|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
IP
|
$2,865.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$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
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
OP
|
$2,865.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,865.96 |
| 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 2-12 HRS CONT MNTR
|
Facility
|
OP
|
$1,679.41
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,679.41 |
| Rate for Payer: Aetna Commercial |
$1,511.47
|
| 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 |
$1,629.03
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.67
|
| Rate for Payer: BCN Commercial |
$1,384.67
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Commercial |
$1,578.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,629.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,511.47
|
| 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 |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$1,377.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$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 |
$1,477.88
|
| 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 2-12 HRS CONT MNTR
|
Facility
|
IP
|
$1,679.41
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,259.56 |
| Max. Negotiated Rate |
$1,679.41 |
| Rate for Payer: Aetna Commercial |
$1,511.47
|
| Rate for Payer: ASR ASR |
$1,629.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.13
|
| Rate for Payer: BCN Commercial |
$1,379.13
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Commercial |
$1,578.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,629.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.41
|
| Rate for Payer: Mclaren Commercial |
$1,511.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$1,377.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,477.88
|
|
|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
OP
|
$1,679.22
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,679.22 |
| Rate for Payer: Aetna Commercial |
$1,511.30
|
| 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 |
$1,628.84
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.52
|
| Rate for Payer: BCN Commercial |
$1,384.52
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,343.38
|
| Rate for Payer: Cash Price |
$1,343.38
|
| Rate for Payer: Cofinity Commercial |
$1,578.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,628.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,511.30
|
| 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 |
$1,427.34
|
| Rate for Payer: Nomi Health Commercial |
$1,376.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.41
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$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 |
$1,477.71
|
| 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 2-12 HRS INTMT MNTR
|
Facility
|
IP
|
$1,679.22
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,259.41 |
| Max. Negotiated Rate |
$1,679.22 |
| Rate for Payer: Aetna Commercial |
$1,511.30
|
| Rate for Payer: ASR ASR |
$1,628.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,378.98
|
| Rate for Payer: BCN Commercial |
$1,378.98
|
| Rate for Payer: Cash Price |
$1,343.38
|
| Rate for Payer: Cofinity Commercial |
$1,578.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.38
|
| Rate for Payer: Healthscope Commercial |
$1,628.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.22
|
| Rate for Payer: Mclaren Commercial |
$1,511.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.34
|
| Rate for Payer: Nomi Health Commercial |
$1,376.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,477.71
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
IP
|
$1,041.69
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$781.27 |
| Max. Negotiated Rate |
$1,041.69 |
| Rate for Payer: Aetna Commercial |
$937.52
|
| Rate for Payer: ASR ASR |
$1,010.44
|
| Rate for Payer: BCBS Trust/PPO |
$855.44
|
| Rate for Payer: BCN Commercial |
$855.44
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cofinity Commercial |
$979.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.35
|
| Rate for Payer: Healthscope Commercial |
$1,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.69
|
| Rate for Payer: Mclaren Commercial |
$937.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.44
|
| Rate for Payer: Nomi Health Commercial |
$854.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.69
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
OP
|
$1,041.69
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,041.69 |
| Rate for Payer: Aetna Commercial |
$937.52
|
| 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 |
$1,010.44
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$858.87
|
| Rate for Payer: BCN Commercial |
$858.87
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cash Price |
$833.35
|
| Rate for Payer: Cofinity Commercial |
$979.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$937.52
|
| 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 |
$885.44
|
| Rate for Payer: Nomi Health Commercial |
$854.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.27
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$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 |
$916.69
|
| 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 EA 12-26 HR UNMNTR
|
Facility
|
OP
|
$1,998.65
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,998.65 |
| Rate for Payer: Aetna Commercial |
$1,798.79
|
| 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 |
$1,938.69
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.89
|
| Rate for Payer: BCN Commercial |
$1,647.89
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,598.92
|
| Rate for Payer: Cash Price |
$1,598.92
|
| Rate for Payer: Cofinity Commercial |
$1,878.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,598.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,938.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,998.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$1,798.79
|
| 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 |
$1,698.85
|
| Rate for Payer: Nomi Health Commercial |
$1,638.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,498.99
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$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 |
$1,758.81
|
| 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 EA 12-26 HR UNMNTR
|
Facility
|
IP
|
$1,998.65
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,498.99 |
| Max. Negotiated Rate |
$1,998.65 |
| Rate for Payer: Aetna Commercial |
$1,798.79
|
| Rate for Payer: ASR ASR |
$1,938.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.29
|
| Rate for Payer: BCN Commercial |
$1,641.29
|
| Rate for Payer: Cash Price |
$1,598.92
|
| Rate for Payer: Cofinity Commercial |
$1,878.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,598.92
|
| Rate for Payer: Healthscope Commercial |
$1,938.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,998.65
|
| Rate for Payer: Mclaren Commercial |
$1,798.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,698.85
|
| Rate for Payer: Nomi Health Commercial |
$1,638.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,498.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,758.81
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
IP
|
$2,909.09
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,181.82 |
| Max. Negotiated Rate |
$2,909.09 |
| Rate for Payer: Aetna Commercial |
$2,618.18
|
| Rate for Payer: ASR ASR |
$2,821.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,388.94
|
| Rate for Payer: BCN Commercial |
$2,388.94
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Commercial |
$2,734.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,821.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,909.09
|
| Rate for Payer: Mclaren Commercial |
$2,618.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Nomi Health Commercial |
$2,385.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,560.00
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,909.09
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,076.36 |
| Max. Negotiated Rate |
$2,909.09 |
| Rate for Payer: Aetna Commercial |
$2,618.18
|
| Rate for Payer: Aetna Medicare |
$1,076.36
|
| Rate for Payer: ASR ASR |
$2,821.82
|
| Rate for Payer: BCBS Complete |
$1,163.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,398.54
|
| Rate for Payer: BCN Commercial |
$2,398.54
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Commercial |
$2,734.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,821.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,909.09
|
| Rate for Payer: Mclaren Commercial |
$2,618.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Nomi Health Commercial |
$2,385.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,548.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,039.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,560.00
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$3,038.67
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,124.31 |
| Max. Negotiated Rate |
$3,038.67 |
| Rate for Payer: Aetna Commercial |
$2,734.80
|
| Rate for Payer: Aetna Medicare |
$1,124.31
|
| Rate for Payer: ASR ASR |
$2,947.51
|
| Rate for Payer: BCBS Complete |
$1,215.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,505.38
|
| Rate for Payer: BCN Commercial |
$2,505.38
|
| Rate for Payer: Cash Price |
$2,430.94
|
| Rate for Payer: Cofinity Commercial |
$2,856.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.94
|
| Rate for Payer: Healthscope Commercial |
$2,947.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,038.67
|
| Rate for Payer: Mclaren Commercial |
$2,734.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,430.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.87
|
| Rate for Payer: Nomi Health Commercial |
$2,491.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,279.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,662.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,130.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,674.03
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$3,038.67
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,279.00 |
| Max. Negotiated Rate |
$3,038.67 |
| Rate for Payer: Aetna Commercial |
$2,734.80
|
| Rate for Payer: ASR ASR |
$2,947.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.36
|
| Rate for Payer: BCN Commercial |
$2,495.36
|
| Rate for Payer: Cash Price |
$2,430.94
|
| Rate for Payer: Cofinity Commercial |
$2,856.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.94
|
| Rate for Payer: Healthscope Commercial |
$2,947.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,038.67
|
| Rate for Payer: Mclaren Commercial |
$2,734.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.87
|
| Rate for Payer: Nomi Health Commercial |
$2,491.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,674.03
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.89
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$22.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$75.34
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$75.34 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: ASR ASR |
$73.08
|
| Rate for Payer: BCBS Trust/PPO |
$61.87
|
| Rate for Payer: BCN Commercial |
$61.87
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$70.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.27
|
| Rate for Payer: Healthscope Commercial |
$73.08
|
| Rate for Payer: Healthscope Whirlpool |
$75.34
|
| Rate for Payer: Mclaren Commercial |
$67.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.04
|
| Rate for Payer: Nomi Health Commercial |
$61.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.30
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$75.34
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$91.11 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$73.08
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$62.12
|
| Rate for Payer: BCN Commercial |
$62.12
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$70.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$73.08
|
| Rate for Payer: Healthscope Whirlpool |
$75.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$67.81
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.04
|
| Rate for Payer: Nomi Health Commercial |
$61.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$37.12
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$44.67 |
| Rate for Payer: Aetna Commercial |
$33.41
|
| Rate for Payer: Aetna Medicare |
$28.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: ASR ASR |
$36.01
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$30.61
|
| Rate for Payer: BCN Commercial |
$30.61
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$34.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$36.01
|
| Rate for Payer: Healthscope Whirlpool |
$37.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$28.82
|
| Rate for Payer: Mclaren Commercial |
$33.41
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.55
|
| Rate for Payer: Nomi Health Commercial |
$30.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.84
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$31.70
|
| Rate for Payer: PHP Medicaid |
$15.45
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.52
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Narrow Network |
$26.02
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$44.67
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP DNSP |
$28.82
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$37.12
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$37.12 |
| Rate for Payer: Aetna Commercial |
$33.41
|
| Rate for Payer: ASR ASR |
$36.01
|
| Rate for Payer: BCBS Trust/PPO |
$30.48
|
| Rate for Payer: BCN Commercial |
$30.48
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$34.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Healthscope Commercial |
$36.01
|
| Rate for Payer: Healthscope Whirlpool |
$37.12
|
| Rate for Payer: Mclaren Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.55
|
| Rate for Payer: Nomi Health Commercial |
$30.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.67
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,849.99
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,904.50 |
| Max. Negotiated Rate |
$7,849.99 |
| Rate for Payer: Aetna Commercial |
$7,064.99
|
| Rate for Payer: Aetna Medicare |
$2,904.50
|
| Rate for Payer: ASR ASR |
$7,614.49
|
| Rate for Payer: BCBS Complete |
$3,140.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,472.32
|
| Rate for Payer: BCN Commercial |
$6,472.32
|
| Rate for Payer: Cash Price |
$6,279.99
|
| Rate for Payer: Cofinity Commercial |
$7,378.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,279.99
|
| Rate for Payer: Healthscope Commercial |
$7,614.49
|
| Rate for Payer: Healthscope Whirlpool |
$7,849.99
|
| Rate for Payer: Mclaren Commercial |
$7,064.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,279.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,672.49
|
| Rate for Payer: Nomi Health Commercial |
$6,436.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,887.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,878.16
|
| Rate for Payer: Priority Health Narrow Network |
$5,502.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,907.99
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,849.99
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,887.49 |
| Max. Negotiated Rate |
$7,849.99 |
| Rate for Payer: Aetna Commercial |
$7,064.99
|
| Rate for Payer: ASR ASR |
$7,614.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,446.41
|
| Rate for Payer: BCN Commercial |
$6,446.41
|
| Rate for Payer: Cash Price |
$6,279.99
|
| Rate for Payer: Cofinity Commercial |
$7,378.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,279.99
|
| Rate for Payer: Healthscope Commercial |
$7,614.49
|
| Rate for Payer: Healthscope Whirlpool |
$7,849.99
|
| Rate for Payer: Mclaren Commercial |
$7,064.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,672.49
|
| Rate for Payer: Nomi Health Commercial |
$6,436.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,887.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,907.99
|
|
|
HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 95984
|
| Hospital Charge Code |
76100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna Commercial |
$63.90
|
| Rate for Payer: ASR ASR |
$68.87
|
| Rate for Payer: BCBS Trust/PPO |
$58.31
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$66.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$68.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.00
|
| Rate for Payer: Mclaren Commercial |
$63.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.35
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.48
|
|
