|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna Medicare |
$178.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.84
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$171.87
|
| Rate for Payer: BCBS Trust/PPO |
$534.52
|
| Rate for Payer: BCN Commercial |
$534.52
|
| Rate for Payer: BCN Medicare Advantage |
$171.87
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.87
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PACE Senior Care Partners |
$163.28
|
| Rate for Payer: PACE SWMI |
$171.87
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Medicare Advantage |
$171.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.11
|
| Rate for Payer: Priority Health Medicare |
$171.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$419.29
|
| Rate for Payer: Railroad Medicare Medicare |
$171.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.98
|
| Rate for Payer: UHC Core |
$574.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.87
|
| Rate for Payer: UHC Medicare Advantage |
$177.03
|
| Rate for Payer: VA VA |
$171.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$419.29 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: BCBS Trust/PPO |
$531.28
|
| Rate for Payer: BCN Commercial |
$531.28
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$419.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.98
|
| Rate for Payer: UHC Core |
$574.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$551.21 |
| Max. Negotiated Rate |
$813.39 |
| Rate for Payer: Aetna Commercial |
$768.20
|
| Rate for Payer: BCBS Trust/PPO |
$698.43
|
| Rate for Payer: BCN Commercial |
$698.43
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$777.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.02
|
| Rate for Payer: Healthscope Commercial |
$813.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PHP Commercial |
$768.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.32
|
| Rate for Payer: UHC Core |
$754.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.83
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$214.65 |
| Max. Negotiated Rate |
$813.39 |
| Rate for Payer: Aetna Commercial |
$768.20
|
| Rate for Payer: Aetna Medicare |
$234.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.43
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$225.94
|
| Rate for Payer: BCBS Trust/PPO |
$702.68
|
| Rate for Payer: BCN Commercial |
$702.68
|
| Rate for Payer: BCN Medicare Advantage |
$225.94
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$777.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.94
|
| Rate for Payer: Healthscope Commercial |
$813.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.83
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PACE Senior Care Partners |
$214.65
|
| Rate for Payer: PACE SWMI |
$225.94
|
| Rate for Payer: PHP Commercial |
$768.20
|
| Rate for Payer: PHP Medicare Advantage |
$225.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.28
|
| Rate for Payer: Priority Health Medicare |
$225.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.21
|
| Rate for Payer: Railroad Medicare Medicare |
$225.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.32
|
| Rate for Payer: UHC Core |
$754.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.94
|
| Rate for Payer: UHC Medicare Advantage |
$232.72
|
| Rate for Payer: VA VA |
$225.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.83
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$346.51 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna Medicare |
$379.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$455.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$455.93
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$364.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.35
|
| Rate for Payer: BCN Commercial |
$1,134.35
|
| Rate for Payer: BCN Medicare Advantage |
$364.74
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.74
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$382.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Senior Care Partners |
$346.51
|
| Rate for Payer: PACE SWMI |
$364.74
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: PHP Medicare Advantage |
$364.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.30
|
| Rate for Payer: Priority Health Medicare |
$364.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$889.83
|
| Rate for Payer: Railroad Medicare Medicare |
$364.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.89
|
| Rate for Payer: UHC Core |
$1,218.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$364.74
|
| Rate for Payer: UHC Medicare Advantage |
$375.68
|
| Rate for Payer: VA VA |
$364.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$889.83 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.49
|
| Rate for Payer: BCN Commercial |
$1,127.49
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$889.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.89
|
| Rate for Payer: UHC Core |
$1,218.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$349.88
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$115.88
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$347.76
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,905.94 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna Commercial |
$2,656.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,415.00
|
| Rate for Payer: BCN Commercial |
$2,415.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,687.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Commercial |
$2,812.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,343.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: PHP Commercial |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,718.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,905.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,750.00
|
| Rate for Payer: UHC Core |
$2,609.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,343.75
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$742.19 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna Commercial |
$2,656.25
|
| Rate for Payer: Aetna Medicare |
$812.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.56
|
| Rate for Payer: BCBS Complete |
$1,250.00
|
| Rate for Payer: BCBS MAPPO |
$781.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,429.69
|
| Rate for Payer: BCN Commercial |
$2,429.69
|
| Rate for Payer: BCN Medicare Advantage |
$781.25
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,687.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.25
|
| Rate for Payer: Healthscope Commercial |
$2,812.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,343.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$820.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: PACE Senior Care Partners |
$742.19
|
| Rate for Payer: PACE SWMI |
$781.25
|
| Rate for Payer: PHP Commercial |
$2,656.25
|
| Rate for Payer: PHP Medicare Advantage |
$781.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,718.75
|
| Rate for Payer: Priority Health Medicare |
$781.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,905.94
|
| Rate for Payer: Railroad Medicare Medicare |
$781.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,750.00
|
| Rate for Payer: UHC Core |
$2,609.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.25
|
| Rate for Payer: UHC Medicare Advantage |
$804.69
|
| Rate for Payer: VA VA |
$781.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,343.75
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,485.86 |
| Max. Negotiated Rate |
$2,192.61 |
| Rate for Payer: Aetna Commercial |
$2,070.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,882.72
|
| Rate for Payer: BCN Commercial |
$1,882.72
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$2,095.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.98
|
| Rate for Payer: Healthscope Commercial |
$2,192.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,827.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: PHP Commercial |
$2,070.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,119.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,485.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,143.88
|
| Rate for Payer: UHC Core |
$2,034.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,827.17
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$2,192.61 |
| Rate for Payer: Aetna Commercial |
$2,070.80
|
| Rate for Payer: Aetna Medicare |
$633.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$761.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$761.32
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$609.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.17
|
| Rate for Payer: BCN Commercial |
$1,894.17
|
| Rate for Payer: BCN Medicare Advantage |
$609.06
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$2,095.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$609.06
|
| Rate for Payer: Healthscope Commercial |
$2,192.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,827.17
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$639.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: PACE Senior Care Partners |
$578.60
|
| Rate for Payer: PACE SWMI |
$609.06
|
| Rate for Payer: PHP Commercial |
$2,070.80
|
| Rate for Payer: PHP Medicare Advantage |
$609.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,119.52
|
| Rate for Payer: Priority Health Medicare |
$609.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,485.86
|
| Rate for Payer: Railroad Medicare Medicare |
$609.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,143.88
|
| Rate for Payer: UHC Core |
$2,034.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$609.06
|
| Rate for Payer: UHC Medicare Advantage |
$627.33
|
| Rate for Payer: VA VA |
$609.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,827.17
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,041.16
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,244.90 |
| Max. Negotiated Rate |
$1,837.04 |
| Rate for Payer: Aetna Commercial |
$1,734.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.41
|
| Rate for Payer: BCN Commercial |
$1,577.41
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cofinity Commercial |
$1,755.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.93
|
| Rate for Payer: Healthscope Commercial |
$1,837.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,530.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.99
|
| Rate for Payer: PHP Commercial |
$1,734.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,775.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,244.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,796.22
|
| Rate for Payer: UHC Core |
$1,704.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,530.87
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,041.16
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$1,837.04 |
| Rate for Payer: Aetna Commercial |
$1,734.99
|
| Rate for Payer: Aetna Medicare |
$530.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$637.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$637.86
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$510.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.00
|
| Rate for Payer: BCN Commercial |
$1,587.00
|
| Rate for Payer: BCN Medicare Advantage |
$510.29
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cash Price |
$1,632.93
|
| Rate for Payer: Cofinity Commercial |
$1,755.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.29
|
| Rate for Payer: Healthscope Commercial |
$1,837.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,530.87
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$535.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$586.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.99
|
| Rate for Payer: PACE Senior Care Partners |
$484.78
|
| Rate for Payer: PACE SWMI |
$510.29
|
| Rate for Payer: PHP Commercial |
$1,734.99
|
| Rate for Payer: PHP Medicare Advantage |
$510.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,775.81
|
| Rate for Payer: Priority Health Medicare |
$510.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,244.90
|
| Rate for Payer: Railroad Medicare Medicare |
$510.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,796.22
|
| Rate for Payer: UHC Core |
$1,704.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.29
|
| Rate for Payer: UHC Medicare Advantage |
$525.60
|
| Rate for Payer: VA VA |
$510.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,530.87
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$777.04
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.55 |
| Max. Negotiated Rate |
$699.34 |
| Rate for Payer: Aetna Commercial |
$660.48
|
| Rate for Payer: Aetna Medicare |
$202.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.82
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCBS Trust/PPO |
$604.15
|
| Rate for Payer: BCN Commercial |
$604.15
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$621.63
|
| Rate for Payer: Cash Price |
$621.63
|
| Rate for Payer: Cofinity Commercial |
$668.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Healthscope Commercial |
$699.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.78
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.48
|
| Rate for Payer: PACE Senior Care Partners |
$184.55
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Commercial |
$660.48
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.02
|
| Rate for Payer: Priority Health Medicare |
$194.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.92
|
| Rate for Payer: Railroad Medicare Medicare |
$194.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.80
|
| Rate for Payer: UHC Core |
$648.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$200.09
|
| Rate for Payer: VA VA |
$194.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.78
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$777.04
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$473.92 |
| Max. Negotiated Rate |
$699.34 |
| Rate for Payer: Aetna Commercial |
$660.48
|
| Rate for Payer: BCBS Trust/PPO |
$600.50
|
| Rate for Payer: BCN Commercial |
$600.50
|
| Rate for Payer: Cash Price |
$621.63
|
| Rate for Payer: Cofinity Commercial |
$668.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.63
|
| Rate for Payer: Healthscope Commercial |
$699.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.48
|
| Rate for Payer: PHP Commercial |
$660.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.80
|
| Rate for Payer: UHC Core |
$648.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.78
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,187.75
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$724.41 |
| Max. Negotiated Rate |
$1,068.98 |
| Rate for Payer: Aetna Commercial |
$1,009.59
|
| Rate for Payer: BCBS Trust/PPO |
$917.89
|
| Rate for Payer: BCN Commercial |
$917.89
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cofinity Commercial |
$1,021.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.20
|
| Rate for Payer: Healthscope Commercial |
$1,068.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.59
|
| Rate for Payer: PHP Commercial |
$1,009.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.22
|
| Rate for Payer: UHC Core |
$991.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.81
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,187.75
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$1,068.98 |
| Rate for Payer: Aetna Commercial |
$1,009.59
|
| Rate for Payer: Aetna Medicare |
$308.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.17
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$296.94
|
| Rate for Payer: BCBS Trust/PPO |
$923.48
|
| Rate for Payer: BCN Commercial |
$923.48
|
| Rate for Payer: BCN Medicare Advantage |
$296.94
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cofinity Commercial |
$1,021.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.94
|
| Rate for Payer: Healthscope Commercial |
$1,068.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.81
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$311.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.59
|
| Rate for Payer: PACE Senior Care Partners |
$282.09
|
| Rate for Payer: PACE SWMI |
$296.94
|
| Rate for Payer: PHP Commercial |
$1,009.59
|
| Rate for Payer: PHP Medicare Advantage |
$296.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.34
|
| Rate for Payer: Priority Health Medicare |
$296.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.41
|
| Rate for Payer: Railroad Medicare Medicare |
$296.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.22
|
| Rate for Payer: UHC Core |
$991.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.94
|
| Rate for Payer: UHC Medicare Advantage |
$305.85
|
| Rate for Payer: VA VA |
$296.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.81
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$876.26
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$208.11 |
| Max. Negotiated Rate |
$788.63 |
| Rate for Payer: Aetna Commercial |
$744.82
|
| Rate for Payer: Aetna Medicare |
$227.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.83
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$219.06
|
| Rate for Payer: BCBS Trust/PPO |
$681.29
|
| Rate for Payer: BCN Commercial |
$681.29
|
| Rate for Payer: BCN Medicare Advantage |
$219.06
|
| Rate for Payer: Cash Price |
$701.01
|
| Rate for Payer: Cash Price |
$701.01
|
| Rate for Payer: Cofinity Commercial |
$753.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.06
|
| Rate for Payer: Healthscope Commercial |
$788.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.20
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.82
|
| Rate for Payer: PACE Senior Care Partners |
$208.11
|
| Rate for Payer: PACE SWMI |
$219.06
|
| Rate for Payer: PHP Commercial |
$744.82
|
| Rate for Payer: PHP Medicare Advantage |
$219.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.35
|
| Rate for Payer: Priority Health Medicare |
$219.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$534.43
|
| Rate for Payer: Railroad Medicare Medicare |
$219.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.11
|
| Rate for Payer: UHC Core |
$731.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.06
|
| Rate for Payer: UHC Medicare Advantage |
$225.64
|
| Rate for Payer: VA VA |
$219.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.20
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$876.26
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$534.43 |
| Max. Negotiated Rate |
$788.63 |
| Rate for Payer: Aetna Commercial |
$744.82
|
| Rate for Payer: BCBS Trust/PPO |
$677.17
|
| Rate for Payer: BCN Commercial |
$677.17
|
| Rate for Payer: Cash Price |
$701.01
|
| Rate for Payer: Cofinity Commercial |
$753.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.01
|
| Rate for Payer: Healthscope Commercial |
$788.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.82
|
| Rate for Payer: PHP Commercial |
$744.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$534.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.11
|
| Rate for Payer: UHC Core |
$731.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.20
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$1,995.25
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$1,795.72 |
| Rate for Payer: Aetna Commercial |
$1,695.96
|
| Rate for Payer: Aetna Medicare |
$518.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.52
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$498.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.31
|
| Rate for Payer: BCN Commercial |
$1,551.31
|
| Rate for Payer: BCN Medicare Advantage |
$498.81
|
| Rate for Payer: Cash Price |
$1,596.20
|
| Rate for Payer: Cash Price |
$1,596.20
|
| Rate for Payer: Cofinity Commercial |
$1,715.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.81
|
| Rate for Payer: Healthscope Commercial |
$1,795.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,496.44
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.96
|
| Rate for Payer: PACE Senior Care Partners |
$473.87
|
| Rate for Payer: PACE SWMI |
$498.81
|
| Rate for Payer: PHP Commercial |
$1,695.96
|
| Rate for Payer: PHP Medicare Advantage |
$498.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,735.87
|
| Rate for Payer: Priority Health Medicare |
$498.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,216.90
|
| Rate for Payer: Railroad Medicare Medicare |
$498.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,755.82
|
| Rate for Payer: UHC Core |
$1,666.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.81
|
| Rate for Payer: UHC Medicare Advantage |
$513.78
|
| Rate for Payer: VA VA |
$498.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,496.44
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
IP
|
$1,995.25
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,216.90 |
| Max. Negotiated Rate |
$1,795.72 |
| Rate for Payer: Aetna Commercial |
$1,695.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,541.93
|
| Rate for Payer: BCN Commercial |
$1,541.93
|
| Rate for Payer: Cash Price |
$1,596.20
|
| Rate for Payer: Cofinity Commercial |
$1,715.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.20
|
| Rate for Payer: Healthscope Commercial |
$1,795.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,496.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.96
|
| Rate for Payer: PHP Commercial |
$1,695.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,735.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,216.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,755.82
|
| Rate for Payer: UHC Core |
$1,666.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,496.44
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
IP
|
$2,227.04
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,358.27 |
| Max. Negotiated Rate |
$2,004.34 |
| Rate for Payer: Aetna Commercial |
$1,892.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,721.06
|
| Rate for Payer: BCN Commercial |
$1,721.06
|
| Rate for Payer: Cash Price |
$1,781.63
|
| Rate for Payer: Cofinity Commercial |
$1,915.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,781.63
|
| Rate for Payer: Healthscope Commercial |
$2,004.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,670.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,892.98
|
| Rate for Payer: PHP Commercial |
$1,892.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,358.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,959.80
|
| Rate for Payer: UHC Core |
$1,859.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,670.28
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
OP
|
$2,227.04
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$2,004.34 |
| Rate for Payer: Aetna Commercial |
$1,892.98
|
| Rate for Payer: Aetna Medicare |
$579.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$695.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$695.95
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$556.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.52
|
| Rate for Payer: BCN Commercial |
$1,731.52
|
| Rate for Payer: BCN Medicare Advantage |
$556.76
|
| Rate for Payer: Cash Price |
$1,781.63
|
| Rate for Payer: Cash Price |
$1,781.63
|
| Rate for Payer: Cofinity Commercial |
$1,915.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,781.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.76
|
| Rate for Payer: Healthscope Commercial |
$2,004.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,670.28
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,892.98
|
| Rate for Payer: PACE Senior Care Partners |
$528.92
|
| Rate for Payer: PACE SWMI |
$556.76
|
| Rate for Payer: PHP Commercial |
$1,892.98
|
| Rate for Payer: PHP Medicare Advantage |
$556.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.52
|
| Rate for Payer: Priority Health Medicare |
$556.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,358.27
|
| Rate for Payer: Railroad Medicare Medicare |
$556.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,959.80
|
| Rate for Payer: UHC Core |
$1,859.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.76
|
| Rate for Payer: UHC Medicare Advantage |
$573.46
|
| Rate for Payer: VA VA |
$556.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,670.28
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
OP
|
$2,754.67
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$2,479.20 |
| Rate for Payer: Aetna Commercial |
$2,341.47
|
| Rate for Payer: Aetna Medicare |
$716.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$860.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$860.83
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$688.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,141.76
|
| Rate for Payer: BCN Commercial |
$2,141.76
|
| Rate for Payer: BCN Medicare Advantage |
$688.67
|
| Rate for Payer: Cash Price |
$2,203.74
|
| Rate for Payer: Cash Price |
$2,203.74
|
| Rate for Payer: Cofinity Commercial |
$2,369.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,203.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.67
|
| Rate for Payer: Healthscope Commercial |
$2,479.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.00
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$723.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$791.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,341.47
|
| Rate for Payer: PACE Senior Care Partners |
$654.23
|
| Rate for Payer: PACE SWMI |
$688.67
|
| Rate for Payer: PHP Commercial |
$2,341.47
|
| Rate for Payer: PHP Medicare Advantage |
$688.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,928.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,396.56
|
| Rate for Payer: Priority Health Medicare |
$688.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,680.07
|
| Rate for Payer: Railroad Medicare Medicare |
$688.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,424.11
|
| Rate for Payer: UHC Core |
$2,300.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$688.67
|
| Rate for Payer: UHC Medicare Advantage |
$709.33
|
| Rate for Payer: VA VA |
$688.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.00
|
|
