
$714.50
|
| Rate for Payer: BCBS Trust/PPO |
$600.26
|
| Rate for Payer: BCN Commercial |
$571.09
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$692.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Healthscope Commercial |
$736.60
|
| Rate for Payer: Healthscope Whirlpool |
$714.50
|
| Rate for Payer: Mclaren Commercial |
$662.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: Nomi Health Commercial |
$604.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.21
|
|
|
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 |
$736.60 |
| Rate for Payer: Aetna Commercial |
$662.94
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$714.50
|
| Rate for Payer: ASR Commercial |
$714.50
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$603.20
|
| Rate for Payer: BCN Commercial |
$571.09
|
| 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 |
$692.40
|
| 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 |
$736.60
|
| Rate for Payer: Healthscope Whirlpool |
$714.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$604.01
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| 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 HMO/PPO/Tiered Network |
$645.41
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$516.36
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
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 |
$276.59 |
| Max. Negotiated Rate |
$425.52 |
| Rate for Payer: Aetna Commercial |
$382.97
|
| Rate for Payer: ASR ASR |
$412.75
|
| Rate for Payer: ASR Commercial |
$412.75
|
| Rate for Payer: BCBS Trust/PPO |
$346.76
|
| Rate for Payer: BCN Commercial |
$329.91
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$399.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Healthscope Commercial |
$425.52
|
| Rate for Payer: Healthscope Whirlpool |
$412.75
|
| Rate for Payer: Mclaren Commercial |
$382.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: Nomi Health Commercial |
$348.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.46
|
|
|
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 |
$425.52 |
| Rate for Payer: Aetna Commercial |
$382.97
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$412.75
|
| Rate for Payer: ASR Commercial |
$412.75
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$348.46
|
| Rate for Payer: BCN Commercial |
$329.91
|
| 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 |
$399.99
|
| 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 |
$425.52
|
| Rate for Payer: Healthscope Whirlpool |
$412.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$348.93
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| 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 HMO/PPO/Tiered Network |
$372.84
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$298.29
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| 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 |
$455.80 |
| Max. Negotiated Rate |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Trust/PPO |
$571.43
|
| Rate for Payer: BCN Commercial |
$543.66
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$659.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Mclaren Commercial |
$631.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
|
|
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 |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$574.24
|
| Rate for Payer: BCN Commercial |
$543.66
|
| 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 |
$659.16
|
| 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 |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| 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 HMO/PPO/Tiered Network |
$614.42
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$491.56
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
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 |
$921.85 |
| Rate for Payer: Aetna Commercial |
$829.66
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$894.19
|
| Rate for Payer: ASR Commercial |
$894.19
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$754.90
|
| Rate for Payer: BCN Commercial |
$714.71
|
| 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 |
$866.54
|
| 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 |
$921.85
|
| Rate for Payer: Healthscope Whirlpool |
$894.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$755.92
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| 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 HMO/PPO/Tiered Network |
$807.72
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$646.22
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$599.20 |
| Max. Negotiated Rate |
$921.85 |
| Rate for Payer: Aetna Commercial |
$829.66
|
| Rate for Payer: ASR ASR |
$894.19
|
| Rate for Payer: ASR Commercial |
$894.19
|
| Rate for Payer: BCBS Trust/PPO |
$751.22
|
| Rate for Payer: BCN Commercial |
$714.71
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$866.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Healthscope Commercial |
$921.85
|
| Rate for Payer: Healthscope Whirlpool |
$894.19
|
| Rate for Payer: Mclaren Commercial |
$829.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: Nomi Health Commercial |
$755.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.23
|
|
|
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 |
$1,488.15 |
| Rate for Payer: Aetna Commercial |
$1,339.34
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$1,443.51
|
| Rate for Payer: ASR Commercial |
$1,443.51
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.65
|
| Rate for Payer: BCN Commercial |
$1,153.76
|
| 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 |
$1,398.86
|
| 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 |
$1,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$1,220.28
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| 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 HMO/PPO/Tiered Network |
$1,303.92
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,043.19
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| 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 |
$967.30 |
| Max. Negotiated Rate |
$1,488.15 |
| Rate for Payer: Aetna Commercial |
$1,339.34
|
| Rate for Payer: ASR ASR |
$1,443.51
|
| Rate for Payer: ASR Commercial |
$1,443.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.69
|
| Rate for Payer: BCN Commercial |
$1,153.76
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,398.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Healthscope Commercial |
$1,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.51
|
| Rate for Payer: Mclaren Commercial |
$1,339.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: Nomi Health Commercial |
$1,220.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.57
|
|
