Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR NERVE GRAFT 1 STRAND ARM/LEG >4 CM

Professional

Both

$1,786.00

Service Code	HCPCS 64893
Min. Negotiated Rate	$648.16
Max. Negotiated Rate	$1,963.07
Rate for Payer: Aetna Commercial	$1,442.60
Rate for Payer: Aetna Medicare	$893.00
Rate for Payer: BCBS Complete	$680.57
Rate for Payer: BCN Commercial	$1,690.14
Rate for Payer: Cash Price	$1,428.80
Rate for Payer: Cash Price	$1,428.80
Rate for Payer: Mclaren Medicaid	$648.16
Rate for Payer: Meridian Medicaid	$680.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,339.50
Rate for Payer: Priority Health Choice Medicaid	$648.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,963.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,963.07
Rate for Payer: UHC Medicaid	$648.16
Rate for Payer: UHCCP Medicaid	$648.16

PR NERVE GRAFT 1 STRAND HAND/FOOT <4 CM

Professional

Both

$3,822.00

Service Code	HCPCS 64890
Min. Negotiated Rate	$624.73
Max. Negotiated Rate	$2,866.50
Rate for Payer: Aetna Commercial	$1,390.93
Rate for Payer: Aetna Medicare	$1,911.00
Rate for Payer: BCBS Complete	$655.97
Rate for Payer: BCN Commercial	$1,628.89
Rate for Payer: Cash Price	$3,057.60
Rate for Payer: Cash Price	$3,057.60
Rate for Payer: Mclaren Medicaid	$624.73
Rate for Payer: Meridian Medicaid	$655.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,866.50
Rate for Payer: Priority Health Choice Medicaid	$624.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,891.92
Rate for Payer: Priority Health Narrow/Tiered Network	$1,891.92
Rate for Payer: UHC Medicaid	$624.73
Rate for Payer: UHCCP Medicaid	$624.73

PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS

Professional

Both

$3,032.00

Service Code	HCPCS 64902
Min. Negotiated Rate	$375.73
Max. Negotiated Rate	$2,274.00
Rate for Payer: Aetna Commercial	$890.94
Rate for Payer: Aetna Medicare	$1,516.00
Rate for Payer: BCBS Complete	$394.52
Rate for Payer: BCN Commercial	$1,019.86
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Mclaren Medicaid	$375.73
Rate for Payer: Meridian Medicaid	$394.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,274.00
Rate for Payer: Priority Health Choice Medicaid	$375.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,184.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,184.56
Rate for Payer: UHC Medicaid	$375.73
Rate for Payer: UHCCP Medicaid	$375.73

PR NERVE GRAFT MLT STRANDS ARM/LEG <4 CM

Professional

Both

$2,701.00

Service Code	HCPCS 64897
Min. Negotiated Rate	$728.03
Max. Negotiated Rate	$2,215.83
Rate for Payer: Aetna Commercial	$1,632.38
Rate for Payer: Aetna Medicare	$1,350.50
Rate for Payer: BCBS Complete	$764.43
Rate for Payer: BCN Commercial	$1,907.76
Rate for Payer: Cash Price	$2,160.80
Rate for Payer: Cash Price	$2,160.80
Rate for Payer: Mclaren Medicaid	$728.03
Rate for Payer: Meridian Medicaid	$764.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,025.75
Rate for Payer: Priority Health Choice Medicaid	$728.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,215.83
Rate for Payer: Priority Health Narrow/Tiered Network	$2,215.83
Rate for Payer: UHC Medicaid	$728.03
Rate for Payer: UHCCP Medicaid	$728.03

PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM

Professional

Both

$3,287.00

Service Code	HCPCS 64898
Min. Negotiated Rate	$788.53
Max. Negotiated Rate	$2,465.25
Rate for Payer: Aetna Commercial	$1,767.51
Rate for Payer: Aetna Medicare	$1,643.50
Rate for Payer: BCBS Complete	$827.96
Rate for Payer: BCN Commercial	$2,066.13
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Mclaren Medicaid	$788.53
Rate for Payer: Meridian Medicaid	$827.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,465.25
Rate for Payer: Priority Health Choice Medicaid	$788.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,399.77
Rate for Payer: Priority Health Narrow/Tiered Network	$2,399.77
Rate for Payer: UHC Medicaid	$788.53
Rate for Payer: UHCCP Medicaid	$788.53

PR NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM

Professional

Both

$3,311.00

Service Code	HCPCS 64895
Min. Negotiated Rate	$760.20
Max. Negotiated Rate	$2,483.25
Rate for Payer: Aetna Commercial	$1,709.01
Rate for Payer: Aetna Medicare	$1,655.50
Rate for Payer: BCBS Complete	$798.21
Rate for Payer: BCN Commercial	$1,994.41
Rate for Payer: Cash Price	$2,648.80
Rate for Payer: Cash Price	$2,648.80
Rate for Payer: Mclaren Medicaid	$760.20
Rate for Payer: Meridian Medicaid	$798.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,483.25
Rate for Payer: Priority Health Choice Medicaid	$760.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,316.48
Rate for Payer: Priority Health Narrow/Tiered Network	$2,316.48
Rate for Payer: UHC Medicaid	$760.20
Rate for Payer: UHCCP Medicaid	$760.20

PR NERVE PEDICLE TRANSFER FIRST STAGE

Professional

Both

$2,294.00

Service Code	HCPCS 64905
Min. Negotiated Rate	$568.50
Max. Negotiated Rate	$1,741.54
Rate for Payer: Aetna Commercial	$1,305.22
Rate for Payer: Aetna Medicare	$1,147.00
Rate for Payer: BCBS Complete	$596.92
Rate for Payer: BCN Commercial	$1,499.42
Rate for Payer: Cash Price	$1,835.20
Rate for Payer: Cash Price	$1,835.20
Rate for Payer: Mclaren Medicaid	$568.50
Rate for Payer: Meridian Medicaid	$596.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,720.50
Rate for Payer: Priority Health Choice Medicaid	$568.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,741.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,741.54
Rate for Payer: UHC Medicaid	$568.50
Rate for Payer: UHCCP Medicaid	$568.50

PR NERVE REPAIR W/CONDUIT EACH NERVE

Professional

Both

$2,700.00

Service Code	HCPCS 64910
Min. Negotiated Rate	$444.53
Max. Negotiated Rate	$2,025.00
Rate for Payer: Aetna Commercial	$998.70
Rate for Payer: Aetna Medicare	$1,350.00
Rate for Payer: BCBS Complete	$466.76
Rate for Payer: BCN Commercial	$1,152.33
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Mclaren Medicaid	$444.53
Rate for Payer: Meridian Medicaid	$466.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,025.00
Rate for Payer: Priority Health Choice Medicaid	$444.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,338.41
Rate for Payer: Priority Health Narrow/Tiered Network	$1,338.41
Rate for Payer: UHC Medicaid	$444.53
Rate for Payer: UHCCP Medicaid	$444.53

PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND

Professional

Both

$335.00

Service Code	HCPCS 64913
Min. Negotiated Rate	$93.51
Max. Negotiated Rate	$295.56
Rate for Payer: Aetna Commercial	$228.03
Rate for Payer: Aetna Medicare	$167.50
Rate for Payer: BCBS Complete	$98.19
Rate for Payer: BCN Commercial	$254.47
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$268.00
Rate for Payer: Mclaren Medicaid	$93.51
Rate for Payer: Meridian Medicaid	$98.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$251.25
Rate for Payer: Priority Health Choice Medicaid	$93.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$295.56
Rate for Payer: Priority Health Narrow/Tiered Network	$295.56
Rate for Payer: UHC Medicaid	$93.51
Rate for Payer: UHCCP Medicaid	$93.51

PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND

Professional

Both

$1,640.00

Service Code	HCPCS 64912
Min. Negotiated Rate	$522.28
Max. Negotiated Rate	$1,566.29
Rate for Payer: Aetna Commercial	$1,126.41
Rate for Payer: Aetna Medicare	$820.00
Rate for Payer: BCBS Complete	$548.39
Rate for Payer: BCN Commercial	$1,348.53
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Mclaren Medicaid	$522.28
Rate for Payer: Meridian Medicaid	$548.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,230.00
Rate for Payer: Priority Health Choice Medicaid	$522.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,566.29
Rate for Payer: Priority Health Narrow/Tiered Network	$1,566.29
Rate for Payer: UHC Medicaid	$522.28
Rate for Payer: UHCCP Medicaid	$522.28

PR NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY

Professional

Both

$5.00

Service Code	HCPCS 01967
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$650.00
Rate for Payer: Priority Health Narrow/Tiered Network	$650.00

PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR

Professional

Both

$222.00

Service Code	HCPCS 96116
Min. Negotiated Rate	$46.01
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCBS Complete	$48.31
Rate for Payer: BCN Commercial	$117.52
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Mclaren Medicaid	$46.01
Rate for Payer: Meridian Medicaid	$48.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50
Rate for Payer: Priority Health Choice Medicaid	$46.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$108.38
Rate for Payer: Priority Health Narrow/Tiered Network	$108.38
Rate for Payer: UHC Medicaid	$46.01
Rate for Payer: UHCCP Medicaid	$46.01

PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR

Professional

Both

$172.00

Service Code	HCPCS 96121
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$82.02
Rate for Payer: Aetna Medicare	$86.00
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCN Commercial	$98.10
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Mclaren Medicaid	$39.19
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.00
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$90.47
Rate for Payer: Priority Health Narrow/Tiered Network	$90.47
Rate for Payer: UHC Medicaid	$39.19
Rate for Payer: UHCCP Medicaid	$39.19

PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY

Professional

Both

$4,520.00

Service Code	HCPCS 62164
Min. Negotiated Rate	$1,313.57
Max. Negotiated Rate	$4,415.41
Rate for Payer: Aetna Commercial	$2,702.98
Rate for Payer: Aetna Medicare	$2,260.00
Rate for Payer: BCBS Complete	$1,379.25
Rate for Payer: BCN Commercial	$4,415.41
Rate for Payer: Cash Price	$3,616.00
Rate for Payer: Cash Price	$3,616.00
Rate for Payer: Mclaren Medicaid	$1,313.57
Rate for Payer: Meridian Medicaid	$1,379.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,390.00
Rate for Payer: Priority Health Choice Medicaid	$1,313.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,712.15
Rate for Payer: Priority Health Narrow/Tiered Network	$3,712.15
Rate for Payer: UHC Medicaid	$1,313.57
Rate for Payer: UHCCP Medicaid	$1,313.57

PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH

Professional

Both

$161.00

Service Code	HCPCS 95937
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$151.39
Rate for Payer: Aetna Commercial	$111.69
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: BCN Commercial	$151.39
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.61
Rate for Payer: Priority Health Narrow/Tiered Network	$139.61

PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT

Professional

Both

$2,563.00

Service Code	HCPCS 64702
Min. Negotiated Rate	$311.62
Max. Negotiated Rate	$1,922.25
Rate for Payer: Aetna Commercial	$649.73
Rate for Payer: Aetna Medicare	$1,281.50
Rate for Payer: BCBS Complete	$327.20
Rate for Payer: BCN Commercial	$787.31
Rate for Payer: Cash Price	$2,050.40
Rate for Payer: Cash Price	$2,050.40
Rate for Payer: Mclaren Medicaid	$311.62
Rate for Payer: Meridian Medicaid	$327.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,922.25
Rate for Payer: Priority Health Choice Medicaid	$311.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$914.45
Rate for Payer: Priority Health Narrow/Tiered Network	$914.45
Rate for Payer: UHC Medicaid	$311.62
Rate for Payer: UHCCP Medicaid	$311.62

PR NEUROPLASTY NERVE HAND/FOOT

Professional

Both

$1,945.00

Service Code	HCPCS 64704
Min. Negotiated Rate	$196.60
Max. Negotiated Rate	$1,458.75
Rate for Payer: Aetna Commercial	$413.18
Rate for Payer: Aetna Medicare	$972.50
Rate for Payer: BCBS Complete	$206.43
Rate for Payer: BCN Commercial	$494.99
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Mclaren Medicaid	$196.60
Rate for Payer: Meridian Medicaid	$206.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,458.75
Rate for Payer: Priority Health Choice Medicaid	$196.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$574.92
Rate for Payer: Priority Health Narrow/Tiered Network	$574.92
Rate for Payer: UHC Medicaid	$196.60
Rate for Payer: UHCCP Medicaid	$196.60

PR NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE

Professional

Both

$989.00

Service Code	HCPCS 64716
Min. Negotiated Rate	$299.69
Max. Negotiated Rate	$898.25
Rate for Payer: Aetna Commercial	$656.90
Rate for Payer: Aetna Medicare	$494.50
Rate for Payer: BCBS Complete	$314.67
Rate for Payer: BCN Commercial	$773.37
Rate for Payer: Cash Price	$791.20
Rate for Payer: Cash Price	$791.20
Rate for Payer: Mclaren Medicaid	$299.69
Rate for Payer: Meridian Medicaid	$314.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$741.75
Rate for Payer: Priority Health Choice Medicaid	$299.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$898.25
Rate for Payer: Priority Health Narrow/Tiered Network	$898.25
Rate for Payer: UHC Medicaid	$299.69
Rate for Payer: UHCCP Medicaid	$299.69

PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW

Professional

Both

$3,240.00

Service Code	HCPCS 64718
Min. Negotiated Rate	$366.79
Max. Negotiated Rate	$2,430.00
Rate for Payer: Aetna Commercial	$765.15
Rate for Payer: Aetna Medicare	$1,620.00
Rate for Payer: BCBS Complete	$385.13
Rate for Payer: BCN Commercial	$926.25
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Mclaren Medicaid	$366.79
Rate for Payer: Meridian Medicaid	$385.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,430.00
Rate for Payer: Priority Health Choice Medicaid	$366.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,075.81
Rate for Payer: Priority Health Narrow/Tiered Network	$1,075.81
Rate for Payer: UHC Medicaid	$366.79
Rate for Payer: UHCCP Medicaid	$366.79

PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST

Professional

Both

$1,619.00

Service Code	HCPCS 64719
Min. Negotiated Rate	$247.29
Max. Negotiated Rate	$1,214.25
Rate for Payer: Aetna Commercial	$517.96
Rate for Payer: Aetna Medicare	$809.50
Rate for Payer: BCBS Complete	$259.65
Rate for Payer: BCN Commercial	$625.96
Rate for Payer: Cash Price	$1,295.20
Rate for Payer: Cash Price	$1,295.20
Rate for Payer: Mclaren Medicaid	$247.29
Rate for Payer: Meridian Medicaid	$259.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,214.25
Rate for Payer: Priority Health Choice Medicaid	$247.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$727.05
Rate for Payer: Priority Health Narrow/Tiered Network	$727.05
Rate for Payer: UHC Medicaid	$247.29
Rate for Payer: UHCCP Medicaid	$247.29

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Facility

$2,322.00

Service Code	CPT 64721
Hospital Charge Code	64721
Hospital Revenue Code	960
Min. Negotiated Rate	$1,616.11
Max. Negotiated Rate	$2,089.80
Rate for Payer: Aetna Commercial	$1,973.70
Rate for Payer: BCBS Trust/PPO	$1,917.74
Rate for Payer: BCN Commercial	$1,917.74
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Cofinity Commercial	$1,996.92
Rate for Payer: Encore Health Key Benefits Commercial	$1,857.60
Rate for Payer: Healthscope Commercial	$2,089.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,741.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,973.70
Rate for Payer: Nomi Health Commercial	$1,904.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,741.50
Rate for Payer: PHP Commercial	$1,973.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,020.14
Rate for Payer: Priority Health Narrow/Tiered Network	$1,616.11
Rate for Payer: UHC Core	$1,938.87
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,741.50

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Professional

Both

$2,322.00

Service Code	HCPCS 64721
Hospital Charge Code	64721
Min. Negotiated Rate	$269.87
Max. Negotiated Rate	$1,741.50
Rate for Payer: Aetna Commercial	$553.21
Rate for Payer: Aetna Medicare	$1,161.00
Rate for Payer: BCBS Complete	$283.36
Rate for Payer: BCN Commercial	$671.78
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Mclaren Medicaid	$269.87
Rate for Payer: Meridian Medicaid	$283.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,741.50
Rate for Payer: Priority Health Choice Medicaid	$269.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$780.25
Rate for Payer: Priority Health Narrow/Tiered Network	$780.25
Rate for Payer: UHC Medicaid	$269.87
Rate for Payer: UHCCP Medicaid	$269.87

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Professional

Both

$2,322.00

Service Code	HCPCS 64721
Min. Negotiated Rate	$269.87
Max. Negotiated Rate	$1,741.50
Rate for Payer: Aetna Commercial	$553.21
Rate for Payer: Aetna Medicare	$1,161.00
Rate for Payer: BCBS Complete	$283.36
Rate for Payer: BCN Commercial	$671.78
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Mclaren Medicaid	$269.87
Rate for Payer: Meridian Medicaid	$283.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,741.50
Rate for Payer: Priority Health Choice Medicaid	$269.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$780.25
Rate for Payer: Priority Health Narrow/Tiered Network	$780.25
Rate for Payer: UHC Medicaid	$269.87
Rate for Payer: UHCCP Medicaid	$269.87

PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

Facility

$2,322.00

Service Code	CPT 64721
Hospital Charge Code	64721
Hospital Revenue Code	960
Min. Negotiated Rate	$409.37
Max. Negotiated Rate	$2,089.80
Rate for Payer: Aetna Commercial	$1,973.70
Rate for Payer: Aetna Medicare	$603.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$725.62
Rate for Payer: Amish Plain Church Group Commercial	$725.62
Rate for Payer: BCBS Complete	$429.80
Rate for Payer: BCBS MAPPO	$580.50
Rate for Payer: BCBS Trust/PPO	$1,908.92
Rate for Payer: BCN Commercial	$1,908.92
Rate for Payer: BCN Medicare Advantage	$580.50
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Cofinity Commercial	$1,996.92
Rate for Payer: Encore Health Key Benefits Commercial	$1,857.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$580.50
Rate for Payer: Healthscope Commercial	$2,089.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,741.50
Rate for Payer: Mclaren Medicaid	$409.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$609.52
Rate for Payer: Meridian Medicaid	$429.80
Rate for Payer: MI Amish Medical Board Commercial	$667.58
Rate for Payer: Molina Medicare/Medicaid	$638.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,973.70
Rate for Payer: Nomi Health Commercial	$1,904.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,741.50
Rate for Payer: PACE Senior Care Partners	$551.48
Rate for Payer: PACE SWMI	$580.50
Rate for Payer: PHP Commercial	$1,973.70
Rate for Payer: PHP Medicare Advantage	$580.50
Rate for Payer: Priority Health Choice Medicaid	$409.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,020.14
Rate for Payer: Priority Health Medicare	$586.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,616.11
Rate for Payer: Railroad Medicare Medicare	$580.50
Rate for Payer: UHC Core	$1,938.87
Rate for Payer: UHC Exchange	$580.50
Rate for Payer: UHC Medicaid	$409.37
Rate for Payer: UHC Medicare Advantage	$580.50
Rate for Payer: UHCCP Medicaid	$409.37
Rate for Payer: VA VA	$580.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,741.50

PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR

Professional

Both

$274.00

Service Code	HCPCS 96132
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$205.50
Rate for Payer: Aetna Commercial	$117.40
Rate for Payer: Aetna Medicare	$137.00
Rate for Payer: BCBS Complete	$65.98
Rate for Payer: BCN Commercial	$192.72
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$219.20
Rate for Payer: Mclaren Medicaid	$62.84
Rate for Payer: Meridian Medicaid	$65.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$205.50
Rate for Payer: Priority Health Choice Medicaid	$62.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.04
Rate for Payer: Priority Health Narrow/Tiered Network	$146.04
Rate for Payer: UHC Medicaid	$62.84
Rate for Payer: UHCCP Medicaid	$62.84

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