|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,999.93
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,783.95 |
| Max. Negotiated Rate |
$3,599.94 |
| Rate for Payer: Aetna Commercial |
$3,399.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,303.54
|
| Rate for Payer: BCN Commercial |
$3,303.54
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cofinity Commercial |
$3,439.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.94
|
| Rate for Payer: Healthscope Commercial |
$3,599.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,999.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,399.94
|
| Rate for Payer: Nomi Health Commercial |
$3,279.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.95
|
| Rate for Payer: PHP Commercial |
$3,399.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,479.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,783.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,519.94
|
| Rate for Payer: UHC Core |
$3,339.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,999.95
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,999.93
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$705.19 |
| Max. Negotiated Rate |
$3,599.94 |
| Rate for Payer: Aetna Commercial |
$3,399.94
|
| Rate for Payer: Aetna Medicare |
$1,039.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,249.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,249.98
|
| Rate for Payer: BCBS Complete |
$740.39
|
| Rate for Payer: BCBS MAPPO |
$999.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,288.34
|
| Rate for Payer: BCN Commercial |
$3,288.34
|
| Rate for Payer: BCN Medicare Advantage |
$999.98
|
| Rate for Payer: Cash Price |
$3,199.94
|
| Rate for Payer: Cofinity Commercial |
$3,439.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$999.98
|
| Rate for Payer: Healthscope Commercial |
$3,599.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,999.95
|
| Rate for Payer: Mclaren Medicaid |
$705.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,049.98
|
| Rate for Payer: Meridian Medicaid |
$740.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,149.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,099.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,399.94
|
| Rate for Payer: Nomi Health Commercial |
$3,279.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.95
|
| Rate for Payer: PACE Senior Care Partners |
$949.98
|
| Rate for Payer: PACE SWMI |
$999.98
|
| Rate for Payer: PHP Commercial |
$3,399.94
|
| Rate for Payer: PHP Medicare Advantage |
$999.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$705.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,479.94
|
| Rate for Payer: Priority Health Medicare |
$1,009.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,783.95
|
| Rate for Payer: Railroad Medicare Medicare |
$999.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,519.94
|
| Rate for Payer: UHC Core |
$3,339.94
|
| Rate for Payer: UHC Exchange |
$999.98
|
| Rate for Payer: UHC Medicaid |
$705.19
|
| Rate for Payer: UHC Medicare Advantage |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$705.19
|
| Rate for Payer: VA VA |
$999.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,999.95
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$277.79
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.34 |
| Max. Negotiated Rate |
$250.01 |
| Rate for Payer: Aetna Commercial |
$236.12
|
| Rate for Payer: BCBS Trust/PPO |
$229.43
|
| Rate for Payer: BCN Commercial |
$229.43
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.23
|
| Rate for Payer: Healthscope Commercial |
$250.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.12
|
| Rate for Payer: Nomi Health Commercial |
$227.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.34
|
| Rate for Payer: PHP Commercial |
$236.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.46
|
| Rate for Payer: UHC Core |
$231.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.34
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$277.79
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$250.01 |
| Rate for Payer: Aetna Commercial |
$236.12
|
| Rate for Payer: Aetna Medicare |
$72.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.81
|
| Rate for Payer: BCBS Complete |
$51.42
|
| Rate for Payer: BCBS MAPPO |
$69.45
|
| Rate for Payer: BCBS Trust/PPO |
$228.37
|
| Rate for Payer: BCN Commercial |
$228.37
|
| Rate for Payer: BCN Medicare Advantage |
$69.45
|
| Rate for Payer: Cash Price |
$222.23
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.45
|
| Rate for Payer: Healthscope Commercial |
$250.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.34
|
| Rate for Payer: Mclaren Medicaid |
$48.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.92
|
| Rate for Payer: Meridian Medicaid |
$51.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.12
|
| Rate for Payer: Nomi Health Commercial |
$227.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.34
|
| Rate for Payer: PACE Senior Care Partners |
$65.98
|
| Rate for Payer: PACE SWMI |
$69.45
|
| Rate for Payer: PHP Commercial |
$236.12
|
| Rate for Payer: PHP Medicare Advantage |
$69.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.68
|
| Rate for Payer: Priority Health Medicare |
$70.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.34
|
| Rate for Payer: Railroad Medicare Medicare |
$69.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.46
|
| Rate for Payer: UHC Core |
$231.95
|
| Rate for Payer: UHC Exchange |
$69.45
|
| Rate for Payer: UHC Medicaid |
$48.97
|
| Rate for Payer: UHC Medicare Advantage |
$69.45
|
| Rate for Payer: UHCCP Medicaid |
$48.97
|
| Rate for Payer: VA VA |
$69.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.34
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$91.72
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Aetna Commercial |
$77.96
|
| Rate for Payer: BCBS Trust/PPO |
$75.75
|
| Rate for Payer: BCN Commercial |
$75.75
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Commercial |
$78.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Healthscope Commercial |
$82.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$75.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PHP Commercial |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.71
|
| Rate for Payer: UHC Core |
$76.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.79
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Aetna Commercial |
$77.96
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.66
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCBS Trust/PPO |
$75.40
|
| Rate for Payer: BCN Commercial |
$75.40
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Commercial |
$78.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Healthscope Commercial |
$82.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.79
|
| Rate for Payer: Mclaren Medicaid |
$16.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Meridian Medicaid |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$75.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PACE Senior Care Partners |
$21.78
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Commercial |
$77.96
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.80
|
| Rate for Payer: Priority Health Medicare |
$23.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.84
|
| Rate for Payer: Railroad Medicare Medicare |
$22.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.71
|
| Rate for Payer: UHC Core |
$76.59
|
| Rate for Payer: UHC Exchange |
$22.93
|
| Rate for Payer: UHC Medicaid |
$16.17
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
| Rate for Payer: UHCCP Medicaid |
$16.17
|
| Rate for Payer: VA VA |
$22.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.79
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
IP
|
$293.06
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.97 |
| Max. Negotiated Rate |
$263.75 |
| Rate for Payer: Aetna Commercial |
$249.10
|
| Rate for Payer: BCBS Trust/PPO |
$242.04
|
| Rate for Payer: BCN Commercial |
$242.04
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$252.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.45
|
| Rate for Payer: Healthscope Commercial |
$263.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.10
|
| Rate for Payer: Nomi Health Commercial |
$240.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.79
|
| Rate for Payer: PHP Commercial |
$249.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.89
|
| Rate for Payer: UHC Core |
$244.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.79
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$293.06
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$263.75 |
| Rate for Payer: Aetna Commercial |
$249.10
|
| Rate for Payer: Aetna Medicare |
$76.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.58
|
| Rate for Payer: BCBS Complete |
$54.25
|
| Rate for Payer: BCBS MAPPO |
$73.27
|
| Rate for Payer: BCBS Trust/PPO |
$240.92
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: BCN Medicare Advantage |
$73.27
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$252.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.27
|
| Rate for Payer: Healthscope Commercial |
$263.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.79
|
| Rate for Payer: Mclaren Medicaid |
$51.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.93
|
| Rate for Payer: Meridian Medicaid |
$54.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.10
|
| Rate for Payer: Nomi Health Commercial |
$240.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.79
|
| Rate for Payer: PACE Senior Care Partners |
$69.60
|
| Rate for Payer: PACE SWMI |
$73.27
|
| Rate for Payer: PHP Commercial |
$249.10
|
| Rate for Payer: PHP Medicare Advantage |
$73.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.96
|
| Rate for Payer: Priority Health Medicare |
$74.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.97
|
| Rate for Payer: Railroad Medicare Medicare |
$73.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.89
|
| Rate for Payer: UHC Core |
$244.71
|
| Rate for Payer: UHC Exchange |
$73.27
|
| Rate for Payer: UHC Medicaid |
$51.67
|
| Rate for Payer: UHC Medicare Advantage |
$73.27
|
| Rate for Payer: UHCCP Medicaid |
$51.67
|
| Rate for Payer: VA VA |
$73.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.79
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$975.06
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$678.64 |
| Max. Negotiated Rate |
$877.55 |
| Rate for Payer: Aetna Commercial |
$828.80
|
| Rate for Payer: BCBS Trust/PPO |
$805.30
|
| Rate for Payer: BCN Commercial |
$805.30
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cofinity Commercial |
$838.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.05
|
| Rate for Payer: Healthscope Commercial |
$877.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.80
|
| Rate for Payer: Nomi Health Commercial |
$799.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.29
|
| Rate for Payer: PHP Commercial |
$828.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$848.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.05
|
| Rate for Payer: UHC Core |
$814.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.29
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$975.06
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$171.90 |
| Max. Negotiated Rate |
$877.55 |
| Rate for Payer: Aetna Commercial |
$828.80
|
| Rate for Payer: Aetna Medicare |
$253.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.71
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: BCBS MAPPO |
$243.76
|
| Rate for Payer: BCBS Trust/PPO |
$801.60
|
| Rate for Payer: BCN Commercial |
$801.60
|
| Rate for Payer: BCN Medicare Advantage |
$243.76
|
| Rate for Payer: Cash Price |
$780.05
|
| Rate for Payer: Cofinity Commercial |
$838.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.76
|
| Rate for Payer: Healthscope Commercial |
$877.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.29
|
| Rate for Payer: Mclaren Medicaid |
$171.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.95
|
| Rate for Payer: Meridian Medicaid |
$180.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$268.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.80
|
| Rate for Payer: Nomi Health Commercial |
$799.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.29
|
| Rate for Payer: PACE Senior Care Partners |
$231.58
|
| Rate for Payer: PACE SWMI |
$243.76
|
| Rate for Payer: PHP Commercial |
$828.80
|
| Rate for Payer: PHP Medicare Advantage |
$243.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$848.30
|
| Rate for Payer: Priority Health Medicare |
$246.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.64
|
| Rate for Payer: Railroad Medicare Medicare |
$243.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.05
|
| Rate for Payer: UHC Core |
$814.18
|
| Rate for Payer: UHC Exchange |
$243.76
|
| Rate for Payer: UHC Medicaid |
$171.90
|
| Rate for Payer: UHC Medicare Advantage |
$243.76
|
| Rate for Payer: UHCCP Medicaid |
$171.90
|
| Rate for Payer: VA VA |
$243.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.29
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.43 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: BCBS Trust/PPO |
$676.90
|
| Rate for Payer: BCN Commercial |
$676.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$144.49 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$213.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.12
|
| Rate for Payer: BCBS Complete |
$151.71
|
| Rate for Payer: BCBS MAPPO |
$204.90
|
| Rate for Payer: BCBS Trust/PPO |
$673.78
|
| Rate for Payer: BCN Commercial |
$673.78
|
| Rate for Payer: BCN Medicare Advantage |
$204.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Mclaren Medicaid |
$144.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.14
|
| Rate for Payer: Meridian Medicaid |
$151.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Senior Care Partners |
$194.65
|
| Rate for Payer: PACE SWMI |
$204.90
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$204.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Medicare |
$206.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: Railroad Medicare Medicare |
$204.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: UHC Exchange |
$204.90
|
| Rate for Payer: UHC Medicaid |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$204.90
|
| Rate for Payer: UHCCP Medicaid |
$144.49
|
| Rate for Payer: VA VA |
$204.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$144.49 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$213.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.12
|
| Rate for Payer: BCBS Complete |
$151.71
|
| Rate for Payer: BCBS MAPPO |
$204.90
|
| Rate for Payer: BCBS Trust/PPO |
$673.78
|
| Rate for Payer: BCN Commercial |
$673.78
|
| Rate for Payer: BCN Medicare Advantage |
$204.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Mclaren Medicaid |
$144.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.14
|
| Rate for Payer: Meridian Medicaid |
$151.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Senior Care Partners |
$194.65
|
| Rate for Payer: PACE SWMI |
$204.90
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$204.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Medicare |
$206.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: Railroad Medicare Medicare |
$204.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: UHC Exchange |
$204.90
|
| Rate for Payer: UHC Medicaid |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$204.90
|
| Rate for Payer: UHCCP Medicaid |
$144.49
|
| Rate for Payer: VA VA |
$204.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM CNS 78699
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78699
|
| Hospital Charge Code |
34100043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.43 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: BCBS Trust/PPO |
$676.90
|
| Rate for Payer: BCN Commercial |
$676.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$144.49 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$213.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.12
|
| Rate for Payer: BCBS Complete |
$151.71
|
| Rate for Payer: BCBS MAPPO |
$204.90
|
| Rate for Payer: BCBS Trust/PPO |
$673.78
|
| Rate for Payer: BCN Commercial |
$673.78
|
| Rate for Payer: BCN Medicare Advantage |
$204.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Mclaren Medicaid |
$144.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.14
|
| Rate for Payer: Meridian Medicaid |
$151.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Senior Care Partners |
$194.65
|
| Rate for Payer: PACE SWMI |
$204.90
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$204.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Medicare |
$206.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: Railroad Medicare Medicare |
$204.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: UHC Exchange |
$204.90
|
| Rate for Payer: UHC Medicaid |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$204.90
|
| Rate for Payer: UHCCP Medicaid |
$144.49
|
| Rate for Payer: VA VA |
$204.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM ENDOCR 78099
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78099
|
| Hospital Charge Code |
34100008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.43 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: BCBS Trust/PPO |
$676.90
|
| Rate for Payer: BCN Commercial |
$676.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$144.49 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$213.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.12
|
| Rate for Payer: BCBS Complete |
$151.71
|
| Rate for Payer: BCBS MAPPO |
$204.90
|
| Rate for Payer: BCBS Trust/PPO |
$673.78
|
| Rate for Payer: BCN Commercial |
$673.78
|
| Rate for Payer: BCN Medicare Advantage |
$204.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Mclaren Medicaid |
$144.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.14
|
| Rate for Payer: Meridian Medicaid |
$151.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Senior Care Partners |
$194.65
|
| Rate for Payer: PACE SWMI |
$204.90
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$204.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Medicare |
$206.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: Railroad Medicare Medicare |
$204.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: UHC Exchange |
$204.90
|
| Rate for Payer: UHC Medicaid |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$204.90
|
| Rate for Payer: UHCCP Medicaid |
$144.49
|
| Rate for Payer: VA VA |
$204.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM GI PROC 78299
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78299
|
| Hospital Charge Code |
34100022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.43 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: BCBS Trust/PPO |
$676.90
|
| Rate for Payer: BCN Commercial |
$676.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
OP
|
$819.59
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$144.49 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: Aetna Medicare |
$213.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.12
|
| Rate for Payer: BCBS Complete |
$151.71
|
| Rate for Payer: BCBS MAPPO |
$204.90
|
| Rate for Payer: BCBS Trust/PPO |
$673.78
|
| Rate for Payer: BCN Commercial |
$673.78
|
| Rate for Payer: BCN Medicare Advantage |
$204.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Mclaren Medicaid |
$144.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.14
|
| Rate for Payer: Meridian Medicaid |
$151.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PACE Senior Care Partners |
$194.65
|
| Rate for Payer: PACE SWMI |
$204.90
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: PHP Medicare Advantage |
$204.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Medicare |
$206.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: Railroad Medicare Medicare |
$204.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: UHC Exchange |
$204.90
|
| Rate for Payer: UHC Medicaid |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$204.90
|
| Rate for Payer: UHCCP Medicaid |
$144.49
|
| Rate for Payer: VA VA |
$204.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM GU 78799
|
Facility
|
IP
|
$819.59
|
|
|
Service Code
|
CPT 78799
|
| Hospital Charge Code |
34100051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.43 |
| Max. Negotiated Rate |
$737.63 |
| Rate for Payer: Aetna Commercial |
$696.65
|
| Rate for Payer: BCBS Trust/PPO |
$676.90
|
| Rate for Payer: BCN Commercial |
$676.90
|
| Rate for Payer: Cash Price |
$655.67
|
| Rate for Payer: Cofinity Commercial |
$704.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.67
|
| Rate for Payer: Healthscope Commercial |
$737.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.65
|
| Rate for Payer: Nomi Health Commercial |
$672.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.69
|
| Rate for Payer: PHP Commercial |
$696.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.24
|
| Rate for Payer: UHC Core |
$684.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.69
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
IP
|
$765.35
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$532.68 |
| Max. Negotiated Rate |
$688.82 |
| Rate for Payer: Aetna Commercial |
$650.55
|
| Rate for Payer: BCBS Trust/PPO |
$632.10
|
| Rate for Payer: BCN Commercial |
$632.10
|
| Rate for Payer: Cash Price |
$612.28
|
| Rate for Payer: Cofinity Commercial |
$658.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.28
|
| Rate for Payer: Healthscope Commercial |
$688.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.55
|
| Rate for Payer: Nomi Health Commercial |
$627.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.01
|
| Rate for Payer: PHP Commercial |
$650.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$665.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.51
|
| Rate for Payer: UHC Core |
$639.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.01
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
OP
|
$765.35
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.93 |
| Max. Negotiated Rate |
$688.82 |
| Rate for Payer: Aetna Commercial |
$650.55
|
| Rate for Payer: Aetna Medicare |
$198.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$239.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$239.17
|
| Rate for Payer: BCBS Complete |
$141.67
|
| Rate for Payer: BCBS MAPPO |
$191.34
|
| Rate for Payer: BCBS Trust/PPO |
$629.19
|
| Rate for Payer: BCN Commercial |
$629.19
|
| Rate for Payer: BCN Medicare Advantage |
$191.34
|
| Rate for Payer: Cash Price |
$612.28
|
| Rate for Payer: Cofinity Commercial |
$658.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.34
|
| Rate for Payer: Healthscope Commercial |
$688.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.01
|
| Rate for Payer: Mclaren Medicaid |
$134.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.90
|
| Rate for Payer: Meridian Medicaid |
$141.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$210.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.55
|
| Rate for Payer: Nomi Health Commercial |
$627.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.01
|
| Rate for Payer: PACE Senior Care Partners |
$181.77
|
| Rate for Payer: PACE SWMI |
$191.34
|
| Rate for Payer: PHP Commercial |
$650.55
|
| Rate for Payer: PHP Medicare Advantage |
$191.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$665.85
|
| Rate for Payer: Priority Health Medicare |
$193.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.68
|
| Rate for Payer: Railroad Medicare Medicare |
$191.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.51
|
| Rate for Payer: UHC Core |
$639.07
|
| Rate for Payer: UHC Exchange |
$191.34
|
| Rate for Payer: UHC Medicaid |
$134.93
|
| Rate for Payer: UHC Medicare Advantage |
$191.34
|
| Rate for Payer: UHCCP Medicaid |
$134.93
|
| Rate for Payer: VA VA |
$191.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.01
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
IP
|
$1,961.56
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,365.25 |
| Max. Negotiated Rate |
$1,765.40 |
| Rate for Payer: Aetna Commercial |
$1,667.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.05
|
| Rate for Payer: BCN Commercial |
$1,620.05
|
| Rate for Payer: Cash Price |
$1,569.25
|
| Rate for Payer: Cofinity Commercial |
$1,686.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.25
|
| Rate for Payer: Healthscope Commercial |
$1,765.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,471.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.33
|
| Rate for Payer: Nomi Health Commercial |
$1,608.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.17
|
| Rate for Payer: PHP Commercial |
$1,667.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,706.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,365.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.17
|
| Rate for Payer: UHC Core |
$1,637.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,471.17
|
|
