|
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
|
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 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 EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$2,484.95 |
| Rate for Payer: Aetna Commercial |
$2,236.45
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$2,410.40
|
| Rate for Payer: ASR Commercial |
$2,410.40
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.93
|
| Rate for Payer: BCN Commercial |
$1,926.58
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$2,484.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,410.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$2,236.45
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| 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 |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,177.31
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,741.95
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,186.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$2,236.45
|
| 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 |
$2,236.45
|
| 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/DROWSY
|
Facility
|
OP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$2,081.98 |
| Rate for Payer: Aetna Commercial |
$1,873.78
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$2,019.52
|
| Rate for Payer: ASR Commercial |
$2,019.52
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.93
|
| Rate for Payer: BCN Commercial |
$1,614.16
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$2,081.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,019.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,873.78
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| 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 |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,824.23
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.47
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,832.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$162.78 |
| Max. Negotiated Rate |
$792.58 |
| Rate for Payer: Aetna Commercial |
$713.32
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$768.80
|
| Rate for Payer: ASR Commercial |
$768.80
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$649.04
|
| Rate for Payer: BCN Commercial |
$614.49
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$792.58
|
| Rate for Payer: Healthscope Whirlpool |
$768.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$713.32
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: Nomi Health Commercial |
$649.92
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| 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 |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$555.60
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$81.79 |
| Max. Negotiated Rate |
$1,211.51 |
| Rate for Payer: Aetna Commercial |
$1,090.36
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$1,175.16
|
| Rate for Payer: ASR Commercial |
$1,175.16
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$992.11
|
| Rate for Payer: BCN Commercial |
$939.28
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| 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 |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$1,211.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$1,090.36
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: Nomi Health Commercial |
$993.44
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,061.53
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$849.27
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
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
|
OP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$893.79 |
| Rate for Payer: Aetna Commercial |
$804.41
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$866.98
|
| Rate for Payer: ASR Commercial |
$866.98
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$731.92
|
| Rate for Payer: BCN Commercial |
$692.96
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| 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 |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$893.79
|
| Rate for Payer: Healthscope Whirlpool |
$866.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$804.41
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: Nomi Health Commercial |
$732.91
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| 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 |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$626.55
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$2,035.16
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$2,035.16 |
| Rate for Payer: Aetna Commercial |
$1,831.64
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,974.11
|
| Rate for Payer: ASR Commercial |
$1,974.11
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,666.59
|
| Rate for Payer: BCN Commercial |
$1,577.86
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$2,035.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,974.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,831.64
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| 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 |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| 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 |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.65
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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
|
|
|
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 |
$162.78 |
| Max. Negotiated Rate |
$2,271.58 |
| Rate for Payer: Aetna Commercial |
$2,044.42
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$2,203.43
|
| Rate for Payer: ASR Commercial |
$2,203.43
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,860.20
|
| Rate for Payer: BCN Commercial |
$1,761.16
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$2,271.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,203.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$2,044.42
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| 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 |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| 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 |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,592.38
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,998.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 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 |
$277.37 |
| Max. Negotiated Rate |
$2,809.76 |
| Rate for Payer: Aetna Commercial |
$2,528.78
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,725.47
|
| Rate for Payer: ASR Commercial |
$2,725.47
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.91
|
| Rate for Payer: BCN Commercial |
$2,178.41
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| 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 |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,809.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,528.78
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| 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 |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,461.91
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,969.64
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 |
$277.37 |
| Max. Negotiated Rate |
$2,809.76 |
| Rate for Payer: Aetna Commercial |
$2,528.78
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,725.47
|
| Rate for Payer: ASR Commercial |
$2,725.47
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.91
|
| Rate for Payer: BCN Commercial |
$2,178.41
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| 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 |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,809.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,528.78
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| 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 |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,461.91
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,969.64
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 |
$162.78 |
| Max. Negotiated Rate |
$1,646.48 |
| Rate for Payer: Aetna Commercial |
$1,481.83
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,597.09
|
| Rate for Payer: ASR Commercial |
$1,597.09
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.30
|
| Rate for Payer: BCN Commercial |
$1,276.52
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,646.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,597.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,481.83
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| 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 |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,442.65
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.18
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$162.78 |
| Max. Negotiated Rate |
$1,646.29 |
| Rate for Payer: Aetna Commercial |
$1,481.66
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,596.90
|
| Rate for Payer: ASR Commercial |
$1,596.90
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.15
|
| Rate for Payer: BCN Commercial |
$1,276.37
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| 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 |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,646.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,596.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,481.66
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| 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 |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,442.48
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.05
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
