|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$2,035.16
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$2,035.16 |
| Rate for Payer: Aetna Commercial |
$1,831.64
|
| 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 |
$1,974.11
|
| Rate for Payer: ASR Commercial |
$1,974.11
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,666.59
|
| Rate for Payer: BCN Commercial |
$1,577.86
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cofinity Commercial |
$1,913.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$2,035.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,974.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$1,831.64
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.89
|
| Rate for Payer: Nomi Health Commercial |
$1,668.83
|
| 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 |
$1,322.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,783.21
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.65
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.94
|
| 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 EXTENDED 61-119 MIN
|
Facility
|
IP
|
$2,271.58
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,476.53 |
| Max. Negotiated Rate |
$2,271.58 |
| Rate for Payer: Aetna Commercial |
$2,044.42
|
| Rate for Payer: ASR ASR |
$2,203.43
|
| Rate for Payer: ASR Commercial |
$2,203.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,851.11
|
| Rate for Payer: BCN Commercial |
$1,761.16
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cofinity Commercial |
$2,135.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.26
|
| Rate for Payer: Healthscope Commercial |
$2,271.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,203.43
|
| Rate for Payer: Mclaren Commercial |
$2,044.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,930.84
|
| Rate for Payer: Nomi Health Commercial |
$1,862.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,476.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,998.99
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
OP
|
$2,271.58
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$2,271.58 |
| Rate for Payer: Aetna Commercial |
$2,044.42
|
| 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 |
$2,203.43
|
| Rate for Payer: ASR Commercial |
$2,203.43
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,860.20
|
| Rate for Payer: BCN Commercial |
$1,761.16
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cofinity Commercial |
$2,135.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$2,271.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,203.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$2,044.42
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,930.84
|
| Rate for Payer: Nomi Health Commercial |
$1,862.70
|
| 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 |
$1,476.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,990.36
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,592.38
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,998.99
|
| 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 W/O VID 12-26 HRS CONT MNTR
|
Facility
|
OP
|
$2,809.76
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,809.76 |
| Rate for Payer: Aetna Commercial |
$2,528.78
|
| 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 |
$2,725.47
|
| Rate for Payer: ASR Commercial |
$2,725.47
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.91
|
| Rate for Payer: BCN Commercial |
$2,178.41
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,641.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,809.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$2,528.78
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| 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 |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.91
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$444.73
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.59
|
| 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 W/O VID 12-26 HRS CONT MNTR
|
Facility
|
IP
|
$2,809.76
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,826.34 |
| Max. Negotiated Rate |
$2,809.76 |
| Rate for Payer: Aetna Commercial |
$2,528.78
|
| Rate for Payer: ASR ASR |
$2,725.47
|
| Rate for Payer: ASR Commercial |
$2,725.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,289.67
|
| Rate for Payer: BCN Commercial |
$2,178.41
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,641.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Healthscope Commercial |
$2,809.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.47
|
| Rate for Payer: Mclaren Commercial |
$2,528.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.59
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
IP
|
$2,809.76
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,826.34 |
| Max. Negotiated Rate |
$2,809.76 |
| Rate for Payer: Aetna Commercial |
$2,528.78
|
| Rate for Payer: ASR ASR |
$2,725.47
|
| Rate for Payer: ASR Commercial |
$2,725.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,289.67
|
| Rate for Payer: BCN Commercial |
$2,178.41
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,641.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Healthscope Commercial |
$2,809.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.47
|
| Rate for Payer: Mclaren Commercial |
$2,528.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.59
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
OP
|
$2,809.76
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,809.76 |
| Rate for Payer: Aetna Commercial |
$2,528.78
|
| 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 |
$2,725.47
|
| Rate for Payer: ASR Commercial |
$2,725.47
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.91
|
| Rate for Payer: BCN Commercial |
$2,178.41
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,641.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,809.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$2,528.78
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| 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 |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.91
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$444.73
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.59
|
| 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 W/O VID 2-12 HRS CONT MNTR
|
Facility
|
IP
|
$1,646.48
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,070.21 |
| Max. Negotiated Rate |
$1,646.48 |
| Rate for Payer: Aetna Commercial |
$1,481.83
|
| Rate for Payer: ASR ASR |
$1,597.09
|
| Rate for Payer: ASR Commercial |
$1,597.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.72
|
| Rate for Payer: BCN Commercial |
$1,276.52
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,547.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,646.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,597.09
|
| Rate for Payer: Mclaren Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.90
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
OP
|
$1,646.48
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,646.48 |
| Rate for Payer: Aetna Commercial |
$1,481.83
|
| 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 |
$1,597.09
|
| Rate for Payer: ASR Commercial |
$1,597.09
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.30
|
| Rate for Payer: BCN Commercial |
$1,276.52
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,547.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,646.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,597.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$1,481.83
|
| 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 |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| 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 |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.73
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.90
|
| 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 W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
IP
|
$1,646.29
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,070.09 |
| Max. Negotiated Rate |
$1,646.29 |
| Rate for Payer: Aetna Commercial |
$1,481.66
|
| Rate for Payer: ASR ASR |
$1,596.90
|
| Rate for Payer: ASR Commercial |
$1,596.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.56
|
| Rate for Payer: BCN Commercial |
$1,276.37
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,547.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Healthscope Commercial |
$1,646.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,596.90
|
| Rate for Payer: Mclaren Commercial |
$1,481.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.35
|
| Rate for Payer: Nomi Health Commercial |
$1,349.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.74
|
|
|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
OP
|
$1,646.29
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,646.29 |
| Rate for Payer: Aetna Commercial |
$1,481.66
|
| 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 |
$1,596.90
|
| Rate for Payer: ASR Commercial |
$1,596.90
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.15
|
| Rate for Payer: BCN Commercial |
$1,276.37
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,547.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,646.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,596.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$1,481.66
|
| 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 |
$1,399.35
|
| Rate for Payer: Nomi Health Commercial |
$1,349.96
|
| 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 |
$1,070.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.73
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.74
|
| 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 W/O VID 2-12 HR UNMNTR
|
Facility
|
OP
|
$1,021.26
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| 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 |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$836.31
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$959.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| 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 |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| 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 |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.73
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
| 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 W/O VID 2-12 HR UNMNTR
|
Facility
|
IP
|
$1,021.26
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$663.82 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| Rate for Payer: ASR ASR |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Trust/PPO |
$832.22
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$959.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
IP
|
$1,959.46
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,273.65 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: ASR ASR |
$1,900.68
|
| Rate for Payer: ASR Commercial |
$1,900.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.76
|
| Rate for Payer: BCN Commercial |
$1,519.17
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,841.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Healthscope Commercial |
$1,959.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.68
|
| Rate for Payer: Mclaren Commercial |
$1,763.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.32
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
OP
|
$1,959.46
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| 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 |
$1,900.68
|
| Rate for Payer: ASR Commercial |
$1,900.68
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.60
|
| Rate for Payer: BCN Commercial |
$1,519.17
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,841.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,959.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$1,763.51
|
| 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 |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| 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 |
$1,273.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.91
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$444.73
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.32
|
| 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 EGD W EUS EXAM ESOPH ONLY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,853.83 |
| Max. Negotiated Rate |
$2,852.05 |
| Rate for Payer: Aetna Commercial |
$2,566.84
|
| Rate for Payer: ASR ASR |
$2,766.49
|
| Rate for Payer: ASR Commercial |
$2,766.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.14
|
| Rate for Payer: BCN Commercial |
$2,211.19
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,680.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,852.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,766.49
|
| Rate for Payer: Mclaren Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.80
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.82 |
| Max. Negotiated Rate |
$2,852.05 |
| Rate for Payer: Aetna Commercial |
$2,566.84
|
| Rate for Payer: Aetna Medicare |
$1,426.02
|
| Rate for Payer: ASR ASR |
$2,766.49
|
| Rate for Payer: ASR Commercial |
$2,766.49
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,335.54
|
| Rate for Payer: BCN Commercial |
$2,211.19
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,680.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,852.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,766.49
|
| Rate for Payer: Mclaren Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,498.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,999.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.80
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,191.64 |
| Max. Negotiated Rate |
$2,979.09 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: Aetna Medicare |
$1,489.54
|
| Rate for Payer: ASR ASR |
$2,889.72
|
| Rate for Payer: ASR Commercial |
$2,889.72
|
| Rate for Payer: BCBS Complete |
$1,191.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,439.58
|
| Rate for Payer: BCN Commercial |
$2,309.69
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,800.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,979.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.72
|
| Rate for Payer: Mclaren Commercial |
$2,681.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: Nomi Health Commercial |
$2,442.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,610.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,088.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,621.60
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,936.41 |
| Max. Negotiated Rate |
$2,979.09 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: ASR ASR |
$2,889.72
|
| Rate for Payer: ASR Commercial |
$2,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.66
|
| Rate for Payer: BCN Commercial |
$2,309.69
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,800.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,979.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.72
|
| Rate for Payer: Mclaren Commercial |
$2,681.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: Nomi Health Commercial |
$2,442.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,621.60
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.35
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$21.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$73.86 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: ASR ASR |
$71.64
|
| Rate for Payer: ASR Commercial |
$71.64
|
| Rate for Payer: BCBS Trust/PPO |
$60.19
|
| Rate for Payer: BCN Commercial |
$57.26
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$69.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Healthscope Commercial |
$73.86
|
| Rate for Payer: Healthscope Whirlpool |
$71.64
|
| Rate for Payer: Mclaren Commercial |
$66.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$71.64
|
| Rate for Payer: ASR Commercial |
$71.64
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$60.48
|
| Rate for Payer: BCN Commercial |
$57.26
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$69.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$73.86
|
| Rate for Payer: Healthscope Whirlpool |
$71.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$66.47
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.62
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
