|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$250.88
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.58 |
| Max. Negotiated Rate |
$225.79 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna Medicare |
$65.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.40
|
| Rate for Payer: BCBS Complete |
$136.44
|
| Rate for Payer: BCBS MAPPO |
$62.72
|
| Rate for Payer: BCBS Trust/PPO |
$195.06
|
| Rate for Payer: BCN Commercial |
$195.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.72
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.72
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.16
|
| Rate for Payer: Mclaren Medicaid |
$129.94
|
| Rate for Payer: Meridian Medicaid |
$136.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PACE Senior Care Partners |
$59.58
|
| Rate for Payer: PACE SWMI |
$62.72
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.27
|
| Rate for Payer: Priority Health Medicare |
$62.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.01
|
| Rate for Payer: Railroad Medicare Medicare |
$62.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.77
|
| Rate for Payer: UHC Core |
$209.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.72
|
| Rate for Payer: UHC Medicare Advantage |
$64.60
|
| Rate for Payer: VA VA |
$62.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.16
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,653.06 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Aetna Commercial |
$3,697.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,361.68
|
| Rate for Payer: BCN Commercial |
$3,361.68
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$3,741.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.00
|
| Rate for Payer: Healthscope Commercial |
$3,915.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,697.50
|
| Rate for Payer: PHP Commercial |
$3,697.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,784.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,653.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,828.00
|
| Rate for Payer: UHC Core |
$3,632.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,262.50
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.12 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Aetna Commercial |
$3,697.50
|
| Rate for Payer: Aetna Medicare |
$1,131.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,359.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,359.38
|
| Rate for Payer: BCBS Complete |
$1,169.06
|
| Rate for Payer: BCBS MAPPO |
$1,087.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,382.12
|
| Rate for Payer: BCN Commercial |
$3,382.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,087.50
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$3,741.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,087.50
|
| Rate for Payer: Healthscope Commercial |
$3,915.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,262.50
|
| Rate for Payer: Mclaren Medicaid |
$1,113.39
|
| Rate for Payer: Meridian Medicaid |
$1,169.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,141.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,250.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,697.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,033.12
|
| Rate for Payer: PACE SWMI |
$1,087.50
|
| Rate for Payer: PHP Commercial |
$3,697.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,087.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,113.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,784.50
|
| Rate for Payer: Priority Health Medicare |
$1,087.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,653.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,087.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,828.00
|
| Rate for Payer: UHC Core |
$3,632.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,087.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,120.12
|
| Rate for Payer: VA VA |
$1,087.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,262.50
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$250.88
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.58 |
| Max. Negotiated Rate |
$225.79 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna Medicare |
$65.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.40
|
| Rate for Payer: BCBS Complete |
$136.44
|
| Rate for Payer: BCBS MAPPO |
$62.72
|
| Rate for Payer: BCBS Trust/PPO |
$195.06
|
| Rate for Payer: BCN Commercial |
$195.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.72
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.72
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.16
|
| Rate for Payer: Mclaren Medicaid |
$129.94
|
| Rate for Payer: Meridian Medicaid |
$136.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PACE Senior Care Partners |
$59.58
|
| Rate for Payer: PACE SWMI |
$62.72
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.27
|
| Rate for Payer: Priority Health Medicare |
$62.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.01
|
| Rate for Payer: Railroad Medicare Medicare |
$62.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.77
|
| Rate for Payer: UHC Core |
$209.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.72
|
| Rate for Payer: UHC Medicare Advantage |
$64.60
|
| Rate for Payer: VA VA |
$62.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.16
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$250.88
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.01 |
| Max. Negotiated Rate |
$225.79 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: BCBS Trust/PPO |
$193.88
|
| Rate for Payer: BCN Commercial |
$193.88
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.70
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.77
|
| Rate for Payer: UHC Core |
$209.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.16
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$243.69
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$219.32 |
| Rate for Payer: Aetna Commercial |
$207.14
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.15
|
| Rate for Payer: BCBS Complete |
$146.91
|
| Rate for Payer: BCBS MAPPO |
$60.92
|
| Rate for Payer: BCBS Trust/PPO |
$189.47
|
| Rate for Payer: BCN Commercial |
$189.47
|
| Rate for Payer: BCN Medicare Advantage |
$60.92
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cofinity Commercial |
$209.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.92
|
| Rate for Payer: Healthscope Commercial |
$219.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.77
|
| Rate for Payer: Mclaren Medicaid |
$139.92
|
| Rate for Payer: Meridian Medicaid |
$146.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.14
|
| Rate for Payer: PACE Senior Care Partners |
$57.88
|
| Rate for Payer: PACE SWMI |
$60.92
|
| Rate for Payer: PHP Commercial |
$207.14
|
| Rate for Payer: PHP Medicare Advantage |
$60.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.01
|
| Rate for Payer: Priority Health Medicare |
$60.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.63
|
| Rate for Payer: Railroad Medicare Medicare |
$60.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.45
|
| Rate for Payer: UHC Core |
$203.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.92
|
| Rate for Payer: UHC Medicare Advantage |
$62.75
|
| Rate for Payer: VA VA |
$60.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.77
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$243.69
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$148.63 |
| Max. Negotiated Rate |
$219.32 |
| Rate for Payer: Aetna Commercial |
$207.14
|
| Rate for Payer: BCBS Trust/PPO |
$188.32
|
| Rate for Payer: BCN Commercial |
$188.32
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cofinity Commercial |
$209.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.95
|
| Rate for Payer: Healthscope Commercial |
$219.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.14
|
| Rate for Payer: PHP Commercial |
$207.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.45
|
| Rate for Payer: UHC Core |
$203.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.77
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,232.45
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$2,009.20 |
| Rate for Payer: Aetna Commercial |
$1,897.58
|
| Rate for Payer: Aetna Medicare |
$580.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.64
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$558.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,735.73
|
| Rate for Payer: BCN Commercial |
$1,735.73
|
| Rate for Payer: BCN Medicare Advantage |
$558.11
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cofinity Commercial |
$1,919.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,785.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.11
|
| Rate for Payer: Healthscope Commercial |
$2,009.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,674.34
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,897.58
|
| Rate for Payer: PACE Senior Care Partners |
$530.21
|
| Rate for Payer: PACE SWMI |
$558.11
|
| Rate for Payer: PHP Commercial |
$1,897.58
|
| Rate for Payer: PHP Medicare Advantage |
$558.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,942.23
|
| Rate for Payer: Priority Health Medicare |
$558.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.57
|
| Rate for Payer: Railroad Medicare Medicare |
$558.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,964.56
|
| Rate for Payer: UHC Core |
$1,864.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.11
|
| Rate for Payer: UHC Medicare Advantage |
$574.86
|
| Rate for Payer: VA VA |
$558.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,674.34
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,232.45
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,361.57 |
| Max. Negotiated Rate |
$2,009.20 |
| Rate for Payer: Aetna Commercial |
$1,897.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.24
|
| Rate for Payer: BCN Commercial |
$1,725.24
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cofinity Commercial |
$1,919.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,785.96
|
| Rate for Payer: Healthscope Commercial |
$2,009.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,674.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,897.58
|
| Rate for Payer: PHP Commercial |
$1,897.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,942.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,964.56
|
| Rate for Payer: UHC Core |
$1,864.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,674.34
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$484.65
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$295.59 |
| Max. Negotiated Rate |
$436.18 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: BCBS Trust/PPO |
$374.54
|
| Rate for Payer: BCN Commercial |
$374.54
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cofinity Commercial |
$416.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.72
|
| Rate for Payer: Healthscope Commercial |
$436.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.95
|
| Rate for Payer: PHP Commercial |
$411.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.49
|
| Rate for Payer: UHC Core |
$404.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.49
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$484.65
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$436.18 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Aetna Medicare |
$126.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.45
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$121.16
|
| Rate for Payer: BCBS Trust/PPO |
$376.82
|
| Rate for Payer: BCN Commercial |
$376.82
|
| Rate for Payer: BCN Medicare Advantage |
$121.16
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cofinity Commercial |
$416.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.16
|
| Rate for Payer: Healthscope Commercial |
$436.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.49
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.95
|
| Rate for Payer: PACE Senior Care Partners |
$115.10
|
| Rate for Payer: PACE SWMI |
$121.16
|
| Rate for Payer: PHP Commercial |
$411.95
|
| Rate for Payer: PHP Medicare Advantage |
$121.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.65
|
| Rate for Payer: Priority Health Medicare |
$121.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.59
|
| Rate for Payer: Railroad Medicare Medicare |
$121.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.49
|
| Rate for Payer: UHC Core |
$404.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.16
|
| Rate for Payer: UHC Medicare Advantage |
$124.80
|
| Rate for Payer: VA VA |
$121.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.49
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,896.50
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,766.58 |
| Max. Negotiated Rate |
$2,606.85 |
| Rate for Payer: Aetna Commercial |
$2,462.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,238.42
|
| Rate for Payer: BCN Commercial |
$2,238.42
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cofinity Commercial |
$2,490.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,317.20
|
| Rate for Payer: Healthscope Commercial |
$2,606.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,172.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,462.02
|
| Rate for Payer: PHP Commercial |
$2,462.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,766.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,548.92
|
| Rate for Payer: UHC Core |
$2,418.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,172.38
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,896.50
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$2,606.85 |
| Rate for Payer: Aetna Commercial |
$2,462.02
|
| Rate for Payer: Aetna Medicare |
$753.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$905.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$905.16
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$724.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,252.03
|
| Rate for Payer: BCN Commercial |
$2,252.03
|
| Rate for Payer: BCN Medicare Advantage |
$724.12
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cofinity Commercial |
$2,490.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,317.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.12
|
| Rate for Payer: Healthscope Commercial |
$2,606.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,172.38
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$760.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$832.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,462.02
|
| Rate for Payer: PACE Senior Care Partners |
$687.92
|
| Rate for Payer: PACE SWMI |
$724.12
|
| Rate for Payer: PHP Commercial |
$2,462.02
|
| Rate for Payer: PHP Medicare Advantage |
$724.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.96
|
| Rate for Payer: Priority Health Medicare |
$724.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,766.58
|
| Rate for Payer: Railroad Medicare Medicare |
$724.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,548.92
|
| Rate for Payer: UHC Core |
$2,418.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.12
|
| Rate for Payer: UHC Medicare Advantage |
$745.85
|
| Rate for Payer: VA VA |
$724.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,172.38
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$895.52
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$805.97 |
| Rate for Payer: Aetna Commercial |
$761.19
|
| Rate for Payer: Aetna Medicare |
$232.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.85
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$223.88
|
| Rate for Payer: BCBS Trust/PPO |
$696.27
|
| Rate for Payer: BCN Commercial |
$696.27
|
| Rate for Payer: BCN Medicare Advantage |
$223.88
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cofinity Commercial |
$770.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.88
|
| Rate for Payer: Healthscope Commercial |
$805.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.64
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$235.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$761.19
|
| Rate for Payer: PACE Senior Care Partners |
$212.69
|
| Rate for Payer: PACE SWMI |
$223.88
|
| Rate for Payer: PHP Commercial |
$761.19
|
| Rate for Payer: PHP Medicare Advantage |
$223.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$779.10
|
| Rate for Payer: Priority Health Medicare |
$223.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$546.18
|
| Rate for Payer: Railroad Medicare Medicare |
$223.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.06
|
| Rate for Payer: UHC Core |
$747.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.88
|
| Rate for Payer: UHC Medicare Advantage |
$230.60
|
| Rate for Payer: VA VA |
$223.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.64
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$895.52
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$546.18 |
| Max. Negotiated Rate |
$805.97 |
| Rate for Payer: Aetna Commercial |
$761.19
|
| Rate for Payer: BCBS Trust/PPO |
$692.06
|
| Rate for Payer: BCN Commercial |
$692.06
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cofinity Commercial |
$770.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.42
|
| Rate for Payer: Healthscope Commercial |
$805.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$761.19
|
| Rate for Payer: PHP Commercial |
$761.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$779.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$546.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.06
|
| Rate for Payer: UHC Core |
$747.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.64
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,106.75
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$675.01 |
| Max. Negotiated Rate |
$996.08 |
| Rate for Payer: Aetna Commercial |
$940.74
|
| Rate for Payer: BCBS Trust/PPO |
$855.30
|
| Rate for Payer: BCN Commercial |
$855.30
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cofinity Commercial |
$951.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.40
|
| Rate for Payer: Healthscope Commercial |
$996.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.74
|
| Rate for Payer: PHP Commercial |
$940.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$962.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$675.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.94
|
| Rate for Payer: UHC Core |
$924.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.06
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,106.75
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$996.08 |
| Rate for Payer: Aetna Commercial |
$940.74
|
| Rate for Payer: Aetna Medicare |
$287.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$345.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$345.86
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$276.69
|
| Rate for Payer: BCBS Trust/PPO |
$860.50
|
| Rate for Payer: BCN Commercial |
$860.50
|
| Rate for Payer: BCN Medicare Advantage |
$276.69
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cofinity Commercial |
$951.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.69
|
| Rate for Payer: Healthscope Commercial |
$996.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.06
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$290.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.74
|
| Rate for Payer: PACE Senior Care Partners |
$262.85
|
| Rate for Payer: PACE SWMI |
$276.69
|
| Rate for Payer: PHP Commercial |
$940.74
|
| Rate for Payer: PHP Medicare Advantage |
$276.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$962.87
|
| Rate for Payer: Priority Health Medicare |
$276.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$675.01
|
| Rate for Payer: Railroad Medicare Medicare |
$276.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.94
|
| Rate for Payer: UHC Core |
$924.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.69
|
| Rate for Payer: UHC Medicare Advantage |
$284.99
|
| Rate for Payer: VA VA |
$276.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.06
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,429.29
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$1,286.36 |
| Rate for Payer: Aetna Commercial |
$1,214.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.56
|
| Rate for Payer: BCN Commercial |
$1,104.56
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.43
|
| Rate for Payer: Healthscope Commercial |
$1,286.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,214.90
|
| Rate for Payer: PHP Commercial |
$1,214.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$871.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.78
|
| Rate for Payer: UHC Core |
$1,193.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.97
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,429.29
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$1,286.36 |
| Rate for Payer: Aetna Commercial |
$1,214.90
|
| Rate for Payer: Aetna Medicare |
$371.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.65
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$357.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.27
|
| Rate for Payer: BCN Commercial |
$1,111.27
|
| Rate for Payer: BCN Medicare Advantage |
$357.32
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.32
|
| Rate for Payer: Healthscope Commercial |
$1,286.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.97
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$375.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,214.90
|
| Rate for Payer: PACE Senior Care Partners |
$339.46
|
| Rate for Payer: PACE SWMI |
$357.32
|
| Rate for Payer: PHP Commercial |
$1,214.90
|
| Rate for Payer: PHP Medicare Advantage |
$357.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.48
|
| Rate for Payer: Priority Health Medicare |
$357.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$871.72
|
| Rate for Payer: Railroad Medicare Medicare |
$357.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.78
|
| Rate for Payer: UHC Core |
$1,193.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.32
|
| Rate for Payer: UHC Medicare Advantage |
$368.04
|
| Rate for Payer: VA VA |
$357.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.97
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,770.78
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,593.70 |
| Rate for Payer: Aetna Commercial |
$1,505.16
|
| Rate for Payer: Aetna Medicare |
$460.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$553.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$553.37
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$442.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,376.78
|
| Rate for Payer: BCN Commercial |
$1,376.78
|
| Rate for Payer: BCN Medicare Advantage |
$442.70
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cofinity Commercial |
$1,522.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.70
|
| Rate for Payer: Healthscope Commercial |
$1,593.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.08
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$464.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$509.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.16
|
| Rate for Payer: PACE Senior Care Partners |
$420.56
|
| Rate for Payer: PACE SWMI |
$442.70
|
| Rate for Payer: PHP Commercial |
$1,505.16
|
| Rate for Payer: PHP Medicare Advantage |
$442.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,540.58
|
| Rate for Payer: Priority Health Medicare |
$442.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,080.00
|
| Rate for Payer: Railroad Medicare Medicare |
$442.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,558.29
|
| Rate for Payer: UHC Core |
$1,478.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.70
|
| Rate for Payer: UHC Medicare Advantage |
$455.98
|
| Rate for Payer: VA VA |
$442.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.08
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,770.78
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$1,593.70 |
| Rate for Payer: Aetna Commercial |
$1,505.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,368.46
|
| Rate for Payer: BCN Commercial |
$1,368.46
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cofinity Commercial |
$1,522.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.62
|
| Rate for Payer: Healthscope Commercial |
$1,593.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.16
|
| Rate for Payer: PHP Commercial |
$1,505.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,540.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,080.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,558.29
|
| Rate for Payer: UHC Core |
$1,478.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.08
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$83.46
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.04
|
| Rate for Payer: UHC Core |
$90.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$28.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.75
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS MAPPO |
$27.00
|
| Rate for Payer: BCBS Trust/PPO |
$83.97
|
| Rate for Payer: BCN Commercial |
$83.97
|
| Rate for Payer: BCN Medicare Advantage |
$27.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.00
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
| Rate for Payer: PACE Senior Care Partners |
$25.65
|
| Rate for Payer: PACE SWMI |
$27.00
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: PHP Medicare Advantage |
$27.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.96
|
| Rate for Payer: Priority Health Medicare |
$27.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.04
|
| Rate for Payer: UHC Core |
$90.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.00
|
| Rate for Payer: UHC Medicare Advantage |
$27.81
|
| Rate for Payer: VA VA |
$27.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
