|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$715.25 |
| Rate for Payer: Aetna Commercial |
$643.73
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$693.79
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$589.72
|
| Rate for Payer: BCN Commercial |
$589.72
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$672.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$693.79
|
| Rate for Payer: Healthscope Whirlpool |
$715.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$643.73
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$626.70
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$501.39
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$629.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$940.29 |
| Rate for Payer: Aetna Commercial |
$846.26
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$912.08
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$775.27
|
| Rate for Payer: BCN Commercial |
$775.27
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Commercial |
$883.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$912.08
|
| Rate for Payer: Healthscope Whirlpool |
$940.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$846.26
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Nomi Health Commercial |
$771.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$823.88
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$659.14
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$705.22 |
| Max. Negotiated Rate |
$940.29 |
| Rate for Payer: Aetna Commercial |
$846.26
|
| Rate for Payer: ASR ASR |
$912.08
|
| Rate for Payer: BCBS Trust/PPO |
$772.17
|
| Rate for Payer: BCN Commercial |
$772.17
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Commercial |
$883.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Healthscope Commercial |
$912.08
|
| Rate for Payer: Healthscope Whirlpool |
$940.29
|
| Rate for Payer: Mclaren Commercial |
$846.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Nomi Health Commercial |
$771.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.46
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,138.43 |
| Max. Negotiated Rate |
$1,517.91 |
| Rate for Payer: Aetna Commercial |
$1,366.12
|
| Rate for Payer: ASR ASR |
$1,472.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.51
|
| Rate for Payer: BCN Commercial |
$1,246.51
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Commercial |
$1,426.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Healthscope Commercial |
$1,472.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.91
|
| Rate for Payer: Mclaren Commercial |
$1,366.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Nomi Health Commercial |
$1,244.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,335.76
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$1,517.91 |
| Rate for Payer: Aetna Commercial |
$1,366.12
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$1,472.37
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,251.52
|
| Rate for Payer: BCN Commercial |
$1,251.52
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Commercial |
$1,426.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,472.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$1,366.12
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Nomi Health Commercial |
$1,244.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,329.99
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,064.05
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,335.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.13 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: ASR ASR |
$454.13
|
| Rate for Payer: BCBS Trust/PPO |
$384.47
|
| Rate for Payer: BCN Commercial |
$384.47
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.23 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna Medicare |
$173.23
|
| Rate for Payer: ASR ASR |
$454.13
|
| Rate for Payer: BCBS Complete |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$386.01
|
| Rate for Payer: BCN Commercial |
$386.01
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$410.22
|
| Rate for Payer: Priority Health Narrow Network |
$328.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,202.96 |
| Max. Negotiated Rate |
$3,251.25 |
| Rate for Payer: Aetna Commercial |
$2,926.12
|
| Rate for Payer: Aetna Medicare |
$1,202.96
|
| Rate for Payer: ASR ASR |
$3,153.71
|
| Rate for Payer: BCBS Complete |
$1,300.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,680.66
|
| Rate for Payer: BCN Commercial |
$2,680.66
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$3,056.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$3,153.71
|
| Rate for Payer: Healthscope Whirlpool |
$3,251.25
|
| Rate for Payer: Mclaren Commercial |
$2,926.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,601.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$2,666.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,848.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,279.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,861.10
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,438.44 |
| Max. Negotiated Rate |
$3,251.25 |
| Rate for Payer: Aetna Commercial |
$2,926.12
|
| Rate for Payer: ASR ASR |
$3,153.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,669.93
|
| Rate for Payer: BCN Commercial |
$2,669.93
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$3,056.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$3,153.71
|
| Rate for Payer: Healthscope Whirlpool |
$3,251.25
|
| Rate for Payer: Mclaren Commercial |
$2,926.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$2,666.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,861.10
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$2,534.65 |
| Rate for Payer: Aetna Commercial |
$2,281.18
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$2,458.61
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,089.82
|
| Rate for Payer: BCN Commercial |
$2,089.82
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Commercial |
$2,382.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$2,458.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,534.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$2,281.18
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| 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 |
$118.16
|
| 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 |
$2,154.45
|
| Rate for Payer: Nomi Health Commercial |
$2,078.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| 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/Tiered Network |
$1,872.72
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,498.17
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,230.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,900.99 |
| Max. Negotiated Rate |
$2,534.65 |
| Rate for Payer: Aetna Commercial |
$2,281.18
|
| Rate for Payer: ASR ASR |
$2,458.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.45
|
| Rate for Payer: BCN Commercial |
$2,081.45
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Commercial |
$2,382.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Healthscope Commercial |
$2,458.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,534.65
|
| Rate for Payer: Mclaren Commercial |
$2,281.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.45
|
| Rate for Payer: Nomi Health Commercial |
$2,078.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,230.49
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,123.62
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,592.71 |
| Max. Negotiated Rate |
$2,123.62 |
| Rate for Payer: Aetna Commercial |
$1,911.26
|
| Rate for Payer: ASR ASR |
$2,059.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,743.92
|
| Rate for Payer: BCN Commercial |
$1,743.92
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cofinity Commercial |
$1,996.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.90
|
| Rate for Payer: Healthscope Commercial |
$2,059.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,123.62
|
| Rate for Payer: Mclaren Commercial |
$1,911.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,805.08
|
| Rate for Payer: Nomi Health Commercial |
$1,741.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,592.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,868.79
|
|
|
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 |
$2,123.62 |
| Rate for Payer: Aetna Commercial |
$1,911.26
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$2,059.91
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.92
|
| Rate for Payer: BCN Commercial |
$1,750.92
|
| 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 Commercial |
$1,996.20
|
| 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 |
$2,059.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,123.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,911.26
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| 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 |
$118.16
|
| 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 |
$1,741.37
|
| 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 |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| 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/Tiered Network |
$1,386.09
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,108.88
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,868.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| 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 |
$606.32 |
| Max. Negotiated Rate |
$808.43 |
| Rate for Payer: Aetna Commercial |
$727.59
|
| Rate for Payer: ASR ASR |
$784.18
|
| Rate for Payer: BCBS Trust/PPO |
$663.88
|
| Rate for Payer: BCN Commercial |
$663.88
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cofinity Commercial |
$759.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.74
|
| Rate for Payer: Healthscope Commercial |
$784.18
|
| Rate for Payer: Healthscope Whirlpool |
$808.43
|
| Rate for Payer: Mclaren Commercial |
$727.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.17
|
| Rate for Payer: Nomi Health Commercial |
$662.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$711.42
|
|
|
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 |
$808.43 |
| Rate for Payer: Aetna Commercial |
$727.59
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$784.18
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$666.55
|
| Rate for Payer: BCN Commercial |
$666.55
|
| 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 Commercial |
$759.92
|
| 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 |
$784.18
|
| Rate for Payer: Healthscope Whirlpool |
$808.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$727.59
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| 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 |
$118.16
|
| 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 |
$662.91
|
| 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 |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| 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/Tiered Network |
$708.35
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$566.71
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$711.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| 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 |
$1,235.74 |
| Rate for Payer: Aetna Commercial |
$1,112.17
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$1,198.67
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.87
|
| Rate for Payer: BCN Commercial |
$1,018.87
|
| 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 Commercial |
$1,161.60
|
| 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 |
$1,198.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,235.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,112.17
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| 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 |
$118.16
|
| 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 |
$1,013.31
|
| 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 |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| 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/Tiered Network |
$319.43
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$255.54
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,087.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| 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 |
$926.80 |
| Max. Negotiated Rate |
$1,235.74 |
| Rate for Payer: Aetna Commercial |
$1,112.17
|
| Rate for Payer: ASR ASR |
$1,198.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.79
|
| Rate for Payer: BCN Commercial |
$1,014.79
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cofinity Commercial |
$1,161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.59
|
| Rate for Payer: Healthscope Commercial |
$1,198.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,235.74
|
| Rate for Payer: Mclaren Commercial |
$1,112.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.38
|
| Rate for Payer: Nomi Health Commercial |
$1,013.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,087.45
|
|
|
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 |
$911.67 |
| Rate for Payer: Aetna Commercial |
$820.50
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$884.32
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$751.67
|
| Rate for Payer: BCN Commercial |
$751.67
|
| 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 Commercial |
$856.97
|
| 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 |
$884.32
|
| Rate for Payer: Healthscope Whirlpool |
$911.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$820.50
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| 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 |
$204.20
|
| 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 |
$747.57
|
| 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 |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| 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/Tiered Network |
$798.81
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$639.08
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| 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 |
$683.75 |
| Max. Negotiated Rate |
$911.67 |
| Rate for Payer: Aetna Commercial |
$820.50
|
| Rate for Payer: ASR ASR |
$884.32
|
| Rate for Payer: BCBS Trust/PPO |
$748.66
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cofinity Commercial |
$856.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.34
|
| Rate for Payer: Healthscope Commercial |
$884.32
|
| Rate for Payer: Healthscope Whirlpool |
$911.67
|
| Rate for Payer: Mclaren Commercial |
$820.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.92
|
| Rate for Payer: Nomi Health Commercial |
$747.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.27
|
|
|
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 |
$2,075.86 |
| Rate for Payer: Aetna Commercial |
$1,868.27
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$2,013.58
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.55
|
| Rate for Payer: BCN Commercial |
$1,711.55
|
| 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 Commercial |
$1,951.31
|
| 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 |
$2,013.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,075.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,868.27
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| 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 |
$118.16
|
| 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 |
$1,702.21
|
| 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 |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| 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/Tiered Network |
$1,818.87
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,455.18
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,826.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| 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 |
$1,556.89 |
| Max. Negotiated Rate |
$2,075.86 |
| Rate for Payer: Aetna Commercial |
$1,868.27
|
| Rate for Payer: ASR ASR |
$2,013.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.70
|
| Rate for Payer: BCN Commercial |
$1,704.70
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cofinity Commercial |
$1,951.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.69
|
| Rate for Payer: Healthscope Commercial |
$2,013.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,075.86
|
| Rate for Payer: Mclaren Commercial |
$1,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.48
|
| Rate for Payer: Nomi Health Commercial |
$1,702.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,826.76
|
|
|
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 |
$1,737.76 |
| Max. Negotiated Rate |
$2,317.01 |
| Rate for Payer: Aetna Commercial |
$2,085.31
|
| Rate for Payer: ASR ASR |
$2,247.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.73
|
| Rate for Payer: BCN Commercial |
$1,902.73
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cofinity Commercial |
$2,177.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,853.61
|
| Rate for Payer: Healthscope Commercial |
$2,247.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,317.01
|
| Rate for Payer: Mclaren Commercial |
$2,085.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,969.46
|
| Rate for Payer: Nomi Health Commercial |
$1,899.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,737.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,038.97
|
|
|
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 |
$2,317.01 |
| Rate for Payer: Aetna Commercial |
$2,085.31
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$2,247.50
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,910.37
|
| Rate for Payer: BCN Commercial |
$1,910.37
|
| 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 Commercial |
$2,177.99
|
| 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 |
$2,247.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,317.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$2,085.31
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| 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 |
$118.16
|
| 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 |
$1,899.95
|
| 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 |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| 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/Tiered Network |
$2,030.16
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,624.22
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,038.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| 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 |
$2,865.96 |
| Rate for Payer: Aetna Commercial |
$2,579.36
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$2,779.98
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,362.98
|
| Rate for Payer: BCN Commercial |
$2,362.98
|
| 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 Commercial |
$2,694.00
|
| 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 |
$2,779.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,865.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$2,579.36
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| 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 |
$204.20
|
| 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 |
$2,350.09
|
| 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 |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| 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/Tiered Network |
$612.90
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$490.32
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,522.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| 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 |
$2,149.47 |
| Max. Negotiated Rate |
$2,865.96 |
| Rate for Payer: Aetna Commercial |
$2,579.36
|
| Rate for Payer: ASR ASR |
$2,779.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,353.53
|
| Rate for Payer: BCN Commercial |
$2,353.53
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Commercial |
$2,694.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Healthscope Commercial |
$2,779.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,865.96
|
| Rate for Payer: Mclaren Commercial |
$2,579.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Nomi Health Commercial |
$2,350.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,522.04
|
|
