|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$115.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$97.80
|
| Rate for Payer: Aetna Medicare |
$29.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.96
|
| Rate for Payer: BCBS Complete |
$48.03
|
| Rate for Payer: BCBS MAPPO |
$28.76
|
| Rate for Payer: BCBS Trust/PPO |
$89.46
|
| Rate for Payer: BCN Commercial |
$89.46
|
| Rate for Payer: BCN Medicare Advantage |
$28.76
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.76
|
| Rate for Payer: Healthscope Commercial |
$103.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.30
|
| Rate for Payer: Mclaren Medicaid |
$45.74
|
| Rate for Payer: Meridian Medicaid |
$48.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.80
|
| Rate for Payer: PACE Senior Care Partners |
$27.33
|
| Rate for Payer: PACE SWMI |
$28.76
|
| Rate for Payer: PHP Commercial |
$97.80
|
| Rate for Payer: PHP Medicare Advantage |
$28.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$28.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.18
|
| Rate for Payer: Railroad Medicare Medicare |
$28.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.25
|
| Rate for Payer: UHC Core |
$96.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.76
|
| Rate for Payer: UHC Medicare Advantage |
$29.63
|
| Rate for Payer: VA VA |
$28.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.30
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$115.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$97.80
|
| Rate for Payer: BCBS Trust/PPO |
$88.92
|
| Rate for Payer: BCN Commercial |
$88.92
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.05
|
| Rate for Payer: Healthscope Commercial |
$103.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.80
|
| Rate for Payer: PHP Commercial |
$97.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.25
|
| Rate for Payer: UHC Core |
$96.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.30
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$43.28
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$11.31
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.54
|
| Rate for Payer: BCN Commercial |
$43.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Mclaren Medicaid |
$10.77
|
| Rate for Payer: Meridian Medicaid |
$11.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Medicare |
$14.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.42
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,016.90
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$239.66 |
| Max. Negotiated Rate |
$915.21 |
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: Aetna Medicare |
$264.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$317.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$317.78
|
| Rate for Payer: BCBS Complete |
$251.64
|
| Rate for Payer: BCBS MAPPO |
$254.22
|
| Rate for Payer: BCBS Trust/PPO |
$790.64
|
| Rate for Payer: BCN Commercial |
$790.64
|
| Rate for Payer: BCN Medicare Advantage |
$254.22
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.22
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.68
|
| Rate for Payer: Mclaren Medicaid |
$239.66
|
| Rate for Payer: Meridian Medicaid |
$251.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$266.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: PACE Senior Care Partners |
$241.51
|
| Rate for Payer: PACE SWMI |
$254.22
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: PHP Medicare Advantage |
$254.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.70
|
| Rate for Payer: Priority Health Medicare |
$254.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$620.21
|
| Rate for Payer: Railroad Medicare Medicare |
$254.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.87
|
| Rate for Payer: UHC Core |
$849.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.22
|
| Rate for Payer: UHC Medicare Advantage |
$261.85
|
| Rate for Payer: VA VA |
$254.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.68
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,016.90
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$620.21 |
| Max. Negotiated Rate |
$915.21 |
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: BCBS Trust/PPO |
$785.86
|
| Rate for Payer: BCN Commercial |
$785.86
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$620.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.87
|
| Rate for Payer: UHC Core |
$849.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.68
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$184.92
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Aetna Commercial |
$157.18
|
| Rate for Payer: Aetna Medicare |
$48.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.79
|
| Rate for Payer: BCBS Complete |
$73.97
|
| Rate for Payer: BCBS MAPPO |
$46.23
|
| Rate for Payer: BCBS Trust/PPO |
$143.78
|
| Rate for Payer: BCN Commercial |
$143.78
|
| Rate for Payer: BCN Medicare Advantage |
$46.23
|
| Rate for Payer: Cash Price |
$147.94
|
| Rate for Payer: Cofinity Commercial |
$159.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.23
|
| Rate for Payer: Healthscope Commercial |
$166.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.18
|
| Rate for Payer: PACE Senior Care Partners |
$43.92
|
| Rate for Payer: PACE SWMI |
$46.23
|
| Rate for Payer: PHP Commercial |
$157.18
|
| Rate for Payer: PHP Medicare Advantage |
$46.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.88
|
| Rate for Payer: Priority Health Medicare |
$46.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.78
|
| Rate for Payer: Railroad Medicare Medicare |
$46.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.73
|
| Rate for Payer: UHC Core |
$154.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.23
|
| Rate for Payer: UHC Medicare Advantage |
$47.62
|
| Rate for Payer: VA VA |
$46.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.69
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$184.92
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.78 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Aetna Commercial |
$157.18
|
| Rate for Payer: BCBS Trust/PPO |
$142.91
|
| Rate for Payer: BCN Commercial |
$142.91
|
| Rate for Payer: Cash Price |
$147.94
|
| Rate for Payer: Cofinity Commercial |
$159.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.94
|
| Rate for Payer: Healthscope Commercial |
$166.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.18
|
| Rate for Payer: PHP Commercial |
$157.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.73
|
| Rate for Payer: UHC Core |
$154.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.69
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$421.26
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$256.93 |
| Max. Negotiated Rate |
$379.13 |
| Rate for Payer: Aetna Commercial |
$358.07
|
| Rate for Payer: Aetna Commercial |
$376.55
|
| Rate for Payer: BCBS Trust/PPO |
$342.35
|
| Rate for Payer: BCBS Trust/PPO |
$325.55
|
| Rate for Payer: BCN Commercial |
$325.55
|
| Rate for Payer: BCN Commercial |
$342.35
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cofinity Commercial |
$380.98
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.40
|
| Rate for Payer: Healthscope Commercial |
$379.13
|
| Rate for Payer: Healthscope Commercial |
$398.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.55
|
| Rate for Payer: PHP Commercial |
$358.07
|
| Rate for Payer: PHP Commercial |
$376.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.84
|
| Rate for Payer: UHC Core |
$369.90
|
| Rate for Payer: UHC Core |
$351.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.25
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.01 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Aetna Commercial |
$376.55
|
| Rate for Payer: Aetna Commercial |
$358.07
|
| Rate for Payer: Aetna Medicare |
$115.18
|
| Rate for Payer: Aetna Medicare |
$109.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.64
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS MAPPO |
$110.75
|
| Rate for Payer: BCBS MAPPO |
$105.32
|
| Rate for Payer: BCBS Trust/PPO |
$327.53
|
| Rate for Payer: BCBS Trust/PPO |
$344.43
|
| Rate for Payer: BCN Commercial |
$344.43
|
| Rate for Payer: BCN Commercial |
$327.53
|
| Rate for Payer: BCN Medicare Advantage |
$110.75
|
| Rate for Payer: BCN Medicare Advantage |
$105.32
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cofinity Commercial |
$380.98
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.75
|
| Rate for Payer: Healthscope Commercial |
$398.70
|
| Rate for Payer: Healthscope Commercial |
$379.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.25
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.07
|
| Rate for Payer: PACE Senior Care Partners |
$105.21
|
| Rate for Payer: PACE Senior Care Partners |
$100.05
|
| Rate for Payer: PACE SWMI |
$105.32
|
| Rate for Payer: PACE SWMI |
$110.75
|
| Rate for Payer: PHP Commercial |
$358.07
|
| Rate for Payer: PHP Commercial |
$376.55
|
| Rate for Payer: PHP Medicare Advantage |
$110.75
|
| Rate for Payer: PHP Medicare Advantage |
$105.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.41
|
| Rate for Payer: Priority Health Medicare |
$105.32
|
| Rate for Payer: Priority Health Medicare |
$110.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.93
|
| Rate for Payer: Railroad Medicare Medicare |
$110.75
|
| Rate for Payer: Railroad Medicare Medicare |
$105.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.84
|
| Rate for Payer: UHC Core |
$351.75
|
| Rate for Payer: UHC Core |
$369.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.07
|
| Rate for Payer: UHC Medicare Advantage |
$108.47
|
| Rate for Payer: VA VA |
$105.32
|
| Rate for Payer: VA VA |
$110.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.25
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$280.58
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.13 |
| Max. Negotiated Rate |
$252.52 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: BCBS Trust/PPO |
$216.83
|
| Rate for Payer: BCN Commercial |
$216.83
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$241.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.46
|
| Rate for Payer: Healthscope Commercial |
$252.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.49
|
| Rate for Payer: PHP Commercial |
$238.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.91
|
| Rate for Payer: UHC Core |
$234.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.44
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$280.58
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$252.52 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Aetna Medicare |
$72.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.68
|
| Rate for Payer: BCBS Complete |
$124.88
|
| Rate for Payer: BCBS MAPPO |
$70.14
|
| Rate for Payer: BCBS Trust/PPO |
$218.15
|
| Rate for Payer: BCN Commercial |
$218.15
|
| Rate for Payer: BCN Medicare Advantage |
$70.14
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$241.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$252.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.44
|
| Rate for Payer: Mclaren Medicaid |
$118.94
|
| Rate for Payer: Meridian Medicaid |
$124.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.49
|
| Rate for Payer: PACE Senior Care Partners |
$66.64
|
| Rate for Payer: PACE SWMI |
$70.14
|
| Rate for Payer: PHP Commercial |
$238.49
|
| Rate for Payer: PHP Medicare Advantage |
$70.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.10
|
| Rate for Payer: Priority Health Medicare |
$70.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.13
|
| Rate for Payer: Railroad Medicare Medicare |
$70.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.91
|
| Rate for Payer: UHC Core |
$234.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.14
|
| Rate for Payer: UHC Medicare Advantage |
$72.25
|
| Rate for Payer: VA VA |
$70.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.44
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,844.61
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$594.64 |
| Max. Negotiated Rate |
$3,460.15 |
| Rate for Payer: Aetna Commercial |
$3,267.92
|
| Rate for Payer: Aetna Medicare |
$999.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,201.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,201.44
|
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: BCBS MAPPO |
$961.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,989.18
|
| Rate for Payer: BCN Commercial |
$2,989.18
|
| Rate for Payer: BCN Medicare Advantage |
$961.15
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cofinity Commercial |
$3,306.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,075.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.15
|
| Rate for Payer: Healthscope Commercial |
$3,460.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,883.46
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,009.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,105.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,267.92
|
| Rate for Payer: PACE Senior Care Partners |
$913.09
|
| Rate for Payer: PACE SWMI |
$961.15
|
| Rate for Payer: PHP Commercial |
$3,267.92
|
| Rate for Payer: PHP Medicare Advantage |
$961.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,344.81
|
| Rate for Payer: Priority Health Medicare |
$961.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,344.83
|
| Rate for Payer: Railroad Medicare Medicare |
$961.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,383.26
|
| Rate for Payer: UHC Core |
$3,210.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$961.15
|
| Rate for Payer: UHC Medicare Advantage |
$989.99
|
| Rate for Payer: VA VA |
$961.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,883.46
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,844.61
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,344.83 |
| Max. Negotiated Rate |
$3,460.15 |
| Rate for Payer: Aetna Commercial |
$3,267.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,971.11
|
| Rate for Payer: BCN Commercial |
$2,971.11
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cofinity Commercial |
$3,306.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,075.69
|
| Rate for Payer: Healthscope Commercial |
$3,460.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,883.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,267.92
|
| Rate for Payer: PHP Commercial |
$3,267.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,344.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,344.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,383.26
|
| Rate for Payer: UHC Core |
$3,210.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,883.46
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna Commercial |
$226.95
|
| Rate for Payer: Aetna Medicare |
$69.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.44
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$66.75
|
| Rate for Payer: BCBS Trust/PPO |
$207.59
|
| Rate for Payer: BCN Commercial |
$207.59
|
| Rate for Payer: BCN Medicare Advantage |
$66.75
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$229.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.75
|
| Rate for Payer: Healthscope Commercial |
$240.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.25
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.95
|
| Rate for Payer: PACE Senior Care Partners |
$63.41
|
| Rate for Payer: PACE SWMI |
$66.75
|
| Rate for Payer: PHP Commercial |
$226.95
|
| Rate for Payer: PHP Medicare Advantage |
$66.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.29
|
| Rate for Payer: Priority Health Medicare |
$66.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.84
|
| Rate for Payer: Railroad Medicare Medicare |
$66.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.96
|
| Rate for Payer: UHC Core |
$222.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.75
|
| Rate for Payer: UHC Medicare Advantage |
$68.75
|
| Rate for Payer: VA VA |
$66.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.25
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna Commercial |
$226.95
|
| Rate for Payer: BCBS Trust/PPO |
$206.34
|
| Rate for Payer: BCN Commercial |
$206.34
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$229.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.60
|
| Rate for Payer: Healthscope Commercial |
$240.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.95
|
| Rate for Payer: PHP Commercial |
$226.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.96
|
| Rate for Payer: UHC Core |
$222.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.25
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna Medicare |
$22.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.55
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$22.04
|
| Rate for Payer: BCBS Trust/PPO |
$68.54
|
| Rate for Payer: BCN Commercial |
$68.54
|
| Rate for Payer: BCN Medicare Advantage |
$22.04
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.04
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.12
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.94
|
| Rate for Payer: PACE Senior Care Partners |
$20.94
|
| Rate for Payer: PACE SWMI |
$22.04
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$22.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.77
|
| Rate for Payer: Railroad Medicare Medicare |
$22.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.58
|
| Rate for Payer: UHC Core |
$73.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.04
|
| Rate for Payer: UHC Medicare Advantage |
$22.70
|
| Rate for Payer: VA VA |
$22.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.12
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$88.16
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: BCBS Trust/PPO |
$68.13
|
| Rate for Payer: BCN Commercial |
$68.13
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.94
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.58
|
| Rate for Payer: UHC Core |
$73.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.12
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$281.68
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$253.51 |
| Rate for Payer: Aetna Commercial |
$239.43
|
| Rate for Payer: Aetna Medicare |
$73.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.02
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$70.42
|
| Rate for Payer: BCBS Trust/PPO |
$219.01
|
| Rate for Payer: BCN Commercial |
$219.01
|
| Rate for Payer: BCN Medicare Advantage |
$70.42
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cofinity Commercial |
$242.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.42
|
| Rate for Payer: Healthscope Commercial |
$253.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.26
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.43
|
| Rate for Payer: PACE Senior Care Partners |
$66.90
|
| Rate for Payer: PACE SWMI |
$70.42
|
| Rate for Payer: PHP Commercial |
$239.43
|
| Rate for Payer: PHP Medicare Advantage |
$70.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.06
|
| Rate for Payer: Priority Health Medicare |
$70.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.80
|
| Rate for Payer: Railroad Medicare Medicare |
$70.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.88
|
| Rate for Payer: UHC Core |
$235.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.42
|
| Rate for Payer: UHC Medicare Advantage |
$72.53
|
| Rate for Payer: VA VA |
$70.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.26
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
IP
|
$281.68
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$253.51 |
| Rate for Payer: Aetna Commercial |
$239.43
|
| Rate for Payer: BCBS Trust/PPO |
$217.68
|
| Rate for Payer: BCN Commercial |
$217.68
|
| Rate for Payer: Cash Price |
$225.34
|
| Rate for Payer: Cofinity Commercial |
$242.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.34
|
| Rate for Payer: Healthscope Commercial |
$253.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.43
|
| Rate for Payer: PHP Commercial |
$239.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.88
|
| Rate for Payer: UHC Core |
$235.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.26
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$937.20
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$843.48 |
| Rate for Payer: Aetna Commercial |
$796.62
|
| Rate for Payer: Aetna Medicare |
$243.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.88
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$234.30
|
| Rate for Payer: BCBS Trust/PPO |
$728.67
|
| Rate for Payer: BCN Commercial |
$728.67
|
| Rate for Payer: BCN Medicare Advantage |
$234.30
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cofinity Commercial |
$805.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.30
|
| Rate for Payer: Healthscope Commercial |
$843.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.90
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$796.62
|
| Rate for Payer: PACE Senior Care Partners |
$222.58
|
| Rate for Payer: PACE SWMI |
$234.30
|
| Rate for Payer: PHP Commercial |
$796.62
|
| Rate for Payer: PHP Medicare Advantage |
$234.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.36
|
| Rate for Payer: Priority Health Medicare |
$234.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$571.60
|
| Rate for Payer: Railroad Medicare Medicare |
$234.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.74
|
| Rate for Payer: UHC Core |
$782.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.30
|
| Rate for Payer: UHC Medicare Advantage |
$241.33
|
| Rate for Payer: VA VA |
$234.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.90
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$937.20
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$571.60 |
| Max. Negotiated Rate |
$843.48 |
| Rate for Payer: Aetna Commercial |
$796.62
|
| Rate for Payer: BCBS Trust/PPO |
$724.27
|
| Rate for Payer: BCN Commercial |
$724.27
|
| Rate for Payer: Cash Price |
$749.76
|
| Rate for Payer: Cofinity Commercial |
$805.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.76
|
| Rate for Payer: Healthscope Commercial |
$843.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$796.62
|
| Rate for Payer: PHP Commercial |
$796.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$571.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.74
|
| Rate for Payer: UHC Core |
$782.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.90
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$480.45 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: BCBS Trust/PPO |
$608.78
|
| Rate for Payer: BCN Commercial |
$608.78
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.23
|
| Rate for Payer: UHC Core |
$657.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.82
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
OP
|
$787.76
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.09 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Medicare |
$204.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.18
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$196.94
|
| Rate for Payer: BCBS Trust/PPO |
$612.48
|
| Rate for Payer: BCN Commercial |
$612.48
|
| Rate for Payer: BCN Medicare Advantage |
$196.94
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.94
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.82
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$206.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PACE Senior Care Partners |
$187.09
|
| Rate for Payer: PACE SWMI |
$196.94
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: PHP Medicare Advantage |
$196.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.35
|
| Rate for Payer: Priority Health Medicare |
$196.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.45
|
| Rate for Payer: Railroad Medicare Medicare |
$196.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.23
|
| Rate for Payer: UHC Core |
$657.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.94
|
| Rate for Payer: UHC Medicare Advantage |
$202.85
|
| Rate for Payer: VA VA |
$196.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.82
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
IP
|
$787.76
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$480.45 |
| Max. Negotiated Rate |
$708.98 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: BCBS Trust/PPO |
$608.78
|
| Rate for Payer: BCN Commercial |
$608.78
|
| Rate for Payer: Cash Price |
$630.21
|
| Rate for Payer: Cofinity Commercial |
$677.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.21
|
| Rate for Payer: Healthscope Commercial |
$708.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.60
|
| Rate for Payer: PHP Commercial |
$669.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.23
|
| Rate for Payer: UHC Core |
$657.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.82
|
|
