|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,123.62
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,337.88 |
| Max. Negotiated Rate |
$1,911.26 |
| Rate for Payer: Aetna Commercial |
$1,805.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,380.35
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cofinity Advantage |
$1,486.53
|
| Rate for Payer: Cofinity Commercial |
$1,826.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.90
|
| Rate for Payer: Healthscope Commercial |
$1,911.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,805.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,592.71
|
| Rate for Payer: PHP Commercial |
$1,805.08
|
| Rate for Payer: Priority Health SBD |
$1,337.88
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,123.62
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,911.26 |
| Rate for Payer: Aetna Commercial |
$1,805.08
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,380.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.55
|
| Rate for Payer: BCN Commercial |
$1,474.55
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cofinity Advantage |
$1,486.53
|
| Rate for Payer: Cofinity Commercial |
$1,826.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,911.26
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,805.08
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,592.71
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,805.08
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,337.88
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,380.35
|
| Rate for Payer: UHC Core |
$1,106.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$834.58
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$808.43
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$509.31 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$687.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.48
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cofinity Advantage |
$565.90
|
| Rate for Payer: Cofinity Commercial |
$695.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.74
|
| Rate for Payer: Healthscope Commercial |
$727.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.32
|
| Rate for Payer: PHP Commercial |
$687.17
|
| Rate for Payer: Priority Health SBD |
$509.31
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$808.43
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,606.31 |
| Rate for Payer: Aetna Commercial |
$687.17
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,606.31
|
| Rate for Payer: BCN Commercial |
$1,606.31
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cofinity Advantage |
$565.90
|
| Rate for Payer: Cofinity Commercial |
$695.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$727.59
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.17
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.32
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$687.17
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$509.31
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.48
|
| Rate for Payer: UHC Core |
$421.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$317.71
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,235.74
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,112.17 |
| Rate for Payer: Aetna Commercial |
$1,050.38
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$434.91
|
| Rate for Payer: BCN Commercial |
$434.91
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cofinity Advantage |
$865.02
|
| Rate for Payer: Cofinity Commercial |
$1,062.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,112.17
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.38
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.80
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,050.38
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$778.52
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.23
|
| Rate for Payer: UHC Core |
$643.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$485.65
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,235.74
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$778.52 |
| Max. Negotiated Rate |
$1,112.17 |
| Rate for Payer: Aetna Commercial |
$1,050.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.23
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cofinity Advantage |
$865.02
|
| Rate for Payer: Cofinity Commercial |
$1,062.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.59
|
| Rate for Payer: Healthscope Commercial |
$1,112.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.80
|
| Rate for Payer: PHP Commercial |
$1,050.38
|
| Rate for Payer: Priority Health SBD |
$778.52
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$911.67
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,474.91 |
| Rate for Payer: Aetna Commercial |
$774.92
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.91
|
| Rate for Payer: BCN Commercial |
$1,474.91
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cofinity Advantage |
$638.17
|
| Rate for Payer: Cofinity Commercial |
$784.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$820.50
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.92
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.75
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$774.92
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$574.35
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.59
|
| Rate for Payer: UHC Core |
$474.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$358.29
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$911.67
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$574.35 |
| Max. Negotiated Rate |
$820.50 |
| Rate for Payer: Aetna Commercial |
$774.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.59
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cofinity Advantage |
$638.17
|
| Rate for Payer: Cofinity Commercial |
$784.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.34
|
| Rate for Payer: Healthscope Commercial |
$820.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.75
|
| Rate for Payer: PHP Commercial |
$774.92
|
| Rate for Payer: Priority Health SBD |
$574.35
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$2,075.86
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,868.27 |
| Rate for Payer: Aetna Commercial |
$1,764.48
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.90
|
| Rate for Payer: BCN Commercial |
$1,296.90
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cofinity Advantage |
$1,453.10
|
| Rate for Payer: Cofinity Commercial |
$1,785.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,868.27
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.48
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.89
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,764.48
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,307.79
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.31
|
| Rate for Payer: UHC Core |
$1,081.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$815.81
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
IP
|
$2,075.86
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,307.79 |
| Max. Negotiated Rate |
$1,868.27 |
| Rate for Payer: Aetna Commercial |
$1,764.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.31
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cofinity Advantage |
$1,453.10
|
| Rate for Payer: Cofinity Commercial |
$1,785.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.69
|
| Rate for Payer: Healthscope Commercial |
$1,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.89
|
| Rate for Payer: PHP Commercial |
$1,764.48
|
| Rate for Payer: Priority Health SBD |
$1,307.79
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
IP
|
$2,317.01
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,459.72 |
| Max. Negotiated Rate |
$2,085.31 |
| Rate for Payer: Aetna Commercial |
$1,969.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,506.06
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cofinity Advantage |
$1,621.91
|
| Rate for Payer: Cofinity Commercial |
$1,992.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,853.61
|
| Rate for Payer: Healthscope Commercial |
$2,085.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,969.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,737.76
|
| Rate for Payer: PHP Commercial |
$1,969.46
|
| Rate for Payer: Priority Health SBD |
$1,459.72
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
OP
|
$2,317.01
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$2,085.31 |
| Rate for Payer: Aetna Commercial |
$1,969.46
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,506.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,595.94
|
| Rate for Payer: BCN Commercial |
$1,595.94
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cofinity Advantage |
$1,621.91
|
| Rate for Payer: Cofinity Commercial |
$1,992.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,853.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$2,085.31
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,969.46
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,737.76
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,969.46
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,459.72
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.06
|
| Rate for Payer: UHC Core |
$1,207.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$910.58
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
OP
|
$2,865.96
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.91
|
| Rate for Payer: BCN Commercial |
$1,474.91
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,862.87
|
| Rate for Payer: UHC Core |
$1,493.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$1,126.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
IP
|
$2,865.96
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,805.55 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
IP
|
$2,865.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,805.55 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
OP
|
$2,865.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.91
|
| Rate for Payer: BCN Commercial |
$1,474.91
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,862.87
|
| Rate for Payer: UHC Core |
$1,493.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$1,126.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
OP
|
$1,679.41
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$865.60
|
| Rate for Payer: BCN Commercial |
$865.60
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Advantage |
$1,175.59
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,058.03
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,091.62
|
| Rate for Payer: UHC Core |
$874.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$660.01
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
IP
|
$1,679.41
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,058.03 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.62
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Advantage |
$1,175.59
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: Priority Health SBD |
$1,058.03
|
|
|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
OP
|
$1,679.22
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,511.30 |
| Rate for Payer: Aetna Commercial |
$1,427.34
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$865.60
|
| Rate for Payer: BCN Commercial |
$865.60
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,343.38
|
| Rate for Payer: Cash Price |
$1,343.38
|
| Rate for Payer: Cofinity Advantage |
$1,175.45
|
| Rate for Payer: Cofinity Commercial |
$1,444.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,511.30
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.34
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.41
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,427.34
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,057.91
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,091.49
|
| Rate for Payer: UHC Core |
$874.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$659.93
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
IP
|
$1,679.22
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,057.91 |
| Max. Negotiated Rate |
$1,511.30 |
| Rate for Payer: Aetna Commercial |
$1,427.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.49
|
| Rate for Payer: Cash Price |
$1,343.38
|
| Rate for Payer: Cofinity Advantage |
$1,175.45
|
| Rate for Payer: Cofinity Commercial |
$1,444.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.38
|
| Rate for Payer: Healthscope Commercial |
$1,511.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.41
|
| Rate for Payer: PHP Commercial |
$1,427.34
|
| Rate for Payer: Priority Health SBD |
$1,057.91
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
IP
|
$1,041.69
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$937.52 |
| Rate for Payer: Aetna Commercial |
$885.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.10
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cofinity Advantage |
$729.18
|
| Rate for Payer: Cofinity Commercial |
$895.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.35
|
| Rate for Payer: Healthscope Commercial |
$937.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.27
|
| Rate for Payer: PHP Commercial |
$885.44
|
| Rate for Payer: Priority Health SBD |
$656.26
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
OP
|
$1,041.69
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$937.52 |
| Rate for Payer: Aetna Commercial |
$885.44
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$865.60
|
| Rate for Payer: BCN Commercial |
$865.60
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cofinity Advantage |
$729.18
|
| Rate for Payer: Cofinity Commercial |
$895.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$937.52
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.44
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.27
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$885.44
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$656.26
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.10
|
| Rate for Payer: UHC Core |
$542.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$409.38
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
OP
|
$1,998.65
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,798.79 |
| Rate for Payer: Aetna Commercial |
$1,698.85
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.91
|
| Rate for Payer: BCN Commercial |
$1,474.91
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,598.92
|
| Rate for Payer: Cash Price |
$1,598.92
|
| Rate for Payer: Cofinity Advantage |
$1,399.06
|
| Rate for Payer: Cofinity Commercial |
$1,718.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,598.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,798.79
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,698.85
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,498.99
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,698.85
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,259.15
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.12
|
| Rate for Payer: UHC Core |
$1,041.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$785.47
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
IP
|
$1,998.65
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$1,798.79 |
| Rate for Payer: Aetna Commercial |
$1,698.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.12
|
| Rate for Payer: Cash Price |
$1,598.92
|
| Rate for Payer: Cofinity Advantage |
$1,399.06
|
| Rate for Payer: Cofinity Commercial |
$1,718.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,598.92
|
| Rate for Payer: Healthscope Commercial |
$1,798.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,698.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,498.99
|
| Rate for Payer: PHP Commercial |
$1,698.85
|
| Rate for Payer: Priority Health SBD |
$1,259.15
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,909.09
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,163.64 |
| Max. Negotiated Rate |
$2,618.18 |
| Rate for Payer: Aetna Commercial |
$2,472.73
|
| Rate for Payer: Aetna Medicare |
$1,454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,890.91
|
| Rate for Payer: BCBS Complete |
$1,163.64
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Advantage |
$2,036.36
|
| Rate for Payer: Cofinity Commercial |
$2,501.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,618.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: PHP Commercial |
$2,472.73
|
| Rate for Payer: Priority Health SBD |
$1,832.73
|
|
