|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$736.60 |
| Rate for Payer: Aetna Commercial |
$662.94
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$714.50
|
| Rate for Payer: ASR Commercial |
$714.50
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$603.20
|
| Rate for Payer: BCN Commercial |
$571.09
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$692.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$736.60
|
| Rate for Payer: Healthscope Whirlpool |
$714.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$662.94
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: Nomi Health Commercial |
$604.01
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$645.41
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$516.36
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$478.79 |
| Max. Negotiated Rate |
$736.60 |
| Rate for Payer: Aetna Commercial |
$662.94
|
| Rate for Payer: ASR ASR |
$714.50
|
| Rate for Payer: ASR Commercial |
$714.50
|
| Rate for Payer: BCBS Trust/PPO |
$600.26
|
| Rate for Payer: BCN Commercial |
$571.09
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$692.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Healthscope Commercial |
$736.60
|
| Rate for Payer: Healthscope Whirlpool |
$714.50
|
| Rate for Payer: Mclaren Commercial |
$662.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: Nomi Health Commercial |
$604.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.21
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$425.52 |
| Rate for Payer: Aetna Commercial |
$382.97
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$412.75
|
| Rate for Payer: ASR Commercial |
$412.75
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$348.46
|
| Rate for Payer: BCN Commercial |
$329.91
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$399.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$425.52
|
| Rate for Payer: Healthscope Whirlpool |
$412.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$382.97
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: Nomi Health Commercial |
$348.93
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.84
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$298.29
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$276.59 |
| Max. Negotiated Rate |
$425.52 |
| Rate for Payer: Aetna Commercial |
$382.97
|
| Rate for Payer: ASR ASR |
$412.75
|
| Rate for Payer: ASR Commercial |
$412.75
|
| Rate for Payer: BCBS Trust/PPO |
$346.76
|
| Rate for Payer: BCN Commercial |
$329.91
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$399.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Healthscope Commercial |
$425.52
|
| Rate for Payer: Healthscope Whirlpool |
$412.75
|
| Rate for Payer: Mclaren Commercial |
$382.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: Nomi Health Commercial |
$348.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.46
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$701.23
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Trust/PPO |
$571.43
|
| Rate for Payer: BCN Commercial |
$543.66
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$659.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Mclaren Commercial |
$631.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$701.23 |
| Rate for Payer: Aetna Commercial |
$631.11
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$680.19
|
| Rate for Payer: ASR Commercial |
$680.19
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$574.24
|
| Rate for Payer: BCN Commercial |
$543.66
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$659.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$701.23
|
| Rate for Payer: Healthscope Whirlpool |
$680.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$631.11
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.42
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$491.56
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$599.20 |
| Max. Negotiated Rate |
$921.85 |
| Rate for Payer: Aetna Commercial |
$829.66
|
| Rate for Payer: ASR ASR |
$894.19
|
| Rate for Payer: ASR Commercial |
$894.19
|
| Rate for Payer: BCBS Trust/PPO |
$751.22
|
| Rate for Payer: BCN Commercial |
$714.71
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$866.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Healthscope Commercial |
$921.85
|
| Rate for Payer: Healthscope Whirlpool |
$894.19
|
| Rate for Payer: Mclaren Commercial |
$829.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: Nomi Health Commercial |
$755.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.23
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$921.85 |
| Rate for Payer: Aetna Commercial |
$829.66
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$894.19
|
| Rate for Payer: ASR Commercial |
$894.19
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$754.90
|
| Rate for Payer: BCN Commercial |
$714.71
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$866.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$921.85
|
| Rate for Payer: Healthscope Whirlpool |
$894.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$829.66
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: Nomi Health Commercial |
$755.92
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$807.72
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$646.22
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$1,488.15 |
| Rate for Payer: Aetna Commercial |
$1,339.34
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$1,443.51
|
| Rate for Payer: ASR Commercial |
$1,443.51
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.65
|
| Rate for Payer: BCN Commercial |
$1,153.76
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,398.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren Commercial |
$1,339.34
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: Nomi Health Commercial |
$1,220.28
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,303.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,043.19
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$967.30 |
| Max. Negotiated Rate |
$1,488.15 |
| Rate for Payer: Aetna Commercial |
$1,339.34
|
| Rate for Payer: ASR ASR |
$1,443.51
|
| Rate for Payer: ASR Commercial |
$1,443.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.69
|
| Rate for Payer: BCN Commercial |
$1,153.76
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,398.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Healthscope Commercial |
$1,488.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.51
|
| Rate for Payer: Mclaren Commercial |
$1,339.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: Nomi Health Commercial |
$1,220.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.57
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$375.88
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.18
|
| Rate for Payer: Priority Health Narrow Network |
$321.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Trust/PPO |
$374.04
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$3,187.50 |
| Rate for Payer: Aetna Commercial |
$2,868.75
|
| Rate for Payer: Aetna Medicare |
$1,593.75
|
| Rate for Payer: ASR ASR |
$3,091.88
|
| Rate for Payer: ASR Commercial |
$3,091.88
|
| Rate for Payer: BCBS Complete |
$1,275.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,610.24
|
| Rate for Payer: BCN Commercial |
$2,471.27
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,996.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$3,187.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,091.88
|
| Rate for Payer: Mclaren Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: Nomi Health Commercial |
$2,613.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,792.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,234.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,805.00
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,071.88 |
| Max. Negotiated Rate |
$3,187.50 |
| Rate for Payer: Aetna Commercial |
$2,868.75
|
| Rate for Payer: ASR ASR |
$3,091.88
|
| Rate for Payer: ASR Commercial |
$3,091.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.49
|
| Rate for Payer: BCN Commercial |
$2,471.27
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,996.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$3,187.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,091.88
|
| Rate for Payer: Mclaren Commercial |
$2,868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: Nomi Health Commercial |
$2,613.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,805.00
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,615.22 |
| Max. Negotiated Rate |
$2,484.95 |
| Rate for Payer: Aetna Commercial |
$2,236.46
|
| Rate for Payer: ASR ASR |
$2,410.40
|
| Rate for Payer: ASR Commercial |
$2,410.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,024.99
|
| Rate for Payer: BCN Commercial |
$1,926.58
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$2,335.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Healthscope Commercial |
$2,484.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,410.40
|
| Rate for Payer: Mclaren Commercial |
$2,236.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: Nomi Health Commercial |
$2,037.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,186.76
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$2,484.95 |
| Rate for Payer: Aetna Commercial |
$2,236.46
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$2,410.40
|
| Rate for Payer: ASR Commercial |
$2,410.40
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.93
|
| Rate for Payer: BCN Commercial |
$1,926.58
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$2,335.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$2,484.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,410.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$2,236.46
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: Nomi Health Commercial |
$2,037.66
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.61
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,358.89
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,186.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$2,081.98 |
| Rate for Payer: Aetna Commercial |
$1,873.78
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$2,019.52
|
| Rate for Payer: ASR Commercial |
$2,019.52
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.93
|
| Rate for Payer: BCN Commercial |
$1,614.16
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,957.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$2,081.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,019.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$1,873.78
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: Nomi Health Commercial |
$1,707.22
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,257.23
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,005.78
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,832.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,353.29 |
| Max. Negotiated Rate |
$2,081.98 |
| Rate for Payer: Aetna Commercial |
$1,873.78
|
| Rate for Payer: ASR ASR |
$2,019.52
|
| Rate for Payer: ASR Commercial |
$2,019.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.61
|
| Rate for Payer: BCN Commercial |
$1,614.16
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,957.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Healthscope Commercial |
$2,081.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,019.52
|
| Rate for Payer: Mclaren Commercial |
$1,873.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: Nomi Health Commercial |
$1,707.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,832.14
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$792.58 |
| Rate for Payer: Aetna Commercial |
$713.32
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$768.80
|
| Rate for Payer: ASR Commercial |
$768.80
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$649.04
|
| Rate for Payer: BCN Commercial |
$614.49
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$745.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$792.58
|
| Rate for Payer: Healthscope Whirlpool |
$768.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$713.32
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: Nomi Health Commercial |
$649.92
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$694.46
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$555.60
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$515.18 |
| Max. Negotiated Rate |
$792.58 |
| Rate for Payer: Aetna Commercial |
$713.32
|
| Rate for Payer: ASR ASR |
$768.80
|
| Rate for Payer: ASR Commercial |
$768.80
|
| Rate for Payer: BCBS Trust/PPO |
$645.87
|
| Rate for Payer: BCN Commercial |
$614.49
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$745.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Healthscope Commercial |
$792.58
|
| Rate for Payer: Healthscope Whirlpool |
$768.80
|
| Rate for Payer: Mclaren Commercial |
$713.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: Nomi Health Commercial |
$649.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.47
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,211.51
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$1,211.51 |
| Rate for Payer: Aetna Commercial |
$1,090.36
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$1,175.16
|
| Rate for Payer: ASR Commercial |
$1,175.16
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$992.11
|
| Rate for Payer: BCN Commercial |
$939.28
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$1,138.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$1,211.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$1,090.36
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: Nomi Health Commercial |
$993.44
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.73
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,211.51
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$787.48 |
| Max. Negotiated Rate |
$1,211.51 |
| Rate for Payer: Aetna Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,175.16
|
| Rate for Payer: ASR Commercial |
$1,175.16
|
| Rate for Payer: BCBS Trust/PPO |
$987.26
|
| Rate for Payer: BCN Commercial |
$939.28
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$1,138.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Healthscope Commercial |
$1,211.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.16
|
| Rate for Payer: Mclaren Commercial |
$1,090.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: Nomi Health Commercial |
$993.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.13
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$580.96 |
| Max. Negotiated Rate |
$893.79 |
| Rate for Payer: Aetna Commercial |
$804.41
|
| Rate for Payer: ASR ASR |
$866.98
|
| Rate for Payer: ASR Commercial |
$866.98
|
| Rate for Payer: BCBS Trust/PPO |
$728.35
|
| Rate for Payer: BCN Commercial |
$692.96
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$840.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Healthscope Commercial |
$893.79
|
| Rate for Payer: Healthscope Whirlpool |
$866.98
|
| Rate for Payer: Mclaren Commercial |
$804.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: Nomi Health Commercial |
$732.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.54
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$893.79 |
| Rate for Payer: Aetna Commercial |
$804.41
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$866.98
|
| Rate for Payer: ASR Commercial |
$866.98
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$731.92
|
| Rate for Payer: BCN Commercial |
$692.96
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$840.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$893.79
|
| Rate for Payer: Healthscope Whirlpool |
$866.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$804.41
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: Nomi Health Commercial |
$732.91
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$783.14
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$626.55
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
IP
|
$2,035.16
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,322.85 |
| Max. Negotiated Rate |
$2,035.16 |
| Rate for Payer: Aetna Commercial |
$1,831.64
|
| Rate for Payer: ASR ASR |
$1,974.11
|
| Rate for Payer: ASR Commercial |
$1,974.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.45
|
| Rate for Payer: BCN Commercial |
$1,577.86
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cofinity Commercial |
$1,913.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.13
|
| Rate for Payer: Healthscope Commercial |
$2,035.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,974.11
|
| Rate for Payer: Mclaren Commercial |
$1,831.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.89
|
| Rate for Payer: Nomi Health Commercial |
$1,668.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.94
|
|
