|
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 |
$2,236.45 |
| Rate for Payer: Aetna Commercial |
$2,112.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.46
|
| Rate for Payer: BCN Commercial |
$1,920.37
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$2,137.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Healthscope Commercial |
$2,236.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,863.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: Nomi Health Commercial |
$2,037.66
|
| Rate for Payer: PHP Commercial |
$2,112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health HMO/PPO |
$2,161.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,664.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,186.76
|
| Rate for Payer: UHC Core |
$2,074.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,863.71
|
|
|
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 |
$1,873.78 |
| Rate for Payer: Aetna Commercial |
$1,769.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.52
|
| Rate for Payer: BCN Commercial |
$1,608.95
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,790.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Healthscope Commercial |
$1,873.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,561.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: Nomi Health Commercial |
$1,707.22
|
| Rate for Payer: PHP Commercial |
$1,769.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health HMO/PPO |
$1,811.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,394.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.14
|
| Rate for Payer: UHC Core |
$1,738.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,561.48
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,081.98
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$1,873.78 |
| Rate for Payer: Aetna Commercial |
$1,769.68
|
| Rate for Payer: Aetna Medicare |
$541.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$650.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$650.62
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$520.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.60
|
| Rate for Payer: BCN Commercial |
$1,618.74
|
| Rate for Payer: BCN Medicare Advantage |
$520.50
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cash Price |
$1,665.58
|
| Rate for Payer: Cofinity Commercial |
$1,790.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.50
|
| Rate for Payer: Healthscope Commercial |
$1,873.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,561.48
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.52
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$598.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.68
|
| Rate for Payer: Nomi Health Commercial |
$1,707.22
|
| Rate for Payer: PACE Senior Care Partners |
$494.47
|
| Rate for Payer: PACE SWMI |
$520.50
|
| Rate for Payer: PHP Commercial |
$1,769.68
|
| Rate for Payer: PHP Medicare Advantage |
$520.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.29
|
| Rate for Payer: Priority Health HMO/PPO |
$1,811.32
|
| Rate for Payer: Priority Health Medicare |
$525.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,394.93
|
| Rate for Payer: Railroad Medicare Medicare |
$520.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.14
|
| Rate for Payer: UHC Core |
$1,738.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$520.50
|
| Rate for Payer: UHC Exchange |
$520.50
|
| Rate for Payer: UHC Medicare Advantage |
$520.50
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$520.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,561.48
|
|
|
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 |
$713.32 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: BCBS Trust/PPO |
$646.98
|
| Rate for Payer: BCN Commercial |
$612.51
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$681.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Healthscope Commercial |
$713.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: Nomi Health Commercial |
$649.92
|
| Rate for Payer: PHP Commercial |
$673.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health HMO/PPO |
$689.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.47
|
| Rate for Payer: UHC Core |
$661.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.43
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$792.58
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$713.32 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna Medicare |
$206.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.68
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$198.15
|
| Rate for Payer: BCBS Trust/PPO |
$651.58
|
| Rate for Payer: BCN Commercial |
$616.23
|
| Rate for Payer: BCN Medicare Advantage |
$198.15
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cash Price |
$634.06
|
| Rate for Payer: Cofinity Commercial |
$681.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.15
|
| Rate for Payer: Healthscope Commercial |
$713.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.43
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.05
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.69
|
| Rate for Payer: Nomi Health Commercial |
$649.92
|
| Rate for Payer: PACE Senior Care Partners |
$188.24
|
| Rate for Payer: PACE SWMI |
$198.15
|
| Rate for Payer: PHP Commercial |
$673.69
|
| Rate for Payer: PHP Medicare Advantage |
$198.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.18
|
| Rate for Payer: Priority Health HMO/PPO |
$689.54
|
| Rate for Payer: Priority Health Medicare |
$200.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.03
|
| Rate for Payer: Railroad Medicare Medicare |
$198.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.47
|
| Rate for Payer: UHC Core |
$661.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.15
|
| Rate for Payer: UHC Exchange |
$198.15
|
| Rate for Payer: UHC Medicare Advantage |
$198.15
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$198.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.43
|
|
|
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 |
$113.12 |
| Max. Negotiated Rate |
$1,090.36 |
| Rate for Payer: Aetna Commercial |
$1,029.78
|
| Rate for Payer: Aetna Medicare |
$314.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$378.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$378.60
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$302.88
|
| Rate for Payer: BCBS Trust/PPO |
$995.98
|
| Rate for Payer: BCN Commercial |
$941.95
|
| Rate for Payer: BCN Medicare Advantage |
$302.88
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$1,041.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.88
|
| Rate for Payer: Healthscope Commercial |
$1,090.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.63
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.02
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$348.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: Nomi Health Commercial |
$993.44
|
| Rate for Payer: PACE Senior Care Partners |
$287.73
|
| Rate for Payer: PACE SWMI |
$302.88
|
| Rate for Payer: PHP Commercial |
$1,029.78
|
| Rate for Payer: PHP Medicare Advantage |
$302.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health HMO/PPO |
$1,054.01
|
| Rate for Payer: Priority Health Medicare |
$305.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$811.71
|
| Rate for Payer: Railroad Medicare Medicare |
$302.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.13
|
| Rate for Payer: UHC Core |
$1,011.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.88
|
| Rate for Payer: UHC Exchange |
$302.88
|
| Rate for Payer: UHC Medicare Advantage |
$302.88
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$302.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.63
|
|
|
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 |
$1,090.36 |
| Rate for Payer: Aetna Commercial |
$1,029.78
|
| Rate for Payer: BCBS Trust/PPO |
$988.96
|
| Rate for Payer: BCN Commercial |
$936.25
|
| Rate for Payer: Cash Price |
$969.21
|
| Rate for Payer: Cofinity Commercial |
$1,041.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.21
|
| Rate for Payer: Healthscope Commercial |
$1,090.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.78
|
| Rate for Payer: Nomi Health Commercial |
$993.44
|
| Rate for Payer: PHP Commercial |
$1,029.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.48
|
| Rate for Payer: Priority Health HMO/PPO |
$1,054.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$811.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.13
|
| Rate for Payer: UHC Core |
$1,011.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.63
|
|
|
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 |
$804.41 |
| Rate for Payer: Aetna Commercial |
$759.72
|
| Rate for Payer: BCBS Trust/PPO |
$729.60
|
| Rate for Payer: BCN Commercial |
$690.72
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$768.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Healthscope Commercial |
$804.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: Nomi Health Commercial |
$732.91
|
| Rate for Payer: PHP Commercial |
$759.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health HMO/PPO |
$777.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$598.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.54
|
| Rate for Payer: UHC Core |
$746.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.34
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$893.79
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$212.28 |
| Max. Negotiated Rate |
$804.41 |
| Rate for Payer: Aetna Commercial |
$759.72
|
| Rate for Payer: Aetna Medicare |
$232.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.31
|
| Rate for Payer: BCBS Complete |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$223.45
|
| Rate for Payer: BCBS Trust/PPO |
$734.78
|
| Rate for Payer: BCN Commercial |
$694.92
|
| Rate for Payer: BCN Medicare Advantage |
$223.45
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cash Price |
$715.03
|
| Rate for Payer: Cofinity Commercial |
$768.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.45
|
| Rate for Payer: Healthscope Commercial |
$804.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.34
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.62
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.72
|
| Rate for Payer: Nomi Health Commercial |
$732.91
|
| Rate for Payer: PACE Senior Care Partners |
$212.28
|
| Rate for Payer: PACE SWMI |
$223.45
|
| Rate for Payer: PHP Commercial |
$759.72
|
| Rate for Payer: PHP Medicare Advantage |
$223.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.96
|
| Rate for Payer: Priority Health HMO/PPO |
$777.60
|
| Rate for Payer: Priority Health Medicare |
$225.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$598.84
|
| Rate for Payer: Railroad Medicare Medicare |
$223.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.54
|
| Rate for Payer: UHC Core |
$746.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.45
|
| Rate for Payer: UHC Exchange |
$223.45
|
| Rate for Payer: UHC Medicare Advantage |
$223.45
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$223.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.34
|
|
|
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 |
$225.14 |
| Max. Negotiated Rate |
$1,831.64 |
| Rate for Payer: Aetna Commercial |
$1,729.89
|
| Rate for Payer: Aetna Medicare |
$529.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$635.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$635.99
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$508.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.11
|
| Rate for Payer: BCN Commercial |
$1,582.34
|
| Rate for Payer: BCN Medicare Advantage |
$508.79
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cofinity Commercial |
$1,750.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.79
|
| Rate for Payer: Healthscope Commercial |
$1,831.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.37
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.23
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$585.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.89
|
| Rate for Payer: Nomi Health Commercial |
$1,668.83
|
| Rate for Payer: PACE Senior Care Partners |
$483.35
|
| Rate for Payer: PACE SWMI |
$508.79
|
| Rate for Payer: PHP Commercial |
$1,729.89
|
| Rate for Payer: PHP Medicare Advantage |
$508.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,770.59
|
| Rate for Payer: Priority Health Medicare |
$513.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.56
|
| Rate for Payer: Railroad Medicare Medicare |
$508.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,790.94
|
| Rate for Payer: UHC Core |
$1,699.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.79
|
| Rate for Payer: UHC Exchange |
$508.79
|
| Rate for Payer: UHC Medicare Advantage |
$508.79
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$508.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.37
|
|
|
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 |
$1,831.64 |
| Rate for Payer: Aetna Commercial |
$1,729.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.30
|
| Rate for Payer: BCN Commercial |
$1,572.77
|
| Rate for Payer: Cash Price |
$1,628.13
|
| Rate for Payer: Cofinity Commercial |
$1,750.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.13
|
| Rate for Payer: Healthscope Commercial |
$1,831.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.89
|
| Rate for Payer: Nomi Health Commercial |
$1,668.83
|
| Rate for Payer: PHP Commercial |
$1,729.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,770.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,790.94
|
| Rate for Payer: UHC Core |
$1,699.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.37
|
|
|
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 |
$225.14 |
| Max. Negotiated Rate |
$2,044.42 |
| Rate for Payer: Aetna Commercial |
$1,930.84
|
| Rate for Payer: Aetna Medicare |
$590.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$709.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$709.87
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$567.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,867.47
|
| Rate for Payer: BCN Commercial |
$1,766.15
|
| Rate for Payer: BCN Medicare Advantage |
$567.89
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cofinity Commercial |
$1,953.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.89
|
| Rate for Payer: Healthscope Commercial |
$2,044.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,703.68
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.29
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$653.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,930.84
|
| Rate for Payer: Nomi Health Commercial |
$1,862.70
|
| Rate for Payer: PACE Senior Care Partners |
$539.50
|
| Rate for Payer: PACE SWMI |
$567.89
|
| Rate for Payer: PHP Commercial |
$1,930.84
|
| Rate for Payer: PHP Medicare Advantage |
$567.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,476.53
|
| Rate for Payer: Priority Health HMO/PPO |
$1,976.27
|
| Rate for Payer: Priority Health Medicare |
$573.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,521.96
|
| Rate for Payer: Railroad Medicare Medicare |
$567.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,998.99
|
| Rate for Payer: UHC Core |
$1,896.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.89
|
| Rate for Payer: UHC Exchange |
$567.89
|
| Rate for Payer: UHC Medicare Advantage |
$567.89
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$567.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,703.68
|
|
|
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 |
$2,044.42 |
| Rate for Payer: Aetna Commercial |
$1,930.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,854.29
|
| Rate for Payer: BCN Commercial |
$1,755.48
|
| Rate for Payer: Cash Price |
$1,817.26
|
| Rate for Payer: Cofinity Commercial |
$1,953.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,817.26
|
| Rate for Payer: Healthscope Commercial |
$2,044.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,703.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,930.84
|
| Rate for Payer: Nomi Health Commercial |
$1,862.70
|
| Rate for Payer: PHP Commercial |
$1,930.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,476.53
|
| Rate for Payer: Priority Health HMO/PPO |
$1,976.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,521.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,998.99
|
| Rate for Payer: UHC Core |
$1,896.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,703.68
|
|
|
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 |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.61
|
| Rate for Payer: BCN Commercial |
$2,171.38
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,107.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,444.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,882.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,472.59
|
| Rate for Payer: UHC Core |
$2,346.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,107.32
|
|
|
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 |
$383.62 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna Medicare |
$730.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$878.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$878.05
|
| Rate for Payer: BCBS Complete |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$702.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.90
|
| Rate for Payer: BCN Commercial |
$2,184.59
|
| Rate for Payer: BCN Medicare Advantage |
$702.44
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.44
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,107.32
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.56
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$807.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| Rate for Payer: PACE Senior Care Partners |
$667.32
|
| Rate for Payer: PACE SWMI |
$702.44
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: PHP Medicare Advantage |
$702.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,444.49
|
| Rate for Payer: Priority Health Medicare |
$709.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,882.54
|
| Rate for Payer: Railroad Medicare Medicare |
$702.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,472.59
|
| Rate for Payer: UHC Core |
$2,346.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.44
|
| Rate for Payer: UHC Exchange |
$702.44
|
| Rate for Payer: UHC Medicare Advantage |
$702.44
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$702.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,107.32
|
|
|
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 |
$383.62 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna Medicare |
$730.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$878.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$878.05
|
| Rate for Payer: BCBS Complete |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$702.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.90
|
| Rate for Payer: BCN Commercial |
$2,184.59
|
| Rate for Payer: BCN Medicare Advantage |
$702.44
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.44
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,107.32
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.56
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$807.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| Rate for Payer: PACE Senior Care Partners |
$667.32
|
| Rate for Payer: PACE SWMI |
$702.44
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: PHP Medicare Advantage |
$702.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,444.49
|
| Rate for Payer: Priority Health Medicare |
$709.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,882.54
|
| Rate for Payer: Railroad Medicare Medicare |
$702.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,472.59
|
| Rate for Payer: UHC Core |
$2,346.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.44
|
| Rate for Payer: UHC Exchange |
$702.44
|
| Rate for Payer: UHC Medicare Advantage |
$702.44
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$702.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,107.32
|
|
|
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 |
$2,528.78 |
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.61
|
| Rate for Payer: BCN Commercial |
$2,171.38
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,107.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$2,304.00
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,444.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,882.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,472.59
|
| Rate for Payer: UHC Core |
$2,346.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,107.32
|
|
|
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 |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,344.02
|
| Rate for Payer: BCN Commercial |
$1,272.40
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1,432.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.90
|
| Rate for Payer: UHC Core |
$1,374.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
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 |
$225.14 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna Medicare |
$428.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$514.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$514.52
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$411.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.57
|
| Rate for Payer: BCN Commercial |
$1,280.14
|
| Rate for Payer: BCN Medicare Advantage |
$411.62
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.62
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.20
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$473.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: PACE Senior Care Partners |
$391.04
|
| Rate for Payer: PACE SWMI |
$411.62
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: PHP Medicare Advantage |
$411.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1,432.44
|
| Rate for Payer: Priority Health Medicare |
$415.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.14
|
| Rate for Payer: Railroad Medicare Medicare |
$411.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.90
|
| Rate for Payer: UHC Core |
$1,374.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.62
|
| Rate for Payer: UHC Exchange |
$411.62
|
| Rate for Payer: UHC Medicare Advantage |
$411.62
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$411.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
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 |
$1,481.66 |
| Rate for Payer: Aetna Commercial |
$1,399.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,343.87
|
| Rate for Payer: BCN Commercial |
$1,272.25
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,415.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Healthscope Commercial |
$1,481.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.35
|
| Rate for Payer: Nomi Health Commercial |
$1,349.96
|
| Rate for Payer: PHP Commercial |
$1,399.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1,432.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.74
|
| Rate for Payer: UHC Core |
$1,374.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.72
|
|
|
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 |
$225.14 |
| Max. Negotiated Rate |
$1,481.66 |
| Rate for Payer: Aetna Commercial |
$1,399.35
|
| Rate for Payer: Aetna Medicare |
$428.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$514.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$514.47
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$411.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.42
|
| Rate for Payer: BCN Commercial |
$1,279.99
|
| Rate for Payer: BCN Medicare Advantage |
$411.57
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,415.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.57
|
| Rate for Payer: Healthscope Commercial |
$1,481.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.72
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.15
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$473.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.35
|
| Rate for Payer: Nomi Health Commercial |
$1,349.96
|
| Rate for Payer: PACE Senior Care Partners |
$390.99
|
| Rate for Payer: PACE SWMI |
$411.57
|
| Rate for Payer: PHP Commercial |
$1,399.35
|
| Rate for Payer: PHP Medicare Advantage |
$411.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1,432.27
|
| Rate for Payer: Priority Health Medicare |
$415.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.01
|
| Rate for Payer: Railroad Medicare Medicare |
$411.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.74
|
| Rate for Payer: UHC Core |
$1,374.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.57
|
| Rate for Payer: UHC Exchange |
$411.57
|
| Rate for Payer: UHC Medicare Advantage |
$411.57
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$411.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.72
|
|
|
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 |
$919.13 |
| Rate for Payer: Aetna Commercial |
$868.07
|
| Rate for Payer: BCBS Trust/PPO |
$833.65
|
| Rate for Payer: BCN Commercial |
$789.23
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$878.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Healthscope Commercial |
$919.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: PHP Commercial |
$868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO |
$888.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$684.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.71
|
| Rate for Payer: UHC Core |
$852.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.95
|
|
|
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 |
$225.14 |
| Max. Negotiated Rate |
$919.13 |
| Rate for Payer: Aetna Commercial |
$868.07
|
| Rate for Payer: Aetna Medicare |
$265.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$319.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$319.14
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$255.31
|
| Rate for Payer: BCBS Trust/PPO |
$839.58
|
| Rate for Payer: BCN Commercial |
$794.03
|
| Rate for Payer: BCN Medicare Advantage |
$255.31
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$878.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.31
|
| Rate for Payer: Healthscope Commercial |
$919.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.95
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.08
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: PACE Senior Care Partners |
$242.55
|
| Rate for Payer: PACE SWMI |
$255.31
|
| Rate for Payer: PHP Commercial |
$868.07
|
| Rate for Payer: PHP Medicare Advantage |
$255.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO |
$888.50
|
| Rate for Payer: Priority Health Medicare |
$257.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$684.24
|
| Rate for Payer: Railroad Medicare Medicare |
$255.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.71
|
| Rate for Payer: UHC Core |
$852.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.31
|
| Rate for Payer: UHC Exchange |
$255.31
|
| Rate for Payer: UHC Medicare Advantage |
$255.31
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$255.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.95
|
|
|
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 |
$1,763.51 |
| Rate for Payer: Aetna Commercial |
$1,665.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.51
|
| Rate for Payer: BCN Commercial |
$1,514.27
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,685.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: PHP Commercial |
$1,665.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,704.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,312.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,724.32
|
| Rate for Payer: UHC Core |
$1,636.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.60
|
|
|
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 |
$383.62 |
| Max. Negotiated Rate |
$1,763.51 |
| Rate for Payer: Aetna Commercial |
$1,665.54
|
| Rate for Payer: Aetna Medicare |
$509.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.33
|
| Rate for Payer: BCBS Complete |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$489.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,610.87
|
| Rate for Payer: BCN Commercial |
$1,523.48
|
| Rate for Payer: BCN Medicare Advantage |
$489.87
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,685.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.87
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.60
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.36
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: PACE Senior Care Partners |
$465.37
|
| Rate for Payer: PACE SWMI |
$489.87
|
| Rate for Payer: PHP Commercial |
$1,665.54
|
| Rate for Payer: PHP Medicare Advantage |
$489.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,704.73
|
| Rate for Payer: Priority Health Medicare |
$494.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,312.84
|
| Rate for Payer: Railroad Medicare Medicare |
$489.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,724.32
|
| Rate for Payer: UHC Core |
$1,636.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.87
|
| Rate for Payer: UHC Exchange |
$489.87
|
| Rate for Payer: UHC Medicare Advantage |
$489.87
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$489.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.60
|
|
