|
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 |
$414.91 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,264.93
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$900.43
|
| Rate for Payer: BCN Commercial |
$900.43
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Cofinity Commercial |
$1,041.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,041.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,339.34
|
| 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 |
$1,264.93
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,264.93
|
| 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 |
$967.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$937.53
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,178.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,101.23
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$937.53 |
| Max. Negotiated Rate |
$1,339.34 |
| Rate for Payer: Aetna Commercial |
$1,264.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.30
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,041.70
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,041.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Healthscope Commercial |
$1,339.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: PHP Commercial |
$1,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: Priority Health SBD |
$937.53
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$289.17 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,008.12 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.88
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,231.25
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,231.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health SBD |
$2,008.12
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna Medicare |
$1,593.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.88
|
| Rate for Payer: BCBS Complete |
$1,275.00
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,231.25
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,231.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health SBD |
$2,008.12
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$2,236.46 |
| Rate for Payer: Aetna Commercial |
$2,112.21
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,768.99
|
| Rate for Payer: BCN Commercial |
$1,768.99
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$2,137.06
|
| Rate for Payer: Cofinity Commercial |
$1,739.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,739.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$2,236.46
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$2,112.21
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$1,565.52
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$1,838.86
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,565.52 |
| Max. Negotiated Rate |
$2,236.46 |
| Rate for Payer: Aetna Commercial |
$2,112.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.22
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$1,739.46
|
| Rate for Payer: Cofinity Commercial |
$2,137.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,739.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Healthscope Commercial |
$2,236.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: PHP Commercial |
$2,112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health SBD |
$1,565.52
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,311.65 |
| Max. Negotiated Rate |
$1,873.78 |
| Rate for Payer: Aetna Commercial |
$1,769.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.29
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,457.39
|
| Rate for Payer: Cofinity Commercial |
$1,790.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,457.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Healthscope Commercial |
$1,873.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: PHP Commercial |
$1,769.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health SBD |
$1,311.65
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,873.78 |
| Rate for Payer: Aetna Commercial |
$1,769.68
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.22
|
| Rate for Payer: BCN Commercial |
$1,503.22
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,790.50
|
| Rate for Payer: Cofinity Commercial |
$1,457.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,457.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,873.78
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$1,769.68
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$1,311.65
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$1,540.67
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,584.43 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,584.43
|
| Rate for Payer: BCN Commercial |
$1,584.43
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$681.62
|
| Rate for Payer: Cofinity Commercial |
$554.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$713.32
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$673.69
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$499.33
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$586.51
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$499.33 |
| Max. Negotiated Rate |
$713.32 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.18
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$554.81
|
| Rate for Payer: Cofinity Commercial |
$681.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Healthscope Commercial |
$713.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: PHP Commercial |
$673.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health SBD |
$499.33
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,211.51
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$1,090.36 |
| Rate for Payer: Aetna Commercial |
$1,029.78
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$412.63
|
| Rate for Payer: BCN Commercial |
$412.63
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$848.06
|
| Rate for Payer: Cofinity Commercial |
$1,041.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$848.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$1,090.36
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$1,029.78
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$763.25
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$896.52
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,211.51
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$763.25 |
| Max. Negotiated Rate |
$1,090.36 |
| Rate for Payer: Aetna Commercial |
$1,029.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.48
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$1,041.90
|
| Rate for Payer: Cofinity Commercial |
$848.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$848.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Healthscope Commercial |
$1,090.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: PHP Commercial |
$1,029.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health SBD |
$763.25
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Commercial |
$759.72
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.86
|
| Rate for Payer: BCN Commercial |
$1,415.86
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$768.66
|
| Rate for Payer: Cofinity Commercial |
$625.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$804.41
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$759.72
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$563.09
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,463.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$661.40
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$563.09 |
| Max. Negotiated Rate |
$804.41 |
| Rate for Payer: Aetna Commercial |
$759.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.96
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$625.65
|
| Rate for Payer: Cofinity Commercial |
$768.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Healthscope Commercial |
$804.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: PHP Commercial |
$759.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health SBD |
$563.09
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
IP
|
$2,035.16
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,282.15 |
| Max. Negotiated Rate |
$1,831.64 |
| Rate for Payer: Aetna Commercial |
$1,729.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.85
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cofinity Commercial |
$1,424.61
|
| Rate for Payer: Cofinity Commercial |
$1,750.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.13
|
| Rate for Payer: Healthscope Commercial |
$1,831.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.89
|
| Rate for Payer: PHP Commercial |
$1,729.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.85
|
| Rate for Payer: Priority Health SBD |
$1,282.15
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$2,035.16
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,831.64 |
| Rate for Payer: Aetna Commercial |
$1,729.89
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.82
|
| Rate for Payer: BCN Commercial |
$1,306.82
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cofinity Commercial |
$1,750.24
|
| Rate for Payer: Cofinity Commercial |
$1,424.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,831.64
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.89
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$1,729.89
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$1,282.15
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$1,506.02
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
IP
|
$2,271.58
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,431.10 |
| Max. Negotiated Rate |
$2,044.42 |
| Rate for Payer: Aetna Commercial |
$1,930.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.53
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cofinity Commercial |
$1,590.11
|
| Rate for Payer: Cofinity Commercial |
$1,953.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,590.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.26
|
| Rate for Payer: Healthscope Commercial |
$2,044.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,930.84
|
| Rate for Payer: PHP Commercial |
$1,930.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,476.53
|
| Rate for Payer: Priority Health SBD |
$1,431.10
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
OP
|
$2,271.58
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$2,044.42 |
| Rate for Payer: Aetna Commercial |
$1,930.84
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.80
|
| Rate for Payer: BCN Commercial |
$1,591.80
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cofinity Commercial |
$1,953.56
|
| Rate for Payer: Cofinity Commercial |
$1,590.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,590.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$2,044.42
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,930.84
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$1,930.84
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,476.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$1,431.10
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$1,680.97
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
IP
|
$2,809.76
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,770.15 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.34
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$1,966.83
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,966.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health SBD |
$1,770.15
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
OP
|
$2,809.76
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.86
|
| Rate for Payer: BCN Commercial |
$1,415.86
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Cofinity Commercial |
$1,966.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,966.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,770.15
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,463.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$2,079.22
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
IP
|
$2,809.76
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,770.15 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.34
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$1,966.83
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,966.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health SBD |
$1,770.15
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
OP
|
$2,809.76
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.86
|
| Rate for Payer: BCN Commercial |
$1,415.86
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Cofinity Commercial |
$1,966.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,966.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,770.15
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,463.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$2,079.22
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
IP
|
$1,646.48
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,037.28 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
|
