|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$257.57 |
| Rate for Payer: Aetna Commercial |
$243.26
|
| Rate for Payer: BCBS Trust/PPO |
$233.62
|
| Rate for Payer: BCN Commercial |
$221.17
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$246.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Healthscope Commercial |
$257.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: Nomi Health Commercial |
$234.68
|
| Rate for Payer: PHP Commercial |
$243.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: Priority Health HMO/PPO |
$248.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.85
|
| Rate for Payer: UHC Core |
$238.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.64
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$257.57 |
| Rate for Payer: Aetna Commercial |
$243.26
|
| Rate for Payer: Aetna Medicare |
$74.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.43
|
| Rate for Payer: BCBS Complete |
$128.08
|
| Rate for Payer: BCBS MAPPO |
$71.55
|
| Rate for Payer: BCBS Trust/PPO |
$235.28
|
| Rate for Payer: BCN Commercial |
$222.51
|
| Rate for Payer: BCN Medicare Advantage |
$71.55
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$246.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.55
|
| Rate for Payer: Healthscope Commercial |
$257.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.64
|
| Rate for Payer: Mclaren Medicaid |
$121.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.12
|
| Rate for Payer: Meridian Medicaid |
$128.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: Nomi Health Commercial |
$234.68
|
| Rate for Payer: PACE Senior Care Partners |
$67.97
|
| Rate for Payer: PACE SWMI |
$71.55
|
| Rate for Payer: PHP Commercial |
$243.26
|
| Rate for Payer: PHP Medicare Advantage |
$71.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: Priority Health HMO/PPO |
$248.99
|
| Rate for Payer: Priority Health Medicare |
$72.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.75
|
| Rate for Payer: Railroad Medicare Medicare |
$71.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.85
|
| Rate for Payer: UHC Core |
$238.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.55
|
| Rate for Payer: UHC Exchange |
$71.55
|
| Rate for Payer: UHC Medicare Advantage |
$71.55
|
| Rate for Payer: UHCCP Medicaid |
$121.98
|
| Rate for Payer: VA VA |
$71.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.64
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 BREAST CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 BREAST CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 CNS TUMOR ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 COLORECTAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,921.50
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$664.15 |
| Max. Negotiated Rate |
$3,529.35 |
| Rate for Payer: Aetna Commercial |
$3,333.28
|
| Rate for Payer: Aetna Medicare |
$1,019.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,225.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,225.47
|
| Rate for Payer: BCBS Complete |
$697.40
|
| Rate for Payer: BCBS MAPPO |
$980.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,223.87
|
| Rate for Payer: BCN Commercial |
$3,048.97
|
| Rate for Payer: BCN Medicare Advantage |
$980.38
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cofinity Commercial |
$3,372.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,137.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.38
|
| Rate for Payer: Healthscope Commercial |
$3,529.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,941.12
|
| Rate for Payer: Mclaren Medicaid |
$664.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,029.39
|
| Rate for Payer: Meridian Medicaid |
$697.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,127.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,333.28
|
| Rate for Payer: Nomi Health Commercial |
$3,215.63
|
| Rate for Payer: PACE Senior Care Partners |
$931.36
|
| Rate for Payer: PACE SWMI |
$980.38
|
| Rate for Payer: PHP Commercial |
$3,333.28
|
| Rate for Payer: PHP Medicare Advantage |
$980.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3,411.70
|
| Rate for Payer: Priority Health Medicare |
$990.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,627.40
|
| Rate for Payer: Railroad Medicare Medicare |
$980.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,450.92
|
| Rate for Payer: UHC Core |
$3,274.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$980.38
|
| Rate for Payer: UHC Exchange |
$980.38
|
| Rate for Payer: UHC Medicare Advantage |
$980.38
|
| Rate for Payer: UHCCP Medicaid |
$664.15
|
| Rate for Payer: VA VA |
$980.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,941.12
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,921.50
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,548.98 |
| Max. Negotiated Rate |
$3,529.35 |
| Rate for Payer: Aetna Commercial |
$3,333.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,201.12
|
| Rate for Payer: BCN Commercial |
$3,030.54
|
| Rate for Payer: Cash Price |
$3,137.20
|
| Rate for Payer: Cofinity Commercial |
$3,372.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,137.20
|
| Rate for Payer: Healthscope Commercial |
$3,529.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,941.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,333.28
|
| Rate for Payer: Nomi Health Commercial |
$3,215.63
|
| Rate for Payer: PHP Commercial |
$3,333.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3,411.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,627.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,450.92
|
| Rate for Payer: UHC Core |
$3,274.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,941.12
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
OP
|
$272.34
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$245.11 |
| Rate for Payer: Aetna Commercial |
$231.49
|
| Rate for Payer: Aetna Medicare |
$70.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.11
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$68.08
|
| Rate for Payer: BCBS Trust/PPO |
$223.89
|
| Rate for Payer: BCN Commercial |
$211.74
|
| Rate for Payer: BCN Medicare Advantage |
$68.08
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$234.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.08
|
| Rate for Payer: Healthscope Commercial |
$245.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.26
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.49
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.49
|
| Rate for Payer: Nomi Health Commercial |
$223.32
|
| Rate for Payer: PACE Senior Care Partners |
$64.68
|
| Rate for Payer: PACE SWMI |
$68.08
|
| Rate for Payer: PHP Commercial |
$231.49
|
| Rate for Payer: PHP Medicare Advantage |
$68.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.02
|
| Rate for Payer: Priority Health HMO/PPO |
$236.94
|
| Rate for Payer: Priority Health Medicare |
$68.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.47
|
| Rate for Payer: Railroad Medicare Medicare |
$68.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.66
|
| Rate for Payer: UHC Core |
$227.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.08
|
| Rate for Payer: UHC Exchange |
$68.08
|
| Rate for Payer: UHC Medicare Advantage |
$68.08
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$68.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.26
|
|
|
HC RADXF UNL COMPUTED TOMO 76497
|
Facility
|
IP
|
$272.34
|
|
|
Service Code
|
CPT 76497
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$245.11 |
| Rate for Payer: Aetna Commercial |
$231.49
|
| Rate for Payer: BCBS Trust/PPO |
$222.31
|
| Rate for Payer: BCN Commercial |
$210.46
|
| Rate for Payer: Cash Price |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$234.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.87
|
| Rate for Payer: Healthscope Commercial |
$245.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.49
|
| Rate for Payer: Nomi Health Commercial |
$223.32
|
| Rate for Payer: PHP Commercial |
$231.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.02
|
| Rate for Payer: Priority Health HMO/PPO |
$236.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.66
|
| Rate for Payer: UHC Core |
$227.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.26
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
IP
|
$89.92
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.45 |
| Max. Negotiated Rate |
$80.93 |
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: BCBS Trust/PPO |
$73.40
|
| Rate for Payer: BCN Commercial |
$69.49
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.94
|
| Rate for Payer: Healthscope Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.43
|
| Rate for Payer: Nomi Health Commercial |
$73.73
|
| Rate for Payer: PHP Commercial |
$76.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.45
|
| Rate for Payer: Priority Health HMO/PPO |
$78.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.13
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.44
|
|
|
HC RADXF UNL DIAGNOSTIC RAD 76499
|
Facility
|
OP
|
$89.92
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
32000242
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$80.93 |
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: Aetna Medicare |
$23.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.10
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$22.48
|
| Rate for Payer: BCBS Trust/PPO |
$73.92
|
| Rate for Payer: BCN Commercial |
$69.91
|
| Rate for Payer: BCN Medicare Advantage |
$22.48
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.48
|
| Rate for Payer: Healthscope Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.44
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.60
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.43
|
| Rate for Payer: Nomi Health Commercial |
$73.73
|
| Rate for Payer: PACE Senior Care Partners |
$21.36
|
| Rate for Payer: PACE SWMI |
$22.48
|
| Rate for Payer: PHP Commercial |
$76.43
|
| Rate for Payer: PHP Medicare Advantage |
$22.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.45
|
| Rate for Payer: Priority Health HMO/PPO |
$78.23
|
| Rate for Payer: Priority Health Medicare |
$22.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.25
|
| Rate for Payer: Railroad Medicare Medicare |
$22.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.13
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.48
|
| Rate for Payer: UHC Exchange |
$22.48
|
| Rate for Payer: UHC Medicare Advantage |
$22.48
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$22.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.44
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
IP
|
$287.31
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$258.58 |
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: BCBS Trust/PPO |
$234.53
|
| Rate for Payer: BCN Commercial |
$222.03
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health HMO/PPO |
$249.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.83
|
| Rate for Payer: UHC Core |
$239.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
HC RADXF UNL FLUORO IR 76496
|
Facility
|
OP
|
$287.31
|
|
|
Service Code
|
CPT 76496
|
| Hospital Charge Code |
32000240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$258.58 |
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna Medicare |
$74.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.78
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$71.83
|
| Rate for Payer: BCBS Trust/PPO |
$236.20
|
| Rate for Payer: BCN Commercial |
$223.38
|
| Rate for Payer: BCN Medicare Advantage |
$71.83
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.83
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.42
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: PACE Senior Care Partners |
$68.24
|
| Rate for Payer: PACE SWMI |
$71.83
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: PHP Medicare Advantage |
$71.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health HMO/PPO |
$249.96
|
| Rate for Payer: Priority Health Medicare |
$72.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.83
|
| Rate for Payer: UHC Core |
$239.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.83
|
| Rate for Payer: UHC Exchange |
$71.83
|
| Rate for Payer: UHC Medicare Advantage |
$71.83
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$71.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
IP
|
$955.94
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$860.35 |
| Rate for Payer: Aetna Commercial |
$812.55
|
| Rate for Payer: BCBS Trust/PPO |
$780.33
|
| Rate for Payer: BCN Commercial |
$738.75
|
| Rate for Payer: Cash Price |
$764.75
|
| Rate for Payer: Cofinity Commercial |
$822.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$764.75
|
| Rate for Payer: Healthscope Commercial |
$860.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$716.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.55
|
| Rate for Payer: Nomi Health Commercial |
$783.87
|
| Rate for Payer: PHP Commercial |
$812.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.36
|
| Rate for Payer: Priority Health HMO/PPO |
$831.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$640.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.23
|
| Rate for Payer: UHC Core |
$798.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$716.96
|
|
|
HC RADXF UNL MAG RES IMAGING 76498
|
Facility
|
OP
|
$955.94
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$860.35 |
| Rate for Payer: Aetna Commercial |
$812.55
|
| Rate for Payer: Aetna Medicare |
$248.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.73
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$238.98
|
| Rate for Payer: BCBS Trust/PPO |
$785.88
|
| Rate for Payer: BCN Commercial |
$743.24
|
| Rate for Payer: BCN Medicare Advantage |
$238.98
|
| Rate for Payer: Cash Price |
$764.75
|
| Rate for Payer: Cash Price |
$764.75
|
| Rate for Payer: Cofinity Commercial |
$822.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$764.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.98
|
| Rate for Payer: Healthscope Commercial |
$860.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$716.96
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.93
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.55
|
| Rate for Payer: Nomi Health Commercial |
$783.87
|
| Rate for Payer: PACE Senior Care Partners |
$227.04
|
| Rate for Payer: PACE SWMI |
$238.98
|
| Rate for Payer: PHP Commercial |
$812.55
|
| Rate for Payer: PHP Medicare Advantage |
$238.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.36
|
| Rate for Payer: Priority Health HMO/PPO |
$831.67
|
| Rate for Payer: Priority Health Medicare |
$241.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$640.48
|
| Rate for Payer: Railroad Medicare Medicare |
$238.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.23
|
| Rate for Payer: UHC Core |
$798.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.98
|
| Rate for Payer: UHC Exchange |
$238.98
|
| Rate for Payer: UHC Medicare Advantage |
$238.98
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$238.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$716.96
|
|
|
HC RADXF UNL NM CARDIOVASC 78499
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78499
|
| Hospital Charge Code |
34100031
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: BCBS Trust/PPO |
$655.91
|
| Rate for Payer: BCN Commercial |
$620.96
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
