|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$481.24 |
| Max. Negotiated Rate |
$687.48 |
| Rate for Payer: Aetna Commercial |
$618.73
|
| Rate for Payer: ASR ASR |
$666.86
|
| Rate for Payer: BCBS Trust/PPO |
$533.00
|
| Rate for Payer: BCN Commercial |
$533.00
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Healthscope Commercial |
$687.48
|
| Rate for Payer: Healthscope Whirlpool |
$666.86
|
| Rate for Payer: Mclaren Commercial |
$618.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.98
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$903.77 |
| Rate for Payer: Aetna Commercial |
$813.39
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$876.66
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$700.69
|
| Rate for Payer: BCN Commercial |
$700.69
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$849.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$903.77
|
| Rate for Payer: Healthscope Whirlpool |
$876.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$813.39
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.43
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$641.68
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.32
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$632.64 |
| Max. Negotiated Rate |
$903.77 |
| Rate for Payer: Aetna Commercial |
$813.39
|
| Rate for Payer: ASR ASR |
$876.66
|
| Rate for Payer: BCBS Trust/PPO |
$700.69
|
| Rate for Payer: BCN Commercial |
$700.69
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$849.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.02
|
| Rate for Payer: Healthscope Commercial |
$903.77
|
| Rate for Payer: Healthscope Whirlpool |
$876.66
|
| Rate for Payer: Mclaren Commercial |
$813.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.32
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$1,458.97 |
| Rate for Payer: Aetna Commercial |
$1,313.07
|
| Rate for Payer: Aetna Medicare |
$711.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: ASR ASR |
$1,415.20
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.14
|
| Rate for Payer: BCN Commercial |
$1,131.14
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,371.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,458.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,415.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$711.71
|
| Rate for Payer: Mclaren Commercial |
$1,313.07
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$782.88
|
| Rate for Payer: PHP Medicaid |
$389.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,327.66
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,035.87
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,283.89
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: VA VA |
$711.71
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,021.28 |
| Max. Negotiated Rate |
$1,458.97 |
| Rate for Payer: Aetna Commercial |
$1,313.07
|
| Rate for Payer: ASR ASR |
$1,415.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.14
|
| Rate for Payer: BCN Commercial |
$1,131.14
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,371.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Healthscope Commercial |
$1,458.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,415.20
|
| Rate for Payer: Mclaren Commercial |
$1,313.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,283.89
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.50
|
| Rate for Payer: Priority Health Narrow Network |
$319.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,187.50 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$2,812.50
|
| Rate for Payer: ASR ASR |
$3,031.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,422.81
|
| Rate for Payer: BCN Commercial |
$2,422.81
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,937.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Commercial |
$3,125.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,031.25
|
| Rate for Payer: Mclaren Commercial |
$2,812.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,750.00
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$2,812.50
|
| Rate for Payer: ASR ASR |
$3,031.25
|
| Rate for Payer: BCBS Complete |
$1,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,422.81
|
| Rate for Payer: BCN Commercial |
$2,422.81
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,937.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Commercial |
$3,125.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,031.25
|
| Rate for Payer: Mclaren Commercial |
$2,812.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,843.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,218.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,750.00
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,705.36 |
| Max. Negotiated Rate |
$2,436.23 |
| Rate for Payer: Aetna Commercial |
$2,192.61
|
| Rate for Payer: ASR ASR |
$2,363.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.81
|
| Rate for Payer: BCN Commercial |
$1,888.81
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$2,290.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.98
|
| Rate for Payer: Healthscope Commercial |
$2,436.23
|
| Rate for Payer: Healthscope Whirlpool |
$2,363.14
|
| Rate for Payer: Mclaren Commercial |
$2,192.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,143.88
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$2,436.23 |
| Rate for Payer: Aetna Commercial |
$2,192.61
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$2,363.14
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.81
|
| Rate for Payer: BCN Commercial |
$1,888.81
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$2,290.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$2,436.23
|
| Rate for Payer: Healthscope Whirlpool |
$2,363.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$2,192.61
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,587.49
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.99
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,143.88
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,041.16
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,428.81 |
| Max. Negotiated Rate |
$2,041.16 |
| Rate for Payer: Aetna Commercial |
$1,837.04
|
| Rate for Payer: ASR ASR |
$1,979.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.51
|
| Rate for Payer: BCN Commercial |
$1,582.51
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cofinity Commercial |
$1,918.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.93
|
| Rate for Payer: Healthscope Commercial |
$2,041.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,979.93
|
| Rate for Payer: Mclaren Commercial |
$1,837.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.22
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,041.16
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$2,041.16 |
| Rate for Payer: Aetna Commercial |
$1,837.04
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$1,979.93
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.51
|
| Rate for Payer: BCN Commercial |
$1,582.51
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cofinity Commercial |
$1,918.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$2,041.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,979.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$1,837.04
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.99
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.98
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$939.98
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.22
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$777.04
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$543.93 |
| Max. Negotiated Rate |
$777.04 |
| Rate for Payer: Aetna Commercial |
$699.34
|
| Rate for Payer: ASR ASR |
$753.73
|
| Rate for Payer: BCBS Trust/PPO |
$602.44
|
| Rate for Payer: BCN Commercial |
$602.44
|
| Rate for Payer: Cash Price |
$621.63
|
| Rate for Payer: Cofinity Commercial |
$730.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.63
|
| Rate for Payer: Healthscope Commercial |
$777.04
|
| Rate for Payer: Healthscope Whirlpool |
$753.73
|
| Rate for Payer: Mclaren Commercial |
$699.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$683.80
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$777.04
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$777.04 |
| Rate for Payer: Aetna Commercial |
$699.34
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$753.73
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$602.44
|
| Rate for Payer: BCN Commercial |
$602.44
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$621.63
|
| Rate for Payer: Cash Price |
$621.63
|
| Rate for Payer: Cofinity Commercial |
$730.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$777.04
|
| Rate for Payer: Healthscope Whirlpool |
$753.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$699.34
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.48
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$707.11
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$551.70
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$683.80
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,187.75
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$831.42 |
| Max. Negotiated Rate |
$1,187.75 |
| Rate for Payer: Aetna Commercial |
$1,068.98
|
| Rate for Payer: ASR ASR |
$1,152.12
|
| Rate for Payer: BCBS Trust/PPO |
$920.86
|
| Rate for Payer: BCN Commercial |
$920.86
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cofinity Commercial |
$1,116.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.20
|
| Rate for Payer: Healthscope Commercial |
$1,187.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,152.12
|
| Rate for Payer: Mclaren Commercial |
$1,068.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,045.22
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,187.75
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$1,187.75 |
| Rate for Payer: Aetna Commercial |
$1,068.98
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$1,152.12
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$920.86
|
| Rate for Payer: BCN Commercial |
$920.86
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cofinity Commercial |
$1,116.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$1,187.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,152.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$1,068.98
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.59
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.78
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$216.62
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,045.22
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$876.26
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$613.38 |
| Max. Negotiated Rate |
$876.26 |
| Rate for Payer: Aetna Commercial |
$788.63
|
| Rate for Payer: ASR ASR |
$849.97
|
| Rate for Payer: BCBS Trust/PPO |
$679.36
|
| Rate for Payer: BCN Commercial |
$679.36
|
| Rate for Payer: Cash Price |
$701.01
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.01
|
| Rate for Payer: Healthscope Commercial |
$876.26
|
| Rate for Payer: Healthscope Whirlpool |
$849.97
|
| Rate for Payer: Mclaren Commercial |
$788.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.11
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$876.26
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$876.26 |
| Rate for Payer: Aetna Commercial |
$788.63
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$849.97
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$679.36
|
| Rate for Payer: BCN Commercial |
$679.36
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$701.01
|
| Rate for Payer: Cash Price |
$701.01
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$876.26
|
| Rate for Payer: Healthscope Whirlpool |
$849.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$788.63
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.82
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$797.40
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$622.14
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.11
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
IP
|
$1,995.25
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,396.68 |
| Max. Negotiated Rate |
$1,995.25 |
| Rate for Payer: Aetna Commercial |
$1,795.72
|
| Rate for Payer: ASR ASR |
$1,935.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.92
|
| Rate for Payer: BCN Commercial |
$1,546.92
|
| Rate for Payer: Cash Price |
$1,596.20
|
| Rate for Payer: Cofinity Commercial |
$1,875.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.20
|
| Rate for Payer: Healthscope Commercial |
$1,995.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,935.39
|
| Rate for Payer: Mclaren Commercial |
$1,795.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.82
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$1,995.25
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$1,995.25 |
| Rate for Payer: Aetna Commercial |
$1,795.72
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$1,935.39
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.92
|
| Rate for Payer: BCN Commercial |
$1,546.92
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$1,596.20
|
| Rate for Payer: Cash Price |
$1,596.20
|
| Rate for Payer: Cofinity Commercial |
$1,875.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$1,995.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,935.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$1,795.72
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.96
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,815.68
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.63
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.82
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
OP
|
$2,227.04
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$2,227.04 |
| Rate for Payer: Aetna Commercial |
$2,004.34
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$2,160.23
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.62
|
| Rate for Payer: BCN Commercial |
$1,726.62
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$1,781.63
|
| Rate for Payer: Cash Price |
$1,781.63
|
| Rate for Payer: Cofinity Commercial |
$2,093.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,781.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$2,227.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,160.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$2,004.34
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,892.98
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,026.61
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,581.20
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,959.80
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
IP
|
$2,227.04
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,558.93 |
| Max. Negotiated Rate |
$2,227.04 |
| Rate for Payer: Aetna Commercial |
$2,004.34
|
| Rate for Payer: ASR ASR |
$2,160.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.62
|
| Rate for Payer: BCN Commercial |
$1,726.62
|
| Rate for Payer: Cash Price |
$1,781.63
|
| Rate for Payer: Cofinity Commercial |
$2,093.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,781.63
|
| Rate for Payer: Healthscope Commercial |
$2,227.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,160.23
|
| Rate for Payer: Mclaren Commercial |
$2,004.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,892.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,959.80
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
OP
|
$2,754.67
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$2,754.67 |
| Rate for Payer: Aetna Commercial |
$2,479.20
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$2,672.03
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,135.70
|
| Rate for Payer: BCN Commercial |
$2,135.70
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$2,203.74
|
| Rate for Payer: Cash Price |
$2,203.74
|
| Rate for Payer: Cofinity Commercial |
$2,589.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,203.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$2,754.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,672.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$2,479.20
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,341.47
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,928.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$519.54
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$415.63
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,424.11
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
IP
|
$2,754.67
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,928.27 |
| Max. Negotiated Rate |
$2,754.67 |
| Rate for Payer: Aetna Commercial |
$2,479.20
|
| Rate for Payer: ASR ASR |
$2,672.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,135.70
|
| Rate for Payer: BCN Commercial |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,203.74
|
| Rate for Payer: Cofinity Commercial |
$2,589.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,203.74
|
| Rate for Payer: Healthscope Commercial |
$2,754.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,672.03
|
| Rate for Payer: Mclaren Commercial |
$2,479.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,341.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,928.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,424.11
|
|
