|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$667.88 |
| Max. Negotiated Rate |
$1,366.12 |
| Rate for Payer: Aetna American Axle |
$986.64
|
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.64
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Advantage |
$1,062.54
|
| Rate for Payer: Cofinity Commercial |
$1,305.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Healthscope Commercial |
$1,366.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,062.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: Priority Health SBD |
$956.28
|
| Rate for Payer: UMR Bronson Commercial |
$667.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.43
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna American Axle |
$986.64
|
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.72
|
| Rate for Payer: BCN Commercial |
$1,217.72
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Advantage |
$1,062.54
|
| Rate for Payer: Cofinity Commercial |
$1,305.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,366.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,062.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.43
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$956.28
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.64
|
| Rate for Payer: UHC Core |
$790.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$596.54
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: UMR Bronson Commercial |
$561.63
|
| Rate for Payer: VA VA |
$781.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.43
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.23 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$234.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: BCBS Complete |
$187.27
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.32
|
| Rate for Payer: UHC Core |
$243.92
|
| Rate for Payer: UHC Exchange |
$183.99
|
| Rate for Payer: UMR Bronson Commercial |
$173.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UMR Bronson Commercial |
$206.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,202.96 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna American Axle |
$2,113.31
|
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna Medicare |
$1,625.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.31
|
| Rate for Payer: BCBS Complete |
$1,300.50
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Advantage |
$2,275.88
|
| Rate for Payer: Cofinity Commercial |
$2,796.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,275.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,601.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: Priority Health SBD |
$2,048.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,113.31
|
| Rate for Payer: UHC Core |
$1,693.90
|
| Rate for Payer: UHC Exchange |
$1,277.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,202.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.44
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,430.55 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna American Axle |
$2,113.31
|
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.31
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Advantage |
$2,275.88
|
| Rate for Payer: Cofinity Commercial |
$2,796.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,275.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: Priority Health SBD |
$2,048.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.44
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$2,281.18 |
| Rate for Payer: Aetna American Axle |
$1,647.52
|
| Rate for Payer: Aetna Commercial |
$2,154.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.52
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Advantage |
$1,774.26
|
| Rate for Payer: Cofinity Commercial |
$2,179.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Healthscope Commercial |
$2,281.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,774.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: PHP Commercial |
$2,154.45
|
| Rate for Payer: Priority Health SBD |
$1,596.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.99
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$2,281.18 |
| Rate for Payer: Aetna American Axle |
$1,647.52
|
| Rate for Payer: Aetna Commercial |
$2,154.45
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.36
|
| Rate for Payer: BCN Commercial |
$1,672.36
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Advantage |
$1,774.26
|
| Rate for Payer: Cofinity Commercial |
$2,179.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$2,281.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,774.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.99
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.45
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$2,154.45
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,596.83
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,647.52
|
| Rate for Payer: UHC Core |
$1,320.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$996.12
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$937.82
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.99
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
IP
|
$2,123.62
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$934.39 |
| Max. Negotiated Rate |
$1,911.26 |
| Rate for Payer: Aetna American Axle |
$1,380.35
|
| Rate for Payer: Aetna Commercial |
$1,805.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,380.35
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cofinity Advantage |
$1,486.53
|
| Rate for Payer: Cofinity Commercial |
$1,826.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.90
|
| Rate for Payer: Healthscope Commercial |
$1,911.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,486.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,592.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,805.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,592.71
|
| Rate for Payer: PHP Commercial |
$1,805.08
|
| Rate for Payer: Priority Health SBD |
$1,337.88
|
| Rate for Payer: UMR Bronson Commercial |
$934.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,592.71
|
|
|
HC EEG AWAKE/DROWSY
|
Facility
|
OP
|
$2,123.62
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,911.26 |
| Rate for Payer: Aetna American Axle |
$1,380.35
|
| Rate for Payer: Aetna Commercial |
$1,805.08
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,380.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,403.25
|
| Rate for Payer: BCN Commercial |
$1,403.25
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cash Price |
$1,698.90
|
| Rate for Payer: Cofinity Advantage |
$1,486.53
|
| Rate for Payer: Cofinity Commercial |
$1,826.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,911.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,486.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,592.71
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,805.08
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,592.71
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,805.08
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,337.88
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,380.35
|
| Rate for Payer: UHC Core |
$1,106.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$834.58
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$785.74
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,592.71
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
IP
|
$808.43
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$355.71 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna American Axle |
$525.48
|
| Rate for Payer: Aetna Commercial |
$687.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.48
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cofinity Advantage |
$565.90
|
| Rate for Payer: Cofinity Commercial |
$695.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.74
|
| Rate for Payer: Healthscope Commercial |
$727.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.32
|
| Rate for Payer: PHP Commercial |
$687.17
|
| Rate for Payer: Priority Health SBD |
$509.31
|
| Rate for Payer: UMR Bronson Commercial |
$355.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.32
|
|
|
HC EEG COMA/SLEEP
|
Facility
|
OP
|
$808.43
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,528.64 |
| Rate for Payer: Aetna American Axle |
$525.48
|
| Rate for Payer: Aetna Commercial |
$687.17
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,528.64
|
| Rate for Payer: BCN Commercial |
$1,528.64
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cash Price |
$646.74
|
| Rate for Payer: Cofinity Advantage |
$565.90
|
| Rate for Payer: Cofinity Commercial |
$695.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$727.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.32
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.17
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.32
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$687.17
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$509.31
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.48
|
| Rate for Payer: UHC Core |
$421.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$317.71
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$299.12
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.32
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$1,235.74
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$543.73 |
| Max. Negotiated Rate |
$1,112.17 |
| Rate for Payer: Aetna American Axle |
$803.23
|
| Rate for Payer: Aetna Commercial |
$1,050.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.23
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cofinity Advantage |
$865.02
|
| Rate for Payer: Cofinity Commercial |
$1,062.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.59
|
| Rate for Payer: Healthscope Commercial |
$1,112.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$926.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.80
|
| Rate for Payer: PHP Commercial |
$1,050.38
|
| Rate for Payer: Priority Health SBD |
$778.52
|
| Rate for Payer: UMR Bronson Commercial |
$543.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$926.80
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$1,235.74
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
74000019
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,112.17 |
| Rate for Payer: Aetna American Axle |
$803.23
|
| Rate for Payer: Aetna Commercial |
$1,050.38
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$413.88
|
| Rate for Payer: BCN Commercial |
$413.88
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cofinity Advantage |
$865.02
|
| Rate for Payer: Cofinity Commercial |
$1,062.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,112.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$926.80
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.38
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.80
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,050.38
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$778.52
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.23
|
| Rate for Payer: UHC Core |
$643.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$485.65
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$457.22
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$926.80
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
OP
|
$911.67
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,403.60 |
| Rate for Payer: Aetna American Axle |
$592.59
|
| Rate for Payer: Aetna Commercial |
$774.92
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,403.60
|
| Rate for Payer: BCN Commercial |
$1,403.60
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cofinity Advantage |
$638.17
|
| Rate for Payer: Cofinity Commercial |
$784.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$820.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.75
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.92
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.75
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$774.92
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$574.35
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.59
|
| Rate for Payer: UHC Core |
$474.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$358.29
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$337.32
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.75
|
|
|
HC EEG ELECTROCEREBRAL SILENCE
|
Facility
|
IP
|
$911.67
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$401.13 |
| Max. Negotiated Rate |
$820.50 |
| Rate for Payer: Aetna American Axle |
$592.59
|
| Rate for Payer: Aetna Commercial |
$774.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.59
|
| Rate for Payer: Cash Price |
$729.34
|
| Rate for Payer: Cofinity Advantage |
$638.17
|
| Rate for Payer: Cofinity Commercial |
$784.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.34
|
| Rate for Payer: Healthscope Commercial |
$820.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.75
|
| Rate for Payer: PHP Commercial |
$774.92
|
| Rate for Payer: Priority Health SBD |
$574.35
|
| Rate for Payer: UMR Bronson Commercial |
$401.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.75
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
IP
|
$2,075.86
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$913.38 |
| Max. Negotiated Rate |
$1,868.27 |
| Rate for Payer: Aetna American Axle |
$1,349.31
|
| Rate for Payer: Aetna Commercial |
$1,764.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.31
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cofinity Advantage |
$1,453.10
|
| Rate for Payer: Cofinity Commercial |
$1,785.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.69
|
| Rate for Payer: Healthscope Commercial |
$1,868.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,453.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,556.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.89
|
| Rate for Payer: PHP Commercial |
$1,764.48
|
| Rate for Payer: Priority Health SBD |
$1,307.79
|
| Rate for Payer: UMR Bronson Commercial |
$913.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,556.89
|
|
|
HC EEG EXTENDED 41-60 MINUTES
|
Facility
|
OP
|
$2,075.86
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
74000003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,868.27 |
| Rate for Payer: Aetna American Axle |
$1,349.31
|
| Rate for Payer: Aetna Commercial |
$1,764.48
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.19
|
| Rate for Payer: BCN Commercial |
$1,234.19
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cofinity Advantage |
$1,453.10
|
| Rate for Payer: Cofinity Commercial |
$1,785.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,868.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,453.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,556.89
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.48
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.89
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,764.48
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,307.79
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.31
|
| Rate for Payer: UHC Core |
$1,081.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$815.81
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$768.07
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,556.89
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
OP
|
$2,317.01
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$2,085.31 |
| Rate for Payer: Aetna American Axle |
$1,506.06
|
| Rate for Payer: Aetna Commercial |
$1,969.46
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,506.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.77
|
| Rate for Payer: BCN Commercial |
$1,518.77
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cofinity Advantage |
$1,621.91
|
| Rate for Payer: Cofinity Commercial |
$1,992.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,853.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$2,085.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,621.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,737.76
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,969.46
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,737.76
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$1,969.46
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$1,459.72
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.06
|
| Rate for Payer: UHC Core |
$1,207.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$910.58
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$857.29
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,737.76
|
|
|
HC EEG EXTENDED 61-119 MIN
|
Facility
|
IP
|
$2,317.01
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
74000004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,019.48 |
| Max. Negotiated Rate |
$2,085.31 |
| Rate for Payer: Aetna American Axle |
$1,506.06
|
| Rate for Payer: Aetna Commercial |
$1,969.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,506.06
|
| Rate for Payer: Cash Price |
$1,853.61
|
| Rate for Payer: Cofinity Advantage |
$1,621.91
|
| Rate for Payer: Cofinity Commercial |
$1,992.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,853.61
|
| Rate for Payer: Healthscope Commercial |
$2,085.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,621.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,737.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,969.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,737.76
|
| Rate for Payer: PHP Commercial |
$1,969.46
|
| Rate for Payer: Priority Health SBD |
$1,459.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,019.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,737.76
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
OP
|
$2,865.96
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna American Axle |
$1,862.87
|
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,403.60
|
| Rate for Payer: BCN Commercial |
$1,403.60
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,006.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,149.47
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,862.87
|
| Rate for Payer: UHC Core |
$1,493.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$1,126.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.41
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,149.47
|
|
|
HC EEG W/O VID 12-26 HRS CONT MNTR
|
Facility
|
IP
|
$2,865.96
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
74000031
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,261.02 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna American Axle |
$1,862.87
|
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,006.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,149.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,261.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,149.47
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
IP
|
$2,865.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,261.02 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna American Axle |
$1,862.87
|
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,006.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,149.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,261.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,149.47
|
|
|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
OP
|
$2,865.96
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna American Axle |
$1,862.87
|
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,403.60
|
| Rate for Payer: BCN Commercial |
$1,403.60
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cash Price |
$2,292.77
|
| Rate for Payer: Cofinity Advantage |
$2,006.17
|
| Rate for Payer: Cofinity Commercial |
$2,464.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,579.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,006.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,149.47
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.07
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,149.47
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$2,436.07
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,805.55
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,862.87
|
| Rate for Payer: UHC Core |
$1,493.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$1,126.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.41
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,149.47
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
IP
|
$1,679.41
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$738.94 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna American Axle |
$1,091.62
|
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.62
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Advantage |
$1,175.59
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,175.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: Priority Health SBD |
$1,058.03
|
| Rate for Payer: UMR Bronson Commercial |
$738.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.56
|
|
