|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$453.81 |
| Rate for Payer: Aetna Commercial |
$428.60
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.57
|
| Rate for Payer: BCBS Complete |
$93.33
|
| Rate for Payer: BCBS MAPPO |
$126.06
|
| Rate for Payer: BCBS Trust/PPO |
$414.53
|
| Rate for Payer: BCN Commercial |
$414.53
|
| Rate for Payer: BCN Medicare Advantage |
$126.06
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Commercial |
$433.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$453.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.17
|
| Rate for Payer: Mclaren Medicaid |
$88.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.36
|
| Rate for Payer: Meridian Medicaid |
$93.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Nomi Health Commercial |
$413.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: PACE Senior Care Partners |
$119.75
|
| Rate for Payer: PACE SWMI |
$126.06
|
| Rate for Payer: PHP Commercial |
$428.60
|
| Rate for Payer: PHP Medicare Advantage |
$126.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$438.68
|
| Rate for Payer: Priority Health Medicare |
$127.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.94
|
| Rate for Payer: Railroad Medicare Medicare |
$126.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.72
|
| Rate for Payer: UHC Core |
$421.03
|
| Rate for Payer: UHC Exchange |
$126.06
|
| Rate for Payer: UHC Medicaid |
$88.90
|
| Rate for Payer: UHC Medicare Advantage |
$126.06
|
| Rate for Payer: UHCCP Medicaid |
$88.90
|
| Rate for Payer: VA VA |
$126.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.17
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$350.94 |
| Max. Negotiated Rate |
$453.81 |
| Rate for Payer: Aetna Commercial |
$428.60
|
| Rate for Payer: BCBS Trust/PPO |
$416.44
|
| Rate for Payer: BCN Commercial |
$416.44
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Commercial |
$433.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Healthscope Commercial |
$453.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Nomi Health Commercial |
$413.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: PHP Commercial |
$428.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$438.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.72
|
| Rate for Payer: UHC Core |
$421.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.17
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$3,013.52
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$531.28 |
| Max. Negotiated Rate |
$2,712.17 |
| Rate for Payer: Aetna Commercial |
$2,561.49
|
| Rate for Payer: Aetna Medicare |
$783.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$941.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$941.73
|
| Rate for Payer: BCBS Complete |
$557.80
|
| Rate for Payer: BCBS MAPPO |
$753.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,477.41
|
| Rate for Payer: BCN Commercial |
$2,477.41
|
| Rate for Payer: BCN Medicare Advantage |
$753.38
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cofinity Commercial |
$2,591.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,410.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$753.38
|
| Rate for Payer: Healthscope Commercial |
$2,712.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,260.14
|
| Rate for Payer: Mclaren Medicaid |
$531.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$791.05
|
| Rate for Payer: Meridian Medicaid |
$557.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$866.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$828.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,561.49
|
| Rate for Payer: Nomi Health Commercial |
$2,471.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,260.14
|
| Rate for Payer: PACE Senior Care Partners |
$715.71
|
| Rate for Payer: PACE SWMI |
$753.38
|
| Rate for Payer: PHP Commercial |
$2,561.49
|
| Rate for Payer: PHP Medicare Advantage |
$753.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,621.76
|
| Rate for Payer: Priority Health Medicare |
$760.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,097.41
|
| Rate for Payer: Railroad Medicare Medicare |
$753.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,651.90
|
| Rate for Payer: UHC Core |
$2,516.29
|
| Rate for Payer: UHC Exchange |
$753.38
|
| Rate for Payer: UHC Medicaid |
$531.28
|
| Rate for Payer: UHC Medicare Advantage |
$753.38
|
| Rate for Payer: UHCCP Medicaid |
$531.28
|
| Rate for Payer: VA VA |
$753.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,260.14
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$3,013.52
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,097.41 |
| Max. Negotiated Rate |
$2,712.17 |
| Rate for Payer: Aetna Commercial |
$2,561.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,488.87
|
| Rate for Payer: BCN Commercial |
$2,488.87
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cofinity Commercial |
$2,591.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,410.82
|
| Rate for Payer: Healthscope Commercial |
$2,712.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,561.49
|
| Rate for Payer: Nomi Health Commercial |
$2,471.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,260.14
|
| Rate for Payer: PHP Commercial |
$2,561.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,621.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,097.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,651.90
|
| Rate for Payer: UHC Core |
$2,516.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,260.14
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$931.70
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$648.46 |
| Max. Negotiated Rate |
$838.53 |
| Rate for Payer: Aetna Commercial |
$791.95
|
| Rate for Payer: BCBS Trust/PPO |
$769.49
|
| Rate for Payer: BCN Commercial |
$769.49
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cofinity Commercial |
$801.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.36
|
| Rate for Payer: Healthscope Commercial |
$838.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.95
|
| Rate for Payer: Nomi Health Commercial |
$763.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.77
|
| Rate for Payer: PHP Commercial |
$791.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$810.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.90
|
| Rate for Payer: UHC Core |
$777.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.77
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$931.70
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$164.26 |
| Max. Negotiated Rate |
$838.53 |
| Rate for Payer: Aetna Commercial |
$791.95
|
| Rate for Payer: Aetna Medicare |
$242.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$291.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$291.16
|
| Rate for Payer: BCBS Complete |
$172.46
|
| Rate for Payer: BCBS MAPPO |
$232.93
|
| Rate for Payer: BCBS Trust/PPO |
$765.95
|
| Rate for Payer: BCN Commercial |
$765.95
|
| Rate for Payer: BCN Medicare Advantage |
$232.93
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cofinity Commercial |
$801.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.93
|
| Rate for Payer: Healthscope Commercial |
$838.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.77
|
| Rate for Payer: Mclaren Medicaid |
$164.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.57
|
| Rate for Payer: Meridian Medicaid |
$172.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$256.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.95
|
| Rate for Payer: Nomi Health Commercial |
$763.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.77
|
| Rate for Payer: PACE Senior Care Partners |
$221.28
|
| Rate for Payer: PACE SWMI |
$232.93
|
| Rate for Payer: PHP Commercial |
$791.95
|
| Rate for Payer: PHP Medicare Advantage |
$232.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$810.58
|
| Rate for Payer: Priority Health Medicare |
$235.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.46
|
| Rate for Payer: Railroad Medicare Medicare |
$232.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.90
|
| Rate for Payer: UHC Core |
$777.97
|
| Rate for Payer: UHC Exchange |
$232.93
|
| Rate for Payer: UHC Medicaid |
$164.26
|
| Rate for Payer: UHC Medicare Advantage |
$232.93
|
| Rate for Payer: UHCCP Medicaid |
$164.26
|
| Rate for Payer: VA VA |
$232.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.77
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,151.47
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$1,036.32 |
| Rate for Payer: Aetna Commercial |
$978.75
|
| Rate for Payer: Aetna Medicare |
$299.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.83
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS MAPPO |
$287.87
|
| Rate for Payer: BCBS Trust/PPO |
$946.62
|
| Rate for Payer: BCN Commercial |
$946.62
|
| Rate for Payer: BCN Medicare Advantage |
$287.87
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cofinity Commercial |
$990.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.87
|
| Rate for Payer: Healthscope Commercial |
$1,036.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$863.60
|
| Rate for Payer: Mclaren Medicaid |
$203.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.26
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$316.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.75
|
| Rate for Payer: Nomi Health Commercial |
$944.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.60
|
| Rate for Payer: PACE Senior Care Partners |
$273.47
|
| Rate for Payer: PACE SWMI |
$287.87
|
| Rate for Payer: PHP Commercial |
$978.75
|
| Rate for Payer: PHP Medicare Advantage |
$287.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,001.78
|
| Rate for Payer: Priority Health Medicare |
$290.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$801.42
|
| Rate for Payer: Railroad Medicare Medicare |
$287.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,013.29
|
| Rate for Payer: UHC Core |
$961.48
|
| Rate for Payer: UHC Exchange |
$287.87
|
| Rate for Payer: UHC Medicaid |
$203.00
|
| Rate for Payer: UHC Medicare Advantage |
$287.87
|
| Rate for Payer: UHCCP Medicaid |
$203.00
|
| Rate for Payer: VA VA |
$287.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$863.60
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,151.47
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$801.42 |
| Max. Negotiated Rate |
$1,036.32 |
| Rate for Payer: Aetna Commercial |
$978.75
|
| Rate for Payer: BCBS Trust/PPO |
$951.00
|
| Rate for Payer: BCN Commercial |
$951.00
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cofinity Commercial |
$990.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.18
|
| Rate for Payer: Healthscope Commercial |
$1,036.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$863.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.75
|
| Rate for Payer: Nomi Health Commercial |
$944.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.60
|
| Rate for Payer: PHP Commercial |
$978.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,001.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$801.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,013.29
|
| Rate for Payer: UHC Core |
$961.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$863.60
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,487.04
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$262.17 |
| Max. Negotiated Rate |
$1,338.34 |
| Rate for Payer: Aetna Commercial |
$1,263.98
|
| Rate for Payer: Aetna Medicare |
$386.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.70
|
| Rate for Payer: BCBS Complete |
$275.25
|
| Rate for Payer: BCBS MAPPO |
$371.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.50
|
| Rate for Payer: BCN Commercial |
$1,222.50
|
| Rate for Payer: BCN Medicare Advantage |
$371.76
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cofinity Commercial |
$1,278.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.76
|
| Rate for Payer: Healthscope Commercial |
$1,338.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.28
|
| Rate for Payer: Mclaren Medicaid |
$262.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.35
|
| Rate for Payer: Meridian Medicaid |
$275.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$408.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.98
|
| Rate for Payer: Nomi Health Commercial |
$1,219.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.28
|
| Rate for Payer: PACE Senior Care Partners |
$353.17
|
| Rate for Payer: PACE SWMI |
$371.76
|
| Rate for Payer: PHP Commercial |
$1,263.98
|
| Rate for Payer: PHP Medicare Advantage |
$371.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,293.72
|
| Rate for Payer: Priority Health Medicare |
$375.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,034.98
|
| Rate for Payer: Railroad Medicare Medicare |
$371.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.60
|
| Rate for Payer: UHC Core |
$1,241.68
|
| Rate for Payer: UHC Exchange |
$371.76
|
| Rate for Payer: UHC Medicaid |
$262.17
|
| Rate for Payer: UHC Medicare Advantage |
$371.76
|
| Rate for Payer: UHCCP Medicaid |
$262.17
|
| Rate for Payer: VA VA |
$371.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.28
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,487.04
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,034.98 |
| Max. Negotiated Rate |
$1,338.34 |
| Rate for Payer: Aetna Commercial |
$1,263.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.15
|
| Rate for Payer: BCN Commercial |
$1,228.15
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cofinity Commercial |
$1,278.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.63
|
| Rate for Payer: Healthscope Commercial |
$1,338.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.98
|
| Rate for Payer: Nomi Health Commercial |
$1,219.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.28
|
| Rate for Payer: PHP Commercial |
$1,263.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,293.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,034.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.60
|
| Rate for Payer: UHC Core |
$1,241.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.28
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,842.32
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,282.25 |
| Max. Negotiated Rate |
$1,658.09 |
| Rate for Payer: Aetna Commercial |
$1,565.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,521.57
|
| Rate for Payer: BCN Commercial |
$1,521.57
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cofinity Commercial |
$1,584.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.86
|
| Rate for Payer: Healthscope Commercial |
$1,658.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,381.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.97
|
| Rate for Payer: Nomi Health Commercial |
$1,510.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.74
|
| Rate for Payer: PHP Commercial |
$1,565.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,602.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,282.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,621.24
|
| Rate for Payer: UHC Core |
$1,538.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,381.74
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,842.32
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$1,658.09 |
| Rate for Payer: Aetna Commercial |
$1,565.97
|
| Rate for Payer: Aetna Medicare |
$479.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$575.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$575.73
|
| Rate for Payer: BCBS Complete |
$341.01
|
| Rate for Payer: BCBS MAPPO |
$460.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,514.57
|
| Rate for Payer: BCN Commercial |
$1,514.57
|
| Rate for Payer: BCN Medicare Advantage |
$460.58
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cofinity Commercial |
$1,584.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.58
|
| Rate for Payer: Healthscope Commercial |
$1,658.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,381.74
|
| Rate for Payer: Mclaren Medicaid |
$324.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.61
|
| Rate for Payer: Meridian Medicaid |
$341.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$529.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.97
|
| Rate for Payer: Nomi Health Commercial |
$1,510.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.74
|
| Rate for Payer: PACE Senior Care Partners |
$437.55
|
| Rate for Payer: PACE SWMI |
$460.58
|
| Rate for Payer: PHP Commercial |
$1,565.97
|
| Rate for Payer: PHP Medicare Advantage |
$460.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,602.82
|
| Rate for Payer: Priority Health Medicare |
$465.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,282.25
|
| Rate for Payer: Railroad Medicare Medicare |
$460.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,621.24
|
| Rate for Payer: UHC Core |
$1,538.34
|
| Rate for Payer: UHC Exchange |
$460.58
|
| Rate for Payer: UHC Medicaid |
$324.80
|
| Rate for Payer: UHC Medicare Advantage |
$460.58
|
| Rate for Payer: UHCCP Medicaid |
$324.80
|
| Rate for Payer: VA VA |
$460.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,381.74
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$112.36
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: BCBS Trust/PPO |
$92.80
|
| Rate for Payer: BCN Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$89.89
|
| Rate for Payer: Cofinity Commercial |
$96.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$101.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.51
|
| Rate for Payer: Nomi Health Commercial |
$92.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.27
|
| Rate for Payer: PHP Commercial |
$95.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.88
|
| Rate for Payer: UHC Core |
$93.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.27
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$112.36
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$29.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.11
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$28.09
|
| Rate for Payer: BCBS Trust/PPO |
$92.37
|
| Rate for Payer: BCN Commercial |
$92.37
|
| Rate for Payer: BCN Medicare Advantage |
$28.09
|
| Rate for Payer: Cash Price |
$89.89
|
| Rate for Payer: Cofinity Commercial |
$96.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.09
|
| Rate for Payer: Healthscope Commercial |
$101.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.27
|
| Rate for Payer: Mclaren Medicaid |
$19.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.49
|
| Rate for Payer: Meridian Medicaid |
$20.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.51
|
| Rate for Payer: Nomi Health Commercial |
$92.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.27
|
| Rate for Payer: PACE Senior Care Partners |
$26.69
|
| Rate for Payer: PACE SWMI |
$28.09
|
| Rate for Payer: PHP Commercial |
$95.51
|
| Rate for Payer: PHP Medicare Advantage |
$28.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.75
|
| Rate for Payer: Priority Health Medicare |
$28.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.20
|
| Rate for Payer: Railroad Medicare Medicare |
$28.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.88
|
| Rate for Payer: UHC Core |
$93.82
|
| Rate for Payer: UHC Exchange |
$28.09
|
| Rate for Payer: UHC Medicaid |
$19.81
|
| Rate for Payer: UHC Medicare Advantage |
$28.09
|
| Rate for Payer: UHCCP Medicaid |
$19.81
|
| Rate for Payer: VA VA |
$28.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.27
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
IP
|
$257.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$179.33 |
| Max. Negotiated Rate |
$231.89 |
| Rate for Payer: Aetna Commercial |
$219.01
|
| Rate for Payer: BCBS Trust/PPO |
$212.80
|
| Rate for Payer: BCN Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cofinity Commercial |
$221.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.13
|
| Rate for Payer: Healthscope Commercial |
$231.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.01
|
| Rate for Payer: Nomi Health Commercial |
$211.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.25
|
| Rate for Payer: PHP Commercial |
$219.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.74
|
| Rate for Payer: UHC Core |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.25
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$257.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$231.89 |
| Rate for Payer: Aetna Commercial |
$219.01
|
| Rate for Payer: Aetna Medicare |
$66.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.52
|
| Rate for Payer: BCBS Complete |
$47.69
|
| Rate for Payer: BCBS MAPPO |
$64.42
|
| Rate for Payer: BCBS Trust/PPO |
$211.82
|
| Rate for Payer: BCN Commercial |
$211.82
|
| Rate for Payer: BCN Medicare Advantage |
$64.42
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cofinity Commercial |
$221.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.42
|
| Rate for Payer: Healthscope Commercial |
$231.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.25
|
| Rate for Payer: Mclaren Medicaid |
$45.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.64
|
| Rate for Payer: Meridian Medicaid |
$47.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.01
|
| Rate for Payer: Nomi Health Commercial |
$211.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.25
|
| Rate for Payer: PACE Senior Care Partners |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.42
|
| Rate for Payer: PHP Commercial |
$219.01
|
| Rate for Payer: PHP Medicare Advantage |
$64.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.16
|
| Rate for Payer: Priority Health Medicare |
$65.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.33
|
| Rate for Payer: Railroad Medicare Medicare |
$64.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.74
|
| Rate for Payer: UHC Core |
$215.15
|
| Rate for Payer: UHC Exchange |
$64.42
|
| Rate for Payer: UHC Medicaid |
$45.43
|
| Rate for Payer: UHC Medicare Advantage |
$64.42
|
| Rate for Payer: UHCCP Medicaid |
$45.43
|
| Rate for Payer: VA VA |
$64.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.25
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
OP
|
$75.38
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$67.84 |
| Rate for Payer: Aetna Commercial |
$64.07
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.56
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$61.97
|
| Rate for Payer: BCN Commercial |
$61.97
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cofinity Commercial |
$64.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$67.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.53
|
| Rate for Payer: Mclaren Medicaid |
$13.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.79
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.07
|
| Rate for Payer: Nomi Health Commercial |
$61.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.53
|
| Rate for Payer: PACE Senior Care Partners |
$17.90
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Commercial |
$64.07
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.58
|
| Rate for Payer: Priority Health Medicare |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.46
|
| Rate for Payer: Railroad Medicare Medicare |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.33
|
| Rate for Payer: UHC Core |
$62.94
|
| Rate for Payer: UHC Exchange |
$18.84
|
| Rate for Payer: UHC Medicaid |
$13.29
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
| Rate for Payer: UHCCP Medicaid |
$13.29
|
| Rate for Payer: VA VA |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.53
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
IP
|
$75.38
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.46 |
| Max. Negotiated Rate |
$67.84 |
| Rate for Payer: Aetna Commercial |
$64.07
|
| Rate for Payer: BCBS Trust/PPO |
$62.26
|
| Rate for Payer: BCN Commercial |
$62.26
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cofinity Commercial |
$64.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.30
|
| Rate for Payer: Healthscope Commercial |
$67.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.07
|
| Rate for Payer: Nomi Health Commercial |
$61.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.53
|
| Rate for Payer: PHP Commercial |
$64.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.33
|
| Rate for Payer: UHC Core |
$62.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.53
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.78
|
| Rate for Payer: BCN Commercial |
$25.78
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$5.78
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$25.66
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicaid |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$5.50
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$42.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$9.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$9.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicaid |
$9.17
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$9.17
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.96
|
| Rate for Payer: BCN Commercial |
$42.96
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.02
|
| Rate for Payer: BCBS MAPPO |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$44.49
|
| Rate for Payer: BCN Commercial |
$44.49
|
| Rate for Payer: BCN Medicare Advantage |
$13.53
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.59
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.21
|
| Rate for Payer: Meridian Medicaid |
$10.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Senior Care Partners |
$12.85
|
| Rate for Payer: PACE SWMI |
$13.53
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicare Advantage |
$13.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.08
|
| Rate for Payer: Priority Health Medicare |
$13.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.67
|
| Rate for Payer: Railroad Medicare Medicare |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.63
|
| Rate for Payer: UHC Core |
$45.19
|
| Rate for Payer: UHC Exchange |
$13.53
|
| Rate for Payer: UHC Medicaid |
$9.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.53
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
